Andersen Lærke Toftegård, Suppli Nis Palm, Dalton Susanne Oksbjerg, Kroman Niels, Rosenberg Jacob, Gögenur Ismail
Herlev Hospital, University of Copenhagen, Department of Surgery , Herlev , Denmark.
Acta Oncol. 2015 May;54(5):704-11. doi: 10.3109/0284186X.2014.998276. Epub 2015 Mar 9.
To determine use and investigate factors associated with use of hypnotics the first year after a diagnosis with breast cancer.
A retrospective registry based cohort study linking clinical data from the Danish Breast Cancer Group with the National Prescription Drug Database and other health and administrative registries. We included 26 082 women diagnosed with early breast cancer as first time primary cancer during 1996-2006. Use of hypnotics was measured as redeemed prescriptions in the first year after diagnosis of early breast cancer. Prior use of hypnotics was defined as one or more prescriptions of hypnotics 13 months to 1 month before diagnosis, and chronic use was defined as four or more prescriptions. Hazard ratios (HRs) for clinical variables, treatment-related factors and sociodemographic factors were calculated.
Among women with no prior history of hypnotic use, 17% became new users with 4% on a chronic level. Among prior users, 82% continued their use with one or more prescriptions of hypnotics and 15% increased their use to a chronic level. Significantly increased hazard ratios for use of hypnotics were seen with increasing age [age 50-59 years: HR 1.43 (95% CI 1.31-1.57), age 60-69: HR 1.57 (95% CI 1.44-1.71)], increasing number of tumor positive lymph nodes [1-3 lymph nodes: HR 1.12 (95% CI 1.05-1.09), 4-9 lymph nodes: HR 1.11 (95% CI 1.02-1.29)], chemotherapy [HR 1.25 (95% CI 1.12-1.39)], somatic comorbidity [HR 1.31 (95% CI 1.21-1.42)] and use of antidepressants the year before breast cancer diagnosis [HR 1.97 (95% CI 1.85-2.10)].
This study detected a group of patients at great risk for initiating and increasing use of hypnotics and preventive and prophylactic mechanism should be investigated and initiated when this group of patients is seen in the clinical setting.
确定乳腺癌诊断后第一年催眠药的使用情况，并调查与催眠药使用相关的因素。
一项基于回顾性登记的队列研究，将丹麦乳腺癌组的临床数据与国家处方药数据库以及其他健康和行政登记处相联系。我们纳入了1996年至2006年期间首次诊断为早期乳腺癌的26082名女性，她们被诊断为首次原发性癌症。催眠药的使用以早期乳腺癌诊断后第一年的处方配药来衡量。催眠药的既往使用定义为诊断前13个月至1个月有一张或多张催眠药处方，长期使用定义为四张或更多处方。计算临床变量、治疗相关因素和社会人口学因素的风险比（HR）。
在既往无催眠药使用史的女性中，17%成为新使用者，4%为长期使用者。在既往使用者中，82%继续使用一张或多张催眠药处方，15%增加使用量至长期使用水平。随着年龄增长（50 - 59岁：HR 1.43（95%CI 1.31 - 1.57），60 - 69岁：HR 1.57（95%CI 1.44 - 1.71））、肿瘤阳性淋巴结数量增加（1 - 3个淋巴结：HR 1.12（95%CI 1.05 - 1.09），4 - 9个淋巴结：HR 1.11（95%CI 1.02 - 1.29））、化疗（HR 1.25（95%CI 1.12 - 1.39））以及乳腺癌诊断前一年使用抗抑郁药（HR 1.97（95%CI 1.85 - 2.10）），催眠药使用的风险比显著增加。
本研究发现了一组有开始和增加使用催眠药高风险的患者，在临床环境中见到这组患者时，应调查并启动预防和预防性机制。
