Effect of Pharmacist Interventions on Medication Adherence to Capecitabine in Cancer Patients: A Systematic Review

  • Atika Wahyu Puspitasari Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • Susi Ari Kristina Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
  • Satibi Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
  • Yayi Suryo Prabandari Department of Public Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Keywords: Capecitabine, Oral chemotherapy, Pharmacist, Adherence


Oral chemotherapy poses challenges regarding patient medication adherence. Pharmacists play a vital role in supporting medication adherence to achieve the effectiveness of therapy. This review aimed to evaluate the impact of pharmacist interventions on medication adherence in patients with cancer taking capecitabine. The literature was systematically reviewed using Scopus, ScienceDirect, Sage Journal, Springer Link, PubMed, and Google Scholar. Key text words included “adherence, pharmacist intervention, capecitabine, oral chemotherapy, and cancer.” We collected original articles published from January 2010 to June 2021 in English that reported pharmacist interventions to enhance capecitabine adherence in adult patients with cancer and assessed adherence rates pre- and post-intervention. Two independent researchers extracted data relevant to inclusion criteria and determined the methodological quality of studies using the Joanna Briggs Institute Critical Appraisal Checklist Tools. A total of 4179 articles were retrieved, of which five were eligible for review. The most common pharmacist intervention strategy was a combination of patient education, with oral and written information provided. Components of patient education were the characteristics of capecitabine, including its mechanism of action, side effects, and their management; current therapeutic regimen; importance of adherence; and risk of non-adherence. Pharmacist interventions provide beneficial impacts on medication adherence, beliefs about medication, and tolerability of side effects. The findings suggest that pharmacist interventions support medication adherence improvement and highlight the role of pharmacist interventions in pharmaceutical oncology care services. Further studies are necessary to assess pharmacist interventions’ long-term effects and clinical outcomes.


Acharya, A. S., Prakash, A., Saxena, P., & Nigam, A. (2013). Sampling: why and how of it? Indian Journal of Medical Specialities, 4(2), 3–7. https://doi.org/10.7713/ijms.2013.0032
Anghel, L. A., Farcas, A. M., & Oprean, R. N. (2019). An overview of the common methods used to measure treatment adherence. Medicine and Pharmacy Reports, 92(2), 117–122. https://doi.org/10.15386/mpr-1201
Bassan, F., Peter, F., Houbre, B., Brennstuhl, M. J., Costantini, M., Speyer, E., & Tarquinio, C. (2014). Adherence to oral antineoplastic agents by cancer patients: Definition and literature review. European Journal of Cancer Care, 23(1), 22–35. https://doi.org/10.1111/ecc.12124
Bauchner, H., Osganian, S., Smith, K., & Triant, R. (2001). Improving parent knowledge about antibiotics: A video intervention. Pediatrics, 108(4), 845–850. https://doi.org/10.1542/peds.108.4.845
Bhattacharya, D., Easthall, C., Willoughby, K. A., Small, M., & Watson, S. (2012). Capecitabine non-adherence: Exploration of magnitude, nature and contributing factors. Journal of Oncology Pharmacy Practice, 18(3), 333–342. https://doi.org/10.1177/1078155211436022
Birand, N., Bosnak, A. S., Diker, O., Abdikarim, A., & Basgut, B. (2019). The role of the pharmacist in improving medication beliefs and adherence in cancer patients. Journal of Oncology Pharmacy Practice, 25(8), 1916–1926. https://doi.org/10.1177/1078155219831377
Chen, L., & Cheung, W. Y. (2014). Potential Drug Interactions in Patients with a History of Cancer. Current Oncology, 21(2), 212–220.
Colombo, L. R. P., Aguiar, P. M., Lima, T. M., & Storpirtis, S. (2017). The effects of pharmacist interventions on adult outpatients with cancer: A systematic review. Journal of Clinical Pharmacy and Therapeutics, 42(4), 414–424. https://doi.org/10.1111/jcpt.12562
Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., & Pecorelli, S. (2015). Interventional tools to improve medication adherence : review of literature. Patient Preference and Adherence, 9(1), 1303–1314.
