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Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1219-1232. [PMID: 38652861 DOI: 10.1080/10428194.2024.2342559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib's favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.
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Affiliation(s)
- Jessica M Stempel
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rong Wong
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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Chapron P, Petit M, Huon JF, Nizet P. [Implementation of pharmaceutical consultations in digestive oncology in a teaching hospital: one-year outcomes]. Bull Cancer 2024; 111:363-370. [PMID: 38438283 DOI: 10.1016/j.bulcan.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The announcement of a cancer diagnosis is traumatic for the patient. In France, an announcement system has been in place, providing medical time for announcement and treatment proposal, nursing time for support, without including the pharmacist. In order to improve management of patients treated with intravenous anticancer drugs, we set up introductory pharmaceutical consultations in digestive oncology. The aims were to assess the situation one year after the introduction of these consultations, and to assess their contribution. METHODS When a patient was diagnosed with digestive cancer and receiving intravenous treatment, a pharmaceutical initiation consultation was scheduled. Indicators of activity (number of consultations, average duration, average preparation time and various delays) and results (number and type of pharmaceutical interventions, patient satisfaction) were collected in order to assess activity. RESULTS Forty-seven pharmaceutical initiation consultations were carried out. The average duration of the consultations was 39.3minutes. Consultations were carried out on average 12.1 days after the medical consultation and 9.6 days before the first chemotherapy treatment. Twenty-nine patients responded to the satisfaction questionnaire. All were satisfied, and the majority of patients said they had improved their knowledge of cancer treatment. DISCUSSION This activity enables us to review with patients essential aspects of their care, such as implanting an implantable chamber catheter, anti-cancer treatment and managing potential side effects and improve their self-care skills.
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Affiliation(s)
- Pierre Chapron
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Mathilde Petit
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Jean-François Huon
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Pierre Nizet
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Efficace F, Cottone F, Yanez B, Kota V, Castagnetti F, Caocci G, Bonifacio M, Patriarca A, Capodanno I, Cristina Miggiano M, Tiribelli M, Breccia M, Luciano L, Giai V, Iurlo A, Abruzzese E, Fava C, Dinner S, Altman JK, Rosti G, Cortes J, Vignetti M, Cella D. Patient-reported symptom monitoring and adherence to therapy in patients with newly diagnosed chronic myeloid leukemia. Cancer 2024; 130:287-299. [PMID: 37801052 PMCID: PMC11357833 DOI: 10.1002/cncr.35021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The authors assessed the clinical utility of patient-reported symptom monitoring in the setting of newly diagnosed chronic myeloid leukemia (CML). The primary objective was to evaluate adherence to therapy. METHODS The authors conducted an international prospective study that included patients with newly diagnosed, chronic-phase CML. Before clinical consultation, patients were provided a tablet computer to self-rate their symptoms, and the results were available in real time to each physician during the patient's visit. Adherence was assessed by pill count and with a validated self-reported questionnaire. The proportions of optimal responders at 3 and 6 months were assessed according to the European LeukemiaNet criteria. RESULTS Between July 2020 and August 2021, 94 patients with a median age of 57 years were enrolled. Pill count adherence analysis indicated that 86 of 93 evaluable patients (92.5%) took at least 90% of prescribed tyrosine kinase inhibitor therapy during the 6-month observation period. The online platform was well accepted by patients and physicians. An optimal response was achieved by 69 of 79 patients (87.3%) at 3 months and by 61 of 81 patients (75.3%) at 6 months. CONCLUSIONS Patient-reported symptom monitoring from the beginning of therapy in patients with CML may be critical to improve adherence to therapy and early molecular response rates (ClinicalTrials.gov identifier NCT04384848).
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Fausto Castagnetti
- Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Luigia Luciano
- Hematology Unit “Federico II,”, University of Naples, Naples, Italy
| | - Valentina Giai
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Iurlo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Abruzzese
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica K Altman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gianantonio Rosti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Camejo N, Castillo C, Tambasco C, Strazzarino N, Requena N, Peraza S, Boronat A, Herrera G, Esperon P, Cuello M, Krygier G. Assessing Adherence to Adjuvant Hormone Therapy in Breast Cancer Patients in Routine Clinical Practice. World J Oncol 2023; 14:300-308. [PMID: 37560342 PMCID: PMC10409554 DOI: 10.14740/wjon1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). A lack of adherence to adjuvant endocrine therapy is common, 31.0-73.0% of women discontinue endocrine treatment before 5 years. The aim of the study was to assess adherence to HT in routine clinical practice in patients assisted at the Clinical Oncology Department of the Hospital de Clinicas - Universidad de la Republica, Uruguay. METHODS Patients treated with HT for stage 0-III BC between 2017 and 2019 were included. The medication possession (MPR) rate was calculated using pharmacy records, and the Morisky-Green Scale was applied to assess adherence. Adherent patients were those with MPR ≥ 0.80 and who correctly answered the Morisky-Green treatment adherence questionnaire. The association of adherence with polypharmacy, treatment, and patient characteristics was assessed using simple logistic models. The associations between qualitative variables and adherence were assessed using simple logistic regression model or Fisher's exact test. The association between quantitative variables and adherence was assessed using the Student's t-test. The odds ratio (OR) for non-adherence to treatment and its 95% confidence interval were estimated. RESULTS Totally, 118 patients were included; 65.2% were treated with aromatase inhibitors (AIs), 36.0% presenting polypharmacy. The adherence rate at the end of 2 years was 81.0 %; and it was associated with age (P = 0.03, OR = 0.96 for non-adherence), with adherent and non-adherent patients having a mean age of 65.0 and 60.3 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI. CONCLUSIONS Adherence to HT was assessed in real life, with 19.0% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. Older patients were associated with being more adherent. The results show the need of the Pharmacy Service and Department of Clinical Oncology Medical Oncology combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.
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Affiliation(s)
- Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Clara Tambasco
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Noelia Strazzarino
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Nicolas Requena
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Silvina Peraza
- Pharmacy Service, Hospital de Clinicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Anna Boronat
- Pharmacy Service, Hospital de Clinicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Patricia Esperon
- Molecular Genetics Laboratory Clinical Biochemistry Department, School of Chemistry, Universidad de la Republica, Montevideo, Uruguay
| | - Mauricio Cuello
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Shallis RM, Wang R, Zeidan AM, Huntington SF, Neparidze N, Stempel JM, Mendez LM, Di M, Ma X, Podoltsev NA. Older patients with chronic myeloid leukemia face suboptimal molecular testing and tyrosine kinase inhibitor adherence. Blood Adv 2023; 7:3213-3224. [PMID: 36939371 PMCID: PMC10338212 DOI: 10.1182/bloodadvances.2022009074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/06/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023] Open
Abstract
Tyrosine kinase inhibitor (TKI) use is critical in the care of patients with chronic myeloid leukemia (CML). Quantitative polymerase chain reaction (qPCR) testing for BCR-ABL1 every 3 months during the first year of TKI treatment is recommended to assure achievement of milestone response goals. Real-world evidence for the patterns of qPCR monitoring and TKI adherence in the older patient population is lacking. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 1192 patients aged ≥66 years (median age, 74 years) with newly diagnosed CML who were followed up for ≥13 months from TKI initiation. In total, 965 patients (81.0%) had ≥1 test, with 425 (35.7%) and 540 (45.3%) of the patients tested during 1, 2, and ≥3 quarters (optimal monitoring) of the first year from TKI initiation, respectively. In multivariable analysis, diagnosis in later years and influenza vaccination before diagnosis, a proxy for health care access, were associated with optimal qPCR monitoring. Use of low-income subsidy and residing in census tracts with the lowest socioeconomic status were associated with less optimal monitoring. Patients with optimal monitoring were 60% more likely to be TKI adherent (odds ratio, 1.60; 95% CI, 1.11-2.31; P = .01) and had improved 5-year survival (hazard ratio, 0.66; 95% CI, 0.49-0.90; P < .01) than those without such monitoring. In this large, real-world study of CML management patterns, many older patients had suboptimal molecular monitoring, which was associated with decreased TKI adherence and worse survival.
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Affiliation(s)
- Rory M. Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Scott F. Huntington
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Natalia Neparidze
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Jessica M. Stempel
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Lourdes M. Mendez
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Mengyang Di
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Nikolai A. Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
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Wreyford L, Gururajan R, Zhou X. When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review. PLoS One 2023; 18:e0282180. [PMID: 37134109 PMCID: PMC10155980 DOI: 10.1371/journal.pone.0282180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. AIM The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. METHODS A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. RESULTS Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. LINE OF ARGUMENT WAS DRAWN Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. CONCLUSION This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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Affiliation(s)
- Leon Wreyford
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Raj Gururajan
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Xujuan Zhou
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
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Verweij L, Ector GICG, Smit Y, van Vlijmen B, van der Reijden BA, Hermens RPMG, Blijlevens NMA. Effectiveness of digital care platform CMyLife for patients with chronic myeloid leukemia: results of a patient-preference trial. BMC Health Serv Res 2023; 23:228. [PMID: 36890512 PMCID: PMC9994406 DOI: 10.1186/s12913-023-09153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE To explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS Effectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. TRIAL REGISTRATION ClinicalTrials.gov NCT04595955 , 22/10/2020.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Geneviève I C G Ector
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yolba Smit
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Rychter A, Miniszewska J, Góra-Tybor J. Personality traits favourable for non-adherence to treatment in patients with chronic myeloid leukaemia: role of type A and D personality. Biopsychosoc Med 2023; 17:1. [PMID: 36658586 PMCID: PMC9854114 DOI: 10.1186/s13030-023-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/15/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The introduction of BCR-ABL tyrosine kinase inhibitors (TKIs) to chronic myeloid leukemia (CML) therapy has revolutionized the treatment of this disease. Although regular TKI intake is a prerequisite for successful therapy, it has been shown that a significant proportion of patients are non-compliant. Recently there is growing evidence that personality traits may influenced the tendency for non-adherence to treatment in patients with chronic diseases. As far as we know, such a relationship in patients with CML has not been examined, yet. The aim of our study was to determine if personality traits favor non-adherence to treatment recommendations. We investigated the relationship between five-factor model personality factors (conscientiousness, neuroticism, agreeableness, extraversion, and openness) and medication non-adherence. We also checked if the patients with type A and type D personality, were at higher risk of poor medication adherence. METHODS The following tools were used: self-constructed survey, the NEO-Five Factor Inventory, the Framingham Type A Scale, the D-Scale 14. The study included 140 CML patients treated with imatinib, dasatinib, or nilotinib. RESULTS 39% of patients reported skipping at least one dose of medication in the month prior to follow-up visit. 51% admitted to skipping such doses from the start of their treatment to the time at which our assessment was performed. We did not find any relationship between the mean values of the analyzed factors of the Big Five (neuroticism, extraversion, openness, agreeableness, conscientiousness) and adherence. However, our analysis revealed that CML patients who admitted to missing doses of drugs during the entire course of treatment demonstrated greater intensity of type A personality traits (p = 0.020). Regarding both factors of type D personality, it was revealed that higher level of negative affectivity significantly decreased the adherence (p = 0.020). CONCLUSION The results of our study indicate that screening for type D and A personalities may help to identify patients who are at higher risk of poor medication adherence.
