Department of Psychology, University of Miami, 5665 Ponce de Leon, Coral Gables, FL, 33146, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
Breast Cancer Res Treat. 2021 Nov;190(1):79-88. doi: 10.1007/s10549-021-06361-x. Epub 2021 Aug 19.
Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence.
We conducted a long-term follow-up (median = 8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0-3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received.
Of those who completed long-term follow-up (n = 59, 44.7%), over half (n = 33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n = 15) had better adherence than those receiving health education (n = 24) on the Forgetfulness/Inconsistency [B(SE) = 0.25(0.14), p = 0.049] and Intentional Nonadherence [B(SE) = 0.31(0.14), p = 0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n = 20): Forgetfulness/Inconsistency [B(SE) = - 0.47(0.25), p = 0.031]; Intentional Nonadherence [B(SE) = - 0.31(0.15), p = 0.027].
Women receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques.
Trial 2R01-CA-064710 was registered March 26, 2006.
尽管有救命的潜力，但许多女性在服用辅助内分泌治疗（AET）治疗乳腺癌（BCa）时难以坚持。先前的研究表明，情绪困扰是 AET 坚持治疗的一个障碍。我们对参加一项试验的女性进行了长期随访（中位随访时间=8 年），该试验旨在测试两种基于术后 5 周的团体为基础的应激管理干预（认知行为疗法[CBT]和放松训练）与注意力匹配的健康教育对照组，对 AET 坚持治疗的长期影响。
我们对手术后患有 0-3 期 BCa 的女性进行了长期随访（n=59，44.7%），这些女性被随机分配到 CBT、放松训练或健康教育组。我们使用内分泌治疗药物使用问卷（ETMUQ）测量坚持治疗的情况。首先，我们通过验证性因素分析确定 ETMUQ 上的因素。然后，我们使用贝叶斯结构方程模型，在控制年龄和接受治疗的情况下，将这些因素回归到研究臂。
在完成长期随访的人群中（n=59，44.7%），超过一半（n=33；55.9%）的人报告普遍存在坚持治疗的问题。接受放松训练（n=15）的女性比接受健康教育（n=24）的女性在 ETMUQ 的健忘/不一致性[B（SE）=0.25（0.14），p=0.049]和故意不遵医嘱[B（SE）=0.31（0.14），p=0.018]方面的依从性更好。接受放松训练的女性与接受 CBT（n=20）的女性相比，在健忘/不一致性[B（SE）=-0.47（0.25），p=0.031]和故意不遵医嘱[B（SE）=-0.31（0.15），p=0.027]方面也有类似的结果。
与接受健康教育或 CBT 的女性相比，接受放松训练的女性在长期治疗中（1）忘记服用 AET 的可能性较低，（2）故意错过 AET 剂量的可能性较低。这证明了需要进行随机试验的必要性，旨在通过纳入基于理论的行为改变技术来提高依从性。
2R01-CA-064710 于 2006 年 3 月 26 日注册。
