Bone marrow transplants or chemotherapy were once the only treatment options available for chronic myeloid leukemia (CML), a rare blood cancer. Until recently, survival rates weren’t remarkable; but new tyrosine kinase inhibitor medications have transformed CML treatment—patients are now living full lives thanks to targeted therapy.
The National Comprehensive Cancer Network (NCCN) Oncology Research Program, in collaboration with Pfizer Independent Grants for Learning & Change, awarded Benjamin Brewer, PsyD, director of clinical psychology services for the School of Medicine Department of Hematology and investigator at the University of Colorado Cancer Center, a two-year grant to assess the treatment of CML at four oncology practices across Colorado, including University of Colorado Hospital, St. Mary’s Hospital, Memorial Hospital and Poudre Valley Hospital.
“CML used to be one of the more difficult blood cancers to treat. Now, almost all patients respond to the new medications,” said Brewer.
“This has dramatically changed the treatment of this rare cancer.”
Oncologists aren’t used to worrying about whether their patients are adhering to their medication regimens. “Now it needs to be top of mind,” Brewer said.
The new study will test an intervention for oncology teams designed to address three concerns relevant to patients with CML and the doctors who treat them. The intervention is designed to improve monitoring of BCR-ABL1, improve the choices physicians make based on data from appropriate monitoring of this gene marker and teach physicians how to better address the problem of patient’s forgetting to take their medication for CML.
“I want to help physicians ask open-ended questions when they meet with their patients and have a true dialogue at every visit,” Brewer explained. “If their patients are having difficulties taking their medications, I want to provide the physicians strategies to help their patients stay on schedule.”
Although vastly better than previous treatment approaches, tyrosine kinase inhibitor medications require lifelong monitoring and adherence. The NCCN guidelines currently recommend testing for BCR-ABL1 every three months after initiating therapy, regardless of treatment response. A recent report found that only 31 percent of community physicians and 52 percent of academic medicine physicians in the United States were correctly tracking this vital marker of treatment response in peripheral blood. Instead many are performing unnecessary bone marrow biopsies to conduct monitoring on a suboptimal timeline.
“The NCCN guidelines can be very complicated and if community physicians only see a few patients a year, it’s hard for them to keep up-to-date on the latest treatments and recommendations,” Brewer said. “They may know what medication to prescribe, but they may not know how patients need to be monitored for the long term and may not know when to switch medications if one stops working.”
Through interactive educational presentations, monitoring of BCR-ABL1 testing rates, and providing feedback about this rate to each practice, Brewer hopes to change physician and medical team behaviors at all four practices over two years and in turn, improve adherence to the NCCN guidelines for the treatment of CML.