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. 2025 Aug 19:OP2500477.
doi: 10.1200/OP-25-00477. Online ahead of print.

Self-Reported Adherence to Cancer Therapy: Development and Validation of the Domains of Subjective Extent of Nonadherence-Cancer Measure

Yashasvini Sampathkumar  1 , Corrine I Voils  2   3 , Gina L Mazza  4 , Lauren Rogak  4 , Brenda F Ginos  4 , Elizabeth D Kantor  1 , Antonia V Bennett  5 , Yulianny De Los Santos  1 , Jennifer Suarez  1 , Camila Lopez  1 , Bharat Narang  1 , Javier González  1 , Kathleen Killoran  1 , Patricia A Spears  5 , Anna P Wolf  6 , Anna Weiss  6   7 , Stephanie B Wheeler  5 , Bryce B Reeve  8 , Ethan Basch  5 , Francesca Gany  1 , Victoria Blinder  1
Affiliations

Self-Reported Adherence to Cancer Therapy: Development and Validation of the Domains of Subjective Extent of Nonadherence-Cancer Measure

Yashasvini Sampathkumar et al. JCO Oncol Pract. .

Abstract

Purpose: Patients with cancer take different types of medications with varying schedules and settings. They are also sometimes instructed to stop medications due to toxicity. To measure self-reported nonadherence in this heterogeneous population, we modified and evaluated a measure originally developed to assess nonadherence to daily oral antihypertensives, the Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence).

Methods: The measure was refined in an iterative process incorporating feedback from patient investigators and participant interviews in English and Spanish. Branching logic was added for participant selection of medication administration setting: (1) only home, (2) only clinic, or (3) partly home/partly clinic. Participants reported their adherence to medications taken over a setting-specific reference period (1 week for home, 1 month for clinic medications). Participants who missed medications then reported on reasons for nonadherence. Adherence was dichotomized for analysis (complete adherence v any nonadherence). For participants who received clinic-administered medications, concordance between chart-abstracted and self-reported adherence was evaluated.

Results: Seventy-three participants completed the measure (68% English; 32% Spanish; 86% female; 44% age ≥60 years). The majority had breast cancer; 64% had metastatic disease. Twenty-six percent (15/58) of participants who received medication in clinic and 24% (11/46) of those who took medication at home reported nonadherence. Participants felt able to respond accurately to both reference periods and perceived all reasons for nonadherence to be relevant. Among participants who completed the final version of the measure for clinic-administered medication, 96% (26/27) accurately reported their adherence compared with chart-abstracted data.

Conclusion: Our results support the validity of the DOSE-Nonadherence-Cancer for assessing cancer treatment nonadherence. This measure can be used to assess nonadherence in patients with cancer receiving a broad array of systemic therapies.

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Conflict of interest statement

Conflict of Interest: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. The views are those of the authors and do not represent those of the Department of Veterans Affairs or the U.S. Government. CV is a consultant for Exact Sciences. AW reports paid advisory board participation for Daiichi-Sankyo, Abbvie, Merck, and Myriad. She has received honoraria from OncLive (MJH Lifesciences), Empire State Hematology & Oncology Society, Society of Breast Imaging. All other authors have no conflict of interests to declare.

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