| Aims1. To investigate urban-rural disparity and characterized the factors influencing adjuvant chemotherapy compliance in breast cancer patients.2. To examine the role of comprehensive nursing intervention on the chemotherapy compliance and psychological status in breast cancer patients.Parti Urban-rural disparity and factors associated with chemotherapy compliance in patients with breast cancerMethodsA total of 2139 breast cancer patients who were diagnosed and treated in Qilu hospital from Jan 1997 to Dec 2011 were enrolled in our study, with 823 rural and 1316 urban patients. We applied Chi-square analysis to identify significant disparities between rural and urban populations.To further explore the factors influencing adjuvant chemotherapy compliance in our patients,1431 were further confirmed to be the patients who should have received adjuvant chemotherapy according to NCCN guidelines and St.Gallen International Breast Cancer Conference.ResultsSignificant rural-urban disparities were found in age at diagnosis (p= 0.0004), history of breast cancer (p= 0.0187) and reason for visiting a doctor (p< 0.0001) among all demographic variables. Rural patients tend to larger tumor size (p< 0.0001) and more metastatic lymph nodes (p< 0.0001) than urban patients. After comparing the surgical procedure preference between rural and urban dwellers, we found that 32.1% patients received radical mastectomy,61.7% received modified radical mastectomy and only a little fraction of 4.0% received breast conserving surgery among patients dwell in rural areas; while 22.9% patients received radical mastectomy, 66.3% received modified radical mastectomy and 9.0% received breast-conserving surgery among patients dwell in cities. Further study showed that receipt of chemotherapy was significantly associated with age at diagnosis and lymph node status of patients. Notably, the rate of patients received adjuvant chemotherapy was significant lower in rural patients(61.15%) than urban patients(67.38%)(p= 0.021).Conclusions1. Differences in rural-urban breast cancer patients, such as age of marriage, histoiy of breast cancer, and reason for visiting a doctor exist in China. Patients in rural area tend to suffer more aggressive tumor histology, larger tumor size and more metastatic lymph nodes, which resulted in the poor prognosis of rural patients.2. Age of diagnosis, history of chemotherapy, lymph node status were important factors influencing the receipt of adjuvant chemotherapy in breast cancer patients.Part Ⅱ The role of comprehensive nursing intervention on chemotherapy compliance in patients with breast cancerMethodsA total of 144 breast cancer patients who were diagnosed and treated in Qilu hospital from May 2014 to May 2015 were involved in the study. All the patients received postoperative adjuvant chemotherapy and were randomly divided into two groups (control group and intervention group). The control group received general nursing, and the intervention group received extra psychological intervention, continuous nursing and synchronous education of family members, in addition to general nursing.ResultsOur results showed that comprehensive nursing intervention could significantly improve the patients" chemotherapy compliance (control group:20%; intervention group:40%:p< 0.0001). Comprehensive nursing intervention could dramatically reduce the negative mental emotion and improve the psychological status of breast cancer patients.Compared with the control group, the rate of terrified and nervous was reduced significantly in the intervention group (p= 0.0010 and p< 0.0001, respectively). The intervention group patients are prone to feel more funny and happy than the control group (p= 0.0010 and p= 0.0013, respectively). However, we did not find significantly difference in bother or reading between the two groups (p= 0.9050 and p = 0.0840, respectively).ConclusionComprehensive nursing intervention such as psychological intervention, continued-nursing and synchronous education on family members could significantly improve the compliance of adjuvant chemotherapy, the psychological status and life quality of breast cancer patients. Our results imply that comprehensive nursing intervention could improve the therapeutic efficacy and prognosis for breast cancer, which is worth recommended for popularizing in clinical practice. |
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