Camejo Natalia, Castillo Cecilia, Tambasco Clara, Strazzarino Noelia, Requena Nicolas, Peraza Silvina, Boronat Anna, Herrera Guadalupe, Esperon Patricia, Cuello Mauricio, Krygier Gabriel
Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay.
Pharmacy Service, Hospital de Clinicas Dr. Manuel Quintela, Montevideo, Uruguay.
World J Oncol. 2023 Aug;14(4):300-308. doi: 10.14740/wjon1647. Epub 2023 Aug 4.
Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). A lack of adherence to adjuvant endocrine therapy is common, 31.0-73.0% of women discontinue endocrine treatment before 5 years. The aim of the study was to assess adherence to HT in routine clinical practice in patients assisted at the Clinical Oncology Department of the Hospital de Clinicas - Universidad de la Republica, Uruguay.
Patients treated with HT for stage 0-III BC between 2017 and 2019 were included. The medication possession (MPR) rate was calculated using pharmacy records, and the Morisky-Green Scale was applied to assess adherence. Adherent patients were those with MPR ≥ 0.80 and who correctly answered the Morisky-Green treatment adherence questionnaire. The association of adherence with polypharmacy, treatment, and patient characteristics was assessed using simple logistic models. The associations between qualitative variables and adherence were assessed using simple logistic regression model or Fisher's exact test. The association between quantitative variables and adherence was assessed using the Student's -test. The odds ratio (OR) for non-adherence to treatment and its 95% confidence interval were estimated.
Totally, 118 patients were included; 65.2% were treated with aromatase inhibitors (AIs), 36.0% presenting polypharmacy. The adherence rate at the end of 2 years was 81.0 %; and it was associated with age (P = 0.03, OR = 0.96 for non-adherence), with adherent and non-adherent patients having a mean age of 65.0 and 60.3 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI.
Adherence to HT was assessed in real life, with 19.0% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. Older patients were associated with being more adherent. The results show the need of the Pharmacy Service and Department of Clinical Oncology Medical Oncology combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.
激素受体阳性乳腺癌（BC）患者的辅助激素治疗（HT）可提高总生存期（OS）。辅助内分泌治疗依从性差很常见，31.0% - 73.0%的女性在5年内中断内分泌治疗。本研究旨在评估乌拉圭共和国大学临床医院临床肿瘤科接受治疗的患者在常规临床实践中对HT的依从性。
纳入2017年至2019年间接受HT治疗0 - III期BC的患者。使用药房记录计算药物持有率（MPR），并应用莫利斯基 - 格林量表评估依从性。依从性患者为MPR≥0.80且正确回答莫利斯基 - 格林治疗依从性问卷的患者。使用简单逻辑模型评估依从性与多重用药、治疗及患者特征之间的关联。使用简单逻辑回归模型或费舍尔精确检验评估定性变量与依从性之间的关联。使用学生t检验评估定量变量与依从性之间的关联。估计不依从治疗的比值比（OR）及其95%置信区间。
共纳入118例患者；65.2%接受芳香化酶抑制剂（AIs）治疗，36.0%存在多重用药情况。2年时的依从率为81.0%；且与年龄相关（P = 0.03，不依从的OR = 0.96），依从性患者和不依从患者的平均年龄分别为65.0岁和60.3岁；然而，依从性与多重用药、原籍地区、婚姻状况、独居、教育程度、职业或分期无关。两种药物的依从性情况相似，但家庭主妇和退休女性对AIs的依从性更高。
在现实生活中评估了对HT的依从性，尽管已知对OS有益、治疗耐受性良好且免费提供，但仍有19.0%的患者不依从治疗。年龄较大的患者依从性更高。结果表明，鉴于这可能对患者的OS产生影响，药房服务部门和临床肿瘤内科需要共同努力制定协调的策略和干预措施以提高依从性。
