Study On The Compliance Of Endocrine Therapy In Postmenopausal Breast Cancer Patients

Objective: Breast cancer is ranking the first in morbidity and fifth in mortality for female's cancer in China.At present,the main treatment of breast cancer is surgery,chemotherapy and radiotherapy,endocrine therapy and targeted therapy are added according to the pathological conditions.Endocrine therapy is more easily accepted by patients because of its more efficacy and less side effects.There are many factors that influence the effect of endocrine therapy,and foreign studies show that patients with good compliance to endocrine therapy can make good prognosis,on the contrary,bad prognosis.However,there are few studies on the compliance to endocrine therapy in China,and most of them are small samples,short-term follow-up studies,lack of follow-up study of 5 years or more.Nowadays,with the aging of population in our country,the incidence of postmenopausal breast cancer has been increasing year by year,and the quality of life and prognosis of patients with postmenopausal breast cancer have been paid more and more attention.Therefore,the research on postmenopausal endocrine therapy for breast cancer patients were investigated to understand the status of compliance to endocrine therapy,to analyze the factors influencing to compliance,and then to provide a certain evidence to protect the effect of endocrine therapy.Method: Patients who underwent surgical treatment from January 1,2010 to December 31,2011 in the fourth hospital of Hebei Medical University were confirmed by pathological examination and had complete data.The questionnaire was completed by phone call or face-to-face follow-up,which including the general condition of patients(including age,marital status,occupation,residence type,whether to live with their children,education level,economic level,medical forms,life can take care of themselves,can adhere to the review,if combined with other chronic diseases),treatment(includingsurgery,AJCC staging,ER and PR(++/+-/-+),oral drug adverse reactions)and compliance(duration,whether to understand the purpose and course of endocrine therapy whether medication,medication,do not forget to stop more than 1 months,with other drugs and health care products,is willing to substitute medication adherence to treatment end).Good compliance standards set as follows:(1)the doctor recommended taking drugs;(2)taken in accordance with the provisions of the dose;(3)the duration of time,more than4 years;(4)missed rate <20%,<6 days / month;(5)to adhere to the end of the treatment(not yet completed 5 years patient).Univariate analysis was used to analyze the factors that might influence the compliance of patients with endocrine therapy,and the2? test was used,and then the univariate regression analysis was performed by Logistic regression analysis.Result: From January 1,2010 to December 31,2011,689 cases of postmenopausal breast cancer patients were in line with the inclusion criteria.547 cases were followed up with the rate 79.39%.There were 67 patients died during the follow up and there were 4 patients refused to answer the investigation.The success rate of the questionnaire was about 87.02%(476/547).The compliance of the 476 cases from the first to the fifth year during the period taking the endocrine medication were 85.92%,82.35%,76.89%,68.07%,50.63% respectively.Endocrine therapy was not performed by 35 cases,accounting for the proportion of follow-up of 7.35%.Related factors to the compliance to Endocrine therapy as follow:1 The type of residential,urban residents with good compliance(77.42%,216/279),higher than rural residents(64.47%,127/197,P=0.002).2 The level of education,junior college degree or above the highest compliance(81.82%,63/77),secondary education compliance center(78.53%,150/191),primary school and the degree of compliance of the minimum(62.50%,130/208),there was significant difference between the three(P=0.000).3 The compliance of urban medical insurance patients(78.23%,194/248)was higher than that of the new rural cooperative medical care(62.83%,120/191,P=0.001).4 Occupation,staff compliance highest(84.13% 53/63),non working staff compliance(75.61%,155/205),the minimum compliance(63.94%,133/208),there was significant difference between the three(P=0.001).5 Tamoxifen replacement patient compliance is the best combination of aromatase inhibitors(81.82%,27/33),aromatase inhibitors compliance center(78.15%,304/389),tamoxifen compliance is the worst(63.16%,12/19),no significant differences between the three groups(P= 0.260).6 The side effects of medication,the compliance of drug adverse reactions(69.79%,67/96)were lower than those without side effects(80.00%,276/345,P=0.033).7 Patient understanding of endocrine therapy: understanding the purpose and significance of endocrine therapy,to know whether the treatment,is willing to adhere to the schedule,periodic review,were statistically significant(P=0.000).8 The recurrence rate of patients with good compliance with endocrine therapy(4.01%,13/324)was lower than that of endocrine therapy(5.26%,8/152,P=0.536).9 There was no significant difference in age,marital status,combined with other diseases,whether to live alone,economic status,life can take care of themselves,the characteristics of the disease(surgery and pathological stage),P>0.05.Conclusion:1 The compliance of endocrine therapy in postmenopausal women with breast cancer decreased year by year,and the rate of taking medicine from the first year to the fifth year was 85.92%,82.35%,76.89%,68.07%,50.63%respectively.2 With higher education,living in urban areas,to enjoy medical insurance,for breast cancer disease and endocrine therapy meaning thoroughly,and can follow the completion of endocrine therapy schedule timing,quantitative order,and timely follow-up,the good compliance.3 No relationship was found between compliance and age,marital status,combined with other diseases,whether to live alone,economic status,life can take care of themselves,the characteristics of the disease itself(surgery and pathological staging)(P>0.05 all).4 There was no difference in the recurrence rate between patients with good compliance and poor endocrine therapy,which may be related to fewer follow-up cases and shorter follow-up time.The association between prognosis and compliance needs further follow-up observation.