Factors Associated with Hematopoietic Stem Cell Transplant Survivors' Adherence to Medical Recommendations

Introduction: Hematopoietic Stem Cell Transplant, a toxic but often lifesaving cancer treatment, puts patients at risk for life-threatening complications.  To reduce these risks, transplant survivors must take medications and change their lifestyle and environment (e.g., avoiding certain foods).   Little is known about their adherence to recommendations.  Furthermore, although sociodemographic factors such as income, race/ethnicity, and education are associated with lower medication adherence in other populations, it is unknown whether these factors are associated with lower adherence in transplant survivors. Methods: As part of a larger study, 315 transplant survivors 9 months to 3 years post-transplant reported whether their physician currently recommended dietary changes, changes to their adult home environment, changes to their social life, and medication therapy, then they reported the extent of their adherence on a 5-point Likert scale and completed measures of sociodemographics, health literacy, and financial strain.  Results: 46% (n=147) of survivors reported receiving at least one recommendation. Of these survivors, 51.7% (n=76) reported less than complete adherence (< 5) and 12.9% (n=19) reported moderate adherence (<3).  Correlational analysis revealed that education was positively associated with adherence (r=0.298, p<0.001). Although income was not correlated with adherence, survivors with greater financial strain reported lower adherence (r=-0.184, p=0.028). Variables not associated with adherence included: race/ethnicity, marital status, and health literacy. Conclusion: Self-reported adherence was relatively high in our sample of transplant survivors.  However, financial strain and education—variables related to health disparities—were associated with lower adherence and warrant future investigation to understand potential disparities in post-transplant adherence.