A reliable method for evaluating drug compliance in children with cancer

Abstract

Poor drug compliance may cause a decreased survival of children with ma-lignancies. Children who fail to take their medications are not receiving optimum amounts of chemotherapy and suboptimal therapy causes a shortened survival in children with cancer. This is a study of prednisone compliance in 52 children with cancer during three distinct phases of therapy. The patients were either known to be taking prednisone (on-therapy group), off prednisone (off-therapy group), or their compliance was unknown (unknown group). Evaluation of prednisone compliance was attempted by measuring hemoglobin level changes, weight changes, and random urinary 17-ketogenic steroids. The results obtained show that while hemoglobin and weight changes are not helpful, a random urine 17-ketogenic steroid assay is able to differentiate clearly those patients who are taking their prednisone. By the use of this assay it was found that 33% of patients who by protocol and instruction were supposed to be receiving prednisone were not complying. Separate analysis of adolescents revealed an even more alarming 59% noncompliance rate. This striking level of noncompliance strongly suggests that the survival of patients may be threatened by noncompliance. Cancer 43:169-173, 1979. OPULATIONS OF CHILDREN with acute leu-P kemia that have been treated with the same drug regimens have shown different induction rates and remission lengths.2,6 One possible explanation for these varying results may be the number of patients who fail to take all of their prescribed medications. Studies of drug compliance in various other disease states have documented that therapeutic regi-mens are not always followed completely. Compliance is known to be related to the severity of the illness, the complexity of the treatment, the duration of therapy, and the severity of the patient's symptom^.',^ Children with cancer, when in remission, are indeed on prolonged, complex therapy while being relatively asymptomatic and poor drug compliance might be expected. This study has evaluated prednisone com

The influence of serum methotrexate concentrations and drug dosage on outcome in childhood acute lymphoblastic leukaemia

“…Thus patients who tolerate low doses of 6-MP and Mtx may be those who have higher intracellular concentrations of metabolites. This study does not address the important variables of patient and physician compliance in drug administration (Smith et al, 1979). It did not compare differences between prescribed and received doses of orally administered cytotoxic drugs.…”

Avaliação da adesão ao tratamento através de questionários: estudo prospectivo de 73 crianças portadoras de leucemia linfoblástica aguda

“…Nevertheless, the results observed for the present sample are similar to those of other studies, in which compliance failures were detected in 2 to 52% of cases. [4][5][6][7][8][9][10][11][12][13][14][15] In a study that included 39 patients from this sample, compliance with treatment was assessed by three different methods. 16 Compliance failures were detected in 53.8% of cases, 33% by questionnaire, 30.7% from notes on medical records and 16.6% by means of 6-MP metabolite assay.…”

“…Against this background, compliance failures are, top a certain extent, to be expected. 4 When they are not detected, such failures can increase the chances of disease relapse, 3 resulting in incorrect assessments of chemotherapy efficacy. 6 Assessment of compliance with treatment can be performed by direct methods (assaying medication levels in biological samples) or by indirect ones (reports by patients or their parents, physicians estimates, counting pills, etc.).…”

“…Nevertheless, little published work has taken as its objective the study of compliance with treatment in children and adolescents with leukemia. [4][5][6][7][8][9][10][11][12][13][14][15][16] This research project took as its primary focus the evaluation of compliance with treatment during the maintenance phase of chemotherapy in a population of children with ALL.…”

Assessment and Measurement of Adherence to Oral Antineoplastic Agents

“…Direct serum or urine 55,57 measures were rare in adults, yet very common in pediatric oncology. 26,[63][64][65][66][67][68][69][70][71][72] However, these measures can only occur in the clinical setting when feasible and cost effective.…”