Promoting High Adherence in CML Patients: Proven Strategies for Health Care Providers
Panelists discuss how health care providers can promote medication adherence by moving beyond labeling patients as noncompliant, instead investigating root causes such as adverse effects, financial toxicity, or forgetfulness, while emphasizing the importance of building trusting relationships, involving caregivers as accountability partners, and creating personalized solutions that address each patient's specific barriers to maintaining their treatment regimen.
Effective Strategies to Improve TKI Adherence in CML: Clinical Summary
Understanding Nonadherence: Moving Beyond Noncompliance
Reframing the Adherence Challenge
- Terminology shift: Replace judgmental terminology (noncompliant patient) with investigation of adherence barriers
- Root cause analysis: Most adherence issues stem from specific, addressable factors rather than deliberate medication avoidance.
- Unexpected PCR fluctuations: Consider adherence issues when molecular monitoring shows unexplained rises
Key Adherence Barriers to Address
1. Adverse Effect Management
- Prioritize symptom assessment during clinical visits
- Address adverse effects proactively and systematically
- Lifestyle-specific considerations (eg, young patients skipping weekend doses for social activities)
2. Financial Toxicity
- Actively screen for financial barriers to medication access
- Connect patients with pharmaceutical assistance programs
- Identify when co-payment issues lead to selective dose skipping
- Implement financial navigation as a standard component of care
3. Complex Dosing Schedules
- Implement reminder systems tailored to patient preference (eg, alarms or mobile applications)
- Simplify regimens when possible
- Consider how new formulations (eg, fasting-independent nilotinib) may reduce complexity
Support System Enhancement
- Accountability partnerships: Involve caregivers or family members in treatment plan
- Supportive relationships: Evidence suggests that, similar to other health behaviors, medication adherence improves with support system engagement.
- Consistent follow-up: Establish regular check-ins specifically focused on adherence
Clinical Approach
- Trust building: Create an environment where patients can honestly discuss adherence challenges
- Intentional visits: Structure appointments to specifically address adherence barriers
- Nonjudgmental inquiry: Explore reasons behind missed doses without criticism
By addressing specific barriers to adherence rather than labeling patients as noncompliant, clinicians can partner with patients to develop personalized strategies that promote consistent tyrosine kinase inhibitor (TKI) therapy and optimize long-term chronic myeloid leukemia (CML) outcomes.
