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Ramsdale E, Mohamed M, Holmes HM, Zubkoff L, Bauer J, Norton SA, Mohile S. Decreasing polypharmacy in older adults with cancer: A pilot cluster-randomized trial protocol. J Geriatr Oncol 2024; 15:101687. [PMID: 38302299 PMCID: PMC10923001 DOI: 10.1016/j.jgo.2023.101687] [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] [Received: 09/08/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Polypharmacy is prevalent in older adults with cancer and associated with multiple adverse outcomes. A single-site, cluster-randomized clinical trial will enroll older adults with cancer and polypharmacy starting chemotherapy and will assess the effectiveness and feasibility of deprescribing interventions by comparing two arms: a pharmacist-led deprescribing intervention and a patient educational brochure. MATERIALS AND METHODS The study will be conducted in two phases. In phase I, focus groups and semi-structured individual interviews will guide adaptation of deprescribing interventions for the oncology clinic (phase Ia), and eight patients will undergo the pharmacist-led deprescribing intervention with iterative adaptations (phase Ib). In phase II, a pilot cluster-randomized trial (n = 72) will compare a pharmacist-led deprescribing intervention with a patient education brochure, with treating oncologists as the cluster. Both efficacy (relative dose intensity of planned chemotherapy, potentially inappropriate medications successfully deprescribed, chemotherapy toxicity, functional status, hospitalizations, falls, and symptoms) and implementation outcomes (barriers and facilitators) will be assessed. DISCUSSION This study is anticipated to provide pilot data to inform a nationwide randomized clinical trial of deprescribing in older adults starting cancer treatment. The cluster randomization is intended to provide an initial estimate for the intervention effect as well as oncologists' intra-class correlation coefficient. Deprescribing interventions may improve outcomes in older adults starting cancer treatment, but these interventions are understudied in this population, and it is unknown how best to implement them into oncology practice. The results of this trial will inform the design of large, randomized phase III trials of deprescribing. CLINICALTRIALS gov Identifier:NCT05046171. Date of registration: September 16, 2021.
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Affiliation(s)
- Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA.
| | - Mostafa Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, McGovern Medical School, TX, USA
| | - Lisa Zubkoff
- Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Jessica Bauer
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Sally A Norton
- School of Nursing, University of Rochester Medical Center, NY, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
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Gibek K. Side effects of treatment with tyrosine kinase inhibitors in patients with chronic myeloid leukaemia and the occurrence of depressive symptoms. Contemp Oncol (Pozn) 2024; 27:277-283. [PMID: 38405209 PMCID: PMC10883194 DOI: 10.5114/wo.2023.135362] [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: 10/23/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction The aim of the study was to check whether individual side effects of treatment with tyrosine kinase inhibitors (TKI) in patients suffering from chronic myeloid leukaemia (CML) contribute to the occurrence of depressive symptoms. In addition, it was decided to check whether there is any correlation between the age, sex, and duration of treatment and the intensity of depressive symptoms, in relation to the occurrence of individual side effects. Material and methods The study included 91 patients with CML treated with TKI. The following questionnaires were used: a questionnaire created by the author, David Goldberg's general health questionnaire-28 (GHQ-28), and the four-dimensional symptom questionnaire (4DSQ). Results Our research showed that fatigue (β = 0.27; p = 0.007), nausea/indigestion (β = 0.26; p = 0.008), bone and joint pain (β = 0.21; p = 0.033), and abdominal pain (β = 0.33; p ≤ 0.001) were the most common side effects of TKI treatment resulting in increased depressive symptoms. Age and duration of treatment had a significant impact on the severity of depressive symptoms in patients experiencing specific side effects of TKI treatment. Conclusions The results indicate the influence of the occurrence of TKI treatment side effects on the development of depressive symptoms. Patients' quality of life can be improved with the cooperation of medical staff in reducing/alleviating the side effects.
