most cancer treatments have been administered in oncology offices or hospitals, but oral medications are becoming increasingly common, and oral formulations of chemotherapy, targeted therapies, and hormonal therapies are available. While oral medications are a welcomed addition to the oncology arsenal because they allow patients to avoid time-consuming and costly office visits, they also require patient compliance to ensure benefit is derived. Studies have shown that non-adherence to oral regimens not only leads to a lack of effect, but can result in increased office or hospital visits and longer hospital stays secondary to complications or disease progression. Further, when patients do not adhere to their prescribed drug regimens, any variability in therapeutic effect may be attributed to a lack of efficacy of the drug, which may result in discontinuation of a potentially useful treatment or even a whole class of agents.
There are many reasons why patients with cancer do not adhere to their oral therapy regimens. Some patients simply forget to take their medication, whereas others fear the side effects or want a break from treatment. Because some oral antineoplastic therapies can result in considerable adverse events, skipping treatments may be especially tempting for patients with cancer. In other cases, cost concerns may be a factor, or there may be complex dosing schedules to contend with, leading to confusion. Fortunately, numerous technologies are available to help patients stick to their treatment regimens. Available technologies include everything from standalone devices such as smart pillboxes to apps that use the iPhone and other platforms to send e-mail alerts and text messages, and even make phone calls to ensure patients take their medication. While these technologies do not solve many compliance issues, such as cost, lack of social support, or fear of adverse effects, they can still play an important role in keeping patients compliant by being part of a multifaceted strategy to improve adherence to oral antineoplastic agents. Standalone devices
Countless standalone devices are available to remind patients to take their medicine or help them keep their pills organized, including high-tech pillboxes and organizers, watches with vibration or alarm reminders, and medication timers. Standalone devices may be especially appealing to older patients or those who do not have a smartphone or are not tech savvy. Newer standalone devices, such as the Maya Pill Dispenser, not only remind patients to take their medication, but also generate compliance reports, allowing medication adherence to be tracked with greater accuracy.Maya Pill Dispenser
Although MedMinder Systems’ Maya pill dispenser resembles a 7-day pill organizer, it is no ordinary pillbox. This 28-compartment, high-tech dispenser comes equipped with wireless technology that sends updates to MedMinder’s central computer about the patient’s dosage activity, which can be viewed online; however, the patient’s home does not require a computer, phone line, wireless router, or any other form of Internet access to monitor this activity. The system features a friendly interface with no digital readouts or buttons, and is programmed remotely via the Internet or through MedMinder over the phone. Once Maya is set up, it can provide both patient reminders and activity monitoring. Reminders include the appropriate pill compartment flashing, and if the medication cup is not removed from the tray within a designated timeframe, there are auditory prompts, automatic phone calls, text messages, and e-mails, depending on how the system is programmed. The patient’s activity log can be viewed online by caregivers and healthcare providers, and the system can be programmed to send real-time email or text message notifications or weekly email reports. Patients or their caregivers can manually refill the trays, or MedMinder-supplied trays pre-filled by a pharmacist may be used instead. The latter option may be especially useful for patients on complex regimens, as it reduces confusion and the risk of medications errors. In addition, if the wrong medication cup is taken, the system sounds an alert, ensuring patients take the correct medication. More information on the Maya, including a video demonstration, is available at www.medminder.com. The Maya pill dispenser can be purchased through Amazon at http://amzn.to/arftM1
, where it retails for $395, which includes a 1-year subscription.Apps
Some studies have shown that e-mail alerts, phone calls, and text message reminders can improve adherence to prescription medications, leading to better outcomes. Patients who are tech savvy and have smartphones may prefer an app, which provide these features and is a far less expensive compliance solution, costing just a few dollars. Apps also allow greater flexibility in terms of which treatments are tracked, allowing reminders to be set for topical and over-the-counter therapies, and may enable other important information to be recorded, such as side effects. Personal Caregiver