内容紹介
Factors Affecting Adherence of Breast Cancer Patients to Adjuvant Hormonal Therapy and Validation of the Evaluation Method
Summary
Background: The long-term use of hormonal therapy is important for the treatment of patients with breast cancer. Therefore, we evaluated the methods used for measuring adherence and examined factors that influence compliance. Our goal was to improve overall adherence to the treatment. Methods: Retrospective analyses by using electronic medical records and questionnaires were performed on 294 patients with breast cancer. The patients were classified into 2 groups based on the mean number of days when a dose was missed over a period of 28 days: group A(range, 0-3 days, n=272)and group B(range, ≥4 days, n=22). Factors that may influence adherence, including age, duration of hormonal therapy, the drug administered in hormonal therapy, the surgical method, axillary lymph node dissection, and adjuvant chemotherapy, were compared between both groups. Results: The adherence rates calculated from electronic medical records and questionnaires were similar. The proportion of patients younger than 50 years was 30% in group A and 50% in group B(p<0.05). Additionally, there was a difference in the duration of hormone therapy(752 days vs 981 days in groups A and B, respectively; p<0.05). Additional factors that are related to low-risk cancer-related procedures, such as breast conserving surgery, may also be linked to poor adherence. Conclusion: Young age and long duration of hormonal therapy are possibly related to poor adherence. Therefore, pharmacists should identify and manage these patients to increase adherence.
要旨
背景: 乳癌術後ホルモン療法は長期間の内服を要するため,服薬アドヒアランスが重要となる。われわれは最初にアドヒアランスを評価し,次にその評価方法の妥当性を検証するとともにアドヒアランス低下に影響する因子の解析を行った。方法: 術後補助療法としてタモキシフェンあるいはアロマターゼ阻害薬を処方された294症例を対象に,電子カルテを用いた後ろ向き解析およびアンケート調査による確認を行った。28日間当たりの平均「服用忘れ日数」が0～3日をA群(272例),4日以上をB群(22例)として2群に分類し,アドヒアランス低下に影響を及ぼす因子(年齢,服薬期間,薬剤,術式,腋窩郭清の有無,補助化学療法の有無)を解析した。結果: A群は50歳未満の患者が30%であるのに対してB群では50%と,若年齢の割合が高かった(p<0.05)。ホルモン薬の平均投与期間はA群752日,B群981日であり,B群がより長期であった(p<0.05)。その他の因子として,乳房温存療法がA群68%に対してB群77%と多い傾向がみられた。考察: 服用忘れは若年齢や長期投与例で多い傾向を認め,また低リスク乳癌に関連する因子の影響も示唆された。
目次
Summary
Background: The long-term use of hormonal therapy is important for the treatment of patients with breast cancer. Therefore, we evaluated the methods used for measuring adherence and examined factors that influence compliance. Our goal was to improve overall adherence to the treatment. Methods: Retrospective analyses by using electronic medical records and questionnaires were performed on 294 patients with breast cancer. The patients were classified into 2 groups based on the mean number of days when a dose was missed over a period of 28 days: group A(range, 0-3 days, n=272)and group B(range, ≥4 days, n=22). Factors that may influence adherence, including age, duration of hormonal therapy, the drug administered in hormonal therapy, the surgical method, axillary lymph node dissection, and adjuvant chemotherapy, were compared between both groups. Results: The adherence rates calculated from electronic medical records and questionnaires were similar. The proportion of patients younger than 50 years was 30% in group A and 50% in group B(p<0.05). Additionally, there was a difference in the duration of hormone therapy(752 days vs 981 days in groups A and B, respectively; p<0.05). Additional factors that are related to low-risk cancer-related procedures, such as breast conserving surgery, may also be linked to poor adherence. Conclusion: Young age and long duration of hormonal therapy are possibly related to poor adherence. Therefore, pharmacists should identify and manage these patients to increase adherence.
要旨
背景: 乳癌術後ホルモン療法は長期間の内服を要するため,服薬アドヒアランスが重要となる。われわれは最初にアドヒアランスを評価し,次にその評価方法の妥当性を検証するとともにアドヒアランス低下に影響する因子の解析を行った。方法: 術後補助療法としてタモキシフェンあるいはアロマターゼ阻害薬を処方された294症例を対象に,電子カルテを用いた後ろ向き解析およびアンケート調査による確認を行った。28日間当たりの平均「服用忘れ日数」が0～3日をA群(272例),4日以上をB群(22例)として2群に分類し,アドヒアランス低下に影響を及ぼす因子(年齢,服薬期間,薬剤,術式,腋窩郭清の有無,補助化学療法の有無)を解析した。結果: A群は50歳未満の患者が30%であるのに対してB群では50%と,若年齢の割合が高かった(p<0.05)。ホルモン薬の平均投与期間はA群752日,B群981日であり,B群がより長期であった(p<0.05)。その他の因子として,乳房温存療法がA群68%に対してB群77%と多い傾向がみられた。考察: 服用忘れは若年齢や長期投与例で多い傾向を認め,また低リスク乳癌に関連する因子の影響も示唆された。