Hurtado-de-Mendoza Alejandra, Cabling Mark L, Lobo Tania, Dash Chiranjeev, Sheppard Vanessa B
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
Clin Breast Cancer. 2016 Aug;16(4):247-255.e3. doi: 10.1016/j.clbc.2016.03.006. Epub 2016 Mar 31.
Adjuvant hormone therapy contributes to reductions in recurrence and mortality for women with hormone receptor-positive breast cancer. However, adherence to hormone therapy is suboptimal. This is the first systematic literature review examining interventions aimed at improving hormone therapy adherence. Researchers followed the PRISMA guidelines. PubMed-Medline, CINAHL, PsychInfo, Ovid-Medline, and EMBASE were searched for behavioral interventions that aimed to enhance adherence to adjuvant hormone therapy in breast cancer survivors. A total of 376 articles were screened for eligibility. Five articles met the study criteria. All interventions presented adherence outcomes after 1-year follow-up. None significantly enhanced adherence compared to the usual care in the primary analysis (odds ratios ranged from 1.03 to 2.06 for adherence and from 1.11 to 1.18 for persistence). All studies targeted patients, and only 3 studies included postmenopausal breast cancer patients. Three tested the same intervention consisting of educational materials. Only one was conducted in the United States. Only one reported participants' ethnicity. Overall, it was unclear whether the studies contained bias. The use of different terminology and operationalization of adherence made comparisons challenging. Interventions to improve adherence to adjuvant hormone therapy in US breast cancer populations that include survivors who are ethnically diverse, premenopausal, and receiving tamoxifen therapy are necessary to inform future interventions. Adoption of consistent adherence definitions/measurements will provide a clearer framework to consolidate aggregate findings. Given the limited efficacy of tested interventions, it is important to engage oncologists and researchers to develop approaches that target different components associated with hormone therapy adherence, such as doctor-patient communication or social support.
辅助激素治疗有助于降低激素受体阳性乳腺癌女性的复发率和死亡率。然而，激素治疗的依从性并不理想。这是第一项系统的文献综述，研究旨在提高激素治疗依从性的干预措施。研究人员遵循PRISMA指南。在PubMed-Medline、CINAHL、PsychInfo、Ovid-Medline和EMBASE中搜索旨在提高乳腺癌幸存者辅助激素治疗依从性的行为干预措施。共筛选了376篇文章以确定其是否符合资格。五篇文章符合研究标准。所有干预措施在1年随访后均呈现了依从性结果。在初步分析中，与常规护理相比，没有一项干预措施能显著提高依从性（依从性的优势比范围为1.03至2.06，持续性的优势比范围为1.11至1.18）。所有研究都针对患者，只有3项研究纳入了绝经后乳腺癌患者。三项研究测试了相同的由教育材料组成的干预措施。只有一项研究在美国进行。只有一项研究报告了参与者的种族。总体而言，尚不清楚这些研究是否存在偏差。不同术语的使用和依从性的操作化使得比较具有挑战性。有必要在美国乳腺癌人群中开展干预措施，以提高辅助激素治疗的依从性，这些人群包括不同种族、绝经前且接受他莫昔芬治疗的幸存者，为未来的干预措施提供参考。采用一致的依从性定义/测量方法将提供一个更清晰的框架来整合总体研究结果。鉴于所测试干预措施的疗效有限，让肿瘤学家和研究人员参与制定针对与激素治疗依从性相关的不同因素（如医患沟通或社会支持）的方法非常重要。
