Intentional nonadherence to self-administered cancer medications: Identifying key factors for tailored interventions

Self-administered cancer treatments are increasingly common. While these treatments are often perceived as more convenient, intentional nonadherence - when patients deliberately choose not to take medication as prescribed - remains a significant challenge and is influenced by a range of motivational factors.

To identify key reasons for intentional nonadherence to self-administered cancer medications, to inform the development of personalised interventions.

A cross-sectional e-survey of 126 adults with cancer was conducted. Adherence was assessed using the Medication Adherence Report Scale (MARS-5). Reasons for intentional nonadherence were measured with the Intentional Non-Adherence Scale (INAS). Principal component analysis was conducted, specifying a four-factor structure based on recent studies. Independent samples t-tests compared factor scores between adherent and nonadherent participants.

Half the sample (50.0%) had a diagnosis of breast cancer, followed by thyroid cancer (16.7%), blood cancer (7.1%), and male urologic cancer (6.3%). Fifty-six percent of participants were classified as nonadherent. The most frequently endorsed reasons for intentional nonadherence were "Because I don't like the side effects" (32%) and "Because I want to think of myself as a healthy person again" (28%). Four INAS factors - Sensitivity to Medicines, Testing Treatment, Inconvenience, and Resisting Illness and Medication accounted for 79% of the variance and demonstrated high internal consistency (Cronbach's α = 0.90-0.96). Nonadherent participants scored significantly higher on all factors compared to adherent participants (p < 0.001).

Intentional nonadherence to self-administered cancer medications is driven by diverse motivational factors, including concerns about side effects and illness identity, highlighting the need for tailored interventions.