Benedict Catherine, Thom Bridgette, Teplinsky Eleonora, Carleton Jane, Kelvin Joanne F
Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY.
Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY.
Clin Breast Cancer. 2017 Jun;17(3):165-170. doi: 10.1016/j.clbc.2016.12.002. Epub 2016 Dec 24.
Adherence to endocrine therapy (ET) is a longstanding problem in breast cancer (BC) survivorship care, particularly among younger women. Younger patients have reported lower ET initiation rates and greater rates of early discontinuation and are considered an "at risk" group for nonadherence. For women who hope to have children in the future, concerns about premature menopause and the implications of postponing childbearing for the 5 to 10 years of ET are widespread. Preliminary evidence suggests that prioritizing fertility, along with concerns about side effects, leads to ET noninitiation and early discontinuation. Clinical efforts to improve adherence might need to consider patients' family-building goals during the course of treatment and to appropriately counsel patients according to their priorities and family-building intentions. Educational materials about family building after cancer are still not consistently available or provided. Helping patients to access trusted informational resources and decision support tools, in conjunction with medical counseling, will promote informed decisions regarding ET adherence and pregnancy that are medically appropriate. Such shared patient-provider decision-making about ET adherence and pregnancy could help to maximize patient autonomy by incorporating their values, preferences, and priorities into decisions, using providers' medical expertise.
坚持内分泌治疗（ET）是乳腺癌（BC）生存护理中长期存在的问题，在年轻女性中尤为突出。据报道，年轻患者的ET起始率较低，早期停药率较高，被视为不坚持治疗的“风险”群体。对于希望未来生育的女性来说，对过早绝经以及因ET治疗5至10年而推迟生育的影响的担忧很普遍。初步证据表明，对生育的优先考虑以及对副作用的担忧导致ET未起始和早期停药。改善依从性的临床努力可能需要在治疗过程中考虑患者的生育目标，并根据患者的优先事项和生育意图进行适当的咨询。关于癌症后生育的教育材料仍然没有持续提供或随时可得。帮助患者获取可靠的信息资源和决策支持工具，并结合医疗咨询，将促进关于ET依从性和妊娠的明智决策，这些决策在医学上是合适的。这种关于ET依从性和妊娠的医患共同决策可以通过将患者的价值观、偏好和优先事项纳入决策，利用医生的医学专业知识，帮助最大限度地提高患者的自主权。
