Noncompliance With Aromatase Inhibitors
In a paper presented at the 29th Annual San Antonio Breast Cancer Symposium (December 2006), Ann Partridge, MD, reported that although postmenopausal women with early-stage, hormone-sensitive breast cancer can reduce their risk of recurrence by use of estrogen-lowering medication (aromatase inhibitors), 15% discontinued refilling their prescriptions for their aromatase inhibitor within one year of beginning that medication. In another portion of the study that looked at the prescription filling habits of 1,111 women on this medication, 19% failed to fill prescriptions for at least 20% of the year.
Source: Early-stage breast cancer: 1 in 5 patients may not adhere to hormone therapy
Commentary
Dr. Partridge notes “Non-adherence is a very complex issue, and the reasons that a patient may not take her medication as directed can include fear of or the experience of side effects, cost of treatment, and negative health beliefs, like the treatment will not help.”
Obviously, this list of possible causes of noncompliance is not exhaustive (nor does Dr. Partridge imply that it is) although I suppose “negative health beliefs” can become used as an elastic clause, encompassing a wide range of patient perceptions.
Just teasing out the role played in noncompliance by the various factors subsumed within the notion of patients interpreting and trusting information about medications is dauntingly complex.
I came across an observation about this story in Cancer Blog: Breast cancer survivors reject chemoprevention drugs:
Notwithstanding my sense that many patients and their families clamor for the latest and greatest biochemical agents available and my own faith in clinical studies, this mistrust of relatively new medications that have been well tested but have been used in routine clinical practice only a brief time has a rational basis and an intuitive appeal. Weighing the risks of taking such a medication against the risks of not taking it until it is historically proven safe and effective is not a trivial decision, either in terms of difficulty or consequences.
Similarly, a given patient, especially one who has survived a chronic disease, may mistrust a specific pharmaceutical manufacturer or pharmaceutical companies in general (see Does Mistrust Of A Pharmaceutical Manufacturer Cause Patient Noncompliance?). In such cases, a pharmaceutical company’s sponsorship of clinical trials may cause a potential user to devalue the results of that research.
Or, a patient may bring to treatment feelings about the medication that may not be voiced unless and until the clinician asks the right question (see Interview-based Patient Adherence Observations).
The patient-clinician relationship likewise has an impact on the patient’s confidence in information about medicines conveyed by his or her healthcare professional.
While still other items could be added to this listing, these should be sufficient to indicate the intricate, interlocking, multifaceted nature of the process involved in a patient’s conscious decision to agree to or reject a medication recommendation.
Finally, I suggest reading this vignette about the problematic attempt to prescribe a new medication to a recently diagnosed diabetic, chronic hypertensive patient that places these theoretical concerns in a real-life, clinical context. The scene is described by a third year medical student who observed the event and wrote about it in his blog at ~ Nothing to do… ~