Baseline Symptoms and Adherence to Oral Breast Cancer Therapy among Older Women

对于每年患激素受体阳性乳腺癌的20万名老年女性来说，辅助剂 内分泌治疗(AET)至少五年可提高总存活率。然而，几乎一半的患者开出了 AET没有吃完他们所有的药。在这一环境和其他一些环境中进行基于教育和提醒的研究 对坚持的影响小得令人失望，事实证明，更复杂的干预措施很难 坚持下去。在这项建议中，我们寻求更好地了解女性所描述的主要症状 遵守AET的障碍。我们借鉴了先前的研究表明，先前存在的症状可能会对 在患者使用AET过程中的重要作用。我们的建议通过以下方式填补了我们理解中的关键空白 检查在常规护理实践中接受治疗的较年长和较少选择的受试者，并使用 已经在美国各地例行收集了。具体地说，我们将使用国家综合 癌症网络的痛苦温度计(DT)及其附带的问题列表，以前曾 显示出患有乳腺癌的老年女性的高负担症状，但尚未出现 与AET联合检查或同时考虑老年人广泛的共病情况 女人。大多数癌症中心在诊断或早期护理时都会管理DT和问题清单，从而增加他们的 通知早期干预的价值，以帮助妇女继续进行AET。我们将调查DT是否 和问题清单是老年妇女停止使用AET的预测，具体目标如下： 1研究诊断时患者报告的痛苦与早期停药的关系。 艾特。我们将利用一组发生绝经后激素受体事件的电子健康记录数据 阳性乳腺癌患者检查诊断时测量的DT(评分0至10)的相关性 在事件发生时间分析中停用AET，考虑了年龄、骨关节炎和其他并发症， 以及其他乳腺癌治疗方法。目的2.探讨患者报告的症状与 AET停药后的诊断。在相同的群体中，使用相同的一般方法，我们将 探讨AET停用和a)患者根据DT问题列表报告的总症状计数)和b) 症状群(如疲劳、睡眠、注意力集中)。我们将同时使用标准回归和创新的 贝叶斯加性回归树在机器学习中的应用使用这种方法，我们将生产 可立即采取行动的发现，通过提供识别高风险的方法来改善遵从性结果 患者是开发新干预措施的主要目标。这也可能是一个重要的 老年患者接受积极治疗方案治疗的其他情况的模型，为护理提供信息 适用于大量老年患者。

For the >200,000 older women who develop hormone receptor positive breast cancer yearly, adjuvant endocrine therapy (AET) for at least five years increases overall survival. Yet almost half of patients prescribed AET fail to take all their pills. Education- and reminder-based studies in this and a number of other settings have had disappointingly small effects on adherence, and more complex interventions have proven difficult to sustain. In this proposal we seek a better understanding of the symptoms that women describe as major barriers to AET adherence. We draw on prior research suggesting that preexisting symptoms may play an important role in patients’ experience with AET. Our proposal fills crucial gaps in our understanding by examining older and less selected subjects treated in a usual care practice, and by using a measure that is already routinely collected across the United States. Specifically, we will use the National Comprehensive Cancer Network’s Distress Thermometer (DT) and its accompanying problem list, which have previously been shown to reveal a high burden of symptoms among older women with breast cancer but have not been examined in association with AET or while accounting for the wide spectrum of comorbid conditions of older women. Most cancer centers administer the DT and problem list at diagnosis or earlier in care, increasing their value for informing early intervention to help women continue their AET. We will investigate whether the DT and problem list are predictive of AET discontinuation among older women, with specific aims as follows: Aim 1 To examine the association of patient-reported distress at diagnosis with early discontinuation of AET. We will utilize electronic health record data from a cohort of incident postmenopausal hormone receptor positive breast cancer patients to examine the association of the DT (scored 0 to 10) measured at diagnosis with AET discontinuation in time-to-event analyses, accounting for age, osteoarthritis, and other comorbidities, and other breast cancer treatments. Aim 2. To explore the association of patient-reported symptoms at diagnosis with discontinuation of AET. In the same cohort and using the same general approach, we will explore AET discontinuation and a) patient-reported overall symptom count based on DT problem list) and b) symptom clusters (e.g., fatigue, sleep, concentration). We will use both standard regression and an innovative application of machine learning using Bayesian Additive Regression Trees. With this approach, we will produce immediately actionable findings to improve adherence outcomes, by providing a means of identifying high-risk patients who are the primary targets for the development of new interventions. It could also be an important model for other conditions that are treated with aggressive treatment regimens in older patients, informing care for a large number of older patients.