Ayres Lorena Rocha, Baldoni André de Oliveira, Borges Anna Paula de Sá, Pereira Leonardo Régis Leira
Departamento de Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Centro de Pesquisa em Assistência Farmacêutica e Farmácia Clínica (CPAFF), Universidade de São Paulo, Avenida do Café, s/no., Campus Universitário da USP, Ribeirão Preto, SP, 14040-903, Brazil,
Int J Clin Pharm. 2014 Feb;36(1):45-54. doi: 10.1007/s11096-013-9833-5. Epub 2013 Aug 11.
Oral treatment in women with breast cancer has been increasingly used. However, a potentially negative side of oral medication is poor patient adherence and/or discontinuation, which reduces the treatment effectiveness, accelerating progression of the disease and reducing the patient survival rate.
To compare the rates of adherence and/or discontinuation and the methodologies used to assess these outcomes. It was conducted an integrative review of original articles published from 2000 to 2012, in which their primary outcome was to quantify medication adherence and/or discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer.
Original studies were searched in the PubMed/MEDLINE, Scopus, Embase and SciELO databases. The Medical Subject Heading was used to define descriptors. The descriptor "breast neoplasms" was used in all combinations. Each of the descriptors "medication adherence" and "patient compliance" were combined with each of the following descriptors "tamoxifen", "aromatase inhibitors", "selective estrogen receptor modulators", or the terms "letrozole", "anastrozole", and "exemestane".
Twenty-four original articles were included. Our study showed a wide range of adherence and discontinuation rates, ranging from 45-95.7 and 12-73 %, respectively. Regarding the methodological development of the selected articles, a high prevalence (87.5 %) of prospective and/or retrospective longitudinal studies was found. In addition, there was a high prevalence of studies using a database (70.8 %). Among some of the studies, it was shown that patient adherence to hormonal therapy gradually reduces, while discontinuation increases during the treatment.
It was observed a great diversity among rates of adherence and/or discontinuation of hormonal therapy for breast cancer, which may be due to a lack of methodology standardization. Therefore, adequate and validated methods to ensure reliability of the results and allow comparison in the literature are needed. Furthermore, adherence decreases and discontinuation increases over time, suggesting the need for patient continuous education and a pharmacotherapeutic follow up by health professionals to improve these clinical outcomes.
乳腺癌女性患者的口服治疗应用日益广泛。然而，口服药物潜在的一个负面问题是患者依从性差和/或停药，这会降低治疗效果，加速疾病进展并降低患者生存率。
比较依从率和/或停药率以及用于评估这些结果的方法。对2000年至2012年发表的原始文章进行了综合综述，这些文章的主要结果是量化激素受体阳性乳腺癌患者口服激素治疗的药物依从性和/或停药情况。
在PubMed/MEDLINE、Scopus、Embase和SciELO数据库中检索原始研究。使用医学主题词来定义描述符。“乳腺肿瘤”描述符用于所有组合。“药物依从性”和“患者依从性”描述符分别与以下描述符“他莫昔芬”“芳香酶抑制剂”“选择性雌激素受体调节剂”或术语“来曲唑”“阿那曲唑”和“依西美坦”中的每一个进行组合。
纳入了24篇原始文章。我们的研究显示依从率和停药率范围广泛，分别为45% - 95.7%和12% - 73%。关于所选文章的方法学发展，发现前瞻性和/或回顾性纵向研究的比例很高（87.5%）。此外，使用数据库的研究比例也很高（70.8%）。在一些研究中表明，患者对激素治疗的依从性在治疗期间逐渐降低，而停药率增加。
观察到乳腺癌激素治疗的依从率和/或停药率存在很大差异，这可能是由于缺乏方法学标准化。因此，需要适当且经过验证的方法来确保结果的可靠性并允许在文献中进行比较。此外，随着时间推移依从性降低而停药率增加，这表明需要对患者进行持续教育以及由健康专业人员进行药物治疗随访以改善这些临床结果。
