An insidious problem facing clinicians worldwide is patient nonadherence to the treatment regimen prescribed. In these situations, even diseases that have curative potential are at risk of further deterioration if patients refuse to take their medications as prescribed.
Scientists are now realizing just how big of an issue nonadherence is. There are a few hypotheses on why patients refuse to take medications prescribed to them. First, they may simply remain unconvinced of the severity of their illness and hence find treatment regimens to be unnecessary and burdensome. Second, patients may simply forget to take the medications prescribed, which is common in old age.
Another possible reason is that they have extreme views about the validity of the treatment regimen prescribed. One example that comes readily to mind are individuals who hold extremely hostile views against vaccines. Some of these views go beyond the area of reasonable doubt to something more conspiratorial. When patients believe that medications do actual harm, they are more likely not to take them — and possibly even lie about it.
Adherence to Imatinib
In Patient Preference and Adherence, Chuah and colleagues conducted a study into the adherence to imatinib among a group of Malaysian patients with gastrointestinal stromal tumor (GIST).
The treatment landscape for imatinib has changed considerably in the last few decades with the introduction of tyrosine kinase inhibitors such as imatinib. The prior mainstay treatment was chemotherapy for unresectable GIST, which had a poor response rate. Imatinib, on the other hand, improves survival for up to 5 years.
Read more about GIST etiology
The main downside to imatinib is that it requires long-term oral therapy in order for its therapeutic potential to be realized. This means that patient adherence is crucial, as the on-off usage of imatinib is unlikely to yield noticeable clinical benefits.
A number of clinical trials have been conducted to study patient adherence to imatinib. Studies have demonstrated that more than half of patients with GIST do not adhere to imatinib treatment. A study placed adherence to imatinib at 24% at 4 weeks after baseline initiation.
Chuah et al conducted their study at an oncology clinic in Malaysia. They recruited patients who were at least 18 years of age with malignant GIST receiving imatinib treatment. The main outcome was adherence to the drug. Questionnaires were prepared for the patients to collect demographic data, assess adherence to imatinib, and ascertain patients’ health-related quality of life.
The results demonstrated that 55.1% of patients did not adhere to imatinib. The main reason cited was that they find it difficult to take the drug every day.
“The results from multiple logistic regression analysis . . . indicated that younger age, presence of comorbidities, and presence of nausea and vomiting were the associated factors of nonadherence to imatinib,” Chuah and colleagues wrote.
In addition, the research team discovered that health-related quality of life outcomes differed between patients who adhered to imatinib treatment and those who did not. The main health-related quality of life outcome that differed significantly between the 2 groups of patients was physical functioning.
“Non-adherence to long-term treatment with imatinib is common and should not be underestimated among patients with metastatic and/or unresectable GIST,” the research team concluded.
Adherence as Mutual Partnership
Much research has been devoted to ways in which physicians can encourage patient adherence to medications prescribed. Research is usually segmented into disease type, but many of the principles governing adherence remain relevant across disciplines.
In Health Education & Behavior, Hofer and colleagues provided some incisive insights into the factors that drive non-adherence to medications. For example, there is a socioeconomic dimension to non-adherence that deserves further exploration. Reports suggest that patients from low-income households who belong to ethnic and racial minorities tend to have a higher risk of non-adherence. This suggests that health access inequalities contribute to non-adherence.
“A growing body of evidence supports the effectiveness of interventions that are culturally tailored, involve one-on-one interpersonal interactions with trusted supporters such as community health workers, and are community-based,” Hofer et al wrote.
One of the ways we can ensure that patients adhere to the medications prescribed can be summed up in 1 word: satisfaction. In other words, patients first need to be satisfied that the medications prescribed can indeed make a clinical difference in the course of their disease; second, they need to be satisfied that adherence to their medications is the best way to achieve some form of recovery.
Read more about GIST treatment
When patients remain unconvinced and unsatisfied with the type of medications prescribed to them, and if they decide to believe in an alternative source of authority (such as the Internet), they are significantly less likely to take their medications.
“We hypothesized that these 3 outcomes [satisfaction with medical information, medical knowledge, and decisional conflict] would be associated with improved medication adherence,” Hofer and colleagues wrote.
Ultimately, the task of understanding why some patients refuse to adhere to the medications prescribed remains an important task for the physicians involved. Blaming and shaming do not do any good; instead, we need to unearth the concerns of our patients and do our best so that both physician and patient can be on the same page.
Chuah PL, Jamal NF, Siew CJ, et al. Assessment of adherence to imatinib and health-related quality of life among patients with gastrointestinal stromal tumor: a cross-sectional study in an oncology clinic in Malaysia. Patient Prefer Adherence. September 22, 2021. doi:10.2147/PPA.S310409
Hofer R, Choi H, Mase R, Fagerlin A, Spencer M, Heisler M. Mediators and moderators of improvements in medication adherence. Health Educ Behav. Published online July 18, 2016. doi:10.1177/1090198116656331