The Clinical Impact of Treatment Intolerance and Nonadherence in CP-CML

Treatment interruptions and nonadherence can have significant clinical consequences, ranging from suboptimal responses to disease relapse. A common challenge is patients not consistently taking their medication as prescribed, which may not always be openly communicated. Clinicians emphasize the importance of directly and compassionately asking patients about missed doses to uncover any adherence issues. Even missing a few doses per month can greatly reduce the chance of achieving deep molecular remission. With the availability of highly effective drugs, true resistance is now less common, but nonadherence remains a leading cause of treatment failure.

Intolerance to therapy significantly affects patients’ quality of life and adherence. Many patients initially struggle with accepting a cancer diagnosis and the prospect of lifelong medication, despite the high curability of the disease. This makes educating patients about the goal of treatment—achieving remission and possibly discontinuing therapy—crucial to motivating adherence. Addressing and managing adverse effects proactively through dose adjustments or switching medications can help improve tolerability. Maintaining a good quality of life on therapy supports ongoing adherence and ultimately better outcomes, including treatment-free remission.

Despite best efforts, some patients face severe intolerance or adherence challenges that lead to poor outcomes. Cases are mentioned where intolerance or refusal to take medication led to more invasive treatments such as transplant or hospice care, underscoring the need for continuous support and communication. Clinicians stress the importance of patient-provider dialogue, timely management of adverse effects, and realistic goal setting to make the treatment journey as manageable as possible while aiming for long-term success.