Abstract IA07: Adherence to oral chemotherapy in children with Acute Lymphoblastic Leukemia

There is persuasive evidence that poor adherence to oral 6MP in children with ALL is prevalent and is associated with relapse. Carefully conducted studies using objective methods to monitor adherence (MEMS Caps) have yielded a critical level of adherence associated with an increased risk of relapse (~95%). These studies have demonstrated that the prevalence of non-adherence (adherence rate <95%) is 44% among children with ALL, and that 47% of the relapses observed among children entering remission in 1st CR are attributable to non-adherence. Vulnerable sub-populations at high risk of non-adherence include: older age (12-21 vs. <12); non-white race/ethnicity (Hispanics, African Americans and Asians); low annual household income/low parental education; household structure (single mother/multiple children); and absence of a routine surrounding pill taking. The most common self-reported reason for missing 6MP doses is forgetting to take medications. On the other hand, the most common facilitator for not missing 6MP doses is parental vigilance. These observations have informed a randomized clinical trial to enhance adherence to oral 6MP; this trial is currently enrolling patients. The comprehensive intervention package consists of a multimedia interactive patient/parent education program (MIPE), and physician-initiated web-based medication scheduling that translates into printed schedules and daily text-message reminders to prompt directly supervised therapy (DST) by the designated parent. We are studying the impact of this intervention package (IP) vs. MIPE alone (Edu) to improve adherence to oral 6MP in children with ALL. This trial is open at 89 sites. Of the 810 patients approached, 478 patients enrolled (participation rate: 59%). We anticipate reaching the target enrollment of 608 by June, 2017, with analyses completed by December, 2017.

Citation Format: Smita Bhatia. Adherence to oral chemotherapy in children with Acute Lymphoblastic Leukemia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA07.