scanning through currently available literature, it was observed that adherence
is one of the main aspects in the case of oral chemotherapy for out-patients.
Because adherence can increase effectiveness of oral chemotherapy.


had been carried out to identify patient’s adherence profiles using a
quantitative –qualitative method in France. Capacitabine was given to 38 breast
and colorectal cancer patients and they had to complete a questionnaire. Then
questionnaire was analyzed by multiple classification analysis to cluster
patients. Electronic medication event monitoring systems were used to evaluate
treatment adherence. Finally interviews were carried out. It was found that over adherence was demonstrated
by majority of the patients (Bourmaud
et al, 2015).

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study was done in 2013 in Japan to evaluate the medication adherence and
factors affecting adherence. Questionnaire was given to 172 out patients who
take oral anti-cancer agents. Questionnaire
was evaluated by customer satisfaction analysis. It was found that
64% patients showed good medication adherence while 36% was insufficient medication adherence. The
percentage of patients with good medication compliance was 87.2%. Overall, the
medication compliance to OACA was better than adherence to OACA. Nine items
that had significant effect on adherence were observed in this study. It was also
observed that necessity of future programs for the improvement of adherence, effectiveness,
safety and continuity of oral anti-cancer agents (Kimura et al, 2014).


had been done to understand the adherence issues to explore adherence
assessment tools in oral chemotherapy in 2013 in USA. Study was carried out in
two parts including randomized phase 2 and a systemic review. It was observed
that no relationship was observed between adherence and cancer outcomes. Seven
adherence tools were identified. They are health care provider’s interviews, patient-reported
adherence with diaries, patient –completed scales, medical event monitoring, automated
voice response, drug/metabolite assays and prescription data bases. Among them
automated voice response was seemed to be capable of real time dependent of
over-adherence (Patel K et al, 2013).


prospective study was carried out for 7 months in a cohort of patients on
capecitabine treat. Analyze the adherence in patients to treat with capecitabine,
their adverse events and the overall health status of patients were the main
objective of the study. Electronic clinical records, dispensing program for
out-patients and interviews with patient were carried out to obtain data. It
was observed that low level of adherence can be associated with the duration of
treatment, toxicities, clinical evaluation and perception of their health
status (Ribeira et al, 2017).


research was carried out in 2011 in USA to assess and measure adherence to oral
chemotherapy. Three dimensions including percentage of medications taken, the
duration and timing of taking medication were used to assess the adherence.
Furthermore eliciting patient report of adherence, pill-count, medical record
audit, drug diaries were used to asses and measure the adherence. It was
concluded that further studies needed for the improvement of adherence (Spoelstra
et al, 2011).


exploratory study was conducted on an intervention to improve the adherence in
cancer patients who undergo oral chemotherapy. Three group pilot study was
carried out to determine how an automated voice response system can reduce the
severity of symptoms and improve adherence. This showed that effective improvement
in patient adherence and managing symptoms for patients who use oral
chemotherapy (Spoelstra et al, 2013).


review has been done in 2007 in USA listing the challenges of oral anti-cancer
agents in patients with advanced breast cancers and to ensure compliance with
an oral agent for the treatment of metastatic breast cancer. It was observed
that rate of adherence depends on psychological socio-economic factors and
individual patient outcome expectations. Adherence and compliance can be
improved by follow-up visits, asking appropriate questions and providing
solutions (Palmieri and Barton, 2017).


study was done with six adolescents who had undergone hematopoietic stem cell
transplantation (HSCT). Daily, weekly, monthly adherence and medication
interruptions were calculated using demographic, clinical information obtained
from caregivers, chart review and electronic pill bottles. This study
demonstrated the importance of routinely assessing adherence in adolescents who
had undergone HSCT (Mc Grady et al, 2014).


