Electronic monitoring of medication adherence in early maintenance phase treatment for pediatric leukemia and lymphoma: identifying patterns of nonadherence

Jennifer M Rohan; Dennis Drotar; Melissa Alderfer; Crista Wetherington Donewar; Linda Ewing; Ernest R Katz; Anna Muriel

doi:10.1093/jpepsy/jst093

Electronic monitoring of medication adherence in early maintenance phase treatment for pediatric leukemia and lymphoma: identifying patterns of nonadherence

J Pediatr Psychol. 2015 Jan-Feb;40(1):75-84. doi: 10.1093/jpepsy/jst093. Epub 2013 Dec 23.

Authors

Jennifer M Rohan¹, Dennis Drotar², Melissa Alderfer³, Crista Wetherington Donewar³, Linda Ewing³, Ernest R Katz³, Anna Muriel³

Affiliations

¹ Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA rohanjenm@gmail.com.
² Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.
³ Department of Psychology, University of Cincinnati, USA, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA, Department of Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital Cancer Center, USA.

Abstract

Objective: To describe patterns of treatment adherence to early maintenance phase therapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL).

Methods: Using an objective observational method (electronic monitoring), adherence was examined for 139 patients aged 7-19 years diagnosed with ALL or LBL across 6 centers.

Results: The mean adherence percentage was 86.2%. Adherence rates declined over the 1-month of follow-up to 83%. 3 linear trajectories of 6-mercaptopurine adherence were identified: (1) exemplary adherence (n = 99): Averaging nearly 100%; (2) deteriorating (n = 23): Adherence decreased from 100 to 60%; and (3) chronically poor adherence (n = 9): Averaging 40%.

Conclusions: Adherence promotion interventions might be tailored to subgroups of patients who demonstrated problematic patterns of treatment adherence that could place them at risk for relapse. This research demonstrates the importance of using objective real-time measures of medication adherence for measuring and documenting adherence patterns.

Keywords: adherence; cancer and oncology; research design and methods; statistical applications.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Child
Child, Preschool
Drug Monitoring
Female
Humans
Male
Medication Adherence / psychology*
Medication Adherence / statistics & numerical data*
Mercaptopurine / therapeutic use*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / psychology*
Young Adult

Substances

Mercaptopurine

Abstract

Publication types

MeSH terms

Substances

Grants and funding