摘要/Abstract
摘要： 目的 ·了解个案管理模式下老年乳腺癌患者 ( ≥ 65岁 )治疗依从性现状，探讨人口学和疾病相关资料对其依从性的影响。方法 ·选取 2013年 3月至 2016年 8月在上海交通大学医学院附属瑞金医院治疗并术后接受个案管理模式的老年乳腺癌患者 654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诊疗（ multi-disciplinary treatment，MDT）方案的依从性；采用 χ2检验分析患者人口学和疾病相关资料对整体治疗依从性的影响，并将有统计学意义的因素纳入 Logistic回归模型，进一步分析老年患者治疗依从性及其影响因素。结果 ·入选患者中 603例（92.20%）需要一种或多种辅助治疗，患者对综合辅助治疗依从性为 88.05%；MDT方案中 45.94%、45.61%、80.93%和 12.94%的患者分别需要接受化学治疗（化疗）、放射治疗（放疗）、内分泌治疗和靶向治疗，患者对上述治疗的实际依从性分别为 91.34%、88.73%、93.65%（中位时间 44.16个月）和 82.05%。根据老年乳腺癌患者需要接受综合治疗种类分析，发现接受 1种、2种、3种、4种治疗的依从性分别为 94.30%，83.68%，87.20%，60.00%；对人口学和疾病相关资料进行分析，显示年龄和患者进行的综合治疗种类是影响老年乳腺癌患者术后综合辅助治疗依从性的重要影响因素（均 P<0.05）；再者，患者文化程度是影响其化疗和放疗单项治疗依从性的因素（ P<0.05）；此外，患者淋巴结转移情况是化疗依从性的影响因素（ P<0.05）。结论 ·个案管理模式有助于提高老年乳腺癌患者辅助治疗依从性。进一步提高老年患者辅助治疗依从性尤其需要关注年龄 > 74岁、文化程度较低、淋巴结阴性以及需要接受综合治疗种类较多的患者。
关键词: 老年乳腺癌, 多学科诊疗, 治疗依从性, 个案管理
Abstract:
Objective · To investigate the current status of adjuvant therapy compliance in elderly breast cancer patients ( ≥ 65 years old) attended the case-management model and to analyze the impact of demographic characteristics and clinical features on adjuvant therapy compliance. Methods · This study enrolled 654 elderly early breast cancer patients who were treated in Ruijin Hospital and subsequently accepted case-management model between March 2013 and August 2016. Data on patients’ compliance to adjuvant therapies which were designedmultidisciplinary treatment (MDT) were collected. The correlation of patients’ adjuvant therapy compliance with demographic characteristics and clinical features were evaluated using χ2 test. The statistically significant variables were taken and the corresponding impact on adjuvant therapy compliance were further analyzed using multiple Logistic regression model. Results · In this study, 603 (92.20%) elderly breast cancer patients were treated with one or a combination of adjuvant therapies according to MDT discussion/recommendation. Overall patients’ compliance to adjuvant therapy was 88.05%. 45.94% patients were required adjuvant chemotherapy, of which 91.34% patients complied in reality; 45.61% patients were required adjuvant radiotherapy, of which 88.73% patients complied in reality; 80.93% patients were required adjuvant endocrine therapy, of which 93.65% (median treatment duration 44.16 months) patients complied in reality; 12.94% patients were required adjuvant targeted therapy, of which 82.05% patients complied in reality.number of adjuvant therapies that elderly early breast cancer patients were required, patients’ compliance to one, two, three and four adjuvant therapies amounted to 94.30%, 83.68%, 87.20% and 60.00% respectively. The results analysis of demographic characteristics and clinical features revealed that, age and number of adjuvant therapies had significant impact on adjuvant therapy compliance in elderly breast cancer patients (P<0.05). Furthermore, patients’ education level showed strong correlation with patients’ compliance to adjuvant chemotherapy and adjuvant radiotherapy (P<0.05). Additionally metastasis to lymph nodes impacted on patients’ compliance to adjuvant chemotherapy (P<0.05). Conclusion · Case-management model is beneficial to improve adjuvant therapy compliance after surgery in elderly breast cancer patients. To further increase patients’ compliance, more efforts should be invested to help patients older than 74 years old, with lower education level, negative lymph nodes and more types of comprehensive treatment.
Key words: elderly breast cancer, multi-disciplinary treatment, treatment compliance, case-management
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