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Affiliation(s)
- Katarzyna Gibek
- Haematology Department, Jagiellonian University Hospital, Kraków, Poland
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Cheng F, Cui Z, Li Q, Wang L, Li W. Adherence to tyrosine kinase inhibitor and clinical outcomes in patients with chronic myeloid leukemia. Int Immunopharmacol 2023; 124:110847. [PMID: 37639851 DOI: 10.1016/j.intimp.2023.110847] [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: 05/01/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To ensure optimal care for patients with chronic myeloid leukemia (CML), adherence to tyrosine kinase inhibitors (TKIs) has emerged as a critical component. The objective of this study was to assess the impact of TKIs adherence on clinical outcomes in a cohort of Chinese CML patients who received treatment with TKIs. METHODS This retrospective study employed a cross-sectional design utilizing questionnaires to assess adherence to TKIs in a sample of 398 patients diagnosed with CML. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-8), which dichotomizes patients into low, medium, and high adherence groups. RESULTS Of the patients included in this study, 34.2% were classified as highly adherent, with 43.2% and 22.6% of patients categorized as having medium and low adherence, respectively. Compared to the low-adherence group, patients in the medium- and high-adherence groups exhibited significantly higher rates of achieving major molecular response (MMR) and lower rates of switching TKIs. Moreover, patients who failed to adhere to TKIs treatment demonstrated significantly lower event-free survival and failure-free survival compared to those in the high-adherence group. Notably, regular molecular monitoring and utilization of the "CML Academy" mobile application were positively associated with increased TKI adherence. On the other hand, patients receiving third-generation or above first-line TKIs treatment displayed reduced adherence. CONCLUSION The findings suggest that high adherence to TKIs treatment confers clinical benefits to patients with CML. Accordingly, the implementation of effective guidance and intervention measures aimed at promoting adherence to TKIs therapy in real-world settings is imperative.
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Affiliation(s)
- Fang Cheng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, Hubei Province 430022, China
| | - Zheng Cui
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, Hubei Province 430022, China
| | - Qiang Li
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, Hubei Province 430022, China
| | - Liu Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, Hubei Province 430022, China
| | - Weiming Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, China.
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Russell K, Moghaddam N, Tickle A. Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2022; 31:e13678. [PMID: 35977801 PMCID: PMC9787612 DOI: 10.1111/ecc.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting. METHOD Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted. RESULTS A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting. CONCLUSION Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.
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Affiliation(s)
- Katie Russell
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
| | - Nima Moghaddam
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of LincolnLincolnUK
| | - Anna Tickle
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
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Chen N, Meng Z, Song J, Kong L, Zhang Y, Guo S, Zhang X, Lu X, Jiang L, Chen R, Jiao Z, Zhao L. miR-506 in patients with chronic myeloid leukemia and its effect on apoptosis of K562 cells. Am J Transl Res 2021; 13:9413-9420. [PMID: 34540060 PMCID: PMC8430173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/07/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the expression of miR-506 in chronic myeloid leukemia (CML) and its influence on the biological function of CML cells. METHODS Altogether 84 CML patients from February 2012 to September 2014 were obtained as the observation group (OG), and 71 healthy people were taken as the control group (CG). miR-506 was tested using RT-qPCR, and the 5-year survival of patients with high and low expression of miR-506 was compared with the median value of miR-506 as the limit. ROC curve was applied to detect the value of miR-506 in diagnosing CML and predicting the 5-year survival of patients, and K562 cell line was transfected with miR-506 inhibitor and miR-506 mimic for observing its effects on the cell proliferation and apoptosis. RESULTS miR-506 in CML patients was evidently lower than that in healthy people, the AUC of diagnosis of miR-506 was 0.883, the total survival of patients with low miR-506 was evidently lower than those with high miR-506, and the AUC of predicted survival of patients was 0.778. The proliferation of cells transfected with miR-506 inhibitor was promoted, the apoptosis and the survival rate reduced. CONCLUSION miR-506 is evidently reduced in CML, and may be applied as a diagnostic and predictive treatment for CML and 5-year related survival; it can also can hinder the viability of K562 cells and promote apoptosis.
