PATIENT COMPLIANCE WITH CRUCIAL DRUG REGIMENS - IMPLICATIONS FOR PROSTATE-CANCER

Understanding of patient compliance with crucial drug regimens has imp roved markedly since 1986, based on data from two objective methods fo r monitoring drug dosing by ambulatory patients. Electronic monitoring records times and dates of drug package use, and chemical markers, in corporated into drug dosage forms, are assayed in plasma. These method s remove the camouflage that masks many poor compliers. In contrast, o ther methods (returned tablet counts, interviews, questionnaires) allo w patients easily to censor evidence for delayed or omitted doses. The new methods show many more and larger errors of omission in both tria ls and practice than previously believed. One patient in about six is punctually compliant, but a modest majority of patients make errors pr obably too small to attenuate or otherwise modify the actions of all b ut the most unforgiving medicines. About a third of patients delay or omit many prescribed doses, thus attenuating or otherwise modifying th e actions of all but the most forgiving drugs. One patient in about si x takes little medicine, though camouflaged as a good complier. Simila r patterns of delayed and omitted doses prevail, essentially independe nt of drug, disease, prognosis, or symptoms;Ln summary, patients take the prescribed dose at intervals longer than prescribed - often by hou rs, sometimes by days, occasionally by weeks. The clinical and economi c consequences of these lapses in dosing are unique to the treatment s ituation and the severity of disease and comorbidity. The new methods have not yet been applied to androgen-blocking agents, but if the find ings resemble those with, e.g. tamoxifen in breast cancer, it will dou btless trigger some rethinking about failed treatment, trial design, a nd clinical management.