Brito Claudia, Portela Margareth Crisóstomo, de Vasconcellos Mauricio Teixeira Leite
Department of Health Administration and Planning of National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Av, Leopoldo Bulhões, 1480/ Sala 717 -Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
BMC Cancer. 2014 Jun 3;14:397. doi: 10.1186/1471-2407-14-397.
BACKGROUND: Despite the excellent results obtained with hormone therapy, the long treatment period and the side effects associated with its use make patient adherence difficult. Moreover, certain aspects of health care can mitigate or exacerbate non-adherence. This study aimed to identify the factors associated with adherence to hormone therapy for breast cancer, with the goal of contributing to the reformulation of the care process and to improvements in outcomes. METHOD: This was a retrospective longitudinal study based on secondary data. The study integrated and analyzed data from a cohort of 5,861 women with breast cancer who were identified in the databases of the Brazilian National Cancer Institute [Instituto Nacional de Câncer - INCA] and the Unified Health System [Sistema Único de Saúde - SUS]. All of the patients were treated at INCA, which dispenses free medication, and the follow-up period lasted from 01/01/2004 to 10/29/2010. The outcome of interest was hormone treatment adherence, which was defined as the possession of medication, and a logistic regression model was employed to identify the socio-demographic, behavioral, clinical, and health care variables that were independently associated with the variations in this outcome. RESULTS: The proportion of women who adhered to hormone therapy was 76.3%. The likelihood of adherence to hormone therapy increased with each additional year of age, as well as among women with a secondary or higher level education, those with a partner, those who underwent surgery, those who had more consultations with a breast specialist and clinical oncologist, and those who underwent psychotherapy; the effect for the latter increased with each additional consultation. Conversely, the likelihood of adherence was lower among patients at a non-curable stage, those who were alcohol drinkers, those who received chemotherapy, those who had undergone more tests and had more hospitalizations, and those who used tamoxifen and combined aromatase inhibitors. CONCLUSION: This study shows that approximately a quarter of the women with breast cancer did not adhere to hormone treatment, thus risking clinical responses below the expected standards. It also identifies the most vulnerable subgroups in the treatment process and the aspects of care that provide better results.
背景：尽管激素疗法取得了优异的疗效，但治疗周期长以及使用该疗法所带来的副作用使得患者难以坚持治疗。此外，医疗保健的某些方面可能会减轻或加剧不依从性。本研究旨在确定与乳腺癌激素治疗依从性相关的因素，以期为优化护理流程和改善治疗效果提供帮助。 方法：这是一项基于二手数据的回顾性纵向研究。该研究整合并分析了巴西国家癌症研究所[Instituto Nacional de Câncer - INCA]和统一卫生系统[Sistema Único de Saúde - SUS]数据库中5861名乳腺癌女性患者的数据。所有患者均在免费提供药物的INCA接受治疗，随访期从2004年1月1日至2010年10月29日。感兴趣的结局是激素治疗依从性，其定义为拥有药物，并采用逻辑回归模型来确定与该结局变化独立相关的社会人口统计学、行为、临床和医疗保健变量。 结果：坚持激素治疗的女性比例为76.3%。激素治疗的依从可能性随着年龄每增加一岁而增加，在具有高中及以上学历的女性、有伴侣的女性、接受手术的女性、与乳腺专科医生和临床肿瘤学家会诊次数更多的女性以及接受心理治疗的女性中也是如此；后者的效果随着每次额外会诊而增加。相反，在不可治愈阶段的患者、饮酒者、接受化疗的患者、接受更多检查和住院次数更多的患者以及使用他莫昔芬和联合芳香化酶抑制剂的患者中，依从可能性较低。 结论：本研究表明，约四分之一的乳腺癌女性未坚持激素治疗，从而有临床反应低于预期标准的风险。它还确定了治疗过程中最脆弱的亚组以及能带来更好效果的护理方面。
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