Department of Gynecology, Endocrinology and Oncology, Phillips-University of Marburg, Marburg, Germany.
Breast Cancer Res Treat. 2013 Feb;138(1):185-91. doi: 10.1007/s10549-013-2417-1. Epub 2013 Jan 20.
Compliance and persistence are often underestimated in breast cancer (BC) treatment. The aim of our study was to analyze the persistence with tamoxifen (TAM) and aromatase inhibitors (AI) in postmenopausal women with hormone-receptor-positive BC and to identify determinants of non-persistence. We used data of the Disease Analyzer database (IMS HEALTH, Germany) including 2,067 general practices and 397 gynecological practices. Out of a dataset of 15 million patients, we identified BC patients with a first-time TAM or AI prescriptions from October 2001 to December 2010. For persistence analyses, 12,412 women on tamoxifen, 2,796 on anastrozole, 647 on exemestane, and 1,657 on letrozole met the inclusion/exclusion criteria. Within 3 years of follow-up, the discontinuation rates increased to 52.2 % for tamoxifen, 47 % for anastrozole, 55.1 % for exemestane, and 44.3 % for letrozole treated women. A minor proportion of patients switched to a different endocrine treatment; 33 % tamoxifen, 20 % anastrozole, 22.9 % exemestane, and 23 % letrozole. The multivariate hazard ratios of the cox regression models showed that patients younger than 50 were most likely to discontinue initial therapy when compared with the reference group of women over 70 (p < 0.001). In contrast, patients treated in gynecologist practice had significantly longer persistence than patients who obtained their prescriptions in general practitioner practice (p < 0.001). In addition, the presence of the co morbidities like diabetes (p < 0.001) or depression (p < 0.002) was also associated with decreased risk of treatment discontinuation. Persistence with all endocrine treatments in women with hormone-receptor-positive BC is low and needs to be significantly increased to improved outcome in clinical practice. Further research is required to understand this complex issue.
在乳腺癌（BC）治疗中，往往低估了依从性和持久性。我们研究的目的是分析激素受体阳性 BC 绝经后妇女使用他莫昔芬（TAM）和芳香化酶抑制剂（AI）的持久性，并确定非持久性的决定因素。我们使用了 IMS HEALTH（德国）的疾病分析器数据库的数据，其中包括 2067 家普通诊所和 397 家妇科诊所。在包含 1500 万患者的数据集，我们确定了 2001 年 10 月至 2010 年 12 月首次使用 TAM 或 AI 处方的 BC 患者。为了进行持久性分析，我们选择了 12412 名服用他莫昔芬、2796 名服用阿那曲唑、647 名服用依西美坦和 1657 名服用来曲唑的女性作为研究对象，这些患者均符合纳入/排除标准。在 3 年的随访中，他莫昔芬组停药率增加到 52.2%，阿那曲唑组为 47%，依西美坦组为 55.1%，来曲唑组为 44.3%。少数患者转为其他内分泌治疗；33%的患者转为他莫昔芬，20%的患者转为阿那曲唑，22.9%的患者转为依西美坦，23%的患者转为来曲唑。Cox 回归模型的多变量风险比显示，与 70 岁以上的女性参考组相比，年龄小于 50 岁的患者最有可能停止初始治疗（p<0.001）。相比之下，在妇科医生诊所接受治疗的患者的持续治疗时间明显长于在全科医生诊所获得处方的患者（p<0.001）。此外，患有合并症（如糖尿病[ p<0.001]或抑郁症[ p<0.002]）也与降低停药风险相关。激素受体阳性 BC 妇女对所有内分泌治疗的依从性都很低，需要显著提高，以改善临床实践中的结果。需要进一步研究以了解这一复杂问题。
