Kidwell Kelley M, Harte Steven E, Hayes Daniel F, Storniolo Anna Maria, Carpenter Janet, Flockhart David A, Stearns Vered, Clauw Daniel J, Williams David A, Henry N Lynn
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Cancer. 2014 Aug 15;120(16):2403-11. doi: 10.1002/cncr.28756. Epub 2014 May 6.
Aromatase inhibitor (AI) therapy results in substantial survival benefits for patients with hormone receptor-positive breast cancer. The rates of poor adherence and discontinuation of AI therapy are high, primarily because of treatment-related toxicities like musculoskeletal pain. Although pain-related symptoms may worsen during AI therapy, the authors hypothesized that nonpersistence with AI therapy was associated with symptoms that were present before treatment initiation.
Postmenopausal women initiating AI therapy who were enrolled in a prospective clinical trial completed questionnaires at baseline to assess sleep, fatigue, mood, and pain. Reasons for treatment discontinuation during the first year of treatment were recorded. Associations between baseline patient-reported symptoms and treatment discontinuation because of toxicity were identified using logistic regression.
Four hundred forty-nine patients were evaluable. The odds of treatment discontinuation were higher in patients who reported a greater number of symptoms before AI initiation. Baseline poor sleep quality was associated with early treatment discontinuation, with an odds ratio (OR) of 1.91 (95% confidence interval [CI], 1.26-2.89; P = .002). Baseline presence of tired feeling and forgetfulness had similar ORs for discontinuation (tired feeling: OR, 1.76; 95% CI, 1.15-2.67; P = .009; forgetfulness: OR, 1.66; 95% CI, 1.11-2.48; P = .015). An increasing total number of baseline symptoms was associated with an increased likelihood of treatment discontinuation, with an OR of 1.89 (95% CI, 1.20-2.96; P = .006) for 3 to 5 symptoms versus 0 to 2 symptoms.
Symptom clusters in breast cancer survivors that are present before the initiation of adjuvant AI therapy may have a negative impact on a patient's persistence with therapy. Interventions to manage these symptoms may improve breast cancer outcomes and quality of life.
芳香化酶抑制剂（AI）疗法能为激素受体阳性乳腺癌患者带来显著的生存益处。AI疗法的依从性差和停药率很高，主要是因为存在肌肉骨骼疼痛等与治疗相关的毒性反应。尽管在AI治疗期间疼痛相关症状可能会加重，但作者推测，AI治疗的不持续性与治疗开始前就已存在的症状有关。
参加一项前瞻性临床试验的开始AI治疗的绝经后女性在基线时完成问卷，以评估睡眠、疲劳、情绪和疼痛情况。记录治疗第一年期间停药的原因。使用逻辑回归分析确定基线时患者报告的症状与因毒性反应停药之间的关联。
449例患者可进行评估。在AI治疗开始前报告症状较多的患者停药几率更高。基线时睡眠质量差与早期停药有关，比值比（OR）为1.91（95%置信区间[CI]，1.26 - 2.89；P = 0.002）。基线时存在疲劳感和健忘的停药OR值相似（疲劳感：OR，1.76；95% CI，1.15 - 2.67；P = 0.009；健忘：OR，1.66；95% CI，1.11 - 2.48；P = 0.015）。基线症状总数增加与停药可能性增加相关，3至5个症状组与0至2个症状组相比，OR为1.89（95% CI，1.20 - 2.96；P = 0.006）。
辅助性AI治疗开始前乳腺癌幸存者中存在的症状群可能会对患者坚持治疗产生负面影响。管理这些症状的干预措施可能会改善乳腺癌治疗效果和生活质量。
