Abstract
Purpose
Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.
Patients and methods
Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.
Results
Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.
Conclusion
Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome.
Acknowledgments
The authors express their deep gratitude to all patients who participated in the study. They also record their appreciation to Professor Nicholas Jackson from the Department of Pathology, Faculty of Medicine, University of Malaya, for his assistance in editing the manuscript, and to all the staff of the hematology clinics of UMMC and AH for their cooperation and assistance. In addition, they acknowledge the University of Malaya for funding this study under grant PG057-2015A. Lastly, they would like to thank the Director General of Health Malaysia for his permission to publish this paper.
Author contributions
BKT, SBT, and LCC designed and BKT performed the study; BKT, SBT, PCB, SSC, SB, LCC, KMC, HNBKJ, and SCE analyzed the data; BKT drafted the manuscript; and LCC, SBT, PCB, KMC, SSC, SB, HNBKJ, and SCE revised the manuscript critically for important intellectual content and approved the final version to be published. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.