Birie Tigist, Gizaw Muluken, Seife Edom, Kassaw Nigussie Assefa, Tilahun Yared, Addissie Adamu, Kantelhardt Eva J, Getachew Sefonias
Assosa University, College of Health Science, Department of Epidemiology and Biostatistics, Assosa, Ethiopia.
Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Oncologist. 2025 Jun 4;30(6). doi: 10.1093/oncolo/oyaf076.
Breast cancer is one of the leading causes of cancer deaths in women worldwide. Systemic treatment can improve survival considerably. Breast cancer patients in many African countries face challenges during treatment and often abandon the recommended cycles of chemotherapy. Therefore, this study aims to describe the magnitude of abandonment and its determinants at 4 tertiary hospitals in Ethiopia.
An institution-based, nested case-control study was conducted. Initially, a cohort of patients with histologically diagnosed stage I-III breast cancer from 2019 to 2020 were reviewed. Then, a total of 400 patients (200 cases and 200 controls) were selected by simple random sampling from the medical log book. The data was collected from patients' charts and with a structured telephone interview-based questionnaire. The bivariate and multivariable logistic regression models were used to find the independent determinants.
Out of 1740 patients, 329 (18.9%) abandoned chemotherapy. The identified determinants for chemotherapy abandonment were stage III versus stage I/II adjusted odds ratio (AOR = 2.2, confidence interval (CI): 1.2-3.7), more financial constraints (AOR = 2.1, CI: 1.1-3.8), self-assertion of being healthy (AOR = 3.4, CI: 1.2-9.7), more expectations about side effects (AOR = 8.4, CI: 1.6-44.3), more intolerability of side effects (AOR = 2.0, CI: 1.2-3.5), initiating chemotherapy during COVID 19 (AOR = 3.0, CI: 1.7-5.2), and more fear of dependence on therapy (AOR = 7.8, CI: 4.4-13.9).
Nearly one-fifth of patients who started chemotherapy eventually abandoned their treatment. This means that patients experienced physical and financial toxicity as well as the efforts of health workers, but no treatment benefit. To avoid this, physicians need to closely follow the patients and explain the need to complete all chemotherapy cycles and treat side effects to avoid treatment abandonment with impaired survival. Additionally, attention must be paid to improving patient follow-up care during pandemics like COVID-19 and subsidizing therapy to ensure accessibility. Moreover, attention should be given to improving the subsidization of therapy and ensuring accessibility.
乳腺癌是全球女性癌症死亡的主要原因之一。全身治疗可显著提高生存率。许多非洲国家的乳腺癌患者在治疗期间面临挑战，常常放弃推荐的化疗周期。因此，本研究旨在描述埃塞俄比亚4家三级医院化疗放弃的程度及其决定因素。
开展一项基于机构的巢式病例对照研究。首先，回顾2019年至2020年组织学诊断为I-III期乳腺癌的患者队列。然后，通过简单随机抽样从医疗日志中选取400名患者（200例病例和200例对照）。数据从患者病历以及基于电话访谈的结构化问卷中收集。采用双变量和多变量逻辑回归模型来确定独立的决定因素。
在1740名患者中，329名（18.9%）放弃了化疗。确定的化疗放弃决定因素包括III期与I/II期相比，调整优势比（AOR = 2.2，置信区间（CI）：1.2 - 3.7）、更多的经济限制（AOR = 2.1，CI：1.1 - 3.8）、自我认为健康（AOR = 3.4，CI：1.2 - 9.7）、对副作用的更多预期（AOR = 8.4，CI：1.6 - 44.3）、对副作用的更多不耐受（AOR = 2.0，CI：1.2 - 3.5）、在新冠疫情期间开始化疗（AOR = 3.0，CI：1.7 - 5.2）以及更多对依赖治疗的恐惧（AOR = 7.8，CI：4.4 - 13.9）。
开始化疗的患者中近五分之一最终放弃了治疗。这意味着患者经历了身体和经济毒性以及医护人员的努力，但没有获得治疗益处。为避免这种情况，医生需要密切关注患者，解释完成所有化疗周期的必要性并治疗副作用，以避免因生存受损而放弃治疗。此外，在新冠疫情等大流行期间必须重视改善患者随访护理并补贴治疗以确保可及性。而且，应关注改善治疗补贴并确保可及性。
