Depressive symptoms in older patients with cancer are negatively associated with adherence to oral anticancer therapy, according to results from a prospective pilot study conducted by researchers in France. This study was published in Supportive Care in Cancer.

Although oral cytotoxic and targeted anticancer agents are often perceived to be more convenient compared with drugs delivered intravenously, patient nonadherence to oral agents can complicate treatment decisions. Nonadherent patients may be prematurely switched to another anticancer agent or experience early treatment termination due to perceived lack of drug efficacy. 

This study enrolled adult patients with solid tumors treated at a comprehensive cancer center in France who were first-time candidates to receive an oral anticancer drug, excluding hormonal therapy for breast cancer and those receiving adjuvant therapy. A trained neuropsychologist assessed patient levels of anxiety, depression, and cognition through patient responses to questionnaires and results of standardized testing administered prior to initiation of oral therapy. Questionnaires regarding adherence to oral anticancer therapy were administered at 1 and 3 months following oral therapy initiation. 

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The median age of the 129 patients enrolled in the study was 70 years. These patients had a wide range of solid tumors, and metastatic disease was present in 81%. More than 83% and 37% of these patients were taking more than 3 and more than 8 concomitant medications, respectively.  Patient reports of nonadherence to oral therapy were 10% and 13% at 1 and 3 months, respectively. 

A significant association was observed between baseline depression and nonadherence to oral therapy at the end of month 1 (P=.046) and month 3 (P=.014). Although nonadherence was also associated with lower cognition, no association was observed between nonadherence and anxiety. 

“Focusing on depressive symptoms before initiation of oral anticancer therapy could help identify patient profiles more likely to fail self-management,” the authors concluded.

Reference

Dos Santos M, Lange M, Gervais R, et al. Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence[published online January 28, 2019]. Support Care Cancer.doi: 10.1007/s00520-019-4644-4