5 Ways to Help Your Cancer Patients Be More Compliant

Neil Chesanow


June 19, 2014

In This Article

High-Tech Solutions?

Technology may improve compliance in the years to come. Take smart pills, such as Proteus Digital Health's ingestible sensor, which was approved by the US Food and Drug Administration (FDA) in 2013.[19] The pill is embedded with a tiny sensor made from silicon and natural ingredients. After it's swallowed, it uses stomach fluid as a power source to broadcast signals back to a battery-powered companion patch worn on the patient's arm. Data -- including time of ingestion, heart rate, body temperature, and other activities -- are then sent wirelessly to a smartphone app used by physicians to better gauge a patient's condition.

Also in development are smart pill bottles to improve compliance, because forgetfulness is a major reason that patients don't take their medications as directed. AdhereTech, for example, makes pill bottles that contain a wireless computer chip that allows the bottle to work anywhere that a cell phone works.[20] It automatically measures how many pills a patient takes and when the patient takes them. If a dose is missed, AdhereTech reminds the patient with an automated phone call or text message, as well as by activating lights and chimes embedded in the bottle cap. The device is currently being tested in clinical trials.

Kevin Volpp, MD, PhD, an internist and behavioral economist at the University of Pennsylvania's Perelman School of Medicine and the Wharton School in Philadelphia, has done pioneering work in the use of economic incentives -- in this case, patient lotteries -- to improve compliance: motivating obese patients to lose weight, smokers to quit smoking, patients with diabetes to take their statins, and patients on warfarin to stick to their regimens.[21]

In the case of warfarin, in which maintaining compliance with therapy is especially challenging, patients were entered into a lottery. Each day that they remembered to take their warfarin, they had a 1-in-5 chance of winning $10, or a 1-in-100 chance of winning $100 in the lottery.[22]

"Rates of nonadherence to warfarin were significantly lower using daily lottery-based incentives," Volpp explained in a congressional staff briefing last year.[21]

"It certainly does show an increase in adherence," adds Ed Pezalla, MD, MPH, National Medical Director, Pharmacy Policy & Strategy at the health insurer Aetna, which funded the research. "People buy lottery tickets knowing that the odds are very small that they're going to win, but it gets you engaged, and that's really what it's all about. It's getting people to think about adherence and being engaged in the process, and less about the size of the reward."

But despite such efforts, physicians remain the key to compliance. Studies show that patients who have good relationships with their doctors are more likely to stay on regimen, but that doctors often fall short in this regard, whether owing to lack of time or lack of people skills.

"At the heart of this problem lie essential questions about human motivation and physicianhood," wrote cardiologist Lisa Rosenbaum, MD, and internist William H. Shrank, MD, in the New England Journal of Medicine last summer.[23] "Whether patients take their medications is ultimately up to them, but physicians' professional responsibility entails both a willingness to help people in need and a constant effort to do better."


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