Adherence to 6-Mercaptopurine (6-MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)

Mira Muxi Yang; Revika Singh; Maureen Haugen; Ashley Duff; Jenny Shoop; Elaine R. Morgan; Jenna E. Rossoff; Joanna L. Weinstein; Mallorie B. Heneghan; Sherif M. Badawy

doi:10.1111/ejh.14386

Adherence to 6-Mercaptopurine (6-MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)

Mira Muxi Yang, Revika Singh, Maureen Haugen, Ashley Duff, Jenny Shoop, Elaine R. Morgan, Jenna E. Rossoff, Joanna L. Weinstein, Mallorie B. Heneghan, Sherif M. Badawy^*

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Low 6-mercaptopurine (6-MP) adherence (< 95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. We examined the relationship of 6-MP adherence to habit strength and health-related quality of life in pediatric ALL. Methods: A single-center, cross-sectional study of 52 participants: 11 patients (mean age 16 ± 4) and 41 parents/caregivers (age 37 ± 5). Participants completed Visual Analogue Scale (VAS_dose), Patient Reported Outcomes Measurement Information System Medication Adherence Scale, and the Self-Regulated Habit Index (SRHI). Twelve semi-structured participant interviews were analyzed using thematic analysis. Results: 81% (42/52) of participants reported high 6-MP adherence (VAS_dose ≥ 95%): patients 91% (10/11), parents 78% (32/41). No significant correlation was found between adherence and habit strength. Reported adherence facilitators included reminders, care team communications, personalized tools, administration experience, self-efficacy, and social support. Conversely, financial burden, scheduling conflicts, and medication access were cited as barriers. Conclusions: One-fifth of participants reported low 6-MP adherence, with habit strength not associated with adherence. Variability of 6-MP routines may prohibit automaticity. While 6-MP adherence may not correlate with habit strength, interventions promoting and strengthening habit formation may overcome barriers to 6-MP adherence and improve outcomes.

Original language	English (US)
Journal	European Journal of Haematology
DOIs	https://doi.org/10.1111/ejh.14386
State	Accepted/In press - 2025

Funding

This work was supported by National Heart, Lung, and Blood Institute. Funding: This project was supported by grant (K23HL150232, PI: Badawy) from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the National Institutes of Health.

Keywords

6-MP
ALL
acute lymphoblastic leukemia
adherence
habit strength

ASJC Scopus subject areas

Hematology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/ejh.14386

Cite this

@article{49c903db5abf4810bb86a61195c73023,

title = "Adherence to 6-Mercaptopurine (6-MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)",

abstract = "Background: Low 6-mercaptopurine (6-MP) adherence (< 95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. We examined the relationship of 6-MP adherence to habit strength and health-related quality of life in pediatric ALL. Methods: A single-center, cross-sectional study of 52 participants: 11 patients (mean age 16 ± 4) and 41 parents/caregivers (age 37 ± 5). Participants completed Visual Analogue Scale (VASdose), Patient Reported Outcomes Measurement Information System Medication Adherence Scale, and the Self-Regulated Habit Index (SRHI). Twelve semi-structured participant interviews were analyzed using thematic analysis. Results: 81% (42/52) of participants reported high 6-MP adherence (VASdose ≥ 95%): patients 91% (10/11), parents 78% (32/41). No significant correlation was found between adherence and habit strength. Reported adherence facilitators included reminders, care team communications, personalized tools, administration experience, self-efficacy, and social support. Conversely, financial burden, scheduling conflicts, and medication access were cited as barriers. Conclusions: One-fifth of participants reported low 6-MP adherence, with habit strength not associated with adherence. Variability of 6-MP routines may prohibit automaticity. While 6-MP adherence may not correlate with habit strength, interventions promoting and strengthening habit formation may overcome barriers to 6-MP adherence and improve outcomes.",

keywords = "6-MP, ALL, acute lymphoblastic leukemia, adherence, habit strength",

author = "Yang, {Mira Muxi} and Revika Singh and Maureen Haugen and Ashley Duff and Jenny Shoop and Morgan, {Elaine R.} and Rossoff, {Jenna E.} and Weinstein, {Joanna L.} and Heneghan, {Mallorie B.} and Badawy, {Sherif M.}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.",

year = "2025",

doi = "10.1111/ejh.14386",

language = "English (US)",

journal = "European Journal of Haematology",

issn = "0902-4441",

publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Adherence to 6-Mercaptopurine (6-MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)

AU - Yang, Mira Muxi

AU - Singh, Revika

AU - Haugen, Maureen

AU - Duff, Ashley

AU - Shoop, Jenny

AU - Morgan, Elaine R.

AU - Rossoff, Jenna E.

AU - Weinstein, Joanna L.

AU - Heneghan, Mallorie B.

AU - Badawy, Sherif M.

PY - 2025

Y1 - 2025

N2 - Background: Low 6-mercaptopurine (6-MP) adherence (< 95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. We examined the relationship of 6-MP adherence to habit strength and health-related quality of life in pediatric ALL. Methods: A single-center, cross-sectional study of 52 participants: 11 patients (mean age 16 ± 4) and 41 parents/caregivers (age 37 ± 5). Participants completed Visual Analogue Scale (VASdose), Patient Reported Outcomes Measurement Information System Medication Adherence Scale, and the Self-Regulated Habit Index (SRHI). Twelve semi-structured participant interviews were analyzed using thematic analysis. Results: 81% (42/52) of participants reported high 6-MP adherence (VASdose ≥ 95%): patients 91% (10/11), parents 78% (32/41). No significant correlation was found between adherence and habit strength. Reported adherence facilitators included reminders, care team communications, personalized tools, administration experience, self-efficacy, and social support. Conversely, financial burden, scheduling conflicts, and medication access were cited as barriers. Conclusions: One-fifth of participants reported low 6-MP adherence, with habit strength not associated with adherence. Variability of 6-MP routines may prohibit automaticity. While 6-MP adherence may not correlate with habit strength, interventions promoting and strengthening habit formation may overcome barriers to 6-MP adherence and improve outcomes.

AB - Background: Low 6-mercaptopurine (6-MP) adherence (< 95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. We examined the relationship of 6-MP adherence to habit strength and health-related quality of life in pediatric ALL. Methods: A single-center, cross-sectional study of 52 participants: 11 patients (mean age 16 ± 4) and 41 parents/caregivers (age 37 ± 5). Participants completed Visual Analogue Scale (VASdose), Patient Reported Outcomes Measurement Information System Medication Adherence Scale, and the Self-Regulated Habit Index (SRHI). Twelve semi-structured participant interviews were analyzed using thematic analysis. Results: 81% (42/52) of participants reported high 6-MP adherence (VASdose ≥ 95%): patients 91% (10/11), parents 78% (32/41). No significant correlation was found between adherence and habit strength. Reported adherence facilitators included reminders, care team communications, personalized tools, administration experience, self-efficacy, and social support. Conversely, financial burden, scheduling conflicts, and medication access were cited as barriers. Conclusions: One-fifth of participants reported low 6-MP adherence, with habit strength not associated with adherence. Variability of 6-MP routines may prohibit automaticity. While 6-MP adherence may not correlate with habit strength, interventions promoting and strengthening habit formation may overcome barriers to 6-MP adherence and improve outcomes.

KW - 6-MP

KW - ALL

KW - acute lymphoblastic leukemia

KW - adherence

KW - habit strength

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SN - 0902-4441

JO - European Journal of Haematology

JF - European Journal of Haematology

ER -

Adherence to 6-Mercaptopurine (6-MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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