Department of Surgery, Indiana University, IN 46202, USA.
Clin Breast Cancer. 2010 Oct 1;10(5):385-91. doi: 10.3816/CBC.2010.n.051.
Compliance with recommended breast cancer treatments outside the context of a clinical trial differs from that in study populations. The purpose of this study was to examine differences in compliance of breast cancer treatments.
We conducted a retrospective review of 529 patients treated at 2 teaching hospitals in the same city from 2003 to 2006. Compliance with adjuvant therapy recommendations and choice of breast-conserving operations were compared between a university hospital (UH) and a county hospital (CH).
The 2 populations demonstrated similar rates of breast conservation (72% vs. 69%). Although use of radiation therapy at the CH was acceptable (82%), patients at the UH were more likely to undergo radiation therapy (95%). The use of hormone therapy was similar at the UH and the CH (> 93%). Patients were more likely to follow physician recommendations for adjuvant chemotherapy at the UH (89%) compared with the CH (70%; P = .0005). Univariate analysis revealed that patient age, tumor size, stage, grade, and estrogen receptor status were all significant predictors of patient compliance with chemotherapy. Preoperative chemotherapy was a strong predictor of patient compliance with chemotherapy (P < .0001). In multivariate analysis, all of the factors predictive of patient compliance in univariate analysis remained significant except tumor grade.
Preoperative chemotherapy appeared to increase compliance compared with adjuvant chemotherapy in the CH population. Compared with national standards, breast-conserving operations and radiation therapy compliance can be accomplished in an acceptable percentage of underinsured patients.
在临床试验之外，乳腺癌治疗的依从性与研究人群中的情况不同。本研究旨在研究乳腺癌治疗依从性的差异。
我们对 2003 年至 2006 年在同一城市的 2 所教学医院接受治疗的 529 例患者进行了回顾性分析。比较了大学医院（UH）和县级医院（CH）在辅助治疗建议的依从性和保乳手术选择方面的差异。
这两个群体的保乳率相似（72%对 69%）。尽管 CH 放疗使用率可接受（82%），但 UH 患者更有可能接受放疗（95%）。UH 和 CH 的激素治疗使用率相似（>93%）。与 CH（70%）相比，UH 患者更有可能遵循医生对辅助化疗的建议（89%；P =.0005）。单因素分析显示，患者年龄、肿瘤大小、分期、分级和雌激素受体状态均是患者化疗依从性的重要预测因素。术前化疗是患者化疗依从性的强烈预测因素（P <.0001）。多因素分析显示，单因素分析中预测患者依从性的所有因素均有意义，除肿瘤分级外。
与 CH 人群中的辅助化疗相比，术前化疗似乎能提高患者的化疗依从性。与国家标准相比，在未充分保险的患者中，保乳手术和放疗的依从性可以达到可接受的比例。
