Ng Huah Shin, Koczwara Bogda, Roder David, Niyonsenga Theo, Vitry Agnes
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.
J Comorb. 2018 Mar 23;8(1):16-24. doi: 10.15256/joc.2018.8.125. eCollection 2018.
The development of comorbidities has become increasingly relevant with longer-term cancer survival.
To assess the pattern of comorbidities among Australian women with breast cancer treated with tamoxifen or an aromatase inhibitor.
Retrospective cohort study using Pharmaceutical Benefits Scheme (PBS) data (10% sample) from January 2003 to December 2014. Dispensing claims data were used to identify comorbidities and classified with the Rx-Risk-V model. The breast cancer cohort had tamoxifen or an aromatase inhibitor dispensed between 2004 and 2011 with no switching between types of endocrine therapy. Comparisons were made between the breast cancer cohort and specific control groups (age- and sex-matched at 1:10 ratio without any dispensing of anti-neoplastic agents during the study period) for the development of five individual comorbidities over time using Cox regression models.
Women treated with tamoxifen had a higher incidence of cardiovascular conditions, diabetes, and pain or pain-inflammation, but a lower incidence of hyperlipidaemia compared with non-cancer control groups, as indicated by PBS data. Women treated with aromatase inhibitors were more likely to develop cardiovascular conditions, osteoporosis, and pain or pain-inflammation compared with non-cancer control groups. The risks of hyperlipidaemia and osteoporosis were significantly lower among tamoxifen users compared with aromatase inhibitor users.
Women with hormone-dependent breast cancer treated with an endocrine therapy had a higher risk of developing specified comorbid conditions than women without cancer, with different comorbidity profiles for those on tamoxifen versus aromatase inhibitors. Further research into the causes and mechanism of development and management of comorbidities after cancer is needed.
随着癌症患者长期生存率的提高，合并症的发生变得越来越重要。
评估接受他莫昔芬或芳香化酶抑制剂治疗的澳大利亚乳腺癌女性患者的合并症模式。
回顾性队列研究，使用2003年1月至2014年12月的药品福利计划（PBS）数据（10%样本）。配药申请数据用于识别合并症，并采用Rx-Risk-V模型进行分类。乳腺癌队列在2004年至2011年期间接受了他莫昔芬或芳香化酶抑制剂治疗，且内分泌治疗类型之间未发生转换。使用Cox回归模型比较乳腺癌队列与特定对照组（年龄和性别按1:10比例匹配，在研究期间未使用任何抗肿瘤药物）随时间推移发生五种个体合并症的情况。
PBS数据显示，与非癌症对照组相比，接受他莫昔芬治疗的女性心血管疾病、糖尿病以及疼痛或疼痛-炎症的发生率较高，但高脂血症的发生率较低。与非癌症对照组相比，接受芳香化酶抑制剂治疗的女性更易发生心血管疾病、骨质疏松症以及疼痛或疼痛-炎症。与使用芳香化酶抑制剂的女性相比，使用他莫昔芬的女性发生高脂血症和骨质疏松症的风险显著较低。
接受内分泌治疗的激素依赖性乳腺癌女性发生特定合并症的风险高于未患癌症的女性，使用他莫昔芬和芳香化酶抑制剂的患者合并症情况不同。需要对癌症后合并症发生的原因、机制及管理进行进一步研究。