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Affiliation(s)
- Anna Rychter
- Department of Haematology, Medical University of Lodz, Lodz, Poland.
| | - Joanna Miniszewska
- Department of Health Psychology, Institute of Psychology, Lodz University, Lodz, Poland
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Bekalu YE, Wudu MA, Gashu AW. Adherence to Chemotherapy and Associated Factors Among Patients With Cancer in Amhara Region, Northeastern Ethiopia, 2022. A Cross-Sectional Study. Cancer Control 2023; 30:10732748231185010. [PMID: 37795961 PMCID: PMC10557419 DOI: 10.1177/10732748231185010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cancer is the leading cause of death worldwide, and poor adherence to chemotherapy has become a public health issue in developing countries, including Ethiopia. OBJECTIVE To assess chemotherapy adherence and associated factors among patients with cancer in the Amhara Region, Northeast Ethiopia. METHODS A hospital-based prospective cross-sectional study design was employed, and a total of 460 cancer patients were enrolled using a systematic random sampling method at Felege Hiwot and Dessie comprehensive specialized hospitals from May 15, 2022, to July 15, 2022, in the Amhara region. The data was gathered through a review of medical records and a face-to-face interview and entered into Epi-Data version 4.6 before being exported to SPSS version 26 for analysis. Furthermore, at 95% confident interval (CI), multivariable binary logistic regression was used, and variables with P-values of <.05 were found to be significant. RESULT The overall response rate in this study was 94.1% (433), with 42.3% of patients adhering to chemotherapy. Moreover, having a family history of cancer [AOR = 3.58, 95% CI (2.22, 5.76)], being female [Adjusted Odds ratio (AOR) = 2.17, 95% CI: (1.31, 3.60)], having no history of comorbidity [AOR = 2.74, 95% CI (1.56, 4.81)], having side effects from chemotherapy [AOR = 3.50, 95% CI (1.55, 7.90)], and having social support [AOR = 1.52, 95% CI (1.21, 1.95)] were important predictors of chemotherapy adherence. CONCLUSION and recommendations: Patients' understanding of illness characteristics and treatment should be improved through health education. Involving family members in the treatment plan will also improve adherence to chemotherapy in this context.
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Affiliation(s)
- Yemane Eshetu Bekalu
- Department of Public Health, ALKAN Health Sciences Business and Technology College, Dessie, Ethiopia
| | - Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Workie Gashu
- Department of Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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10
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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11
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Lory P, Perche L, Blanc J, Fouquier B, Giroux A, Thomassin A, Devaux M, Renaudin A, Di Martino C, Quipourt V, Bengrine-Lefèvre L, Schmitt A. Adherence to oral anti-cancer therapies in older patients is similar to that of younger patients. J Oncol Pharm Pract 2022:10781552221103547. [DOI: 10.1177/10781552221103547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The use of oral anti-cancer therapies is becoming increasingly common in the management of cancers, raising the question of adherence. The objective of this study was to assess adherence to oral anti-cancer therapies, as well as the impact of various factors that may influence it. Methods Patients starting oral chemotherapy (tyrosine kinase inhibitor or cytotoxic) were followed up for 3 months using a medication diary, which was given to the patient by the pharmacist during a multidisciplinary consultation. Adherence was assessed using the diary, as well as by counting the tablets they brought back. Results One hundred and fifty patients were included in the study. The main oral chemotherapy agents prescribed were palbociclib (23.3%), everolimus (18.7%), and capecitabine (13.3%). The adherence at the end of the 3 months, by means of dose intensity (i.e. percent of the dose prescribed that has been taken), was 95.5%. No significant difference in adherence was found based on age, sex, family circumstances, health status, co-medication, type of oral therapy, tumor location, number of previous treatment lines, or presence of toxicity. The main reasons for non-adherence were forgetting (50%) and toxicity (21%). Fifty-seven patients prematurely discontinued the study: 40.3% for toxicity and 36.8% for disease progression. Conclusion Adherence in this study is high in comparison to literature, which can be explained by close multidisciplinary follow-up. Moreover, no significant difference was observed between younger and older patients.
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Affiliation(s)
- Pauline Lory
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Louise Perche
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Julie Blanc
- Biostatistics and Data Management Unit, Centre Georges-François Leclerc, Dijon, France
| | - Bastian Fouquier
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Audrey Giroux
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Amélie Thomassin
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Madeline Devaux
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Amélie Renaudin
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Cyril Di Martino
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
| | | | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
- INSERM U1231, University of Burgundy, Dijon, France
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12
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Hicks BM, Chun DS, Peacock Hinton S, Hsu CD, Tan HJ, Lund JL. Patterns of first-line targeted therapy utilization and adherence among older adults diagnosed with metastatic renal cell carcinoma. J Geriatr Oncol 2022; 13:325-333. [PMID: 34782282 DOI: 10.1016/j.jgo.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the rapid approval of targeted therapies for metastatic renal cell carcinoma (mRCC) evidence on real world treatment patterns remains limited. This study evaluated patterns of first-line targeted therapy utilization and adherence in older adults, a population with a high burden of RCC. METHODS 2093 patients aged ≥66 years with a primary diagnosis of mRCC were identified from United States (US)-based cancer registry and administrative claims data (2007-2015). We included only patients with de novo disease. We assessed the initiation of first-line targeted therapy within four months of diagnosis and persistence and adherence to targeted therapy, using the proportion of days covered (PDC). Multivariable logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to describe characteristics associated with targeted therapy versus no targeted therapy initiation and for high (≥80% PDC) versus low adherence. RESULTS 28.8% of patients received first-line targeted therapy within four months of diagnosis, with the proportion of patients receiving targeted therapy increasing over time. Older age (one-year increment OR:0.95 95%CI 0.93, 0.97), high comorbidity burden (OR:0.65 95%CI0.46, 0.93) and clear cell histology (OR:1.54 95%CI 1.19, 2.00) were associated with targeted therapy initiation. 48.2% of patients exhibited a high PDC to oral targeted therapy at 120 days, which was attenuated with inclusion of patients who died during the time period (34.2% PDC ≥80%). CONCLUSION Increasing age, high comorbidity burden and non-clear cell histology were associated with decreased targeted therapy initiation among patients with de novo mRCC. Our findings suggest adherence to oral therapies was low; future research exploring the mechanisms and impact of low adherence in this older patient population is warranted.
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Affiliation(s)
- Blánaid M Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, UK..
| | - Danielle S Chun
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon Peacock Hinton
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC, USA
| | - Christine D Hsu
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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13
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Ector GI, Verweij L, Hermens RP, Blijlevens NM. Filling the gaps of patient information needs and information perception in chronic myeloid leukemia with the patient-physician co-produced web-based platform CMyLife. PATIENT EDUCATION AND COUNSELING 2022; 105:686-694. [PMID: 34226069 DOI: 10.1016/j.pec.2021.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND For patients with chronic myeloid leukemia, a web-based platform CMyLife was developed. Its aim is to enhance patient empowerment, by adequate information provision, among others. Before evaluating its effect, information provision and needs in current care were assessed. OBJECTIVE To assess patients' evaluation of received information and information needs before CMyLife utilization and whether this information source is used correspondingly. Additionally, we explored predicting patient factors in information perception. PATIENT INVOLVEMENT CMyLife platform was developed with active patient participation. METHODS We conducted a cross-sectional survey among 203 CML patients before launch of the CMyLife platform, using validated questionnaires on information provision and predictive factors. We focused on website utilization during the first 3 years, using Google Analytics. Regression analyses were performed to determine influence of patient factors on information perception. RESULTS Global perceived information provision was scored 42.8 (0-100). Information on other services such as rehabilitation and psychological support, and effects of treatment on sexuality showed room for improvement. One out of 3 knew where to find useful health information online. But more information was desired by 36% of them. Age ≥65 years, time since diagnosis and low education were positively associated with this need. Pages on medication and side effects were visited the most. DISCUSSION To fill the gap in perceived provision and needs, information should be adjusted more to the individual in content, manner and timing. Age, time since diagnosis, and educational level are of influence in perceived information, and specific needs within these groups should be further explored. PRACTICAL VALUE CMyLife provides reliable and up-to-date information for low eHealth literacy skilled patients concerning multiple topics indicated by patients.
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Affiliation(s)
- Geneviève Icg Ector
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Lynn Verweij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella Pmg Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Ma Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives. Therapie 2022; 77:229-240. [DOI: 10.1016/j.therap.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
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15
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Melis EJ, Zwart-van Rijkom JE, Egberts TC, van den Bemt BJ, Witteveen PO, Gardarsdottir H. The association between patient satisfaction with information and adherence to oral anticancer agents. J Oncol Pharm Pract 2022; 29:637-645. [PMID: 35130094 DOI: 10.1177/10781552221077258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Adherence to anticancer agents is a critical factor in achieving adequate clinical response, and became a major challenge for patients and caregivers since the increased substitution of parenteral cytostatic by oral drugs. One of the factors that influences adherence is how well informed patients are about their therapy. This study assesses the association between patient satisfaction with information about oral anticancer agents and adherence. MATERIALS AND METHODS This study was conducted among patients (≥18 years) who began oral anticancer therapy. Patients satisfaction with information and adherence were assessed using validated questionnaires. Adherence was also assessed using refill data. Logistic regression was applied to assess the association between overall patient satisfaction with information and both self-reported adherence and adherence based on an MPR value of above 80%. RESULTS In total, 124 patients were included in the study. The median (IQR) satisfaction with information was 15.0(4) on a scale of 0-17. Eighty-two percent of participants reported adherence, while the refill data demonstrated that 64.5% of patients had an adherence rate of 80% or higher. Overall satisfaction with information was not significantly associated with self-reported adherence (OR adj 0.98 [95% CI 0.85-1.15]) or refill-based adherence (OR adj 1.11 [95% CI 0.99-1.24]). CONCLUSION The findings indicate no significant relationship between patient satisfaction with information and adherence. The population was highly satisfied with information about the oral anticancer agents, which indicates a high level of satisfaction with usual care. However, the refill data reveals that 35.5% of patients were not adherent.
