Re: Adherence to therapy with oral antineoplastic agents.

Partridge et al. provided an excellent and timely review on patient compliance issues of prescribed oral therapy (1). This important area merits the attention of every oncology clinician, in view of the increasing number of new oral antineoplastic agents. The review would have been more complete, however, if it had pointed out that pharmacist involvement in patient education is essential in achieving compliance in the ambulatory setting. Patient education (often referred to as patient counseling) by pharmacists on oral medications is recognized as an important component of optimal patient care (2). The importance of patient counseling by pharmacists is not difficult to see when one considers the process of prescribed drug therapy. Most current antineoplastic agents are typically prepared by the pharmacist and administered intravenously to the patient by the nurse in a clinic. In contrast, oral agents are usually dispensed by the pharmacist and self-administered by the patient. Not surprisingly, pharmacist counseling has been used to help optimize patient compliance in contexts in which oral agents are commonly prescribed (e.g., cardiology). For instance, a MEDLINE search using the subject headings “patient compliance” and “pharmacists” yielded 19 studies that found a positive association between patient compliance and pharmacist counseling. More specifically, a systematic review by the Cochrane Collaboration of randomized controlled trials of the effect of expanding outpatient pharmacists’ roles on patient outcomes found that pharmacist counseling statistically significantly improved patient outcomes (10 of 13 studies) and compliance (three of six studies) (3). Oncology clinicians have until now had the luxury of paying little attention to compliance once the patient has agreed to a course of treatment. With the advent of more oral agents, it is clear that this will no longer hold true. The issue of optimal patient compliance is a complex one, and addressing it will require using the full potentials of all health care professionals involved in chemotherapy delivery.