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Affiliation(s)
- Nafei Chen
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Zhen Meng
- Department of Hematology, Hudson International Peace Hospital, Heng Shui City People’s HospitalHengshui 053000, Hebei Province, China
| | - Jiaojie Song
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Lingfang Kong
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Yehua Zhang
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Suli Guo
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Xiaokun Zhang
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Xin Lu
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Licai Jiang
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Ran Chen
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Zongjiu Jiao
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
| | - Liyun Zhao
- Department of Hematology, Xingtai People’s HospitalXingtai 054000, Hebei Province, China
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Bao M, Yang S, Gale RP, Zhang Y, Liu X, Zhu H, Liang R, Liu B, Zhou L, Li Z, Dou X, Shi D, Wang T, Meng L, Li W, Jiang Q. Mental Health in Persons With Chronic Myeloid Leukemia During the SARS-CoV-2 Pandemic: The Need for Increased Access to Health Care Services. Front Psychiatry 2021; 12:679932. [PMID: 34168583 PMCID: PMC8217438 DOI: 10.3389/fpsyt.2021.679932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 02/05/2023] Open
Abstract
Mental health problems in the general population have been reported during the SARS-CoV-2 pandemic; however, there were rare data in persons with chronic myeloid leukemia (CML). Therefore, we performed a cross-sectional study on mental health evaluated using the 9-item Patient Health Questionnaire (PHQ-9; depression), the 7-item Generalized Anxiety Disorder (GAD-7; anxiety), and the 22-item Impact of Event Scale-Revised (IES-R; distress), including subscales of avoidance, intrusion, and hyper-arousal in persons with CML, non-cancer persons, and immediate family members of persons with cancer as controls (≥16 years) by an online survey. Data from 3,197 persons with CML and 7,256 controls were collected. In multivariate analyses, CML was significantly associated with moderate to severe depression (OR = 1.6; 95% Confidence Interval [CI], 1.4, 1.9; p < 0.001), anxiety (OR = 1.4 [1.1, 1.7]; p = 0.001), distress (OR = 1.3 [1.1, 1.5]; p < 0.001), and hyper-arousal (OR = 1.5 [1.3, 1.6]; p < 0.001). Moreover, delay in regular monitoring was significantly associated with depression (OR 1.3 [1.0, 1.7]; p = 0.024), anxiety (OR = 1.3 [1.0, 1.8]; p = 0.044), avoidance (OR = 1.2 [1.0, 1.4]; p = 0.017), and intrusion (OR = 1.2 [1.0, 1.4]; p = 0.057); tyrosine kinase-inhibitor dose reduction or discontinuation, depression (OR = 1.9 [1.3, 2.8]; p = 0.001), distress (OR = 2.0 [1.4, 2.8]; p < 0.001), avoidance (OR = 1.6 [1.2, 2.1]; p = 0.004), intrusion (OR = 1.6 [1.1, 2.1]; p = 0.006), and hyper-arousal (OR = 1.3 [1.0, 1.8]; p = 0.088). We concluded that persons with CML during the SARS-CoV-2 pandemic have worse mental health including depression, anxiety, and distress symptoms. Decreasing or stopping monitoring or dose resulted in adverse mental health consequences.
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Affiliation(s)
- Mei Bao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Sen Yang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Yanli Zhang
- Department of Hematology, Henan Provincial Tumor Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huanling Zhu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Bingcheng Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology, Chinese Academy of Medical Sciences, Tianjin, China
| | - Li Zhou
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongru Li
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xuelin Dou
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Dayu Shi
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Tao Wang
- Department of Epidemiology and Biostatistics School of Public Health Peking University Health Science Center, Beijing, China
| | - Li Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiming Li
- Department of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
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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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Al-Ghazaly J, Al-Dubai W, Noaman Y, Abdullah M, Al-Gharasi L, Rosti G. Outcome of Imatinib Treatment in Yemeni Patients With Chronic Myeloid Leukemia and the Influence of Nonadherence to Treatment and Duration of Previous Hydroxyurea Therapy. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2020; 20:e144-e153. [PMID: 31983635 DOI: 10.1016/j.clml.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In a developing country like Yemen, data are limited regarding the outcome of imatinib treatment of chronic myeloid leukemia and the effect of nonadherence to imatinib treatment and previous duration of hydroxyurea treatment. PATIENTS AND METHODS A longitudinal cohort study, which included 164 Yemeni patients, was performed. Data regarding the disease characteristics, adherence to treatment (the medication possession ratio) and outcome were analyzed. RESULTS After a median follow-up of 60 months and a median duration of imatinib treatment of 46 months, 79 (48.2%) patients were adherent to treatment. In adherent patients, the overall survival and progression-free survival (PFS) were 78 (98.7%) and 73 patients (92.4%), respectively and major molecular response (MMR) rates at 12 months and at 46 months were 32 (41.0%) and 45 patients (57.0%), respectively, compared with 67 (78.8%), 51 (60%), 5 (6.9%), and 2 patients (2.4%), respectively, in nonadherent patients (P < .001 for all parameters). Nonadherence to imatinib treatment and duration of hydroxyurea treatment of more than 12 months before starting imatinib were found to adversely affect PFS in univariate (hazard ratio [HR], 7.5 and 9.7, respectively and P < .001 for both) and multivariate (HR, 5.6 and 9.3; P = .001 and P < .001, respectively) analysis. High risk Sokal score was found to adversely affect PFS in univariate analysis (HR of high to low risk, 2.8; P < .022) but not in multivariate analysis. CONCLUSION Yemeni patients who were adherent to imatinib therapy achieved response rates similar to that of international standards. Nonadherence to imatinib treatment and previous duration of hydroxyurea treatment for more than 12 months, as a proxy of long interval between diagnosis and starting imatinib treatment, reduced the optimal response to imatinib therapy.