Coutsouvelis, J., Adams, J., Dip, G., Bortz, H., Chau, M., Chiang, K., Foo, J., Ibrahim, K., Kerr, K., O’Connor, S., Powell, M., Rowan, G., Siderov, J., Tey, A., Tran, J., Vasileff, H., & Munro, C. (2020). Standard of practice in oncology and haematology for pharmacy services. Journal of Pharmacy Practice and Research, 50, 528–545. https://doi.org/10.1002/jppr.1686
Eek, D., Krohe, M., Mazar, I., Horsfield, A., Pompilus, F., Friebe, R., & Shields, A. L. (2016). Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: A review of the literature. Patient Preference and Adherence, 10, 1609–1621. https://doi.org/10.2147/PPA.S106629
Eldeib, H. K., Abbassi, M. M., Hussein, M. M., Salem, S. E., & Sabry, N. A. (2019). The Effect of Telephone-Based Follow-Up on Adherence, Efficacy, and Toxicity of Oral Capecitabine-Based Chemotherapy. Telemedicine and E-Health, 25(6), 462–470. https://doi.org/10.1089/tmj.2018.0077
Felton, M. A., Van Londen, G. J., & Marcum, Z. A. (2016). Medication adherence to oral cancer therapy: The promising role of the pharmacist. Journal of Oncology Pharmacy Practice, 22(2), 378–381. https://doi.org/10.1177/1078155214559114
Hajj, M. S. el, Jaam, M. J., & Awaisu, A. (2018). Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review. Research in Social Adn Administrative Pharmacy, 14(6), 507–520.
Hefner, J., Berberich, S., Lanvers, E., Sanning, M., Steimer, A. K., & Kunzmann, V. (2018). Patient–doctor relationship and adherence to capecitabine in outpatients of a german comprehensive cancer center. Patient Preference and Adherence, 12, 1875–1887. https://doi.org/10.2147/PPA.S169354
Krikorian, S., Pories, S., Tataronis, G., Caughey, T., Chervinsky, K., Lotz, M., Shen, A. H., & Weissmann, L. (2019). Adherence to oral chemotherapy: Challenges and opportunities. Journal of Oncology Pharmacy Practice, 25(7), 1590–1598. https://doi.org/10.1177/1078155218800384
Krolop, L., Ko, Y., Schwindt, P. F., Schumacher, C., Fimmers, R., & Jaehde, U. (2013). Adherence management for patients with cancer taking capecitabine : a prospective two-arm cohort study. BMJ Open, 3(7), e003139. https://doi.org/10.1136/bmjopen-2013-003139
Lam, W. Y., & Fresco, P. (2015). Medication Adherence Measures: An Overview. BioMed Research International, 1–12.
Lin, C., Clark, R., Tu, P., Bosworth, H. B., Zullig, L. L., Lin, C., & Clark, R. (2017). Breast cancer oral anti-cancer medication adherence : a systematic review of psychosocial motivators and barriers. Breast Cancer Research and Treatment, 165(2), 247–260. https://doi.org/10.1007/s10549-017-4317-2
Lopez-martin, C., Siles, M. G., Alcaide-Garcia, J., & Felipe, V. F. (2014). Role of clinical pharmacists to prevent drug interactions in cancer outpatients : a single-centre experience. International Journal of Clinical Pharmacy, 36(6), 1251–1259. https://doi.org/10.1007/s11096-014-0029-4
Maleki, S., Alexander, M., Fua, T., Liu, C., Rischin, D., & Lingaratnam, S. (2019). A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies. Journal of Oncology Pharmacy Practice, 25(1), 130–139. https://doi.org/10.1177/1078155218783814
McCue, D. A., Lohr, L. K., & Pick, A. M. (2014). Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy, 34(5), 481–494. https://doi.org/10.1002/phar.1399
Puspitasari, A. W., Kristina, S. A. R. I., & Prabandari, Y. S. (2021). Overview of Adherence and Influencing Factors to Capecitabine In Cancer Patients : Systematic Review. International Journal of Pharmaceutical Research, 13(1), 3106–3118.
Reigner, B., Blesch, K., & Weidekamm, E. (2001). Clinical Pharmacokinetics of Capecitabine. Clin Pharmacokinet, 40(2), 85–104.
