Contributions
Abstract: PB1498
Type: Publication Only
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
Oral targeted therapies (OTT) have transformed the treatment of chronic lymphocytic leukemia (CLL). Prior studies in cancer patients (pts) have reported variable adherence rates (12-100%) to OTT with suboptimal adherence associated with inferior outcomes. Data from studies in CLL suggest that even brief treatment interruptions can lead to lower survival rates. However, defining optimal adherence and routine measurement of adherence in clinical practice is challenging. Techniques for measuring adherence include self-reporting, pill counts, electronic monitoring systems, prescription database analysis and assessment of serum/urine drug levels. We conducted a pilot study to evaluate the performance of multiple strategies for measuring adherence in a busy oncology practice caring for older adults (OA) with CLL.
Aims
The aims of this study were three-fold:
1. To compare the utilization of self-report [brief adherence rating scale (BARS)], pill count and Medical Event Monitoring System (MEMS) Cap (an electronic bottle cap) to measure adherence to OTT in OA with CLL.
2. To determine the adherence rate and factors impacting adherence.
3. To correlate adherence rate with disease outcomes.
Methods
Pts ≥70 years (yrs) with CLL and other lymphoid disorders on OTT were followed monthly for the first 3 months (mos), then every 3 mos for 1 year. Nursing home residents were excluded. Pt, disease and treatment characteristics [including a geriatric assessment (GA)] were recorded at baseline. Adherence was measured at every visit with BARS, pill count and MEMS Cap. Data on adverse events and disease outcomes were also collected.
Results
Of the 54 pts screened, 25 were enrolled. Median age was 77 yrs (71-93 yrs), 21 pts had CLL, 3 had mantle cell lymphoma and 1 had marginal zone lymphoma. Geriatric syndromes (GS) detected at baseline included cognitive impairment (28%), depression (24%), polypharmacy (92%) and recent falls (12%); 48% pts had ≥2 GS. Most frequently used OTT were ibrutinib (n=17) and venetoclax (n=5). So far, pts have completed a total of 63 visits (30 virtual, 33 in-person) with median follow up of 3.3 mos. BARS was the most consistently used measure of adherence (63/63 visits, 100%). MEMS cap data was obtained on 13% of total visits. Pill package incompatibility (68%), refusal to use MEMS cap (8%) and clinical trial participation (4%) precluded use of MEMS cap in 80% (n=20) of pts. Pill counts could be performed at only 8% of visits due to increasing usage of telehealth (51%), unavailability of pill packaging (32%) or logistic issues (17%). Median adherence using both BARS and MEMS cap was 100% (range, 70%>100% for BARS; 82-100% for MEMS cap). Only 4 pts had less than 100% adherence at any visit. Patient’s self-report accurately reflected MEMS cap measured adherence in these instances. Five pts (20%) required dose interruptions, mostly due to adverse events. Six pts discontinued therapy and 2 pts died of unrelated causes. Chronological age and presence GS were not associated with adherence rate or outcomes.
Conclusion
Objective measurement of adherence to oral therapies remains challenging with poor applicability of electronic pill bottle cap devices due to pill package incompatibility and increasing use of virtual/tele visits. Despite its limitations, self-report remains a feasible tool to measure adherence in routine clinical practice. Abbreviated adherence scales and other electronic monitoring technologies may be able to overcome existing challenges and warrant further study.
Keyword(s): Chronic lymphocytic leukemia, Elderly, Ibrutinib
Abstract: PB1498
Type: Publication Only
Session title: Chronic lymphocytic leukemia and related disorders - Clinical
Background
Oral targeted therapies (OTT) have transformed the treatment of chronic lymphocytic leukemia (CLL). Prior studies in cancer patients (pts) have reported variable adherence rates (12-100%) to OTT with suboptimal adherence associated with inferior outcomes. Data from studies in CLL suggest that even brief treatment interruptions can lead to lower survival rates. However, defining optimal adherence and routine measurement of adherence in clinical practice is challenging. Techniques for measuring adherence include self-reporting, pill counts, electronic monitoring systems, prescription database analysis and assessment of serum/urine drug levels. We conducted a pilot study to evaluate the performance of multiple strategies for measuring adherence in a busy oncology practice caring for older adults (OA) with CLL.
Aims
The aims of this study were three-fold:
1. To compare the utilization of self-report [brief adherence rating scale (BARS)], pill count and Medical Event Monitoring System (MEMS) Cap (an electronic bottle cap) to measure adherence to OTT in OA with CLL.
2. To determine the adherence rate and factors impacting adherence.
3. To correlate adherence rate with disease outcomes.
Methods
Pts ≥70 years (yrs) with CLL and other lymphoid disorders on OTT were followed monthly for the first 3 months (mos), then every 3 mos for 1 year. Nursing home residents were excluded. Pt, disease and treatment characteristics [including a geriatric assessment (GA)] were recorded at baseline. Adherence was measured at every visit with BARS, pill count and MEMS Cap. Data on adverse events and disease outcomes were also collected.
Results
Of the 54 pts screened, 25 were enrolled. Median age was 77 yrs (71-93 yrs), 21 pts had CLL, 3 had mantle cell lymphoma and 1 had marginal zone lymphoma. Geriatric syndromes (GS) detected at baseline included cognitive impairment (28%), depression (24%), polypharmacy (92%) and recent falls (12%); 48% pts had ≥2 GS. Most frequently used OTT were ibrutinib (n=17) and venetoclax (n=5). So far, pts have completed a total of 63 visits (30 virtual, 33 in-person) with median follow up of 3.3 mos. BARS was the most consistently used measure of adherence (63/63 visits, 100%). MEMS cap data was obtained on 13% of total visits. Pill package incompatibility (68%), refusal to use MEMS cap (8%) and clinical trial participation (4%) precluded use of MEMS cap in 80% (n=20) of pts. Pill counts could be performed at only 8% of visits due to increasing usage of telehealth (51%), unavailability of pill packaging (32%) or logistic issues (17%). Median adherence using both BARS and MEMS cap was 100% (range, 70%>100% for BARS; 82-100% for MEMS cap). Only 4 pts had less than 100% adherence at any visit. Patient’s self-report accurately reflected MEMS cap measured adherence in these instances. Five pts (20%) required dose interruptions, mostly due to adverse events. Six pts discontinued therapy and 2 pts died of unrelated causes. Chronological age and presence GS were not associated with adherence rate or outcomes.
Conclusion
Objective measurement of adherence to oral therapies remains challenging with poor applicability of electronic pill bottle cap devices due to pill package incompatibility and increasing use of virtual/tele visits. Despite its limitations, self-report remains a feasible tool to measure adherence in routine clinical practice. Abbreviated adherence scales and other electronic monitoring technologies may be able to overcome existing challenges and warrant further study.
Keyword(s): Chronic lymphocytic leukemia, Elderly, Ibrutinib