Avi Leader1, Noam Benyamini2, Anat Gafter-Gvili3, Juliet Dreyer4, Bronya Calvarysky5, Alina Amitai6, Osnat Yarchovsky-Dolberg7, Giora Sharf8, Eric Tousset9, Opher Caspi10, Martin Ellis7, Itai Levi11, Sabina De Geest12, Pia Raanani13. 1. Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: avileader@yahoo.com. 2. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. 3. Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine A, Rabin Medical Center, Petah Tikva, Israel. 4. Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. 5. Department of Pharmacy, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. 6. Department of Pharmacy, Meir Medical Center, Kfar Saba, Israel. 7. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel. 8. Israeli CML Patients Organization, Netanya, Israel. 9. AARDEX Group, Visé, Belgium. 10. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Integrative Medicine and Cancer Survivorship Program, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel. 11. Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel. 12. Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland; Academic Center of Nursing and Midwifery, Department Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium. 13. Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Nonadherence to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) has been associated with inferior outcomes. Scarce evidence exists on the effectiveness of adherence-enhancing interventions. The present pilot study evaluated the feasibility and effectiveness of an intervention to improve TKI adherence in adult CML patients. PATIENTS AND METHODS: Using a quasi-experimental pre-post intervention design, we included a convenience sample of 58 CML patients (median age, 60.5 years; interquartile range, 19) receiving TKI treatment in 4 hematology institutes in Israel (median previous treatment duration, 34 months; interquartile range, 60). Of the 58 patients, 36 (62%) were receiving first-line treatment. TKI adherence was assessed using electronic monitoring for 7 months (4 months for the baseline assessment and for 3 months after the intervention) and defined as the percentage of days with dosing taken as prescribed. The multilevel intervention combined training of health care workers and multiple behavioral change techniques (eg, motivational interviewing, feedback on electronic monitoring printouts, behavioral change techniques tailored to reasons for nonadherence). The baseline and postintervention adherence were compared using generalized estimating equation models. RESULTS: The median baseline electronically monitored adherence (n = 55) was 97.5% (range, 48%-100%). The odds of taking the drug daily as prescribed were 58% greater after intervention (odds ratio, 1.58; 95% confidence interval [CI], 1.16-2.15). Adherence improved by only 1.5% overall (95% CI, 0.1%-2.8%) but by 8.5% (i.e. from 71.2% average adherence before intervention, to 79.6% after; P = .04) in a subgroup of 10 nonadherent patients (baseline adherence < 90%). CONCLUSION: TKI adherence improved with our pilot intervention, mainly in patients with suboptimal baseline adherence.
BACKGROUND: Nonadherence to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) has been associated with inferior outcomes. Scarce evidence exists on the effectiveness of adherence-enhancing interventions. The present pilot study evaluated the feasibility and effectiveness of an intervention to improve TKI adherence in adult CMLpatients. PATIENTS AND METHODS: Using a quasi-experimental pre-post intervention design, we included a convenience sample of 58 CMLpatients (median age, 60.5 years; interquartile range, 19) receiving TKI treatment in 4 hematology institutes in Israel (median previous treatment duration, 34 months; interquartile range, 60). Of the 58 patients, 36 (62%) were receiving first-line treatment. TKI adherence was assessed using electronic monitoring for 7 months (4 months for the baseline assessment and for 3 months after the intervention) and defined as the percentage of days with dosing taken as prescribed. The multilevel intervention combined training of health care workers and multiple behavioral change techniques (eg, motivational interviewing, feedback on electronic monitoring printouts, behavioral change techniques tailored to reasons for nonadherence). The baseline and postintervention adherence were compared using generalized estimating equation models. RESULTS: The median baseline electronically monitored adherence (n = 55) was 97.5% (range, 48%-100%). The odds of taking the drug daily as prescribed were 58% greater after intervention (odds ratio, 1.58; 95% confidence interval [CI], 1.16-2.15). Adherence improved by only 1.5% overall (95% CI, 0.1%-2.8%) but by 8.5% (i.e. from 71.2% average adherence before intervention, to 79.6% after; P = .04) in a subgroup of 10 nonadherent patients (baseline adherence < 90%). CONCLUSION: TKI adherence improved with our pilot intervention, mainly in patients with suboptimal baseline adherence.
Authors: Shoshana M Rosenberg; Keith J Petrie; Annette L Stanton; Lan Ngo; Emma Finnerty; Ann H Partridge Journal: J Natl Cancer Inst Date: 2020-05-01 Impact factor: 13.506
Authors: Christel C L M Boons; Lonneke Timmers; Jeroen J W M Janssen; Peter E Westerweel; Nicole M A Blijlevens; Willem M Smit; Imke H Bartelink; Janneke A Wilschut; Eleonora L Swart; N Harry Hendrikse; Jacqueline G Hugtenburg Journal: Eur J Clin Pharmacol Date: 2020-06-02 Impact factor: 2.953
Authors: Smita Bhatia; Lindsey Hageman; Yanjun Chen; F Lennie Wong; Elizabeth L McQuaid; Christina Duncan; Leo Mascarenhas; David Freyer; Nkechi Mba; Paula Aristizabal; David Walterhouse; Glen Lew; Pamela Helen-Heilge Kempert; Thomas Bennett Russell; Rene Y McNall-Knapp; Shana Jacobs; Ha Dang; Elizabeth Raetz; Mary V Relling; Wendy Landier Journal: JAMA Netw Open Date: 2020-08-03