ASCO 2014: For kids taking medication, fewer adults is sometimes better
Missing an occasional dose of medicine may not seem like a big deal, but for kids with acute lymphoblastic leukemia (ALL), it can have dire consequences. Now City of Hope researchers have assessed the factors that can contribute to so-called medication non-adherence. One of their more surprising discoveries: Having multiple adults involved with administering medication actually lowers the likelihood that kids will take the drugs as they should.
The results will be presented at the American Society of Clinical Oncology annual meeting on June 1.
"ALL is a highly treatable cancer, but patients need to take ongoing oral chemotherapy for two years after the initial remission to reduce likelihood of relapses," said Smita Bhatia, M.D., M.P.H., senior author of the study and the Ruth Ziegler Chair in Population Sciences at City of Hope. "By identifying factors linked to non-adherence, we can identify at-risk patients and intervene to ensure that they stay on track with the medication schedule."
City of Hope researchers had already found that not non-adherence to medication regimens can triple a patient's risk of relapse. They also knew that almost half of pediatric ALL patients don't take their medication as they should. Understanding the reasons for such non-adherence is a first step in reducing the risk of relapse.
In their new analysis, Bhatia, Wendy Landier, Ph.D., R.N., assistant professor in the Department of Population Sciences, and their colleagues studied 462 pediatric ALL patients taking maintenance oral chemotherapy. Using a combination of questionnaires, demographic data and devices that track when the drug bottles were opened, the researchers found that the following factors are associated with non-adherence:
- Patient is 12 years of age or older.
- Parental education is at, or less than, high school level.
- Annual household income is less than $50,000.
- Being of Hispanic or African-American ethnicity.
- Not taking the follow-up medication at the same time each day.
- Taking follow-up medication with dairy products.
- Involving two or more adults to supervise administering the medication.
The last factor was an unexpected finding, because the presence of multiple adults should theoretically increase the likelihood of the medication being administered. But the researchers speculate that having multiple adults involved may lead to a lower likelihood of adherence because each adult assumes another administered the medication.
With respect to the observation regarding dairy products, Landier and Bhatia noted that patients and their parents are advised against taking the medication with dairy products, which makes the medication less absorbable. Those who chose to disregard this instruction may also be less likely to be stringent about adhering to the medication schedule, they said.
Given these findings, Landier and Bhatia are currently designing and implementing interventions to enhance maintenance therapy adherence among vulnerable patient groups.
Learn more about City of Hope's population sciences program.
The abstract (#10013) is available ahead of the meeting on ASCO's website.