Factors influencing adherence in CML and ways to improvement: Results of a patient-driven survey of 2546 patients in 63 countries

Abstract

CML Advocates Network and were filled in by patients online and offline. Patient characteristics, treatment and motivations were collected. Adherence was assessed by the 8-item Morisky Medication Adherence scale. Logistic regression models were fitted to investigate the influence of different factors on adherence. Overall, 2 546 questionnaires from 63 countries and 79 CML patient organisations were evaluable. 32.7% of participants were highly adherent, 46.5% were in the medium and 20.7% in the low adherence group. Factors increasing the probability of being in the high adherence group are older age, male sex, management of side effects, only one tablet per day and feeling well informed about CML by the doctor. More than 2 years since diagnosis were significantly lowering the chance as was the use of reminding tools. Living arrangements, multiple medication and personal payment obligations increased the probability to be at least in the medium adherent group. This is the most comprehensive study conducted to date to gain knowledge about factors causing non-adherence in CML. Better information on the disease, medication and management of side effects, supported by haematologists, is key to improve adherence.

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

“…Other quantitative studies using a questionnaire found percentages of nonadherent CML patients ranging from 0% to 47%. 11,12,19,23,30,[34][35][36][37][38][39][40][41] Differences in the extent of nonadherence in studies are a well-known phenomenon in adherence research and relate to the drug, follow-up period and differences in measurement and calculation of adherence. 9,42 In the present study, a self-composed question was used to measure nonadherence ("How often do you not take your CML medicine?").…”

“…9,42 In the present study, a self-composed question was used to measure nonadherence ("How often do you not take your CML medicine?"). In the other studies, 11,12,19,23,30,[34][35][36][37][38][39][40][41] alternative questionnaires were used to measure medication adherence. Although the differences in measurements make it difficult to compare the results of studies, it is clear that a considerable number of CML patients have difficulties with adhering to their medication regimen.…”

“…[14][15][16] In patients with cancer, the occurrence of side effects is one of the most important factors associated with nonadherence. 15 Higher CML complexity 17 and regimen complexity, 18 longer time since diagnosis, 11,19 poor communication with healthcare providers (HCP), [20][21][22] lack of knowledge and understanding of patients 11,23 and lower level of social support 23 are other factors related to nonadherence relevant in CML treatment. Patients may be intentionally or unintentionally nonadherent with the use of their medication.…”

Nilotinib efficacy, safety, adherence and impact on quality of life in newly diagnosed patients with chronic myeloid leukaemia in chronic phase: a prospective observational study in daily clinical practice

“…Several factors associated with high adherence to TKI therapy have been reported in the literature. In an international, patient‐led study (Geissler et al , ), factors associated with high adherence were older age, male sex, management of side effects, the administration of only one tablet per day, and patients feeling well informed about CML by the doctor, whereas a recent Polish study (Rychter et al , ) reported that patients over 65 years and patients with at least one comorbid disease had better adherence to TKIs. That same study also found no differences in adherence among patients treated with imatinib, dasatinib or nilotinib ( P = 0·249) (Rychter et al , ).…”

Differences in treatment and monitoring of chronic myeloid leukemia with regard to age, but not sex: Results from a population‐based study

“…An obviously important requirement for an effective treatment is that the treatment is used as indicated. Although CML is a fatal disease, poor patients' compliance with TKI treatment is common and is associated with reduced effectiveness . Marin et al, using an electronic medication monitoring system, showed that proper adherence with TKI treatment is a major predictor of achieving major molecular remission (MMR) with relative risks between 11.7 and 17.6 .…”