Clinical and laboratory evaluation of compliance in acute lymphoblastic leukaemia.
OBJECTIVE
To evaluate compliance in children with acute lymphoblastic leukaemia (ALL).


METHODS
Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6-mercaptopurine metabolites.


RESULTS
A total of 39 patients who had concluded maintenance phase of chemotherapy were included in the study. Mothers were responsible for delivering 6-MP in 87% of cases. Thirty five interviewees said that medical prescription was well understood and that the main reason for non-compliance was forgetfulness. Non-compliance was detected through interviews (33.3% of the cases), reports from medical charts (30.7%), and drug determination (16.6%); 53.8% of children were found to be non-compliant. Non-compliance was significantly associated with chronic undernourishment. Although not statistically significant, there was a trend for the group of non-compliant children to be associated with low per capita family income. No significant associations of non-compliance with age at diagnosis, gender, parents' schooling level, number of family members, power consumption, and medians of absolute leucocyte or neutrophil blood counts were detected. A short follow up period precluded valid analysis on outcome. In the non-compliant group (n = 21), seven children relapsed, contrasting with three relapses in the compliant group (n = 18).


CONCLUSIONS
Results suggest that non-compliance is one of the mechanisms which underlies the adverse influence of socioeconomic factors on the outcome of children with ALL. Additional studies are necessary to confirm this hypothesis. Comprehensive approaches to the problem of non-compliance are urgently needed.
Haematology Division, Department of Paediatrics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. benigna@uol.com.br
B M
BM
de Oliveira
M B
MB
Viana
C L
CL
Zani
A J
AJ
Romanha
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D009035:Mothers; D009748:Nutrition Disorders / Q000150:complications; D010349:Patient Compliance; D011203:Poverty; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence
D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D015122:Mercaptopurine