Maximizing Adherence | CML Alliance
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Maximizing AdherenceMaximizing Adherence

Adherence to therapeutic regimen is an important determinant of treatment outcome. A variety of factors may reduce adherence to long-term oral therapy1,2

  • Personal, treatment, and systemic challenges may lead to reduced patient adherence to long-term therapies, including oral tyrosine kinase inhibitors (TKIs)2
  • Studies have shown that long-term oral therapies have adherence rates often below 50%1
  • Wide variations in medication-taking behavior have been reported in several clinical trials3
  • The asymptomatic nature of Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML) may lead some patients whose disease is under control to develop dosing complacency and adherence issues4
  • While increased frequency of daily dose decreased adherence rates, no significant differences were seen between qd and bid dosing regimens5
  • Patients in more advanced stages of CML may have higher health care costs than patients in the chronic phase6


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Healthcare providers play a critical role in promoting adherence. They are in an ideal position to practice educational strategies to enhance or maintain adherence, such as

  • Establishing relationships with patients that permit free discussion of adherence problems and solutions7
  • Understanding the key factors in adherence, such as the motivation, habits, health beliefs, and socioeconomic status and how they relate to their patients7,8
  • Inviting patients to talk about their medication routines and asking them about adherence at every visit2
  • Clearly stating the purpose of the drug and helping patients establish a routine for taking it2
  • Reinforcing the need for adherence to achieve and maintain an optimal response, such as a major molecular response (MMR)9

This section is designed to help reinforce the importance of adherence for patients taking oral CML therapy. It includes clinical data that support the need for improved adherence and tips to help patients remember to take their medications. There are also support materials available for download that may help improve adherence among patients.

Remember: the healthcare provider is key in helping patients achieve optimal outcomes by educating them to take their medication safely and correctly!


Next: Importance of Adherence

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References

  1. Partridge AH, Avorn J, Wang, PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94(9):652-661.
  2. Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009;59(1):56-66.
  3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
  4. Zeidan A, Wang ES, Wetzler M. What is imatinib-resistant chronic myeloid leukemia: identifying and managing loss of response. Clin Adv Hematol Oncol. 2008;6(9):678-683.
  5. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-1310.
  6. Darkow T, Henk HJ, Thomas SK, et al. Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics. 2007;25(6):481-496.
  7. Schaffer SD, Yoon SJ. Evidence-based methods to enhance medication adherence. Nurse Pract. 2001;26(12):44-54.
  8. Lehane E, McCarthy G. Medication non-adherence—exploring the conceptual mire. Int J Nurs Pract. 2009;15(1):25-31.
  9. Noens L, van Lierde M-A, De Bock R, et al. Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113(22):5401-5411.