title: Comprehensive Evaluation of Adherence to Therapy, Its Associations, and Its Implications in Patients With Chronic Myeloid Leukemia Receiving Imatinib.
abstract: BACKGROUND
  Adherence to oral therapy over a long period is important for optimal outcomes in chronic myeloid leukemia (CML).
  
  
  METHODS
  Patients in the chronic phase of CML (taking imatinib for ≥ 6 months) were assessed by the 8-item Morisky Medication Adherence Scale and European Organisation for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (C30 and CML 24). Patients were classified as adherent (score 8) and nonadherent (score ≤ 7) as per the 8-item Morisky Medication Adherence Scale.
  
  
  RESULTS
  Among 221 patients (male to female ratio = 133:88; median age, 39 (18-65) years; median duration of imatinib, 4 years), the nonadherence rate was 55% (N = 122/221). None of the demographic parameters, including occupation, education status, income, and availability of caregiver, were associated with nonadherence. QoL scores, especially the symptom scores associated with side effects of imatinib, significantly differed between adherent and nonadherent patients. Multivariate analysis revealed global health status as the sole predictor of adherent behavior (odds ratio, 0.978; 95% confidence interval, 0.963-0.994; P = .007). A higher proportion of adherent patients achieved deeper molecular responses. Low QoL was associated with nonadherence to imatinib in patients with CML.
  
  
  CONCLUSIONS
  It is likely that increased long-term symptom burden due to side effects of imatinib could contribute to nonadherence. Interventions targeting individual components of QoL may improve adherence and outcomes in CML.
authors.affiliation: Department of Psycho-oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Unnikrishnan
authors.affiliation: Department of Psycho-oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Surendran
authors.initials: S
authors.lastname: Veeraiah
authors.affiliation: Department of Molecular Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Samson
authors.initials: S
authors.lastname: Mani
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Rejiv
authors.initials: R
authors.lastname: Rajendranath
authors.affiliation: Department of Tumor Registry and Biostatistics, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Swaminathan
authors.initials: S
authors.lastname: Rajaraman
authors.affiliation: Department of Psycho-oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Grace Sahaya
authors.initials: GS
authors.lastname: Vidhubala Elangovan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Radhakrishnan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Trivadi S
authors.initials: TS
authors.lastname: Ganesan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.
authors.forename: Tenali G
authors.initials: TG
authors.lastname: Sagar
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India. Electronic address: prasanth.ganesan@cancerinstitutewia.org.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Ganesan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D007194:India / Q000453:epidemiology; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: CML; India; Molecular response; Outcomes; Quality of life