Pre-Op Capecitabine Therapy Adherence Should Be Monitored In Rectal Cancer Patients

Concordance differs between measures of rectal cancer patient adherence to preoperative capecitabine therapy

medwireNews: Adherence to preoperative oral capecitabine therapy for rectal cancer differs according to how it is assessed, Spanish researchers have found.

They say that clinical records for patients with stage II or III rectal cancer had no mention of non-adherence, whereas the patient self-reported adherence rate, as measured using the Simplified Medication Adherence Questionnaire (SMAQ), was 83.2%.

This gave “almost perfect” concordance for the two methods of assessment, with a modified Kappa index of 0.82, the team reports in the Annals of Oncology.              

But concordance was judged as only “fair”, with a modified Kappa index of 0.56, for the 100% rate of adherence from clinical history and the 67.9% adherence calculated by pharmacists using a pill count of returned medicine.

“Our results show the need for health professionals to systematically evaluate therapeutic adherence as a routine part of the treatment process, once the reliability of the assessment method has been checked”, write Josep Maria Borras, from the University of Barcelona in Spain, and co-authors.

Of the 119 patients in the study, 118 had clinical records available at follow-up, 107 had a full SMAQ record and 109 had pill count data.

Multivariable analysis did not reveal any predictors of capecitabine adherence among patient factors, such as age or gender, or disease markers, including clinical or pathological stage, tumour location in the rectum, symptoms at diagnosis or use of other medications.

However, patients who had low levels of anxiety on the hospital anxiety depression scale before beginning capecitabine treatment were a significant 6.96 times more likely to adhere to the 6-week regimen than those with high levels of anxiety.

This suggests that anxiety “is a clinically manageable risk factor to take into account when detected”, the authors believe.

The team concludes: “Health professionals should assess adherence problems with the patient during the consultation, especially the presence of anxiety at treatment initiation, in order to identify patients at risk of non-adherence.

“Pharmacists could also monitor the pill count at the end of the treatment and inform the physician about any adherence problems observed.”


Font R, Espinas JA, Layos L, et al. Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry? Ann Oncol; Advance online publication 6 March 2017. DOI:

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