My colleague Erik Greb wrote an interesting blog post yesterday about new drug delivery technology reminiscent of childhood games. Games have changed dramatically, but the concept of using them to help educate applies today. Take for example, the problem of patient compliance. A video game called “Re-Mission” (HopeLab) is helping children and teens to “blast away” cancer cells (at least on screen). The point is that it empowers the young patient to take control, which unfortunately is not the case with many adult patients with cancer.
The problem with cancer patients taking their medication as prescribed has become even worse during this economic downturn. The situation is now at the point that some physicians are calling for drug manufacturers to closely consider whether oral chemotherapy drugs are in fact better for patients than traditional intravenous formulations.
What’s the connection? According to physicians at the University of Pennsylvania School of Medicine, the growing shift toward oral chemotherapy medication, while providing patients freedom and independence, is also presenting a greater risk of skipped doses, missed refills, and drug administration errors. “People assume that if you have cancer, you’re going to take your medication, but for a whole host of reasons that may not happen. We need to recognize the reality of nonadherence,” says Angela DeMichele, MD, MSCE at the university’s Abramson Cancer Center, in a prepared statement. The cost of chemotherapy agents is a major factor in noncompliance, especially for seniors. And for time-sensitive diseases such as cancer, strict compliance is critical. The problem may even worsen for patients who take combination drugs (such as HIV patients who take multiple-API tablets) and who may get into the mistaken mindset that missing a pill is, afterall, not as bad as missing three.
The solution may not be simply returning to i.v. therapies, providing written material, or holding educational sessions with healthcare providers. According to the physicians’ statement, studies of behavioral intervention to increase compliance show that these methods have minimal impact. Instead, DeMichele suggests high-tech methods such as cell phone programs and computerized pill boxes. Future methods may include controlled-release dosing with implants or microneedles.
Even with these technical tools, which would certainly increase the cost of prescription medication, the ultimate goal of patient compliance will be challenging. Perhaps there is a lesson to be learned from a child’s video game: compliance and patient empowerment must go hand-in-hand.