TREATMENT COMPLIANCE IN CHILDHOOD AND ADOLESCENCE

Experience reveals that there is significant noncompliance with self-a dministered medication, especially in chronic conditions such as cance r. Noncompliance transcends the boundary of disease categories and age group. However, this is most prevalent during the adolescent years wh en the process of transition from parental dependency to autonomy prod uces confusion as to who is responsible for administration of medicati on. Noncompliance can result in the misjudgment of efficacy of a drug or regimen that may necessitate additional tests, alteration of dose, treatment course, and hospitalization. Currently in the United States, a large percentage of pediatric cancer patients are treated according to research protocols. In a research setting, noncompliance can resul t in erroneous or inconsistent findings, potentially affecting investi gational results. With the availability of venous access ports and sop histicated, yet easy-to-operate pumps, increasingly, it is possible to administer parenteral medications at home. This adds a new dimension to the self-administration of medication that previously concerned mai nly oral therapy. Various factors concerning the patient, disease, hea lth providers, and treatment characteristics determine how well a give n regimen is adhered to. Because a significant number of determinants are involved, it is often not possible, with any degree of certainty, to identify noncompliers or to predict the level of patient adherence to the treatment. Major factors in any successful therapy include the availability of effective medications and compliance with therapy regi men. With the advent of more successful treatments for childhood and a dolescent cancer, the compliance factor is gaining greater importance because therapy currently is given with curative, rather than palliati ve intent. The availability of questionnaires, tests. and devices can help, to some extent, examine the degree of patient compliance. Family and social support, individualized programs, reminders to reduce forg etfulness, personalized needs assessment, and education can reduce non compliance. Compliance is a complex and multifaceted issue that is sti ll poorly understood and requires further investigation.