***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose . The aim of this prospect i ve observational study was to investigate the patterns of treatment adherence to orally administered chemotherapy of patients being treated for cancer . Methods . Patients were asked to participate in the survey during their visits to the study centers ’ pharmacists or doctors to obtain their oral medication from April 2008 until May 2009 . The data were collected using a self-reported anonymous 7-page long question naire , which contained questions about their demographic profile , disease and treatment characteristics , and side-effects and adherence information , both intentional and nonintentional . Results . 99 Patients completed the question naire . Missing values ranged from 1 % to 8 % . Unintended nonadherence to therapy was reported by 19 patients . The most important factor correlating with unintended nonadherence was the patient ’s belief regarding treatment effectiveness since only 16.7 % of the patients believing that their treatment is effective reported nonadherence as opposed to 62.5 % for those that did not believe that treatment is effective ( p = 0.03 ) . Intentional nonadherence was reported by 14 patients The most important factor correlating to intentional nonadherence was time since disease diagnosis , as nonadherence was reported by 33.3 % of the patients having the disease less than 6 months , compared to 16.7 % for those between 6 and 24 months and 8.3 % for those between 2 and 5 years ( p = 0.01 ) . Conclusion . Greek patients seem to have similar nonadherence pattern as in other countries . Confidence in treatment efficacy appeared as a significant adherence determinant BACKGROUND Cyclophosphamide-methotrexate-5-fluorouracil ( CMF ) is often selected as adjuvant chemotherapy for older patients with early-stage breast cancer due to perceived superior tolerability . We sought to measure persistence with CMF , adherence to oral cyclophosphamide , and the association of these with toxic effects . PATIENTS AND METHODS CALGB 49907 was a r and omized trial comparing st and ard chemotherapy ( CMF or AC , provider/patient choice ) with capecitabine in patients aged ≥65 with stage I-IIIB breast cancer . Those r and omized to st and ard therapy and choosing CMF were prescribed oral cyclophosphamide 100 mg/m(2 ) for 14 consecutive days in six 28-day cycles . Persistence was defined as being prescribed six cycles of at least one of the three CMF drugs . Adherence was the number of  cyclophosphamide  doses that women reported they had taken divided by the number prescribed . Persistence and adherence were based on case report forms and medication calendars . RESULTS Of 317 r and omized to st and ard chemotherapy , 133 received CMF . Median age was 73 ( range 65 - 88 ) . Seventy-one percent su bmi tted at least one medication calendar ; 65 % persisted with CMF . Non-persistence was associated with node negativity ( P = 0.019 ) , febrile neutropenia ( P = 0.002 ) , and fatigue ( P = 0.044 ) . Average adherence was 97 % during prescribed cycles . CONCLUSIONS Self-reported adherence  to cyclophosphamide was high , but persistence was lower , which may be attributable to toxic effects PURPOSE Patient adherence is critical in evaluating the effectiveness of an oral therapy . We sought to measure adherence among women r and omly assigned to capecitabine in a preplanned sub study of a multicenter clinical trial . PATIENTS AND METHODS Cancer and Leukemia Group B study CALGB 49907 was a r and omly assigned trial comparing st and ard chemotherapy versus oral chemotherapy with capecitabine in patients age 65 years or older with early-stage breast cancer . We used microelectronic monitoring system ( MEMS ) caps on participants ' capecitabine bottles to record pill bottle openings . Capecitabine was given in two divided daily doses for 14 consecutive days of a 21-day cycle for six cycles . Adherence was calculated as the number of doses taken divided by doses expected , taking into account toxicity-related dosing changes . A participant was defined as adherent if 80 % or more of expected doses were recorded by MEMS . RESULTS Overall , 161 patients were enrolled . Median age was 71 years ( range , 65 to 89 years ) ; 124 patients ( 83 % ) persisted with capecitabine to completion of planned protocol therapy . Adherence was 78 % across all cycles , and adherence did not vary by cycle ( P = .32 ) . Twenty-five percent