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Affiliation(s)
- Eward J Melis
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Toine Cg Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Bart Jf van den Bemt
- Department of Pharmacy, 6033Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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16
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Barbosa ADP, Rodrigues Martins M, Dewulf NDLS, Carneiro WJ, Oliveira FNMD, Lemes GA, Cunha MMBD, Cruz ADC, Cunha LCD. Pro-adherence complementary audiovisual educational intervention model for chronic myeloid leukemia patients treated with imatinib mesylate. J Oncol Pharm Pract 2022; 29:521-528. [PMID: 35044256 DOI: 10.1177/10781552211073894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Imatinib mesylate (IM) treatment adherence is a challenge, especially in an economic-social population neglected from developing countries. OBJECTIVE To create a new complementary audiovisual educational intervention model to improve IM treatment adherence of CML patients. METHODS Two adherence verification methods were applied before and after intervention: modified Morisky-Green test and molecular responses (BCR-ABL transcripts quantification). Adherence estimates were calculated using univariate and multivariate component analysis (MCA) for the socio-demographic and clinical characteristics of patients. RESULTS Modified Morisky-Green test results demonstrated a substantial increase of CML patient adherence from 23% (pre-film) to 65% (post-film). Greater improvement was obtained for patients presenting major molecular response (MMR) from 38% (pre-film) to 60% (post-film). Although slight gain for complete molecular response (CMR) from 23% (pre-film) to 26% (post-film) was achieved, it represents a total tumour regression. MCA identified that females <50 years-old, using less than two medications (no disease associated) and CMR condition were the most benefited with intervention. CONCLUSION Audiovisual educational intervention was an effective complementary pro-adherence model, activating patient memory and improving IM treatment adherence. Although this intervention shows effective, not all patients responded as expected, being necessary a combination of educational and clinical interventions to improve IM adherence.
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Affiliation(s)
- Adriana do Prado Barbosa
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Marcelo Rodrigues Martins
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Nathalie de Lourdes Souza Dewulf
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Wilsione José Carneiro
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Flávia Neri Meira de Oliveira
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Guilherme Andrade Lemes
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | | | - Alessandro de Carvalho Cruz
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
| | - Luiz Carlos da Cunha
- Toxic-Pharmacological Studies and Research Center (NEPET), School of Pharmacy, 67824Federal University of Goiás, Goiânia, Brazil
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Oswald LB, Hyland KA, Eisel SL, Hoogland AI, Knoop H, Nelson AM, Pinilla-Ibarz J, Sweet K, Jacobsen PB, Jim HS. Correlates of fatigue severity in patients with chronic myeloid leukemia treated with targeted therapy. Support Care Cancer 2022; 30:87-94. [PMID: 34231041 PMCID: PMC8639627 DOI: 10.1007/s00520-021-06408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Tyrosine kinase inhibitors (TKIs) substantially improve survival for patients with chronic myeloid leukemia (CML), but fatigue associated with TKIs can negatively impact patients' quality of life and adherence. This study sought to identify correlates of fatigue (e.g., sociodemographic characteristics, clinical characteristics, health behaviors) among patients with CML taking TKIs who reported moderate to severe fatigue. METHODS Adults with CML experiencing at least moderate fatigue were recruited for a pilot trial of a cognitive behavioral intervention to improve fatigue. Data collected pre-intervention were used to explore concurrent correlates of fatigue in univariate and multivariable models. RESULTS Participants (N = 44, 48% female) were M = 55.6 years old (SD = 12.6) and had been diagnosed with CML M = 5.2 years prior (SD = 5.3). Participants had been taking their current TKI for M = 2.5 years (SD = 2.7). Most participants (64%) had previously been treated with ≥ 1 other TKI. More than three-quarters of participants (77%) reported severe fatigue. In univariate models, worse fatigue was associated with higher BMI (r = -0.36, p = 0.018), prior treatment with other TKI(s) (r = - 0.34, p = 0.024), worse sleep disturbance (r = - 0.51, p < 0.001), and less physical activity (r = 0.31, p = 0.043). In a multivariable model, significant univariate correlates accounted for 39% of the variance in fatigue. Worse fatigue remained significantly correlated with higher BMI (β = - 0.33, p = 0.009) and more disturbed sleep (β = - 0.45, p < 0.001). CONCLUSION Results may inform future research aiming to identify fatigued patients with CML at risk for experiencing more severe fatigue during TKI therapy. Identifying predictors of fatigue severity could aid clinicians in identifying which patients will benefit from referrals to supportive therapy. TRIAL REGISTRATION NCT02592447, October 30, 2015.
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Affiliation(s)
- Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Kelly A. Hyland
- Department of Psychology, University of South Florida, Tampa, FL
| | - Sarah L. Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - Ashley M. Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | | | - Kendra Sweet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Paul B. Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
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18
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Obeng-Kusi M, MacDonald K, van Lierde MA, Lee CS, De Geest S, Abraham I. No margin for non-adherence: Probabilistic kaplan-meier modeling of imatinib non-adherence and treatment response in CML (ADAGIO study). Leuk Res 2021; 111:106734. [PMID: 34735932 DOI: 10.1016/j.leukres.2021.106734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although adherence to imatinib is critical for attaining treatment responses in chronic myeloid leukemia, there is evidence of varying adherence among patients. Our aim was to model and determine the margin of tolerance, if any, required to ensure treatment responses among patients prescribed imatinib before treatment response is at risk. METHOD We performed post hoc analyses of the ADAGIO study conducted in Belgium on 169 evaluable patients (Blood 2009). Applying Kaplan-Meier methods using adherence instead of the conventional time variable, we modeled the likelihood of complete cytogenetic (CCyR), complete hematological (CHR), major molecular (MMR) and optimal (OR) response as a function of 90-day pill count adherence. RESULTS Analyses showed that ∼100 % adherence of prescribed dose is associated with probabilities of 0.84 for CHR, 0.83 for CCyR, 0.82 for OR, and 0.77 for MMR; compared to, 0.37 (CHR and CCyR), 0.35 (OR), and 0.39 (MMR) at 90 % adherence. Increasing intake of imatinib from 90 % to 100 % of the prescribed dose increased the likelihood of the various treatment responses by 1.95-2.35-fold. CONCLUSION There is virtually no margin for nonadherence, if the objective is to optimize the likelihood of treatment response, and a minimal margin to avoid impaired treatment response.
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Affiliation(s)
- Mavis Obeng-Kusi
- Center for Health Outcomes and Pharmacoeconomic Research & Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | | | - Christopher S Lee
- Connell School of Nursing, Boston College, Boston, MA, USA; Australian Catholic University, Melbourne, Victoria, Australia
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research & Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Matrix45, Tucson, AZ, USA.
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Guglielmelli P, Palandri F, Selleri C, Cilloni D, Mendicino F, Mazza P, Pastore D, Palumbo GA, Santoro M, Pavone V, Impera S, Morelli M, Coco P, Valsecchi D, Passamonti F, Breccia M. Adherence to ruxolitinib, an oral JAK1/2 inhibitor, in patients with myelofibrosis: interim analysis from an Italian, prospective cohort study (ROMEI). Leuk Lymphoma 2021; 63:189-198. [PMID: 34521299 DOI: 10.1080/10428194.2021.1969388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ROMEI, a prospective, observational study in patients with myelofibrosis receiving the oral JAK1/2 inhibitor ruxolitinib in real-world practice, assesses treatment adherence based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Here, we present MMAS-8 results at week 24. Overall, 101 of 188 evaluable patients completed the questionnaire at every visit (full completers). Mean (±standard deviation) total MMAS-8 scores remained stable from week 4 to week 24 in the overall population (7.54 ± 0.77 and 7.67 ± 0.70, respectively) and full completers (7.53 ± 0.79 and 7.67 ± 0.73, respectively). Rates of low (MMAS-8 ˂6) or medium (MMAS-8 ≥ 6 to ˂8) adherence were 25-40% and 26-36%, respectively. Fifty-five full completers (54%) reported ≥1 change in adherence category (improvement and/or worsening), most of which were associated with unintentional behavior. The data suggest that one-third of patients receiving ruxolitinib may be undertreated due to non-adherence, potentially undermining disease control, and indicate a need for better interventions addressing noncompliance to oral therapies.
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Affiliation(s)
- Paola Guglielmelli
- CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Palandri
- Policlinico S.Orsola-Malpighi, Dipartimento di Oncologia e di Ematologia, Azienda Ospedaliero-Universitaria di Bologna, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Italy
| | - Carmine Selleri
- UOC di Ematologia e Trapianti di Cellule Staminali Emopoietiche, Dipartimento di Medicina, Università di Salerno, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Patrizio Mazza
- C/O Ospedale Moscati, Department of Hematology-Oncology, Taranto, Italy
| | | | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Unità Operativa di Ematologia con TMO AOU "Policlinico - San Marco", Università degli Studi di Catania, Catania, Italy
| | - Marco Santoro
- Dipartimento di Chirurgia, Stomatologia e Oncologia Sperimentale (DiChirOnS), Università degli Studi di Palermo, Palermo, Italy
| | | | | | - Mara Morelli
- Novartis Oncology, Novartis Farma SpA, Varese, Italy
| | - Paola Coco
- Novartis Oncology, Novartis Farma SpA, Varese, Italy
| | | | - Francesco Passamonti
- Università degli Studi dell'Insubria, Ospedale di Circolo - ASST Sette Laghi, Varese, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
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20
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Chuah PL, Jamal NF, Siew CJ, Ahmad Bustamam RS, Jeyasingam V, Khong KC. Assessment of Adherence to Imatinib and Health-Related Quality of Life Among Patients with Gastrointestinal Stromal Tumor: A Cross-Sectional Study in an Oncology Clinic in Malaysia. Patient Prefer Adherence 2021; 15:2175-2184. [PMID: 34588767 PMCID: PMC8473016 DOI: 10.2147/ppa.s310409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate the rate and predictors of non-adherence to imatinib in gastrointestinal stromal tumor (GIST) patients, as well as to compare the difference in health-related quality of life (HRQOL) between adherent and non-adherent patients. PATIENTS AND METHODS A cross-sectional study at the Oncology Clinic, Hospital Kuala Lumpur was conducted from March to August 2018. All patients with metastatic and/or unresectable GIST aged ≥18 years old and on at least 3 months of imatinib were included. Adherence to imatinib was assessed using the 10-item validated Medication Compliance Questionnaire, with a score of <100% indicating non-adherence. Non-adherence predictors were determined by multiple logistic regressions. HRQOL was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The difference in the mean HRQOL scores between adherent and non-adherent groups was determined by multivariate analysis of variance. RESULTS A total of 89 patients were enrolled, of which 49 (55.1%) were considered non-adherent. The significant predictors of non-adherence were age (adjusted odds ratio [OR] 0.93; CI 0.89-0.98; P = 0.007), presence of nausea and vomiting (OR 5.63; CI 1.25-25.27; P = 0.024), and presence of comorbidities (OR 4.56; CI 1.44-14.40; P = 0.010). Patients who were in the adherent group showed significantly better score in overall HRQOL, F (15, 73) = 2.09, P < 0.02; Pillai's trace = 0.3, partial eta squared = 0.30. CONCLUSION Non-adherence to long-term treatment with imatinib among patients with GIST should not be underestimated. Significant predictors of non-adherence among this population are younger age, presence of nausea and vomiting, as well as comorbidities. Patients with good adherence portrayed better HRQOL.
