Journal of Cancer Research and Clinical Oncology

, Volume 142, Issue 7, pp 1539–1547 | Cite as

Young age and high cost are associated with future preference for stopping tyrosine kinase inhibitor therapy in Chinese with chronic myeloid leukemia

  • Qian Jiang
  • Zheng-Chen Liu
  • Song-Xin Zhang
  • Robert Peter Gale
Original Article – Clinical Oncology

Abstract

Purpose

To explore therapy-goals and patients’ expectations regarding discontinuing tyrosine kinase inhibitors (TKIs) therapy in Chinese with chronic myeloid leukemia (CML). To identify variables associated with these expectations and preferences.

Methods

Noninterventional, cross-sectional study using questionnaires distributed to persons with CML and answered anonymously.

Results

With CML in chronic phase, 888 respondents were evaluable. In total, 513 respondents (58 %) were male. Median age was 41 years (range 18–88 years). Median TKI therapy duration was 3 years (range <1–13 years). In total, 735 respondents (83 %) paid part or all of the cost of TKI. As their treatment goal, 430 of 888 respondents (48 %) reported treatment-free remission (TFR). In the future, 734 respondents (83 %) expected to discontinue TKI. Multivariate analyses confirmed younger age [HR = 1.3; (1.1, 1.4); P < 0.001] and higher out-of-pocket expense [HR = 1.2; (1.1, 1.4); P < 0.001] were associated with TFR as a therapy-goal. Both variables were also associated with patients’ hope to stop TKI therapy in the future: HR = 1.4; (0.8, 1.7; P < 0.001) and HR = 1.5; (1.3, 1.8; P < 0.001). Achieving a complete molecular response [HR = 1.8 (1.1, 2.9); P = 0.017] and decreased quality of life resulting from adverse effects [HR = 1.2; (1.0, 1.5); P = 0.021] were factors associated with the expectation of discontinuing TKI therapy.

Conclusions

Younger age and higher out-of-pocket cost are associated with patients’ preference for stopping TKI therapy.

Keywords

Tyrosine kinase inhibitors Chronic myeloid leukemia Imatinib Nilotinib Dasatinib 

Notes

Author contributions

JQ designed the study, collected, analyzed and interpreted the data, and drafted the article. LZC designed the study. ZSX collected the data. RPG interpreted the data and drafted the article. All authors read and approved the final typescript.

Funding

This study was funded by National Natural Science Foundation of China (No. 81370637). RPG acknowledges support from the National Institute of Health Research (NIHR) Biomedical Research Centre funding scheme.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures 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.

Informed consent

Because the survey used anonymous questionnaires, the Ethics Committee of Peoples Hospital determined informed consent of participants was not required.

Supplementary material

432_2016_2159_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)

