Adherence and beliefs about medication in Cancer Patients with oral chemotherapy of capecitabine

Yang Siyu, Lu Zhenqi School Of Nursing , Fudan University

Fudan University Shanghai Cancer Center

01

02

03

04

Background And Objective

Research Method

Research Result

Conclusion

CONTENT

01 PART ONE Background And Objective

1.Background And Objective

Although the traditional chemotherapy was given by intravenous most, the oral chemotherapy have existed for 50 years.

Capecitabine was the most commonly used drug of oral chemotherapy for cancer patients.

Breast Cancer Gastric Cancer Colorectal

Cancer

1.Background And Objective

Advantages Disadvantages

Chemotherapy at home

Avoid the injury of the vein Preferable

Lack of health education

No side effect monitor

Adherence

1.Background And Objective

Beliefs about medication is one of the most important factors affect medication adherence in chronic disease. It was raised by Horne.

Necessity

Concern

General-overuse

General-harm

Specific medication General medication

Beliefs about medication

1.Background And Objective

Describe the adherence

and beliefs about

medication of

capecitabine .

Explore the relationship

between adherence and

beliefs about

medication.

02 PART TWO Research Method

2.Research Method

Research site: Fudan University Shanghai Cancer center , the department of chemotherapy and outpatients chemotherapy center Sampling Method: Convenience sampling Sample size: 129(the sample size was calculated by pre-experiment)

Patient with malignant tumor

Chemotherapy with

capecitabine

Age ≥18

Informed consent

Inclusion Criteria

History of mental disease

Patient doesn’t finish survey

Exclusion Criteria

2.Research Method

Research tools: General information questionnaire(self-designed) Morisky medication adherence questionnaire（Morisky,2008)

• It is self-reported by patients and contains 8 questions.

• Patients answer “yes” or “no” to every question. “yes”=0,

“no”=1. the 5thquestion are reverse scoring.

• High adherence: score of 8

Medium adherence: score of 6 to ＜8

Low adherence score of ＜6

2.Research Method

Research tools:

Beliefs about medication questionnaire-specific(Horne,1999)

• It has two dimension : necessity and concern.

• Every dimension has 5 items.

• Responses for each item ranged from 1 (strongly disagree) to 5 (strongly

agree).

• high necessity: score of ＞12.5

high concern: score of＞12.5

• Difference of necessity and concern=beliefs about medication

positive: necessity>concern

negative: necessity<concern

2.Research Method

protection of the human rights

Approved by ethics committee of Fudan University

Shanghai Cancer Center

Informed concent

Protect patients’privacy principle of voluntariness

03 PART THREE Research Result

Demographic characteristics

Value Percentage

Gender

Male 69 53.5%

Female 60 46.5%

Age

＜40 26 20.2%

40-60 55 42.6%

≥60 48 37.2%

Education

Illiteracy 10 7.8%

Primary school 19 14.7%

Junior high school 34 26.4%

Senior high school 32 24.8%

Bachelor’s degree or above 34 26.3%

Form of payment

Urban medical insurance 105 81.4%

Rural cooperation medical insurance

16 12.4%

No insurance 8 6.2%

Disease characteristics

Value Percentage

Cancer diagnosis

Gastric 30 25.6%

Colon 33 25.6%

Renal 35 27.1%

breast 26 20.2%

Others 5 3.8%

Staging of disease

Ⅰ 8 6.2%

Ⅱ 10 7.8%

Ⅲ 43 33.3%

Ⅳ 68 52.7%

Surgery

Yes 77 59.7%

No 52 40.3%

Chemotherapy regimen

Single agent chemotherapy 30 23.3%

Combination chemotherapy 99 76.7%

Time

0-3 month 38 29.4%

3-6 month 37 28.8%

6-12 month 32 24.8%

≥12month 22 17.0%

3.Research result

3.1Medication adherence of capecitabine

Top score: 8

Lowest score: 1.75

Average score: 7.06± 1.22

High adherence

[PERCENTAGE]