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Affiliation(s)
- Paik Ling Chuah
- Department of Pharmacy, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
- Correspondence: Paik Ling Chuah Department of Pharmacy, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, MalaysiaTel +60 3 2615 5834 Email
| | - Nurnina Fareeha Jamal
- Department of Pharmacy, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Chai Jin Siew
- Department of Pharmacy, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Ros Suzanna Ahmad Bustamam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Vaishnavi Jeyasingam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Khei Choong Khong
- Department of Pharmacy, National Cancer Institute, Ministry of Health, Putrajaya, Malaysia
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21
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Social and Financial Barriers to Optimum TKI Treatment in Patients with Chronic Myeloid Leukemia-A Knowledge-Attitudes-Practices Study from India. Mediterr J Hematol Infect Dis 2021; 13:e2021004. [PMID: 33489043 PMCID: PMC7813279 DOI: 10.4084/mjhid.2021.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Outcomes in chronic myeloid leukemia (CML) have vastly improved after introducing tyrosine kinase inhibitors. However, patients in low and middle-income countries (LMICs) face many challenges due to social and financial barriers. Objective This study was conducted to understand socio-economic hindrances, knowledge-attitudes-practices, and assessing nonadherence to treatment in chronic phase CML patients taking imatinib. Materials and Methods Patients of chronic phase CML, aged 15 and above, taking imatinib for six months or more were included in the study. A questionnaire (in the Hindi language) was administered, inquiring about the nature of the disease and its treatment, how imatinib was obtained, drug-taking behavior, and the treatment’s economic and social burden. Nonadherence was assessed by enquiring patients for missed doses since the last hospital visit and for any treatment interruptions of ≥7 days during the entire course of treatment (TIs). Results Four hundred patients were enrolled (median age 37 years, median duration on imatinib 63 months). Patients hailed from 16 different Indian states, and 29.75% had to travel more than 500 kilometers for their hospital visit. Scheduled hospital visits were missed by 14.75%. A third of the patients were unaware of the lifelong treatment duration, and 41.75% were unaware of the risks of discontinuing treatment. Treatment was financed by three different means −61.75% received imatinib via the Glivec International Patient Assistance Program (GIPAP), 14.25% through a cost-reimbursement program, and 24% self-paying. 52.75% of patients felt financially burdened due to the cost of drugs (self-paying patients), cost of investigations, the expenditure of the commute and stay for the hospital visit, and loss of working days due to hospital visits. 41.25% of patients reported missed doses in the last three months, and 9% reported missing >10% doses. 16.5% of patients reported TIs. Nonadherence>10% and TIs were significantly higher in self-paying patients (15.6% and 25% respectively). Conclusion We observed that patient awareness about the disease was suboptimal. Patients felt inconvenienced and financially burdened by the treatment. Nonadherence and treatment interruptions were observed in 41.25% and 16.5%, respectively. These issues were prevalent in self-paying patients.
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22
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Munro L, Myers G, Gould O, LeBlanc M. Clinical pharmacy services in an ambulatory oncology clinic: Patient perception and satisfaction. J Oncol Pharm Pract 2020; 27:1086-1093. [PMID: 32842862 DOI: 10.1177/1078155220950412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Studies have shown that patients rate pharmacists more favourably when the pharmacist expresses interest in the patient and attends to patients' perspectives. There is limited available evidence evaluating both patient perception and satisfaction regarding clinical pharmacy services provided in an ambulatory oncology clinic. METHODS This was a prospective mixed methods study involving surveys and patient interviews. Consenting participants completed a survey at their first visit evaluating their perceptions of the importance of the clinical pharmacy services offered in the ambulatory oncology clinic. They completed a second survey 6-8 weeks later to re-evaluate their perceptions and to measure satisfaction ratings. The final component of this study involved semi-structured one-on-one telephone interviews to gather qualitative data regarding the study objectives. RESULTS A total of 35 participants completed the survey, of which eleven completed one-on-one patient telephone interviews. Patients perceived the clinical pharmacy services assessed as important to their care before receiving treatment. The ratings of the importance of the pharmacist in managing patients' nausea/vomiting significantly decreased when remeasured, whereas the importance of meeting the pharmacist in the clinic significantly increased. The importance of the role of the pharmacist was highlighted in patient interviews as well: patients particularly valued the pharmacist's initiative to meet them in the clinic, the education provided by pharmacist, and the pharmacist's accessibility throughout treatment. CONCLUSIONS Overall, patients in the ambulatory oncology clinic perceived the services offered as important to their care and they were highly satisfied.
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Affiliation(s)
- Lauren Munro
- Horizon Health Network, Moncton, New Brunswick, Canada
| | - Glenn Myers
- Horizon Health Network, Moncton, New Brunswick, Canada
| | - Odette Gould
- Horizon Health Network, Moncton, New Brunswick, Canada
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23
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Ector GI, Westerweel PE, Hermens RP, Braspenning KA, Heeren BC, Vinck OM, de Jong JJ, Janssen JJ, Blijlevens NM. The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach. J Med Internet Res 2020; 22:e15895. [PMID: 32412424 PMCID: PMC7260663 DOI: 10.2196/15895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/11/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves.
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Affiliation(s)
- Geneviève Icg Ector
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Rosella Pmg Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Ae Braspenning
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Barend Cm Heeren
- REshape Innovation Center, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jan Jm de Jong
- Dutch Patient Advocacy Group 'Hematon', Utrecht, Netherlands
| | - Jeroen Jwm Janssen
- Department of Hematology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Nicole Ma Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
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24
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Schmidt SJ, Wurmbach VS, Lampert A, Bernard S, Haefeli WE, Seidling HM, Thürmann PA. Individual factors increasing complexity of drug treatment-a narrative review. Eur J Clin Pharmacol 2020; 76:745-754. [PMID: 32239242 PMCID: PMC7239823 DOI: 10.1007/s00228-019-02818-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022]
Abstract
Purpose Complexity of drug treatment is known to be a risk factor for administration errors and nonadherence promoting higher healthcare costs, hospital admissions and increased mortality. Number of drugs and dose frequency are parameters often used to assess complexity related to the medication regimen. However, factors resulting from complex processes of care or arising from patient characteristics are only sporadically analyzed. Hence, the objective of this review is to give a comprehensive overview of relevant, patient-centered factors influencing complexity of drug treatment. Methods A purposeful literature search was performed in MEDLINE to identify potential complexity factors relating to the prescribed drug (i.e. dosage forms or other product characteristics), the specific medication regimen (i.e. dosage schemes or additional instructions), specific patient characteristics and process characteristics. Factors were included if they were associated to administration errors, nonadherence and related adverse drug events detected in community dwelling adult patients. Results Ninety-one influencing factors were identified: fourteen in “dosage forms”, five in “product characteristics”, twelve in “dosage schemes”, nine in “additional instructions”, thirty-one in “patient characteristics” and twenty in “process characteristics”. Conclusions Although the findings are limited by the non-systematic search process and the heterogeneous results, the search shows the influence of many factors on the complexity of drug treatment. However, to evaluate their relevance for individual patients, prospective studies are necessary. Electronic supplementary material The online version of this article (10.1007/s00228-019-02818-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steffen J Schmidt
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Viktoria S Wurmbach
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Simone Bernard
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Petra A Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
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25
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Nguyen BKH, Wu BS, Sanoff HK, Lafata JE. Patient-Oncologist Communication Regarding Oral Chemotherapy During Routine Office Visits. JCO Oncol Pract 2020; 16:e660-e667. [PMID: 32119593 PMCID: PMC7427422 DOI: 10.1200/jop.19.00550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although studies in other clinical areas have shown that patient-clinician communication can positively influence adherence to medications, little is known about how oncologists address medication counseling during routine office visits. We describe patient-oncologist office-based discussions of oral chemotherapy treatment. METHODS Transcripts of 24 patient-oncologist office visits were obtained from a national database. Patients were aged ≥ 19 years and prescribed capecitabine for colorectal cancer. We developed a structured coding worksheet using medication-counseling concepts previously identified as important to medication adherence and a grounded approach. Two coders reviewed transcripts for oncologists' provision of medication information, assessment of patients' adherence to medication, and the provision of self-management support for management of adverse effects. We assessed interrater reliability with Cohen κ statistics. We describe the counseling concepts present within patient-oncologist conversations and present illustrative quotes to describe how they were discussed. RESULTS Oncologists generally provided patients who had yet to initiate therapy comprehensive medication information; those in the midst of treatment received less information. Oncologists discussed patients' continued use of the medication (or discontinuation) among all patients who had initiated therapy (N = 18). How the patient was taking the medication (ie, therapy implementation) was less commonly discussed. Medication adverse effects were also discussed in all encounters. Self-management strategies were commonly provided, albeit mostly in response to a presenting symptom and not preemptively. Patients' use of concurrent medications, financial access to therapy, and assessments of logistical arrangements were discussed more sporadically. CONCLUSION Using audio recordings from a national sample of patient-oncologist office visits, we identified several potentially important opportunities to enhance medication counseling among patients prescribed capecitabine for the treatment of colorectal cancer.
