Compliance with oral drug therapy in patients with hematologic malignancy.

Abstract

Compliance with oral self-administered allopurinol (daily medication) and prednisone (intermittent medication) as well as compliance with monthly scheduled clinic appointments, were examined in 108 patients with newly diagnosed hematologic malignancy. Baseline levels of compliance (control group) were compared to results obtained after implementation of three intervention packages, whose aim was to increase compliance. The packages included combinations of education, home psychologic support and restructuring, and training in pill taking. A 24-hour profile of the two drugs and their metabolites was first determined. Serum samples were then obtained monthly over 6 months and analyzed for presence of the drugs. Control patients were fully compliant with allopurinol only 16.8% of the time. This rate increased significantly (44% to 48% of the time) for those who received any one of the intervention programs. With respect to prednisone, control patients were compliant 26.8% of the time, with no real improvement after interventions. Finally, self reports overestimated compliance by a factor of two when compared to drug analysis. The results indicated that full compliance with oral medications was remarkably low among our patients who have treatable and in some cases curable hematologic malignancy. However, compliance can be significantly improved by the use of various intervention packages.

Pharmacokinetic/pharmacodynamic correlation and blood-level testing in imatinib therapy for chronic myeloid leukemia

“…25 However, patients may overestimate their adherence to oral cancer therapies by a factor of two in discussions with their physicians. 26 A recent study showed that adherence to imatinib therapy among some patients with Ph þ CML is less than ideal (Tsang et al, J Clin Oncol 2006; 24: 330s. abstract 6119).…”

Assessment and Measurement of Adherence to Oral Antineoplastic Agents

“…The medical record is also a source of prescriptions ordered, modifications to the regimen, and adherence. [19][20][21][22][23][24][25][26][27] However, medical records are known to be incomplete or inaccurate. 28 When electronic medical records are fully implemented, this may become a more reliable source of information.…”

“…MEMS is not considered to be a practical tool in the clinical setting due to its excessive cost. Pill counts 7,56 and medical record clinical note audits occurred, [19][20][21][22][23]25,62 yet were not very common, probably due to the labor intensive nature of conducting these measures. Direct serum or urine 55,57 measures were rare in adults, yet very common in pediatric oncology.…”

The Challenges of Oral Agents as Antineoplastic Treatments

“…11 When biologic measures, such as urine or serum assays are used, specific ranges of blood or urine levels are expected to be associated with adherence to a medication regimen. 12,13 The operational definition of adherence is dependent upon which of these measures, or combination of these measures, is used to assess adherence.…”