Medication Adherence in Cancer Care: More Than Taking the Pill – Part 2
Amy & Aimee (00:01)
Welcome back to Voices in Oncology from STO. I’m Aimee Faso, and I’m with my co-host Amy DePue. In part one, we spoke with Dr. Benyam Muluneh about why medication adherence matters in oncology, the many barriers patients face, and the importance of approaching these conversations with trust and partnership.
In this episode, we continue our discussion with Benyam and look at the role of the multidisciplinary care team in supporting patients on oral cancer therapies. We’ll talk about new opportunities to improve adherence, misconceptions healthcare professionals should challenge, and practical ways to help patients feel supported throughout their treatment.
We talk a lot about the multidisciplinary team and how it is more than just provider, APP and a clinic nurse, it’s the nurse navigators and it’s the pharmacy technicians who are behind the scenes and it’s caregivers and also that patient, the patient in the center, the rest of us kind of swirling around. Can you bring that together for this level of adherence?
Benyam (01:14)
Absolutely. Obviously, it’s definitely a team effort. We know providers, physicians, APPs, identify who is a candidate for these drugs. And if organizations have, for example, a program like an adherence management program that patients are referred into, you know, those are the providers are the ones that would be really initiating like a you need some support, so I’m gonna refer you to this to this program. And really ensuring that working closely with the pharmacy team, the nursing team, whenever there’s dosing changes needed and ensuring through the big picture, is this the right drug and is this the right delivery mechanism for this patient or should they be on an IV potentially? So, I think those pieces are important. I often say like the clinical pharmacist could be the backbone for this process. And so, the nurse navigators are like the connected tissue. They really are the glue and yeah, and often the first line of defense, right, for everything that patient is having. And so, it really becomes important that whether it’s, you know, triaging concerns that the patient is having, managing certain side effects, and just in general, sort of providing a supportive structure for the patient, the nurse navigation team can play a critical role in this process. Oftentimes, clinical pharmacists have a lot of responsibility, but I I’ve always felt like this is a process that really can be coordinated by the pharmacy team. And that’s because the clinical pharmacists also serve to connect the patient and the team to the specialty pharmacy where the drug is actually being handled. And so, I think having an embedded pharmacy team is also really critical.
Social workers are really key for this process as well. Really thinking through the psychosocial piece, right? A lot of this can be really stressful. I mean, one risk factor we didn’t even touch on because repeatedly, not just in oncology, but in all conditions, has been shown to predict non-adherence is actually depression. So that we know PHQ scores, like that is a known predictor. And so, we know that like having our social work team really addressing psychosocial pieces as well as helping support access pieces as well can be really critical. They can obviously ensure that patients can have ways to coming to the clinic and ensuring, you know, if there’s like housing issues and access, you know, the like local support that’s needed. They can also obviously have the expertise to be able to do that. So that’s really huge. And then financial counselors or in certain contexts it might be like a medication access teams and also be really critical to make sure the patients continue to get their medications and have copay assistance programs if needed.
And then last but not least is the caregiver. They’re really a key piece of this and I really think that ensuring that the caregiver also has the support that they need. And if they have a feeling of a good caregiver can actually really help with the clinical team as well because that caregiver can really help support the patient and ensure that the patient is a is taken care of and is adhering and getting their needs met to the best of their abilities. And so that’s I think another important part of the team. As well as the patient, obviously. Yeah. So, the patient at the center.
Amy & Aimee (04:23)
That caregiver is very, very important. I agree with that. Yep. Yeah. It’s so many people that are needed to support the patient. It always impresses me on how many people will get involved to support those patients. But I think what you’re speaking to shows why. I was wondering, are there any innovations or opportunities that you see that could help improve medication adherence?
Benyam (04:48)
Yeah, I think there’s a lot of exciting innovations that are in the pipeline. There have been a lot of interesting pilot projects we’ve been involved with, various AI-trained chatbots. One project that we’re currently working on is capturing patient reported outcomes, capturing symptoms, as well as adherence measures, and then giving them curated messages to address their symptoms. So, if they’re lower grade symptoms, then you can sort of train the chatbot to provide some non-pharmacologic recommendations to address their nausea or their constipation, or diarrhea. But then if those strategies are not working, or if it’s a more serious side effect, then it would triage them to the clinic. And the idea behind this is that everyone is using AI. They’re sort of using it without any regulation and no boundaries, no guardrails. And so, these tools that are now being developed have the appropriate guardrails and they’re vetted by clinicians and they’re using tools that are approved by our institution, our professional society, so you can set it up to offset some of the burden that might be existing on the clinical side. So, I’m really excited about that as a potential way to extend care to some patients.
Amy & Aimee (06:02)
Yeah, that’s very interesting. AI is getting more involved just in general. So definitely a topic to come, but…
Benyam (06:09)
Yes, yes, for sure.
