PATIENT COMPLIANCE - PharmXpert Academy

TherapeuticAdherence in Chronic Myeloid Leukemia:Results of a Patient-driven Pilot SurveyOptimal adherence to oral cancer therapy is of keyimportance to maximise treatment effectiveness inpatients. With the advance of molecular target therapies,cancer treatment in more and more indications istransforming from in-hospital care towards oral treatmentin an outpatient setting. With cancer becoming achronic disease, patients are often required to take thedrug indefinitely on a daily basis. Ensuring an optimaladherence to treatment over the long-term period couldbe a challenge. As data on the driving factors of nonadherencein oncology is scarce, a pan-European workgroupof the CML Advocates Network has conducted a pilot studywhich has unveiled differences of non-adherence betweencountries, administration types and use of adherence toolsin Chronic Myeloid Leukemia. This pilot study has providedthe groundwork for a larger global adherence study that iscurrently ongoing in 12 languages.BackgroundChronic Myeloid Leukemia (CML) has been pioneeringtargeted therapies in cancer, and since Imatinib’s broadavailability in 2001, the effect of intentional and nonintentionalnon-adherence has been observed. Noens et al.(2009) first demonstrated that non-adherence to Imatinibis very common and associated with poorer response totreatment. More recently, Marin et al. (2010) found acorrelation between low adherence rate (less than 90%)and the six-year probability of achieving a major molecularresponse (MMR). In addition, non-adherence was found to bethe main reason for losing response to CML treatment. Thesestudies emphasise that strict adherence to the prescribedImatinib dose is key to ensuring treatment effectiveness inpatients with CML.There is not much literature on potential reasons fornon-adherence to oral anti-cancer treatments (Ruddy, 2009).Even less data is available on reasons why CML patients mightbe non-adherent to Imatinib therapy (Breccia, 2011; Eliasson,2011). A number of factors may influence compliance to oralmedication regimens (Partridge et al., 2002). These not onlyinclude treatment-related aspects but also individual patientcharacteristics and personal factors (Ruddy et al., 2009) aswell as patient education, supporting self-management ofpatients and engaging their social network (EBMT NursesGroup, 2011). A recent study has also revealed that only 53%of CML patients reported strict adherence, with adherencebeing influenced by the availability of patient information,social support and concomitant drug burden (Efficace et al.,2012).Both intentional and non-intentional non-adherence inCML are very common, but so far, the reasons, as well asthe feasibility of supportive adherence tools, have not beeninvestigated in depth.For this reason, the CML Advocates Network, a globalnetwork of 68 leukemia patient advocacy groups in 55countries, has run a pilot survey to gain greater understandingof CML patients’ attitudes and behaviours surroundingadherence, and to develop the questionnaire for a larger studyto ultimately support physicians and patients to improvecompliance and to develop adherence tools. Given thelimitations of a pilot survey with small participant numbers,the primary objective was to confirm the accessibility andusability of the questionnaire in anticipation of a broader,global survey.MethodologyThe pilot survey was provided in eight languages: Czech,Dutch, English, French, German, Hebrew, Italian and Polish.The questionnaire was developed by patient advocates andCML experts with in-kind logistical support from Bristol-MyersSquibb. Local CML patient advocacy groups disseminatedthe online questionnaire, based on a SNAP Surveys technicalsurvey platform, to 10-20 CML patients per country. Thesurvey data was compiled and analysed by an independentstatistician. To determine whether the pilot survey measuresare reliable, Cronbach’s alpha was employed to assess theconsistency and reliability of the data results across thesurvey. A Cronbach’s alpha of 0.81 was produced, indicatingan expectation of CML duration to be strongly associatedwith CML medication duration. This suggests that there issome level of reliability and consistency within the survey.Given the pilot survey’s design and distribution methods,the results are biased as the recruitment addressed rathereducated, informed, younger, active patients who are online.DemographicsIn total 150 total online responses from 10 different countrieswere received over a period of two weeks. Austria (n=1),Czech Republic (24), France (21), Germany (25), Israel (25),Italy (19), Netherlands (18), Poland (11), Switzerland (1) andUnited Kingdom (5). The responses reflect the general CMLpatient demographics, with the majority (96%) of patientshaving CML in chronic phase, a relatively even split betweenmale (46.3%) and female (53.7%). The average age ofrespondents was 51 years.ResultsOf note is that the pilot survey was not powered to bestatistically significant. The pilot was designed to confirm theusefulness of the questionnaire and to develop indicators foran upcoming broader, statistically significant research work.However, the pilot survey already indicates that theremight be substantial differences in adherence acrosscountries. When asked whether patients missed at least onedose within the past month, non-adherence rates varied from32 Journal For Patient Compliance Strategies to enhance Adherence and Health OutcomesVolume 2 - Issue 4