Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis.
Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis.
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DOI：
10.1007/s10549-015-3471-7
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发表时间：
2015-07
影响因子：
3.8
通讯作者：
Irwin SA
中科院分区：
文献类型：
--
作者：
Mausbach BT;Schwab RB;Irwin SA
这项荟萃分析的目的是分析有关乳腺癌女性患者抑郁对不坚持辅助内分泌治疗(AET)的影响的现有证据。使用与AET依从性相关的术语搜索Medline和QicINFO数据库，从开始到2015年5月1日。根据预定的选择标准对文章进行综述和选择，并从纳入的研究中提取效应大小。使用随机效应荟萃分析获得合并效应估计。在确定的312篇文章中，有9篇符合纳入标准。总体而言，抑郁与不坚持AET显著相关(Cohen‘s d=0.35，95%CI 0.19-0.52)。患者年龄(<；65比≥65岁)、研究随访时间(<；18个月比≥18个月)或评估依从性的方法(客观与自我报告)并没有显著减缓这一效果。然而，在这些亚组中，只有较年轻的患者(d=0.46；95%可信区间0.19-0.72)和持续时间较短的研究(d=0.49；95%可信区间0.22-0.76)才发现抑郁的显著影响。这些结果表明，在抑郁症状较重的女性中，AET的依从性可能较低，在AET的早期阶段(<；18个月)，这种影响可能在年轻女性中加剧。乳腺癌女性患者抑郁症状的处理可能有助于提高对AET的依从性，并改善癌症治疗结果。
The purpose of this meta-analysis was to analyze the available evidence concerning the effects of depression on non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer. MEDLINE and PsycInfo databases from inception through May 1, 2015 were searched using terms related to AET adherence. Articles were reviewed and selected based on predetermined selection criteria, and effect sizes from included studies were extracted. Pooled effect estimates were obtained using random-effects meta-analyses. Of the 312 articles identified, 9 met the inclusion criteria. Overall, depression was significantly associated with non-adherence to AET (Cohen’s d = 0.35, 95 % CI 0.19–0.52). This effect was not significantly moderated by patient age (<65 vs ≥65 years), length of study follow-up (<18 months vs ≥18 months), or method of assessing adherence (objective vs self-report). However, within these subgroups, significant effects of depression were found only for younger patients (d = 0.46; 95 % CI 0.19–0.72) and in studies of shorter duration (<18 months) (d = 0.49; 95 % CI 0.22–0.76). These results suggest that AET adherence may be lower among women with greater depressive symptoms, and this effect may be exacerbated in younger women during the early phases (<18 months) of AET. Management of depressive symptoms in women with breast cancer may help in enhancing adherence to AET and improve cancer treatment outcomes.