Poor patient compliance with instructions for continuous sialogogues after 131I therapy

Objectives To analyze the role of patient compliance as a factor in evaluating the effectiveness of continuous sialogogues to prevent salivary side effects from I-131 therapy in differentiated thyroid cancer patients. Methods Differentiated thyroid cancer patients who were clinically scheduled for an I-131 therapy at MedStar Washington Hospital Center between 2012 and 2013 were given instructions for continuous sialogogues per standard clinical protocol. The prospective survey was given at multiple time points. Results Ninety-nine patients consented to participate of whom 94 participants had complete data. The mean prescribed I-131 activity was 121 +/- 50 mCi (4.5 +/- 1.9 GBq), range 27.5-288 mCi (1.0-10.7 GBq ). Overall, only 10% (9/94) of patients were compliant with continuous sialogogues. Even though all patients took sialogogues on the first day of post-therapy, 17% of participants did not continuously take sialogogues during the first day, 60% during the first night, and 72% on the second day despite rigorous instructions to continue for two days. Conclusion Despite repetitive instructions to use sialogogues continuously, most patients (90%) were not compliant. In future studies, strict monitoring and evaluation of patient compliance will be crucial when assessing the effect of continuous versus intermittent or delayed initiation of sialogogues.