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Affiliation(s)
- Jameel Al-Ghazaly
- Department of Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Hematology unit, Al-Jomhori Teaching Hospital, Sana'a, Yemen.
| | - Waled Al-Dubai
- Department of Biochemistry and Cytogenetics, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Yousr Noaman
- Molecular Unit, National Oncology Center, Sana'a, Yemen
| | | | | | - Gianantonio Rosti
- Institute of Hematology and Medical Oncology "Seràgnoli," University of Bologna, Bologna, Italy
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Mohamed MR, Ramsdale E, Loh KP, Arastu A, Xu H, Obrecht S, Castillo D, Sharma M, Holmes HM, Nightingale G, Juba KM, Mohile SG. Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis. Oncologist 2020; 25:e94-e108. [PMID: 31570516 PMCID: PMC6964156 DOI: 10.1634/theoncologist.2019-0406] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population. MATERIALS AND METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. RESULTS Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3-2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. CONCLUSION PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies. IMPLICATIONS FOR PRACTICE Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.
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Affiliation(s)
- Mostafa R. Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Asad Arastu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Huiwen Xu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Public Health, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Spencer Obrecht
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Daniel Castillo
- MLIS‐Miner Library, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Manvi Sharma
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, UniversityMississippiUSA
| | - Holly M. Holmes
- The University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Katherine M. Juba
- Department of Pharmacy, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Pharmacy Practice, Wegmans School of PharmacyRochesterNew YorkUSA
| | - Supriya G. Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
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Clinical Importance of Drug Adherence during Tyrosine Kinase Inhibitor Therapy for Chronic Myelogenous Leukemia in Chronic Phase. REPORTS 2019. [DOI: 10.3390/reports2040025] [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] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm constituting approximately 15% of newly diagnosed leukemia in adult patients. Development of tyrosine kinase inhibitors (TKIs) have dramatically improved outcomes in patients with chronic CML in chronic phase. However, adverse drug events (ADEs) associated with TKI therapy have influenced drug adherence, resulting in adverse clinical outcomes and a decline in the quality of life (QoL). In this study, we carried out a unique questionnaire survey to evaluate ADEs, which comprised 14 adverse events. We compared drug adherence rates between patients using imatinib and those who switched from imatinib to nilotinib, a second-generation TKI. Following the switch, the total number of ADEs decreased considerably in most cases. Simultaneously, better QoL was observed in the nilotinib group than in the imatinib group. Drug adherence was measured using Morisky’s 9-item Medication Adherence Scale (MMAS). MMAS increased significantly after switching to nilotinib in all cases. Drug adherence is a critical factor for achieving molecular response in patients with CML. In fact, our results showed a strong inverse correlation between clinical outcome (international scale (IS)) and adherence (MMAS), with a stronger tendency in the nilotinib group than in the imatinib group. In conclusion, low occurrence of ADEs induced a high level of QoL and a good clinical response with second-generation TKI nilotinib treatment.
