Brett J, Fenlon D, Boulton M, Hulbert-Williams N J, Walter F M, Donnelly P, Lavery B, Morgan A, Morris C, Watson E
Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
Faculty of Health Sciences, University of Southampton, Southampton, UK.
Eur J Cancer Care (Engl). 2018 Jan;27(1). doi: 10.1111/ecc.12601. Epub 2016 Nov 30.
Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be suboptimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were the presence of side effects (p < .03), greater concerns about AET (p < .001) and a lower perceived necessity to take AET (p < .001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were younger age (<65) (p < .001), post-secondary education (p = .046) and paid employment (p = .031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions.
尽管辅助内分泌治疗（AET）在降低乳腺癌复发率和死亡率方面具有显著疗效，但已知其依从性并不理想。本研究旨在调查与不依从相关的因素，并为制定支持女性并促进依从性的干预措施提供依据。一项关于测量依从水平、经历的副作用、对药物的信念、获得的支持以及社会人口学细节的问卷调查被发送给292名乳腺癌诊断后2至4年的女性。探讨了AET不依从者和依从者之间的差异，并报告了与故意和非故意不依从相关的因素。大约四分之一的受访者，即46人（22%），为不依从者，其中包括29名（14%）故意不依从者和17名（8%）非故意不依从者。与故意不依从显著相关的因素包括存在副作用（p < 0.03）、对AET的担忧更大（p < 0.001）以及认为服用AET的必要性较低（p < 0.001）。一半的样本（105/211）报告称副作用对其生活质量有中度或高度影响。与非故意不依从相关的因素包括年龄较轻（<65岁）（p < 0.001）、接受过高等教育（p = 0.046）和有带薪工作（p = 0.031）。故意不依从和非故意不依从之间存在明显差异。区分这两种不依从类型可能有助于定制支持和建议干预措施。
