Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study

Abstract

PurposePoor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.Patients and methodsIndividual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.ResultsFour themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.ConclusionMalaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome.

Needs for information and reasons for (non)adherence in chronic myeloid leukaemia: Be aware of social activities disturbing daily routines

“…Unintentional nonadherence occurred when social activities disturbed the patients’ daily routines, making patients forget an intake. This is in line with the existing adherence literature . Interestingly, the most often reported facilitator for adherence in the present study was taking the medication as part of a daily routine and having become accustomed to take medication on a daily basis.…”

“…Patients felt unjustified reassured that "occasional" nonadherence does not matter. 20,21 20,21,27,28 Interestingly, the most often reported facilitator for adherence in the present study was taking the medication as part of a daily routine and having become accustomed to take medication on a daily basis. This is an important cue for HCP.…”

“…24 Although many data from mainly quantitative studies on factors influencing adherence are available, 25 the reasons of patients with CML for nonadherence are still not fully understood and qualitative studies are scarce. 20,21,[26][27][28] In addition, to support patients to adhere to their medication, adequate information and communication is essential. 9,21,23,29,30 Despite the considerable attention medication adherence has received in recent years, the provision of information remains insufficient.…”

“…Unintentional nonadherence refers to unplanned behaviour and may be the result of forgetfulness or patients may not have understood the instructions or have difficulties with the treatment schedule . Although many data from mainly quantitative studies on factors influencing adherence are available, the reasons of patients with CML for nonadherence are still not fully understood and qualitative studies are scarce . In addition, to support patients to adhere to their medication, adequate information and communication is essential .…”

Experiences of living with chronic myeloid leukaemia and adhering to tyrosine kinase inhibitors: A thematic synthesis of qualitative studies

“…Physical symptoms commonly included nausea and/or vomiting, pain, skin problems and fatigue. Medication and disease effects were reported as impacting on daily life, usual activities and adherence (Bolarinwa et al, 2018;Boons et al, 2018;Chen et al, 2014;Eliasson et al, 2011;Lim et al, 2017;Tan et al, 2017;Wu et al, 2015):…”