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The Achilles’ Heel of Oral Cancer Meds?
Adherence is defined by WHO (World Health Organization) as:
“The extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed upon recommendations from a healthcare provider.”
While it is stupidly obvious that no medicine works unless we take it, it still might be surprising to learn that poor adherence is the most important reason for failure to response to some cancer therapies.
There is more robust research about adherence in CML (chronic myeloid leukemia) as oral meds such as imatinib (Gleevec or Glivec) have been the standard of care for many years. This has been studied by patient groups as well as physicians. Giora Sharf and Jan Geissler of the CML Network Group performed a study of 2,546 CML patients in 79 countries that identified using both online and paper surveys to identify reasons for non-adherence, as well as to identify at-risk groups. See my interviews from ASH 2013: Part 1 and Part 2.
The titles of the these publications tell us most of what we need to know:
Poor adherence is the main reason for loss of CCyR and imatinib failure for chronic myeloid leukemia patients on long-term therapy. Ibrahim et al., 2011: Ibrahim AR, Eliasson L, Apperley JF et al. Blood 2011;117 (14): 3733-3736.
Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. Marin D, Bazeos A, Mahon FX et al.J Clin Oncol 2010;28(14): 2381-2389.
In an article co-authored by our very own Betsy Dennison RN, we find research uncovering many of the causes of patients not talking their meds as prescribed for another blood cancer, MDS (myelodysplastic syndromes). Sadly, MDS is not an uncommon complication of the chemo-immunotherapy used to treat our CLL.
We, as CLL patients now have access to oral therapies. Oral therapies for cancer place the responsibility on the patient for the accuracy of dosing.
It also gives rise to many questions
Will we also impact our optimal clinical outcomes by nonadherence, intentionally or unintentionally?
Who of us are at risk for nonadherence?
Are you satisfied with the information you’ve received about taking your medication?
Do you have side effects that tempt you to occasionally skip a dose?
Adherence to oral cancer medications is not a one-person solution – it requires a team effort. Asking questions of our healthcare team and educating ourselves can help us be adherent.
Still, even if our providers don’t do the best job of explaining the importance of how we take our pills, and even if we feel better if we skip the occasional day with no obvious or immediate downside, it is ultimately our responsibility to manage our medications.
Brian Koffman 3/20/15