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Affiliation(s)
- Bobbie K H Nguyen
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Benjamin S Wu
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hanna K Sanoff
- UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.,UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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26
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Wang Y, Zhang P, Han Y, Nelson RS, McLeod HL, Tao K, Yuan Y, Zhang M, Xiang H, Zhou H. Adherence to Adjuvant Imatinib Therapy in Patients with Gastrointestinal Stromal Tumor in Clinical Practice: A Cross-Sectional Study. Chemotherapy 2020; 64:197-204. [PMID: 31955170 DOI: 10.1159/000505177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adherence to imatinib therapy has been significantly associated with disease progression and direct medical costs in gastrointestinal stromal tumor (GIST) patients. However, adherence to oral anticancer drugs is frequently hindered by the influence of various factors. The aim of this study was to evaluate the prevalence of imatinib adherence and its influencing factors among GIST patients in the adjuvant setting. METHODS Adherence of GIST patients (receiving imatinib for ≥1 month) was assessed using the 8-item Morisky Medication Adherence Scale (MMAS), with a score <8 indicating nonadherence. Quality of life and social support were evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C30) and Social Support Rating Scale (SSRS). Factors associated with nonadherence were identified by multivariate logistic regression analysis. Imatinib plasma concentrations were determined and compared between adherent and nonadherent groups. RESULTS A total of 158 GIST patients were enrolled, 92 (58.2%) patients were considered nonadherent. Intentional nonadherence, especially feeling hassled by treatment plan (34.2% of patients), was common. In the multivariate logistic regression analysis, gender (OR 2.68, 95% CI 1.33-5.41; p = 0.0058), place of residence (OR 3.20, 95% CI 1.39-7.35; p = 0.0061), and global health status (OR 1.02, 95% CI 1.00-1.04; p = 0.0378) were significantly associated with nonadherence. Moreover, imatinib plasma concentrations in nonadherent patients were significantly lower than that in the good adherence group (p = 0.0338). CONCLUSIONS Poor adherence to imatinib is a notable problem in Chinese GIST patients in the adjuvant therapy setting. The predominant indicators of nonadherence in this study were gender (female), living in a rural area, and harboring a low global health status score. These indicators may aid clinicians in determining where increased efforts in promoting adherence may be beneficial.
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Affiliation(s)
- Yirong Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Clinical Pharmacy, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Han
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ryan S Nelson
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida, USA
| | - Howard L McLeod
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida, USA
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yonghua Yuan
- Department of Clinical Pharmacy, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Min Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Clinical Pharmacy, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Hongping Xiang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhou
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
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27
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Huguet F, Cayuela J, Cambier N, Carpentier N, Tindel M, Violet I, Zunic P, Lascaux A, Etienne G, Didier Innocent ADIKO, Shanti AMENATARAJAN, Carla ARAUJO, Omar BENBRAHIM, Martial BOISSEAU, Dominique BORDESSOULE, Azzedine BOUDERBALA, Nathalie CAMBIER, Valerie COITEUX, Pascale CONYMAKHOUL, Regis COSTELLO, Martine DELAIN, Viviane DUBRUILLE, Abderrazak ELYAMANI, Gabriel ETIENNE, Jose FERNANDES, Reda GARIDI, Agnes GUERCIBRESLER, Denis GUYOTAT, Maya HACINI, Eric HERMET, Francoise HUGUET, Jean Christophe IANOTTO, Bertrand JOLY, Eric JOURDAN, Fabrice LAROSA, Axelle LASCAUX, Sophie LEFORT, Anne MARFAING, Jean-Pierre MAROLLEAU, Jessica MICHEL, Franck NICOLINI, Isabelle PLANTIER, Philippe QUITTET, Philippe RODON, Laurence SANHES, Ioana VAIDA, Bruno VILLEMAGNE, Sorin VISANICA, Laurent VOILLAT, Patricia ZUNIC. Nilotinib efficacy, safety, adherence and impact on quality of life in newly diagnosed patients with chronic myeloid leukaemia in chronic phase: a prospective observational study in daily clinical practice. Br J Haematol 2019; 187:615-626. [DOI: 10.1111/bjh.16145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Françoise Huguet
- Department of Haematology Toulouse University Cancer Institute ToulouseFrance
| | - Jean‐Michel Cayuela
- Laboratory of Haematology University Hospital Saint‐Louis AP‐HP and EA3518, University Paris Diderot ParisFrance
| | - Nathalie Cambier
- Department of Oncology and Haematology Saint Vincent de Paul Hospital LilleFrance
| | | | | | | | - Patricia Zunic
- Department of Haematology University Hospital Centre, Saint‐Pierre Reunion IslandFrance
| | - Axelle Lascaux
- Department of Clinical Haematology and Cell Therapy Haut‐Lévêque Hospital, Bordeaux University Hospital PessacFrance
| | - Gabriel Etienne
- Department of Medical Oncology Institut Bergonié Bordeaux France
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28
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Boons CCLM, Tromp VNMF, Neppelenbroek NJM, Timmers L, van Schoor NM, Swart EL, Hendrikse NH, Janssen JJWM, Hugtenburg JG. Satisfaction with information on nilotinib treatment in chronic myeloid leukemia patients. Acta Oncol 2019; 58:891-896. [PMID: 30905234 DOI: 10.1080/0284186x.2019.1585944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Christel C. L. M. Boons
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vashti N. M. F. Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nienke J. M. Neppelenbroek
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Eleonora L. Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - N. Harry Hendrikse
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jeroen J. W. M. Janssen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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29
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Andrade AR, Leitão DDS, Paz IP, Evangelista TR, Mello VJD, Hamoy M. Analysis of imatinib adherence in chronic myeloid leukemia: a retrospective study in a referral hospital in the Brazilian Amazon. Hematol Transfus Cell Ther 2019; 41:106-113. [PMID: 31079656 PMCID: PMC6517621 DOI: 10.1016/j.htct.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/31/2018] [Accepted: 09/17/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There has been a revolution in the treatment of Chronic Myeloid Leukemia since imatinib's introduction. However, patient adherence has a great impact on the response obtained with medical treatment. This study's objective was to analyze the drug adherence and the factors that influenced it in patients with Chronic Myeloid Leukemia in a referral hospital in the Brazilian Amazon. METHOD This was a retrospective study including 120 patients with Chronic Myeloid Leukemia from January 2002 to December 2014. The adherence was estimated by the Proportion of Days Covered and the persistence by Kaplan-Meier analysis. The data was analyzed in Epi Info 7® software and the relationship between the variables was analyzed by Fisher's exact test. A p-value lower than 0.05 was considered significant. RESULTS Twenty-seven patients (22.5%) were considered non-adherent. There has been irregular medication use and disinterest in the treatment in 20.83% (n=25), of which 13 were considered non-adherent (p<0.001). A total of 26.67% (n=32) abandoned the treatment for a period. Of those, 56.25% (n=18) were non-adherent (p<0.001). Distance to the hospital, lack of medication and side-effects were all non-significant to low adherence. At the end of a 360-day follow-up, 44.16% (n=53) of patients presented a break in persistence, whose average was 255 days. CONCLUSION The adherence found in this study was similar to that found in others of its kind. The only factors that negatively influenced the adherence were disinterest and abandonment of treatment, which can reflect the need to individually educate Chronic Myeloid Leukemia patients.
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Affiliation(s)
| | | | | | | | | | - Moisés Hamoy
- Universidade Federal do Pará (UFPA), Belém, PA, Brazil
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Patel K, Sudhir VS, Kabadi S, Huang JC, Porwal S, Thakkar K, Pagel JM. Impact of dosing frequency (once daily or twice daily) on patient adherence to oral targeted therapies for hematologic malignancies: a retrospective cohort study among managed care enrollees. J Oncol Pharm Pract 2019; 25:1897-1906. [PMID: 30823852 PMCID: PMC6839022 DOI: 10.1177/1078155219827637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose Existing studies evaluating patient adherence to oral targeted therapies such as tyrosine kinase inhibitors focus on small populations with single malignancies. This study evaluated patterns of use of oral agents in a larger population across multiple hematologic malignancies. Methods Adult patients diagnosed with a hematologic malignancy and prescribed oral targeted therapy between 2011 and 2016 (N = 18,976) were identified from the MarketScan Commercial Claims and Encounters, and Medicare Supplemental databases. Eligible patients were enrolled in monthly prescription plans 6 months before and 12 months after the index date (date of first prescription claim; n = 2442). Multivariable logistic regressions were used to determine predictors of adherence using the medication possession ratio (MPR) and persistence through prescription refill gaps. Results The overall median adherence was 0.9 (MPR ≥ 80%) and was comparable between once-daily (QD) and twice-daily (BID) groups. Overall, 59% of patients were persistent at 12 months. Patients on QD and BID products did not have any significant differences in adherence (fixed-interval MPR, odds ratio 0.94; 95% confidence interval (CI), 0.75–1.18) or persistence (odds ratio 0.93; 95% CI, 0.75–1.17) 12 months from index. Significant predictors of adherence and persistence included patient age, total inpatient admissions, number of adverse events, and total hospital visits. Conclusion Patient-specific clinical factors, rather than regimen-specific factors, were the main predictors of oral targeted therapy adherence and persistence. Adherence to oral targeted therapies appears to be similar for patients on QD and BID regimens in the real-world setting.
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Affiliation(s)
- Krish Patel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Shaum Kabadi
- US Medical Affairs, AstraZeneca LP, Gaithersburg, MD, USA
| | | | | | | | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
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A New Take on a Resource-Based Model of Quality of Life in Hemato-Oncological Patients: Demographic, Personal, and Social Factors. J Clin Psychol Med Settings 2019; 26:430-439. [DOI: 10.1007/s10880-019-09600-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ector GICG, Govers TM, Westerweel PE, Grutters JPC, Blijlevens NMA. The potential health gain and cost savings of improving adherence in chronic myeloid leukemia. Leuk Lymphoma 2019; 60:1485-1492. [PMID: 30668187 DOI: 10.1080/10428194.2018.1535113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Healthcare costs are rising due to an increase in chronic diseases, including chronic myeloid leukemia (CML) due to improved survival. In CML care, patient adherence and physician adherence are key elements. We assessed the potential health gain and cost savings when both are improved, using a decision analytic model that integrated various sources of evidence. The current situation was compared to a theoretical situation in which either patient or physician adherence is improved, in terms of costs and quality-adjusted life years (QALYs). Current patient adherence rate is 74%, improvement to 100% resulted in 0.1031 QALYs gained and a saving of €17,509 per patient over a 25-year period. Improving physician adherence from 72% to 100%, resulted in 0.0380 QALYs and €7606. Enhancement of either adherence results in substantial health gain and cost savings. Regarding the rising healthcare costs, new strategies should focus on improving adherence to keep healthcare affordable in the future.