Amy & Aimee (06:10)
So, it’d be interesting to see how that affects adherence.
Benyam (06:13)
Definitely.
Amy & Aimee (06:16)
What are any misconceptions that you would like to point out that maybe healthcare professionals have about adherence?
Benyam (06:24)
One assumption is that patients are taking their medicines. And I think that comes from the fact that sometimes the way that we ask, you know, if you are saying like, “So you’re taking your medicine, right?” They’re they are taking it. Not all, but they’re taking it. And so, I think that’s really one huge misconception, kind of out of big picture to kind of bring it all together. And I think the other piece though is that patients are hesitant to disclose mainly because they don’t want to bother us. And that actually like came out in a lot of our interviews. And that kind of kind of broke my heart a little bit. Like it just made me sad when I was listening to these transcripts over and over again. You know, we would ask, “Why do you want to take the medicine?” And all of them were like, “I want to be there for my family.” “I want to walk my daughter down the aisle.” “I want to see my son graduate.” So, they’re really motivated to actually be well and be healthy.
But a lot of them end up having these bothersome symptoms or these concerns and they feel like they can’t really bring it up to us because they presume it’s not that serious. It’s not that important. So then so that’s when they start taking you know matters into their own hands. And so, a lot of them are going to the internet. They’re going on message boards. We’re actually doing a study where we’re thematically analyzing patient message boards and the support that they’re providing to one another. And of course they’re going to ChatGPT. So, I think like building that trusting relationships so they can come to us and we can work together as a partnership to find solutions for them.
Amy & Aimee (07:54)
So, we need to let them know that they’re not bothering us.
Benyam (07:57)
Yes.
Amy & Aimee (07:58)
That’s so important.
Benyam (07:59)
Yeah.
Amy & Aimee (07:59)
So, without sharing any identifying information, could you tell us about a patient perhaps that could illustrate why adherence matters?
Benyam (08:09)
One example really showing why asking specific questions matters is a patient that we were seeing in clinic about three or four weeks after starting their therapy. And overall, this patient was tolerating the medicine just fine, no access issues. They seemed to be overall doing just fine. And then they happened to mention running out of my drug and it and that didn’t really make sense based on the quantity that they perceived. And so, I asked, so you “Just to clarify, you’re taking one tablet once a day, correct?” And the patient said, “No, I’m taking two tablets a day.” Yeah. And it was a very simple thing. And the directions were once a day on the bottle. And then I realized that when the patient started in the hospital, they were receiving a different tablet strength, so they were taking two tablets a day. And so, when they left the hospital, they got a larger, so from 50 milligrams to a 100 milligrams, but they continued taking two tablets per day. Now they didn’t have any side effects, which is a thing, thank goodness. But I realized after that that I need to even when it’s a simple one tablet once a day, I need to be like “You’re taking one tablet once a day, correct?” So, verifying these pieces can be really important. And I can also think of several examples of situations where our oncologists were gonna switch therapy, assuming this drug is no longer working. But it was really that the drug was not being taken as prescribed. And so, the action we can take to can be optimizing adherence managing side effects rather than just switching them to another drug.
Amy & Aimee (09:41)
I think that’s an excellent example. Because a lot of times when patients are starting these medications, they’re getting so much information. And what we think is a simple instruction may get lost in all of the clutter of information that they’re getting.
Benyam (09:55)
Yes.
Amy & Aimee (09:55)
So, asking, “How are you taking your medication? When are you taking it?” You’re right, can really show you a lot of information about what they’re doing.
What is one thing that you would like our listeners, patients, healthcare professionals, whoever is out there listening to us, what would you really want them to remember about this discussion on medication adherence?
Benyam (10:20)
I would probably say that it is a complex problem with enormous consequences, but it is one that we can solve together in partnership with the patient. I think that’s the big thing. And I think you all had actually a catchphrase. Ask early, ask often.
Amy & Aimee (10:38)
Yes.
Benyam (10:38)
Maybe that can be our takeaway.
Amy & Aimee (10:43)
Today’s conversation reminds us that medication adherence isn’t simply just taking medication on schedule. It’s about understanding each patient’s unique challenges and working together as a team to remove the barriers that can stand between patients and the treatments designed to help them. Medication adherence is a shared responsibility among patients, caregivers, pharmacists, physicians, nurses, nurse navigators, and the entire oncology team.
Benyam, thank you so much for joining us today and sharing your expertise. We so appreciate it. And thank you for listening to Voices in Ecology from STO. To learn more about STO and future podcast episodes, please visit sto-online.org.
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Voices in Oncology is produced by the Society for Translational Oncology, STO, for educational and informational purposes only. Content does not constitute medical advice and should not be used as a substitute for professional clinical judgment. The views and opinions expressed by guests are their own and do not reflect the official position of STO. Mention of any product, service, organization, or therapy does not constitute an STO endorsement.
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