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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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Prevalence and determinants of non-adherence to Imatinib in the first 3-months treatment among newly diagnosed Ethiopian's with chronic myeloid leukemia. PLoS One 2019; 14:e0213557. [PMID: 30845227 PMCID: PMC6405163 DOI: 10.1371/journal.pone.0213557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/19/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives Imatinib has shown to be highly efficacious in the treatment of chronic myeloid leukemia (CML) but continuous dosing and patient adherence is essential treatment success. The study aimed to assess prevalence and reasons for non-adherence to Imatinib in newly diagnosed patients with CML in the first 3-months of treatment. Methods The study was conducted from October 1, 2016 to November 30, 2017 at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A total of 147 newly diagnosed patients were followed and their adherence status was determined using the 8-items Morisky Medication Adherence Scale and reasons for their non-adherence were evaluated using semi-structured questionnaire. Descriptive statistics were used to summarize the data while multivariable logistic regression was employed to explore associations among variables of interest. Results Participants’ median age at time of confirmed diagnosis was 36 years; with most of them in the age group of <40 years (64.6%). Males comprised 59.2%. Adherence rate was found to be 55.1%. Those who lived in rural area, had low income, adverse drug events and comorbidity were significantly associated with treatment non-adherence. Most (68.4%) patients missed their medication due to adverse drug events. Three patients were lost-to-follow-up. Among 144 patients who finished the 3-month follow-up, 91.7% of them achieved complete hematologic remission. Morisky high adherent (AOR = 8.6, 95%CI:4.32–11.1) was positively associated with complete hematologic remission. Conclusions Overall treatment adherence is suboptimal. Thus, efforts should be made to improve adherence and further study is required to explore impact adherence on the cytogenetic and molecular responses of Ethiopian patients with CML.
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Bolarinwa RA, Olowookere SA, Owojuyigbe TO, Origbo EC, Durosinmi MA. Challenges to Care and Medication Adherence of Patients With Chronic Myeloid Leukemia in a Resource Limited Setting: A Qualitative Study. J Patient Exp 2018; 5:195-200. [PMID: 30214926 PMCID: PMC6134545 DOI: 10.1177/2374373517748641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The factors related to care of patients with chronic myeloid leukemia (CML) often affects treatment outcome. We examined adherence to medication and other challenges to care in our patients on treatment of CML. This qualitative study involved in-depth interviews of 20 patients with CML receiving free imatinib (Glivec) from the Glivec International Patients' Assistance Program. Data collected were thematically analyzed. Findings revealed that despite free drug assistance, there was relative lack of awareness resulting in inappropriate health-seeking behavior. The challenges cut across situations such as poverty, fear of the sustenance of the compassionate drug program, and living far away from the clinic. Forgetfulness was reported as the cause of poor adherence in this study. Suggested solutions include increasing community awareness, ensuring sustainability of the program and establishing more treatment centers nationwide. Strategies such as reminders and patents' support will improve drug adherence among this cohort.
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Affiliation(s)
- R A Bolarinwa
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - S A Olowookere
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - T O Owojuyigbe
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - E C Origbo
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
| | - M A Durosinmi
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Nigeria
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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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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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Outcome of Frontline Treatment with "Generic" Imatinib In Adult Patients with Chronic Myeloid Leukemia in Algerian Population: A Multicenter Study. Mediterr J Hematol Infect Dis 2017; 9:e2017062. [PMID: 29181139 PMCID: PMC5667527 DOI: 10.4084/mjhid.2017.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction In a developing country like Algeria, such expensive therapy is not available. Alternative approaches are needed to help these adult. In Algeria 'imatib' (CIPLA-India) was introduced in 2006; but no study has been published yet in the North Africa region regarding response and outcome of this copy in CML patients. The goal of this multicenter study is to characterize newly adult CML in the western region of Algeria and to assess the effectiveness and safety of imatib (IM, copy) as frontline therapy for patients with CML. Patients and Methods The study was carried out in 7 hematology centers in the western Algeria. Patients, who were diagnosed to be suffering from CML between January 1st, 2007 and December 31st, 2014 were selected for data analysis. All patients received a copy preparation, consisting of the alpha crystal form of imatinib, (IM, copy) at an oral dose of 400 mg daily and monitored for tolerance and side effects while on therapy. Results Between January 2007 and December 2014, 355 patients with CML were treated with imatib (Copy). The median follow- up of the study was 46 months (range: 13-107 months). Complete hematological response (CHR) was seen in 83% of patients within 3 months. According to the Sokal score, 72% patients with low, 78% with intermediate and 69% with high risk disease achieved a CHR in 3 months (p=0.26) and according to the EUTOS score, 81% of patients with low and 70% with high risk disease achieved a CHR in 3 months (p=0.08). The major molecular response (MMR) at six months (M6), M9, M12, M18 and M24 was 21%, 38%, 35%, 51% and 67% respectively and 34% of patients achieved a complete molecular response (CMR). The projected 5-year overall survival (OS) rate was 83%. Side effects of imatib (copy) in this study were similar to those reported previously for the entire imatinib mesylate treatment study and only 8% of patients were intolerant to imatib (copy) and treated with a second generation of BCR-ABL inhibitor. Conclusion This study reflects real world experience treating patients with CML in a developing country and thus sheds light on differences in this population compared to Western countries. In conclusion, imatib (copy) is effective and safe in treating patients with CML in chronic phase and proves to have a durable outcome. To our knowledge this is the first study reporting the response to imatib (copy) in an Algerian population.
