Karavites Lindsey C, Kane Anna K, Zaveri Shruti, Xu Yanfei, Helenowski Irene, Hansen Nora, Bethke Kevin P, Rasmussen-Torvik Laura J, Khan Seema A
Department of Surgery, University of Illinois College of Medicine at Mt. Sinai Hospital, Chicago, Illinois.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Cancer Prev Res (Phila). 2017 Jul;10(7):389-397. doi: 10.1158/1940-6207.CAPR-17-0029. Epub 2017 May 30.
Tamoxifen and other endocrine agents have proven benefits for women with ductal carcinoma (DCIS), but low patient acceptance is widely reported. We examined factors associated with tamoxifen acceptance and adherence among DCIS patients who received a recommendation for therapy in a multidisciplinary setting. Using our institutional database, we identified women diagnosed with DCIS, 1998 to 2009, who were offered tamoxifen. We recorded data on demographics, tumor and therapy variables, tamoxifen acceptance, and adherence to therapy for ≥4 years. Univariable and multivariable analyses were conducted using logistic regression to identify factors specific to each group that were related to acceptance and adherence. A total of 555 eligible women identified, of whom 369 were offered tamoxifen; 298 (81%) accepted, among whom 214 (72%) were adherent, 59 of 298 (20%) were nonadherent, and for 25 (8%), adherence was undetermined. After stepwise elimination in adjusted logistic regression models, acceptance of breast radiotherapy was associated with acceptance of tamoxifen [OR, 2.22; 95% confidence interval (CI), 1.26-3.90; < 0.01], as was a medical oncology consultation (OR, 1.76; 95% CI, 0.99-3.15; = 0.05). Insured patients were more likely to adhere to tamoxifen (OR, 6.03; 95% CI, 2.60-13.98; < 0.01). The majority of nonadherent women ( = 38/56, 68%) discontinued the drug during the first year of treatment with 48 (86%) citing adverse effect(s) as the reason. In a multidisciplinary, tertiary care setting, we observed relatively high rates of acceptance and adherence of tamoxifen. Acceptance of tamoxifen and radiotherapy were associated, and adherence was influenced by insurance status. Tamoxifen acceptance and adherence following resection of DCIS of the breast is related to acceptance of radiotherapy and may be improved by confirmation of the recommendation by a medical oncologist. Despite the low cost of tamoxifen, adherence to therapy is significantly impacted by lack of insurance; those who discontinue therapy report adverse effects as a major reason. .
他莫昔芬及其他内分泌药物已被证实对患有导管原位癌（DCIS）的女性有益，但据广泛报道患者接受度较低。我们研究了在多学科环境中接受治疗建议的DCIS患者中与他莫昔芬接受度和依从性相关的因素。利用我们机构的数据库，我们确定了1998年至2009年期间被诊断为DCIS且被提供他莫昔芬的女性。我们记录了人口统计学、肿瘤和治疗变量、他莫昔芬接受度以及≥4年的治疗依从性数据。使用逻辑回归进行单变量和多变量分析，以确定与接受度和依从性相关的每组特定因素。共确定了555名符合条件的女性，其中369名被提供他莫昔芬；298名（81%）接受了，其中214名（72%）依从，298名中的59名（20%）不依从，25名（8%）的依从性未确定。在调整后的逻辑回归模型中逐步排除因素后，接受乳腺放疗与接受他莫昔芬相关[比值比（OR），2.22；95%置信区间（CI），1.26 - 3.90；P < 0.01]，医学肿瘤学咨询也是如此（OR，1.76；95% CI，0.99 - 3.15；P = 0.05）。参保患者更有可能坚持服用他莫昔芬（OR，6.03；95% CI，2.60 - 13.98；P < 0.01）。大多数不依从的女性（56名中的38名，68%）在治疗的第一年就停药了，48名（86%）将不良反应作为原因。在多学科的三级医疗环境中，我们观察到他莫昔芬的接受度和依从率相对较高。他莫昔芬的接受度与放疗相关，依从性受保险状况影响。乳腺DCIS切除术后他莫昔芬的接受度和依从性与放疗的接受度有关，医学肿瘤学家对建议的确认可能会提高接受度和依从性。尽管他莫昔芬成本较低，但缺乏保险会显著影响治疗依从性；那些停药的人将不良反应作为主要原因。
