The CML Advocates Network has conducted a large international study with 2546 patients from 79 countries in 12 languages. It aimed to investigate motivations and behavioural patterns of adherence in CML, and subsequently support hematologists and patients to improve adherence and develop adherence tools. After first data had been presented at the scientific programme of EHA congress in June 2013, the CML Advocates Network is presenting new results of its multivariate analysis on factors predicting intentional non-adherence at the anuual congress of the American Society of Hematology (ASH) in New Orleans 2013! Click on "Read more" for the abstract, or here to download the poster.
Factors Predicting Intentional Non-Adherence In Chronic Myeloid Leukemia: A Multivariate Analysis On 2546 Patients By The CML Advocates Network
2LeukaNET e.V., Riemerling, Germany
3Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
4Gruppo AIL Pazienti Leucemia Mieloide Cronica, Rome, Italy
5Stichting Contactgroep Leukemie, Utrecht, Netherlands
6Leukaemia CARE, Worcester, United Kingdom
7Polish Nationwide Association for CML Patients Aid, Warsaw, Poland
8LMC France, Marseille, France
9Diagnoza CML, Prague, Czech Republic
10Inserm CIC 0802, CHU de Poitiers, Poitiers, France
11Israeli CML Patients Organization, Netanya, Israel
Based on previous literature and on clinical relevance, a pool of 16 candidate factors, potentially predicting intentional non-adherence, was selected for analysis. These included: frequency of CML medication, co-payment for CML treatment, and current TKI therapy. Patients who reported having skipped intentionally one or more doses over the last year were considered as "intentional non-adherers". Univariate logistic regression analysis was performed to examine the impact of pre-selected candidate factors on the probability of intentional non-adherence. Two multivariate models were fitted based on line of therapy received by patients (i.e. first line and second or greater lines of therapy).
Overall, 51.6% of all respondents reported having missed at least one dose unintentionally over the last year, and 19.5% did so intentionally. This analysis regards the intentional non-adherent population (n=490). Of those, 60% were on imatinib, 20% on nilotinib, 14% on dasatinib, 6% on other TKIs.
Several factors predicted intentional non-adherence in univariate analysis, including education level (P=0.016) and co-payment for TKIs (P=0.005). For patients on first line TKI (n=1551), the following factors independently predicted a higher likelihood of being intentional non-adherers: younger age (P=0.015), longer time since diagnosis (P<0.001), lower satisfaction with information received from healthcare providers (P=0.002), higher burden on social life (P<0.001) and not being fully informed on the importance of adherence (P=0.042). Non-adherence was lower when patients were told every dose was important to make the treatment work (P=0.042). Overall, intentional non-adherers intended to avoid fatigue (13%), diarrhea and GI issues (11%), nausea (10%) and muscle pain (9%). For patients in second or greater lines of therapy (n=985) all of the above factors were still statistically significant except for satisfaction with information received. Being female (P<0.001) also increased the likelihood of intentional non-adherence in this group.