Analysis Of The Status Of Adjuvant Endocrine Therapy Compliance In Patients With Hormone Receptor-positive Breast Cancer

BackgroundBreast cancer is the most common cancer among women in the world.Although the incidence of breast cancer in Asia is lower than in Europe and the United States,the annual incidence of breast cancer in China is increased by 3%every year.Endocrine therapy such as tamoxifen(TAM)and aromatase inhibitor(AI)are important components of hormone receptor-positive breast cancer treatment.Numerous studies have confirmed early breast cancer recurrence,metastasis and death can be significantly reduced by adjuvant endocrine therapy.According to the National Comprehensive Cancer Network(NCCN)guidelines,adjuvant endocrine therapy lasts for at least 5 years,and high-risk patients are extended to 10 years.Some studies have shown that patients who complete standard adjuvant endocrine therapy continue to have a reduced risk of recurrence after 5 years[1,2].However,in endocrine therapy for 5-10 years,the decrease in compliance is one of the main reasons for the effect of endocrine therapy.In the real world,the compliance rate of adjuvant endocrine therapy is about 47%-97%[3].The main reasons for affecting compliance are many aspects,such as age,complications,economic constraints,lack of guidance,and treatment options.The aim of this study was to evaluate the association between adjuvant endocrine therapy compliance and disease-free survival(DFS)in patients with hormone receptor-positive breast cancer.At the same time,we analyzed and assessed the reasons for the impact of compliance,and proposed a feasible strategy to improve compliance.Purpose1.To investigate the application of postoperative adjuvant endocrine therapy in patients with hormone receptor-positive breast cancer in the outpatient department of Qilu Hospital of Shandong University from 2011 to 2014,and to record the compliance of endocrine therapy.2.The main reasons for affecting compliance,and analyzing possible factors that influence compliance.3.Evaluate the efficacy of adjuvant endocrine therapy and analyze the association between adherence and DFS.4.Collect common adverse reactions,evaluate drug safety,provide evidence for strengthening the management of toxicity,guiding clinical drug supervision,and improving the effectiveness of endocrine therapy in patients with receptor-positive breast cancer.MethodsA retrospective analysis of patients with stage ?-? breast cancer who underwent postoperative adjuvant endocrine therapy at Qilu Hospital of Shandong University from 2011 to 2014.By collecting basic information and pathological data of patients,questionnaires were used for telephone follow-up or outpatient follow-up to understand the drug use,medication compliance and adverse reactions during treatment.In this study,we obtained a total of 307 patients.Logistic regression analysis was used to analyze the demographic characteristics,pathological features,adverse reactions,and factors affecting adjuvant radiotherapy and compliance.Kaplan-Meier curves and log-rank tests were used to assess the relationship between medication adherence and disease-free survival.In addition,during the follow-up,the gynecological color ultrasound data of patients with endometrial thickening and toremifene(TOR)using TAM were collected and analyzed to understand the difference in the effect of TAM and TOR on the endometrium.ResultsOf all 307 patients with receptor-positive breast cancer,236 patients completed standard adjuvant endocrine therapy,accounting for 76.8%.The adherence rate of adjuvant endocrine therapy gradually decreased with the prolongation of medication time.The compliance rates from the first year to the fifth year were 96.4%,89.2%,83.1%,78.2%.and 70.7%%There is a difference in treatment adherence between different drugs,and compliance with TAM treatment is worse than AI.108 patients completed 7 years of TAM-assisted endocrine therapy,accounting for 71.5%.81 patients with AI treatment,accounting for 80.2%.The main reasons for discontinuation of treatment include:the occurrence of side effects,lack of knowledge about drugs,concerns about side effects,and conscious healing.Using logistic univariate analysis,we found that the possible influencing factors of poor adherence included low education and poor tolerance during treatment,and that receiving radiation therapy was associated with greater compliance.After all factors were included in the multivariate analysis to exclude age and tumor grade interference factors,we found adverse reactions were protective factors for compliance(OR 1.519;95%CI 1.138-1.764;p = 0.024),and poor tolerance was a risk factor for compliance(OR 0,924;95%CI 0.005-0.198;p=0.031)Both are independent factors of compliance.Patient's age.occupation,place of residence,combined disease,tumor size,and lymph node metastasis were not associated with compliance.Kaplan-Meier survival curve analysis showed that patient compliance was associated with disease-free survival,and the difference was statistically significant(p<0.05).In the TAM group,the most common adverse reaction was endometrial thickening,a total of 64 cases were observed,accounting for 42.4%.In the AI group,the most common adverse reaction was joint muscle pain.A total of 55 cases were observed,accounting for 54.5%.ConclusionThe reduction of compliance will have an impact on disease-free survival.Clinicians should strive to strengthen1.The compliance of adjuvant endocrine therapy in patients with hormone receptor-positive breast cancer is generally poor,and clinicians and nurses need to strengthen medication guidance and supervision to further improve compliance.2.The low level of education and poor tolerance of treatment are the influencing factors of compliance.Patients with postoperative adjuvant radiotherapy have better compliance.3.Reduced compliance will have an impact on disease-free survival.4.Tne most common adverse reaction of TAM is endometrnial thickening.The most common adverse reaction of AI is joint muscle pain.