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Yu L, Qin YZ, Jiang Q. [Analysis on tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia in the real world: experience from single center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:754-760. [PMID: 29081191 PMCID: PMC7348370 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 01/07/2023]
Abstract
Objective: To explore status of tyrosine kinase inhibitor (TKI) discontinuation in patients with chronic myeloid leukemia (CML) in the chronic phase (CP) in the real world, to analyze causes, factors and outcomes associated with TKI discontinuation and the possibility of pursuit treatment-free remission (TFR) in China. Methods: From January 2013 to August 2016, data of CML-CP patients in Peking University People's Hospital which were not enrolled in clinical trials were retrospectively collected and analyzed. Results: Data of 662 CML-CP patients were collected. With a median follow-up after TKI-therapy of 26 months (range, 3-187 months) , 187 patients (28.2%) experienced TKI cessation of at least 2 weeks. Causes of TKI discontinuation included hematologic adverse events 57.8% (n=108) , non-hematologic adverse events 30.4% (n=57) , financial burden 25.1% (n=47) , and others 7.0% (n= 13) . Multivariate analyses showed female, ≥40 years, no co-morbidity, and interval from diagnosis to TKI initiation ≥6 months, TKI switch and patients from other hospitals were factors associated with TKI discontinuation because of hematologic adverse effects. Female and patients from other hospitals were factors associated with TKI discontinuation because of non-hematologic adverse effect. TKI switch, generic TKI used and patients from other hospitals were factors associated with TKI discontinuation because of financial toxicity. Patients TKI discontinuation because of hematologic, non-hematologic or financial toxicity achieved a lower complete cytogenetic response or complete molecular response (CMR) than those with uninterrupted TKI-therapy. Patients with TKI discontinuation because of hematologic or financial toxicity had a shorter progression-free survival than those with uninterrupted TKI-therapy. 5 of 7 patients who obtained sustained CMR and discontinued TKI-therapy experienced disease recurrence with a median duration of 3 months (range, 2-32 months) . In 39 patients from other hospitals who aimed to confirm their optimal response of sustained CMR in Peking University People's Hospital, 21 (53.8%) were BCR-ABL positive. Conclusion: In the real world in China, half of CML-CP patients who discontinued TKI-therapy were incurred to TKI-related hematologic adverse effect, and both a quarter of them, TKI-related non-hematologic toxicities and financial toxicity, respectively. Discontinued TKI-therapy due to hematologic adverse events or financial toxicity was associated with lower TKI-therapy response rates. Nowadays, based on the Chinese situation, it is too early to talk about TFR.
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Affiliation(s)
- L Yu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboatory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Maeda Y, Okamoto A, Kawaguchi SI, Konishi A, Yamamoto K, Eguchi G, Kanai Y, Yamaguchi T. Improved Drug Adherence in Patients with Chronic Myeloid Leukemia in the Chronic Phase by Switching to Second-Generation Tyrosine Kinase Inhibitors. Acta Haematol 2017; 138:140-142. [PMID: 28869927 DOI: 10.1159/000477893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/30/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Yasuhiro Maeda
- Department of Hematology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan
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Botti S, Gargiulo G, Bombaci F, Artioli G, Cosentino C, Pignatelli AC, Torino D, Lionetti MM, Samarani E, Cappucciati L, Bordiga P, Diodati A, Caffarri C, Rosini I, Pane F. Clinical pathway for patients with Chronic Myeloid Leukaemia: The Euriclea Project. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:5-12. [PMID: 28752827 DOI: 10.23750/abm.v88i3 -s.6608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence. The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients. METHODS A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers. Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis. RESULTS Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. DISCUSSION The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.
