Chabrier Michaël, Bezy Olivier, Mouret Marie-Ange, Bay Jacques-Olivier, Jalenques Isabelle
CHU de Clermont-Ferrand Gabriel-Montpied, Service de psychiatrie d'adultes A et psychologie médicale, Équipe mobile psycho-oncologie, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
Bull Cancer. 2013 Oct;100(10):1017-22. doi: 10.1684/bdc.2013.1824.
The improper adherence to therapy is an emerging medical and economic issue in oncology which raised with the increasing use of oral anti-cancer treatment. Currently, the average rate of non-adherence to oral anti-cancer therapy is estimated at around 21%. In this study, we use the examples of the imatinib treatment against chronic lymphocytic leukemia and the tamoxifene treatment against breast cancer to assess the negative consequences of the non-adherence to therapy in terms of medical outcome and health care cost. One of the main causes of non-adherence to these oral cancer treatments is depression. Surprisingly, this aspect is still relatively unknown to oncologists, while depression has been taken into account for the treatment of other chronic diseases (e.g. diabetes…). We therefore propose that cancer patients should be screened for depression throughout their treatment to improve the adherence to therapy. Cancer patients should have the opportunity to explain their own perception of their disease and their treatment that are key parameters in the onset of depression. The recent use of oral therapy in cancer treatment should thus be accompanied by the establishment of a global management of cancer patient on a case-by-case basis.
治疗依从性不佳是肿瘤学领域一个新出现的医学和经济问题，随着口服抗癌治疗的使用增加而产生。目前，口服抗癌治疗的平均不依从率估计约为21%。在本研究中，我们以伊马替尼治疗慢性淋巴细胞白血病和他莫昔芬治疗乳腺癌为例，评估治疗不依从在医学结果和医疗保健成本方面的负面后果。这些口服癌症治疗不依从的主要原因之一是抑郁症。令人惊讶的是，肿瘤学家对这方面仍然相对不了解，而抑郁症在其他慢性病（如糖尿病……）的治疗中已被考虑在内。因此，我们建议在癌症患者的整个治疗过程中对其进行抑郁症筛查，以提高治疗依从性。癌症患者应有机会解释他们对自己疾病和治疗的看法，这些是抑郁症发病的关键因素。因此，在癌症治疗中最近使用口服疗法时，应建立针对癌症患者的逐案整体管理。
