Patient, caregiver and provider perspectives on cancer treatment adherence in Singapore: A qualitative study.

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Background: Breast and colorectal cancers remain among the most prevalent in Singapore. Adherence to prescribed therapies critically influences clinical outcomes and healthcare costs, yet suboptimal adherence persists. While local research has emphasised socioeconomic determinants, few qualitative studies have examined broader influences such as side effects, healthcare experiences and social support. This study explores multilevel determinants of treatment adherence from the perspectives of patients, caregivers and healthcare providers (HCPs). Methods: We conducted a qualitative descriptive study at a public cancer centre in Singapore, using semi-structured interviews with (i) HCP involved in cancer care and (ii) patients with stage I to III BC or CRC and their caregivers to explore factors influencing treatment adherence. Interviews were conducted between October 2024 and July 2025, and were audio-recorded, transcribed verbatim, and analysed using applied thematic analysis. We organised the findings using the five World Health Organisation (WHO) multidimensional adherence model (MAM) dimensions. Results: We interviewed 17 HCPs, 27 patients (18 BC; 9 CRC), and 5 caregivers. Median HCP age was 42 years; most had > 9 years’ cancer-care experience. Median patient age was 60 years; most were female and ethnically Chinese. Patient and HCP accounts primarily mapped to four WHO adherence dimensions: patient-related, health system and provider-related, therapy-related and socioeconomic factors. Facilitators common to both groups included patient-level supports (notably family support) and health system/provider factors such as trust in clinicians. Patients emphasised intrinsic motivation, perceived empathy and clear communication from HCPs; HCPs highlighted patients’ personal goals and perceived health benefits as motivating factors. Identified barriers included therapy-related issues—most prominently treatment side effects—and socioeconomic constraints, including out-of-pocket costs, which HCPs perceived to disproportionately affect lower socioeconomic groups. Patients described patient-level barriers (negative emotions, fluctuating motivation) and system-level limitations (perceived inadequacy of public insurance coverage). Therapy-specific challenges included bodily adjustments (e.g., drainage devices, stoma care). HCPs also noted practical challenges such as disruption to daily life, work, and logistical burdens associated with treatment access. Conclusions: This study reveals multiple, interacting facilitators and barriers to cancer treatment adherence across patient, provider, therapy and socioeconomic domains. Greater clarity on these interactions can guide development of targeted, contextually appropriate interventions to enhance adherence and improve outcomes.