had conducted in 2009 in USA to avoid non adherence and early cessation of
which act as substantial barriers to the delivery of valuable therapy. Aim of
this study was to identify the potential obstacles to adherence and
persistence. Personal characteristics, treatment features and systems had been
identified as obstacles to the adherence. Techniques used to assess the
adherence included self-report pill-count, microelectronic monitoring systems, prescription
data base analysis and the assessment of serum or urine drug levels. Further educational,
behavioral and multidimensional interventions were also used as adherence improvement
tools (Ruddy et al, 2009).


multi center observational cohort study was carried out to investigate the
effect of pharmaceutical care program on the adherence of breast and colorectal
cancer patients treated with capacitabine. Patients were divided in to two
groups including control group and intervention group which receives
intensified care consisting written and spoken information. Adherence was
measured by using an electronic medication event monitoring system. Results
showed that the importance of care to assure effectiveness of oral chemotherapy
(Simons et al, 2011).


had been done in 2012 in USA on adherence management in patients on oral chemo
therapies. It had described, the ways and methods to overcome common barriers
that affect adherence. Methods that they had used are monitoring and
involvement of family or care takers, patient education and building strong
health care provider-patient relationship (Wood. L, 2012).


this study 30 patients with colorectal and breast cancer who are using
capecitabine were included. The patients were asked to bring any medication
left at the time of scheduled visits. Questionnaire was given at the first
visit and 8-12 weeks after the treatment. It was found that no absolute
adherence to oral capecitabine treatment, but the level of adherence was
somewhat good. They had concluded that the need of a greater focus in the
monitoring the involvement of patient with oral treatment (Figueiredo et
al, 2014).


observational multicenter study was carried out including 216 patients.
Anti-cancer drug usage and adherence was assessed by means of a telephonic pill
count, a questionnaire, a review of the patient’s medical file and pharmacy
medication records. While majority of the population showed good adherence,
other patients showed both under and over adherence. It was found that majority
of non-adherent patients appear due to experienced side effects. Optimal
adherence was shown by patients who are not living alone and being highly
educated. Interventions should be taken to improve the adherence of non-adherent
patients (Timmers et al, 2014).


who are suffering from breast or colorectal cancer and taking capecitabine were
recruited from UK teaching hospital. Non adherence was reported by 23.3% of the
43 participants. Capecitabine adherence was high with a strong conviction that
the therapy is needed. It was found that further interventions should be taken
to improve the adherence of the patients (Bhattacharya et al,


study was carried out to explore processes and factors influencing non
adherence and their relatedness in patients taking oral tyrosine kinase. 30
patients of different ages and with different types of cancers were
interviewed. Treatment related side effects, hopes, anxiety, trust, and
feedback mechanisms were used to determine the adherence. It was observed that
certain processes and factors influenced non adherence. It was concluded that
open climate and a trust-based relationship should be established in patients which
feel comfortable to openly discuss the therapy related difficulties (Verbrugghe
et al, 2016).


study had done with 21 chronic myeloid leukemia patients who were prescribed
with Imitanib. In depth interviews were carried out and their adherence had
been previously measured using a medication events monitoring device. It was
found that both intentional and unintentional reasons affect for non-adherence.
Finding ways to deal with side effects and using prompts as reminders to take
medications were observed as favorable factors that improves adherence. It was
suggested that interventions should be designed to ensure that patients with
chronic myeloid leukemia adhere well to their oral drug regimens (Eliasson et
al, 2011).


was observed that the necessity of health care providers to adapt with practice
changes aimed at supporting patients and optimizing adherence. To minimize
barriers and enhance facilitators to oral treatment adherence, making model or personal
systems were used as potential mechanisms. It was suggested that additional
research is needed to understand what works for patients and how health care
providers can change systems and strategies to support patients to achieve
optimal adherence (Fennimore LA et al, 2017).


to the current screened literature numerous types of interventions were
investigated to evaluate the factors that affect medication in out-patients as
well as steps that can be applied to overcome barriers to the adherence to oral
medications. Lack of patient education, belief of the patient regarding the
cure, serious nature of the side effects, cost of the medication had become
major factors that affect adherence. Therefore barriers that affect adherence had
to be identified first and necessary solutions must be implemented.



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