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Affiliation(s)
- Geneviève I C G Ector
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tim M Govers
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands.,b MedValue , Nijmegen , The Netherlands
| | - Peter E Westerweel
- c Department of Hematology , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Janneke P C Grutters
- d Department for Health Evidence , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nicole M A Blijlevens
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands
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Yanamandra U, Malhotra P, Sahu K, Sushma Y, Saini N, Chauhan P, Gill J, Rikhi D, Khadwal A, Prakash G, Lad D, Suri V, Kumari S, Varma N, Varma S. Variation in Adherence Measures to Imatinib Therapy. J Glob Oncol 2018; 4:1-10. [PMID: 30241224 PMCID: PMC6223484 DOI: 10.1200/jgo.2016.007906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The introduction of tyrosine kinase inhibitors has transformed the care of patients with chronic myeloid leukemia, with survival approaching that of healthy individuals. Current-day challenges in chronic myeloid leukemia care include adherence to tyrosine kinase inhibitor therapy. We studied adherence from resource-constrained settings and tried to analyze the factors responsible for nonadherence in these individuals. We also correlated adherence to current molecular status. PATIENTS AND METHODS This was a single-center, cross-sectional, observational study from north India. It consisted of a questionnaire-based survey in which a one-to-one interview technique was used by trained nursing staff administering the Modified Morisky Adherence Scale (MMAS-9) questionnaire. Adherence was also measured on the basis of physician's assessment. JMP 13.0.0 was used for statistical analysis. RESULTS A total of 333 patients with a median age of 42 years were included in the study. The median BCR-ABL/ABL ratio (IS) was 0.175 (0.0 to 98.0). The mean MMAS-9 score was 11 ± 2. Adherence was seen in 54.95% on the basis of MMAS-9, whereas physician's assessment reported adherence in 90.39% of patients. Using the χ2 test, no relationship was found between the two assessment techniques. There was a significant relationship between major molecular response status and adherence by physician's assessment and MMAS-9 ( P < .001). Bivariate analysis by logistic fit showed a good relation between the MMAS-9 score and the BCR-ABL/ABL ratio (IS), χ2 (1,220) = 135.45 ( P < .001). On multivariate analysis, enrolment in the Novartis Oncology Access program (a patient assistance program) was significantly associated with adherence ( P = .012). CONCLUSION This study highlights the lack of adherence in real-world settings and the various factors responsible. Such studies are important from a public health services perspective in various settings around the world because they may lead to corrective action being taken at the institutional level.
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Affiliation(s)
- Uday Yanamandra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pankaj Malhotra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - K.K. Sahu
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Yanamandra Sushma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neha Saini
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pooja Chauhan
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Jasmeen Gill
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepika Rikhi
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Alka Khadwal
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Gaurav Prakash
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepesh Lad
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Vikas Suri
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Savita Kumari
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neelam Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Subhash Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
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Leader A, Gafter-Gvili A, Benyamini N, Dreyer J, Calvarysky B, Amitai A, Yarchovsky-Dolberg O, Sharf G, Tousset E, Caspi O, Ellis M, Levi I, Raanani P, De Geest S. Identifying Tyrosine Kinase Inhibitor Nonadherence in Chronic Myeloid Leukemia: Subanalysis of TAKE-IT Pilot Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e351-e362. [PMID: 30122203 DOI: 10.1016/j.clml.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND There are inconsistencies in reports on correlates for nonadherence (NA) to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML). The diagnostic accuracy of subjective adherence measures using electronic monitoring (EM) as the reference standard is yet to be determined. This study aimed to evaluate correlates of TKI NA using EM and test the diagnostic accuracy of subjective adherence measures. PATIENTS AND METHODS CML patients receiving a TKI for any duration were enrolled at 4 hematology institutes, and adherence was measured for 4 months. EM adherence was the reference adherence measure, expressed as the percentage of days with the drug taken as prescribed. Subjective adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) self-report and clinician-reported visual analog scale (VAS) at 2 time points. Baseline theory-derived correlates of NA were identified using single and multiple regression analysis. The diagnostic accuracy of BAASIS and clinician-reported VAS was tested against an exploratory EM NA cutoff of < 95%. RESULTS The median EM adherence (n = 55) was 97.5% (range, 48-100%), while the 25th percentile was 92.1%. Lack of membership in a CML patient support group, living alone, and third-line treatment were associated with EM NA on multiple regression analysis. The BAASIS self-report (n = 94) had a sensitivity of 67% and a specificity of 71% for diagnosing NA, while clinician-reported VAS (n = 89) had a sensitivity of 78% and specificity of 42%. CONCLUSION A quarter of patients had potentially clinically meaningful NA. These NA correlates and the BAASIS provide a basis for identifying nonadherent patients who can be targeted by interventions.
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Affiliation(s)
- Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Noam Benyamini
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Juliet Dreyer
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Bronya Calvarysky
- Department of Pharmacy, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Alina Amitai
- Department of Pharmacy, Meir Medical Center, Kfar Saba, Israel
| | - Osnat Yarchovsky-Dolberg
- Sackler School of Medicine, Tel Aviv University, Israel; Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Giora Sharf
- Israeli CML Patients Organization, Netanya, Israel
| | | | - Opher Caspi
- Sackler School of Medicine, Tel Aviv University, Israel; Integrative medicine and Cancer Survivorship Program; Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Martin Ellis
- Sackler School of Medicine, Tel Aviv University, Israel; Integrative medicine and Cancer Survivorship Program; Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Itai Levi
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Center of Nursing and Midwifery, Department Public Health and Primary Care, KU Leuven, Belgium
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Rood JAJ, Lissenberg-Witte BI, Eeltink C, Stam F, van Zuuren FJ, Zweegman S, Verdonck- de Leeuw IM. The need for information among patients with hematological malignancies: Psychometric analyses of the 62-item Hematology Information Needs Questionnaire (HINQ-62). PLoS One 2018; 13:e0201699. [PMID: 30092035 PMCID: PMC6084926 DOI: 10.1371/journal.pone.0201699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/22/2018] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to investigate the psychometric characteristics (content validity, internal consistency, and subscale structure) of the Hematology Information Needs Questionnaire-62 (HINQ-62), a patient reported outcome measure (PROM) for assessing the need for information among patients with hematological malignancies (HM-patients). Baseline data were used from a prospective study on the need for information which 336 newly diagnosed HM-patients had completed. In phase 1 (design phase), data from the first 135 patients were used and in phase 2 (validation phase), data from the remaining 201 HM patients were used. Content validity was analyzed by examining irrelevance of items. Items were considered irrelevant if more than 10% of the patients scored totally disagree on that item. The subscale structure of the HINQ-62 was investigated with Factor analysis (FA) (exploratory FA in phase 1 and confirmatory FA in phase 2). Cronbach's α was computed for the different subscales and >.70 was considered as good internal consistency. None of the 62 HINQ-items were irrelevant. Exploratory FA identified five subscales: "Disease, symptoms, treatment and side-effects", "Etiology, sleep and physical changes", "Self-care", "Medical tests and prognosis", and "Psychosocial". Root Mean Square Error of Approximation (RMSEA) among patients was 0.037 in phase 1 and 0.045 in phase 2. The comparative fit index (CFI)/Tucker-Lewis index -non-normed fit index among patients was 0.984/0.983 and 0.948/0.946, in phase 1 and 2 respectively. The internal consistency of the subscales was good, with Cronbach's α 0.82-0.99. The HINQ is a valid PROM for assessing the need for information among Dutch HM-patients at diagnosis.
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Affiliation(s)
- Janneke A. J. Rood
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
- Department of Internal medicine, Northwest Clinics, Alkmaar, the Netherlands
- * E-mail:
| | | | - Corien Eeltink
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Frank Stam
- Department of Internal medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
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Boons CCLM, Harbers L, Timmers L, de Jong J, Swart EL, Harry Hendrikse N, Janssen JJWM, Hugtenburg JG. Needs for information and reasons for (non)adherence in chronic myeloid leukaemia: Be aware of social activities disturbing daily routines. Eur J Haematol 2018; 101:643-653. [PMID: 30058149 DOI: 10.1111/ejh.13155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To obtain insight into patients' reasons for medication (non)adherence in chronic myeloid leukaemia (CML) and needs and wishes regarding information and communication. METHODS A mixed-method study on the basis of a questionnaire and semi-structured interviews. The CML patient advocacy group asked patients to participate. RESULTS Sixty-one patients (54 ± 12 years, 43% male) using imatinib, dasatinib or nilotinib participated. Fifteen patients (25%) reported to miss an intake at least once a month. Most were not worried about missing an intake and did not discuss missed intakes with their healthcare provider (HCP). Social activities disturbing daily routines and the wish to avoid side effects resulted in nonadherence. Patients wanted extensive and understandable information provided timely on all aspects of CML treatment, in particular on side effects, and a more supportive HCP attitude. CONCLUSIONS Nonadherence to CML medication does not cause concern in all patients and is not discussed pro-actively. HCP have a clear role in supporting medication adherence in CML and must be aware that social activities disturbing daily routines contribute to nonadherence. HCP should discuss (non)adherence in a direct manner, motivate patients to play an active role in managing their medication and timely provide extensive and understandable information on all aspects of CML.
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Affiliation(s)
- Christel C L M Boons
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Netherlands
| | - Lorette Harbers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
| | - Lonneke Timmers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Netherlands
| | | | - Eleonora L Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
| | - N Harry Hendrikse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
| | - Jeroen J W M Janssen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Haematology, Cancer Center Amsterdam, Netherlands
| | - Jacqueline G Hugtenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, Cancer Center Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Netherlands
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Comorbidity Burden and Use of Concomitant Medications at CML Diagnosis: A Retrospective Analysis of 527 Patients From the Polish Adult Leukemia Group Registry. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e283-e285. [DOI: 10.1016/j.clml.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/22/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
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Soverini S, Mancini M, Bavaro L, Cavo M, Martinelli G. Chronic myeloid leukemia: the paradigm of targeting oncogenic tyrosine kinase signaling and counteracting resistance for successful cancer therapy. Mol Cancer 2018; 17:49. [PMID: 29455643 PMCID: PMC5817796 DOI: 10.1186/s12943-018-0780-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/01/2018] [Indexed: 12/12/2022] Open
Abstract
Deregulated activity of BCR-ABL1, a nonreceptor tyrosine kinase encoded by the fusion gene resulting from the t(9;22)(q34;q11) chromosomal translocation, is thought to be the driver event responsible for initiation and maintenance of chronic myeloid leukemia (CML). BCR-ABL1 was one of the first tyrosine kinases to be implicated in a human malignancy and the first to be successfully targeted. Imatinib mesylate, the first tyrosine kinase inhibitor (TKI) to be approved for therapeutic use, was hailed as a magic bullet against cancer and remains one of the safest and most effective anticancer agents ever developed. Second- and third-generation TKIs were later introduced to prevent or counteract the problem of drug resistance, that may arise in a small proportion of patients. They are more potent molecules, but have been associated to more serious side effects and complications. Patients achieving stable optimal responses to TKI therapy are predicted to have the same life expectancy of the general population. However, TKIs do not ‘cure’ CML. Only a small proportion of cases may attempt therapy discontinuation without experiencing subsequent relapse. The great majority of patients will have to assume TKIs indefinitely – which raises serious pharmacoeconomic concerns and is now shifting the focus from efficacy to compliance and quality of life issues. Here we retrace the steps that have led from the biological acquisitions regarding BCR-ABL1 structure and function to the development of inhibitory strategies and we discuss drug resistance mechanism and how they can be addressed.
