Chronic myeloid leukemia patients’ adherence to peroral tyrosine kinase inhibitors compared with adherence as estimated by their physicians

Abstract

PurposeTo evaluate chronic myeloid leukemia (CML) patients’ adherence to peroral tyrosine kinase inhibitors in Finland and to compare this with adherence as estimated by their physicians. Other aspects studied included how patients’ knowledge of the disease and its treatment influence adherence.Materials and methodsA total of 120 CML patients were contacted between June 2012 and September 2013 in eight secondary or tertiary care hospitals in Finland. Of these, 86 participated in the study. This covers approximately 20% of all Finnish CML patients. The mean age was 57.8 years and 52% were male. Of the patients, 79.1% were using imatinib, 10.5% dasatinib, and 10.5% nilotinib. The patient-reported adherence (experienced adherence) was evaluated using the eight-item Morisky Medication Adherence Scale (MMAS). In addition, the treating physicians were asked to give their subjective opinion on their patients’ adherence (observed adherence). The experienced adherence was compared with the observed adherence using a three-level rating system (high, medium, low). All patients were personally interviewed and their demographic data collected. The statistical analysis of the data was based on descriptive statistics presented as frequencies, percentages, means, and medians. The kappa coefficient was calculated between the patient’s and the doctor’s assessment of adherence.ResultsA total of 23% (20/86) of the patients were fully adherent according to the MMAS, while physicians evaluated 94% (80/86) of the patients as fully adherent. The physicians’ estimate was too optimistic in 73% of cases. The discrepancy was confirmed by a kappa value of −0.004. The patients’ knowledge of the disease and its treatment was poor in all adherence levels.ConclusionThe patient-reported adherence to tyrosine kinase inhibitor treatments in Finland was found to be the same as that found in the majority of previous studies. However, there seems to be a very weak agreement between the patient’s and the physician’s assessment of adherence. This study suggests that physicians overestimate the adherence of CML patients and base their assessment primarily on the clinical treatment response.

Drivers and Barriers to Medication Adherence in Patients with Chronic Myeloid Leukaemia: A Qualitative Study

“…Unlike other studies, our sample did not a l l o w u s t o a s s o c i a t e t h i s w i t h y o u n g e r a g e , l i v i n g a l o n e a n d m a l e g e n d e r , h o w e v e r [2][3][4]6,7,10,11,14,17,19,26,[28][29][30][31][37][38][39]. While others have suggested that non-adherence may be caused by complacency and sustained disease control [4,6,[29][30][31]38], this was not the case in our participants although some speculated this might be the case in settings without public health care.…”

“…From a total of 341 identified abstracts of journal articles published within the past ten years, 67 described QoL and treatment adherence in patients with CML and were thus selected for full-text analysis -five used qualitative methods [19,29,35,37,38].…”

“…Non-adherence has also been linked to lacking knowledge about CML and treatment, co-payment, poor communication from health care providers and complacency due to sustained disease control [2][3][4]6,7,[10][11][12]14,17,19,[26][27][28][29][30][31][32][35][36][37][38][39]. Results diverge about adherence and type of TKI and may relate to the drug as well as patients' experiences with earlier treatments [7,8,19].…”

Factors influencing adherence in CML and ways to improvement: Results of a patient-driven survey of 2546 patients in 63 countries

“…As few as 14% of CML patients were perfectly adherent in a Belgian example described by Noens et al (2009) while a third of the patients had to be classified as non-adherent. Also, in a Finnish sample only 23% of patients were highly adherent (Kekale et al 2014). Similarly, in a US sample described by Darkow et al (2007) 31% of the patients reported a treatment interruption within a year of observation.…”

The value of quality of life assessment in chronic myeloid leukemia patients receiving tyrosine kinase inhibitors

“…Interestingly, Kakele et al conducted a study to compare adherence reported by patients with that perceived by their physicians 42 and found that physicians were too optimistic in assessing their patients' adherence.…”