Alatawi Yasser, Hansen Richard A, Chou Chiahung, Qian Jingjing, Suppiramaniam Vishnu, Cao Guanqun
Department of Pharmacy Practice, Collage of Pharmacy, University of Tabuk, 7970 King Fahad Rd, Tabuk, 47713-2611, Saudi Arabia.
Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA.
Breast Cancer. 2021 Mar;28(2):277-288. doi: 10.1007/s12282-020-01155-3. Epub 2020 Sep 9.
The purpose of this study was to examine the impact of preexisting cognitive impairments on survival and medication adherence, and whether chronic medication adherence mediates or moderates the association between cognitive impairments and mortality in patients with breast cancer.
This retrospective cohort study of older female patients diagnosed with breast cancer was conducted using the Surveillance, Epidemiology, and End Results Medicare Linked Database. We examined the risk of mortality from cancer and non-cancer causes in patients with and without a history of cognitive impairment. In addition, we examined if chronic medication adherence rates differ between these groups of patients and if medication adherence mediates or moderates the association between cognitive impairments and non-cancer mortality.
Mortality from cancer-specific (HR 1.13, 95% CI 1.04-1.23) and non-cancer causes (HR 1.16, 95% CI 1.11-1.21) as well as all-cause mortality (HR 1.30, 95% CI 1.23-1.38) was significantly higher in patients with cognitive impairments compared to those without cognitive impairment. Both groups showed low adherence levels to chronic medication before and after the breast cancer diagnosis. Further analysis did not show that medication adherence mediates or moderates the relationship between cognitive impairment and non-cancer mortality (p value > 0.05).
The results of this study indicate that older female patients with cognitive impairments and a breast cancer diagnosis have a heightened risk of cancer-specific and non-cancer mortality. Our findings do not indicate that chronic medication adherence plays a role in the association between a history of cognitive impairment and mortality, it is still necessary to further investigate this issue.
本研究的目的是探讨既往存在的认知障碍对生存和药物依从性的影响，以及长期药物依从性是否介导或调节乳腺癌患者认知障碍与死亡率之间的关联。
本回顾性队列研究使用监测、流行病学和最终结果医疗保险关联数据库，对诊断为乳腺癌的老年女性患者进行研究。我们检查了有和没有认知障碍病史的患者因癌症和非癌症原因导致的死亡风险。此外，我们还检查了这些患者组之间的长期药物依从率是否存在差异，以及药物依从性是否介导或调节认知障碍与非癌症死亡率之间的关联。
与无认知障碍的患者相比，有认知障碍的患者因癌症特异性（风险比1.13，95%置信区间1.04-1.23）和非癌症原因（风险比1.16，95%置信区间1.11-1.21）导致的死亡率以及全因死亡率（风险比1.30，95%置信区间1.23-1.38）显著更高。两组在乳腺癌诊断前后对长期药物的依从水平都较低。进一步分析未显示药物依从性介导或调节认知障碍与非癌症死亡率之间的关系（p值>0.05）。
本研究结果表明，患有认知障碍且诊断为乳腺癌的老年女性患者因癌症特异性和非癌症原因导致死亡的风险更高。我们的研究结果并未表明长期药物依从性在认知障碍病史与死亡率之间的关联中起作用，仍有必要进一步研究这个问题。
