Department of Gynecology and Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
Breast Cancer Res Treat. 2012 Jan;131(2):491-9. doi: 10.1007/s10549-011-1801-y.
This study evaluates compliance and persistence in adjuvant endocrine breast cancer (BC) therapy by clearly analyzing reasons of therapy cessation by differentiating clinical meaningful situations. In order to illuminate the complex field of personal motivation to therapy, a single institution study with a more individual-based approach might better be suited to provide a detailed case documentation than the more epidemiologic approach of large database studies. An unselected cohort of 698 patients (≤ 80 years) diagnosed with hormonal receptor-positive BC from 1997 to 2008 at the University Hospital Basel, Switzerland, was analyzed. The term "non-persistence" was exclusively used for patients where the discontinuation of endocrine therapy (ET) could have been modified by more intensive care and improved counseling (e.g., in women who lost faith/motivation to therapy or those who suffered from therapy-related side effects). These cases must be differentiated from cases where therapy cessation was inevitable (e.g., due to recurrent disease or severe intercurrent illness). Out of the 685 patients to whom ET was recommended, 42 patients (6.1%) refused and never began treatment (non-compliance). Women younger than 50 were more likely to be non-compliant (P < 0.001). 12.9% of the patients who started therapy were non-persistent to therapy. Patients who were treated by general practitioners tended to be non-persistent more often compared to those treated by oncologists (17.7% vs. 11.3%; P = 0.07). The aim of a non-persistence rate between 10 and 15% is realistic when patients are treated by specialized oncologists. Interventions are needed to support patients, particularly the younger ones, to comply with therapy. Efforts should be made to make sure that all physicians, above all general practitioners, who are involved in BC treatment, are provided with current knowledge as to guarantee an optimal patient management.
本研究通过明确区分导致治疗停止的临床有意义的情况，评估辅助内分泌乳腺癌（BC）治疗的依从性和持久性。为了阐明治疗个人动机的复杂领域，与大型数据库研究的更具流行病学方法相比，采用更个体化的方法进行的单机构研究可能更适合提供详细的案例记录。分析了瑞士巴塞尔大学医院 1997 年至 2008 年间诊断为激素受体阳性 BC 的 698 例（≤80 岁）患者的未选择队列。“非持续性”一词仅用于那些可以通过更强化的护理和改善咨询来改变内分泌治疗（ET）停药的患者（例如，对治疗失去信心/动机或因治疗相关副作用而受苦的患者）。这些情况必须与治疗停止不可避免的情况（例如，由于疾病复发或严重的并发疾病）区分开来。在建议接受 ET 的 685 例患者中，有 42 例（6.1%）拒绝且从未开始治疗（不依从）。年龄小于 50 岁的女性更有可能不依从（P<0.001）。开始治疗的患者中有 12.9%对治疗不持久。由全科医生治疗的患者比由肿瘤医生治疗的患者更有可能不持久（17.7%比 11.3%；P=0.07）。当患者由专科肿瘤医生治疗时，达到 10%至 15%的不持久率是现实的。需要采取干预措施来支持患者，特别是年轻患者，以使其依从治疗。应努力确保所有参与 BC 治疗的医生，尤其是全科医生，都掌握最新知识，以保证最佳的患者管理。
