Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; PhD Program in Biomedicine, Universitat Pompeu Fabra, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain.
Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain.
Maturitas. 2024 Apr;182:107918. doi: 10.1016/j.maturitas.2024.107918. Epub 2024 Jan 20.
To study the impact of comorbidities, multimorbidity, and multimorbidity clusters on adherence to recommended follow-up guidelines among long-term breast cancer survivors.
Retrospective cohort study based on 2078 women diagnosed with breast cancer from 2000 to 2006 and followed up from 2012 to 2016.
Adherence to breast cancer follow-up recommendations (annual medical visit and imaging) was determined. Comorbidities were classified as acute/chronic. Multimorbidity was defined as the presence of two or more chronic comorbidities aside from breast cancer. Five multimorbidity clusters were considered. Multivariate logistic regression models were fitted to determine the relationship between adherence to recommendations and the presence of comorbidities and multimorbidity, considering both sociodemographic and clinical characteristics.
Overall adherence to recommendations was 79.5 %. Adherence was lower among long-term breast cancer survivors with no comorbidities (75.8 %). Among multimorbidity clusters, adherence was highest in the anxiety and fractures cluster (84.3 %) and was lowest in the musculoskeletal and cardiovascular cluster (76.4 %). In adjusted multivariate models, multimorbidity was associated with higher levels of adherence (OR = 1.52 95 %CI 1.16-1.99), and adherence was highest in the metabolic and degenerative cluster (OR = 2.2 95 %CI 1.4-3.5).
Adherence to follow-up recommendations was higher among long-term breast cancer survivors with multimorbidity than among those without. Adherence also differed by multimorbidity cluster. These results suggest suboptimal adherence to the current follow-up recommendations in certain groups, suggesting the need to adapt clinical practice guidelines to reflect patients' comorbidities and different characteristics.
研究合并症、多种合并症和多种合并症簇对长期乳腺癌幸存者遵循推荐随访指南的影响。
基于 2000 年至 2006 年诊断为乳腺癌的 2078 名女性和 2012 年至 2016 年随访的回顾性队列研究。
确定乳腺癌随访建议（年度医疗就诊和影像学检查）的依从性。合并症分为急性/慢性。多种合并症定义为除乳腺癌以外存在两种或两种以上慢性合并症。考虑了五种多种合并症簇。采用多变量逻辑回归模型来确定建议的依从性与合并症和多种合并症的存在之间的关系，同时考虑社会人口统计学和临床特征。
总体建议的依从率为 79.5%。无合并症的长期乳腺癌幸存者的依从率较低（75.8%）。在多种合并症簇中，焦虑和骨折簇的依从率最高（84.3%），肌肉骨骼和心血管簇的依从率最低（76.4%）。在调整后的多变量模型中，多种合并症与更高水平的依从性相关（OR=1.52，95%CI 1.16-1.99），代谢和退行性簇的依从率最高（OR=2.2，95%CI 1.4-3.5）。
与无合并症的长期乳腺癌幸存者相比，多种合并症的长期乳腺癌幸存者更遵循随访建议。依从性也因多种合并症簇而异。这些结果表明，某些人群对当前随访建议的依从性较差，这表明需要调整临床实践指南，以反映患者的合并症和不同特征。
