National Cancer Control Research Institute, National Cancer Center, Goyang-si, South Korea.
Support Care Cancer. 2010 Feb;19(2):211-20. doi: 10.1007/s00520-009-0802-4. Epub 2010 Jan 15.
Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population.
We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors.
Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence.
Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population.
据报道，癌症幸存者在接受其他疾病治疗方面的护理不如一般人群多；然而，目前尚不清楚患者的行为是否也对此有影响。本研究旨在与一般人群相比，检查癌症幸存者对降压药物的依从性及其相关因素。
我们使用了国家健康保险的药房理赔和参保数据，该保险涵盖了 97%的韩国人口。总共确定了 2455193 名患者，包括 12636 名（0.5%）接受降压药物治疗的癌症幸存者。80%或以上的累积药物依从性被定义为适当的药物依从性。我们分别进行了两次多因素逻辑回归分析，以比较两个人群中适当依从性的比例，并确定影响癌症幸存者药物依从性的因素。
癌症幸存者适当药物依从性的比例低于一般人群（调整后的优势比=0.85；95%置信区间，0.82-0.88）。根据癌症类型，药物依从性存在显著差异。其他一些因素，如年龄较大、收入较低、居住在农村地区和降压药物持续时间，也会影响降压药物的依从性。与一般人群不同，年龄较小的幸存者表现出更高的依从性。
参与幸存者护理的临床医生应检查患者对降压药物的依从性，并评估不依从的可能原因。需要进一步研究以确定不依从的原因，并为这一脆弱人群制定有效的干预措施。
