Neugut Alfred I, Hillyer Grace Clarke, Kushi Lawrence H, Lamerato Lois, Buono Donna L, Nathanson S David, Bovbjerg Dana H, Mandelblatt Jeanne S, Tsai Wei-Yann, Jacobson Judith S, Hershman Dawn L
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Breast Cancer Res Treat. 2016 Jul;158(1):127-138. doi: 10.1007/s10549-016-3855-3. Epub 2016 Jun 10.
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006-2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32-5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998-3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.
对于许多非转移性乳腺癌女性患者而言，辅助化疗可预防复发并延长生存期。过早中断化疗的女性患者可能会减少这些益处，但对于预测早期中断化疗的因素却知之甚少。我们旨在前瞻性地确定乳腺癌女性患者辅助化疗早期中断的发生率及原因。我们在美国的三个医疗保健机构中开展了一项前瞻性队列研究。在2006年至2010年间新诊断出的1158例非转移性乳腺癌女性患者中，我们分析了445例（38.4%）按照公认指南开始接受标准辅助化疗的患者。我们在基线时以及治疗期间对患者进行了两次访谈，询问其社会人口统计学/心理社会因素及治疗决策情况，并收集了临床数据。根据她们开始的化疗方案所需的周期数对患者进行分类。观察结果为早期中断化疗（<计划周期数的80%）。在分析的患者中，392例（88.1%）完成了规定的治疗。最强的预测因素是接受需要>4个周期治疗的方案（较长方案为18.1%，4个周期方案为7.4%）（比值比[OR]为2.59，95%置信区间为1.32 - 5.08），同时对种族、年龄、分期、激素受体状态、社会支持、乐观情绪、精神信仰、压力和身体症状进行了控制。纪念症状评估量表上较高水平的心理症状也增加了早期中断化疗的几率（OR为1.92，95%置信区间为0.998 - 3.68）。大多数开始接受乳腺癌辅助化疗的患者完成了规定的方案，但早期中断化疗与较长的方案相关，并且对于有心理副作用的患者具有边缘统计学意义。
