Side effects of aromatase inhibitors versus tamoxifen: the patients' perspective
Side effects of aromatase inhibitors versus tamoxifen: the patients' perspective
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DOI：
10.1016/j.amjsurg.2006.06.018
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发表时间：
2006-10-01
影响因子：
3
通讯作者：
Johnson, Nathalie
中科院分区：
文献类型：
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作者：
Garreau, Jennifer R.;DeLaMelena, Tammy;Johnson, Nathalie
背景：激素治疗是雌激素受体阳性（ER+）乳腺癌的主要治疗方法。在芳香化酶抑制剂（AIs）出现之前，他莫昔芬（TAM）一直是广泛使用的药物。尽管AIs的耐受性似乎比他莫昔芬好，但它们的安全性确实不同，而且这些副作用在社区实践中还没有得到很好的描述。我们调查了接受辅助激素治疗的ER+乳腺癌患者，以确定这些药物如何影响他们的生活质量，以及副作用或成本是否影响他们继续治疗的决定。方法：采用邮寄问卷和社区癌症登记。结果：902份调查中有452份回复，回复率为50%。82%的受访者接受了某种形式的雌激素阻断治疗（辅助激素治疗）。其中54%的人服用他莫昔芬，46%的人服用人工智能。他莫昔芬和人工智能使用者最麻烦的症状分别包括潮热（35%/30%）、体重增加（14%/15%）、失眠（17%/17%）和关节疼痛（12%/23%,P = 0.002）。39%的TAM用户和46%的AI用户正在服用药物来控制症状。50%的TAM用户和39%的AI用户服用维生素E来帮助控制潮热。42%的TAM用户和32%的AI用户服用Advil（惠氏，弗吉尼亚州里士满）治疗肌肉/关节疼痛；47.5%的AI使用者改换药物以改善症状，而他莫昔芬使用者只有37% （P = 0.015）。他莫昔芬和人工智能使用者控制副作用的平均药物费用为每月67.36美元。结论：在我们的调查中，他莫昔芬和人工智能使用者都报告了显著且不同的副作用。人工智能用户更频繁地出现肌肉骨骼疾病，而且更多的人工智能用户改变了治疗方法。AI和他莫昔芬使用者均使用辅助药物控制症状。在这两组中，尽管缺乏证据支持维生素E在这种情况下的有效性，但仍有大量的人使用维生素E来帮助潮热。治疗费用和症状控制不是治疗的主要障碍。(c) 2006年摘录医药有限公司版权所有。
Background: Hormonal therapy is a mainstay in the management of estrogen receptor-positive (ER+) breast cancer. Tamoxifen (TAM) has been the drug widely used until the recent emergence of the aromatase inhibitors (AIs). Although AIs appear to be better tolerated than tamoxifen, they do have a different safety profile and these side effects have not been well characterized in community practice. We surveyed patients with ER+ breast cancers who received adjuvant hormonal therapy to determine how these medications impacted their quality of life and whether side effects or cost influenced decisions to continue therapy.Methods: A mailed questionnaire and community cancer registry were used.Results: Four hundred fifty-two of 902 surveys were returned for a 50% response rate. Eighty-two percent of respondents were placed on (adjuvant hormonal therapy) some form of estrogen-blocking therapy. Fifty-four percent of these were placed on tamoxifen and 46% on an AI. The most troublesome symptoms for tamoxifen and AI users, respectively, included hot flashes (35%/30%), weight gain (14%/15%), insomnia (17%/17%), and joint aches (12%/23%, P = .002). Thirty-nine percent of TAM users and 46% of AI users were taking medications to control their symptoms. Fifty percent of TAM users and 39% of AI users took vitamin E to help control hot flashes. Forty-two percent of TAM users versus 32% of AI users took Advil (Wyeth, Richmond, VA) for muscle/joint aches; 47.5% of AI users switched medication to improve symptoms as compared with only 37% of tamoxifen users (P = .015). The average cost of medications to control side effects for both tamoxifen and AI users was $67.36 per month.Conclusions: In our survey, both tamoxifen and AI users reported significant and different side effects. AI users suffered more frequently from musculoskeletal complaints, and more AI users switched therapy. Both AI and tamoxifen users used adjunctive medications for symptom control. In both groups, a large number used vitamin E to help hot flashes despite weak evidence to support its effectiveness in this setting. Cost of therapy and symptom control was not a major barrier to care. (c) 2006 Excerpta Medica Inc. All rights reserved.