Zhang P, Zhang J, Zhang B, Yang W C, Hu J B, Sun X F, Zhai G, Qian H R, Li Y, Xu H, Feng F, Wu X Y, Liu H L, Liu H J, Qiu H B, Wu X J, Zhou Y B, Shen K T, Kou Y W, Fu Y, Jie Z G, Zou X M, Cao H, Gao Z D, Tao K X
Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Gastrointestinal Surgery, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Sep 25;24(9):775-782. doi: 10.3760/cma.j.cn.441530-20210426-00174.
To analyze the current adherence to imatinib in patients with gastrointestinal stromal tumors (GIST) in China and its influencing factors. A cross-sectional survey was conducted. Study period: from October 1, 2020 to November 31, 2020. Study subjects: GIST patients taking imatinib who were diagnosed and treated in public tertiary level A general hospitals or oncology hospitals; those who had not been pathologically diagnosed, those who never received imatinib, or those who had taken imatinib in the past but stopped afterwards were excluded. The Questionnaire Star online surgery platform was used to design a questionnaire about the adherence to adjuvant imatinib therapy of Chinese GIST patients. The link of questionnaire was sent through WeChat. The questionnaire contained basic information of patients, medication status and Morisky Medication Adherence Scale. A total of 2162 questionnaires from 31 provinces, autonomous regions, and municipalities were collected, of which 2005 were valid questionnaires, with an effective rate of 92.7%. The survey subjects included 1104 males and 901 females, with a median age of 56 (22-91) years old. Working status: 609 cases (30.4%) in the work unit, 729 cases (36.4%) of retirement, 667 cases of flexible employment or unemployment (33.3%). Education level: 477 cases (23.8%) with bachelor degree or above, 658 cases (32.8%) of high school, 782 cases (39.0%) of elementary or junior high school, 88 cases (4.4%) without education. Marital status: 1789 cases (89.2%) were married, 179 cases (8.9%) divorced or widowed, 37 cases (1.8%) unmarried. Two hundred and ninety-four patients (14.7%) had metastasis when they were first diagnosed, including 203 liver metastases, 52 peritoneal metastases, and 39 other metastases. One thousand eight hundred and sixty-nine patients underwent surgical treatment, of whom 1642 (81.9%) achieved complete resection. The median time of taking imatinib was 25 (1-200) months. Common adverse reactions of imatinib included 1701 cases (84.8%) of periorbital edema, 1031 cases (51.4%) of leukopenia, 948 cases (47.3%) of fatigue, 781 cases (39.0%) of nausea and vomiting, 709 cases (35.4%) of rash, and 670 cases (33.4%) of lower extremity edema. The score of the Morisky Medication Adherence Scale showed that 392 cases (19.6%) had poor adherence, 1023 cases (51.0%) had moderate adherence, and 590 cases (29.4%) had good adherence. Univariate analysis showed that gender, age, work status, economic income, residence, education level, marriage, the duration of taking medication and adverse reactions were associated with adherence to adjuvant imatinib therapy (all <0.05). Multivariate analysis showed that female (OR=1.264, =0.009), non-retirement (OR=1.454, =0.001), monthly income ≤4000 yuan (OR=1.280, =0.036), township residents (OR=1.332, =0.005), unmarried or divorced or widowed (OR=1.362, =0.026), the duration of imatinib medication >36 months (OR=1.478, <0.001) and adverse reactions (OR=1.719, =0.048) were independent risk factors for poor adherence to adjuvant imatinib. Among patients undergoing complete resection, 324 (19.7%) had poor adherence, 836 (50.9%) had moderate adherence, and 482 (29.4%) had good adherence. Meanwhile, 55 patients with good adherence (11.4%) developed recurrence after surgery, 121 patients with moderate adherence (14.5%) developed recurrence, 61 patients with poor adherence (18.8%) developed recurrence, and the difference was statistically significant (=0.017). The adherence to adjuvant therapy with imatinib in Chinese GIST patients is relatively poor. Females, non-retirement, monthly income ≤4000 yuan, township residents, unmarried or divorced or widowed, the duration of imatinib medication >36 months, and adverse reactions are independently associated with poor adherence of GIST patients. Those with poor adherence have a higher risk of recurrence after surgery. Positive interventions based on the above risk factors are advocated to improve the prognosis of patients with GIST.
分析我国胃肠间质瘤（GIST）患者目前对伊马替尼的依从性及其影响因素。开展一项横断面调查。研究期间：2020年10月1日至2020年11月31日。研究对象：在公立三级甲等综合医院或肿瘤医院确诊并接受伊马替尼治疗的GIST患者；排除未经过病理诊断、从未接受过伊马替尼治疗或过去曾服用伊马替尼但后来停药的患者。使用问卷星在线调研平台设计关于中国GIST患者辅助伊马替尼治疗依从性的问卷。问卷链接通过微信发送。问卷内容包括患者基本信息、用药情况及Morisky药物依从性量表。共收集来自31个省、自治区、直辖市的2162份问卷，其中有效问卷2005份，有效率为92.7%。调查对象中男性1104例，女性901例，中位年龄为56（22 - 91）岁。工作状态：在职609例（30.4%），退休729例（36.4%），灵活就业或无业667例（33.3%）。文化程度：本科及以上477例（23.8%），高中658例（32.8%），小学或初中782例（39.0%），未上学88例（4.4%）。婚姻状况：已婚1789例（89.2%），离异或丧偶179例（8.9%），未婚37例（1.8%）。294例患者（14.7%）初诊时已有转移，其中肝转移203例，腹膜转移52例，其他转移39例。1869例患者接受了手术治疗，其中1642例（81.9%）实现了完全切除。服用伊马替尼的中位时间为25（1 - 200）个月。伊马替尼常见不良反应包括眶周水肿1701例（84.8%）、白细胞减少1031例（51.4%）、乏力948例（47.3%）、恶心呕吐781例（39.0%）、皮疹709例（35.4%）、下肢水肿670例（33.4%）。Morisky药物依从性量表评分显示，依从性差的有392例（19.6%），中等依从性的有1023例（51.0%），依从性好的有590例（29.4%）。单因素分析显示，性别、年龄、工作状态、经济收入、居住地、文化程度、婚姻状况、用药时长及不良反应与辅助伊马替尼治疗依从性相关（均P<0.05）。多因素分析显示，女性（OR = 1.264，P = 0.009）、非退休（OR = 1.454，P = 0.001）、月收入≤4000元（OR = 1.280，P = 0.036）、乡镇居民（OR = 1.332，P = 0.005）、未婚或离异或丧偶（OR = 1.362，P = 0.026）、伊马替尼用药时长>36个月（OR = 1.478，P<0.001）及不良反应（OR = 1.719，P = 0.048）是辅助伊马替尼治疗依从性差的独立危险因素。在接受完全切除的患者中，依从性差的有324例（19.7%），中等依从性的有836例（50.9%），依从性好的有482例（29.4%）。同时，依从性好的患者中有55例（11.4%）术后复发，中等依从性的有121例（14.5%）复发，依从性差的有61例（18.
