个案管理模式下乳腺癌病人辅助内分泌治疗依从性分析

Compliance analysis of adjuvant endocrine therapy for breast cancer patients under case management mode

目的分析个案管理模式下乳腺癌病人术后辅助内分泌治疗服药依从性的现状及影响其依从性的相关因素。方法2013年6月~2017年7月在我院治疗并术后接受个案管理模式的需辅助内分泌治疗的乳腺癌病人2072例,收集人口学和疾病相关资料,分析其对多学科专家集体制定(multi-disciplinary treatment,MDT)内分泌服药方案的依从性,采用χ2检验分析病人人口学资料和疾病相关因素对辅助内分泌治疗服药依从性的影响。采用Logistic回归分析其影响因素。结果2072例乳腺癌病人5年间的辅助内分泌治疗依从性分别99.61%、98.69%、97.38%、94.65%、84.51%。服药中位时间(33.5±15.55)个月。对人口学和疾病相关资料进行分析显示,年龄、文化程度、肿瘤分期(TNM分期)、服药年限对服药依从性有影响(P<0.05)。结论个案管理模式有助于提高乳腺癌术后辅助内分泌治疗病人的服药依从性,进一步提高乳腺癌术后辅助内分泌治疗的服药依从性,尤其需要关注年龄≥65岁、肿瘤分期较早和服药年限>3年的病人。

Objective To investigate the current status of postoperative adjuvant endocrine therapy compliance in breast cancer patients attended the case management model,and to discuss the factors affecting their compliance. Methods From June 2013 to July 2017,this study enrolled 2072 breast cancer patients who received case management and accepted adjuvant endocrine therapy at Ruijin Hospital. Demographic characteristics and disease-related features were collected. Chi-square test was used to analyze the impact of these data on patients’ compliance on the endocrine therapy designed by multidisciplinary treatment( MDT). The statistically significant variables were further analyzed by logistic regression to fine out its corresponding impact level. Results The 5-year follow-up of adjuvant endocrine therapy,with a median time of( 33. 55 ± 15. 55) months,the compliance of 2 072 breast cancer patients was 99. 61%,98. 69%,97. 38%,94. 65% and 84. 51%,respectively. The results of analysis showed that age,education,tumor stage( TNM stage) and the duration of endocrine therapy,all have statistically significant influence on therapy compliance( P < 0. 05). Conclusion The case management model is helpful to improve the adjuvant endocrine therapy compliance after breast cancer surgery. To further improve the therapy compliance,more attention should be paid to the patients older than 65,taking endocrine medicine over 3 years and early tumor stage.