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Adherence – Simple solutions for successful care

Every fall, I would catch my annual bout of bronchitis. I knew the routine: a week off from school, plenty of ginger ale, and an antibiotic regimen made easy via a tidy Z-Pack.

“FINISH THE ENTIRE PACK!” said every doctor and nurse. The importance was two-fold: I was sick and needed treatment, and I wanted to avoid developing any bacterial resistance. I think I did a good job, but like most people, I probably missed a dose or two. 

Medication adherence is hard! Life has a knack for getting in the way, breaking our routine, preying on our weak short-term memories, “Did I take my medication already? Or was that yesterday?” Medication adherence during cancer treatment is even harder.

Oral Oncolytics

Over the past two decades, the number and utilization of oral oncology therapies has boomed – particularly with the advent of targeted therapies such as CDK4/6, BTK, and PARP inhibitors. 

A two-sided coin, while oral oncolytics are patient-friendly in so many ways (e.g., reduced hospital and office visits, improved quality-of-life), those benefits come with added responsibilities levied on patients and caretakers: taking the right med at the right time, communicating side effects, transparency to the clinical team, and more.

It all sounds so simple, and yet study after study has shown that adherence to oral medications – even in high-stakes, chronic settings like cancer – is surprisingly low. Meanwhile the potential consequences – decreased medication efficacy, disease progression, increased hospitalizations, or even death [1,2,3]  – are significant. Taken together, the cost of non-adherence in cancer has been estimated at ~$70,000 to ~$160,000 per person (See fig. 1).

Figure 1

Unadjusted medication nonadherence costs

Graph diagram showing unadjusted medication nonadherence costs
Averages across studies, 2015 $USD [4]

Contributing factors of non-adherence

A simple task done once is easy, but doing a simple task every day is hard. However, there are additional factors that contribute to non-adherence during cancer treatment:

  • Lack of knowledge or experience at treatment start - New routines are tough, having zero experience to support our success.
  • Memory and forgetting - Cognitive challenges impact everyone, and some diseases and treatments have increased cognitive effects.
  • Side effects - Medication can impact different people in different ways. Side effects can discourage adherence as prescribed.
  • Complex and dynamic treatment schedules - Different pills at different times, all with different instructions, that are frequently changing, impedes establishing a routine.
  • Cost - Medication costs money and some resort to spreading out doses while looking for lower-cost options. [5]

Simple tools with significant results - text messages approximately double the odds of adherence

A simple solution, easy to use, is usually the most effective. Therefore, an effective tool is one that has widespread adoption with established routine use – mobile phones and cellular technology are shared across age, socio-economic status, and geography. While more complex solutions may deliver advanced value, a simple reminder at the right time, in the proper way, has the potential for massive impact.

Using a simple SMS reminder (a text message) improves a baseline adherence of 50% to nearly 70% [6], with near universal acceptance, even if receiving only generic reminders. The solution does require some consideration, specifically to ensure that messages are sent at the proper times based on the prescribed schedule.

“It’s really simple, I almost always forget in the moment, but with a simple text message, I already know I’m due for some meds.”

How Navio Delivers

At Navio, we aim to meet you where you’re at and help you stay on track with your medications during cancer treatment. When you use Navio’s app, a medication checklist is automatically created for you based on your treatment plan - no need to worry about setup. Text message reminders are sent to you at the time of each medication, with a simple link to mark that it has been taken. You’re reminded to take your medications at the correct prescribed time in a way that you can rely on, and you can always refer back to your checklist to see if everything was taken.


4 screens showing Navio's medication checklist
Navio's Medication Checklist


How to start receiving text messages for your treatment

We help people better manage their treatment, starting with simple support to make it through the day. Get access and join in here!

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517768/
  2. https://www.jmcp.org/doi/full/10.18553/jmcp.2020.26.2.186
  3. https://link.springer.com/article/10.1007%2Fs00520-017-3584-0
  4. https://www.ncbi.nlm.nih.gov/pubmed/29358417;
  5. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2484905
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Written by

Jonathan Brown

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