Disease acceptance and adherence to imatinib in Taiwanese chronic myeloid leukaemia outpatients

Abstract

Background The launch of imatinib has turned chronic myeloid leukaemia (CML) into a chronic illness due to the dramatic improvement in survival. Several recent studies have demonstrated that poor adherence to imatinib may hamper the therapeutic outcomes and result in increased medical expenditures, whilst research on exploring the reasons for non-adherence to imatinib is still limited. Objective This study aimed to explore the experience of patients as they journey through their CML treatments and associated imatinib utilisation in order to understand the perceptions, attitudes and concerns that may influence adherence to imatinib treatment. Setting This study was conducted at oncology outpatient clinics in a medical centre in southern Taiwan. Methods CML patients who regularly attended the oncology outpatient clinics to receive imatinib treatment from October 2011 to March 2012 were invited to participate in the study. Semi-structured face-to-face interviews were used to explore patients’ experiences and views of their treatment, their current CML status and CML-related health conditions, their concerns about imatinib treatment and imatinib-taking behaviours. Patient interviews were recorded, transcribed verbatim and thematically analysed using the constant comparison approach. Main outcome measure Themes related to patients’ views of the disease and health conditions, worries and concerns influencing imatinib utilisation behaviours are reported. Results Forty-two CML patients participated in the interviews. The emerging themes included: acceptance of current disease and health status, misconceptions about disease progression, factors associated with adherence to imatinib, concerns and management of adverse drug effects. Participants regarded CML as a chronic disease but had misconceptions about disease progression, therapeutic monitoring, resistance to imatinib and symptoms of side effects. Participants were generally adherent to imatinib and favoured long-term prescriptions to avoid regular outpatient visits for medication refills. Experiencing adverse effect was the main reason influencing adherence and led to polypharmacy. Most participants altered medicine-taking behaviours to maintain long-term use of imatinib. Conclusion Taiwanese CML patients are adherent to imatinib but report changing their medication-taking behaviour due to adverse drug effects and associated polypharmacy. Patients’ misconceptions of the disease and medication suggests that it is necessary to improve communication between patients and healthcare professionals. Routinely providing updated information as part of the patient counselling process should be considered as a means of improving this communication.

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

“…Concern raised by patients over the long-term safety of TKIs is also in keeping with a German survey that found that the fear of harmful effects from TKIs ranked even higher than the fear of CML progression 27. While Chen et al17 reported that knowledge of potential for drug resistance served as a positive motivation for sustaining imatinib adherence among Taiwanese CML patients, the present study showed contradictory findings.…”

“…Discrepancies between the perspectives of health care providers and CML patients on adherence to TKIs13,14 and health-related quality of life have also been reported 15. To understand the medicine-taking practices of CML patients, qualitative studies in the United Kingdom, Taiwan, and Australia have demonstrated some psychological factors that facilitate TKI adherence, including faith in clinicians,16 belief in treatment efficacy,17 and comparison to other patients in worse circumstances 14. These studies also found that side effects, forgetfulness, complacency, lack of access to medical advice, and poor communication with health care providers are important barriers to TKIs adherence 14,16.…”

Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature

“…Regardless of many demographic considerations, including gender, socioeconomic status and education level, the patients' difficulty in adhering to oral oncological agents has been well documented across tumor types, including solid tumors (gastrointestinal stromal tumors) [46], male breast cancer [47,48], pancreatic neuroendocrine tumors [49], non-small cell lung cancer [50] and renal cell cancer [51], in countries all across the world [52,53,54]. This has also been documented in hematological malignancies [2] including the whole age spectrum of CML patients: both younger [5] and older age groups [55].…”

Patients' perceptions about diagnosis and treatment of chronic myeloid leukemia: a cross-sectional study among Brazilian patients

“…The factors known to predict adherence to therapy include information about the disease, [37][38][39] frequent contact with a single hematologist, easy access to the treatment clinic 38,39 and participation in decision-making about the disease and treatment. 38 A study has shown that patients felt inappropriately reassured by physicians that their nonadherence would not have a detrimental effect on their clinical response.…”