CML survey reveals patient TKI adherence, disease anxiety

By Lynda Williams, Senior medwireNews Reporter

Survey results suggest that chronic myeloid leukaemia (CML) patients using tyrosine kinase inhibitor (TKI) therapy have good adherence to treatment but might benefit from counselling regarding their illness.

Massimo Breccia, from Sapienza University in Rome, Italy, and colleagues report the responses of 1133 CML patients who completed a 25-item questionnaire probing patient influences on TKI adherence and perceptions of the future.

Over half (58.1%) of the respondents were male, their median age was 57 years and most (79.6%) had a median disease duration of less than 10 years, the authors report in Leukemia Research.

Sixty percent of patients said they had never forgotten to take their drug, 26% said they rarely forgot, 13% sometimes forgot and 1% said they often forgot to take their TKI, with just 5% admitting they had ever forgotten to refill a prescription.

When asked to summarise their adherence, 55% of patients said that they missed their drug less than 3 days a month, while 4% said they missed their drug 4 to 7 days a month or more than 7 days.

Although 43% of patients had postponed a dose and 3.7% did this regularly, the majority (91%) of patients stated that they had never stopped treatment without consulting their doctor and 92% said they had never neglected their doctor’s treatment advice.

None of the patients said they had discontinued treatment because they did not understand the importance of adherence, with 89% stating they understood the consequences of scarce adherence. Discontinuation was instead attributed to forgetfulness (58%), adverse effects (14%), a sense to feel sick (5%) and concomitance with other drugs (6%).

When asked about issues associated with CML and treatment they would like to discuss with their physician but cannot do so, 41% of patients mentioned discomfort, anxiety and fear of the future, while 19% referred to psychological problems, 12% work issues, 10% relationships and family life, and 9% sexual issues.

“This is an important finding as often these issues are not part of routine visits and additional psychological counselling might be necessary to further help CML patients to cope with the disease and the fear of disease progression”, Breccia et al say.

Patients were also asked whether they would accept treatment interruption if they could achieve a “perfect and long-lasting response”. Although 16% of patients said they would interrupt treatment because of poor tolerance, 20% said they would not find “much difference” as they were used to treatment and 49% would not wish to interrupt treatment from fear their disease would return.

Noting that research suggests that around half of patients retain a molecular response without relapse when imatinib is discontinued during a deep, long-lasting molecular response, the authors conclude: “We can speculate on these results that healthcare physicians should improve patient's knowledge on making appropriate judgment as to long-term effects from treatment, dealing with missing doses and adverse effects reinforcing the importance of adherence.

“Moreover, increased knowledge about treatment free remission is necessary in order to illustrate the importance of deep molecular response and possible discontinuation.”

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