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Affiliation(s)
- Simona Soverini
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Manuela Mancini
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luana Bavaro
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michele Cavo
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giovanni Martinelli
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Al-Amri AM. Outcome of Chronic Myeloid Leukemia-Chronic Phase Patients Treated With Imatinib: A Local Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:199-203. [PMID: 29397347 DOI: 10.1016/j.clml.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/30/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Imatinib was the first tyrosine kinase inhibitor that has revolutionized the therapy of chronic myeloid leukemia. It binds breakpoint cluster region-Abelson kinase domain inducing apoptosis of the leukemic cells. In this study, we assessed the efficacy and toxicity of imatinib therapy in patients with chronic myeloid leukemia in chronic phase (CML-CP) in our hospital. PATIENTS AND METHODS We retrospectively analyzed the outcome of 17 patients with CML-CP treated with imatinib. RESULTS The median age at the time of presentation was 35 years with male preponderance. The most common presenting clinical features were fatigue, abdominal distention, and discomfort. Forty-seven percent of patients had fever at presentation whereas 35.29% were referred to our hospital because of incidental findings of high blood cell counts. With a median follow-up of 8 years (range, 2-16 years) the overall survival is 100% and progression-free survival 85%. Two patients had acceptable adverse effects. CONCLUSION After a median follow-up of 8 years, imatinib was found to induce long survival with manageable side effect in adult Saudi patients with CML-CP.
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Affiliation(s)
- Ali M Al-Amri
- Department of Internal Medicine/Oncology, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Eastern Province, Kingdom of Saudi Arabia.
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Shen C, Zhao B, Liu L, Shih YCT. Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia. Cancer 2018; 124:364-373. [PMID: 28976559 PMCID: PMC5764158 DOI: 10.1002/cncr.31050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKIs) improve the survival of patients with chronic myeloid leukemia (CML) dramatically; however, nonadherence to TKI therapy may lead to resistance to the therapy. TKIs are very expensive and are covered under Part D insurance for Medicare patients. To the authors' knowledge, the impact of low-income subsidy status and cost sharing on adherence among this group has not been well studied in the literature. METHODS Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare Part D data from the years 2007 through 2012 were used in the current study. The authors identified 836 patients with CML with Medicare Part D insurance coverage who were new TKI users. Treatment nonadherence was defined as a binary variable indicating the percentage of days covered was <80% during the 180-day period after the initiation of TKI therapy. Logistic regression was used to examine the relationship between out-of-pocket costs per 30-day drug supply, Medicare Part D plan characteristics, and treatment adherence while controlling for other patient characteristics. RESULTS Overall, 244 of the 836 patients with CML (29%) were nonadherent to targeted oral therapy during the 180 days after the initiation of treatment with TKIs. The multivariable logistic regression demonstrated that patients with heavily subsidized (odds ratio, 6.7; 95% confidence interval, 2.8-15.9) and moderately subsidized (odds ratio, 3.0; 95% confidence interval, 1.4-6.5) Medicare Part D plans were much more likely to demonstrate nonadherence compared with patients without a subsidy. CONCLUSIONS The current population-based study found a significantly higher rate of nonadherence among heavily subsidized patients with substantially lower out-of-pocket costs, which suggests that future research is needed to help lower the nonadherence rate among these individuals. Cancer 2018;124:364-73. © 2017 American Cancer Society.
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Affiliation(s)
- Chan Shen
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bo Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bouwman L, Eeltink CM, Visser O, Janssen JJWM, Maaskant JM. Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation. BMC Cancer 2017; 17:739. [PMID: 29121889 PMCID: PMC5679497 DOI: 10.1186/s12885-017-3735-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Medication non-adherence is associated with poor health outcomes and increased health care costs. Depending on definitions, reported non-adherence rates in cancer patients ranges between 16 and 100%, which illustrates a serious problem. In malignancy, non-adherence reduces chances of achievement of treatment response and may thereby lead to progression or even relapse. Except for Chronic Myeloid Leukemia (CML), the extent of non-adherence has not been investigated in hematological-oncological patients in an outpatient setting. In order to explore ways to optimize cancer treatment results, this study aimed to assess the prevalence of self-administered medication non-adherence and to identify potential associated factors in hematological-oncological patients in their home situation. METHODS This is an exploratory cross-sectional study, carried out at the outpatient clinic of the Department of Hematology at the VU University medical center, Amsterdam, the Netherlands between February and April 2014. Hematological-oncological outpatients were sent questionnaires retrieving information on patient characteristics, medication adherence, beliefs about medication, anxiety, depression, coping, and quality of life. We performed uni- and multivariable analysis to identify predictors for medication non-adherence. RESULTS In total, 472 participants were approached of which 259 (55%) completed the questionnaire and met eligibility criteria. Prevalence of adherence in this group (140 male; 54,1%; median age 60 (18-91)) was 50%. In univariate analysis, (lower) age, (higher) education level, living alone, working, perception of receiving insufficient social support, use of bisphosphonates, depression, helplessness (ICQ), global health, role function, emotional function, cognitive function, social functioning, fatigue, dyspnea, diarrhea were found to be significantly related (p = <0.20) to medication non-adherence. In multivariable analysis, younger age, (higher) education level and fatigue remained significantly related (p = <0.10) to medication non-adherence. CONCLUSIONS This cross-sectional study shows that 50% of the participants were non-adherent. Lower age, living alone and perception of insufficient social support were associated factors of non-adherence in hematological-oncological adult patients in their home-situation.
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Affiliation(s)
- Linda Bouwman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Corien M. Eeltink
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
- Cancer Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Otto Visser
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Jolanda M. Maaskant
- Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, Amsterdam, the Netherlands
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Hefner J, Csef EJ, Kunzmann V. Adherence and Coping Strategies in Outpatients With Chronic Myeloid Leukemia Receiving Oral Tyrosine Kinase Inhibitors. Oncol Nurs Forum 2017; 44:E232-E240. [PMID: 29052661 DOI: 10.1188/17.onf.e232-e240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess adherence and coping strategies in outpatients with chronic myeloid leukemia (CML) on oral tyrosine kinase inhibitors (TKIs).
. DESIGN Prospective, descriptive.
. SETTING An interdisciplinary oncology outpatient clinic in Germany.
. SAMPLE 35 outpatients with CML on oral TKIs.
. METHODS Adherence and coping strategies were assessed with questionnaires. Clinical data were extracted from medical charts.
. MAIN RESEARCH VARIABLES Adherence rates, main coping strategies, and frequency and contents of single coping strategies.
. FINDINGS 18 patients showed adherence according to the applied screening instrument. Main coping strategies were spirituality and search for meaning. The two single items most frequently specified were adhering to medical instructions and trusting in the medical personnel involved.
. CONCLUSIONS The low adherence rate of 51% most likely resulted from using the Basel Assessment of Adherence Scale as the questionnaire of choice. The relevance of spirituality and search for meaning as main coping strategies has not been shown previously in outpatients with CML. Most patients wish to obey medical instructions accurately and put trust in their oncologists; this introduces a resource that should gain relevance considering the increasing number of oral anticancer drugs.
. IMPLICATIONS FOR NURSING Nurses are encouraged to routinely assess adherence and spiritual needs in outpatients with CML. Spirituality and search for meaning represent pivotal coping strategies in this group, which has an excellent prognosis. Oncology nurses may help provide tailored support, thereby ameliorating care for these patients.
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Barata A, Wood WA, Choi SW, Jim HSL. Unmet Needs for Psychosocial Care in Hematologic Malignancies and Hematopoietic Cell Transplant. Curr Hematol Malig Rep 2017; 11:280-7. [PMID: 27113094 DOI: 10.1007/s11899-016-0328-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Individuals diagnosed with hematologic malignancies experience significant unmet psychological, physical, informational, financial, and spiritual needs. The goal of the current review is to summarize and highlight recent research focused on these issues in the diagnosis and treatment periods and beyond. The review also describes the needs of adolescent and young adult (AYA) and pediatric patients. While a large body of research has reported on unmet needs among adult hematologic cancer patients, there is far less data regarding the challenges confronted by AYA and pediatric populations. Available data suggests that among all age groups, hematopoietic cell transplantation (HCT) is a risk factor for greater unmet needs. Recommendations for screening and evidence-based interventions to prevent or ameliorate unmet needs are provided. Future research is needed to develop additional evidence-based psychosocial interventions with a focus on hematologic cancer.
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Affiliation(s)
- Anna Barata
- Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- IIB Sant Pau and Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | | | | | - Heather S L Jim
- Moffitt Cancer Center, 12902 Magnolia Drive MRC-PSY, Tampa, FL, 33612, USA.
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Kawakami K, Yokokawa T, Kobayashi K, Sugisaki T, Suzuki K, Suenaga M, Yamaguchi K, Inoue A, Machida Y, Yamaguchi T, Hama T. Self-Reported Adherence to Capecitabine on XELOX Treatment as Adjuvant Therapy for Colorectal Cancer. Oncol Res 2017; 25:1625-1631. [PMID: 28766482 PMCID: PMC7841266 DOI: 10.3727/096504017x15012905098071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adherence has become an important issue in modern oncology treatment. Most studies have included heterogeneous target tumor types, regimens, and therapy settings. Our study focused on capecitabine during capecitabine plus oxaliplatin (XELOX) treatment as an adjuvant therapy for colorectal cancer. The main aims of this study were to evaluate real-life adherence to capecitabine and to investigate candidate factors that might decrease adherence. We studied 338 consecutive patients who received XELOX treatment between December 1, 2011, and April 30, 2015, at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research. Our study assessed adherence to capecitabine through patient-reported treatment diaries and interviewed nonadherents to determine the reasons for not taking capecitabine at a pharmaceutical outpatient clinic. We calculated the adherence rate in a cycle as: number of times the patient took capecitabine/28. Relative dose intensities and factors associated with deteriorating adherence to capecitabine were retrospectively surveyed from electronic patient records. Uni- and multivariate logistic regression analyses were used to investigate factors associated with optimal adherence. The study covered 282 patients who received 2,055 cycles of XELOX. Median adherence rate was 94.0% in the first cycle, and median relative dose intensity of capecitabine was 77.8%. The most common reasons for nonadherence were nausea/vomiting and diarrhea. The presence of the following factors was not significantly associated with adherence: ECOG performance status ≥1 (p = 0.715), clinical stage (p = 0.408), primary tumor site (p = 0.576), age ≥70 years at study entry (p = 0.757), female gender (p = 0.504), and not living alone (p = 0.579). The adherence rate from this study was significantly higher than the adherence from metastatic settings. Adherence-enhancing interventions for capecitabine in XELOX treatment as adjuvant therapy comprised management of nausea/vomiting and diarrhea.
