Adherence to Oral Chemotherapy

[Mramjohn, BSN, MSN, RN]

A diagnosis of childhood cancer can frequently increase thoughts of doubt, possible loss of life, and loss of hope for the future. These issues can alter the attention of family life to delivering emotional help and attention to the sick child which disrupts the everyday normal routine. The disruption can have an unfavorable effect on relationships inside the family, between husband and wife, parents and kids, and amongst siblings. The family needs information regarding treatment prior to starting. Although, healthcare professionals need to make sure information being delivered is appropriated considering the families' state of mind at the time of diagnosis.

It is important that healthcare professionals acknowledge the initial stage of shock the family has experienced, as well as the problems they are likely to confront in handling an overwhelming situation in an unfamiliar environment. This stage is usually hard for families to absorb all the information that is about to be given to them regarding treatment.

I work as a pediatric hematology/oncology nurse and I have come across a noncompliance with children and adolescents with ALL adhering to taking their everyday oral chemotherapy. It is not often, but it can happen.

There are eight attributes to adhering to oral chemotherapy in children and adolescents with ALL were identified.

• The first attribute is patient and family readiness and willingness to follow the prescribed regimen.
• The second attribute is being consistent in taking the medication in the maintenance phase of their treatment.
• The third attribute is family and patients working as a team with their healthcare providers.
• The fourth attribute is they need to pay close attention to doses, times of administration, and if it can be given with or without food. One of the medication that is given throughout maintenance is called Mercaptopurine (6mp). It is very important to during treatment patient get lab done every two weeks or monthly depending where they are receiving treatment to adjust dose of medication. Depending on lab results the physician or physician extender may alter the dose of the medication.
• The fifth attribute is making sure the patient and family or whomever will be administering the medication understands the dose has changed. In doing so it is very important to communicate that information to the family, child or adolescent in making sure the correct dose is given.
• The sixth attribute is making sure they understand that there will be adjustments to doses according to their complete blood count.
• The seventh attribute is having the child or adolescent actively participate in the process if they are able to understand.
• The eighth attribute is making sure to supervise the adolescent even if the adolescent is responsible the family member needs to make sure they are taking it.

There have been cases where parents trust the adolescent has taken medication, and they do not take it because they feel good and think they are not sick. Oh yes! Encouraging the parents to actively participate in their child's care and having them assume the responsibility will reinforce that they can do it. Encouraging parents to become more hands on will increase their self-esteem. Another consequence identified is potential for maintaining desired chemotherapy levels.

Adherence can be a challenging commitment for countless patients, and the choice to take oral chemotherapy must be grounded on a mutual agreement between the patient and physician, with right support from oncology team. Encouraging the parents to actively participate in their child's care and having them assume the responsibility will reinforce that they can do it. Encouraging parents to become more hands on will increase their self-esteem. Another consequence identified is potential for maintaining desired chemotherapy levels. Patients and families have to realize that ALL can be curative, so it is very important that they adhere to the medication regimen.

[Ahvegas]

Great article, thanks for your excellent insight Martine.

[Lex_pedsRN]

Well written! Thank you for sharing this. It is a challenge, but your article highlights the challenges that the patient and family face and how we as nurses can help them overcome these obstacles, fears or misunderstandings. Education is definitely on-going!