Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia
Abstract Background Treatment‐free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DM...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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Wiley
2023-08-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6296 |
| _version_ | 1797242699896586240 |
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| author | Yilin Chen Na Xu Yunfan Yang Zhenfang Liu Mengxing Xue Li Meng Qun He Chunyan Chen Qingshu Zeng Huanling Zhu Xin Du Jing Zou Wenjun He Jingming Guo Suning Chen Guolin Yuan Hui Wu Mei Hong Fanjun Cheng Bingcheng Liu Yanli Zhang Weiming Li |
| author_facet | Yilin Chen Na Xu Yunfan Yang Zhenfang Liu Mengxing Xue Li Meng Qun He Chunyan Chen Qingshu Zeng Huanling Zhu Xin Du Jing Zou Wenjun He Jingming Guo Suning Chen Guolin Yuan Hui Wu Mei Hong Fanjun Cheng Bingcheng Liu Yanli Zhang Weiming Li |
| author_sort | Yilin Chen |
| collection | DOAJ |
| description | Abstract Background Treatment‐free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality‐of‐life (QoL) and mental health in CML patients with full‐dose TKI, low‐dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients' perspectives on TKI discontinuation. Methods We conducted a cross‐sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation. Results 1450 responses were included in the analysis. 44.3% of respondents reported a moderate‐to‐severe impact of TKI treatment on their QoL. 17% of respondents had moderate‐to‐severe anxiety. 24.4% of respondents had moderate‐to‐severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long‐term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full‐dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping. Conclusions TKI dose reduction showed a significant improvement of patients' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients' quality‐of‐life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission. |
| first_indexed | 2024-03-12T00:55:21Z |
| format | Article |
| id | doaj.art-9db00ffe981742fbbe1f2808187f0a3e |
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| language | English |
| last_indexed | 2024-04-24T18:43:23Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
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| series | Cancer Medicine |
| spelling | doaj.art-9db00ffe981742fbbe1f2808187f0a3e2024-03-27T09:11:00ZengWileyCancer Medicine2045-76342023-08-011216172391725210.1002/cam4.6296Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemiaYilin Chen0Na Xu1Yunfan Yang2Zhenfang Liu3Mengxing Xue4Li Meng5Qun He6Chunyan Chen7Qingshu Zeng8Huanling Zhu9Xin Du10Jing Zou11Wenjun He12Jingming Guo13Suning Chen14Guolin Yuan15Hui Wu16Mei Hong17Fanjun Cheng18Bingcheng Liu19Yanli Zhang20Weiming Li21Department of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaDepartment of Hematology, Nanfang Hospital Southern Medical University Guangzhou ChinaDepartment of Hematology, West China Hospital Sichuan University Chengdu ChinaDepartment of Hematology The First Affiliated Hospital of Guangxi Medical University Nanning ChinaNational Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology The First Affiliated Hospital of Soochow University Suzhou ChinaDepartment of Hematology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaDepartment of Hematology Xiangya Hospital of Central South University Changsha ChinaDepartment of Hematology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan ChinaDepartment of Hematology First Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Hematology, West China Hospital Sichuan University Chengdu ChinaDepartment of Hematology and Shenzhen Bone Marrow Transplantation Public Service Platform, Shenzhen Second People's Hospital The First Affiliated Hospital of Shenzhen University Shenzhen ChinaDepartment of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaDepartment of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaDepartment of Hematology First Clinical Medical College of China Three Gorges University, Yichang Central People's Hospital Yichang ChinaNational Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology The First Affiliated Hospital of Soochow University Suzhou ChinaDepartment of Hematology Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science Xiangyang ChinaDepartment of Hematology Hanchuan People's Hospital Hanchuan ChinaDepartment of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaDepartment of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaState Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin ChinaDepartment of Hematology The Affiliated Cancer Hospital of Zhengzhou University Zhengzhou ChinaDepartment of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan ChinaAbstract Background Treatment‐free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality‐of‐life (QoL) and mental health in CML patients with full‐dose TKI, low‐dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients' perspectives on TKI discontinuation. Methods We conducted a cross‐sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation. Results 1450 responses were included in the analysis. 44.3% of respondents reported a moderate‐to‐severe impact of TKI treatment on their QoL. 17% of respondents had moderate‐to‐severe anxiety. 24.4% of respondents had moderate‐to‐severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long‐term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full‐dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping. Conclusions TKI dose reduction showed a significant improvement of patients' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients' quality‐of‐life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission.https://doi.org/10.1002/cam4.6296chronic myeloid leukemiamental healthquality‐of‐lifeTKI dose reductiontreatment‐free remission |
| spellingShingle | Yilin Chen Na Xu Yunfan Yang Zhenfang Liu Mengxing Xue Li Meng Qun He Chunyan Chen Qingshu Zeng Huanling Zhu Xin Du Jing Zou Wenjun He Jingming Guo Suning Chen Guolin Yuan Hui Wu Mei Hong Fanjun Cheng Bingcheng Liu Yanli Zhang Weiming Li Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia Cancer Medicine chronic myeloid leukemia mental health quality‐of‐life TKI dose reduction treatment‐free remission |
| title | Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| title_full | Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| title_fullStr | Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| title_full_unstemmed | Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| title_short | Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| title_sort | quality of life mental health and perspective on tki dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia |
| topic | chronic myeloid leukemia mental health quality‐of‐life TKI dose reduction treatment‐free remission |
| url | https://doi.org/10.1002/cam4.6296 |
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