Clinical and laboratory evaluation of compliance in acute lymphoblastic leukaemia

Abstract

Aim: To evaluate compliance in children with acute lymphoblastic leukaemia (ALL). Methods: Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6-mercaptopurine metabolites. Results: A total of 39 patients who had concluded maintenance phase of chemotherapy were included in the study. Mothers were responsible for delivering 6-MP in 87% of cases. Thirty five interviewees said that medical prescription was well understood and that the main reason for non-compliance was forgetfulness. Non-compliance was detected through interviews (33.3% of the cases), reports from medical charts (30.7%), and drug determination (16.6%); 53.8% of children were found to be non-compliant. Noncompliance was significantly associated with chronic undernourishment. Although not statistically significant, there was a trend for the group of non-compliant children to be associated with low per capita family income. No significant associations of non-compliance with age at diagnosis, gender, parents' schooling level, number of family members, power consumption, and medians of absolute leucocyte or neutrophil blood counts were detected. A short follow up period precluded valid analysis on outcome. In the non-compliant group (n = 21), seven children relapsed, contrasting with three relapses in the compliant group (n = 18). Conclusions: Results suggest that non-compliance is one of the mechanisms which underlies the adverse influence of socioeconomic factors on the outcome of children with ALL. Additional studies are necessary to confirm this hypothesis. Comprehensive approaches to the problem of non-compliance are urgently needed.A cute lymphoblastic leukaemia (ALL) is the most common malignancy in childhood. Nowadays, 70-80% of the recently diagnosed children in developed countries present a disease free survival of over five years, and most will eventually be cured.

Adesão à antibioticoterapia profilática em crianças com anemia falciforme: um estudo prospectivo

“…In Brazil, in children with lymphoblastic leukaemia, a statistically significant association was observed between compliance and malnutrition, probably due to socioeconomic condition. 22 These findings confirm that assessment of compliance is a complex process, making compliance difficult to measure usage of 88% of antihypertensive drugs was enough to maintain blood pressure under control. 20 The methodology employed in the present study did not allow for approaching this aspect, since there would be a need for a systematic recording of the infection episodes, their severity and probable etiology, and also methods and techniques to assess compliance in a continuous scale or, at least, in several increasing * p = 0.098 (chi-square trend analysis).…”

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

“…[4][5][6][7][8][9][10][11][12][13][14][15] In a study that included 39 patients from this sample, compliance with treatment was assessed by three different methods. 16 Compliance failures were detected in 53.8% of cases, 33% by questionnaire, 30.7% from notes on medical records and 16.6% by means of 6-MP metabolite assay. Twenty-one patients exhibited compliance failures detected by at least one of these criteria and eight by at least two of them.…”

“…Nevertheless, little published work has taken as its objective the study of compliance with treatment in children and adolescents with leukemia. [4][5][6][7][8][9][10][11][12][13][14][15][16] This research project took as its primary focus the evaluation of compliance with treatment during the maintenance phase of chemotherapy in a population of children with ALL.…”

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.…”

“…Direct serum or urine 55,57 measures were rare in adults, yet very common in pediatric oncology. 26,[63][64][65][66][67][68][69][70][71][72] However, these measures can only occur in the clinical setting when feasible and cost effective.…”