Oral adherence in adults with acute myeloid leukemia (AML): Results of a mixed methods study.
Bryant, AL; LeBlanc, TW; Albrecht, TA; Chan, Y-N; Richardson, J; Foster, MC; Dang, M; Owenby, S; Wujcik, D
Published in: Journal of Clinical Oncology
105 Background: The incidence of AML is increasing, in part due to an aging population. Amid established intravenous (IV) or subcutaneous chemotherapies , recent drug approvals have ushered in an era of oral medication (OM) approaches to treating AML, shifting the burden of daily adherence from clinicians to patients. We aimed to identify and summarize adherence to oral therapy in this population. Methods: Our mixed methods study design used focus groups (FG) and patient surveys. After IRB approval, 11 patients and 4 caregivers participated in 4 focus groups. Results were used to develop a 37-item OM adherence needs assessment. Subsequently, AML patients were recruited and consented at three cancer centers to complete surveys (online, at the clinic, hospital, or from home). Results: 100 patients completed the OM survey. Most were male (62%), racial/ethnic diversity (33%), < 65 years (59%), and college-educated (52%). The to be taken was the most frequent and troublesome challenge. Loss of appetite was the most commonly reported and problematic side effect. Although half of the patients stated, “no side effect would cause them to stop taking OM”, another 25% indicated nausea would cause non-adherence. The best strategy to support taking OM was to make it part of the daily routine. Directions for taking OM were most commonly found on medication bottles or received from the health care team (HCT); patients felt HCTs were the best source of directions. Nearly 1/3 of patients indicated they skip the OM dose altogether when they forget to take it. When asked what would help improve adherence: smaller pills, easier packaging, and scheduling assistance were most frequently reported. Older individuals (>65 years) had a slightly more positive attitude towards oral medication (p =.51). Younger patients (<65 years) were more accepting of taking oral vs IV meds, (p = .03). Conclusions: This study represents the first assessment of OM adherence in patients with AML. Three themes emerged in FG transcript analysis that informed the development of a 37-item survey that was subsequently completed by 100 patients. Findings provide the basis for further exploration of interventions to enhance and increase adherence to OM regimens.
