title: Factors influencing adherence in CML and ways to improvement: Results of a patient-driven survey of 2546 patients in 63 countries.
abstract: Optimal adherence to CML therapy is of key importance to maximize treatment effectiveness. Two clinical studies (ADAGIO and Hammersmith) have proven a clear correlation between adherence and achieving optimal treatment response and have revealed that non-adherence is common in CML patients (Marin et al. in J Clin Oncol 28(24):2381-2388, 2010, Noens et al. in Haematologica 99(33):437-447, 2014). The aim of this study is to assess the extent of suboptimal adherence and to investigate motivations and behavioural patterns of adherence in a worldwide patient sample. Questionnaires were provided by the CML Advocates Network and were filled in by patients online and offline. Patient characteristics, treatment and motivations were collected. Adherence was assessed by the 8-item Morisky Medication Adherence scale. Logistic regression models were fitted to investigate the influence of different factors on adherence. Overall, 2 546 questionnaires from 63 countries and 79 CML patient organisations were evaluable. 32.7% of participants were highly adherent, 46.5% were in the medium and 20.7% in the low adherence group. Factors increasing the probability of being in the high adherence group are older age, male sex, management of side effects, only one tablet per day and feeling well informed about CML by the doctor. More than 2 years since diagnosis were significantly lowering the chance as was the use of reminding tools. Living arrangements, multiple medication and personal payment obligations increased the probability to be at least in the medium adherent group. This is the most comprehensive study conducted to date to gain knowledge about factors causing non-adherence in CML. Better information on the disease, medication and management of side effects, supported by haematologists, is key to improve adherence.
authors.affiliation: Leukemia Patient Advocates Foundation, Bern, Switzerland. jan@cmladvocates.net.|LeukaNET e.V., Riemerling, Germany. jan@cmladvocates.net.|, Münzgraben 6 P.O.B. 453, CH-3000, Bern, Switzerland. jan@cmladvocates.net.
authors.forename: Jan
authors.initials: J
authors.lastname: Geissler
authors.affiliation: Leukemia Patient Advocates Foundation, Bern, Switzerland.|Israeli CML Patients Organization, Netanya, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Sharf
authors.affiliation: Gruppo AIL Pazienti Leucemia Mieloide Cronica, Rome, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Bombaci
authors.affiliation: LMC France, Marseille, France.
authors.forename: Mina
authors.initials: M
authors.lastname: Daban
authors.affiliation: Stichting Hematon, Utrecht, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: De Jong
authors.affiliation: Leukaemia CARE, Worcester, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Gavin
authors.affiliation: Diagnoza CML, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Pelouchova
authors.affiliation: Polish Nationwide Association for CML Patients Aid, Warsaw, Poland.
authors.forename: Euzebiusz
authors.initials: E
authors.lastname: Dziwinski
authors.affiliation: Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.affiliation: Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany.
authors.forename: Verena Sophia
authors.initials: VS
authors.lastname: Hoffmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000970:Antineoplastic Agents
keywords: Adherence patient motivations; Behavioural patterns of adherence; CML treatment adherence; Chronic myeloid leukaemia; Driving factors of nonadherence; Factors causing nonadherence; Haematology; Molecular response; Morisky Medication Adherence scale; Optimal adherence; Patient advocacy; Patient-driven survey; Tyrosine kinase inhibitors