Wijeratne Don Thiwanka, Booth Christopher M, Seneviratne Sanjeewa, Gyawali Bishal, Jalink Matt, Soysa Malinthi, Abhayaratna Sachith, Promod Hasitha, Wijesinghe Punika, Gunasekera Sanjeeva
Department of General Internal Medicine, Queen's University, 94 Stuart Street, Kingston, ON K7L3N6, Canada.
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston K7L5P9, Canada.
Ecancermedicalscience. 2021 Oct 12;15:1301. doi: 10.3332/ecancer.2021.1301. eCollection 2021.
Breast cancer is the most common cancer globally as well as in Sri Lanka. Improvements in cancer care have allowed patients to live to an older age. With advancing age, incidence of non-communicable diseases (NCDs) increases. Cancer diagnoses tend to take attention away from the treatment of other comorbidities, given its importance. The objective of this study was to describe healthcare delivery for NCDs among female breast cancer survivors treated at the National Cancer Institute of Sri Lanka (NCISL) and identify opportunities to optimise non-cancer medical care in this cohort.
A total of 420 women were identified from the breast cancer database at the NCISL, who were 50-80 years at the time of their breast cancer diagnosis, were within 12-24 months from the date of diagnosis, had completed their active cancer treatment and were in complete remission. Of this population, 228 (54%) women who had documented NCDs at the time of diagnosis were identified and were followed-up via telephone to collect details regarding existing comorbidities and the screening and development of new comorbidities.
At the time of cancer diagnosis, 216/228 (95%) of patients had hypertension, 104/228 (46%) had type 2 diabetes and 17/228 (8%) had ischaemic heart disease (IHD). The prevalence of other comorbidities was very low. During the post diagnosis period, 11 patients developed type 2 diabetes, while 2 developed IHD. Osteoporosis screening using dual-energy X-ray absorptiometry scanning was very low at diagnosis 21/228 (9%) but improved in post cancer treatment follow-up 112/228 (49%, p < 0.001). Only 95/228 (42%) were screened for other cancers.
Hypertension was the most prevalent comorbidity while type 2 diabetes and dyslipidaemia were the most common diagnoses post-treatment. In these patients, screening for osteoporosis and other cancers remains very low, emphasising a missed opportunity.
乳腺癌是全球以及斯里兰卡最常见的癌症。癌症护理水平的提高使患者能够活到更高龄。随着年龄增长，非传染性疾病（NCDs）的发病率上升。鉴于癌症诊断的重要性，它往往会使人们的注意力从其他合并症的治疗上转移开。本研究的目的是描述在斯里兰卡国家癌症研究所（NCISL）接受治疗的女性乳腺癌幸存者中，非传染性疾病的医疗服务情况，并确定在该队列中优化非癌症医疗护理的机会。
从NCISL的乳腺癌数据库中总共识别出420名女性，她们在乳腺癌诊断时年龄为50 - 80岁，诊断日期在12 - 24个月内，已完成积极的癌症治疗且处于完全缓解状态。在这一人群中，识别出228名（54%）在诊断时患有已记录非传染性疾病的女性，并通过电话随访收集有关现有合并症以及新合并症的筛查和发生情况的详细信息。
在癌症诊断时，216/228（95%）的患者患有高血压，104/228（46%）患有2型糖尿病，17/228（8%）患有缺血性心脏病（IHD）。其他合并症的患病率非常低。在诊断后的时期，11名患者患上了2型糖尿病，2名患者患上了IHD。诊断时使用双能X线吸收测定扫描进行骨质疏松症筛查的比例非常低，为21/228（9%），但在癌症治疗后的随访中有所改善，为112/228（49%，p < 0.001）。仅95/228（42%）的患者接受了其他癌症的筛查。
高血压是最普遍的合并症，而2型糖尿病和血脂异常是治疗后最常见的诊断。在这些患者中，骨质疏松症和其他癌症的筛查率仍然很低，这凸显了一个被错失的机会。
