Adherence to Treatment Regimes in Adolescent and Young Adult Cancer Patients

Abstract

Adherence, defined as the extent to which a patient’s behavior coincides with medical or health advice, can have significant implications for AYA with cancer. Some of the facilitators of and barriers to adherence for the AYA population are similar to those confronting pediatric and adult populations, while others are distinct and unique to this age group. Best evaluated through a biopsychosocial model, unique barriers for AYAs include the impact of illness on physical well-being as physical development proceeds, the importance of “normality” in this age range, the impact of peer interaction, progressive evolution of the relationship with parents, and the distractibility that may mark adolescence. This evolution continues through young adulthood, a period of increasing and shifting behavioral, financial, social, and familial responsibilities. A developmentally oriented framework for considering adherence among AYA with cancer is critical and encompasses specific approaches to enhancing patient engagement in the treatment process and the healthcare system, including the use of electronic gaming and monitoring; attention to the state of evolution of patient’ cognitive and emotional functioning and psychological status; evaluation of patients’ knowledge, belief framework around locus of control in health and illness; the AYA’s perception of severity of illness and the related perception of vulnerability or invulnerability; and the dynamics of the relationship between healthcare providers and AYA patients, with particular emphasis on open and collaborative interaction. When coupled with knowledge of potential tools to assess adherence, this framework can position providers to better address and support adherence among this population.