Oral adherence in adults with acute myeloid leukemia (AML): Results of a mixed methods study.

Abstract

105 Background: The incidence of AML is increasing, in part due to an aging population. Amid established intravenous (IV) or subcutaneous chemotherapies , recent drug approvals have ushered in an era of oral medication (OM) approaches to treating AML, shifting the burden of daily adherence from clinicians to patients. We aimed to identify and summarize adherence to oral therapy in this population. Methods: Our mixed methods study design used focus groups (FG) and patient surveys. After IRB approval, 11 patients and 4 caregivers participated in 4 focus groups. Results were used to develop a 37-item OM adherence needs assessment. Subsequently, AML patients were recruited and consented at three cancer centers to complete surveys (online, at the clinic, hospital, or from home). Results: 100 patients completed the OM survey. Most were male (62%), racial/ethnic diversity (33%), < 65 years (59%), and college-educated (52%). The to be taken was the most frequent and troublesome challenge. Loss of appetite was the most commonly reported and problematic side effect. Although half of the patients stated, “no side effect would cause them to stop taking OM”, another 25% indicated nausea would cause non-adherence. The best strategy to support taking OM was to make it part of the daily routine. Directions for taking OM were most commonly found on medication bottles or received from the health care team (HCT); patients felt HCTs were the best source of directions. Nearly 1/3 of patients indicated they skip the OM dose altogether when they forget to take it. When asked what would help improve adherence: smaller pills, easier packaging, and scheduling assistance were most frequently reported. Older individuals (>65 years) had a slightly more positive attitude towards oral medication (p =.51). Younger patients (<65 years) were more accepting of taking oral vs IV meds, (p = .03). Conclusions: This study represents the first assessment of OM adherence in patients with AML. Three themes emerged in FG transcript analysis that informed the development of a 37-item survey that was subsequently completed by 100 patients. Findings provide the basis for further exploration of interventions to enhance and increase adherence to OM regimens.

Impact of Oncology Pharmacists on the Knowledge, Attitude, and Practices of Clinicians to Enhance Patient Engagement of Self-Administered Oral Oncolytics

“…Despite the critical importance of taking oral oncolytics such as venetoclax as prescribed, adherence to oral anticancer therapies is lower than adherence to intravenous anticancer therapies and ranges from 20-100% [24]. The reasons for patient non-adherence are multifactorial, including complex treatment regimens in addition to patients' other prescribed medications, side effects from oral anticancer therapies, inconvenient clinic follow-up, abandoned prescription refills, inadequate supervision, suboptimal patientclinician communication, complex socioeconomic factors, cost, misunderstanding of prescribed therapy, pill burden, pill aversion, and difficult packaging [24][25][26]. Pharmacists are positioned to improve adherence of complex regimens containing oral chemotherapy [27].…”

“…This is a detailed conversation facilitated by providing patient handouts, calendars, and specific printed instructions individualized to the patient. Incorporating medication administration into part of patients' daily routine, using pillboxes, setting phone alarms or reminders, creating a schedule, and developing a tracking system are all strategies that can be tailored to individual patient needs [24,26]. Given the frequently changing therapy schedule, pharmacists can develop medication calendars for patients and schedule check-ins to assess patient understanding.…”

Impact of an Oncology Clinical Pharmacist on Patient Engagement in Self-Administered Oral Oncolytic Therapy: Case Study of Venetoclax in Acute Myeloid Leukemia Patients

“…Despite the critical importance of taking oral oncolytics like venetoclax as prescribed, adherence to oral anticancer therapies is lower than adherence to intravenous anticancer therapies and ranges from 20-100% [24]. The reasons for patient non-adherence are multifactorial, including complex treatment regimens in addition to patients' other prescribed medications, side effects from oral anticancer therapies, inconvenient clinic follow-up, abandoned prescription refills, inadequate supervision, suboptimal patient-clinician communication, complex socioeconomic factors, cost, misunderstanding of prescribed therapy, pill burden, pill aversion, and difficult packaging [24][25][26]. Pharmacists are positioned to improve adherence of complex regimens containing oral chemotherapy [27].…”

“…This is a detailed conversation facilitated by providing patient handouts, calendars, and specific printed instructions individualized to the patient. Incorporating medication administration into part of patients' daily routine, utilizing pillboxes, setting phone alarms or reminders, creating a schedule, and developing a tracking system are all strategies that can be tailored to individual patient needs [24,26]. Given the frequently changing therapy schedule, pharmacists can develop medication calendars for patients and schedule check-ins to assess patient understanding.…”