We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field.

In this issue, we are privileged to feature an innovative study led by Dr. Yongfeng CHEN from The Chinese University of Hong Kong, in collaboration with Professor Marques Shek Nam NG and Professor Carmen Wing Han CHAN. Their research, titled "Exploring the Role of Medication Perceptions in Adherence to Oral Anticancer Agents among Patients with Gastrointestinal Tract Cancer", unveils critical psychological determinants of treatment adherence through a pioneering mixed-methods approach.

Why We Chose This Research Topic

Oral anticancer agents (OAAs) have transformed cancer care by enabling patients to receive treatments at home. However, this convenience comes with a critical challenge of upkeeping adherence—a global concern across cancer care settings. This challenge is even more pressing in patients with gastrointestinal (GI) tract cancers, who often rely on cytotoxic OAAs administered in long-term, intermittent regimens. Our previous review found a median adherence rate of 68% in this population. Such suboptimal adherence may compromise treatment effectiveness and increases mortality risk.

To address this challenge, we turned to the Common-Sense Model of Self-Regulation (CSM). Unlike traditional frameworks that view patients as passive recipients of care, they are regarded as active problem solvers in the CSM. This model emphasizes that patients’ medication perceptions—both cognitive and emotional responses to medication—shape adherence. While existing studies have focused largely on cognitive responses, our clinical observations revealed that pivotal roles of emotions. Therefore, we conducted a mixed-methods study, integrating quantitative surveys and qualitative interviews, to capture both measurable data and authentic patient voices for building a more comprehensive understanding about how medication perceptions influence adherence.

What We Discovered

Our survey showed that only 58.9% of patients fully adhered to their prescribed OAAs regimens, whereas 25% stopped when they felt worse, 17% forgot doses, and 9% discontinued when they felt better. Patients who fully adhered to OAAs were characterized by significantly lower general harm beliefs and perceived sensitivity to medicine, while significantly higher self-efficacy in managing OAAs. Through patient voices, four major themes emerged:

• Emphasizing the effectiveness of OAAs despite their hazardous nature.
• Experiencing negative emotions in relation to taking OAAs, including concern and reluctance.
• Taking responsibility for routine OAAs management at home.
• Encountering multiple barriers to taking OAAs, including adverse effects,polypharmacy, poor memory, unpleasant drug characteristics, and lack of knowledge about managing OAAs.

By integrating quantitative and qualitative data, we found that:

• Patients with higher general harm beliefs tended to reinforce the hazardous nature of OAAs, resulting in lower adherence.
• Those rated a higher level of sensitivity to medication were more likely to consider sensitivity to the adverse effects of OAAs, thereby presenting lower adherence.
• Those reported a higher level of medication self-efficacy might have a higher possibility of overcoming barriers to taking OAAs and showing better adherence. 

Implications for Cancer Care

Our findings support the application of the CSM in explaining adherence behaviors and offer new insights into effective management of OAAs among patients with GI tract cancer:

• Targeting negative medication perceptions, such as exaggerated harmful or adverse effects of OAAs, to promote adherence.
• Enhancing self-management ability to empower patients to take an active role in managing OAAs and overcoming barriers at home.
• Integrating emotional management strategies, such as addressing concerns and reluctance, in adherence-enhancing programs.
•  Screening for negative medication perceptions, such as harm beliefs and perceived sensitivity to medication, may help identify high-risk patients with non-adherence.

We are committed to supporting patients who manage OAAs at home. Building on this study, we are developing and evaluating a program that addresses medication perceptions and promotes adherence. We welcome your continued engagement with our ongoing research.

References

Chen Y, Ng MSN, Dong B, Chan CWH. "These Drugs Are Going to Save Our Lives" A Mixed Methods Study on the Role of Medication Perceptions in Adherence to Oral Anticancer Agents Among Patients With Gastrointestinal Tract Cancer. Psychooncology. 2025;34(7):e70213. doi: 10.1002/pon.70213.

From left to right: the second author and co-supervisor, Professor Marques Shek Nam NG; the first author and principal investigator, Dr. Yongfeng CHEN; and the corresponding author and supervisor, Professor Carmen Wing Han CHAN