Chlebowski Rowan T, Geller Michelle L
Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA 90502-2064, USA.
Oncology. 2006;71(1-2):1-9. doi: 10.1159/000100444. Epub 2007 Mar 5.
Despite the demonstrated efficacy of long-duration adjuvant tamoxifen and aromatase inhibitor use in breast cancer management, information on adherence to such therapy is limited. Therefore, we reviewed the published literature regarding hormonal therapy adherence in clinical trial and practice settings.
A systematic search of the PubMed database, augmented by a review of manuscript references and conference proceedings, commonly identified adherence reports in clinical trials but identified only 9 adherence reports in clinical practice settings.
In adjuvant breast cancer clinical trials with longer (> or =4 years) follow-up, hormonal therapy (tamoxifen or aromatase inhibitors) was prematurely discontinued by about 23-28% of the study participants. Adherence to aromatase inhibitors did not differ from adherence to tamoxifen in this setting. In breast cancer prevention trials, tamoxifen was prematurely discontinued by 20-46% of the participants. In clinical practice settings, only 2 reports addressed longer-duration (>4 years) adherence to adjuvant tamoxifen use. In these, tamoxifen was prematurely discontinued by 30-50% of the patients.
Adherence to prescribed breast cancer hormone therapy has not received concerted attention. Current, albeit limited, evidence suggests long-term hormone therapy adherence may represent an area limiting optimal breast cancer patient treatment.
尽管已证明长期使用辅助性他莫昔芬和芳香化酶抑制剂在乳腺癌治疗中具有疗效，但关于此类治疗依从性的信息有限。因此，我们回顾了已发表的有关临床试验和实际临床环境中激素治疗依从性的文献。
对PubMed数据库进行系统检索，并辅以对手稿参考文献和会议论文集的回顾，通常能找到临床试验中的依从性报告，但在实际临床环境中仅找到9份依从性报告。
在随访时间较长（≥4年）的辅助性乳腺癌临床试验中，约23%-28%的研究参与者过早停用激素治疗（他莫昔芬或芳香化酶抑制剂）。在此情况下，芳香化酶抑制剂的依从性与他莫昔芬的依从性无差异。在乳腺癌预防试验中，20%-46%的参与者过早停用他莫昔芬。在实际临床环境中，仅有2份报告涉及长期（>4年）辅助性他莫昔芬使用的依从性。在这些报告中，30%-50%的患者过早停用他莫昔芬。
对规定的乳腺癌激素治疗的依从性尚未得到一致关注。目前虽证据有限，但表明长期激素治疗依从性可能是限制乳腺癌患者最佳治疗的一个领域。
