Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Breast Cancer Res Treat. 2022 Jun;193(3):567-577. doi: 10.1007/s10549-022-06583-7. Epub 2022 Apr 19.
Side effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL).
Patients aged ≥ 70 years with stage I-III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time.
Overall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = - 4.37; 95% CI - 7.96 to - 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = - 11.10; 95% CI - 18.80 to - 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement.
A large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy.
副作用是导致老年患者停止辅助内分泌治疗的主要原因。本研究旨在探讨老年患者在开始辅助内分泌治疗后 2 年内停止治疗的预测因素，并研究早期停药与功能状态和生活质量（QoL）之间的关系。
纳入年龄≥70 岁、接受辅助内分泌治疗的 I-III 期乳腺癌患者。主要终点为 2 年内停止内分泌治疗。使用单变量逻辑回归模型评估停药的危险因素。使用线性混合模型评估 QoL 和功能状态随时间的变化。
共纳入 258 例患者，其中 36%的患者在开始治疗后 2 年内停止治疗。未发现与治疗停药相关的老年预测因素。肿瘤分期与早期停药呈负相关。与继续治疗的患者相比，停药患者的乳腺癌特异性 QoL 较差（b=-4.37；95%CI-7.96 至-0.78；p=0.017），尤其是在未来展望子量表上（b=-11.10；95%CI-18.80 至-3.40；p=0.005），停药后并未恢复。停药与功能改善无关。
相当一部分老年患者在开始辅助内分泌治疗后 2 年内停止治疗，但老年特征并不能预测治疗的早期停药。停止辅助内分泌治疗并没有对 QoL 和功能状态产生积极影响，这意味着在这组患者中观察到的较差 QoL 可能不是内分泌治疗的不良反应引起的。
