胃癌患者术后替吉奥治疗的依从性及其影响因素

Adherence and its influencing factors of tegafur,gimeracil and oteracil potassium treatment in patients with gastric cancer after operation

目的探究胃癌TNM(肿瘤-淋巴结-远端转移)Ⅲ期患者术后替吉奥(S-1)治疗的依从性及其影响因素。方法收集南京中医药大学第二附属医院2018年10月至2022年4月胃癌Ⅲ期术后口服S-1治疗的成人患者病历,根据其S-1治疗相关记录,对这些患者S-1治疗的依从性及相关因素进行回顾性分析。依从性好定义为患者在186 d内完成了8个周期(连续用药14 d、停药7 d为1个周期)的S-1治疗。将患者分为S-1治疗依从性好和差2组,对影响患者依从性的因素进行单因素和多因素分析。结果共有148例患者纳入研究,男性116例(78.4%),女性32例(21.6%);中位年龄67(27~85)岁。69例(46.6%)患者依从性好,在设定时间内完成了≥8个周期的S-1治疗;79例(53.4%)依从性差。79例患者中断或未如期完成治疗的原因分别为严重不良反应30例(38.0%),患者拒绝治疗27例(34.2%)和疗效不佳22例(27.8%)。单因素和多因素logistic回归分析结果显示,对疾病的认知为"不了解"或"一知半解"[比值比(OR)=5.368,95%置信区间(CI):1.488~19.370,P=0.010;OR=3.393,95%CI:1.309~8.793,P=0.012]、胃癌病程为<1年(OR=10.214,95%CI:2.400~43.472,P=0.002)和TNMⅢa(OR=3.879,95%CI:1.522~9.886,P=0.005)是胃癌患者S-1治疗依从性低的独立影响因素。结论胃癌Ⅲ期患者术后S-1治疗依从性好的患者不足一半。患者对疾病的认知度低、胃癌病程短和胃癌Ⅲa期是患者S-1治疗依从性低的独立影响因素。增加患者对疾病的认知度,加强患者教育可能是改善S-1治疗依从性的重要策略。

Objective To explore the adherence and its influencing factors of tegafur,gimeracil and oteracil potassium(S⁃1)treatment in patients with tumor⁃node⁃metastasis(TNM)stageⅢgastric cancer after operation.Methods Medical records of adult patients with stageⅢgastric cancer after operation in the Second Affiliated Hospital of Nanjing University of Chinese Medicine from October 2018 to April 2022 and treated with oral S⁃1 were collected,and the S⁃1 adherence and its related factors in these patients were retrospectively analyzed according to their S⁃1 treatment information.Good adherence was defined as completing 8 cycles of S⁃1 treatment within 186 days(14 days of continuous medication and 7 days of discon⁃tinuation as 1 cycle).The patients were divided into good and poor S⁃1 adherence groups.Univariate and multivariate logistic regression analysis were performed to analyze the factors affecting S⁃1 adherence of patients.Results A total of 148 patients were entered in the study,including 116 males(78.4%)and 32 females(21.6%),with a median age of 67(27⁃85)years.Sixty⁃nine patients(46.6%)completed≥8 cycles of S⁃1 treatment within the set time and had good adherence;79(53.4%)patients had poor adherence.The reasons for interruption or failure to complete treatments as scheduled in the 79 patients were serious adverse reactions in 30(38.0%)patients,refusal to treat in 27(34.2%)patients,and poor curative effect in 22(27.8%)patients.Univariate and multivariate logistic regression analysis showed that lack of or partial understanding of the disease[odds ratio(OR)=5.368,95%confidence interval(CI):1.488-19.370,P=0.010;OR=3.393,95%CI:1.309-8.793,P=0.012],gastric cancer with a course of less than 1 year(OR=10.214,95%CI:2.400-43.472,P=0.002),and TNM stageⅢa(OR=3.879,95%CI:1.522-9.886,P=0.005)were the independent influencing factors of poor adherence to S⁃1 treatment in patients with gastric cancer.Conclusions Less than half of the gastric cancer patients with stageⅢafter operation had good adherence to S⁃1 treatment.Insufficient understanding of the disease,short duration of gastric cancer,and TNM stageⅢa were independent influencing factors for poor adherence to S⁃1 treatment in gastric cancer patients.Increasing patients′understanding of the disease and strengthening patient education may be important strategies to improve S⁃1 treatment compliance.