Patient preferences for stopping tyrosine kinase inhibitors in chronic myeloid leukemia.
BACKGROUND
We used an interview-assisted survey of patients with chronic myeloid leukemia (cml) at a single tertiary care centre to explore patient reactions to and preferences for, and the risk-acceptability of, stopping tyrosine kinase inhibitor (tki) treatment.


METHODS
The study included patients with confirmed cml currently being treated with a tki. The survey was conducted by structured interview using a standard form. Patient preferences were explored in a case-based scenario using 0%-100% visual analog scales and 5-point Likert scales. Data were analyzed using proportions for dichotomous variables and medians and interquartile ranges for continuous variables.


RESULTS
Of 63 patients approached, 56 completed the survey. Participant responses suggest that the idea of stopping tki use is appealing to many patients if there is a chance of long-term stable disease and a high probability of response upon restarting a tki. Participants were more likely to stop their tki as the risk of relapse decreased. Participants reported loss of disease control and failure of disease to respond to treatment as important concerns if they chose to stop their tki.


CONCLUSIONS
Given the current 60% estimated rate of relapse after discontinuation of tki therapy, most patients with cml chose to continue with tki. However, at the lower relapse rates reported with second-generation tkis, participants were more undecided, demonstrating a basic understanding of risk. Contrary to our hypothesis, neither compliance nor occurrence of side effects significantly affected patient willingness to stop their tki.
Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON. ; Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON.
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Sanford
Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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Kyle
Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON. ; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON.
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Lazo-Langner
Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON.
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Xenocostas
Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON.
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Chin-Yee
Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON.
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Howson-Jan
Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, London, ON.
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Hsia
Chronic myeloid leukemia; patient preference; tyrosine kinase inhibitors