More than half of patients have poor compliance?

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In the treatment of children with malignant tumors, in addition to intravenous chemotherapy during hospitalization, there are some oral medications that require extra-hospital treatment.Patients with acute lymphoblastic leukemia (ALL) need to take 6-mercaptopurine (6-MP) and methotrexate (MTX) maintenance therapy to reduce recurrence rate and ensure long-term remission after early intensive and consolidation therapy; chronic myeloid systemPatients with leukemia (CML) require long-term tyrosine kinase inhibitor (TKI) for targeted therapy.Previous studies have shown that 27%-98% of children with cancer have a medication non-compliance, while more than 50% of children with cancer have poor medication compliance during maintenance therapy.In 2012, the US Children’s Oncology Cooperative Group (COG) conducted a study of 327 children with ALL and found that even a relatively low rate of non-compliance (<95%) for 6-MP treatment increased recurrence during maintenance therapy.risks of.It can be seen that the low compliance of oral drug therapy is prevalent in children with malignant tumors, and seriously affects the prognosis of children, which needs to be paid attention to by pediatricians.01 What factors affect the compliance of children with cancer?Yelena P. Wu et al. specifically studied oral drug compliance during maintenance of children and adolescents in ALL. The article was published in the Journal of Pediatric Oncology.The study included 900 patients with ALL who were 0-21 years old. The drug compliance was calculated by analyzing the drug holding rate during the maintenance treatment period (providing the sum of drug days/sum of treatment days). The results showed that the total 6- 巯 嘌呤 嘌呤 Compliance is 85%, and methotrexate compliance is 81%.Further studies on gender, age, ethnicity and other factors found that: • The older the patient, the worse the drug compliance, such as 0-5 years old children with methotrexate and 6-MP compliance significantly higher than 12-17 years old and 18-21 age group.Whites, blacks/African Americans, Asians, and Spanish have lower compliance with other races.• Patients covered by the Child Health Insurance Plan (CHIP) have significantly lower adherence than those of commercial or Medicaid insurance, while patients receiving commercial insurance have significantly higher adherence than those receiving Medicaid.There was no significant difference in drug compliance between patients of different genders.Nobuko Hijiya and Meinolf Suttorp mentioned in a paper on how to treat chronic myeloid leukemia (CML) in children and adolescents. A 13-year-old male patient with chronic stage CML responded well after taking imatinib and was treated.The BCR-ABL1 fusion gene was negative (MR4) after 24 months.However, at the 30th month, BCR-ABL1 turned positive, and its copy number increased exponentially, but no mutation at the kinase site was detected. Later, the patient admitted that he had stopped taking 4 drugs.Month, the reason is that from the Internet, patients with deep molecular reactions can safely stop TKI treatment and stop taking drugs without discussion with their parents or doctors.Adolescent children's increased rebellious and risk-taking behavior, coupled with concerns about drug side effects, led to reduced compliance with treatment.At the same time, studies have shown that prolonged treatment time, simultaneous multi-drug therapy and symptomatic remission are the reasons for poor compliance in 30% to 70% of patients with chronic diseases, although in children with malignant tumors such as ALL, deliberately not insisting on maintenance treatment is veryLess occurs (8%), but 15% of patients repeatedly forget to take medication.2 How to improve drug compliance in children with cancer?What doctors can do: • Communicate with patients and parents to develop a recommended medication schedule.• Other personnel (such as pharmacists, caregivers, medical assistants, specialists) to help strengthen medication information.• Provide the patient with information such as a mission manual.• Discuss with patients and parents about the safety of communicating drugs and reduce their concerns about drug side effects.• Regularly prescribe new prescriptions (such as monthly or weekly) to enhance their awareness of medication.What you can do with your patients: • Take your medication into your daily routine and take it at regular intervals (such as before going to bed).• Use the medication kit and record the daily dose or missed medication.• Use visual cues (for example, tips on the refrigerator, on the mirror).Ask family members or friends to remind themselves to take the medicine.• Set the medication alarm (on an alarm clock, watch or mobile phone).• Sign an agreement with your parents to agree not to forget to take medicine to get rewards.• Tell the doctor about the dose of the drug and the reasons for not taking it, and seek a solution.. • Use of electronic devices: If you have a reminder function or when you are not able to use the time, you can send reminders to other family members via Bluetooth, etc.; download the mobile APP that can remind you to take the medicine.The electronic microchip attached to the tablet can be used as a pH sensor for gastric acid.Once the pill is swallowed, a signal is sent to the smartphone app for recording.Children with malignant tumors are a group that requires special attention. Many factors influence their compliance with treatment. During their treatment, especially during long-term oral drug therapy, medical care, patients and parents need to work together to improve their disease.Treatment compliance to achieve the best therapeutic effect. , please do not reprint without the authorization of the copyright owner.


The author ouyangshaoxia