of participants took fewer than 80 % of expected doses and were nonadherent . In a logistic regression model , participants with node-negative disease ( P = .01 ) and mastectomy ( P = .01 ) were more likely to be nonadherent . Adherence was not related to age , tumor stage , or hormone receptor status . Adherence was not significantly associated with relapse-free survival or grade 3 or 4 toxicity . CONCLUSION Most older women with early-stage breast cancer were adherent to short-term oral chemotherapy in a r and omized clinical trial . Age was not associated with adherence Purpose In this prospect i ve multi-centre observational cohort study , we investigated the effect of an intensified multidisciplinary pharmaceutical care programme on the adherence of cancer patients treated with capecitabine , a prodrug of fluorouracil . Patients and methods Twenty-four colorectal and 24 breast cancer patients participated in this study . Patients of the control group ( n = 24 ) received st and ard care , patients of the intervention group ( n = 24 ) received intensified pharmaceutical care consisting of written and spoken information .  Adherence to capecitabine chemotherapy was measured using an  electronic medication event monitoring system ( MEMS ™ ) . Results Patients in the intervention group exhibited an enhanced but not significantly different mean overall adherence compared to the control group ( 97.9 % vs 90.5 % , p = 0.069 ) . Mean daily adherence was significantly higher in the intervention group ( 96.8 % vs 87.2 % , p = 0.029 ) . Variability of both adherence parameters was considerably reduced when pharmaceutical care was provided . At the end of the observation period of 126 days , the probability of still being treated  with capecitabine was found to be 48 % in the control group and 83 % in the intervention group ( p = 0.019 , log-rank test ) . The relative risk for a deviating drug intake interval , i.e. < 10 or > 14 instead of 12 h , in the intervention group was found to be 0.51 ( 95 % CI , 0.46–0.56 ) compared with the control group ( p < 0.05 , Chi-square test ) . Conclusions The provision of intensified pharmaceutical care  can enhance adherence to and prolong treatment with capecitabine . The results underline the importance of multidisciplinary care to assure the effectiveness of oral chemotherapy Abstract . Objective : Little is known about patient compliance with oral adjuvant chemotherapy . It is estimated to be poor especially in Japan , where it is still unusual for patients to be directly informed of their diagnosis of malignancy . 5-Fluorouracil ( 5-FU ) was measured in hair sample s to assess patient exposure to 5-FU , and its potential usefulness is discussed as an index of compliance with postoperative adjuvant chemotherapy . Methods : Hair sample s obtained from 55 patients , who had received oral 5-FU ( total dose 27 - 41 g ) as postoperative adjuvant chemotherapy over a 6-month period , were used for the analysis of 5-FU . The drug was extracted from the hair using ethyl acetate , and its fluorescence derivatization was employed for measurement with HPLC . The detection limit of 5-FU in hair was 0.01 ppm . Results : In 22 out of 55 sample s 5-FU content was under the detection limit , whereas in the remaining 33 sample s the drug was detected in a range of 0.006 - 2.125 ng per hair str and ; in addition , drug content showed a log-normal distribution . 5-FU was detected in the hair collected from those patients who were possibly compliant with the postoperative oral adjuvant chemotherapy . Conclusion : As many as 40 % of the patients analysed were supposed to be much less compliant . Even in the possibly compliant patients , the degree of compliance with the therapy varied according to a log-normal distribution Background : Use of oral chemotherapy agents to treat cancer has increased . Patients are responsible for adhering to complex regimens while managing symptoms from adverse effects of the chemotherapy . Objective : This study examined an intervention to manage symptoms and adherence to oral agents . Methods : A 3-group pilot study determined how an Automated Voice Response ( AVR ) system alone ( n = 40 ) , or the AVR with strategies to manage symptoms and adherence ( n = 40 ) , or the AVR with strategies to manage adherence ( n = 39 ) reduced symptom severity and improved adherence . Participants received a Symptom Management Toolkit , completed a baseline interview , and