Study Looks at Treatment Adherence in Teens
People often have a hard time remembering to take their medications. This can lead to big problems for patients with leukemia, who often have to continue taking complicated pill regimens at home for up to 2 1/2 years after they finish their most intensive treatment at the hospital. “One common reason patients give for not taking their pills is that they have busy lifestyles and they forget,” said Dennis Drotar, PhD, director of the Center for Adherence Promotion and Self-Management at Cincinnati Children’s.
Drotar is currently leading a study that looks at treatment adherence in adolescents with acute lymphoblastic leukemia (ALL). The intervention comprises five hour-long sessions. “In the sessions, the family identifies what the major barriers are, and then brainstorms solutions with a therapist. The goal is to develop collaboration between the patient and the family,” said Drotar. Patients develop a written plan to help remember to take the medications. An electronically tagged pill bottle tells the researchers how frequently patients take their medications over the course of maintenance therapy, providing data on the usefulness of the intervention strategies.
Previous studies have shown that treatment adherence is tough for adolescents with ALL. In one of Drotar’s pilot studies of adolescents with ALL, a full 20-30 percent of patients did not show any metabolites in their blood from one of the primary drugs they were supposed to be taking. “We were amazed by that pilot study, because you would think that with a disease like this, 100 percent of patients would take medication,” said Drotar. “But in some ways, it could be that life takes over and you don’t think of yourself as a sick person.” Still, Drotar notes, forgetting to take medications for leukemia could be dangerous, and might lead to relapse. “The problem is that teenagers often think of themselves as less vulnerable than they really are,” he said. “There is often a mismatch between a parent’s perception of a child’s vulnerability and a child’s own perception of it. And that sometimes comes up in the sessions when the parents say they feel like they are nagging their child to take medication.”
Common strategies that come up in brainstorming sessions include building the medications into a daily routine, using pill boxes separated into days of the week, keeping track in writing and having written reminders, and anticipating some of the issues that will get in the way ahead of time so patients can avoid them. “One of the most important things is opening the line of communication between the parents and the child,” said Drotar.
The NIH-funded multi-site study began in 2008 and is expected to last for five years. Co-principal investigators include John Perentesis, MD, FAAP, director of the Oncology Program, and Alexander Vinks, PharmD, PhD, FCP, director of the Clinical Pharmacology Research Unit at Cincinnati Children’s.
