Adesão ao tratamento farmacológico no pós-transplante de células-tronco hematopoéticas

Abstract

Introduction: Post-hematopoietic stem cell transplantation is a period in which adherence to pharmacological treatment is crucial to prevent complications such as graft-versus-host disease and graft failure. Therefore, the following research questions were formulated: What is the degree of adherence to pharmacological treatment in post-HSCT? What are the determining factors of adherence to pharmacological treatment in post-HSCT patients? What are the strategies to support adherence to pharmacological treatment used by post-HSCT patients? Objective: To investigate adherence to pharmacological treatment in post-hematopoietic stem cell transplant patients. Method: This is a cross-sectional study carried out between January and October 2024 in a reference hospital for hematopoietic stem cell transplantation in the state of Rio Grande do Norte. The population consisted of patients undergoing oral pharmacotherapy after stem cell grafting, treated at the Day Hospital. A questionnaire covering sociodemographic and clinical data, the Treatment Adherence Measurement Instrument, and questions about facilitating factors, challenges, interventions, and technologies to support adherence were used. Pearson's chi-square test and Student's t-test were used. Variables with p≤0.20 in the univariate analysis were included in the multiple logistic regression model. The magnitude of the association was calculated by the Prevalence Ratio. The significance level was 5% and the Confidence Interval was 95%. The project was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, under opinion 6,599,477 and CAAE: 76470723.9.0000.5537. Results: The sample consisted of 99 participants, with a predominance of females (56.6%) and a mean age of 44.7 years. The most common diagnosis was acute myeloid leukemia (35.4%). Autologous transplantation was the most frequent type (52.5%) and systemic arterial hypertension was the most prevalent comorbidity (13.1%). 72.7% of the participants showed high adherence, with 45.5% achieving maximum adherence. The pharmacotherapeutic complexity index ranged from 6.5 to 47.0. The main factors facilitating adherence were health education (71.7%) and family support (69.7%), while the most cited challenges were psychological issues (53.5%). Support strategies such as alarms (45.4%) and medication organizer containers (43.4%) were widely used. The strategies most cited as useful to support adherence were medication guides and mobile applications. Logistic regression revealed that adherence to treatment was associated with the absence of systemic arterial hypertension, use of support strategies and fewer days post-transplant. Conclusion: Adherence to pharmacological treatment was high in most of the sample and was shown to be favored by the absence of arterial hypertension, use of support strategies and shorter posttransplant time, in addition to being influenced by the type of transplant and degree of complexity of pharmacotherapy.