Adherence to oral chemotherapy in pediatric oncology: a scoping review of challenges and strategies

Abstract

This scoping review aims to identify and synthesize evidence on barriers, factors influencing adherence, and interventions to improve adherence to oral chemotherapy in pediatric oncology. Methods Following the PRISMA-ScR guidelines, a scoping review search was conducted across PubMed, Web of Science, Cochrane, OVID, and Scopus databases. Eligible studies included those focusing on pediatric cancer patients prescribed oral chemotherapy and interventions aimed at improving adherence. Studies in English, published from inception to November 2024, were included. Data extraction covered study characteristics, barriers, influencing factors, and strategies for adherence. Results were narratively synthesized under thematic headings. Results A total of 15 studies met the inclusion criteria, encompassing qualitative, quantitative, and mixed-method designs. Barriers to adherence included emotional challenges (e.g., anxiety, resistance to treatment), medication-related issues (e.g., taste, side effects, complex regimens), and logistical difficulties (e.g., transportation, daily integration). Sociodemographic factors such as caregiver education level, economic status, and family structure significantly influenced adherence. Interventions like medication diaries, daily text reminders, home-based care programs, and caregiver education demonstrated effectiveness in improving adherence. Family and health system-focused strategies emerged as the most impactful approaches. Conclusion Adherence to oral chemotherapy in pediatric oncology is multifaceted, influenced by emotional, logistical, and educational factors. Effective interventions address these barriers holistically, emphasizing caregiver support and tailored strategies. Future research should focus on developing and validating scalable, culturally sensitive adherence interventions. Practice implications Given the emotional difficulties and logistical challenges faced by patients and caregivers, nurses play a critical role in maintaining adherence through caregiver education and the use of medication adherence support tools (e.g., medication diaries or text message reminders). Nurse-led family-centered care models and home-based adherence programs have the potential to be effective in improving medication adherence.