Promoting Treatment Adherence in Adolescent Leukemia
Scientific evidence suggests that many adolescents with acute lymphoblastic leukemia (ALL) do not
take their medication in accord with their prescribed treatment regimens. Such nonadherence has several
undesirable clinical and scientific consequences:(1) mortality and morbidity due to relapse;(2) problems in
the validity of data concerning clinical trials of medication treatment, which if undetected, may create the
potential for iatrogenic toxicity. However, there are little scientific data concerning the efficacy of
psychological interventions that have been designed to limit the prevalence and impact of nonadherence to
ALL treatment. To address this important scientific need, this study will conduct a randomized clinical trial
(RCT) with 170 adolescents with ALL to evaluate a family centered, problem-solving intervention (FPST) to
promote adherence to oral medication treatment. This problem solving intervention will be compared with
basic psychological care. The proposed intervention model is novel in its integration of three key
components derived from theory and research on adherence to treatment with pediatric chronic illnesses and
cast within the developmental context of families with adolescent children. These components are: 1) training
in collaborative problem solving and effective parent-adolescent communication to reduce barriers that
interfere with adherence to oral medication treatment;2) promotion of adolescents'active participation in and
motivation for the management of ALL therapy;3) emphasis on parental support and adolescent adherence
to treatment that is consistent with the developmental needs of the adolescent. The primary hypothesisof
the proposed study is as follows: a family-centered problem solving intervention will result in improved
adherence to prescribed oral medication 6MP and Decadron among adoelscents with ALL comparedwith
basic psychosocial care. We anticipate that the proposed study will identify effective strategies to promote
adherence among adolescents with ALL and will potentially lead to improved medical outcomes for these
adolescents. Second, we anticipate that the principles of the intervention model will generalize beyond ALL
to adolescents with other forms of cancer as well as other chronic conditions and their families. Finally,
improving adherence to oral medication during maintenance therapy for adolescents who participate in
clinical trials would improve the validity of the data drawn from those investigations.