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Patients’ and hematologists’ concerns regarding tyrosine kinase-inhibitor therapy in chronic myeloid leukemia

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

To explore patients’ and hematologists’ concerns regarding tyrosine kinaseinhibitor (TKI)-therapy and identify variables associated these concerns. Methods A cross-sectional questionnaire including 16 common issues related to TKI-therapy was distributed to adults with chronic myeloid leukemia (CML) receiving TKIs and hematologists treating CML patients and answered anonymously.

Results

Data from 1518 patient respondents receiving TKI-therapy ≥ 3 months were analyzed. 939 (62%) were male. Median age was 42 years. 72% were receiving imatinib. Median TKI-therapy duration was 27 months. Data from 259 hematologist respondents were analyzable. 154 (59%) treated > 5 persons with CML per month. Median number of concerns was 5 (range 0–16) for both patients and hematologists. The top five issues for both cohorts were new drug development, stopping TKI-therapy, TKI-reimbursement policies, TKI-related adverse effects and long-term efficacy of TKIs. 12 issues attracted proportionally discordant attention between patients and hematologists. Patients were more concerned with TKI-reimbursement policies, price reduction of TKIs, TKI-related adverse effects, restrictions to daily life, CML knowledge and interpretation of laboratory data, whereas hematologists were more concerned with stopping TKI-therapy, TKI choice, monitoring, TKI dose-adjustment, quality of generics and switching between branded and generic TKIs. In multivariate analyses female sex [OR = 1.4 (1.1–1.7); p = 0.008], education level ≥ bachelor e[OR = 1.8 (1.4–2.2); p < 0.001], TKI-therapy duration 36–< 60 months [OR = 1.4 (1.0–1.9); p = 0.049] and having adverse impact on daily life and work [OR = 1.5 (1.2–1.8]; p = 0.001] were associated with greater numbers of patients’ concerns.

Conclusions

Our data suggested hematologists need to be aware of CML patients’ concerns to improve their quality-of-life and patient-hematologist communication.

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References

  • Baccarani M, Deininger MW, Rosti G et al (2013) European Leukemia net recommendations for the management of chronic myeloid leukemia: 2013. Blood 122(6):872–884

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bower H, Björkholm M, Dickman PW, Höglund M, Lambert PC, Andersson TM (2016) Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population. J Clin Oncol 34(24):2851–2857

    Article  CAS  PubMed  Google Scholar 

  • Chen L, Guérin A, Xie J, Wu EQ, Yu AP, Ericson SG, Jabbour E (2012) Monitoring and switching patterns of patients with chronic myeloid leukemia treated with imatinib in community settings: a chart review analysis. Curr Med Res Opin 28(11):1831–1839

    Article  CAS  PubMed  Google Scholar 

  • Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL (2014) Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol 32(4):306–311

    Article  PubMed  Google Scholar 

  • Efficace F, Breccia M, Saussele S, Kossak-Roth U, Cardoni A, Caocci G, Chie W, Naeem A, Nicolatou-Galitis O, Cocks K, Vignetti M, Baccarani M, Mandelli F, Sprangers M, GIMEMA and EORTC Quality of Life Group (2012) Which health-related quality of life aspects are important to patients with chronic myeloid leukemia receiving targeted therapies and to health care professionals? Ann Hematol 91(9):1371–1381

    Article  PubMed  Google Scholar 

  • Goldberg SL (2015) Monitoring chronic myeloid leukemia in the real world: gaps and opportunities. Clin Lymphoma Myeloma Leukemia 15(12):711–714

    Article  Google Scholar 

  • Goldberg SL, Cortes JE, Gambacorti-Passerini C, Hehlmann R, Khoury HJ, Michallet M, Paquette RL, Simonsson B, Zyczynski T, Foreman A, Abruzzese E, Andorsky D, Beeker A, Cony-Makhoul P, Hansen R, Lomaia E, Olavarria E, Mauro MJ (2017) First-line treatment selection and early monitoring patterns in chronic phase-chronic myeloid leukemia in routine clinical practice: simplicity. Am J Hematol 92(11):1214–1223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hehlmann R, Lauseker M, Saußele S, Pfirrmann M, Krause S, Kolb HJ, Neubauer A, Hossfeld DK, Nerl C, Gratwohl A, Baerlocher GM, Heim D, Brümmendorf TH, Fabarius A, Haferlach C, Schlegelberger B, Müller MC, Jeromin S, Proetel U, Kohlbrenner K, Voskanyan A, Rinaldetti S, Seifarth W, Spieß B, Balleisen L, Goebeler MC, Hänel M, Ho A, Dengler J, Falge C, Kanz L, Kremers S, Burchert A, Kneba M, Stegelmann F, Köhne CA, Lindemann HW, Waller CF, Pfreundschuh M, Spiekermann K, Berdel WE, Müller L, Edinger M, Mayer J, Beelen DW, Bentz M, Link H, Hertenstein B, Fuchs R, Wernli M, Schlegel F, Schlag R, de Wit M, Trümper L, Hebart H, Hahn M, Thomalla J, Scheid C, Schafhausen P, Verbeek W, Eckart MJ, Gassmann W, Pezzutto A, Schenk M, Brossart P, Geer T, Bildat S, Schäfer E, Hochhaus A, Hasford J (2017) Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia 31(11):2398–2406

