JOPHON NCPD (2021 May/June) - Teenagers and Young Adults with Cancer: An exploration of Factors Contributing to Treatment Adherence-ARTICLE: JOPHON CNE (2021 May/June)

ARTICLE: JOPHON CNE (2021 May/June) - Teenagers and Young Adults with Cancer

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This systematic appraisal reviews evidence on treatment adherence among teenagers and young adults (TYAs; 13–24) with cancer, a group reported as least likely to follow medical regimens and at increased risk of relapse or death when nonadherent. Seven peer‑reviewed studies (published from 2005 onward, conducted in developed countries) were included after database searching and reference checking. Using thematic analysis, the authors identified eight recurring themes: (1) difficulties measuring adherence, (2) the healthcare professional’s role, (3) interventions to improve adherence, (4) parental role, (5) transition to maintenance therapy, (6) need for more information for TYAs, (7) risk‑taking, and (8) desire for “normal life.”<br /><br />A major finding is that adherence is complex and hard to measure consistently. Studies used self‑report, blood metabolite levels (e.g., 6‑mercaptopurine), and electronic monitoring, each with limitations (bias/overestimation, pharmacokinetic variability, and potential manipulation). Combining objective and subjective measures may improve accuracy. Across quantitative studies, average adherence commonly fell below the 95% level often considered “optimal,” with patterns of exemplary, deteriorating, or chronically poor adherence.<br /><br />Communication and trusting relationships are central: professionals should assess adherence repeatedly from the start of treatment in a non‑stigmatizing way, discuss side effects and distress, and support self‑management. Parents remain crucial, particularly as responsibility shifts to the young person; adherence is often worse when TYAs manage medication alone. Nonadherence may increase during maintenance phases (especially in ALL) when patients feel well, perceive fewer immediate consequences, and want to resume normal life. The review proposes an adapted biopsychosocial, “four‑quadrant” adherence model incorporating personal, external (including parents/peers), treatment, and system factors. The authors conclude that higher‑quality research is needed, especially on targeted interventions to improve adherence in this age group.

Keywords

treatment adherence

teenagers and young adults

cancer

nonadherence measurement

6-mercaptopurine monitoring

electronic medication monitoring

healthcare professional communication

parental involvement

maintenance therapy transition

biopsychosocial adherence model