Tyrosine kinase inhibitors in patients with chronic myelogeneous leukemia: defining the role of social risk factors and non-adherence to treatment
Objective: To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients.
Methods: This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists’ consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship.
Results: Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients’ level of education could not explain low adherence rates behavior.
Conclusions: Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates.
2. Brunner AM, Campigotto F, Sadrzadeh H, Drapkin BJ, Chen YB, Neuberg DS, Fathi AT. Trends in all-cause mortality among patients with chronic myeloid leukemia: a Surveillance, Epidemiology, and End Results database analysis. Cancer. 2013;119(14):2620262-9. doi: 10.1002/cncr.28106
3. de Almeida MH, Pagnano KB, Vigorito AC, Lorand-Metze I, de Souza CA. Adherence to tyrosine kinase inhibitor therapy for chronic myeloid leukemia: a Brazilian single-center cohort. Acta Haematol. 2013;130(1):16-22. doi: 10.1159/000345722
4. Hirji I, Gupta S, Goren A, Chirovsky DR, Moadel AB, Olavarria E, Victor TW, Davis CC. Chronic myeloid leukemia (CML): association of treatment satisfaction, negative medication experience and treatment restrictions with health outcomes, from the patient's perspective. Health Qual Life Outcomes. 2013;11:167. doi: 10.1186/1477-7525-11-167
5. Jabbour E, Kantarjian H, O'Brien S, Rios MB, Abruzzo L, Verstovsek S, Garcia-Manero G, Cortes J. Sudden blastic transformation in patients with chronic myeloid leukemia treated with imatinib mesylate. Blood. 2006;107(2):480-482.
6. Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, McMurray JJ, Rouleau JL, Aylward PE, White HD, Califf RM, Schulman KA. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J. 2006;151(1):206-212.
7. Nichols GA, Vupputuri S, Lau H. Medical care costs associated with progression of diabetic nephropathy. Diabetes Care. 2011;34(11):2374-2378. doi: 10.2337/dc11-0475
8. Santoleri F, Sorice P, Lasala R, Rizzo RC, Costantini A. Patient adherence and persistence with Imatinib, Nilotinib, Dasatinib in clinical practice. PLoS One. 2013;8(2):e56813. doi: 10.1371/journal.pone.0056813
9. Darkow T, Henk HJ, Thomas SK, Feng W, Baladi JF, Goldberg GA, Hatfield A, Cortes J. Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics. 2007;25(6):481-496.
10. Sabaté E, editor. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.
11. Noens L, van Lierde MA, De Bock R, Verhoef G, Zachée P, Berneman Z, Martiat P, Mineur P, Van Eygen K, MacDonald K, De Geest S, Albrecht T, Abraham I. Prevalence, determinants, and outcomes of non-adherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113(22):5401-5411. doi: 10.1182/blood-2008-12-196543
12. Nkwi P, Nyamongo I, Ryan G. [internet] Field Research into Social Issues: Methodological Guidelines. Washington, DC: UNESCO, 2001. Available at: http://www.ccs.neu.edu/course/is4800sp12/resources/qualmethods.pdf (accessed 3 May 2015).
13. Pope C, Mays N. Qualitative Research in Health Care. London: BMJ Books; 2000.
14. Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, Apperley JF, Szydlo R, Desai R, Kozlowski K, Paliompeis C, Latham V, Foroni L, Molimard M, Reid A, Rezvani K, de Lavallade H, Guallar C, Goldman J, Khorashad JS. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. Clin Oncol. 2010;28(14):2381-2388. doi: 10.1200/JCO.2009.26.3087
15. StCharles M, Bollu VK, Hornyak E, Coombs J, Blanchette CM, DeAngelo DJ. Predictors of treatment non-adherence in patients treated with imatinib mesylate for chronic myeloid leukemia. Blood (ASH Annual Meeting Abstracts) 2009;114:2209.
16. Jabbour EJ, Kantarjian H, Eliasson L, Cornelison AM, Marin D. Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia. Am J Hematol. 2012;87(7):687-691. doi: 10.1002/ajh.23180
17. Efficace F, Baccarani M, Rosti G, Cottone F, Castagnetti F, Breccia M, Alimena G, Iurlo A, Rossi AR, Pardini S, Gherlinzoni F, Salvucci M, Tiribelli M, Vignetti M, Mandelli F. Investigating factors associated with adherence behaviour in patients with chronic myeloid leukemia: an observational patient-centered outcome study. Br J Cancer. 2012;107(6):904-909. doi: 10.1038/bjc.2012.348
18. Chen LC, Chen TC, Huang YB, Chang CS. Disease acceptance and adherence to imatinib in Taiwanese chronic myeloid leukaemia outpatients. Int J Clin Pharm. 2014;36(1):120-127. doi: 10.1007/s11096-013-9867-8
19. Guilhot F, Coombs J, Szczudlo T, Zernovak O, Paolantonio M, Bender C, Macdonald NJ, Shapiro A. The patient journey in chronic myeloid leukemia patients on tyrosine kinase inhibitor therapies: qualitative insights using a global ethnographic approach. Patient. 2013;6(2):81-92. doi: 10.1007/s40271-013-0006-3
20. Okumura LM, Rotta I, Correr CJ. Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review. Int J Clin Pharm. 2014;36(5):882-891. doi: 10.1007/s11096-014-9982-1
21. O'Brien S, Radich JP, Abboud CN, Akhtari M, Altman JK, Berman E, Curtin P, DeAngelo DJ, Deininger M, Devine S, Fathi AT, Gotlib J, Jagasia M, Kropf P, Moore JO, Pallera A, Reddy VV, Shah NP, Smith BD, Snyder DS, Wetzler M, Gregory K, Sundar H. Chronic myelogenous leukemia, version 1.2015. J Natl Compr Canc Netw. 2014;12(11):1590-1610.
22. Wu S, Chee D, Ugalde A, Butow P, Seymour J, Schofield P. Lack of congruence between patients' and health professionals' perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study. Palliat Support Care. 2015;13(2):255-263. doi: 10.1017/S1478951513001260
23. Guilhot F, Coombs J, Szczudlo T, Zernovak O, Paolantonio M, Bender C, Macdonald NJ, Shapiro A. The patient journey in chronic myeloid leukemia patients on tyrosine kinase inhibitor therapies: qualitative insights using a global ethnographic approach. Patient. 2013;6(2):81-92. doi: 10.1007/s40271-013-0006-3
24. Malbasa T, Kodish E, Santacroce SJ. Adolescent adherence to oral therapy for leukemia: a focus group study. J Pediatr Oncol Nurs. 2007;24(3):139-151.
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