Pinheiro Laura C, Wheeler Stephanie B, Reeder-Hayes Katherine E, Samuel Cleo A, Olshan Andrew F, Reeve Bryce B
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Oncol Pract. 2017 May;13(5):e463-e473. doi: 10.1200/JOP.2016.018630. Epub 2017 Mar 14.
Endocrine therapy (ET) underuse puts women at increased risk for breast cancer (BC) recurrence. Our objective was to determine if health-related quality of life (HRQOL) subgroups were associated with underuse.
Data came from the third phase of the Carolina Breast Cancer Study. We included 1,599 women with hormone receptor-positive BC age 20 to 74 years. HRQOL was measured, on average, 5 months postdiagnosis. Subgroups were derived using latent profile (LP) analysis. Underuse was defined as not initiating or adhering to ET by 36 months postdiagnosis. Multivariable logistic regression models estimated adjusted odds ratios (ORs) between HRQOL LPs and underuse. The best HRQOL LP was the reference. Chemotherapy- and race-stratified models were estimated, separately.
Initiation analyses included 953 women who had not begun ET by their 5-month survey. Of these, 154 never initiated ET. Adherence analyses included 1,114 ET initiators, of whom 211 were nonadherent. HRQOL was not significantly associated with noninitiation, except among nonchemotherapy users, with membership in the poorest LP associated with increased odds of noninitiation (adjusted OR, 5.5; 95% CI, 1.7 to 17.4). Membership in the poorest LPs was associated with nonadherence (LP1: adjusted OR, 2.2; 95% CI, 1.2 to 4.0 and LP2: adjusted OR,1.9; 95% CI, 1.1 to 3.6). Membership in the poorest LP was associated with nonadherence among nonchemotherapy users (adjusted OR, 2.1; 95% CI, 1.2 to 5.1).
Our results suggest women with poor HRQOL during active treatment may be at increased risk for ET underuse. Focusing on HRQOL, a modifiable factor, may improve targeting of future interventions early in the BC continuum to improve ET initiation and adherence and prevent BC recurrence.
内分泌治疗（ET）使用不足会使女性乳腺癌（BC）复发风险增加。我们的目标是确定健康相关生活质量（HRQOL）亚组是否与使用不足相关。
数据来自卡罗来纳乳腺癌研究的第三阶段。我们纳入了1599名年龄在20至74岁之间的激素受体阳性乳腺癌女性。HRQOL平均在确诊后5个月进行测量。亚组通过潜在类别（LP）分析得出。使用不足定义为确诊后36个月内未开始或未坚持内分泌治疗。多变量逻辑回归模型估计HRQOL潜在类别与使用不足之间的调整优势比（OR）。最佳的HRQOL潜在类别作为参照。分别估计了化疗和种族分层模型。
起始分析纳入了953名在5个月调查时未开始内分泌治疗的女性。其中，154人从未开始内分泌治疗。依从性分析纳入了1114名开始内分泌治疗的患者，其中211人未坚持治疗。HRQOL与未开始治疗无显著关联，但在未接受化疗的患者中除外，属于最差潜在类别的患者未开始治疗的几率增加（调整优势比，5.5；95%置信区间，1.7至17.4）。属于最差潜在类别与未坚持治疗相关（潜在类别1：调整优势比，2.2；95%置信区间，1.2至4.0；潜在类别2：调整优势比，1.9；95%置信区间，1.1至3.6）。属于最差潜在类别与未接受化疗患者的未坚持治疗相关（调整优势比，2.1；95%置信区间，1.2至5.1）。
我们的结果表明，在积极治疗期间HRQOL较差的女性内分泌治疗使用不足的风险可能增加。关注HRQOL这一可改变的因素，可能会改善乳腺癌连续过程中早期未来干预的针对性，以提高内分泌治疗的起始率和依从性，并预防乳腺癌复发。
