Hershman Dawn L, Kushi Lawrence H, Hillyer Grace Clarke, Coromilas Ellie, Buono Donna, Lamerato Lois, Bovbjerg Dana H, Mandelblatt Jeanne S, Tsai Wei-Yann, Zhong Xiaobo, Jacobson Judith S, Wright Jason D, Neugut Alfred I
Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Breast Cancer Res Treat. 2016 May;157(1):133-43. doi: 10.1007/s10549-016-3788-x. Epub 2016 Apr 16.
Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90 days gap). Serial interviews were conducted at baseline and every 6 months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18 %) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4 %), stage 1 (60.6 %), and on an aromatase inhibitor (68.1 %). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95 % CI 0.23-0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (p < 0.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.
乳腺癌辅助内分泌治疗（ET）的不依从现象很常见。我们的目标是确定心理社会因素与内分泌治疗中断之间的关联。我们招募了2006年至2010年期间在综合医疗保健系统中接受治疗的乳腺癌女性患者。利用接受内分泌治疗患者的一个子集，我们根据药房记录（间隔≥90天）调查了与内分泌治疗中断（停药）相关的因素。在基线时以及每6个月进行一次系列访谈。对癌症治疗功能评估（FACT）、医疗结果调查、治疗满意度问卷（TSQM）、事件影响量表（IES）、人际关怀过程测量以及决策信念和担忧进行了评估。多变量模型评估了与治疗中断相关的因素。在我们最终队列中开始接受内分泌治疗并随后进行评估的523名女性中，94名（18%）在2年随访期间治疗中断。该队列主要为白人（74.4%）、1期（60.6%），且正在使用芳香化酶抑制剂（68.1%）。收入最高类别的女性治疗中断的几率较低（比值比0.43，95%置信区间0.23 - 0.81）。基线时的生活质量和对内分泌治疗的态度与治疗中断相关。在随访时，FACT、TSQM和IES与治疗中断相关（p < 0.001）。大多数女性继续接受内分泌治疗。对内分泌治疗态度更好、生活质量更高且治疗满意度更高的女性治疗中断的可能性较小，而报告有侵入性/回避性想法的女性治疗中断的可能性更大。应评估旨在改善患者心理社会福祉的干预措施，以提高依从性。
