title: Electronic monitoring of medication adherence in early maintenance phase treatment for pediatric leukemia and lymphoma: identifying patterns of nonadherence.
abstract: OBJECTIVE
  To describe patterns of treatment adherence to early maintenance phase therapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL).
  
  
  METHODS
  Using an objective observational method (electronic monitoring), adherence was examined for 139 patients aged 7-19 years diagnosed with ALL or LBL across 6 centers.
  
  
  RESULTS
  The mean adherence percentage was 86.2%. Adherence rates declined over the 1-month of follow-up to 83%. 3 linear trajectories of 6-mercaptopurine adherence were identified: (1) exemplary adherence (n = 99): Averaging nearly 100%; (2) deteriorating (n = 23): Adherence decreased from 100 to 60%; and (3) chronically poor adherence (n = 9): Averaging 40%.
  
  
  CONCLUSIONS
  Adherence promotion interventions might be tailored to subgroups of patients who demonstrated problematic patterns of treatment adherence that could place them at risk for relapse. This research demonstrates the importance of using objective real-time measures of medication adherence for measuring and documenting adherence patterns.
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA rohanjenm@gmail.com.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Rohan
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Alderfer
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Crista Wetherington
authors.initials: CW
authors.lastname: Donewar
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Ewing
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Ernest R
authors.initials: ER
authors.lastname: Katz
authors.affiliation: Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Muriel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D015122:Mercaptopurine / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology*; D055815:Young Adult
chemical_list: D015122:Mercaptopurine
keywords: adherence; cancer and oncology; research design and methods; statistical applications