Llarena Natalia C, Estevez Samantha L, Tucker Susan L, Jeruss Jacqueline S
Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Natl Cancer Inst. 2015 Aug 25;107(10). doi: 10.1093/jnci/djv202. Print 2015 Oct.
Adjuvant tamoxifen reduces breast cancer recurrence risk and mortality; however, initiation and treatment persistence are poor for younger patients. We hypothesized that a unique set of factors, including fertility concerns, would contribute to the poor tamoxifen use among premenopausal patients.
From 2007 to 2012, 515 premenopausal patients younger than age 45 years, with stage 0 to III hormone receptor-positive breast cancer, for whom tamoxifen was recommended, were identified. Clinical and pathologic tumor characteristics, treatment regimens, and fertility concerns were recorded. Clinical factors associated with tamoxifen noninitiation and discontinuation were identified using univariate and multivariable analysis. After the recommendation for tamoxifen, patient reasons for tamoxifen noninitiation or discontinuation were also documented. All statistical tests were two-sided.
Based on multivariable analysis, fertility concerns were statistically associated with both noninitiation (odds ratio = 5.04, 95% confidence interval (CI) = 2.29 to 11.07) and early discontinuation (hazard ratio = 1.78, 95% CI = 1.09 to 3.38) of tamoxifen. Other independent predictors of noninitiation included a diagnosis of ductal carcinoma in situ, declining radiation, and not receiving chemotherapy (stage I-III). Additionally, smoking and not receiving radiation therapy were statistically significant predictors of early withdrawal from therapy. Primary patient reasons for noninitiation and early discontinuation included concerns about side effects and fertility.
This study provided insight into factors associated with tamoxifen use for reproductive-aged breast cancer survivors, with a new focus on fertility. Fertility concerns negatively impacted tamoxifen initiation and continuation among premenopausal patients. Interventions to optimize treatment initiation and persistence for young cancer patients should include access to fertility preservation options.
辅助性他莫昔芬可降低乳腺癌复发风险和死亡率；然而，年轻患者的起始治疗率和治疗依从性较差。我们推测，包括生育相关担忧在内的一系列独特因素，会导致绝经前患者他莫昔芬使用情况不佳。
2007年至2012年期间，共纳入515例年龄小于45岁、激素受体阳性的0至III期乳腺癌绝经前患者，这些患者均被建议使用他莫昔芬。记录临床和病理肿瘤特征、治疗方案以及生育相关担忧。采用单因素和多因素分析确定与未起始使用及停用他莫昔芬相关的临床因素。在建议使用他莫昔芬后，还记录了患者未起始使用或停用他莫昔芬的原因。所有统计检验均为双侧检验。
基于多因素分析，生育相关担忧在统计学上与未起始使用他莫昔芬（比值比=5.04，95%置信区间（CI）=2.29至11.07）和早期停药（风险比=1.78，95%CI=1.09至3.38）均相关。未起始使用他莫昔芬的其他独立预测因素包括原位导管癌诊断、放疗减少以及未接受化疗（I至III期）。此外，吸烟和未接受放疗在统计学上是早期停药的显著预测因素。未起始使用和早期停药的主要患者原因包括对副作用和生育的担忧。
本研究深入探讨了与生育年龄乳腺癌幸存者使用他莫昔芬相关的因素，特别关注了生育问题。生育相关担忧对绝经前患者他莫昔芬的起始使用和持续使用产生了负面影响。优化年轻癌症患者治疗起始率和依从性的干预措施应包括提供生育力保存选择。
