Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Med Internet Res. 2021 Sep 16;23(9):e27576. doi: 10.2196/27576.
Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery.
This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs.
Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated.
A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39).
This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.
多学科治疗（MDT）和辅助治疗与乳腺癌患者生存率的提高有关。然而，患者不遵守 MDT 决策的情况很常见。我们开发了一种基于智能手机的应用程序，可以方便患者术后的全程管理。
本研究旨在探讨治疗不依从的影响因素，并确定基于智能手机的应用程序是否可以提高 MDT 依从率。
纳入 2013 年 3 月至 2019 年 5 月期间接受浸润性乳腺癌诊断并接受 MDT 的患者。患者分为 3 组：预应用组（2017 年 11 月，在应用程序推出之前）；未使用应用程序组（2017 年 11 月之后但未使用应用程序）；和应用程序使用组（2017 年 11 月之后并使用应用程序）。进行单因素和多因素分析以确定与 MDT 依从性相关的因素。还评估了特定辅助治疗（包括化疗、放疗、内分泌治疗和靶向治疗）的依从性。
共纳入 4475 例患者，预应用组、未使用应用程序组和使用应用程序组分别包括 2966 例（66.28%）、861 例（19.24%）和 648 例（14.48%）患者。总体而言，有 15.53%（695/4475）的患者未接受 MDT 建议；不依从率从 2013 年的 27.4%（75/273）到 2019 年的 8.8%（44/500）不等。多因素分析表明，使用应用程序与辅助治疗的依从性独立相关。与预应用组的患者相比，使用应用程序组的患者不太可能偏离 MDT 建议（比值比[OR]0.61，95%置信区间[CI]0.43-0.87；P=.007）；未使用应用程序组没有明显差异（P=.77）。此外，使用应用程序降低了辅助化疗（OR 0.41，95%CI 0.27-0.65；P<.001）和放疗（OR 0.49，95%CI 0.25-0.96；P=.04）的不依从率，但对抗 HER2 治疗（P=.76）或内分泌治疗（P=.39）没有影响。
基于智能手机的应用程序可以提高接受辅助治疗的患者的 MDT 依从性；这对于辅助化疗和放疗更为明显。
