在综合性医疗保健系统中，个人和临床社会支持与激素受体阳性乳腺癌患者对辅助内分泌治疗的依从性之间的关系。
Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system.
机构信息
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, USA.
Columbia University Medical Center, New York, NY, USA.
出版信息
Breast Cancer Res Treat. 2018 Aug;170(3):623-631. doi: 10.1007/s10549-018-4774-2. Epub 2018 Apr 18.
PURPOSE
We evaluated associations between personal and clinical social support and non-adherence to adjuvant endocrine therapy (AET) in a large, Northern California breast cancer (BC) cohort from an integrated healthcare network.
METHODS
This study included 3382 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-III hormone receptor-positive BC and who responded to the Medical Outcomes Study Social Support and Interpersonal Processes of Care surveys, approximately 2 months post-diagnosis. We used logistic regression to evaluate associations between tertiles of social support and non-initiation (< 2 consecutive prescription fills within a year after diagnosis). Among those who initiated treatment, we used proportional hazards regression to evaluate associations with discontinuation (≥ 90 day gap) and non-adherence (< 80% medical possession ratio).
RESULTS
Of those who initiated AET (79%), approximately one-fourth either discontinued AET or were non-adherent. AET non-initiation was more likely in women with moderate (adjusted OR 1.18, 95% CI 0.96-1.46) or low (OR 1.30, 95% CI 1.05-1.62) versus high personal social support (P trend = 0.02). Women with moderate (HR 1.20, 95% CI 0.99-1.45) or low (HR 1.32, 95% CI 1.09-1.60) personal social support were also more likely to discontinue treatment (P trend = 0.01). Furthermore, women with moderate (HR 1.25, 95% CI 1.02-1.53) or low (HR 1.38, 95% CI 1.12-1.70) personal social support had higher non-adherence (P trend = 0.007). Associations with clinical social support and outcomes were similar. Notably, high clinical social support mitigated the risk of discontinuation when patients' personal support was moderate or low (P value = 0.04).
CONCLUSIONS
Women with low personal or clinical social support had higher AET non-adherence. Clinician teams may need to fill support gaps that compromise treatment adherence.
目的
我们评估了个人和临床社会支持与大北加州综合医疗网络中激素受体阳性乳腺癌（BC）队列中辅助内分泌治疗（AET）不依从之间的关系。
方法
这项研究包括 3382 名女性，她们在 2005 年至 2013 年期间被诊断为 I-III 期激素受体阳性 BC，并在诊断后约 2 个月对医疗结果研究社会支持和人际护理过程调查做出了回应。我们使用逻辑回归评估了社会支持三分位与不开始（<一年中连续两次处方填充）之间的关系。对于那些开始治疗的患者，我们使用比例风险回归评估了与停药（≥90 天的差距）和不依从（<80%的医疗占有率）的关系。
结果
在开始 AET 的患者中（约 79%），大约有四分之一的患者停止了 AET 或不依从。与高个人社会支持相比，中（调整后的 OR 1.18，95%CI 0.96-1.46）或低（OR 1.30，95%CI 1.05-1.62）个人社会支持的患者更有可能不开始 AET（趋势 P=0.02）。中（HR 1.20，95%CI 0.99-1.45）或低（HR 1.32，95%CI 1.09-1.60）个人社会支持的患者也更有可能停止治疗（趋势 P=0.01）。此外，中（HR 1.25，95%CI 1.02-1.53）或低（HR 1.38，95%CI 1.12-1.70）个人社会支持的患者不依从率更高（趋势 P=0.007）。与临床社会支持和结果相关的因素相似。值得注意的是，当患者的个人支持为中或低时，高临床社会支持减轻了停药的风险（P 值=0.04）。
结论
低个人或临床社会支持的患者 AET 不依从率更高。临床团队可能需要填补影响治疗依从性的支持空白。
Zotero 插件