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hochhaus A, Larson RA, Guilhot F, Radich JP, Branford S, Hughes TP, Baccarani M, Deininger MW, Cervantes F, Fujihara S, Ortmann CE, Menssen HD, Kantarjian H, O’Brien SG, Druker BJ (2017) Long-term outcomes of imatinib treatment for chronic myeloid leukemia. N Engl J Med 376(10):917–927

    Article  CAS  PubMed  Google Scholar 

  • Ibrahim AR, Eliasson L, Apperley JF, Milojkovic D, Bua M, Szydlo R, Mahon FX, Kozlowski K, Paliompeis C, Foroni L, Khorashad JS, Bazeos A, Molimard M, Reid A, Rezvani K, Gerrard G, Goldman J, Marin D (2011) Poor adherence is the main reason for loss of CCyR and imatinib failure for chronic myeloid leukemia patients on long-term therapy. Blood 117(14):3733–3736

    Article  CAS  PubMed  Google Scholar 

  • Jiang Q, Gale RP (2016b) Molecular monitoring of tyrosine kinase inhibitor therapy of chronic myeloid leukemia in China. J Cancer Res Clin Oncol 142(7):1549–1555

    Article  CAS  PubMed  Google Scholar 

  • Jiang Q, Liu ZC, Zhang SX, Gale RP (2016a) Young age and high cost are associated with future preference for stopping tyrosine kinase inhibitor therapy in Chinese with chronic myeloid leukemia. J Cancer Res Clin Oncol 142(7):1539–1547

    Article  CAS  PubMed  Google Scholar 

  • Jiang Q, Wang H, Yu L, Gale RP (2017a) Higher out-of-pocket expenses for tyrosine kinase-inhibitor therapy is associated with worse health-related quality-of-life in persons with chronic myeloid leukemia. J Cancer Res Clin Oncol 143(12):2619–2630

    Article  PubMed  Google Scholar 

  • Jiang Q, Wang HB, Yu L, Gale RP (2017b) Variables associated with patient-reported outcomes in persons with chronic myeloid leukemia receiving tyrosine kinase-inhibitor therapy. J Cancer Res Clin Oncol 143(6):1013–1022

    Article  CAS  PubMed  Google Scholar 

  • Mesa RA, Miller CB, Thyne M, Goldberger S, Fazal S, Ma X, Wilson W, Paranagama DC, Dubinski DG, Naim A, Parasuraman S, Boyle J, Mascarenhas JO (2017) Differences in treatment goals and perception of symptom burden between patients with myeloproliferative neoplasms (MPNs) and hematologists/oncologists in the United States: findings from the MPN Landmark survey. Cancer 123(3):449–458

    Article  PubMed  Google Scholar 

  • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Chronic Myeloid Leukemia (2018). http://www.nccn.org/professionals/physician_gls/pdf/cml

  • Saleh MN, Haislip S, Sharpe J, Hess T, Gilmore J, Jackson J, Sail KR, Ericson SG, Chen L (2014) Assessment of treatment and monitoring patterns and subsequent outcomes among patients with chronic myeloid leukemia treated with imatinib in a community setting. Curr Med Res Opin 30(4):529–536

    Article  CAS  PubMed  Google Scholar 

  • Steensma DP, Komrokji RS, Stone RM, List AF, Garcia-Manero G, Huber JM, Dennison B, Sekeres MA (2014) Disparity in perceptions of disease characteristics, treatment effectiveness, and factors influencing treatment adherence between physicians and patients with myelodysplastic syndromes. Cancer 120(11):1670–1676

    Article  PubMed  Google Scholar 

  • Wilson KA, Dowling AJ, Abdolell M, Tannock IF (2000) Perception of quality of life by patients, partners and treating physicians. Qual Life Res 9(9):1041–1052

    Article  CAS  PubMed  Google Scholar 

  • Winn AN, Keating NL, Dusetzina SB (2016) Factors associated with tyrosine kinase inhibitor initiation and adherence among medicare beneficiaries with chronic myeloid leukemia. J Clin Oncol 34(36):4323–4328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The results of this study were presented in part at the American Society of Hematology (ASH) Annual Meeting in San Diego, December 3–6, 2016. This study was funded by National Natural Science Foundation of China (No. 81370637).

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Correspondence to Qian Jiang.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Jiang, Q., Yu, L. & Gale, R.P. Patients’ and hematologists’ concerns regarding tyrosine kinase-inhibitor therapy in chronic myeloid leukemia. J Cancer Res Clin Oncol 144, 735–741 (2018). https://doi.org/10.1007/s00432-018-2594-8

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