接受乳腺癌内分泌治疗的女性的症状及症状归因
Symptoms and Symptom Attribution Among Women on Endocrine Therapy for Breast Cancer.
作者信息
Rosenberg Shoshana M, Stanton Annette L, Petrie Keith J, Partridge Ann H
机构信息
Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA; Jonsson Comprehensive Cancer Center and Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA; Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA; Jonsson Comprehensive Cancer Center and Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA; Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
出版信息
Oncologist. 2015 Jun;20(6):598-604. doi: 10.1634/theoncologist.2015-0007. Epub 2015 May 1.
BACKGROUND
Adherence to adjuvant endocrine therapy (ET) influences breast cancer survival. Because ET side effects are frequently cited as reasons for nonadherence, understanding how perceptions and motivations in relation to ET are associated with symptom attribution can help promote timely symptom management.
MATERIALS AND METHODS
Participants were 2,086 breast cancer survivors recruited through the Army of Women registry who were current tamoxifen or aromatase inhibitor (AI) users. Participants reported whether they were bothered by each of 47 symptoms during the past month and whether they thought each symptom was related to taking ET. Frequencies of overall symptoms and symptoms attributed and misattributed to ET were calculated, and linear regression was used to assess sociodemographics, emotions, and illness perceptions as predictors of symptoms attributed to ET.
RESULTS
Women attributed a mean of 8.9 symptoms and misattributed a mean of 1.5 symptoms to ET. In the multivariable analysis, younger age, a more recent diagnosis, AI use (vs. tamoxifen), anxiety, depressive symptoms, more ET-related negative emotions, more concern about long-term ET use, and greater perceived ET necessity were independently associated with attribution of more symptoms to ET. More perceived ET necessity was associated with correctly attributing symptoms to ET, whereas higher depressive symptoms and more concern about ET use were associated with misattribution of symptoms to ET.
CONCLUSION
Given that many women perceive a range of symptoms as a consequence of ET, attention to these symptoms may reduce symptom burden and improve quality of life, potentially improving ET adherence and optimizing survival.
IMPLICATIONS FOR PRACTICE
Many breast cancer survivors on endocrine therapy (ET) experience a range of side effects while taking ET. Targeting potentially modifiable factors associated with attributing a greater number of symptoms to ET, including perceived need for ET, concerns about long-term ET use, negative emotions toward ET, and symptoms of anxiety and depression, may reduce symptom burden and improve quality of life.
背景
辅助内分泌治疗（ET）的依从性会影响乳腺癌患者的生存情况。由于ET的副作用常被视为不依从的原因，了解与ET相关的认知和动机如何与症状归因相关联，有助于促进及时的症状管理。
材料与方法
研究对象为通过“女性大军”登记处招募的2086名乳腺癌幸存者，她们正在服用他莫昔芬或芳香化酶抑制剂（AI）。参与者报告过去一个月中是否受到47种症状中每种症状的困扰，以及他们是否认为每种症状与服用ET有关。计算总体症状以及归因于和错误归因于ET的症状的频率，并使用线性回归评估社会人口统计学、情绪和疾病认知作为归因于ET的症状的预测因素。
结果
女性平均将8.9种症状归因于ET，平均将1.5种症状错误归因于ET。在多变量分析中，年龄较小、诊断时间较近、使用AI（相对于他莫昔芬）、焦虑、抑郁症状、更多与ET相关的负面情绪、对长期使用ET的更多担忧以及更高的ET必要性认知，均与更多症状归因于ET独立相关。更高的ET必要性认知与正确将症状归因于ET相关，而更高的抑郁症状和对ET使用的更多担忧与将症状错误归因于ET相关。
结论
鉴于许多女性将一系列症状视为ET的结果，关注这些症状可能减轻症状负担并改善生活质量，从而可能提高ET的依从性并优化生存情况。
对实践的启示
许多接受内分泌治疗（ET）的乳腺癌幸存者在服用ET时会经历一系列副作用。针对与更多症状归因于ET相关的潜在可改变因素，包括对ET的感知需求、对长期使用ET的担忧、对ET的负面情绪以及焦虑和抑郁症状，可能减轻症状负担并改善生活质量。
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