Oral Anticancer Agent Therapy Adherence in Patients With CLL and Multiple Chronic Conditions

Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow that progresses over time. The number of abnormal lymphocytes (white blood cells) increases in the blood and bone marrow, leaving less room for healthy white blood cells, red blood cells, and platelets, which can cause infection, anemia, and bleeding too easily. Oral anticancer agents (OAA) give individuals with CLL a means of managing their disease. However, multiple chronic conditions (MCC) are common in individuals with CLL, and beginning OAA therapy increases the treatment burden.

Researchers led by Justin Gatwood, PhD, MPH, of the University of Tennessee Health Science Center, investigated adherence to OAAs in adult patients with CLL starting OAA treatment and evaluated the extent to which the initiation of OAA treatment impacted adherence to medications for existing MCCs. They presented their results at the 64th American Society of Hematology Annual Meeting and Exhibition.

The retrospective cohort study utilized commercial and Medicare claims data to identify patients with CCL aged >18 years who had been continuously enrolled 12 months prior and 12 month following OAA initiation and treated for at least 2 select chronic conditions (eg, diabetes, hypertension, hyperlipidemia). Medication adherence was determined by proportion of days covered (PDC) and was compared 12 months before and after OAA initiation by Wilcoxon signed-rank tests and McNemar’s tests. Researchers also used multivariate logistic regression to identify possible predictors of OAA adherence in the first year of therapy while controlling for available demographic and clinical characteristics.

The study population comprised 1051 patients with CLL and MCC. Of these, 246 were commercial patients and 805 were Medicare patients. The mean OAA adherence for commercial and Medicare patients was 79.8% and 74.7%, respectively. An increase in comorbidity was associated with lower odds of OAA adherence, specifically in Medicare patients. Among patients with commercial coverage, the odds of OAA adherence were lower for those living in the South. Compared with the first 6 months after beginning OAA treatment, mean PDCs in the second half of the year noticeably declined

Overall, researchers found that “initial OAA adherence was generally good among adults with CLL, with a majority of patients reaching accepted thresholds of adequate anticancer medication use.” They also reported that there was limited evidence of decreases in adherence to oral antidiabetic, antihypertensive, or lipid-lowering agents in the first year following OAA initiation.

Despite the positive findings, researchers concluded with a reminder, saying “these findings do not negate the need for careful monitoring of medication use in these populations over the course of time, as some eventual declines in comorbid chronic disease medication adherence were observed.”

Source: Gatwood J, Dashputre A, Rajpurohit A, et al. Impact of initiating oral anticancer agent therapy for chronic lymphocytic leukemia among adults with multiple chronic conditions. Abstract #4920. Presented at the 64th ASH Annual Meeting and Exposition; December 12, 2022; New Orleans, Louisiana.