Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jennifer Rohan, Ph.D.

Second Advisor

Rosalie Corona, Ph.D.

Third Advisor

Heather Jones, Ph.D.

Fourth Advisor

Oswaldo Moreno, Ph.D.

Fifth Advisor

Marcia Winter, Ph.D.


Adherence during the maintenance phase of pediatric cancer treatment is critical to prevent relapse and ensure long-term, event-free survival. Yet, little research has been done to examine individual- and family-level factors that may relate to adherence during the maintenance phase of treatment, particularly among Latinx patients. This is surprising given findings demonstrating that children who miss more than 5% of their prescribed oral chemotherapy medicine, most commonly 6-mercaptopurine (6MP), are 2.5-2.7 times more likely to relapse than children who take 95% or more of their prescribed 6MP. Pediatric cancer patients face unique adherence challenges given the importance of family involvement in children’s care. As such, it is important to consider both individual- and family-level factors when examining adherence. Objective. Conducted a secondary data analysis to investigate individual- and family-level factors that may predict 6MP medication adherence patterns, in a multisite cohort of pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) or lymphoblastic leukemia (LBL), in a sample that is 34% Latinx. Methods. Participants included 139 patients ages 7-19 years diagnosed with ALL or LBL, across six centers. Medication adherence was measured daily for 15 months using electronic monitoring of 6MP. At baseline, 6 months, and 15 months, participants reported on individual- (e.g., child depressive symptoms, caregiver depressive symptoms, child/adolescent health beliefs) and family-level (e.g., caregiver-child communication, younger children within the home) factors that might predict adherence patterns. Medical history was evaluated via standardized medical chart reviews at baseline, 6 months, 15 months, which included information on prescribed daily 6MP dose and duration of cancer diagnosis. Results. Results demonstrated characteristic differences between the adherence groups (e.g., age, dose, health beliefs). Results further indicated that developmental age group was the strongest predictor of medication adherence, such that youth in the middle-late adolescence age group were significantly more likely to be in the nonadherent group than youth in the preadolescent or early-middle adolescence age groups. Dosage and health beliefs, specifically positive outcome expectancy, also significantly predicted adherence group membership. Preliminary exploratory analyses indicate that predictors of adherence may differ between Latinx and non-Latinx, white patients. These results must be interpreted cautiously as the current study focused on outcomes rather than processes and social stratification. Furthermore, exploratory analyses indicated that adherence and quality of life were not significantly related in the current study, in either direction. Conclusions. Older adolescents may be at increased risk for nonadherence, which is an area of major concern warranting future research in this area. Findings also indicate that fostering positive outcome expectancy among youth at the start of maintenance phase may serve to enhance adherence during this phase of treatment. Future work examining adherence behaviors should continue to assess longitudinal individual, family, and medication-level factors.


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