Medication Adherence and Self-Efficacy of Medication Management in Older Adults Immediately Following Hematopoietic Cell Transplant (HCT)

Background Patients undergoing hematopoietic cell transplant (HCT) identify challenges in medication management during the transition from HCT hospitalization to home. Given the risks of complex medication regimens and post-HCT cognitive impairment, older adults may be at increased risk of suboptimal medication management. Methods We conducted cross-sectional analyses of baseline data from a prospective longitudinal study examining medication adherence after HCT at a single academic center. We recruited consecutive adults with hematologic malignancy who underwent allogeneic HCT. We defined older age as ≥ 65. At day 30 post-HCT, we collected baseline patient reported assessments: medication adherence (Medication Adherence Report Scale 5 - MARS5), self-efficacy (PROMIS Self-Efficacy-Managing Medications and Treatment-Short Form 8a), quality of life (QOL) (FACT-BMT), depression (HADS-Depression), anxiety (HADS-anxiety), post-traumatic stress disorder (PTSD: PCL-C) and cognitive impairment (Short Blessed Test). We defined adherence as MARS5 score = 25 and cognitive impairment as Short Blessed scores ≥ 4. Results We enrolled 150 patients after HCT, of whom 53 (35.3%) were older adults. Older adults were predominantly male (57%), White (94%), received reduced intensity conditioning (96%), and required hospitalization during HCT (85%). A minority of older adults (11%) reported cognitive impairment at D30 post-HCT. Most older adults (81.1%) reported medication adherence and high self-efficacy of medication management (mean T-score=50, SD=6.5). Figure 1 demonstrates medication adherence and self-efficacy of medication management were similar between older and younger adults undergoing HCT. No baseline sociodemographic or clinical characteristics were associated with self-reported medication adherence. Cognitive impairment in older adults was associated with lower self-efficacy of medication management (B=-6.2, p=0.007). Medication adherence was associated with fewer baseline symptoms of PTSD, and self-efficacy of medication management was associated with higher QOL and less psychological distress (Table 1). Discussion While many older adults report high medication adherence and self-efficacy of medication management, a significant minority struggle with adherence and medication management immediately post-HCT. Use of self-reported medication adherence may have resulted in under-reporting of non-adherence. Nevertheless, post-HCT cognitive impairment negatively impacts medication management in older adults and suggests the importance of screening for cognitive impairment after receipt of conditioning chemotherapy. Finally, medication management is importantly associated with post-HCT quality of life and psychological distress, and future studies are needed to understand impact on outcomes and experience of older adults post-HCT.