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Cancer protocol should balance therapeutic, compliance

You are a motivated patient, you have found a great doctor, and you have what you feel is a perfect protocol to treat your cancer. Motivated to do everything exactly right, you have your grocery list ready to go and your supplements organized into daily doses. This is going to be great!

Just one week later, you’ve fallen off the wagon. You aren’t sticking to the nutrition plan because your kids had several busy days of sports practices and your husband was under the weather. It’s difficult to prepare food for yourself when you are taking care of everyone else! To make matters worse, you have supplements in your pill box from the last few days that you didn’t take.

That bedtime dose of supplements was hard to remember after the tiring days you’ve had lately. As you lie down to fall asleep, you realized that you completely forgot about your mid-day relaxation time which was supposed to be reserved for prayer and meditation.

Dr. Jonathan Stegall

Dr. Jonathan Stegall — founder of the Center for Advanced Medicine, one of Cancer Tutor's verified clinics — practices integrative oncology, which involves combining the best of modern medicine with natural therapies.

Cancer Tutor Verified Clinic

Center for Advanced Medicine
Dr. Stegall on Cancer Tutor

But you have stage IV cancer, this is literally life or death. What happened to that motivation you had just one week ago? What’s that saying about the best-laid plans often going awry?

Compliance is a challenge faced by both patients and physicians, and non-compliance can have severe consequences. In 1990, a study by Sullivan et al determined that hospitalizations due to medication non-adherence alone cost over $13 billion. [1]

What determines compliance?

A review of the literature from a period of over 50 years found that patient adherence is related to social support, family relationships, marital status, and living arrangements. The most important factor for patient compliance was determined to be social support, with those patients having the greatest support system being the most adherent. [2]

In my practice, I have found that the patients with the strongest support systems are not only more compliant with recommended interventions, but also have better treatment outcomes. I suspect that their improved results are not simply because of their improved compliance, but also because they tend to feel loved and have their emotional needs met more frequently.

Are most patients compliant?

In examining patient adherence, it is not surprising that more complex regimens involving lifestyle changes result in a lower rate of compliance. Brownell and Cohen noted in a 1995 study that dietary modification is especially difficult for patients, even when extensive patient education is offered. [3] This is not surprising to me, as the most difficult aspect for patients in my office – and the most stressful one – is following my nutrition recommendations exactly as written. My colleagues in this field have noticed the same.

When it comes to compliance with cancer treatment, one study found that only 36 percentof patients were fully compliant with the recommended treatments. [4] Not surprisingly, the patients who were non-compliant did not do as well as those who were compliant.

How can I possibly take all these supplements?!

Those of us in the integrative oncology world are very concerned about patient compliance with nutritional supplementA product, generally taken orally, that contains one or more ingredients (such as vitamins or amino acids) that are intended to supplement one's diet and are not considered food. regimens, not only because we believe these supplements to be important, but also because patient compliance can be an issue. Some physicians’ regimens have patients taking in excess of 100 pills and capsules each day! Not surprisingly, scheduling and taking this many supplements can become a part-time job.

Studies have found that more complex regimens involving oral intake of capsules and pills also result in lower compliance. One study found that patients who take 13 or more pills per day had a compliance rate of less than 20 percent! [5]

This brings up a very important point, which is that a supplement protocol is only good if it is can be reasonably adhered to. It is vital that doctors be sensitive to patient factors that can impact compliance, such as work and family schedules, appetite, swallowing issues, absorption capability, and lower gastrointestinal ailments. An overly complex and unrealistic supplement regimen designed to fail is only going to frustrate a patient — the last thing we want to do when dealing with cancer.

Putting it all together

Every aspect of a cancer treatment protocol should strike a balance between therapeutic effectiveness and patient compliance. This is where a dynamic therapeutic relationship between doctor and patient is vital, as a one-size-fits-all approach is not optimal. Patients should make every effort to be as compliant as possible, while also communicating to their treatment team any concerns and potential barriers which exist.

Doctors must display a willingness to put themselves in the patient’s shoes and realize just how difficult some protocols can be to follow. Protocols should be designed in a way which maximizes that specific patient’s chances of compliance. Because at the end of the day, all we can do is our best.


  1. Sullivan S, Kreling DH, Hazlet TK. Noncompliance with medication regimens and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate. J Res Pharmaco Econ. 1990; 2:19-33.
  2. DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004a; 23: 207–18.
  3. Brownell KD, Cohen LR. Adherence to dietary regimens. 1: an overview of research. Behav Med. 1995; 20: 149–54.
  4. Li BD, Brown WA, Ampil FL, et al. Patient compliance is critical for equivalent clinical outcomes for breast cancer treated by breast-conservation therapy. Ann Surg. 2000;231:883–9.
  5. Graveley EA, Oseasohn CS. Multiple drug regimens: medication compliance among veterans 65 years and older. Res Nurs Health. 1991;14:51–8.