Electronic Monitoring of Medication Adherence in Early Maintenance Phase Treatment for Pediatric Leukemia and Lymphoma: Identifying Patterns of Nonadherence

Rohan, Jennifer; Drotar, Dennis; Alderfer, Melissa A.; Donewar, Crista Wetherington; Ewing, Linda J.; Katz, Ernest R.; Muriel, Anna C.

doi:10.1093/jpepsy/jst093

Cited by 30 publications

(59 citation statements)

References 25 publications

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“…In our study, the rate of nonadherence measured by the MMAS-8 for patients is higher than what has been reported previously. 8,[10][11][12]17 Hispanic and adolescent patients have higher rates of nonadherences. 10,46 The strength of our study is the diverse patient population, which is reflective of ALL patients treated at our center.…”

Section: Discussionmentioning

confidence: 99%

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Heneghan

Hussain

Barrera

et al. 2020

Pediatric Blood & Cancer

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Background Adherence to oral chemotherapy, including 6‐mercaptopurine (6‐MP), is suboptimal in pediatric acute lymphoblastic leukemia (ALL), which is associated with increased risk of relapse. Study objectives were to examine self‐reported adherence to 6‐MP and related barriers to adherence, mapped to the capability, opportunity, motivation, and behavior (COM‐B) model for behavior change. Procedure Forty‐nine parents (median, 39 years old; 76% females) and 15 patients (median, 17 years old, 20% females) completed the study survey. Results Suboptimal adherence was reported in 43% of parents and 73% of patients. Most parents and patients (80% and 90%, respectively) reported ≥1 adherence barrier. Parents reported difficulty helping their child meet others with ALL (43%), contacting community organizations (39%), and meeting other parents (37%). Patients reported difficulty finding out what their medications are (40%), finding out what 6‐MP does (47%), and meeting other patients (40%). Using the COM‐B, we found that parents and patients endorsed barriers in multiple components, especially physical (55%, 67%) and social opportunity (56%, 47%), highlighting that barriers to adherence may be multifaceted. Conclusions Our results suggest that parents and patients with ALL face various prevalent barriers to medication adherence and provide insight into the development of behavioral interventions focused on promoting adherence, which is essential to prevent relapse and optimize health outcomes in ALL.

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Section: Discussionmentioning

confidence: 99%

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Heneghan

Hussain

Barrera

et al. 2020

Pediatric Blood & Cancer

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“…1 Prior studies of adherence to oral 6MP in children with ALL have reported adherence rates ranging from 70% to 95% by using a variety of subjective and objective measures. [2][3][4][5][6][7][8][9] We have previously shown that inadequate systemic exposure to 6MP because of poor 6MP adherence (,95% adherence rate, objectively measured by the Medication Event Monitoring System [MEMS; WestRock Healthcare, Sion, Switzerland]) is associated with increased risk of relapse. 2,10 Accurate assessment of 6MP intake is therefore critical to ensure timely interventions for patients with poor adherence.…”

Section: Introductionmentioning

confidence: 99%

Comparison of self-report and electronic monitoring of 6MP intake in childhood ALL: a Children’s Oncology Group study

Landier

Chen

Hageman

et al. 2017

Blood

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• Self-report overestimated electronically monitored 6MP adherence at least some of the time in a large majority of patients (84.4%).• Nonadherers were more likely to overreport 6MP intake (47%) compared with adherent patients (8%).Adequate exposure to oral 6-mercaptopurine (6MP) during maintenance therapy for childhood acute lymphoblastic leukemia (ALL) is critical for sustaining durable remissions; accuracy of self-reported 6MP intake is unknown. We aimed to directly compare self-report to electronic monitoring (Medication Event Monitoring System [MEMS]) and identify predictors of overreporting in a cohort of 416 children with ALL in first remission over 4 study months (1344 patient-months for the cohort) during maintenance therapy. Patients were classified as "perfect reporters" (self-report agreed with MEMS), "overreporters" (self-report was higher than MEMS by ‡5 days/month for ‡50% of study months), and "others" (not meeting criteria for perfect reporter or overreporter). Multivariable logistic regression examined sociodemographic and clinical characteristics, 6MP dose intensity, TPMT genotype, thioguanine nucleotide levels, and 6MP nonadherence (MEMS-based adherence <95%) associated with the overreporter phenotype; generalized estimating equations compared 6MP intake by self-report and MEMS. Self-reported 6MP intake exceeded MEMS at least some of the time in 84% of patients. Fifty patients (12%) were classified as perfect reporters, 98 (23.6%) as overreporters, 2 (0.5%) as underreporters, and 266 (63.9%) as others. In multivariable analysis, the following variables were associated with the overreporter phenotype: non-white race: Hispanic, odds ratio (OR), 2.4, P 5 .02; Asian, OR, 3.1, P 5 .02; African American, P < .001; paternal education less than college (OR, 1.4, P 5 .05);

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“…Therefore, mediation adherence should be assessed and monitored routinely throughout the course of treatment. For children and adolescents with leukemia or lymphoma who are prescribed two doses of 6MP per day, adherence decreases as rapidly as 6% per day, with rates falling as much as 40% over time . As children enter adolescence, the variability in the timing of medication administration often increases and nonadherence becomes even more prevalent .…”

Section: Discussionmentioning

confidence: 99%

“…For children and adolescents with leukemia or lymphoma who are prescribed two doses of 6MP per day, adherence decreases as rapidly as 6% per day, with rates falling as much as 40% over time . As children enter adolescence, the variability in the timing of medication administration often increases and nonadherence becomes even more prevalent . To capture the anticipated changes in medication adherence over time, providers are encouraged to assess and monitor medication adherence at each follow‐up outpatient clinic visit.…”

Section: Discussionmentioning

confidence: 99%

“…Self-and parent-reported assessments of medication adherence should be obtained routinely using standardized language that assesses each specific medication for a specific period of time (e.g., In the last 7 days, how many times have you [has your child] missed a dose of [INSERT MEDICATION NAME] by a designated member of a multidisciplinary team?). [8] The high rates of medication nonadherence (19-53%), [4,[9][10][11][12][13][14][15] especially among adolescents, [9,11,14] support the implementation of routine and standardized assessment of medication adherence. Assessing nonadherence may identify patients at risk for suboptimal treatment outcomes as nonadherence is associated with an increased risk of relapse and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Assessing Medication Adherence as a Standard of Care in Pediatric Oncology

Pai

McGrady

2015

Pediatric Blood & Cancer

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Poor adherence to pediatric cancer treatment protocols may prevent children and adolescents from realizing the potential benefits of therapy. This paper presents the evidence for a standard of care for supporting medication adherence. Databases were reviewed for articles examining adherence and including children and/or adolescents with cancer. Fourteen articles (i.e., qualitative, quantitative, review, and randomized clinical trials) were evaluated for rigor.There is moderate-quality evidence to support a strong recommendation for adherence to be assessed routinely and monitored throughout the treatment. Integrating the proposed clinical procedures into standard clinical care may improve outcomes for children and adolescents with cancer. Pediatr Blood Cancer 2015;62:S818-S828. C 2015 Wiley Periodicals, Inc.

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Electronic Monitoring of Medication Adherence in Early Maintenance Phase Treatment for Pediatric Leukemia and Lymphoma: Identifying Patterns of Nonadherence

Cited by 30 publications

References 25 publications

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia

Comparison of self-report and electronic monitoring of 6MP intake in childhood ALL: a Children’s Oncology Group study

Assessing Medication Adherence as a Standard of Care in Pediatric Oncology

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