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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.
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.
Shares Fragmented care and guideline gaps and the tags protocol-upgrade, upgrade:promising.
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Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Toxicity and quality of life are undervalued and the tags protocol-upgrade, upgrade:promising.
Shares Fragmented care and guideline gaps and the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
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