Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
J Natl Cancer Inst. 2024 Jun 7;116(6):920-928. doi: 10.1093/jnci/djae061.
Many studies have examined patient-related factors affecting adjuvant hormone therapy adherence in patients with breast cancer. Our study aimed to examine associations of family-related factors with adjuvant hormone therapy discontinuation and breast cancer-specific mortality.
By cross-linking 7 Swedish health registers, we performed a cohort study that included all patients with breast cancer who initiated adjuvant hormone therapy during 2006-2019 in Sweden (N = 10 701). A group-based multitrajectory model was used to identify familial adversity groups based on 3 dimensions: material deprivation, negative family dynamics, and loss or threat of loss. Cox proportional hazard models were used to investigate associations of familial adversity with hormone therapy discontinuation and breast cancer-specific mortality.
We identified 5 distinctive familial adversity groups among the cohort participants. Compared with women who had low familial adversity, higher risks to discontinue adjuvant hormone therapy were observed among women with material deprivation (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.20 to 1.43), negative family dynamics (HR = 1.16, 95% CI = 1.06 to 1.28), loss or threat of loss (HR = 1.15, 95% CI = 1.00 to 1.32), or high familial adversity (HR = 1.53, 95% CI = 1.40 to 1.68). Furthermore, women with material deprivation (HR = 1.37, 95% CI = 1.05 to 1.79), negative family dynamics (HR = 1.41, 95% CI = 1.01 to 1.97), or high adversity (HR = 1.67, 95% CI = 1.26 to 2.23) were at higher risk of dying from breast cancer.
Familial adversity is associated with a higher risk of adjuvant hormone therapy discontinuation and breast cancer-specific mortality. Family-related factors identified in our study may help identify high-risk patients for interventions to prevent treatment discontinuation and subsequently improve breast cancer outcomes.
许多研究已经探讨了影响乳腺癌患者接受辅助激素治疗的患者相关因素。我们的研究旨在探讨与家庭相关的因素与辅助激素治疗中断和乳腺癌特异性死亡率之间的关系。
通过交叉链接 7 个瑞典健康登记处，我们进行了一项队列研究，该研究纳入了 2006 年至 2019 年期间在瑞典开始接受辅助激素治疗的所有乳腺癌患者（N=10701）。使用基于群组的多轨迹模型，根据 3 个维度（物质剥夺、负面家庭动态和丧失或面临丧失的威胁）确定家族逆境组。使用 Cox 比例风险模型来研究家族逆境与激素治疗中断和乳腺癌特异性死亡率之间的关系。
在队列参与者中，我们确定了 5 个独特的家族逆境组。与家族逆境较低的女性相比，物质剥夺（危险比 [HR]=1.31，95%置信区间 [CI]=1.20 至 1.43）、负面家庭动态（HR=1.16，95%CI=1.06 至 1.28）、丧失或面临丧失的威胁（HR=1.15，95%CI=1.00 至 1.32）或高家族逆境（HR=1.53，95%CI=1.40 至 1.68）的女性中断辅助激素治疗的风险更高。此外，物质剥夺（HR=1.37，95%CI=1.05 至 1.79）、负面家庭动态（HR=1.41，95%CI=1.01 至 1.97）或高逆境（HR=1.67，95%CI=1.26 至 2.23）的女性死于乳腺癌的风险更高。
家族逆境与辅助激素治疗中断和乳腺癌特异性死亡率的风险增加相关。我们在研究中确定的与家庭相关的因素可能有助于识别高危患者，以便进行干预以预防治疗中断，并随后改善乳腺癌的结局。
