# A structured support programme for everyone taking cancer tablets at home

Source: https://onco.cc/ideas/idea-upgrade-oral-anticancer-medicine-adherence-programme/  
OnCo record `idea-upgrade-oral-anticancer-medicine-adherence-programme` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

More cancer treatment now comes as tablets taken at home, where nobody sees missed doses or side effects building up. A nursing guideline recommends a structured programme: a check at the start of who may struggle, teaching, follow-up calls from the team, and coaching. The trials behind it are small and mixed, so this is promising rather than settled.

## Summary

The guideline. The Oncology Nursing Society's 2022 guideline, built with GRADE methods and patient representatives, suggested an adherence risk assessment, education addressing adherence, ongoing assessment, proactive follow-up, coaching and motivational interviewing in addition to usual care, and suggested that services implement a structured oral anticancer medication programme.

The evidence under it. The systematic review written for that guideline concluded that "risk assessment, ongoing or periodic assessment, proactive follow-up, motivational interviewing, or structured programs may improve adherence", while education or coaching alone "may improve or have little to no effect", and interactive technology was no better than non-interactive. An earlier scoping review found 56 studies, of which 14 were randomised trials and 33 enrolled fewer than 100 patients; fewer than half of the studies with a comparison group (44.7 per cent) reported a statistically significant improvement in adherence or persistence, and the programmes that did best were pharmacist-led and built in regular monitoring with follow-up by a clinician.

What is not known. How many services run such a programme has not been measured in any survey OnCo found, and no trial has yet shown that better adherence through these programmes changes survival or admissions. The upgrade is cheap and low-risk; the evidence says it probably helps adherence and leaves the size of the effect open.

## Fields

- Kind: Idea
- Last checked: 2026-10-20
- Tags: protocol-upgrade; upgrade:promising; evidence:moderate
- Hypothesis: A structured programme for oral anticancer medicines (a risk assessment at the first prescription, a teaching session, calls from the team in weeks one, two and four, and pharmacist review at every dose change) raises the proportion of patients who take at least 90 per cent of prescribed doses by at least ten percentage points over current teaching, and reduces unplanned admissions for toxicity.
- Rationale: The shift to tablets moved the work of giving treatment from the day unit to the kitchen table without moving the monitoring with it. The components that the review found most promising are the ones that restore contact: a team member calling at set times, and someone checking doses whenever they change.
- Proposed test: A cluster-randomised trial across oncology practices starting patients on oral kinase inhibitors, CDK4/6 inhibitors or capecitabine, with adherence from dispensing records at six months as the primary endpoint and unplanned admissions, dose intensity and patient-reported side effects as secondary endpoints, against each practice's current teaching.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Belcher et al., ONS Guidelines to Support Patient Adherence to Oral Anticancer Medications (Oncol Nurs Forum 2022): https://doi.org/10.1188/22.ONF.279-295
- Waseem et al., Interventions to Support Adherence to Oral Anticancer Medications: systematic review and meta-analysis (Oncol Nurs Forum 2022): https://doi.org/10.1188/22.ONF.E4-E16
- Rosenberg et al., Interventions to Enhance Adherence to Oral Antineoplastic Agents: a scoping review (J Natl Cancer Inst 2020): https://doi.org/10.1093/jnci/djz244

## Connected records

- ideas: [Pharmacist interaction check before every oral cancer-drug prescription](https://onco.cc/ideas/idea-acc-pharmacist-interaction-review-oral-anticancer/), [Start low and step up: individualised titration of oral cancer drugs, randomised](https://onco.cc/ideas/idea-tr1-start-low-titrate-up-oral-agents/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Targeted Therapy](https://onco.cc/fronts/targeted-therapy/)
- technologies: [CDK4/6 inhibitors](https://onco.cc/technologies/cdk46-inhibitor/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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