References

  1. Apperley JF (2015) Chronic myeloid leukemia. Lancet (London, England) 385:1447–1459CrossRefGoogle Scholar
  2. Arora NK, McHorney CA (2000) Patient preferences for medical decision making: who really wants to participate? Med Care 38:335–341CrossRefPubMedGoogle Scholar
  3. Baccarani M, Deininger MW, Rosti G et al (2013) European LeukemiaNet recommendations for the management of chronic myeloid leukemia. Blood 122:872–884CrossRefPubMedGoogle Scholar
  4. Breccia M, Alimena G (2014) Discontinuation of tyrosine kinase inhibitors and new approaches to target leukemic stem cells: treatment-free remission as a new goal in chronic myeloid leukemia. Cancer Lett 347:22–28CrossRefPubMedGoogle Scholar
  5. Brom L, Pasman HRW, Widdershoven GAM et al (2014) Patients’ preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients. PLoS One 9(6):e100435CrossRefPubMedPubMedCentralGoogle Scholar
  6. Cortes JE, Baccarani M, Guilhot F et al (2010) Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study. J Clin Oncol 28:424–430CrossRefPubMedGoogle Scholar
  7. 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 32:306–311CrossRefPubMedGoogle Scholar
  8. Efficace F, Baccarani M, Breccia M et al (2011) Health-related quality of life in chronic myeloid leukemia patients receiving long-term therapy with imatinib compared with the general population. Blood 118:4554–4560CrossRefPubMedGoogle Scholar
  9. Gambacorti-Passerini C, Antolini L, Mahon F-X et al (2011) Multicenter independent assessment of outcomes in chronic myeloid leukemia patients treated with imatinib. J Natl Cancer Inst 103:553–561CrossRefPubMedGoogle Scholar
  10. Ganesan P, Sagar TG, Dubashi B et al (2011) Non-adherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol 86:471–474CrossRefPubMedGoogle Scholar
  11. Ibrahim AR, Eliasson L, Apperley JF et al (2011) Poor adherence is the main reason for loss of CCyR and imatinib failure for chronic myeloid leukemia patients on long-term therapy. Blood 117:3733–3736CrossRefPubMedGoogle Scholar
  12. Jiang Q, Gale RP (2016) Molecular monitoring of tyrosine kinase inhibitor therapy of chronic myeloid leukemia in China. J Cancer Res Clin Oncol (accepted)Google Scholar
  13. Kantarjian HM, Hochhaus A, Saglio G et al (2011) Nilotinib versus imatinib for the treatment of patients with newly diagnosed chronic phase, Philadelphia chromosome-positive, chronic myeloid leukemia: 24-month minimum follow-up of the phase 3 randomized ENESTnd trial. Lancet Oncol 12:841–851CrossRefPubMedGoogle Scholar
  14. Kapoor J, Agrawal N, Ahmed R et al (2015) Factors influencing adherence to imatinib in Indian chronic myeloid leukemia patients: a cross-sectional study. Mediterr J Hematol Infect Dis 7:e2015013CrossRefPubMedPubMedCentralGoogle Scholar
  15. Kekäle M, Talvensaari K, Koskenvesa P, Porkka K, Airaksinen M (2014) Chronic myeloid leukemia patients’ adherence to per-oral tyrosine kinase inhibitors compared with adherence as estimated by their physicians. Patient Prefer Adherence 8:1619–1627CrossRefPubMedPubMedCentralGoogle Scholar
  16. Kim D-W, Banavali SD, Bunworasate U et al (2010) Chronic myeloid leukemia in the Asia-Pacific region: current practice, challenges and opportunities in the targeted therapy era. Leuk Res 34:1459–1471CrossRefPubMedGoogle Scholar
  17. Kodama Y, Morozumi R, Matsumura T et al (2012) Increased financial burden among patients with chronic myelogenous leukemia receiving imatinib in Japan: a retrospective survey. BMC Cancer 12:152CrossRefPubMedPubMedCentralGoogle Scholar
  18. Mahon FX, Réa D, Guilhot J et al (2010) Discontinuation of imatinib in patients with chronic myeloid leukemia who have maintained complete molecular remission for at least 2 years: the prospective, multicentre Stop Imatinib (STIM) trial. Lancet Oncol 11:1029–1035CrossRefPubMedGoogle Scholar
  19. Marin D, Bazeos A, Mahon FX et al (2010) Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol 28:2381–2388CrossRefPubMedGoogle Scholar
  20. Mühlbacher AC, Bethge S (2015) Patients’ preferences: a discrete-choice experiment for treatment of non-small-cell lung cancer. Eur J Health Econ 16:657–670CrossRefPubMedGoogle Scholar
  21. National Comprehensive Cancer Network (2016) NCCN clinical practice guidelines in oncology: chronic myelogenous leukemia version 1. Fort Washington PA. National Comprehensive Care Network. 2015. http://www.nccn.org/professionals/physician_gls/pdf/cml.pdf. Accessed 26 March 2016
  22. Noens L, Van Lierde MA, De Bock R et al (2009) Prevalence, determinants, and outcomes of non-adherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood 113:5401–5411CrossRefPubMedGoogle Scholar
  23. Rousselot P, Huguet F, Rea D et al (2007) Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years. Blood 109:58–60CrossRefPubMedGoogle Scholar
  24. Sanford D, Kyle R, Lazo-Langner A et al (2014) Patient preferences for stopping tyrosine kinase inhibitors in chronic myeloid leukemia. Curr Oncol 21:e241–e249CrossRefPubMedPubMedCentralGoogle Scholar
  25. Wang A-H, Wang Y-Y, Yao Y et al (2010) Summary of 615 patients of chronic myeloid leukemia in Shanghai from 2001 to 2006. J Exp Clin Cancer Res 29:20CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Qian Jiang
    • 1
    • 2
  • Zheng-Chen Liu
    • 3
  • Song-Xin Zhang
    • 3
  • Robert Peter Gale
    • 4
  1. 1.Peking University People’s Hospital, Peking University Institute of HematologyBeijing Key Laboratory of Hematopoietic Stem Cell TransplantationBeijingChina
  2. 2.Collaborative Innovation Center of HematologySoochow UniversitySuzhouPeople’s Republic of China
  3. 3.New Sunshine Charity FoundationBeijingChina
  4. 4.Division of Experimental Medicine, Department of Medicine, Haematology Research CentreImperial College LondonLondonUK

Personalised recommendations