Birmingham, AL—Medication adherence is overstated for young patients with the most common type of pediatric cancer, according to a new study.
The article, published in the journal Blood, points out that pediatric patients with acute lymphocytic leukemia (ALL), as well as their parents, are likely to tell physicians they followed drug regimens more closely than they actually did.
The University of Alabama at Birmingham–led study reports that 84% of patients with ALL or their parents over-reported adherence to prescriptions for 6-mercaptopurine (6MP), an oral maintenance therapy. The issue is that 95% of doses of the drug, which is prescribed for 2 years after chemotherapy to help patients achieve lasting remission, must be taken to be effective.
“Because this therapy is administered orally every day, we cannot supervise our patients to make sure they are taking their pills,” explained senior author Smita Bhatia, MD, MPH. “Findings from this study suggest that we need better ways to monitor intake of medications as prescribed.”
The study is touted as the first to directly compare self-reporting against electronic monitoring in pediatric cancer patients.
For the research, involving 416 pediatric ALL patients from 87 participating institutions across the United States, the study team provided 6MP prescription pill bottles that contained a microprocessor chip in the cap to log the date and time the bottle was opened.
Logs were then compared against self-report questionnaires completed by patients or their parents and provided to their physicians at monthly check-ups.
A direct inverse trend in over-reporting was documented. Of those found to adhere to their regimens at least 95% of the time, a small percentage (8%) over-reported their intake. Among those found to be nonadherent, however, a substantially larger percentage (47%) exaggerated compliance.
Lead study author Wendy Landier, PhD, RN, also of the University of Alabama at Birmingham, organized separate one-on-one interviews with patients and their parents to try and determine why the drug regimens weren’t being followed closely.
“We found that partnering with a parent was very conducive to our patients’ adherence, playing a key role in combatting forgetfulness,” said Landier, who reported that forgetfulness was the most common reason for failing to take or administer the medications.
In response to the results, a trial was initiated whereby physicians send personalized text messages to both patients and their parents at a prescribed time reminding them to take their medicine. Both patient and parent then report back, via text, that the indicated dose was taken.
“Our first study showed that non-adherence was prevalent, increasing the risk of relapse,” Bhatia noted. “We then found that parental vigilance was an important facilitator to adherence, while forgetting to take the medication was the most commonly reported barrier. We used these findings to inform the intervention trial to help families improve adherence to treatment. We hope that this will be a real step in improving outcomes in children with leukemia.”
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