Understanding and Challenges in Taking Tyrosine Kinase Inhibitors among Malaysian Chronic Myeloid Leukemia Patients: A Qualitative Study

Background: In Malaysia, the treatment for chronic myeloid leukemia (CML) has long been delivered under the
Malaysian Patient Assistance Program (MYPAP), but research on identifying factors contributing to non-adherence to
tyrosine kinase inhibitors (TKIs) is still limited. The current study explored understanding and challenges of Malaysian
CML patients in taking imatinib and nilotinib. Methods: Semi-structured, face-to-face interviews were conducted
with 13 CML patients receiving treatment at a public tertiary care center, and were analyzed using the content analysis
approach. Results: The patients generally demonstrated inadequate knowledge, particularly of the natural history and
staging of CML, the function of TKIs, and the methods used for monitoring the effectiveness of treatment. A number of
them also had experiences of withholding, skipping or altering the treatment, mainly due to the life-disturbing adverse
drug effects (ADRs), forgetfulness, and religious and social issues. Besides, most of them were found having limited
skills in managing the ADRs, and not using prompts as reminders to take the medications. Furthermore, even though
nilotinib was generally perceived as better tolerated as compared with imatinib, the inconvenience caused by the need
to take it twice daily and on an empty stomach was constantly highlighted by the patients. Conclusion: While TKIs
are widely used for CML treatment in Malaysia, the findings have revealed a lack of patient education and awareness,
which warrants an integrated plan to reinforce medication adherence.