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Photo courtesy of ASH
ORLANDO, FL—A study comparing subjective versus objective reporting of treatment compliance in patients with acute lymphoblastic leukemia (ALL) has shown that about a fourth of patients over-report how compliant they are with taking 6-mercaptopurine (6MP) as part of their maintenance therapy.
An earlier analysis of the Children’s Oncology Group (COG) AALL03N1 compliance study showed that adherence rates of less than 95% were associated with a 3.7-fold increased risk of relapse.
And about 40% of patients were non-adherent. Yet patients indicate they are taking their medication when questioned.
“We ask our patients if they are taking their meds,” said Wendy Landier, PhD, “and they tell us they are.”
“Even in this cohort who were being closely monitored and knew that they were being closely monitored electronically and were asked to self-report, we found over-reporting.”
Dr Landier, of the University of Alabama at Birmingham, reported these findings comparing self-reported adherence with electronic monitoring of 6MP intake at the 2015 ASH Annual Meeting (abstract 82).
The investigators collected data over 6 months from 416 ALL patients who were 21 years at diagnosis or younger and were receiving 6MP as part of their maintenance therapy.
Investigators measured subjective self-reporting by a patient questionnaire, which included patient demographic information in addition to the number of days the patient took 6MP over the past month.
For the objective medication event-monitoring system (MEMS), patients received a 6MP bottle that was fitted with a TrackCapTM. The cap had a microprocessor chip that recorded the date and time of each bottle opening.
Investigators downloaded the data at the end of the study. They then compared the MEMS with the self-reported data.
The investigators classified perfect reporters as those whose self-report corresponded to their MEMS.
They classified over-reporters as those whose self-report was greater than their MEMS data for 5 days or more and 50% of the months.
The rest they classified as others.
Patients were a median age of 6.0 years, and 277 (66.6%) were male. Parents completed the survey for patients younger than 12.
Two hundred forty-two patients (60.9%) had fathers whose education was less than some college, 159 (38.4%) had NCI high-risk disease, and 168 (40.4%) were non-adherent to 6MP as determined by earlier analysis of the COG AALL03N1 study.
Thirty-six percent were non-Hispanic white, 37% were Hispanic, 14% Asian, and 13% African American.
The investigators monitored the patients’ 6MP intake for a total of 1344 patient-months at 87 COG sites.
And the correlation between subjective and objective reporting was moderate, Dr Landier said, with the correlation ranging from 0.36 to 0.58.
Twelve percent of the patients were perfect reporters, with no difference between the reporting methods.
Twenty-four percent over-reported their intake, 1% under-reported their intake, and 64% were other.
The investigators analyzed variables associated with over-reporting and found that age 12 years or older (P=0.02), being Hispanic (P=0.02), Asian (P=0.02), or African American (P<0.001), paternal education less than college (P=0.02), and being classified as 6MP non-adherent (P<0.001) were all significant.
“Over-reporting of 6MP ingestion is common,” Dr Landier said, with 88% of patients or parents over-reporting the number of days 6MP was taken.
“What we’ve learned from this study is that we cannot rely on patients’ self-report in the clinic,” she said. “What we found is that only 12% of our patients are perfect, so to speak, and that the others mainly over-estimate, and I don’t believe intentionally.”
“[W]e need to have a better way of identifying which patients are at risk for over-reporting their intake, whether they’re aware of it or not,” she added. 
Photo courtesy of ASH
ORLANDO, FL—A study comparing subjective versus objective reporting of treatment compliance in patients with acute lymphoblastic leukemia (ALL) has shown that about a fourth of patients over-report how compliant they are with taking 6-mercaptopurine (6MP) as part of their maintenance therapy.
An earlier analysis of the Children’s Oncology Group (COG) AALL03N1 compliance study showed that adherence rates of less than 95% were associated with a 3.7-fold increased risk of relapse.
And about 40% of patients were non-adherent. Yet patients indicate they are taking their medication when questioned.
“We ask our patients if they are taking their meds,” said Wendy Landier, PhD, “and they tell us they are.”
“Even in this cohort who were being closely monitored and knew that they were being closely monitored electronically and were asked to self-report, we found over-reporting.”
Dr Landier, of the University of Alabama at Birmingham, reported these findings comparing self-reported adherence with electronic monitoring of 6MP intake at the 2015 ASH Annual Meeting (abstract 82).
The investigators collected data over 6 months from 416 ALL patients who were 21 years at diagnosis or younger and were receiving 6MP as part of their maintenance therapy.
Investigators measured subjective self-reporting by a patient questionnaire, which included patient demographic information in addition to the number of days the patient took 6MP over the past month.
For the objective medication event-monitoring system (MEMS), patients received a 6MP bottle that was fitted with a TrackCapTM. The cap had a microprocessor chip that recorded the date and time of each bottle opening.
Investigators downloaded the data at the end of the study. They then compared the MEMS with the self-reported data.
The investigators classified perfect reporters as those whose self-report corresponded to their MEMS.
They classified over-reporters as those whose self-report was greater than their MEMS data for 5 days or more and 50% of the months.
