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Patient Perspective: Critical Factors in Improving Patients’ Adherence to Oral Medications

Conquering The Multiple Myeloma Continuum Series One
Yelak Biru
Patient, North Texas Myeloma Support Group Leader; Member, International Myeloma Foundation; Advisory Committee Chair, Global Myeloma Action Network

There remains no consensus of agreement regarding a cure for multiple myeloma, but the past several years have seen tremendous progress in terms of patient support, treatment, and drug innovation for this devastating cancer. Now more than ever, patients with multiple myeloma have unprecedented numbers of treatment options to choose from for their deadly plasma-cell neoplastic diseases.

EFFECTIVE ORAL THERAPIES

In a remarkable change from previous years, effective all-oral combination therapies will soon become a reality for patients with multiple myeloma. In 2015, Farydak (panobinostat) was added as a new-in-class oral pan-HDAC inhibitor to the already approved immunomodulatory agents–Thalomid (thalidomide), Revlimid (lenalidomide), and Pomalyst (pomalidomide).

In addition, the significant possibility of the accelerated approval of ixazomib by the FDA1 and the various phase 1 and phase 2 clinical trials that are currently in progress for oprozomib2 make this exciting development a very close and likely reality.

As stated in the main article, an all-oral future treatment plan opens the door for more treatment options, more convenience, and an overall better quality of life for patients and their care team.

ADDED RESPONSIBILITY FOR PATIENTS

With more treatment options, convenience, and control, patients must accept the added burden of responsibility to become educated. Likewise, their oncology care team, including pharmaceutical companies, must create the means by which patients can become educated.

Frequent, open communication between patients and their oncology care team is critical in addressing the drug adherence issues that are described in the main article. With less frequent visits secondary to the home delivery and administration of oral drugs, communication needs to be more intentional.

PATIENT–DOCTOR TRUST

Also critical is a patient–doctor bidirectional trust. Patients need to trust that their doctors have their best interest at heart, and doctors need to trust that patients will be fully responsible in their care; this, however, can lead to a “catch-22.” Without education and communication, trust is built on thin soil; without adequate trust, the willingness to teach, learn, and communicate is minimized.

Regardless, patients with multiple myeloma need to fully understand that multiple myeloma is a vicious cancer that they cannot trust, even when they are feeling well. As a result, patients need to take their prescribed medication during induction and maintenance therapy, when they are feeling well as much as when they are not feeling well.

A 360 VIEW OF THE PATIENT

It is important that the extended healthcare team have a 360 view of their patient’s financial, emotional, physical, and psychological situation to provide dynamic and personalized care. Surveys and one-on-one discussions at the doctor’s office are useful in getting that started.

However, these encounters are only points in time, and they can result in a “halo effect” of side effect, symptom, and overall situation reporting. Can the power of emerging technologies, such as wearable devices, mobile technology, and big data, be used to pull data from patients to get an ongoing view of their condition and, based on that accumulated data, allow the oncology care team to provide pertinent information for the patient?

In the end, education will only address the patient’s lack of adherence to their oral cancer therapies. The 5 Ps–patients, providers, pharma, payers, and policymakers—need to work globally and collaboratively to address the causes of high drug prices, to innovate and reduce treatment-altering side effects, and, in general, to address the availability of and access to drugs for those who need them most.

References

  1. Takeda. U.S. FDA grants priority review to Takeda’s ixazomib for patients with relapsed/refractory multiple myeloma. Press release. September 9, 2015. www.takeda.com/news/2015/20150909_7117.html. Accessed October 25, 2015.
  2. ClinicalTrials.gov. Phase 1b/2, multicenter, open-label study of oprozomib and dexamethasone in patients with relapsed and/or refractory multiple myeloma. https://clinicaltrials.gov/ct2/show/NCT01832727. Accessed October 26, 2015.

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