University of South Australia, Adelaide, SA
Flinders Medical Centre, Adelaide, SA.
Med J Aust. 2018 Jan 15;208(1):24-28. doi: 10.5694/mja17.00006.
To compare how frequently selected chronic diseases developed in women with breast cancer receiving endocrine therapy, and in women without cancer.
DESIGN, SETTING AND PARTICIPANTS: Retrospective, rolling cohort study, analysing a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for the period 1 January 2003 - 31 December 2014. Women with breast cancer who first commenced endocrine therapy between January 2004 and December 2011 were identified, and age- and sex-matched (1:10) by comorbidity with control groups of women who did not have a dispensing record for antineoplastic agents during the study period or the comorbidity of interest at baseline.
Development of any of eight pre-selected comorbidities, identified in PBS claims data with the RxRisk-V model.
Women with hormone-dependent breast cancer were significantly more likely than women in the control group to develop depression (overall hazard ratio [HR], 1.36; 95% CI, 1.26-1.46), pain or pain-inflammation (HR, 1.30; 95% CI, 1.23-1.38), osteoporosis (overall HR, 1.27; 95% CI, 1.17-1.39), diabetes (HR, 1.24; 95% CI, 1.10-1.41), cardiovascular disorders (overall HR, 1.22; 95% CI, 1.13-1.32), and gastric acid disorders (HR, 1.20; 95% CI, 1.13-1.28). The hazard ratios for developing cardiovascular disorders, depression and osteoporosis were highest during the first year of endocrine therapy. The risk of hyperlipidaemia was lower among women with breast cancer than in the control group (HR, 0.88; 95% CI, 0.81-0.96). There was no significant difference between the two groups in the risk of reactive airway diseases (HR, 1.05; 95% CI, 0.98-1.13).
Comorbid conditions are more likely to develop in women who have been diagnosed with hormone-dependent breast cancer than in women without cancer. Our results further support the need to develop appropriate models of care to manage the multiple chronic disorders of breast cancer survivors.
比较接受内分泌治疗的女性乳腺癌患者和无癌症女性中常见慢性疾病的发病频率。
设计、地点和参与者：回顾性滚动队列研究，分析了 2003 年 1 月 1 日至 2014 年 12 月 31 日期间 Pharmaceutic Benefits Scheme（PBS）数据的随机 10%样本。2004 年 1 月至 2011 年 12 月期间首次开始内分泌治疗的女性乳腺癌患者被确定，通过合并症与研究期间没有抗肿瘤药物配药记录或基线时具有合并症的对照组进行年龄和性别匹配（1:10）。
在 PBS 索赔数据中使用 RxRisk-V 模型识别的八种预先选定的合并症的发展。
与对照组相比，激素依赖性乳腺癌女性发生抑郁（总体危险比[HR]，1.36；95%置信区间[CI]，1.26-1.46）、疼痛或疼痛-炎症（HR，1.30；95%CI，1.23-1.38）、骨质疏松症（总体 HR，1.27；95%CI，1.17-1.39）、糖尿病（HR，1.24；95%CI，1.10-1.41）、心血管疾病（总体 HR，1.22；95%CI，1.13-1.32）和胃酸紊乱（HR，1.20；95%CI，1.13-1.28）的可能性显著更高。在内分泌治疗的第一年，发生心血管疾病、抑郁和骨质疏松症的危险比最高。与对照组相比，乳腺癌女性发生高脂血症的风险较低（HR，0.88；95%CI，0.81-0.96）。两组间发生反应性气道疾病的风险无显著差异（HR，1.05；95%CI，0.98-1.13）。
与无癌症女性相比，诊断为激素依赖性乳腺癌的女性更有可能出现合并症。我们的研究结果进一步支持需要制定适当的护理模式来管理乳腺癌幸存者的多种慢性疾病。
