Beyond Survival: Psychological Burden Impairs Medication Adherence in Chinese Patients with Chronic Myeloid Leukemia on TKI Therapy

Increasing research has linked mental health to reduced adherence in chronic diseases, yet this interplay remains insufficiently explored in chronic myeloid leukemia (CML).

We conducted a cross-sectional online survey to analyze the critical role of non-treatment factors among Chinese CML patients receiving tyrosine kinase inhibitor (TKI) therapy. Anxiety and depression were assessed with the GAD-7/PHQ-9, quality of life (QoL) with the SF-12. Medication adherence was assessed using the Medication Possession Ratio (MPR), calculated as the percentage of actual medication possession days relative to the theoretical medication possession days. Binary logistic regression was used to identify factors associated with psychological burden and adherence.

Of 486 patients included, 52.5% reported anxiety (mild: 45.3%; moderate-severe: 7.2%) and 40.5% reported depression (mild: 29.8%; moderate-severe: 10.7%). QoL was impaired in both physical and mental domains (mean SF-12 PCS 46.22; MCS 45.62). Employment status and higher SF-12 PCS scores were significantly associated with lower psychological burden. Compared with patients reporting medium or high adherence, those with low adherence had higher rates of anxiety (20.2% vs 3.5% and 3.3%, P < 0.001) and depression (17.4% vs 8.8% and 8.7%, P=0.007) and lower MCS scores (43.72 vs 46.45 and 45.75, P=0.021). Binary logistic regression analysis showed that therapy duration, line of treatment, and psychological burden were significantly associated with adherence, patients with elevated psychological burden had 76.0% lower adherence odds (OR=0.24; 95% CI: 0.13-0.44; P<0.001), the strongest influencing factor.

Psychological burden is the strongest determinant of impaired medication adherence in Chinese patients with CML on TKI therapy. Interventions that reduce psychological burden, particularly by promoting social-role participation and improving perceptions of physical health, may offer a new dimension for optimizing long-term outcomes in CML.