Background: Despite impactful result achieved with imatinib, about 40% of patients experience treatment failure and more than 15% the persistence of long-term side effects that impaired quality of life. Aims: To investigate how a change in TKI therapy has an impact on familiar, social and working setting of CML patients’ daily life. Methods: A structured questionnaire was administered to patients switched to nilotinib second-line after imatinib resistance or intolerance for not less than 6 months and not more than 36 months, regardless type of response. Twenty- five Italian centers participated collecting 142 patients. Results: There were 61% males and 39% females, median age was 57 years (range 29-91). 65% with superior scholar degree. Median time from diagnosis for the overall cohort was 8 years, with 9% diagnosed less than 4 years, 66% from >4 to<10 years and 25% for ≥10 years. Sixty-one% of patients changed because of loss of efficacy with imatinib, whereas 39% for persistence of intolerance. Median time in imatinib treatment was 5 years, whereas median time with nilotinib after switch was 2 years. Overall, the level of satisfaction was requested to nilotinib and imatinib, respectively, and 93% of nilotinib-treated patients reported high level as compared to 52% of imatinib-treated patients. Dissecting this data, nilotinib-treated population reported in particular high satisfaction for achieved response (64%), for the level of daily quality of life (33%) and for tolerability (32%). Comparing imatinib and nilotinib, the majority of patients reported an impact of therapy on daily activities: 64% with imatinib reported low productivity at work (as compared to 33% with nilo- tinib) with 57% of them required absences from work (as compared to 35% with nilotinib). Analysing psychological perceptions, 64% of patients treated with imatinib reported the sensation of no longer feel themselves (as com- pared to 33% with nilotinib), and 36% to feel uncomfortable with their families (as compared to 18% with nilotinib). Overall, after switch, more patients referred a strong improvement of approach in daily living towards disease and therapy. More common emotions requested to patients to represent actu- al therapy with nilotinib were “trust” (65% vs 24% with imatinib), “joy” (52% vs 4% with imatinib) and “serenity” (29% vs 10% with imatinib); indeed, referred to previous therapy with imatinib, the more common emotions report- ed were “worry” (52% vs 22% with nilotinib), sadness” (30% vs 6% with nilo- tinib). “fear” (27% vs 15% with nilotinib), “frustration” (22% vs 4% with nilo- tinib). After switching to nilotinib, it has been asked perceptions about a pos- sible discontinuation: 50% of patients would discontinue due to trust in per- sonal physician, 26% to no longer feel sick and only 18% of patients would not stop for fear to losing all benefits achieved. Summary/Conclusions: The results of this patient-centered analysis indicating high level of satisfaction in CML patients who switch to nilotinib after previous imatinib therapy, with improvements toward social, working and familiar daily life.
How patients perceive a switch from imatinib to nilotinib: results of a patient-centered analysis
BONIFACIO, Massimiliano;
2016-01-01
Abstract
Background: Despite impactful result achieved with imatinib, about 40% of patients experience treatment failure and more than 15% the persistence of long-term side effects that impaired quality of life. Aims: To investigate how a change in TKI therapy has an impact on familiar, social and working setting of CML patients’ daily life. Methods: A structured questionnaire was administered to patients switched to nilotinib second-line after imatinib resistance or intolerance for not less than 6 months and not more than 36 months, regardless type of response. Twenty- five Italian centers participated collecting 142 patients. Results: There were 61% males and 39% females, median age was 57 years (range 29-91). 65% with superior scholar degree. Median time from diagnosis for the overall cohort was 8 years, with 9% diagnosed less than 4 years, 66% from >4 to<10 years and 25% for ≥10 years. Sixty-one% of patients changed because of loss of efficacy with imatinib, whereas 39% for persistence of intolerance. Median time in imatinib treatment was 5 years, whereas median time with nilotinib after switch was 2 years. Overall, the level of satisfaction was requested to nilotinib and imatinib, respectively, and 93% of nilotinib-treated patients reported high level as compared to 52% of imatinib-treated patients. Dissecting this data, nilotinib-treated population reported in particular high satisfaction for achieved response (64%), for the level of daily quality of life (33%) and for tolerability (32%). Comparing imatinib and nilotinib, the majority of patients reported an impact of therapy on daily activities: 64% with imatinib reported low productivity at work (as compared to 33% with nilo- tinib) with 57% of them required absences from work (as compared to 35% with nilotinib). Analysing psychological perceptions, 64% of patients treated with imatinib reported the sensation of no longer feel themselves (as com- pared to 33% with nilotinib), and 36% to feel uncomfortable with their families (as compared to 18% with nilotinib). Overall, after switch, more patients referred a strong improvement of approach in daily living towards disease and therapy. More common emotions requested to patients to represent actu- al therapy with nilotinib were “trust” (65% vs 24% with imatinib), “joy” (52% vs 4% with imatinib) and “serenity” (29% vs 10% with imatinib); indeed, referred to previous therapy with imatinib, the more common emotions report- ed were “worry” (52% vs 22% with nilotinib), sadness” (30% vs 6% with nilo- tinib). “fear” (27% vs 15% with nilotinib), “frustration” (22% vs 4% with nilo- tinib). After switching to nilotinib, it has been asked perceptions about a pos- sible discontinuation: 50% of patients would discontinue due to trust in per- sonal physician, 26% to no longer feel sick and only 18% of patients would not stop for fear to losing all benefits achieved. Summary/Conclusions: The results of this patient-centered analysis indicating high level of satisfaction in CML patients who switch to nilotinib after previous imatinib therapy, with improvements toward social, working and familiar daily life.
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