Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review

Neil E Fleshner; Shabbir M H Alibhai; Kim A Connelly; Ilidio Martins; Bernhard J Eigl; Himu Lukka; Armen Aprikian

doi:10.1177/17588359231152845

Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review

Ther Adv Med Oncol. 2023 Mar 29:15:17588359231152845. doi: 10.1177/17588359231152845. eCollection 2023.

Authors

Neil E Fleshner¹, Shabbir M H Alibhai², Kim A Connelly³, Ilidio Martins⁴, Bernhard J Eigl⁵, Himu Lukka⁶, Armen Aprikian⁷

Affiliations

¹ Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON M5G 2M9, Canada.
² University Health Network, University of Toronto, Toronto, ON, Canada.
³ Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.
⁴ Kaleidoscope Strategic Inc., Toronto, ON, Canada.
⁵ BC Cancer Vancouver, University of British Columbia, Vancouver, BC, Canada.
⁶ Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
⁷ McGill University Health Centre, McGill University, Montreal, QC, Canada.

Abstract

Background: Orally administrated agents play a key role in the management of prostate cancer, providing a convenient and cost-effective treatment option for patients. However, they are also associated with adherence issues which can compromise therapeutic outcomes. This scoping review identifies and summarizes data on adherence to oral hormonal therapy in advanced prostate cancer and discusses associated factors and strategies for improving adherence.

Methods: PubMed (inception to 27 January 2022) and conference databases (2020-2021) were searched to identify English language reports of real-world and clinical trial data on adherence to oral hormonal therapy in prostate cancer using the key search terms 'prostate cancer' AND 'adherence' AND 'oral therapy' OR respective aliases.

Results: Most adherence outcome data were based on the use of androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (mCRPC). Self-reported and observer-reported adherence data were used. The most common observer-reported measure, medication possession ratio, showed that the vast majority of patients were in possession of their medication, although proportion of days covered and persistence rates were considerably lower, raising the question whether patients were consistently receiving their treatment. Study follow-up for adherence was generally around 6 months up to 1 year. Studies also indicate that persistence may drop further with longer follow-up, especially in the non-mCRPC setting, which may be a concern when years of therapy are required.

Conclusions: Oral hormonal therapy plays an important role in the treatment of advanced prostate cancer. Data on adherence to oral hormonal therapies in prostate cancer were generally of low quality, with high heterogeneity and inconsistent reporting across studies. Short study follow-up for adherence and focus on medication possession rates may further limit relevance of available data, especially in settings that require long-term treatment. Additional research is required to comprehensively assess adherence.

Keywords: adherence; hormonal therapy; oral therapy; prostate cancer.

Publication types

Review