Non-compliance with oral chemotherapy in childhood leukaemia

Lilleyman, J S; Lennard, Lynne

doi:10.1136/bmj.313.7067.1219

Cited by 63 publications

(35 citation statements)

References 19 publications

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“…The alternative explanation is that there is variable failure of compliance with the oral drugs prescribed. Non-compliance may be more common than is acknowledged (Davies et al, 1993;Lilleyman & Lennard, 1996).…”

Section: Discussionmentioning

confidence: 99%

Continuing (maintenance) therapy in lymphoblastic leukaemia: lessons from MRC UKALL X

et al. 1997

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Summary.The relationship between the prescribed dose of drugs during continuing (maintenance) therapy, the degree of marrow suppression caused, and subsequent event-free survival was examined in a cohort of 740 children with lymphoblastic leukaemia treated on MRC UKALL X. Girls, younger children, and patients who had received intensification treatment, were prescribed lower doses of mercaptopurine, became neutropenic more readily, and had more interruptions of treatment. Children who had one or more episodes of neutropenia with a count of < 0 . 5 × 10 9 /l had a better prognosis than those who never became neutropenic.We conclude that early intensification treatment influences the probability of neutropenia during continuing treatment and that patients exhibiting myelosuppression during this phase of treatment have a better chance of prolonged remission.

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Section: Discussionmentioning

confidence: 99%

Continuing (maintenance) therapy in lymphoblastic leukaemia: lessons from MRC UKALL X

et al. 1997

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“…Important problems using extemporaneous formulations are the instability, the often short shelf-life and the unknown bioavailability. Non-optimal palatability might increase the non-compliance of these products, which might be an important factor in treatment failure [21]. In international trials, which are frequent in paediatric oncology, this non-compliance can interfere with the outcome of the studies [22].…”

Section: Discussionmentioning

confidence: 99%

Licensing and labelling of drugs in a paediatric oncology ward

Berg

Tak

2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• High percentages of off-label and unlicensed drug use are common in paediatrics.• Data in paediatric oncology patients hardly exist.• Extemporaneously prepared formulations are common. WHAT THIS STUDY ADDS• Off-label and unlicensed use is substantially higher for cytostatic drugs in paediatric as compared with adult oncology.• Comparison with other paediatric reports on drug use cannot be made due to different percentages of diseases in the reports and other rules to dispense medication in the out-patient setting.• There is an urgent need for suitable formulations, licensing of dosages and provision of data on safety and efficacy in children with malignancies. AIMPaediatric drug prescriptions are known for their high percentages of off-label and unlicensed use. In paediatric oncology data available are scarce. The aim of this paper is an analysis of the licensing and labelling status of all prescribed medication over a 2 week period in a Dutch paediatric oncology centre. METHODSAn analysis of the delivery of medication by the hospital pharmacy to patients admitted to the paediatric oncology centre was carried out. RESULTSIn total 268 precriptions were filed for 39 patients. In 87% of children unlicensed medication was used. Fifty-nine per cent of the children received at least two unlicensed drugs. In total 72% of the drugs were used licensed and on-label was found in 57% of the prescriptions. There was a trend that in younger children percentages were lower. International and local guidelines necessitated in many cases unlicensed use, e.g. intrathecal prednisolone, low dose medication such as heparin, ethanol and vancomycin for locking intravenous devices and higher intravenous vancomycin dosages. There were no major differences with respect to type of malignancy. CONCLUSIONOur figures are substantially higher than the figures reported from adult oncology. Comparison with other paediatric reports are cumbersome, due to different percentages of diseases in the reports and other rules to dispense medication in the outpatient setting. Our data are in line with reports mentioning the higher percentages of unlicensed and off-label use. Our data further underpin the need for more research on suitable formulations, dosages, safety and efficacy in these children.

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“…A large proportion of these relapses take place during the outpatients phase of treatment. 24,25 With certain communities and ethnic groups, it is difficult to convince family members of the need for continued treatment during the maintenance phase, when the children appear to be cured. 7 These data suggest that other explanations, in addition to biological factors, are needed for the unfavorable progress of patients who live under adverse conditions.…”

Section: Discussionmentioning

confidence: 99%

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

Oliveira¹,

Viana²,

Mattos-Arruda³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To evaluate compliance in children with acute lymphoblastic leukemia. Method: Compliance was assessed through specific interviews.Results: A total of 73 patients, aged under 18 and who had concluded the maintenance phase of chemotherapy, were enrolled on the study. Eighty-one per cent of the interviews were conducted with the patients mothers; 92% of the families stated that medical instructions had been understood well. Interviews indicated that 27% of the patients did not receive their medication twice or more during the maintenance phase, without medical direction for this. These children were considered non-compliant. Sixteen per cent of the children failed to receive their medication three times or more. The main reason for non-compliance was forgetfulness. In ten cases the reported dosage of drugs was not that which was prescribed. No significant associations of non-compliance with parents schooling level, number of family members or per capita family income were detected. The 8.5-year estimated probability of event free survival was 72.4% (95% CI: 59.2-82.3). The event free survival curves for non-compliant children were not statistically different from those for the compliant group.Conclusions: Results suggest that comprehensive approaches to the problem of non-compliance are urgently needed.J Pediatr (Rio J). 2005;81(3):245-50: Chemotherapy, treatment, prognosis.

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Non-compliance with oral chemotherapy in childhood leukaemia

Cited by 63 publications

References 19 publications

Continuing (maintenance) therapy in lymphoblastic leukaemia: lessons from MRC UKALL X

Continuing (maintenance) therapy in lymphoblastic leukaemia: lessons from MRC UKALL X

Licensing and labelling of drugs in a paediatric oncology ward

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

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