(124) Identification and Evaluation of Evidence-Based Adherence Metrics for Oral Oncolytics: a Systematic Review

Poster Abstract: Background/Rationale: Oral oncolytics comprise almost 50% of new medications for the treatment of cancer. Administration of oral oncolytics is convenient for patients as it minimizes the need for frequent infusion visits. Nevertheless, the success of oral oncolytics in clinical practice requires strict adherence despite demanding administration schedules, cost, and adverse effects. Data from Ganesan et. al. and Marin et. al. provided compelling evidence regarding the relationship of high adherence to oral oncolytics to positive clinical outcomes in the Chronic Myeloid Leukemia population. These literature findings call for validated adherence tools to be employed in clinical practice to identify, address, and improve this modifiable risk factor.

Objective: The objective of this study is to quantify and qualify current published and validated adherence metrics for prescribed oral oncolytics with the goal of defining the impact of these adherence tools on patient outcomes.

Methods: Four databases (PubMed, Embase, CINAHL Plus, and APA PsycINFO) were queried using previously defined search terms pertaining to four domains: cancer, drug, compliance, and metrics. The abstracts were screened for duplication and reviewed by two independent reviewers with a third reviewer for conflict resolution. This structure was repeated for the subsequent steps of full text review, data extraction, and quality assessment. The specifics of these articles as well as the quality of each were explored in the data extraction phase. Information was collated for results and conclusion.

Results: 751 abstracts were identified for review with 74 articles selected for full text review. Remaining articles underwent data extraction and quality assessment. Results of data extraction and quality assessment are pending.

Discussion/conclusion: Our assessments of the available literature utilizing validated adherence tools in the clinical practice setting are pending, but will provide information on the availability of clinically validated adherence tools or will serve as a call to action to establish a new tool that can be utilized in this patient population.

References (must also be included in final poster): 1. Vrijens, B., De Geest, S., Hughes, D.A., Przemyslaw, K., Demonceau, J., Ruppar, T., Urquhart, J. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691–705.
2. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. doi:10.1056/NEJMra050100.
3. Belcher SM, Mackler E, Muluneh B, et al. ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications. Oncol Nurs Forum. 2022;49(4):279-295. doi:10.1188/22.ONF.279-295.
4. World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. https://apps.who.int/iris/bitstream/ handle/10665/42682/9241545992.pdf;jsessionid=DBEAC6EF FC242ABCA955A8AE60F36BCF?sequence=1.
5. Weaver KE, Camacho F, Hwang W, et al. Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women. Am J Clin Oncol 2013; 36: 181–187. Epub 2012/02/09. doi: 10.1097/COC.0b013e3182436ec1. PubMed PMID: 22314001; PMCID: PMC3355198.
6. Ganesan P, Sagar TG, Dubashi B, et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol. 2011;86(6):471-474. doi:10.1002/ajh.22019.
7. Marin D, Bazeos A, Mahon FX, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28(14):2381-2388. doi:10.1200/JCO.2009.26.3087.
8. De Geest S, Zullig LL, Dunbar-Jacob J, Hughes D, Wilson IB, Vrijens B. Improving medication adherence research reporting: ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Eur J Cardiovasc Nurs. 2019;18(4):258-259. doi:10.1177/1474515119830298.
9. Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 Hematology/Oncology Pharmacist Association Best Practices for the Management of Oral Oncolytic Therapy: Pharmacy Practice Standard. J Oncol Pract. 2019;15(4):e346-e355. doi:10.1200/JOP.18.00581.