Treatment adherence and adverse event management in chronic lymphocytic leukemia: challenges and strategies for the future

ABSTRACT

Introduction

There has been a paradigm shift in the treatment of chronic lymphocytic leukemia (CLL) over the past decade. With the advent of self-administered targeted oral anticancer agents (OAAs), the treatment of CLL has begun to shift from the infusion clinic to the patient’s home. This introduced new challenges including patient non-adherence, class-specific adverse effects, and financial toxicity to treatment. In this paper, we discuss a structured approach to identifying and addressing barriers to optimal patient outcomes.

Areas covered

We will ground our discussion using the five dimensions of adherence as defined by the World Health Organization (WHO): therapy factors, health-system factors, condition-related factors, social/economic factors, and patient factors. We discuss how each of these domains present in patients with CLL. We will also discuss how we can prevent and address these barriers in through the various phases of treatment.

Expert opinion

A multidisciplinary program to support patients on OAAs is critical for patients with CLL. This team should involve pharmacists and social workers in addition to nursing, advanced practitioner and physician colleagues. The program should aim to identify, prevent, and address patient-specific barriers by offering individualized solutions. We describe how such a program can be designed and implemented.

KEYWORDS:

• Adherence
• CLL
• oral oncolytics
• targeted therapy
• BTK inhibitors
• venetoclax

Article highlights

• Elucidates barriers to oral anticancer agent (OAA) adherence in patients with chronic lymphocytic leukemia (CLL) in the context of the WHO five dimensions of adherence

• Highlights treatment toxicities and access barriers unique to CLL patients that prevent treatment adherence

• Barriers to adherence separated by phase in treatment (pre- and post-treatment initiation)

• Objectives of multidisciplinary intervention needed to support medication adherence in patients with CLL explained

• Provides possible structure of a multidisciplinary intervention to support OAA adherence in patients with CLL

Declaration of interest

B Muluneh serves as a consultant for Servier Pharmaceuticals. B Muluneh’s spouse is an employee and stockholder of Novartis Pharmaceuticals. M Upchurch is currently completing a postdoctoral fellowship sponsored by GSK, plc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.