1. Psychological Factors Affecting the Willingness to Accept a Possible Tyrosine Kinase Inhibitor (TKI) Discontinuation in Chronic Myeloid Leukaemia (CML) Patients
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Cutica I, Riva S, Orlandi EM, Iurlo A, Vener C, Elena C, Bucelli C, Cattaneo D, Tomezzoli E, and Pravettoni G
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tki discontinuation ,chronic myeloid leukaemia ,patients’ perspective ,risk preferences ,decision-making ,Medicine (General) ,R5-920 - Abstract
Ilaria Cutica,1,* Silvia Riva,2,* Ester Maria Orlandi,3 Alessandra Iurlo,4 Claudia Vener,1 Chiara Elena,3 Cristina Bucelli,4 Daniele Cattaneo,1,4 Elisa Tomezzoli,5 Gabriella Pravettoni1,5 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; 2Department of Psychology and Pedagogic Science, St Mary’s University, London, UK; 3Hematology Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy; 4Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; 5Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy*These authors contributed equally to this workCorrespondence: Ilaria Cutica, Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20123, Italy, Tel +39 02 50321562, Fax +39 02 50318938, Email ilaria.cutica@unimi.itPurpose: Patients with chronic myeloid leukemia (CML) who present a sustained deep molecular response (DMR) for a stable period of time might benefit from discontinuing tyrosine kinase inhibitors (TKIs). A significant number of patients seem able to reach this stage due to the availability of TKIs. However, many patients remain reluctant about TKI discontinuation and may refuse treatment interruption. The purpose of this study was to explore the clinical and psycho-cognitive factors that may influence the decision to discontinue TKI therapy, thereby gaining a better understanding of patients’ viewpoints on TKI discontinuation.Patients and Methods: One hundred and nineteen patients diagnosed with CML aged between 34 and 69 were enrolled (67 males and 52 females). Different clinical information and psycho-cognitive aspects such as attitude toward risk behaviours, risk preferences, need for cognitive closure, and tendency to resist to changes were assessed through the administration of a battery of questionnaires.Results: A higher tendency toward risk behaviours and the tendency to focus on possible gain in the short term rather than on losses might represent important predictors for the willingness to accept TKI discontinuation. Possible relapses following interruption of the therapy are the most common reason for concern. Furthermore, lower levels of resistance to change and having previously experienced the desire to interrupt the therapy might lead patients to accept a higher probability of relapse risk when facing such a decision.Conclusion: TKI discontinuation appears appealing and challenging at the same time for many CML patients, and different factors may influence this decision. Psychology plays a crucial role in assisting physician-patient communication and informed decision-making.Keywords: TKI discontinuation, chronic myeloid leukaemia, patients’ perspective, risk preferences, decision-making
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- 2022