Predictors of physician nonadherence to chemotherapy regimens

Article Abstract:

Compliance to medical treatment is an important aspect of medical care, and it is estimated that from 25 to 50 percent of patients fail to comply completely with medical instructions; this noncompliance may take the form of failing to take prescribed medications, failing to keep scheduled appointments, and failing to alter personal habits. However, noncompliance is not the exclusive domain of the patient. Physicians, too, may fail to comply by not adhering to accepted protocols of treatment. In the case of chemotherapy for cancer, failure to administer treatment according to accepted schedules and doses may compromise the health of the patient. To determine which factors might contribute to the failure of physicians to adhere to chemotherapeutic protocols, a study was undertaken of 107 women about to begin chemotherapy for breast cancer. A total of 29 physicians at 3 locations administered the treatments that were analyzed in the study. The analysis was limited to a single type of cancer to reduce the number of variables that might confound the results. Fourteen physicians prescribed unjustified modifications of treatment at some point in the study, affecting 52 percent of the breast cancer patients. Treatment complexity was not found to affect the likelihood of physician noncompliance. However, older patients were more likely to receive unjustified variations, as were lower income and non-white patients. Indeed, the study found that physician non-adherence was greater in clinics than in academic settings or in community practices, but this effect may be the result of the fact that the clinic patients are more likely to be poor or non-white. The study also found that patients with advanced stage disease were more likely to receive prescription changes that were unjustified from a medical standpoint. Physicians should be apprised of these influences, of which they may be unaware. A full examination of the attitudes of physicians towards patients and specific diseases may be necessary to assure that accepted treatment protocols are being properly carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Management, Physician and patient, Physician-patient relations, Physicians, Behavior, Medical professions, Breast cancer

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Patient noncompliance with self-administered chemotherapy

Article Abstract:

Advances in chemotherapy may be of little value for the patient who does not comply with the physician's instructions. Although noncompliance is likely to be due numerous emotional and behavioral factors, it may be possible to identify patient characteristics which predispose an individual toward noncompliance with drug therapy instructions. To investigate possible such factors, physicians from a variety of settings were asked to refer patients who were about to undergo their first course of chemotherapy for breast cancer. Each patient was interviewed five times: at the beginning of chemotherapy, and again at one week, four, thirteen, and 26 weeks. The initial interview rated patients on variables such as age, race, income, social support, marital status, education, etc. Later interviews also rated patients for depression and cognitive dysfunction. Patients were also questioned about the number of pills taken; compliance questions were limited to only the week preceding the interview, to minimize errors from faulty recall. Noncompliance was quantified both in terms of the percentage of the prescribed drug actually taken over the 26-week period, and the number of occasions on which the criterion level was not taken. Almost half (47 percent) of the patients took less than 90 percent of the prescribed dosage. The primary factor in determining compliance was the setting; patients in private practices or clinics were less likely to comply than patients in an academic setting. Lower income level was also related to noncompliance, possibly because lower-income patients possess fewer coping resources. These two factors account for only a small part of the variability seen in patient compliance. Noncompliance may be too complex to be simply predicted, or it may be related to personality factors not observed in this study or to factors yet to be determined. Since cancer is perceived as a life-threatening condition, a patient noncompliance of almost 50 percent is distressing and further efforts must be made to identify and compensate for the factors involved. (Consumer Summary produced by Reliance Medical Information, Inc.)

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The scapegoat effect on food aversions after chemotherapy

Article Abstract:

Learned food aversion is an important mechanism for preventing animals from eating noxious substances. Often called the Garcia effect by animal psychologists, food aversion results when nausea occurs after eating a particular food. The food becomes unappealing, even though it may have been completely unrelated to the nausea. This phenomenon may be observed in cancer patients being treated with chemotherapy. The patient may eat a normal meal and then experience nausea resulting from the drug treatment; the net result is that the foods eaten become unappealing. This undesirable state of affairs might be avoided by introducing a scapegoat food. Animal studies have confirmed that when a novel food and a familiar food are consumed, any subsequent nausea is more likely to result in aversion to the new food than to the familiar food. To determine whether a similar phenomenon may be at work in humans, 25 cancer patients undergoing chemotherapy participated in an experimental evaluation of learned food aversion. Patients were divided into two groups, one of which was given halvah, an unfamiliar food, prior to chemotherapy; the other group was given cookies. The patients completed a take-home questionnaire on which they evaluated their desire for and satisfaction with their regular meals. Although there were no differences between the two groups in nausea after chemotherapy, the group given the unfamiliar halvah expressed greater satisfaction with their regular meals than did the patients receiving cookies. The results indicate that the halvah did, in fact, serve as a scapegoat food and improved the satisfaction of the patients with regular food items. Of course, the patients did develop an aversion to halvah; significantly more of the patients receiving halvah developed an aversion to halvah than the other patients developed an aversion to cookies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Food and nutrition, Cancer patients, Nausea

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