Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer
Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer
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DOI：
10.1200/jco.2003.07.071
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发表时间：
2003-02-15
影响因子：
45.3
通讯作者：
Avorn, J
中科院分区：
文献类型：
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作者：
Partridge, AH;Wang, PS;Avorn, J
目的：尽管临床试验已经清楚地证明了他莫昔芬对原发性乳腺癌患者的益处，但人们对这种药物在普通人群中的实际使用情况知之甚少。我们试图估计妇女开始他莫昔芬作为辅助乳腺癌治疗的依从性和不依从性的预测因素。患者和方法：研究对象为年龄在50岁或以上，开始使用他莫昔芬治疗原发性乳腺癌，并在1990年至1996年的研究期间参加了新泽西州的医疗补助计划或老年人和残疾人药物援助计划（N = 2378）。主要结果测量指标是在治疗的第一年使用他莫昔芬处方的天数，以及在开始服用他莫昔芬后的4年，这是依从性好与依从性差的预测指标。结果：23%的患者在超过五分之一的研究天数中没有服用他莫昔芬，尽管平均而言，患者在第一年的治疗中有87%的时间服用了他莫昔芬。最年轻、最年长、非白人和乳房切除术患者的坚持率明显较低；在服用他莫昔芬之前看过肿瘤科医生的患者有明显更高的依从率。到治疗第4年，总体依从性下降到50%。结论：与其他慢性药物相比，他莫昔芬的平均依从性较高。然而，由于依从性差，近四分之一的患者可能面临临床反应不足的风险。由于他莫昔芬治疗在预防早期乳腺癌妇女复发和死亡方面的有效性，有必要进一步努力确定和。防止非最佳依从性。
Purpose : Although clinical trials have clearly demonstrated the benefits of tamoxifen in women with primary breast cancer, little is known about how this drug is actually used in the general population. We sought to estimate adherence and predictors of nonadherence in women starting tamoxifen as adjuvant breast cancer therapy.Patients and Methods: Subjects were age IS years or older initiating tamoxifen for primary breast cancer and enrolled in New Jersey's Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs during the study period, from 1990 to 1996 (N = 2,378). Main outcome measures were number of days covered by filled prescriptions for tamoxifen in the first year of therapy with the 4 years after tamoxifen initiation for a subset, predictors of good versus poor adherence.Results: Twenty-three percent of patients missed taking tamoxifen on more than one fifth of days studied, although on average, patients filled prescriptions for tamoxifen for 87% of their first year of treatment. The youngest, oldest, nonwhite, and mastectomy patients had significantly lower rates of adherence; patients who had seen an oncologist before taking tamoxifen had significantly higher rates of adherence. Overall adherence decreased to 50% by year 4 of therapy.Conclusion: The mean level of adherence to tamoxifen is high compared with other chronic medications. However, nearly one fourth of patients may be at risk for inadequate clinical response because of poor adherence. Because of the efficacy of tamoxifen therapy in preventing recurrence and death in women with early-stage breast cancer, further efforts are necessary to identify and. prevent suboptimal adherence.