Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients
Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients
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DOI：
10.1200/jco.2009.25.9655
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发表时间：
2010-09-20
影响因子：
45.3
通讯作者：
Neugut, Alfred I.
中科院分区：
文献类型：
--
作者：
Hershman, Dawn L.;Kushi, Lawrence H.;Neugut, Alfred I.
虽然研究发现激素敏感性乳腺癌（BC）的辅助激素治疗可显著降低复发率和死亡率，但药物依从性并不理想。我们调查了在北加州Kaiser Permanente医疗系统登记的患者早期停止和不坚持激素治疗的比率和预测因素。患者和方法我们确定了1996年至2007年诊断为激素敏感期I-III期BC的女性，并使用自动药房记录来识别激素治疗处方和补充日期。我们使用Cox比例风险回归模型分析激素治疗早期停药和不依从（药物占有率< 80%）的相关因素。结果：我们确定了8769例BC患者，他们符合我们的资格标准，并且在诊断1年内至少服用了一种他莫昔芬（43%）、芳香化酶抑制剂（26%）或两种药物（30%）。年龄较小或较大、乳房肿瘤切除术（v乳房切除术）和合并症与早期停药有关，而亚洲种族、已婚、早期诊断、接受化疗或放疗以及较长的处方补充间隔与完成4.5年的治疗有关。在那些继续治疗的患者中，类似的因素与完全坚持治疗有关。年龄小于40岁的女性停药的风险最高（风险比，1.51;95% CI, 1.23 ~ 1.85）。到4.5年时，32%的患者停止了治疗，而在继续治疗的患者中，72%的患者完全坚持治疗。结论只有49%的BC患者在最佳方案下全程接受激素辅助治疗。年轻女性不坚持服药的风险较高。干预措施，以提高依从性和继续激素治疗是必要的，特别是对年轻妇女。
Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system.Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy.Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent.Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.