The use of erlotinib in daily practice: a study on adherence and patients' experiences

<p>Abstract</p> <p>Background</p> <p>Adherence to pharmacological therapy is a complex and multi-factorial issue that can substantially alter the outcome of treatment. It has been shown that cancer patients, especially when using long-term medication, have similar adherence rates to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for non-adherence is essential for the development of interventions that may increase adherence. This paper presents the CAPER-erlotinib protocol, which is designed to study the relationship between adherence to erlotinib and both the plasma concentration and side-effects in patients with NSCLC. Further, the relationships between patient characteristics, disease characteristics, side-effects, quality of life, patient beliefs and attitude towards disease and medication, dose adjustments, reasons for discontinuation and plasma concentration of erlotinib will be explored.</p> <p>Methods/Design</p> <p>In this prospective observational cohort study 65 NSCLC patients of 18 years or older starting treatment with erlotinib will be followed for a period up to 16 weeks. The main study parameters are adherence, the plasma concentration of erlotinib and the number and grade of side-effects. At baseline and on erlotinib treatment in weeks 3-4, 8-9, 12 and 15-16, patients will be asked to fill out a questionnaire. In weeks 3-4, 8-9 and 15-16 blood samples are collected, which will be analysed for plasma concentration of erlotinib. Adherence will be measured using a medication event monitoring system.</p> <p>Discussion</p> <p>The present study aims to get more insight into patients' experiences with the use of erlotinib in daily practice and the various aspects that govern adherence. We hypothesize that side-effects play an important role in the way patients use erlotinib. We expect that the present study will provide valuable knowledge which will be useful for health care professionals to develop interventions to support patients. This approach will improve the adherence and persistence with the use of erlotinib in order to derive optimal benefit from the medication.</p> <p>Trial Registration</p> <p><a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1830">NTR1830</a></p

Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication

Background: Repeat prescribing used in long-term pharmacotherapy is often associated with inadequate patient medication, including non-adherence. In this paper we explore patients' drug refill adherence with repeat prescriptions and relate refill data to patient age and gender, type of prescriber, type of prescribed drug, and reimbursement level. Methods: During one week of 2002, copies of 3636 repeat prescriptions filled at 16 large Swedish pharmacies were collected. Satisfactory refill adherence was defined as dispensed refills covering 80-120% of the prescribed treatment time. Under- and oversupplying were defined as 120% coverage, respectively. Result: The average level of refill adherence was 57%, and the level of under- and oversupplying 21% and 22%, respectively. There was no gender difference. Patients who were exempt from payment had higher oversupplies than others (33% versus 19%), and patients of general practitioners had higher refill adherence than patients of hospital physicians. The highest refill adherence was observed for contraceptives (81%) and the lowest for anti-asthmatics, proton pump inhibitors and non-steroidal anti-inflammatory drugs (30-40%). Conclusions: Refill non-adherence includes both under- and oversupplying and may vary due to different attitudes between prescribers and between patients. Different therapeutic indications and reimbursement systems are other apparent causes. These observations should be considered in programs aiming to assist patients in following medication prescriptions