Increased use of oral anticancer agents (OAAs) has empowered adults with chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML) to manage their therapy, but this shift may complicate medication use, particularly among adults with multiple chronic conditions (MCC).
Methods
This retrospective cohort study used 2013–2018 commercial and Medicare claims data to assess medication use in adults with CML or CLL. To be included, patients must have been at least 18 years old, diagnosed with and had 2+ claims for an OAA indicated for either CML or CLL, continuously enrolled 12 months before and after OAA initiation, and treated for (2+ fills) at least two select chronic conditions. Proportion of days covered (PDC) determined medication adherence and was compared for 12 months before and after OAA initiation by Wilcoxon signed-rank tests, McNemar's tests, and difference-in-differences models.
Results
Among CLL patients, mean OAA adherence in the first year of therapy was 79.8% (SD: 21.1) and 74.7% (SD: 24.9) for commercial and Medicare patients, respectively; mean adherence for CML patients was 84.5% (SD: 15.8) and 80.1% (SD: 20.1) for commercial and Medicare patients, respectively. Adherence and the proportion adherent (PDC ≥ 80%) to comorbid therapies was generally unchanged following OAA initiation. Consistently unremarkable changes in MCC adherence were observed in 12-month difference-in-differences models, but significant decline was observed in MCC adherence after 6 months of OAA use.
Conclusions
OAA initiation among adults with CML or CLL was not associated with significant, initial changes to adherence to medications for chronic diseases.
AlrawashdhNSweasyJErstadB, et al.Survival trends in chronic lymphocytic leukemia across treatment eras: US SEER database analysis (1985–2017). Ann Hematol2021; 100: 2501–2512.
2.
PulteDGondosARedanielMT,et al.Survival of patients with chronic myelocytic leukemia: comparisons of estimates from clinical trial settings and population-based cancer registries. Oncologist2011; 16: 663–671.
3.
GreerJAAmoyalNNisotelL, et al.A systematic review of adherence to oral antineoplastic therapies. Oncologist2016; 21: 354–376.
4.
RuddyKMayerEPartridgeA. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin2009; 59: 56–66.
5.
AccordinoMKHershmanDL. Disparities and challenges in adherence to oral antineoplastic agents. Am Soc Clin Oncol Ed Book2013; 33: 271–276.
6.
TrivediDLandsman-BlumbergPDarkowT, et al.Adherence and persistence among chronic myeloid leukemia patients during second-line tyrosine kinase inhibitor treatment. J Manag Care Spec Pharm2014; 20: 1006–1015.
7.
PhuarHLBegleyCEChanW,et al.Tyrosine kinase inhibitors and the relationship with adherence, costs, and health care utilization in commercially insured patients with newly diagnosed chronic myeloid leukemia: a retrospective claims-based study. Am J Clin Oncol2020; 43: 517–525.
8.
GuerinAChenLWuEQ, et al.A retrospective analysis of therapy adherence in imatinib resistant or intolerant patients with chronic myeloid leukemia receiving nilotinib or dasatinib in a real-world setting. Curr Med Res Opin2012; 28: 1155–1162.
9.
DoshiJAJahnkeJRamanS, et al.Treatment utilization patterns of newly initiated oral anticancer agents in a national sample of Medicare beneficiaries. J Manag Care Spec Pharm2021; 27: 1457–1468.
10.
WardMAFangGRichardsKL, et al.Comparative evaluation of patients newly initiating first-generation versus second-generation tyrosine kinase inhibitors for chronic myeloid leukemia and medication adherence, health services utilization, and healthcare costs. Curr Med Res Opin2015; 31: 289–297.
11.
WinnANKeatingNLDusetzinaSB. Factors associated with tyrosine kinase inhibitor initiation and adherence among medicare beneficiaries with chronic myeloid leukemia. J Clin Oncol2016; 34: 4323–4328.
12.
DusetzinaSBWinnANAbelGA, et al.Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol2014; 32: 306–311.
13.
ShenCZhaoBLiuL,et al.Adherence to tyrosine kinase inhibitors among Medicare part D beneficiaries with chronic myeloid leukemia. Cancer2018; 124: 364–373.
14.
GarnerMLKlineTMillerJ, et al.Impact of adherence to ibrutinib on clinical outcomes in real-world patients with chronic lymphocytic leukemia. J Adv Pract Oncol2021; 12: 20–28.
CortesJ. How to manage CML patients with comorbidities. Blood2020; 136: 2507–2512.
17.
RotbainECNiemannCURostgaardK, et al.Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death. Leukemia2021; 35: 2570–2580.
18.
OnoTTakahashiNKizakiM, et al.Prognostic effect of comorbidities in patients with chronic myeloid leukemia treated with a tyrosine kinase inhibitor. Cancer Sci2020; 111: 3714–3725.
19.
SausseleSKraubMPHehlmannR, et al.Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV. Blood2015; 126: 42–49.
20.
GordonMJChurnetskiMAlqahtaniH, et al.Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. Cancer2018; 124: 3192–3200.
21.
SavAKingMAWhittyJA, et al.Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect2015; 18: 312–324.
22.
SawesiSCarpenterJSJonesJ. Reasons for nonadherence to tamoxifen and aromatase inhibitors for the treatment of breast cancer: a literature review. Clin J Oncol Nurs2014; 18: E50–E57.
23.
LashTLFoxMPWestrupJL, et al.Adherence to tamoxifen over the five-year course. Breast Canc Res Treat2006; 99: 215–220.
24.
NeugutAISubarMWildeET, et al.Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol2011; 29: 2534–2542.
25.
LeeMJKhanMMSalloumRG. Recent trends in cost-related medication nonadherence among cancer survivors in the United States. J Manag Care Spec Pharm2018; 24: 56–64.
26.
LuZKXiongXBrownJ, et al.Impact of cost-related medication nonadherence on economic burdens, productivity loss, and functional abilities: management of cancer survivors in medicare. Front Pharmacol2021; 12: 706289.
27.
WilliamsCDavidoffAJHalpernMT,et al.Medication nonadherence and patient cost responsibility for rural and urban cancer survivors. J Clin Oncol. 2021; 39(28 suppl 4): 4.
28.
ZhaoJZhengZHanX, et al.Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States. Value Health2019; 22: 762–767.
29.
DashputreAAGatwoodKSSchmidtJ,et al.Impact of oral oncolytic initiation on medication adherence for pre-existing comorbid chronic conditions. J Oncol Pharm Pract2020; 26: 835–845.
CanfieldSLZuckermanAAnguianoRH, et al.Navigating the wild west of medication adherence reporting in specialty pharmacy. J Manag Care Spec Pharm2019; 25: 1073–1077.
