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2 results

  • Lack of congruence between patients' and health professionals' perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study

  • Simon Wu, Desmond Chee, Anna Ugalde, Phyllis Butow, John Seymour, Penelope Schofield
  • Journal:
    Palliative & Supportive Care / Volume 13 / Issue 2 / April 2015
    Published online by Cambridge University Press:
    13 February 2014, pp. 255-263
  • Objective:

    Consistent use of imatinib is critical for treatment success in chronic myeloid leukemia, yet perfect adherence to the prescribed clinical regimen is reported to be as low as 14%. This study aimed to understand patients' experiences of chronic myeloid leukemia with a qualitative approach, including identified facilitators and barriers to adherence, drawing on patients' and health professionals' perspectives, recording comments made by patients and health professionals involved with the same treatment team.

    Method:

    We recruited patients with chronic myeloid leukemia prescribed imatinib therapy and health professionals involved in their treatment from a specialized cancer center. Semi-structured qualitative interviews were recorded, transcribed, and manually analyzed using interpretive phenomenological analysis. Recruitment ceased upon saturation, with 16 patients and 10 health professionals (hematologists n = 4, nurses n = 3, pharmacists n = 3).

    Results:

    Twelve patients reported at least one instance of nonadherence. Reasons for unintentional nonadherence included forgetfulness related to variations of routine and doctor–patient communication issues. Reasons for intentional nonadherence included desires to reduce dose-dependent side effects and insufficient support. Patients who reported higher nonadherence rates felt complacent following periods of sustained disease control or had received conflicting advice regarding nonadherence. Health professionals had difficulty in accurately evaluating medication adherence due to a lack of reliable measures, utilizing patient self-report and manifestations of suboptimal disease control to guide assessments.

    Significance of Results:

    Adherence issues persist throughout the course of treatment. While high patient-reported nonadherence rates were recorded, health professionals were often unaware of the complex causes, compounded by an inadequacy of adherence assessment tools. Some patients reported nonadherence events because of insufficient education or lack of access to prompt medical guidance. These issues should be addressed to improve clinical practice.

  • Chapter 15 - Nonobstetrical surgical interventions during pregnancy

  • from Section 2 - Fetal effects of cancer treatments and interventions
  • Edited by Gideon Koren, University of Toronto, Michael Lishner, Tel-Aviv University
  • Book:
    Cancer in Pregnancy and Lactation
    Published online:
    05 December 2011
    Print publication:
    10 November 2011, pp 95-116

  • Summary

    This chapter discusses the treatment of acute and chronic leukemia during pregnancy. Leukemia occurs very rarely during pregnancy. The majority of cases are acute leukemia; of which two-thirds are myeloblastic (AML) and one-third are lymphoblastic (ALL). Chronic myeloid leukemia (CML) is found in less than 10% of leukemia cases during pregnancy, and chronic lymphocytic leukemia (CLL) is extremely rare. The treatment of CML has evolved dramatically since the introduction of tyrosine kinase inhibitors (TKI). There are several options for the treatment of CLL. When treatment is indicated, cytoreduction may be accomplished mechanically with leukapheresis. The most popular drugs are: chlorambucil, which is contra-indicated during the first trimester of pregnancy because of its teratogenicity; and fludarabine, an anti-metabolite. Corticosteroids may be used for the treatment of autoimmune complications, as in nonpregnant patients. Hairy cell leukemia is very rare during pregnancy. Interferon alpha was historically used in the treatment of this disease.