Paradox of wellness and nonadherence among Nigerian women on breast cancer chemotherapy

J Cancer Res Ther. Jul-Sep 2008;4(3):107-10. doi: 10.4103/0973-1482.42640.

Abstract

Context: Intentional nonadherence among cancer patients is rare and may occur only when the benefits of treatment are not obvious to the patient.

Aims: To highlight a group of women on chemotherapy for breast cancer who defaulted from their medications because they were improving.

Settings and design: A study was carried out of the reasons for nonadherence to medications among women receiving chemotherapy for breast cancer at a Nigerian teaching hospital between January 1993 and December 2002.

Materials and methods: A retrospective review of patients' records was done.

Results: Of the 188 women who received chemotherapy during the study period, 152 (80.9%) defaulted from treatment at one point or another. The reasons for nonadherence were available in 101 patients. Among these, 18 (18.0%) reported nonadherence because they felt better after commencing chemotherapy. They were aged 31-50 years (Mean = 35.6 (SD3.2)). Six (33.3%) of them presented in AJCC Stage I, and 10 (55.6%) in stage II. Age and disease stage at presentation were found to have significant influence on their reason for nonadherence. Of the nine women on neo-adjuvant chemotherapy, six (66.7%) had complete response but defaulted and five (55.6%) re-presented within a year with metastatic disease. Three of the patients receiving systemic post-surgery chemotherapy presented within a year with local recurrence. Most of the other patients were subsequently lost to follow-up.

Conclusions: Nonadherence due to wellness among breast cancer patients is associated with poor outcome. We propose a detailed prospective study to establish factors that may influence such behavior.

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Female
  • Humans
  • Medication Adherence / psychology*
  • Middle Aged
  • Nigeria
  • Retrospective Studies

Substances

  • Antineoplastic Agents