Sardi, L., Idri, A., & Fernández-Alemán, J. L. (2017). A systematic review of gamification in e-Health. Journal of Biomedical Informatics, 71, 31–48. https://doi.org/10.1016/j.jbi.2017.05.011
Schellens, J. (2007). Clinical Pharmacology : Concise Drug Reviews Capecitabine. The Oncologist, 12, 152–155. https://doi.org/10.1634/theoncologist.12-2-152
Schneider, S. M., Hess, K., & Gosselin, T. (2011). Interventions to Promote Adherence with Oral Agents. Seminars in Oncology Nursing, 27(2), 133–141. https://doi.org/10.1016/j.soncn.2011.02.005
Simons, S., Ringsdorf, S., Braun, M., Mey, U. J., Schwindt, P. F., Ko, Y. D., Schmidt-Wolf, I., Kuhn, W., & Jaehde, U. (2011). Enhancing adherence to capecitabine chemotherapy by means of multidisciplinary pharmaceutical care. Supportive Care in Cancer, 19(7), 1009–1018. https://doi.org/10.1007/s00520-010-0927-5
Spoelstra, S. L., & Given, C. W. (2011). Assessment and Measurement of Adherence to Oral Antineoplastic Agents. Seminars in Oncology Nursing, 27(2), 116–132. https://doi.org/10.1016/j.soncn.2011.02.004
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020 : GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 0(0), 1–41. https://doi.org/10.3322/caac.21660
Timmers, L., Swart, E. L., Boons, C. C. L. M., Mangnus, D., van de Ven, P. M., Peters, G. J., Boven, E., & Hugtenburg, J. G. (2012). The use of capecitabine in daily practice: A study on adherence and patients’ experiences. Patient Preference and Adherence, 6, 741–748. https://doi.org/10.2147/PPA.S36757
Vacher, L., Thivat, E., Poirier, C., Mouret-Reynier, M. A., Chollet, P., Devaud, H., Dubray-Longeras, P., Kwiatkowski, F., Durando, X., van Praagh-Doreau, I., & Chevrier, R. (2020). Improvement in adherence to Capecitabine and Lapatinib by way of a therapeutic education program. Supportive Care in Cancer, 28(7), 3313–3322. https://doi.org/10.1007/s00520-019-05144-x
Viswanathan, M., Golin, C. E., Jones, C. D., Jones, C. D., Blalock, S. J., Wines, R. C. M., Coker-Schwimmer, E. J. L., Rosen, D. L., Sista, P., & Lohr, K. N. (2012). Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States A Systematic Review. Annals of Internal Medicine, 157(11), 785–795.
Wagstaff, A. J., Ibbotson, T., Goa, K. L., Muggia, F. M., York, N., York, N., & Papamichael, D. (2003). A Review of its Pharmacology and Therapeutic Efficacy in the Management of Advanced Breast Cancer. Drugs, 63(2), 217–236.
Walko, C. M., Lindley, C., Hill, C., & Carolina, N. (2005). Capecitabine : A Review. Clinical Therapeutics, 27(1), 23–44.
Wick, J. A., & Elswick, B. M. (2018). Impact of Pharmacist Delivered Education on Early Parent Awareness and Perceptions Regarding Human Papillomavirus (HPV) Vaccination in the Community Pharmacy Setting in West Virginia. INNOVATIONS in Pharmacy, 9(3), 8. https://doi.org/10.24926/iip.v9i3.1396
Wood, L. (2012). A review on adherence management in patients on oral cancer therapies. European Journal of Oncology Nursing, 16(4), 432–438. https://doi.org/10.1016/j.ejon.2011.10.002
World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.
Zullig, L. L., Affairs, V., Peterson, E. D., Bosworth, H. B., Affairs, V., Internal, G., Carolina, N., & Sciences, B. (2015). Ingredients of Successful Interventions to Improve Medication Adherence. JAMA, 310(24), 2611–2612. https://doi.org/10.1001/jama.2013.281078.8
How to Cite
Puspitasari, A. W., Kristina, S. A., Satibi, & Prabandari, Y. S. (2022). Effect of Pharmacist Interventions on Medication Adherence to Capecitabine in Cancer Patients: A Systematic Review. Indonesian Journal of Pharmacy, 33(1), 22-33. https://doi.org/10.22146/ijp.2284
Review Article