Influence of Patient and Treatment Factors on Adherence to Adjuvant Endocrine Therapy in Breast Cancer
Influence of Patient and Treatment Factors on Adherence to Adjuvant Endocrine Therapy in Breast Cancer
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DOI：
10.1188/14.onf.274-285
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发表时间：
2014-05-01
影响因子：
1.9
通讯作者：
Sereika, Susan M.
中科院分区：
文献类型：
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作者：
Bender, Catherine M.;Gentry, Amanda L.;Sereika, Susan M.
目的/目的：综合评估可能预测辅助内分泌治疗不依从的患者、疾病或治疗因素，并探讨这些因素在乳腺癌患者中是否存在相互作用。设计：重复测量设计。地点：匹兹堡大学癌症研究所妇女癌症项目门诊服务中心和参与者的家。样本：91名接受内分泌治疗的早期乳腺癌患者。方法：连续评估内分泌治疗前18个月的依从性。在四个时间点（时间1至时间4）评估患者和疾病或治疗因素。时间1（基线）为内分泌治疗开始前两周内。时间2-4每隔6个月发生一次，在时间1之后18个月。主要研究变量：依从性、患者因素、疾病或治疗因素。研究结果：乳腺癌患者接受内分泌治疗的前18个月依从性显著下降。在开始治疗前出现消极情绪和症状预示着内分泌治疗随着时间的推移不坚持。随着时间的推移，对经济困难、症状、疾病阶段和更复杂的药物治疗方案的认识加剧了消极情绪对依从性的影响。结论：乳腺癌患者如果在开始治疗前出现抑郁或焦虑等症状，可能存在不坚持内分泌治疗的风险。对护理的启示：肿瘤科护士应该警惕患有抑郁或焦虑或正在经历症状的乳腺癌妇女。对消极情绪和症状的管理可能会导致更好的依从性。
Purpose/Objectives: To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer.Design: Repeated-measures design.Setting: The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes.Sample: 91 women with early-stage breast cancer who received endocrine therapy.Methods: Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2-4 occurred at six-month intervals, as many as 18 months after Time 1.Main Research Variables: Adherence, patient factors, and illness or treatment factors.Findings: Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time.Conclusions: Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy.Implications for Nursing: Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.