Kuba Sayaka, Ishida Mayumi, Nakamura Yoshiaki, Taguchi Kenichi, Ohno Shinji
Department of Breast Oncology, National Hospital Organization, Kyushu Cancer Center, Kyushu, Japan.
Department of Surgery, Nagasaki University, 1-7-1 Sakamoto-machi, Nagasaki, Nagasaki, 852-8501, Japan.
Breast Cancer. 2016 Jan;23(1):128-133. doi: 10.1007/s12282-014-0540-4. Epub 2014 Jun 17.
Although 8-73 % of breast cancer patients who receive adjuvant endocrine therapy discontinue it, discontinuation is little studied in Asian breast cancer patients.
To determine frequency and reasons for discontinuation at a single institution, we reviewed records and database information for women with hormone receptor-positive breast cancer who were treated at the National Kyushu Cancer Center 2001-2006, defining "persistence" as continued endocrine treatment (even when physicians decided to stop because of recurrent disease or severe adverse effects), and "discontinuation" as ending therapy due to patient's wishes.
Among 686 patients who started adjuvant endocrine therapy, 607 patients (88 %) persisted, 79 patients (12 %) discontinued. Of the 79 patients who discontinued, 37 (46 %) did so because of side effects, 26 (33 %) stopped appointments, 11 (14 %) stopped for "no particular reason", 4 (5 %) to get pregnant, and 1 (1 %) for economic reasons. The rate of persistence was higher in patients with lymph node involvement than in those without lymph node involvement (92 vs. 87 %; P = 0.03).
Clinicians should discuss side effects with patients, both as part of informed consent and to prepare them to continue therapy, and should be aware that over time, patients' reasons for discontinuation change.
尽管接受辅助内分泌治疗的乳腺癌患者中有8%-73%会中断治疗，但在亚洲乳腺癌患者中，中断治疗的情况鲜有研究。
为确定单一机构中治疗中断的频率及原因，我们回顾了2001年至2006年在国立九州癌症中心接受治疗的激素受体阳性乳腺癌女性患者的病历和数据库信息，将“持续治疗”定义为持续进行内分泌治疗（即使医生因疾病复发或严重不良反应而决定停药），将“中断治疗”定义为因患者意愿而结束治疗。
在开始辅助内分泌治疗的686例患者中，607例（88%）持续治疗，79例（12%）中断治疗。在79例中断治疗的患者中，37例（46%）因副作用中断，26例（33%）停止就诊，11例（14%）“无特殊原因”停药，4例（5%）为怀孕停药，1例（1%）因经济原因停药。有淋巴结转移的患者持续治疗率高于无淋巴结转移的患者（92%对87%；P=0.03）。
临床医生应与患者讨论副作用，这既是知情同意的一部分，也是为让患者做好继续治疗的准备，同时应意识到随着时间推移，患者中断治疗的原因会发生变化。
