Kemp Anna, Preen David B, Saunders Christobel, Boyle Frances, Bulsara Max, Malacova Eva, Roughead Elizabeth E
Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia.
School of Surgery, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia.
Springerplus. 2014 Jun 4;3:282. doi: 10.1186/2193-1801-3-282. eCollection 2014.
Despite evidence supporting at least five years of endocrine therapy for early breast cancer, many women discontinue therapy early. We investigated the impact of initial therapy type and specific comorbidities on discontinuation of endocrine therapy in clinical practice.
We identified women in a population-based cohort with a diagnosis of early breast cancer and an incident dispensing of anastrozole, letrozole or tamoxifen from 2003-2008 (N = 1531). Pharmacy and health service data were used to determine therapy duration, treatment for pre-existing and post-initiation comorbidities (anxiety, depression, hot flashes, musculoskeletal pain, osteoporosis, vaginal atrophy), demographic and other clinical characteristics. Time to discontinuation of initial, and any, endocrine therapy was calculated. Cox regression determined the association of different characteristics on early discontinuation.
Initial endocrine therapy continued for a median of 2.2 years and any endocrine therapy for 4.8 years. Cumulative probability of discontinuing any therapy was 17% after one year and 58% by five years. Initial tamoxifen, pre-existing musculoskeletal pain and newly-treated anxiety predicted shorter initial therapy but not discontinuation of any therapy. Early discontinuation of any therapy was associated with newly-treated hot flashes (HR = 2.1, 95% CI = 1.3-3.3), not undergoing chemotherapy (HR = 1.4, 95% CI = 1.1-1.8) and not undergoing mastectomy (HR = 1.5, 95% CI = 1.2-1.8).
Less than half of women completed five years of endocrine therapy. Women at greatest risk of stopping any therapy early were those with newly-treated hot flashes, no initial chemotherapy, or no initial mastectomy. This suboptimal use means that the reductions in recurrence demonstrated in clinical trials may not be realised in practice.
尽管有证据支持对早期乳腺癌进行至少五年的内分泌治疗，但许多女性过早停止治疗。我们在临床实践中研究了初始治疗类型和特定合并症对内分泌治疗中断的影响。
我们在一个基于人群的队列中识别出2003年至2008年诊断为早期乳腺癌并首次配用阿那曲唑、来曲唑或他莫昔芬的女性（N = 1531）。利用药房和卫生服务数据确定治疗持续时间、对起始前和起始后合并症（焦虑、抑郁、潮热、肌肉骨骼疼痛、骨质疏松症、阴道萎缩）的治疗、人口统计学和其他临床特征。计算初始内分泌治疗和任何内分泌治疗的中断时间。Cox回归确定不同特征与早期中断之间的关联。
初始内分泌治疗的中位持续时间为2.2年，任何内分泌治疗的中位持续时间为4.8年。停止任何治疗的累积概率在1年后为17%，在5年后为58%。初始使用他莫昔芬、起始前存在肌肉骨骼疼痛和新治疗的焦虑预示初始治疗时间较短，但不是任何治疗的中断。任何治疗的早期中断与新治疗的潮热（HR = 2.1，95%CI = 1.3 - 3.3）、未接受化疗（HR = 1.4，95%CI = 1.1 - 1.8）和未接受乳房切除术（HR = 1.5，95%CI = 1.2 - 1.8）相关。
不到一半的女性完成了五年的内分泌治疗。早期停止任何治疗风险最高的女性是那些有新治疗的潮热、未进行初始化疗或未进行初始乳房切除术的女性。这种未达最佳标准的使用意味着临床试验中显示的复发率降低在实践中可能无法实现。
