Impact of cognitive functions on oral anticancer therapies adherence

Abstract

Background: Oral anticancer therapies have now an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the relationship between cognitive functions and oral medication adherence in order to identify patient profiles that are more likely to be non-adherents, with a focus on the elderly population particularly at risk. Methods: This prospective pilot study included patients initiating a first exclusive oral therapy. Before initiation of treatment, we performed a standardized neuropsychological test battery and an assessment of autonomy, depression and anxiety. Information on socio-demographic conditions was collected. Adherence to oral therapy was evaluated by two self-assessment questionnaires and an observance sheet at 1 and 3 months after start of treatment. We present here only the results at 1 month. Results: Among 126 patients enrolled, 111 (88%) completed the adherence questionnaires at 1 month with an adherence rate of 90% and a median age at baseline of 70. Global cognitive impairment was observed in 50% with the Montreal Cognitive assessment (MoCA). Working memory disorders and depression were significantly associated with non-adherence: [1.38 (1.03-1.85); P= 0.0326] and [4.67 (1.11-19.59); P= 0.0352] respectively. A relationship was found between age and MoCA score and also with working memory impairement, with for both of them a higher impact above 70 years (P< 0.005). Conclusions: Working memory dysfunctions and depression appear as predictors of non-adherence. Focusing on cognitive functions before initiation of oral anticancer therapy is therefore relevant to identify patient profiles more likely to fail self-management of oral anticancer therapy and therefore help decision-making, particularly in elderly.