Clinical and laboratory evaluation of compliance in acute lymphoblastic leukaemia
Clinical and laboratory evaluation of compliance in acute lymphoblastic leukaemia
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DOI：
10.1136/adc.2003.030775
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发表时间：
2004-08-01
影响因子：
5.2
通讯作者：
Romanha, AJ
中科院分区：
文献类型：
--
作者：
de Oliveira, BM;Viana, MB;Romanha, AJ
目的：评估儿童急性淋巴细胞白血病（ALL）的依从性。方法：通过特定的访谈，从医疗图表的注释，并测定红细胞6-巯基嘌呤代谢产物进行评估。结果：共有39例患者谁结束了维持阶段的化疗被纳入本研究。在87%的病例中，母亲负责提供6-MP。35名受访者表示，对医疗处方很了解，不遵医嘱的主要原因是健忘。通过访谈（33.3%的病例）、病历报告（30.7%）和药物测定（16.6%）发现不依从;发现53.8%的儿童不依从。不遵守规定与长期营养不良密切相关。虽然在统计上不显著，但有一种趋势是，不遵守规定的儿童群体与人均家庭收入低有关。未检测到不依从性与诊断时的年龄、性别、父母的受教育程度、家庭成员数量、耗电量和绝对白细胞或中性粒细胞计数的中位数之间的显著相关性。随访时间短，无法对结局进行有效分析。在不依从组（n = 21），7例儿童复发，与3例复发的依从组（n = 18）。结论：结果表明，不依从性的机制之一，其背后的不利影响的社会经济因素对儿童与ALL的结果。需要进一步的研究来证实这一假设。迫切需要对不遵守问题采取综合办法。
Aim: To evaluate compliance in children with acute lymphoblastic leukaemia (ALL).Methods: Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6-mercaptopurine metabolites.Results: A total of 39 patients who had concluded maintenance phase of chemotherapy were included in the study. Mothers were responsible for delivering 6-MP in 87% of cases. Thirty five interviewees said that medical prescription was well understood and that the main reason for non-compliance was forgetfulness. Non-compliance was detected through interviews (33.3% of the cases), reports from medical charts (30.7%), and drug determination (16.6%); 53.8% of children were found to be non-compliant. Non-compliance was significantly associated with chronic undernourishment. Although not statistically significant, there was a trend for the group of non-compliant children to be associated with low per capita family income. No significant associations of non-compliance with age at diagnosis, gender, parents' schooling level, number of family members, power consumption, and medians of absolute leucocyte or neutrophil blood counts were detected. A short follow up period precluded valid analysis on outcome. In the non-compliant group (n = 21), seven children relapsed, contrasting with three relapses in the compliant group (n = 18).Conclusions: Results suggest that non-compliance is one of the mechanisms which underlies the adverse influence of socioeconomic factors on the outcome of children with ALL. Additional studies are necessary to confirm this hypothesis. Comprehensive approaches to the problem of non-compliance are urgently needed.