Multi-method approach increases detection of nonadherent patients by 49.4%-69.0% in breast cancerNew methods help doctors track breast cancer medication use

European journal of clinical pharmacology Published July 16, 2026 Study authors: Ebid Abdel-Hameed I, Elshewy Rana, Mostafa Mahmoud I, Eid Reem, Mobarez Mohamed A, Shash Emad PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that a multi-method approach significantly increases the detection of nonadherent patients in breast cancer care.

This randomized controlled trial involved 500 breast cancer patients on oral anticancer medications (OAMs) to evaluate the concordance and feasibility of self-report tools versus refill-based metrics. The study compared two sets of self-report tools (Arm A: MMAS-8 and MARS-5; Arm B: ARMS and SMAQ) against prescription refill data (MPR and PDC).

Refill-based measures estimated higher adherence than self-reported tools. However, a multi-method approach significantly increased the detection of nonadherent patients by 49.4%-69.0%. Among self-reported measures, ARMS showed the strongest concordance with refill metrics (kappa = 0.51-0.55; AUC ≈ 0.80), while MARS-5 and MMAS-8 followed ARMS in performance. SMAQ showed weaker performance.

While no single gold standard exists for adherence assessment, the study suggests that PDC-based combinations detected more nonadherent cases than MPR alone. Integrating brief self-reported scales with objective metrics is feasible and provides a more comprehensive assessment of medication use to identify at-risk patients.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in monitoring treatment adherence for breast cancer patients on oral anticancer medications. While previous coverage focused on the efficacy of neoadjuvant chemotherapy with angiogenesis inhibitors, tamoxifen's impact on recurrence, and Chinese herbal decoctions for management of side effects, this study provides specific data on identifying nonadherent patients using multi-method approaches.

When a patient is diagnosed with breast cancer, staying on top of their oral medications is vital for treatment success. However, it can be hard for doctors to know if a patient is taking their pills exactly as prescribed. This study looked at different ways to track that consistency.

Researchers compared what patients reported about their own habits against pharmacy refill data. They found that while pharmacy records often showed higher adherence than self-reports, combining both methods significantly improved the ability to find patients who were not following their medication plans. Specifically, using a multi-method approach increased the detection of nonadherent patients by 49.4% to 69.0%.

While no single perfect method exists for tracking medicine use, this study suggests that combining short self-report tools with pharmacy data is a practical way to find at-risk patients. This helps doctors provide better support to those who need it most.

What this means for you:

Combining patient reports with pharmacy records helps doctors identify more people struggling to take their medication.

Common questions

How does this help doctors treat breast cancer?

By using a combination of patient reports and pharmacy refill data, doctors can more accurately identify which patients are struggling to take their oral medications. This allows them to provide better support and ensure the treatment remains effective for every individual.

Are self-reported tools accurate enough?

The study found that pharmacy records often showed higher adherence than what patients reported themselves. However, some specific tools like ARMS showed strong agreement with refill metrics, while others like SMAQ performed weaker.

What was the main benefit of using multiple methods?

Using a multi-method approach significantly increased the detection of patients who were not following their medication plans by 49.4% to 69.0%. This gives doctors a much clearer picture of patient behavior than using just one method alone.

Study Details

Study typeRct

EvidenceLevel 2

PublishedJul 2026

PMID42455332

View Original Abstract ↓

PURPOSE: Adherence to oral anticancer medications (OAMs) is critical for clinical outcomes in breast cancer (BC), yet assessment methods lack standardization. The goal is to evaluate OAMs adherence in BC patients utilizing the most common adherence assessment methods on the same population, as well as to test the feasibility and concordance of these methods when used separately or in combination. METHODS: 500 BC patients on OAMs at the National Cancer Institute, Cairo, were randomized into a two-period crossover study evaluating self-report tools (Arm A: Morisky Medication Adherence Scale (MMAS-8) and the Medication Adherence Report Scale (MARS-5); Arm B: the Adherence to Refills and Medications Scale (ARMS) and the Simplified Medication Adherence Questionnaire (SMAQ)) with a three-month interval to minimize respondent burden and order effects. Prescription refill data were calculated via Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC). Agreement, diagnostic performance, and receiver operating characteristic analyses were performed. RESULTS: Refill-based measures estimated higher adherence than self-reported tools. A multi-method approach significantly increased the detection of nonadherent patients (49.4%-69.0%). PDC-based combinations detected more nonadherent cases than MPR. Among self-reported measures, ARMS demonstrated the strongest concordance with refill-based metrics (κ = 0.51-0.55; AUC≈0.80), followed by MARS-5 and MMAS-8, whereas SMAQ showed weaker performance. CONCLUSION: Methodological variability significantly impacts reported adherence rates. While no single "gold standard" exists, integrating brief self-reported scales with objective metrics is feasible and provides a more comprehensive and clinically informative assessment of medication use. This multi-method approach is essential for identifying at-risk patients and tailoring adherence-support interventions in oncology.

Multi-method approach increases detection of nonadherent patients by 49.4%-69.0% in breast cancerNew methods help doctors track breast cancer medication use

How this fits prior evidence

Common questions

Study Details

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Multi-method approach increases detection of nonadherent patients by 49.4%-69.0% in breast cancerNew methods help doctors track breast cancer medication use

How this fits prior evidence

Common questions

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