Leukemia is the most common cancer in children and adolescents and represents almost 1 of 3 cancers found in these populations. Of the 4 main types of leukemia—acute myeloid leukemia, acute lymphocytic leukemia (ALL), chronic myeloid leukemia, and chronic lymphocytic leukemia—the one that occurs in children and teens most often is ALL. Chronic leukemias and acute myeloid leukemia are rare in this age-group. Here, the focus will be on ALL.
Copenhagen, Denmark—Adherence to infusional or injectable anticancer drugs is not problematic—as long as the patient gets the infusion or injection, adherence is assured—but adherence is an emerging problem with newer oral anticancer drugs.
According to a study presented at the 2016 European Society for Medical Oncology Congress, nonadherence may not be willful but may, in fact, be related to the presence of cognitive disturbances and depression, especially in aging patients.
“With more oral therapies being used to treat cancer, how these therapies are actually being used has become an important topic. We wanted to pay specific attention to factors that may impact adherence in elderly patients,” explained Bénédicte Clarisse-Lecorbeiller, PharmD, PhD, Centre François Baclesse, Caen, France, a co-investigator of the study.
“We wanted to assess the relationship between cognitive functions and oral medication adherence to identify patient profiles who are more likely to be nonadherent,” stated lead investigator Melanie Dos Santos, MD, of the same institution.
For the prospective, single-center study, 126 adult patients with cancer who were about to initiate their first oral therapy were enrolled, with 111 completing adherence questionnaires. Before the initiation of treatment, patients took a battery of neuropsychological tests to assess cognition, anxiety, depression, and autonomy (ie, the ability to perform daily activities).
Adherence to oral therapy was evaluated using 2 self-assessment questionnaires and an observance sheet at 1 and 3 months after initiation of therapy.
Median age at baseline was 70 years, with more than 50% of patients aged >70 years. The rate of adherence at 1 month was 90%.
Global cognitive impairment was observed in 50% of patients, as evaluated with the Montreal Cognitive Assessment screening tool. Depression was observed in 18% of patients.
The investigators found a significant association between age >70 years and Montreal Cognitive Assessment scores, and also with working memory impairment (P <.005).
At 1 month, in the 10% of patients who were nonadherent, short-term memory and working memory performance (P = .03) and depression (P = .04) were significantly associated with nonadherence.
“Both working memory disorders and depression are frequently observed among the elderly,” noted Dr ClarisseLecorbeiller, in a separate interview.
These findings suggest that older patients prescribed oral anticancer therapy should be evaluated for cognitive changes and depression before starting therapy, with the awareness that both of those factors could have a negative influence on the ability to take oral anticancer agents as prescribed.