University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Case Western Reserve University, Cleveland, OH, USA.
Support Care Cancer. 2022 Nov;30(11):9329-9340. doi: 10.1007/s00520-022-07326-6. Epub 2022 Sep 10.
Aromatase inhibitors (AIs) prolong survival for postmenopausal women with hormone receptor-positive breast cancer (HR + BC) but also burden patients with symptoms, a major reason for suboptimal AI adherence. This study characterizes inter-relationships among symptom measures; describes neuropsychological symptom burden trajectories; and identifies trajectory group membership predictors for postmenopausal women prescribed anastrozole for HR + BC.
This study utilized prospectively collected data from a cohort study. Relationships among various self-reported symptom measures were examined followed by a factor analysis to reduce data redundancy before trajectory analysis. Four neuropsychological scales/subscales were rescaled (range 0-100) and averaged into a neuropsychological symptom burden (NSB) score, where higher scores indicated greater symptom burden. Group-based trajectory modeling characterized NSB trajectories. Trajectory group membership predictors were identified using multinomial logistic regression.
Women (N = 360) averaged 61 years old, were mostly White, and diagnosed with stage I HR + BC. Several measures were correlated temporally but four neuropsychological measures had strong correlations and dimensional loadings. These four measures, combined for the composite NSB, averaged (mean ± standard deviation) 17.4 ± 12.9, 18.0 ± 12.7, 19.5 ± 12.8, and 19.8 ± 13.0 at pre-anastrozole, 6, 12, and 18 months post-initiation, respectively. However, the analysis revealed five NSB trajectories-low-stable, low-increasing, moderate-stable, high-stable, and high-increasing. Younger age and baseline medication categories (pre-anastrozole), including anti-depressants, analgesics, anti-anxiety, and no calcium/vitamin D, predicted the higher NSB trajectories.
This study found relationships among neuropsychological symptom measures and distinct trajectories of self-reported NSB with pre-anastrozole predictors. Identifying symptom trajectories and their predictors at pre-anastrozole may inform supportive care strategies via symptom management interventions to optimize adherence for women with HR + BC.
芳香化酶抑制剂（AIs）可延长绝经后激素受体阳性乳腺癌（HR+BC）患者的生存期，但也会给患者带来各种症状负担，这是 AI 治疗依从性不佳的主要原因。本研究旨在描述各症状测量指标之间的相互关系，描述神经心理症状负担的轨迹，并确定接受阿那曲唑治疗 HR+BC 后绝经后妇女的轨迹组群特征。
本研究利用前瞻性队列研究收集的数据。首先，对各种自我报告的症状测量指标之间的关系进行了检验，然后进行了因子分析以减少数据冗余，再进行轨迹分析。对 4 个神经心理学量表/分量表进行重新标度（范围 0-100），并平均为神经心理症状负担（NSB）评分，分数越高表示症状负担越重。采用基于群组的轨迹建模方法对 NSB 轨迹进行特征描述。采用多项逻辑回归识别轨迹组群特征。
共纳入 360 名女性，平均年龄为 61 岁，大多数为白人，诊断为 I 期 HR+BC。一些指标在时间上呈相关性，但有 4 个神经心理学指标有很强的相关性和维度负荷。这 4 个指标组合为综合 NSB，分别在阿那曲唑治疗前（pre-anastrozole）、治疗后 6、12、18 个月的平均值（平均值±标准差）为 17.4±12.9、18.0±12.7、19.5±12.8 和 19.8±13.0。然而，分析结果显示出 5 种 NSB 轨迹-低稳定、低增长、中稳定、高稳定和高增长。年龄较小和基线药物类别（pre-anastrozole），包括抗抑郁药、镇痛药、抗焦虑药和无钙/维生素 D，预测了更高的 NSB 轨迹。
本研究发现了神经心理症状测量指标之间的关系以及与阿那曲唑治疗前预测因素相关的自我报告 NSB 的不同轨迹。在接受阿那曲唑治疗前识别出症状轨迹及其预测因素，可能为 HR+BC 患者提供通过症状管理干预优化依从性的支持性护理策略。
