We present the case of a 24 year old childhood cancer survivor with non-compliance of medication. Patient SB d.o.b. 30/07/1987, presented with a squint and loss of vision in the right eye at the age of four years. He was diagnosed with a craniopharyngioma and had a frontal craniotomy. Two years later, an MRI showed recurrence so he had further frontal surgery followed by irradiation (50 Gy in 28 fractions). Post operatively he was diagnosed with panhypopituitarism and remained blind in the right eye. At 18 years he was transferred to the adult clinic. At that time, medication included thyroxine, hydrocortisone, depot testosterone, DDAVP solution and growth hormone. Blood tests showed low free thyroxine of 3 pmol/L, low testosterone of 0.2 nmol/L and a low IGF 1 of 3.4 nmol/L. At repeated consultations with the specialist nurse, consultant and GP, the patient insisted he was taking his medication. However, contact with the surgery over the last five years has shown that he may miss anywhere between 2 and 10 months of medication. Review of paediatric notes suggests there was non-compliance from the age of 12 years. He has now been transferred to prednisolone and nebido and continues on thyroxine. Growth hormone and DDAVP have been discontinued. Recent blood tests (2011) again show low testosterone (3.0 nmol/L) and thyroxine (<5 pmol/L) levels. Follow up MRI scans show no evidence of tumour recurrence but substantial damage to the right frontal lobe. Formal neuropsychological assessment only shows non-specific attention memory deficit of the type seen following any cerebral insult and not thought related to non-compliance. Our case highlights the problem of non-compliance with medication in a childhood cancer survivor and suggests there is a need for further research to identify risk factors and how to address this problem.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.