Original Article

Adherence to Capecitabine Among Patients With Gastrointestinal Cancer: A Prospective Cohort Study

Abstract

Adherence to capecitabine, an effective oral chemotherapy agent, is essential in achieving treatment response in cancer. In this study, we aimed to investigate factors associated with non-adherence to capecitabine in a sample of patients with gastrointestinal cancer. We enrolled 98 patients with colon, rectal or gastric cancers who were undergoing treatment with capecitabine as part of their single or multi-agent chemotherapy regimen. The patients were followed during cohort time up to four consecutive cycles of their chemotherapy. For adherence measurement, the participants were asked to bring back the leftover medicines at the time of follow-up visits and were considered adherent if they had taken ≥95% of their prescribed dose. The mean adherence rate was 97.7%, and the patients were adherent to capecitabine in 93.1% of their cycles. The patients who underwent neoadjuvant chemotherapy were significantly less adherent to capecitabine (60%) as compared with adjuvant (95.2%) and palliative chemotherapy (94.6%) [P=0.004]. Multivariable logistic regression revealed that neoadjuvant chemotherapy and the presence of nausea and mucositis were inversely associated with adherence rate. We did not find any association between adherence and any of our laboratory findings. Our findings suggest a high adherence rate to capecitabine among patients with gastrointestinal cancers. Neoadjuvant chemotherapy and the presence of nausea and mucositis may play a significant role in non-adherence to capecitabine.  

1. Bhattacharya D, Easthall C, Willoughby KA, Small M, Watson S. Capecitabine non-adherence: exploration of magnitude, nature and contributing factors. J Oncol Pharm Pract. 2012;18(3):333-42.
2. Liu G, Franssen E, Fitch MI, Warner E. Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol. 1997;15(1):110-5.
3. Figueiredo Junior AG, Forones NM. Study on adherence to capecitabine among patients with colorectal cancer and metastatic breast cancer. Arq Gastroenterol. 2014;51(3):186-91.
4. Cassidy J, Twelves C, Van Cutsem E, Hoff P, Bajetta E, Boyer M, et al. First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profile compared with intravenous 5-fluorouracil/leucovorin. Ann Oncol. 2002;13(4):566-75.
5. Twelves C, Wong A, Nowacki MP, Abt M, Burris H, 3rd, Carrato A, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 2005;352(26):2696-704.
6. Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94(9):652-61.
7. Timmers L, Boons CC, Mangnus D, Van de Ven PM, Van den Berg PH, Beeker A, et al. Adherence and Patients' Experiences with the Use of Capecitabine in Daily Practice. Front Pharmacol. 2016;7:310.
8. Mathes T, Pieper D, Antoine SL, Eikermann M. Adherence influencing factors in patients taking oral anticancer agents: a systematic review. Cancer Epidemiol. 2014;38(3):214-26.
9. Kawakami K, Yokokawa T, Kobayashi K, Sugisaki T, Suzuki K, Suenaga M, et al. Self-Reported Adherence to Capecitabine on XELOX Treatment as Adjuvant Therapy for Colorectal Cancer. Oncol Res. 2017;25(9):1625-31.
10. Partridge AH, Archer L, Kornblith AB, Gralow J, Grenier D, Perez E, et al. Adherence and persistence with oral adjuvant chemotherapy in older women with early-stage breast cancer in CALGB 49907: adherence companion study 60104. J Clin Oncol. 2010;28(14):2418-22.
11. Hefner J, Berberich S, Lanvers E, Sanning M, Steimer AK, Kunzmann V. Patient-doctor relationship and adherence to capecitabine in outpatients of a German comprehensive cancer center. Patient Prefer Adherence. 2018;12:1875-87.
12. Jiang Y, Wickersham KE, Zhang X, Barton DL, Farris KB, Krauss JC, et al. Side Effects, Self-Management Activities, and Adherence to Oral Anticancer Agents. Patient Prefer Adherence. 2019;13:2243-52.
13. Fernández-Ribeiro F, Olivera-Fernández R, Crespo-Diz C. Adherence and safety study in patients on treatment with capecitabine. Farm Hosp. 2017;41(2):204-21.
14. Hirao C, Mikoshiba N, Shibuta T, Yamahana R, Kawakami A, Tateishi R, et al. Adherence to oral chemotherapy medications among gastroenterological cancer patients visiting an outpatient clinic. Jpn J Clin Oncol. 2017;47(9):786-94.
15. Font R, Espinas JA, Layos L, Martinez Villacampa M, Capdevila J, Tobeña M, et al. Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry? Ann Oncol. 2017;28(4):831-5.
16. Zahrina AK, Norsa'adah B, Hassan NB, Norazwany Y, Norhayati I, Roslan MH, et al. Adherence to capecitabine treatment and contributing factors among cancer patients in Malaysia. Asian Pac J Cancer Prev. 2014;15(21):9225-32.
17. Amlani A, Kumar A, Ruan JY, Cheung WY. Compliance with adjuvant capecitabine in patients with stage II and III colon cancer: comparison of administrative versus medical record data. Cancer Med. 2016;5(8):1776-82.
18. Krolop L, Ko YD, Schwindt PF, Schumacher C, Fimmers R, Jaehde U. Adherence management for patients with cancer taking capecitabine: a prospective two-arm cohort study. BMJ Open. 2013;3(7).
19. Common Terminology Criteria for Adverse Events (CTCAE) Version 5. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017.
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IssueVol 60 No 11 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v60i11.11649
Keywords
Capecitabine Adherence Gastrointestinal cancer Oral chemotherapy Side effects
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Khajeh-Mehrizi A, Emami SAH, Safaee Nodehi SR, Jahangard-Rafsanjani Z, Roudini K, Dabiri MR, Emami SAM. Adherence to Capecitabine Among Patients With Gastrointestinal Cancer: A Prospective Cohort Study. Acta Med Iran. 2023;60(11):662-669.