乳腺癌绝经前女性的辅助内分泌治疗：墨西哥的患者依从性和医生处方实践。
Adjuvant endocrine therapy for premenopausal women with breast cancer: Patient adherence and physician prescribing practices in Mexico.
机构信息
Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Batallon de San Patricio 112, San Pedro Garza Garcia, Nuevo Leon, 66278, Mexico; Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama en Mexico, Holbein 227, Int 210AB, Cd. de los Deportes, Mexico City, 03720, Mexico.
Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Batallon de San Patricio 112, San Pedro Garza Garcia, Nuevo Leon, 66278, Mexico; Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama en Mexico, Holbein 227, Int 210AB, Cd. de los Deportes, Mexico City, 03720, Mexico.
出版信息
Breast. 2021 Oct;59:8-15. doi: 10.1016/j.breast.2021.05.013. Epub 2021 Jun 1.
BACKGROUND
In resource-constrained settings, data regarding breast cancer patients' adherence to endocrine therapy (ET) and physicians' prescribing practices is limited. This study aims to decrease this knowledge gap in a real-world clinical practice.
METHODS
Premenopausal women with stage 0-III hormone-sensitive breast cancer and receiving adjuvant ET during the past 1-5 years were identified in three Mexican referral centers. Participants' self-reported ET compliance, clinicopathologic characteristics, ET-related knowledge and beliefs, experienced adverse effects, social support, and patient-physician relationships were evaluated. Physician ET prescribing practices were compared with the gold standard according to international and national guidelines to assess clinicians' adherence to standard-of-care prescription.
RESULTS
In total, 95/132 (72%) and 35/132 (27%) participants reported complete and acceptable adherence, respectively. Incomplete adherence was mainly attributed to forgetfulness, adverse effects, and unwillingness to take ET. Being employed/studying (p = 0.042), worrying about long-term ET use (p = 0.031), and experiencing >7 ET-related symptoms (p = 0.018) were associated with incomplete adherence. Guideline-endorsed regimens were prescribed in 84/132 (64%) patients, while the rest should have undergone ovarian function suppression (OFS) but instead received tamoxifen monotherapy.
CONCLUSIONS
Premenopausal Mexican women self-report remarkably high rates of adequate ET adherence. However, a considerable proportion misses ≥1 doses/month, usually because of forgetfulness. Notably, only 64% receive standard-of-care ET due to suboptimal prescription of OFS. Interventions that remind patients to take their ET, refine physicians' knowledge on the importance of OFS in high-risk patients, and increase access to OFS could prove pivotal to enhance optimal ET implementation and adherence, which could translate into improved patient outcomes.
背景
在资源有限的情况下，关于乳腺癌患者内分泌治疗（ET）依从性和医生处方实践的数据有限。本研究旨在缩小这一知识差距。
方法
在墨西哥的三个转诊中心，确定了过去 1-5 年内接受辅助 ET 治疗的 0-III 期激素敏感型乳腺癌的绝经前女性。评估了参与者的 ET 依从性自评、临床病理特征、ET 相关知识和信念、不良事件经历、社会支持和医患关系。根据国际和国家指南，将医生的 ET 处方实践与黄金标准进行比较，以评估临床医生对标准护理处方的依从性。
结果
共有 95/132（72%）和 35/132（27%）名参与者报告了完全和可接受的依从性。不完全依从主要归因于健忘、不良事件和不愿意接受 ET。在职/在校（p=0.042）、担心长期使用 ET（p=0.031）和经历>7 个 ET 相关症状（p=0.018）与不完全依从相关。84/132（64%）患者接受了指南推荐的方案，而其余患者本应接受卵巢功能抑制（OFS），但实际上接受了他莫昔芬单药治疗。
结论
墨西哥绝经前女性自我报告的 ET 依从性率很高。然而，相当一部分人每月漏服≥1 次，通常是因为健忘。值得注意的是，由于 OFS 的处方不理想，只有 64%的人接受了标准的 ET 治疗。提醒患者服用 ET 的干预措施、提高医生对高危患者 OFS 重要性的认识以及增加 OFS 的可及性，可能对提高 ET 的实施和依从性至关重要，从而改善患者的预后。
Zotero 插件