Philipps-University of Marburg, Department of Endocrinology, Reproductive Medicine and Osteoporosis, Germany.
Crit Rev Oncol Hematol. 2010 Feb;73(2):156-66. doi: 10.1016/j.critrevonc.2009.02.001. Epub 2009 Mar 18.
Better compliance and persistence with therapy are associated with improved patient outcomes. As more and more patients survive breast cancer, compliance with adjuvant therapy becomes increasingly important. In clinical trials, compliance with adjuvant endocrine therapy among women with breast cancer is usually high. Retrospective analyses of databases and medical records from clinical practice, insurance databases of prescription refills, and survey data show a significant decrease in persistence after 12 months of therapy. With ongoing therapy, a further decline in persistence of up to 50% has been reported. A consistent methodology is needed to measure patient behavior and identify patients who are not adhering to therapy. Promising strategies for enhancing adherence to treatment in clinical practice include improving access to health care, increasing patient satisfaction, managing side effects, patient education, and better communication between the patient and health care provider. Positive relationships between patients and their health care providers, and frequent monitoring and feedback, may be most effective. While the lack of conformity across studies in measuring makes cross-study comparisons difficult, this review evaluates the available data regarding compliance and persistence with adjuvant endocrine therapies for breast cancer (tamoxifen and aromatase inhibitors) and presents strategies for improving adherence.
更好的治疗依从性和持久性与改善患者结局相关。随着越来越多的乳腺癌患者存活，辅助治疗的依从性变得越来越重要。在临床试验中，乳腺癌患者接受辅助内分泌治疗的依从性通常较高。来自临床实践的数据库和病历、处方药续方保险数据库以及调查数据的回顾性分析表明，治疗 12 个月后，坚持治疗的比例显著下降。持续治疗时，据报道坚持治疗的比例进一步下降了高达 50%。需要一种一致的方法来衡量患者的行为并识别不依从治疗的患者。提高临床实践中治疗依从性的有前景的策略包括改善获得医疗保健的机会、提高患者满意度、管理副作用、患者教育以及改善医患沟通。患者与医疗保健提供者之间的积极关系以及频繁的监测和反馈可能最有效。尽管在衡量方面的研究缺乏一致性使得跨研究比较变得困难，但本综述评估了有关乳腺癌（他莫昔芬和芳香化酶抑制剂）辅助内分泌治疗的依从性和持久性的现有数据，并提出了提高依从性的策略。
