Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht.
Ann Oncol. 2013 Sep;24(9):2324-9. doi: 10.1093/annonc/mdt195. Epub 2013 May 23.
There is substantial nonadherence to effective adjuvant endocrine therapy for breast cancer prevention. We therefore examined patients' trade-offs between the efficacy, side-effects, and regimen duration, and whether trade-offs predicted nonadherence.
Trade-offs from 241 women were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated ACA utilities, the relative importance of each treatment property was calculated and a benefit/drawback ratio between the importance of the efficacy versus that of the side-effects and other treatment properties. Nonadherence was assessed through composites of validated self-report measures.
Efficacy was most important. The side-effects joint and muscle pain and risk of endometrial cancer were almost as important. The benefit/drawback ratio showed 16% of the women to value the efficacy less than the side-effects and other treatment properties. A higher benefit/drawback ratio was associated with decreased nonadherence [adjusted odds ratio (OR) 0.1, 95% confidence interval 0.03-0.3].
One in six women do not consider the efficacy of endocrine therapy to outweigh its drawbacks. Knowing women's trade-offs is likely to identify women at risk for nonadherence and to help clinicians in tailoring their communication and care to different needs of individual women.
乳腺癌预防的有效辅助内分泌治疗存在大量不依从。因此，我们研究了患者在疗效、副作用和治疗方案持续时间之间的权衡取舍，以及这些权衡取舍是否可以预测不依从。
通过定制的个体化自适应联合分析（ACA）选择任务评估了 241 名患者的权衡取舍。从估计的 ACA 效用中，计算了每种治疗特性的相对重要性，以及疗效与副作用和其他治疗特性之间的利弊比。通过经过验证的自我报告措施的综合评估来评估不依从性。
疗效最重要。副作用联合肌肉疼痛和子宫内膜癌风险也同样重要。利弊比显示，16%的女性认为疗效不如副作用和其他治疗特性重要。更高的利弊比与较低的不依从率相关[调整后的比值比（OR）0.1，95%置信区间 0.03-0.3]。
六分之一的女性认为内分泌治疗的疗效不如其缺点重要。了解患者的权衡取舍可能有助于识别不依从的风险患者，并帮助临床医生根据个体患者的不同需求调整沟通和护理。