were r and omized to receive 8 weekly AVR calls . An exit interview occurred at 10 weeks . Results : Mean age was 59.6 years , with 70 % female and 76 % white , and 42 % were nonadherent , with missed doses increasing with regimen complexity . Symptom severity declined over time in all groups . No difference was found in adherence rates , and higher adherence was related with lower symptom severity across groups . Conclusions : Adherence , a significant clinical problem , can affect efficacy of the cancer treatment . The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from adverse effects . Implication s for Practice : Nurses need to focus on patient education by ensuring patient underst and ing of oral agent regimen and the need to adhere to the oral agent for efficacious cancer treatment . Nurses can promote the use of medication reminders and self-management of symptoms from adverse effects , to support adherence to the oral agent Purpose : When oral anticancer agents are used for adjuvant chemotherapy of colorectal cancer , compliance and feasibility become issues because of the long treatment time . Appropriate studies of these issues are lacking . We investigated compliance and feasibility during a weekday-on/weekend-off schedule of oral UFT ( uracil-tegafur ) over a period of 1 year administered as adjuvant chemotherapy to patients with colorectal cancer . Patients and methods : A UFT dose of 600 mg/day was prescribed according to a weekday-on/weekend-off schedule to 87 patients after potentially curative resection . Compliance was investigated in three ways : physician interview , patient self-report , and chemical analysis of urine . The results were compared with the dose prescribed . Feasibility was evaluated on the basis of two indices : relative performance ( RP ) , which was the ratio of the actual total dose taken to the total dose planned , and individual dose intensity ( IDI ) , which was the ratio of the actual dose taken to the dose planned during a given period . Results : The compliance assessed by physician interview and by patient self-report conformed well with the prescribed dose , the rate of agreement among the three compliance measures being more than 94 % . Chemical analysis of urine in 38 of the patients revealed that they were actually taking the drug . The RP was 0.72 , and the IDI was 0.8 . Conclusion : From these results , the feasibility of the weekday-on/weekend-off schedule was judged to be good . It is suggested that the feasibility would be even better if the dose of UFT was set according to body surface area Objectives : While oral anticancer treatment has increased the convenience for patients with no risk of venous access complications compared to intravenous drug administration , a high level of compliance can not always be assumed . The aim of the present report was to evaluate real-life drug adherence in a prospect i ve cohort analysis of patients with gastrointestinal or breast cancer treated with capecitabine-based chemotherapy .  Methods : Twenty-nine Swiss oncologists recruited patients receiving capecitabine , either as monotherapy or in combination with other chemotherapeutic agents , in a prospect i ve fashion . Patients recorded both their  capecitabine intake and any adverse effects each day in patient diaries . Results : A total of 177 patients were included , 143 ( 81 % ) with gastrointestinal tumours and 34 ( 19 % ) with breast cancer . Overall , 161 patients ( 91 % ) were considered as fully compliant , while 16 patients ( 9 % ) reported some kind of compliance error . Reasons for non-compliance included forgetting to take treatment ( n = 9 ) , side effects ( n = 4 ) and misunderst and ing instructions ( n = 3 ) . Self-reported compliance was not influenced by age or Eastern Cooperative Oncology Group performance status , but there was a trend towards better compliance with capecitabine therapy if fewer adverse effects occurred ( p = 0.07 , simple logistic regression ) . Conclusions : Self-reported compliance with capecitabine-based therapy in clinical practice is high and seems to be adversely affected by side effects Using an ' intelligent ' tablet bottle which , unknown to the patient , electronically records the times of opening , we have assessed the compliance of patients with prescribed oral alt 
    Output:
    
Of note , only the automated voice response seems capable of real-time detection of over-adherence , as observed in N0747 .