Uptake And Long-Term Adherence To Adjuvant Endocrine Therapy Among Women With Hormone Receptor Positive Breast Cancer In Baoding City

Objective: To investigate the status of uptake and long-term adherence to adjuvant endocrine therapy among women with HR positive breast cancer,analysis the factor associated which compliance,in order to promote the application of adjuvant endocrine therapy in breast cancer patients in Bao Ding City.Methods: Retrospective questionnairesPatients with HR positive breast cancer,who underwent surgical treatment in Baoding No.1 Center Hospital from Jan 1st 2007 to Dec 31 st 2014,were followed up retrospectively.1 Referencing to materials,the questionnaires was unified.And then,the data was collected through looking up medical recorders,such as patients’ information,contact information,sociological factors,pathological staging,basic treatment,combined disease and suggested endocrine drug,etc.,fill in follow-up tables for numbering.2 The telephone follow up was carried out by two doctors special in breast cancer.The content of follow-up included with the ET and review,the drug dosage,medication time and medical order,drug occupation ratio,understanding of the adverse drug reaction,influencing factors,etc.Telephone follow-up was carried out during 10:00 to 11:40 am,16:00 to 19:00 pm during Monday to Sunday.Every telephone follow-up was repeated four times at different time of different day.The case was lost to follow-up until failed to connecting.The deadline of fellow-up was December 31,2015.3 The main end point was uptake ratio and early discontinuation ratio,respectively.The data were analyzed by SPSS 22.0 statistical software,the enumeration data were tested using χ2 test,with the significance at α test level = 0.05(double test).Results:1 A total of 473 patients were enrolled and 415 cases were successfully followed up,accounting for 87.74%.Among of the 415 patients,4 males and 377 females were included.2 Uptake of adjuvant endocrine therapy agents was 83.6%(347/415).Total 68(16.4%,68/415)patients didn’t undergo endocrine therapy,the reasons are without doctors’ notification(50.0%),patients’ indifference(35.3%),economic difficulties(11.8%)and without medical order for combined disease(2.9%).3 Without considering the cases without doctors’ notification.The remaining 381 cases were suggested undergoing postoperative adjuvant endocrine therapy,as the research objects of compliance in-commission rate.Single factor analysis showed that,menopausal status(P=0.010),educational status(P=0.039),Traffic convenience(P=0.005),initial department is Breast Department(P<0.001),the doctors’ intensive education(P<0.001),adjuvant chemotherapy(P=0.001),postoperative radiotherapy(P=0.001),family per capital monthly income of more than 3000 yuan(P=0.003),Hospital expense insurance reimbursement(P<0.001),outpatient payment can be reimbursed(P=0.007),were positively correlated with adjuvant endocrine therapy,has statistical significance.Logistic multivariate analysis,menopausal status(P=0.048),initial department is Breast Department(P=0.047),Hospital reimbursement(P=0.039),positively correlated with adjuvant endocrine therapy,were Independent influencing factors of patient accept treatment.4 Among of the 381 cases who were suggested undergoing the therapy,280 cases appeared well compliance without early discontinuation.Early discontinuation not according to doctor’s advice was 101 cases.The rate of early discontinuation,form the first to the fifth year,were 21.2 %,27.5 %,34.7 %,44.8 %,52.2 %,respectively.5.A single factor analysis of early withdrawal is related to place of residence(P=0.028),educational status(P=0.010),traffic convenience(P<0.001),re-examination support of accompany family member(P<0.001),follow-up hospital(P<0.001),review the doctor(P<0.001),reexamination interval(P<0.001),initial department(P=0.017),the doctors’ intensive education(P<0.001),postoperative radiotherapy(P<0.001),person income(P=0.001),family income(P<0.001),hospitalization payment(P<0.001),outpatient payment(P<0.001).Logistic multivariate analysis showed that four factors,including the follow-up hospital as the original operation hospital(P=0.025),re-examination interval(less than 6 months)(P<0.001),the doctors’ intensive education before discharge(P=0.005),were positively associated with postoperative endocrine therapy and were the independent factor that affects the patient’s adjuvant endocrine therapy.Conclusions:1 The rate of application of endocrine therapy in patients with ER/PR positive breast cancer in Baoding city is slightly low and the long-term medication adherence was poor.2 Essential measures of improving the application rate and compliance include promoting the construction of mammary glands,strengthening the training of medical personnel,and improving patient education.3 It is important to focus on patients with post-menopause,nonradiotherapy,low degree education,irregular review and financial difficult,which will improve the uptake and long-term compliance of adjuvant endocrine therapy.