Ensuring patients adhere to oral medications for cancer can be a complex task, especially if patients have low health literacy. Oral medications for cancer continue to be more prevalent, but rates of adherence to oral therapy vary widely by population, cancer type, and level of education. At the 2018 American Society of Clinical Oncology Annual Meeting, researchers presented the results of a study that hypothesized health literacy’s connection to oral medication adherence and whether a multilevel intervention approach would result in greater adherence.

In this active, randomized, controlled trial, patients were randomized (1:1) to receive clinical care plus education by an RN or the addition of a multilevel intervention, including:

  • A brief web-based educational video on cancer and oral cancer drugs
  • Periodic reinforcement of educational messages with videos
  • Brief phone calls 24 hours and two weeks after each encounter
  • Offers of facilitative services (if needed)

Adult patients with cancer on any oral cancer medication were eligible for the study. Exclusion criteria included:

  • Eastern Cooperative Oncology Group performance status of 3 or higher
  • Concurrent chemo-radiation therapy
  • Hormonal therapy
  • Nonadherence (defined as history of missing two or more oncology clinic appointments)
  • Pregnancy
  • Residence in a nursing home
  • Dementia
  • Lacking decisional capacity

A baseline of health literacy was formed using the Rapid Estimate of Adult Literacy in Medicine. The study’s primary outcome is focused on oral medication adherence (e.g., the expected medication refills completed), with secondary outcomes focused on follow-up visit adherence, adherence to other prescribed medications, healthcare use, and other healthcare outcomes.

According to the researchers, with a one-sided alpha = 0.05, the target sample size of 110 patients will yield 90% power to test the primary hypothesis.