ORLANDO—A study of physicians from five countries found that nurses and hematologists counseling patients with chronic myeloid leukemia about the importance of adherence to prescribed tyrosine kinase inhibitors (TKIs) or having an established adherence protocol, such as medication diaries, pill organizers, or informational calendars, was associated with im proved adherence, and those patients who took the drugs as prescribed had significantly better therapeutic milestones.
“Adherence is a problem because it’s a chronic disease, and after 6, 12, or 18 months, the patients do not feel sick,” said lead author François Guilhot, MD, from University Hospital Center of Poitiers, France. “They don’t have signs of leukemia, and they have some side effects from the therapy.”
Guilhot and colleagues surveyed 405 physicians in Brazil, France, Italy, Russia, and Spain online about their adherence perceptions and practices used to increase patients’ willingness to continue on the drugs and reviewed 1155 patient treatment histories and compliance records, with the dates of all initial and refill prescriptions.
Overall, 47% to 57% of patients had missed some doses, with an average of more than 10% of patients missing 10% or more of their prescribed daily dose. Greater adherence to the drugs was significantly correlated with achievement of better therapeutic milestones, which may affect the long-term outcomes.
“When healthcare providers are involved in counseling, it has an impact of improving missed doses,” said coauthor John Coombs, with Novartis Pharm a - ceuticals. Patient record reviews showed that patients in France, Italy, and Spain demonstrated improved adherence to their therapy if they received individual counseling by the nurse and/or hematologist.
Guilhot said he meets with returning patients for about 20 to 25 minutes, talking about the importance of taking their medications as ordered. He also sends them follow-up letters to improve results. In addition, nurses from the center’s clinical results department provide additional education.
“I spend time to make sure the treatment is taken by my patients,” Guilhot said.
Most physicians surveyed said they discussed adherence with patients at each appointment, but only approximately half of the doctors considered adherence a priority or viewed nonadherence as a major driver of disease progression, with physicians in Italy and Brazil expressing neutral feelings about the link between adherence and improved outcomes. Physicians surveyed said they believed they take an appropriate level of responsibility about adherence education, but that they also thought nurses and pharmacists could play a more active role. They indicated that they felt forgetfulness was a major contributor to nonadherence as well