摘要
目的:评价儿童急性淋巴细胞性白血病(ALL)治疗的依从性。方法:依从性通过具体的随访、体格检查图表的注解、6-巯基嘌呤(MP)最终代谢物中的血红素的测定来评估。结果:39例处于化疗阶段维持的患儿进入该研究。87%的病例为母亲负责给患儿服用6-MP。35位受访者说药物治疗很容易理解。
Aim: To evaluate compliance in children with acute lym-phoblastic leukaemia (ALL) . Methods: Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6 - mer-captopurine 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 so-cioeconomic 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.