Medium adherence

[PERCENTAGE]

Low adherence

[PERCENTAGE]

Medication adherence

Highly adherent Medium adherent Low adherent

3.Research result

3.1Medication adherence of capecitabine

Top score: 8

Lowest score: 1.75

Average score: 7.06± 1.22

32

26

4

126

6

26

23

23

94

103

125

3

123

103

106

106

3

0 20 40 60 80 100 120 140

How often do you forget to take capecitabine

Do you fell hassled about sticking treatment plan?

do you sometimes stop taking your medicine when you fellbetter.

Do you taking capecitabine yesterday

When you travel or leave home, do youforget to bring your medication

Have you ever cut back or stopped taking capecitabinewhen you feel worse

Have you ever stop taking capecitabine forsome otherreasons

Do you sometimes forget to take capecitabine

Medication Adherence of capecitabine

often/sometimes no yes（occasionally）

17.8%

20.2%

20.2%

17.8%

3.Research result

3.2Beliefs about Medication of capecitabine

Necessity: 11-25 medium score: 18

Concern： 8-25 medium score:15

Difference of necessity and concern: 2 P＜0.05

3.Research result

3.2Beliefs about Medication of capecitabine

Top score: 25

Lowest score: 11

Average score: 17.76± 2.88

Difference of necessity and concern:2.40± 4.53 P＜0.05

0 10 20 30 40 50 60 70 80 90

My life would be impossible without capecitabine

Whitout capecitabine I would be very ill

My health,at present,depends on capecitabine

Capecitabine protect me from becoming worse

My health will depend on capecitabine in the future

Necessity

strongly disagree/disagree uncertain strongly agree/agree

3.Research result

3.2Beliefs about Medication of capecitabine

Top score: 25

Lowest score: 11

Average score: 17.76± 2.88

Difference of necessity and concern:2.40± 4.53 P＜0.05

73

54

37

26

78

33

21

42

30

25

23

54

50

73

26

0 10 20 30 40 50 60 70 80 90

Somes I worry about long term effect of capecitabine

Having to take my medicine worries me

I sometimes worry about becoming too depent oncapecitabine

Capecitabine disrupt my life

Capecitabine is a mystery to me

Concern

strongly disagree/disagree uncertain strongly agree/agree

3.Research result

3.3Patients’attitude towards capecitabine

Ambivalent N=102 (79.1%)

Acceptable N=24

(18.6%)

Skeptical N=1

(0.8%)

Insignificant N=2

(1.6%)

（12.5）

Necessity

Concern

3.Research result

3.4Correlation between adherence and beliefs about medication

R=0.237, P＜0.05

Adherence and necessity: R=0.179, P＜0.05

Adherence and concern: R=-0.166, P<0.05

3.5Correlation between attitude and medication adherence

Adherence

＜6 6-8 8

Value % Value % Value % Total

Acceptable 2 8.3 8 33.3 14 58.4 24

Ambivalent 18 17.6 37 36.3 47 46.1 102

skeptical 1 100 0 0 0 0 1

insignificant 0 0 2 100 0 0 2

04 PART FOUR Conclusion

3.Conclusion

1

2

3

Most of the cancer patients with capecitabine has

good adherence, However there are still 16.4% of

patients are nonadherence.

Although most of the patients think taking

capecitabine was necessary, there are more than 2/3

of them has strong concern about oral chemotherapy.

There is a positive correlation between adherence

and beliefs about medication of cancer patients

with capecitabine.

3.Conclusion

Facilitating adherence of capecitabine

Giving health education

Monitoring side effect

Psychological nursing We should focus on that most of the patients

were ambivalent about capecitabine .It will give a bad effect on medication adherence.

Nurse should take measures to make patients keep a good mindset in order to patients can be active following cancer treatment.

Thank You For Listening