Fatores associados à persistência à terapia hormonal em mulheres com câncer de mama

Abstract

OBJECTIVETo analyze factors associated with persistence to breast cancer hormone therapy in order to contribute to the quality of care improvement.METHODSRetrospective longitudinal study, based on secondary data. A cohort of 5,861 women with breast cancer registered in different datasets of the Brazilian National Cancer Institute and the Brazilian Unified Health System were analyzed. All women were treated at this hospital, which provides free medication, and the follow-up period was from January 2004 to October 2010. Sociodemographic, behavioral, and clinical variables, as well as aspects of lifestyle and health care, were considered in the explanation of variations in the persistence to hormone therapy, applying the Kaplan-Meier method and the Cox proportional hazard model.RESULTSOverall persistence to hormone therapy was 79.0% at the end of the first year, and 31.0% in five years of treatment. The risk of discontinuing hormone therapy was higher among women under 35 years old, with more advanced disease (stages III and IV), alcohol drinkers, those undergoing chemotherapy, and for each additional hospitalization, exam performed, and month between diagnosis and beginning of treatment. In the opposite direction, the risk of discontinuity was lower among women who had at least finished high school, those with partner, with a family history of cancer, those who had undergone breast surgery, and who had outpatient visits to a Mastologist, and a Clinical Oncologist.CONCLUSIONSThe majority of the women with breast cancer (69.0%) do not persist with hormone treatment for the five years recommended, increasing the risk of inadequate clinical results. The results show aspects of care that can provide better results.

Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama

“…This relation has also been observed in previous studies 6,23 , in which women with more involved lymph nodes presented a higher rate of discontinuity and, as a consequence, lower success in the employed therapy, which also reaffirms the known inverse relation between the survival rate and the cancer stage at the moment of diagnosis 7 .…”

“…A possible explanation for this relation is that the surgical procedure is many times indicated for patients with earlier stage, whereas in women with advanced disease, this therapeutic modality is often forgotten, considering the systemic treatment is prioritized 6,25 . According to Kemp, women undergoing more aggressive treatment may notice their condition as more severe and recognize their increased need of endocrine therapy.…”

“…We calculated the persistence measurement through the estimated level of persistence with therapy (ELPT) method, which considers the time between the beginning of the hormonal therapy and its abandonment or discontinuity for 60 days or longer by doing the accounting of the last supply of the obtained medication 6,17 . Non-persistent was the patient that discontinued treatment during the mentioned term and without death confirmation.…”

“…sociodemographic characteristics -age at diagnosis (until 40 years old; 50-69 years old; 70 years old or older) 18 ; educational level in years of complete studies (low, ; comorbidities described in medical record (yes or no); family history of cancer; Charlson comorbidity index (CCI) 21 (attributing two points in the report of only one neoplasm, and three points, four or more according to the quantity of self-reported comorbidities); 3. support characteristics -kind of hormonal therapy (TMX or anastrozole); performance of chemotherapy, radiotherapy and surgery; number of appointments in clinical oncology (up to 13 appointments and 14 or more) 6 ; number of hospitalizations during the observation period (none; up to 2; 3 or more) 19 .…”

“…Nevertheless, the desirable results many times are not achieved due to problems such as low adherence and low persistence in the recommended treatment, whose associated factors should be carefully evaluated. Evidence ensures that benefits in the change from the mortality and disease recurrence rates only happen effectively if the treatment is completely followed 6,7 . Attention has been given to adherence and persistence studies (A & P) due to the concept that clinical results of the treatment are not only affected by how patients take the drugs, but also by the period of uninterrupted use 8 .…”