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Oral adherence in adults with acute myeloid leukemia (AML): results of a mixed methods study



The incidence of AML is increasing, in part due to an aging population. Since 2017, eight novel agents have been introduced, 6 of which are oral: midostaurin, enasidenib, ivosidenib, gilteritinib, glasdegib, and venetoclax. With an increase in oral medications (OMs), patients face associated side effects that accompany OMs, which often decreases adherence. We aimed to identify and summarize adherence to OMs in this population.


Our mixed method design used focus groups (FG) and patient surveys. After IRB approval, 11 patients and 4 caregivers participated in 4 FGs. Themes from the FGs were used to develop a 37-item OMs adherence needs assessment. Participants were recruited and consented at three cancer centers to complete surveys (online, at the clinic, hospital, or from home).


A total of 100 patients completed OMs survey. The number of pills to be taken was the most frequent and troublesome challenge. The most frequently reported interventions that would improve patient adherence were smaller pills, easier packaging, and scheduling assistance. Nearly 33% of patients indicated they skip OMs dose altogether when they forget to take it. Younger patients (< 65 years) were more accepting of taking oral compared with intravenous medications (p = .03).


This study represents the first assessment of OMs adherence in adults with AML. Findings provide the basis for further exploration of interventions to enhance and increase adherence to OMs regimens.

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This work was supported by Astellas, Inc. We also thank UNC Connected Health for Applications and Interventions (CHAI) core for their efforts in facilitating the interviews and analysis. We thank the patients, caregivers, and nursing staff from all sites for their support of this study.


This work was supported in part by the University of North Carolina at Chapel Hill’s Connected Health Applications & Interventions Core (CHAI Core) through a grant from NIH (DK056350) to the University of North Carolina Nutrition Obesity Research Center AND/OR from NCI (P30-CA16086) to the Lineberger Comprehensive Cancer Center.

Author information

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ashley Leak Bryant, Thomas LeBlanc, Tara Albrecht, Ya-Ning Chan, Jaime Richardson, Matthew Foster, Melissa Dang, William Dudley Susie Owenby, and Debbie Wujcik. The first draft of the manuscript was written by Dr. Ashley Leak Bryant and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Ashley Leak Bryant.

Ethics declarations

The study was reviewed and approved by the University of North Carolina at Chapel Hill Institutional Review Board (IRB). Informed consent was obtained by all participants prior to joining the groups.

Conflict of interest

Dr. Bryant has received grants from Carevive during the conduct of the study and honorarium outside the submitted work. Dr. Leblanc has received personal fees from AbbVie, personal fees from Agios, grants and personal fees from AstraZeneca, personal fees from Amgen, personal fees from CareVive, personal fees and other from Celgene, personal fees from Daiichi-Sankyo, personal fees from FlatIron, personal fees from Helsinn, personal fees from Heron, personal fees from Medtronic, personal fees from Otsuka, personal fees from Pfizer, grants and personal fees from Seattle Genetics, personal fees from UpToDate, personal fees from Welvie, grants from American Cancer Society, grants from Duke University, grants from NINR/NIH, grants from Jazz Pharmaceuticals, outside the submitted work. Ms. Chan has received assistantship, and scholarship from University of North Carolina at Chapel Hill outside the submitted work. Ms. Richardson has provided consulting for Roche/Ventana outside the submitted work. Dr. Foster has received grants from Celgene, grants from MacroGenics, grants from Bellicum Pharmaceuticals, other from Daiichi-Sankyo, outside the submitted work. Dr. Dudley has received consultation fee from Carevive Systems, Inc. during the conduct of the study. Ms. Owenby and Dr. Wujcik are employed by Carevive System, Inc. during the conduct of the study. Dr. Albrecht and Ms. Dang have no conflict of interest to disclose.

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Bryant, A.L., LeBlanc, T.W., Albrecht, T. et al. Oral adherence in adults with acute myeloid leukemia (AML): results of a mixed methods study. Support Care Cancer (2020). https://doi.org/10.1007/s00520-020-05349-5

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  • Acute myeloid leukemia
  • Oral adherence
  • Symptoms
  • Side effects
  • Medication assessment
  • Barriers