Changing Patient Perceptions to Promote Adherence to Oral Antimyeloma Oncolytics

The management of multiple myeloma (MM) is undergoing a seismic shift from acute treatment to a chronic care model that requires long-term treatment. This trend is fueled by the availability of an increasing number of novel oral oncolytic therapies for patients with MM, including thalidomide (Thal_omid), lenalidomide (Revlimid), pomalidomide (Pomalyst), panobinostat (Farydak), ixazomib (Ninlaro), and many more in the pipeline.¹ MM therapy has traditionally been delivered in the controlled environment of an infusion suite in a hospital or a clinic, where the administration and monitoring is effectively managed by the healthcare team. However, the advent of oral oncolytics has changed the dynamics of MM care delivery, and shifted the burden of medication administration to the patients. Patients are now responsible for self-administering often complex dosing regimens at home, monitoring their symptoms, managing their side effects, and making dose adjustments. Although the majority of patients prefer oral therapies because of their flexibility, convenience, better quality of life, and sense of empowerment, oral oncolytics have also created new and unique challenges for the oncology care team.²

Of primary concern is the significant potential for nonadherence to oral oncolytics; this gains particular relevance in the chronic care setting, which is where the MM field is heading toward. Moreover, whereas healthcare professionals in chronic diseases (eg, diabetes, hypertension, asthma) may be more experienced with managing patient nonadherence to prescription medication, their oncology counterparts may be less familiar with adherence measures, largely because of the predominant use of intravenous oncology treatments.³ It is imperative that healthcare professionals, particularly oncology nurses and nurse navigators, are educated on the complex issue of adherence, including patient barriers to adherence, adherence assessments, and intervention strategies to improve patient outcomes. In particular, oncology care teams must be mindful of the importance of educating and communicating to patients that nonadherence to oral oncolytic therapy is associated with serious consequences so they may change patient beliefs, and, therefore, facilitate adherent behavior.

Consequences of Nonadherence

According to the World Health Organization (WHO), adherence is defined as