Lin Cheryl, Clark Rachel, Tu Pikuei, Bosworth Hayden B, Zullig Leah L
Policy and Organizational Management Program, Duke University, 2204 Erwin Road, Durham, NC, 27705, USA.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 W. Chapel Hill Street, Durham, NC, USA.
Breast Cancer Res Treat. 2017 Sep;165(2):247-260. doi: 10.1007/s10549-017-4317-2. Epub 2017 Jun 1.
In the past decade, there has been an increase in the development and use of oral anti-cancer medications (OAMs), especially for breast cancer-the most prevalent cancer in women. However, adherence rates for OAMs are often suboptimal, leading to lower survival rate, increased risk of recurrence, and higher healthcare costs. Our goal was to identify potentially modifiable psychosocial facilitators and barriers that may be targeted to increase OAM adherence for breast cancer patients.
We systematically searched PubMed for studies published in the U.S. by June 15, 2016 that addressed the following: (1) OAMs for breast cancer; (2) medication adherence; and (3) at least one psychosocial aspect of adherence.
Of the 1752 papers screened, 21 articles were included and analyzed. The most commonly reported motivators for adherence are patient-provider relationships (n = 11 studied, 82% reported significant association) and positive views and beliefs of medication (n = 9 studied, 89% reported significant association). We also identified consistent evidence of the impact of depression and emotions, perception of illness, concern of side effects, self-efficacy in medication management and decision making, knowledge of medication, and social support on OAM adherence.
Compared to traditional demographic, system, and clinical-related factors that have been well documented in the literature but are not easily changed, these cognitive, psychological, and interpersonal factors are more amendable via intervention and therefore could generate greater benefit in improving patient compliance and health outcomes. As OAMs shift treatment administration responsibility onto patients, continuous provider communication and education on illness and regimen are the keys to supporting patients' medication behavior.
在过去十年中，口服抗癌药物（OAMs）的研发和使用有所增加，尤其是用于治疗乳腺癌——女性中最常见的癌症。然而，OAMs的依从率往往不理想，导致生存率降低、复发风险增加以及医疗成本升高。我们的目标是确定可能可改变的心理社会促进因素和障碍，这些因素可作为提高乳腺癌患者OAM依从性的目标。
我们系统地检索了截至2016年6月15日在美国发表的、涉及以下内容的PubMed研究：（1）用于乳腺癌的OAMs；（2）药物依从性；（3）依从性的至少一个心理社会方面。
在筛选的1752篇论文中，纳入并分析了21篇文章。最常报告的依从动机是患者与提供者的关系（11项研究，82%报告有显著关联）以及对药物的积极看法和信念（9项研究，89%报告有显著关联）。我们还确定了抑郁和情绪、疾病认知、副作用担忧、药物管理和决策中的自我效能、药物知识以及社会支持对OAM依从性影响的一致证据。
与文献中已充分记录但不易改变的传统人口统计学、系统和临床相关因素相比，这些认知、心理和人际因素更易于通过干预进行调整，因此在改善患者依从性和健康结果方面可能产生更大的益处。由于OAMs将治疗管理责任转移到患者身上，提供者持续的沟通以及关于疾病和治疗方案的教育是支持患者用药行为的关键。
