Strategies to improve adherence to treatment in adolescents and young adults with cancer: a systematic review

Abstract

Purpose:

Adolescents and young adults (AYAs) with cancer have higher rates of nonadherence to treatment relative to younger and older cancer patients. Efforts to improve adherence in this population are therefore increasing. This review aimed: 1) to synthesize recommendations and strategies used to improve treatment adherence in AYAs with cancer, and 2) to summarize the available evidence supporting the efficacy of adherence-promoting strategies for AYAs with cancer.

Methods:

We conducted a systematic review with two stages: 1) a narrative stage, to analyze expert recommendations, and 2) an evaluative stage, to summarize quantitative evidence for interventions. Four electronic databases were searched for studies involving AYAs, aged 10–39 years, with cancer, published from 2005 to 2015. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to ensure quality of the review. The Delphi list was used to assess study quality.

Results:

Nine articles were identified in the narrative stage of the review. For the evaluative stage, out of 113 screened abstracts, only one eligible intervention was identified. Common themes of adherence-promoting strategies were grouped into five domains: developmental, communication, educational, psychological well-being, and logistical/management strategies. Strategies to address developmental stage and to improve communication were the most highly recommended to improve adherence. Few strategies focused on the role of the patient in adherence. One intervention found that a behaviorally targeted computer game could significantly improve adherence to prescribed oral medication in AYAs with cancer.

Conclusion:

Although numerous studies report challenges to treatment adherence in AYAs with cancer, little research has systematically evaluated the impact of implementing recommended strategies and interventions in this age group. The present review extends the current literature through its focus on strategies recommended to improve adherence, rather than focusing on barriers and risk factors for nonadherence. There is now a need for more rigorous research to systematically assess the effect of implementing strategies to improve AYAs’ adherence to cancer treatment.

Keywords::

• neoplasms
• emerging adulthood
• interventions
• communication
• psychosocial

Acknowledgments

The authors wish to acknowledge the support of Associate Professor Richard Cohn, Head of Clinical Oncology, Sydney Children’s Hospital, and Ms Brittany McGill (Clinical Psychologist, Behavioural Sciences Unit). The Behavioural Sciences Unit is supported by the Kids with Cancer Foundation.

Disclosure

Claire E Wakefield is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia (grant number APP1067501) and an Early Career Development Fellowship from the Cancer Institute of NSW (grant number 11/ECF/3-43). Ursula M Sansom-Daly is supported by an Early Career Fellowship from the Cancer Institute of NSW (grant number 14/ECF/1-11). The authors report no other conflicts of interest in this work.