Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis.
Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis.
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DOI：
10.1093/annonc/mdv590
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Cuzick J
中科院分区：
文献类型：
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作者：
Smith SG;Sestak I;Forster A;Partridge A;Side L;Wolf MS;Horne R;Wardle J;Cuzick J
在这篇关于乳腺癌预防治疗决策研究的系统综述中，我们观察到所有药物的低吸收率和较差的长期持久性。我们的荟萃分析包括21000多名妇女，结果表明，6名符合条件的妇女中只有1人决定采取预防性治疗。5年的持续时间较低，限制了这些妇女的预防效果。对于乳腺癌风险增加的女性来说，预防性治疗是一种降低风险的选择。预防治疗的有效性，以减少乳腺癌的发病率取决于适当水平的吸收和坚持治疗。我们的目的是系统地回顾报道在高风险妇女中使用和坚持使用治疗药物来预防乳腺癌的文章，并确定影响这些结果的心理、临床和人口因素。在PubMed、CINAHL、EMBASE和PsychInfo中进行检索，得到3851篇独特的文章。标题、摘要和全文筛选，共53篇，再从参考文献列表中筛选出4篇研究，共计57篇。本综述在PROSPERO进行了前瞻性注册（CRD42014014957）。一项荟萃分析纳入了24篇文章，报道了21423名妇女的26项摄取研究。合并摄取估计为16.3%[95%置信区间（CI） 13.6-19.0]，异质性高（I2 = 98.9%, P < 0.001）。摄取不受研究地点或药物的影响，但在试验环境中[25.2% (95% CI 18.3-32.2)]显著高于在非试验环境中[8.7% (95% CI 6.8-10.9)] （P < 0.001）。与高摄取相关的因素包括活检异常、医生建议、较高的客观风险、较少的副作用或试验关注以及年龄较大。第一年的依从性（每天使用或坚持）是足够的。然而，只有一项研究报告了5年的持久性≥80%。与较低依从性相关的因素包括他莫昔芬（相对于安慰剂或雷洛昔芬）、抑郁、吸烟和年龄较大。所有的定性研究都讨论了乳腺癌的风险。预防乳腺癌治疗剂的使用率很低，长期服用往往不足以使妇女体验到充分的预防效果。在试验中，摄取率较高，这表明进一步的工作应侧重于在常规护理中实施预防性治疗。
In this systematic review of studies investigating decision-making in the context of breast cancer preventive therapy, we observed low uptake of all agents and poor long-term persistence. Our meta-analysis including over 21 000 women demonstrated that only 1 in 6 eligible women decided to take preventive therapy. Persistence for 5 years was low, limiting the preventive effect in these women. Preventive therapy is a risk reduction option for women who have an increased risk of breast cancer. The effectiveness of preventive therapy to reduce breast cancer incidence depends on adequate levels of uptake and adherence to therapy. We aimed to systematically review articles reporting uptake and adherence to therapeutic agents to prevent breast cancer among women at increased risk, and identify the psychological, clinical and demographic factors affecting these outcomes. Searches were carried out in PubMed, CINAHL, EMBASE and PsychInfo, yielding 3851 unique articles. Title, abstract and full text screening left 53 articles, and a further 4 studies were identified from reference lists, giving a total of 57. This review was prospectively registered with PROSPERO (CRD42014014957). Twenty-four articles reporting 26 studies of uptake in 21 423 women were included in a meta-analysis. The pooled uptake estimate was 16.3% [95% confidence interval (CI) 13.6–19.0], with high heterogeneity (I2 = 98.9%, P < 0.001). Uptake was unaffected by study location or agent, but was significantly higher in trials [25.2% (95% CI 18.3–32.2)] than in non-trial settings [8.7% (95% CI 6.8–10.9)] (P < 0.001). Factors associated with higher uptake included having an abnormal biopsy, a physician recommendation, higher objective risk, fewer side-effect or trial concerns, and older age. Adherence (day-to-day use or persistence) over the first year was adequate. However, only one study reported a persistence of ≥80% by 5 years. Factors associated with lower adherence included allocation to tamoxifen (versus placebo or raloxifene), depression, smoking and older age. Risk of breast cancer was discussed in all qualitative studies. Uptake of therapeutic agents for the prevention of breast cancer is low, and long-term persistence is often insufficient for women to experience the full preventive effect. Uptake is higher in trials, suggesting further work should focus on implementing preventive therapy within routine care.