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Affiliation(s)
- Stefano Botti
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
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Factors influencing adherence in CML and ways to improvement: Results of a patient-driven survey of 2546 patients in 63 countries. J Cancer Res Clin Oncol 2017; 143:1167-1176. [PMID: 28289895 DOI: 10.1007/s00432-017-2372-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
Abstract
Optimal adherence to CML therapy is of key importance to maximize treatment effectiveness. Two clinical studies (ADAGIO and Hammersmith) have proven a clear correlation between adherence and achieving optimal treatment response and have revealed that non-adherence is common in CML patients (Marin et al. in J Clin Oncol 28(24):2381-2388, 2010, Noens et al. in Haematologica 99(33):437-447, 2014). The aim of this study is to assess the extent of suboptimal adherence and to investigate motivations and behavioural patterns of adherence in a worldwide patient sample. Questionnaires were provided by the CML Advocates Network and were filled in by patients online and offline. Patient characteristics, treatment and motivations were collected. Adherence was assessed by the 8-item Morisky Medication Adherence scale. Logistic regression models were fitted to investigate the influence of different factors on adherence. Overall, 2 546 questionnaires from 63 countries and 79 CML patient organisations were evaluable. 32.7% of participants were highly adherent, 46.5% were in the medium and 20.7% in the low adherence group. Factors increasing the probability of being in the high adherence group are older age, male sex, management of side effects, only one tablet per day and feeling well informed about CML by the doctor. More than 2 years since diagnosis were significantly lowering the chance as was the use of reminding tools. Living arrangements, multiple medication and personal payment obligations increased the probability to be at least in the medium adherent group. This is the most comprehensive study conducted to date to gain knowledge about factors causing non-adherence in CML. Better information on the disease, medication and management of side effects, supported by haematologists, is key to improve adherence.
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Botti S, Gargiulo G, Bombaci F, Artioli G, Cosentino C, Pignatelli AC, Torino D, Lionetti MM, Samarani E, Cappucciati L, Bordiga P, Diodati A, Caffarri C, Rosini I, Pane F. Clinical pathway for patients with Chronic Myeloid Leukaemia: The Euriclea Project. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28752827 PMCID: PMC6357587 DOI: 10.23750/abm.v88i3-s.6608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence. The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients. METHODS A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers. Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis. RESULTS Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. DISCUSSION The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.
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Affiliation(s)
- Stefano Botti
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy,Correspondence: Stefano Botti, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, E-mail:
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- Federico II University Hospital of Naples, Italian Society of Hematology President, Italy
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Dunbar-Jacob J, Rohay JM. Predictors of medication adherence: fact or artifact. J Behav Med 2016; 39:957-968. [PMID: 27306683 DOI: 10.1007/s10865-016-9752-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/26/2016] [Indexed: 12/31/2022]
Abstract
Numerous studies have examined socio-demographic, psychosocial, and other factors as potential contributors to poor adherence. Variability exists in the strength and consistency of findings. We speculated that the method of measuring adherence might be a factor in the variability in identification of predictor variables. We examined the identification of predictors of adherence by method of measurement in two randomized, controlled trials of adherence interventions. Both studies used the Aardex Medication Event Monitor and the Morisky Self-Report Scale. Twenty-one days of baseline data from 698 subjects were examined in relation to measures of depression, functional status, perceived therapeutic efficacy, number of co-morbidities, and socio-demographic indices. Analysis included Spearman rho, Pearson r, and multiple logistic regression. Differences in the identification of predictors between adherence measurement methods were identified. These data support the hypothesis that different measurement methods yield different predictors of adherence.
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Affiliation(s)
- Jacqueline Dunbar-Jacob
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Room 350, Pittsburgh, PA, 15261, USA.
| | - Jeffrey M Rohay
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Room 412, Pittsburgh, PA, 15261, USA
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Young age and high cost are associated with future preference for stopping tyrosine kinase inhibitor therapy in Chinese with chronic myeloid leukemia. J Cancer Res Clin Oncol 2016; 142:1539-47. [DOI: 10.1007/s00432-016-2159-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 01/14/2023]
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