The rest they classified as others.
Patients were a median age of 6.0 years, and 277 (66.6%) were male. Parents completed the survey for patients younger than 12.
Two hundred forty-two patients (60.9%) had fathers whose education was less than some college, 159 (38.4%) had NCI high-risk disease, and 168 (40.4%) were non-adherent to 6MP as determined by earlier analysis of the COG AALL03N1 study.
Thirty-six percent were non-Hispanic white, 37% were Hispanic, 14% Asian, and 13% African American.
The investigators monitored the patients’ 6MP intake for a total of 1344 patient-months at 87 COG sites.
And the correlation between subjective and objective reporting was moderate, Dr Landier said, with the correlation ranging from 0.36 to 0.58.
Twelve percent of the patients were perfect reporters, with no difference between the reporting methods.
Twenty-four percent over-reported their intake, 1% under-reported their intake, and 64% were other.
The investigators analyzed variables associated with over-reporting and found that age 12 years or older (P=0.02), being Hispanic (P=0.02), Asian (P=0.02), or African American (P<0.001), paternal education less than college (P=0.02), and being classified as 6MP non-adherent (P<0.001) were all significant.
“Over-reporting of 6MP ingestion is common,” Dr Landier said, with 88% of patients or parents over-reporting the number of days 6MP was taken.
“What we’ve learned from this study is that we cannot rely on patients’ self-report in the clinic,” she said. “What we found is that only 12% of our patients are perfect, so to speak, and that the others mainly over-estimate, and I don’t believe intentionally.”
“[W]e need to have a better way of identifying which patients are at risk for over-reporting their intake, whether they’re aware of it or not,” she added.
Photo courtesy of ASH
ORLANDO, FL—A study comparing subjective versus objective reporting of treatment compliance in patients with acute lymphoblastic leukemia (ALL) has shown that about a fourth of patients over-report how compliant they are with taking 6-mercaptopurine (6MP) as part of their maintenance therapy.
An earlier analysis of the Children’s Oncology Group (COG) AALL03N1 compliance study showed that adherence rates of less than 95% were associated with a 3.7-fold increased risk of relapse.
And about 40% of patients were non-adherent. Yet patients indicate they are taking their medication when questioned.
“We ask our patients if they are taking their meds,” said Wendy Landier, PhD, “and they tell us they are.”
“Even in this cohort who were being closely monitored and knew that they were being closely monitored electronically and were asked to self-report, we found over-reporting.”
Dr Landier, of the University of Alabama at Birmingham, reported these findings comparing self-reported adherence with electronic monitoring of 6MP intake at the 2015 ASH Annual Meeting (abstract 82).
The investigators collected data over 6 months from 416 ALL patients who were 21 years at diagnosis or younger and were receiving 6MP as part of their maintenance therapy.
Investigators measured subjective self-reporting by a patient questionnaire, which included patient demographic information in addition to the number of days the patient took 6MP over the past month.
For the objective medication event-monitoring system (MEMS), patients received a 6MP bottle that was fitted with a TrackCapTM. The cap had a microprocessor chip that recorded the date and time of each bottle opening.
Investigators downloaded the data at the end of the study. They then compared the MEMS with the self-reported data.
The investigators classified perfect reporters as those whose self-report corresponded to their MEMS.
They classified over-reporters as those whose self-report was greater than their MEMS data for 5 days or more and 50% of the months.
The rest they classified as others.
Patients were a median age of 6.0 years, and 277 (66.6%) were male. Parents completed the survey for patients younger than 12.
Two hundred forty-two patients (60.9%) had fathers whose education was less than some college, 159 (38.4%) had NCI high-risk disease, and 168 (40.4%) were non-adherent to 6MP as determined by earlier analysis of the COG AALL03N1 study.
Thirty-six percent were non-Hispanic white, 37% were Hispanic, 14% Asian, and 13% African American.
The investigators monitored the patients’ 6MP intake for a total of 1344 patient-months at 87 COG sites.
And the correlation between subjective and objective reporting was moderate, Dr Landier said, with the correlation ranging from 0.36 to 0.58.
Twelve percent of the patients were perfect reporters, with no difference between the reporting methods.
Twenty-four percent over-reported their intake, 1% under-reported their intake, and 64% were other.
The investigators analyzed variables associated with over-reporting and found that age 12 years or older (P=0.02), being Hispanic (P=0.02), Asian (P=0.02), or African American (P<0.001), paternal education less than college (P=0.02), and being classified as 6MP non-adherent (P<0.001) were all significant.
“Over-reporting of 6MP ingestion is common,” Dr Landier said, with 88% of patients or parents over-reporting the number of days 6MP was taken.
“What we’ve learned from this study is that we cannot rely on patients’ self-report in the clinic,” she said. “What we found is that only 12% of our patients are perfect, so to speak, and that the others mainly over-estimate, and I don’t believe intentionally.”
“[W]e need to have a better way of identifying which patients are at risk for over-reporting their intake, whether they’re aware of it or not,” she added.