New research published in Blood suggests young patients with acute lymphoblastic leukemia (ALL)—and their parents—are likely to over-report treatment adherence.
In a study of 416 pediatric ALL patients, 84% of patients or their parents said the patients took more 6-mercaptopurine (6MP) than they actually did.
6MP is prescribed for 2 years after chemotherapy with the goal of producing durable remissions, but studies show that over 95% of the prescribed doses must be taken for the medication to be effective.
“Because this therapy is administered orally every day, we cannot supervise our patients to make sure they are taking their pills,” said study author Smita Bhatia, MD, of the University of Alabama at Birmingham.
“Findings from this study suggest that we need better ways to monitor intake of medications as prescribed.”
This study included 416 pediatric ALL patients followed over 4 months. Patients received prescription pill bottles for their 6MP that contained a microprocessor chip in the cap to log the date and time the bottle was opened.
The logs were compared to self-report questionnaires completed by patients or their parents and provided to physicians at monthly check-ups.
Patients were classified as:
- Perfect reporters—self-report corresponded to data from the Medication Event Monitoring System (MEMS)
- Over-reporters—self-report was greater than MEMS data by more than 5 days per month for more than 50% of the study months
- Others—all patients not meeting criteria for perfect- or over-reporter.
Twelve percent of patients were classified as perfect reporters, 23.6% were over-reporters, 0.5% were under-reporters, and 63.9% were classified as “others.”
Self-reported 6MP intake exceeded MEMS data at least some of the time in 84% of patients.
“We observed that there was an inverse relationship between over-reporting and the extent of non-adherence,” Dr Bhatia noted.
Of the patients who adhered to their regimens (defined as taking their prescribed dose 95% of the time), a small percentage (8%) over-reported their intake.
However, among those found to be non-adherent, a substantially larger percent (47%) over-reported.
In order to find out why patients were not taking their prescribed medication, study author Wendy Landier, PhD, RN, also of the University of Alabama at Birmingham, organized interviews with patients and their parents.
In these interviews, Dr Landier noted that forgetfulness was the primary reason for non-adherence.
“We found that partnering with a parent was very conducive to our patients’ adherence, playing a key role in combatting forgetfulness,” she said.
Recognizing the importance of parental involvement in patient adherence, the researchers were inspired to conduct further research to make parents more involved.
In a trial that builds on this study, 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,” Dr Bhatia said. “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.”
