Imatinib-related symptom burden linked to adherence in Indian CML patients

By Shreeya Nanda, Senior medwireNews Reporter

Research shows low adherence to imatinib in Indian patients with chronic myeloid leukaemia (CML), with an association between nonadherence and worse symptom burden related to treatment.

Among 221 chronic phase CML patients who had received imatinib treatment for a median of 4 years, 45% were fully adherent, as indicated by a score of 8 on the Morisky Medication Adherence Scale. The remaining 55% of patients had scores of 7 or lower and were classed as nonadherent.

In contrast to previous research, no patient- or treatment-related factors, such as income status and awareness of disease and treatment, were associated with adherence, the team from the Cancer Institute (WIA) in Chennai, India, reports in Clinical Lymphoma, Myeloma and Leukemia.

There were significant differences between adherent and nonadherent patients with respect to quality of life, as assessed by the European Organization of Research and Treatment for Cancer Quality of Life Questionnaire C30 (EORTC QLQ C30) and the EORTC QLQ CML 24 scales.

Specifically, global health status, physical and role functioning scores were significantly higher in adherent versus nonadherent patients, while symptom scores for fatigue, nausea and vomiting, pain, dyspnoea and appetite loss - known side effects of imatinib - were higher in nonadherent patients.

Nonadherence was also significantly associated with increased impact on worry/mood and on daily life, body image problems, and reduced satisfaction with care and information.

Researcher Prasanth Ganesan and co-workers believe that "increased long term symptom burden due to side effects of imatinib could contribute to nonadherence", a finding supported by the adherence questionnaire, which showed that "46% of patients stopped medications when they felt worse".

In multivariate analysis, global health status was the only parameter that significantly predicted adherent behaviour, leading the authors to suggest that "[i]nterventions targeting individual components of QoL may improve adherence and outcomes in CML."

They highlight the impact nonadherence can have on molecular responses, which are predictive of long-term treatment outcomes, finding that among 54 nonadherent patients, none achieved undetectable levels of BCR-ABL transcripts, compared with half of 58 adherent patients.

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