The need for effective digital solutions to enhance adherence to oral anti-cancer medicines in adults: a systematic review of reviews (Preprint)

Abstract

Adherence to anti-cancer medicines is critical for the success of cancer treatments, however, non-adherence is still challenging while evidence of adherence interventions in cancer is limited.

This systematic review aimed to synthesise evidence of available reviews of interventions to improve adherence to oral anti-cancer medicines in adult cancer survivors.

A comprehensive search was undertaken on seven electronic databases and three oncology journals. Two reviewers independently conducted study selection, quality assessment using AMSTAR 2, and data extraction of selected reviews. The PRISMA-2020 checklist was adapted to report results.

Twenty-eight reviews were included for a narrative synthesis. The overall quality of systematic reviews was low. Four main adherence-promoting strategies were education, reminder, behaviour and monitoring, and multi-component. Digital technology-based interventions were reported in most reviews (n=26). Few interventions applied theories (n=10), design frameworks (n=2), or engaged stakeholders (n=1) in the development processes. The effectiveness of interventions was inconsistent between and within reviews. However, interventions using multiple adherence-promoting strategies were more likely to be effective than single-strategy interventions (11 reviews). Unidirectional communication (7 reviews) and technology alone (11 reviews) were not sufficient to demonstrate improvement in adherence outcomes. Nurses and pharmacists play a critical role in promoting patients’ adherence to oral cancer therapies, especially with the support of digital technologies (6 reviews).

Multi-component interventions are potentially effective in promoting patients’ adherence to oral-anti cancer medicines. The seamless integration of digital solutions with direct clinical contacts is likely to be effective in promoting adherence. It is important for future research in developing comprehensive digital adherence interventions to be evidence-based, theory-based, and rigorously evaluated.