Enhanced documentation of capecitabine adherence in stage II–III colorectal cancer: A quality improvement initiative at the University Hospital of Navarra.

Abstract

470 Background: Adherence to oral chemotherapy is critical to achieving optimal treatment outcomes. In stage II–III colorectal cancer, poor documentation of capecitabine intake limits the ability to evaluate compliance and manage toxicity. During Q1 2024, fewer than 25% of treatment cycles at the University Hospital of Navarra included adherence data in the medical record. This project, developed within the 2024 ASCO Quality Training Program in collaboration with Fundación ECO, aimed to improve the documentation rate to at least 75%. Methods: Over six months, a stepwise, multidisciplinary intervention was implemented. Oncology professionals were trained on the importance of documenting adherence, and patients received education on correct capecitabine intake. The electronic health record (EHR) was updated with a dedicated field to record adherence at each treatment cycle. At treatment initiation, patients completed the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess risk of nonadherence. A patient-friendly compliance chart was also distributed for self-monitoring. Monthly tracking of adherence documentation was performed before and after each intervention. Results: Initial adherence documentation was under 25%. After staff education and EHR updates, it increased to 80.16%. Following the incorporation of the MMAS-8 tool and compliance chart, adherence documentation further improved to 89.12%, surpassing the 75% target. Conclusions: This initiative significantly enhanced the documentation of capecitabine adherence, supporting safer and more effective use of oral chemotherapy. The integration of EHR tools, structured patient engagement, and staff education proved effective. The project highlights the impact of systematic quality improvement and reinforces the value of collaboration through programs like the ASCO QTP and Fundación ECO. Adherence documentation rate during intervention phases. Phase Adherence Documentation (%) Baseline (Q1 2024) <25% After staff training + EHR update 80.16% After MMAS-8 + compliance chart 89.12%