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Gomez-de-León A, Gómez-Almaguer D, Ruiz-Delgado GJ, Ruiz-Arguelles GJ. Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective. Expert Rev Hematol 2017; 10:809-819. [PMID: 28742419 DOI: 10.1080/17474086.2017.1360180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.
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Affiliation(s)
- Andrés Gomez-de-León
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
| | - David Gómez-Almaguer
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
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Rychter A, Jerzmanowski P, Hołub A, Specht-Szwoch Z, Kalinowska V, Tęgowska U, Seferyńska I, Kołkowska-Leśniak A, Lech-Marańda E, Góra-Tybor J. Treatment adherence in chronic myeloid leukaemia patients receiving tyrosine kinase inhibitors. Med Oncol 2017; 34:104. [PMID: 28444623 PMCID: PMC5405100 DOI: 10.1007/s12032-017-0958-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/12/2017] [Indexed: 01/28/2023]
Abstract
Failure to comply with treatment recommendations is very common in patients, but still poorly recognised by doctors. The current practice of using oral therapy on a large scale has been increasingly adopted for cancer patients. Chronic myeloid leukaemia (CML) is just such an example, where the introduction of taking new oral medications, the tyrosine kinase BCR-ABL inhibitors (TKI), has now revolutionised the treatment. The aim of our study was to assess treatment adherence in a group of Polish CML patients (a survey was conducted on 140 patient aged ≥18 years) treated with oral TKI (imatinib, dasatinib and nilotinib) taking into account the following variables: gender, age, education, place of residence, family circumstances and duration of therapy. In addition, we evaluated whether there is a relationship between how patients perceive their level of adherence to treatment recommendations with how subjectively the required dosage regimen was followed. Half the patients admitted to skipping at least one drug dose during the entire course of treatment and 39% did so within their last treatment month. Patients were also found to overestimate their own adherence assessment; around 60% of those missing at least 1 drug dose within the last treatment month believed they 'always' followed recommendations. The study demonstrated that adherence deteriorates over time. Furthermore, patients aged >65 years and patients suffering at least one comorbid disease had better adherence (p < 0.011). There were no differences in adherence among patients treated with imatinib, dasatinib and nilotinib (p = 0.249).
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Affiliation(s)
- Anna Rychter
- Department of Hematology, Medical University of Lodz, 2 Ciolkowskiego Street, 93-510 Lodz, Poland
| | - Piotr Jerzmanowski
- Hematology Clinic, Multidisciplinary Center for Oncology and Traumatology, Lodz, Poland
| | - Adam Hołub
- Hematology Clinic, Multidisciplinary Center for Oncology and Traumatology, Lodz, Poland
| | | | | | - Urszula Tęgowska
- Department of Hematology, Copernicus Memorial Hospital, Toruń, Poland
| | - Ilona Seferyńska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Ewa Lech-Marańda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joanna Góra-Tybor
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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Machado-Alba JE, Machado-Duque ME. Use patterns of first-line inhibitors of tyrosine kinase and time to change to second-line therapy in chronic myeloid leukemia. Int J Clin Pharm 2017; 39:851-859. [PMID: 28508322 DOI: 10.1007/s11096-017-0484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/08/2017] [Indexed: 12/25/2022]
Abstract
Background Chronic myeloid leukemia (CML) has a low incidence but a high burden of disease, and is treated with high-cost tyrosine kinase inhibitors (TKI). Objective To determine the time from the start of a first-line TKI until it passes to second-line, and to establish the reasons for the change of therapy time. Setting Patients with Philadelphia-positive CML treated with some TKI. Methods Retrospective cohort study, between January 1 2007 and July 31 2015, with information obtained from medical records, the time to change initial drugs to secondline therapy, and the reasons for change, were identified. Kaplan-Meier survival analysis was carried out. Main outcome measure A change in therapy to the secondline TKI and the final reason for the change of therapy. Results A total of 247 patients treated were found in 22 cities in Colombia with a mean age of 53.2 ± 15.2 years. The drug most used as initial therapy was imatinib; 53.8% of cases had to change to another TKI. 50% of patients changed therapy in 42 months, men in 24 and women in 67 months (95% CI 14.314-33.686; p = 0.001). Being male (OR 2.23; 95% CI 1.291-3.854; p = 0.004) and receiving hydroxyurea (OR 3.65; 95% CI 1.601-8.326; p = 0.002) were associated with a higher probability of switching to nilotinib or dasatinib, while receiving a new-generation TKI (OR 0.15; 95% CI 0.071-0.341; p < 0.001) reduced this risk. Conclusions A high proportion of patients needed to change to a second line with nilotinib and dasatinib management. It is necessary to obtain more real world evidence, to improve the effectiveness, adherence and safety of the treatment.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud-Programa de Medicina, Universidad Tecnológica de Pereira- Audifarma S.A., Paraje la Julita, AA: 97, Pereira, Risaralda, 660003, Colombia.
| | - Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud-Programa de Medicina, Universidad Tecnológica de Pereira- Audifarma S.A., Paraje la Julita, AA: 97, Pereira, Risaralda, 660003, Colombia
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Jacobs JM, Pensak NA, Sporn NJ, MacDonald JJ, Lennes IT, Safren SA, Pirl WF, Temel JS, Greer JA. Treatment Satisfaction and Adherence to Oral Chemotherapy in Patients With Cancer. J Oncol Pract 2017; 13:e474-e485. [DOI: 10.1200/jop.2016.019729] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Although patients with cancer overwhelming prefer oral to intravenous chemotherapy, little is known about adherence to oral agents. We aimed to identify the rates and correlates of adherence in patients with diverse malignancies. Materials and Methods: Ninety patients with chronic myeloid leukemia or metastatic renal cell carcinoma, non–small-cell lung cancer, or breast cancer enrolled in this prospective, single-group, observational study of medication-taking behaviors. Adherence was measured via self-report and with an electronic pill cap (Medication Event Monitoring System cap). Patients completed surveys regarding symptom distress, mood, quality of life, cancer-specific distress, and satisfaction with clinician communication and treatment at baseline and 12-week follow-up. Results: As measured by the Medication Event Monitoring System, patients took, on average, 89.3% of their prescribed oral chemotherapy over the 12 weeks. One quarter of the sample was less than 90% adherent, and women were more adherent than men (mean difference, 9.59%; SE difference, 4.50%; 95% CI, −18.65 to −0.52; P = .039). Improvements in patient symptom distress (B = −0.79; 95% CI, −1.41 to −0.18), depressive symptoms (B = –1.57; 95% CI, –2.86 to –0.29), quality of life (B = 0.38; 95% CI ,0.07 to 0.68), satisfaction with clinician communication and treatment (B = 0.73; 95% CI, 0.49 to 0.98), and perceived burden to others (B = −1.28; 95% CI, −2.20 to −0.37) were associated with better adherence. In a multivariate model, improved treatment satisfaction (B = 0.71; 95% CI, 0.48 to 0.94) and reduced perceived burden (B = −0.92; 95% CI, −1.76 to −0.09) were the strongest indicators of better adherence. Conclusion: Women and patients who reported increased treatment satisfaction and reduced burden to others were more adherent to oral chemotherapy. Interventions that help patients improve communication with clinicians and reduce burden may optimize oral chemotherapy adherence.
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Affiliation(s)
- Jamie M. Jacobs
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Nicole A. Pensak
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Nora J. Sporn
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - James J. MacDonald
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Inga T. Lennes
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Steven A. Safren
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - William F. Pirl
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Jennifer S. Temel
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
| | - Joseph A. Greer
- Massachusetts General Hospital Cancer Center and Harvard Medical School; Boston University School of Public Health, Boston, MA; University of Colorado Denver–Anschutz Medical Campus, Aurora, CO; University of California Los Angeles, Los Angeles, CA; University of Miami, Coral Gables; and University of Miami Miller School of Medicine, Miami, FL
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Normen M, Veeraiah S, Ganesan P. Living with chronic myeloid leukemia in India-an exploratory study. Psychooncology 2017; 26:711-714. [DOI: 10.1002/pon.4202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Michelle Normen
- Department of Psycho-oncology & Resource Centre for Tobacco Control (RCTC); Cancer Institute (WIA); Chennai Tamil Nadu India
| | - Surendran Veeraiah
- Department of Psycho-oncology & Resource Centre for Tobacco Control (RCTC); Cancer Institute (WIA); Chennai Tamil Nadu India
| | - Prasanth Ganesan
- Department of Medical Oncology; Cancer Institute (WIA); Chennai Tamil Nadu India
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Johnson LA. Factors influencing oral adherence: qualitative metasummary and triangulation with quantitative evidence. Clin J Oncol Nurs 2017; 19:6-30. [PMID: 26030389 DOI: 10.1188/15.s1.cjon.6-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concern about adherence to oral agents among patients with cancer has grown as more oral agents are being used for cancer treatment. Knowledge of common factors that facilitate or inhibit adherence to oral medication regimens can be beneficial to clinicians in identifying patients at risk for nonadherence, in planning care to address barriers to adherence, and in educating patients about ways to improve adherence. OBJECTIVES The focus of this review is to synthesize the evidence about factors that influence adherence and identify implications for practice. METHODS Literature was searched via PubMed and CINAHL®. Evidence regarding factors influencing adherence was synthesized using a metasummary of qualitative research and triangulated with findings from quantitative research. FINDINGS Forty-four factors influencing adherence were identified from 159 research studies of patients with and without cancer. Factors associated with adherence in oncology and non-oncology cases included provider relations, side effects, forgetfulness, beliefs about medication necessity, establishing routines for taking medication, social support, ability to fit medications in lifestyle, cost, and medication knowledge. Among patients with cancer, depression and negative expectations of results also were shown to have a negative relationship to adherence.
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