保定市激素受体阳性乳腺癌患者辅助内分泌治疗依从性及其影响因素调查

发布时间：2018-05-30 23:17

本文选题：乳腺癌 + 内分泌治疗　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过了解保定市激素受体阳性乳腺癌患者辅助内分泌治疗的应用率及长期服药依从性及其影响因素,为如何提高患者辅助内分泌治疗依从性提供依据。方法:问卷调查以保定市第一中心医院2007年1月1日至2014年12月31日期间,在该院行乳腺癌手术治疗,并于该院完成后续化疗、放疗,受体ER和/或PR阳性的乳腺癌患者为研究对象。1参考相关文献,制定调查问卷,查阅住院病历及门诊电子系统,收集资料,包括患者基本信息、联系方式、社会学因素、肿瘤病理类型分期、治疗基本情况、合并疾病、医嘱内分泌药物种类等,填写随访表,进行编号。2随访由乳腺科专科两名医生,电话随访患者内分泌治疗及复查情况,核对药物剂量、用药时间与医嘱的复合程度,药物占有比,了解有无药物副反应,影响用药因素等。均为电话随访,时间周一至周日,10:00至11:40,16:00至19:00,每例电话在不同日不同时间重复拨打4次,若未能接通,按失访处理。随访截止时间为2015年12月31日。3主要研究终点为:辅助内分泌治疗应用率、非医嘱早期停药率。应用SPSS 22.0统计软件进行数据分析,样本率的比较采用χ2检验,检验水准α=0.05(双侧)。结果:1共纳入研究对象473例,其中58例失访,成功随访415例,占87.74%。随访成功的研究对象中,男性4例,女性377例,中位年龄51.00岁。2入组的415例研究对象中,内分泌治疗的应用率83.6%(347/415)。共有68例(16.4%,68/415)患者未启动内分泌治疗,未启动治疗的原因依次为:医生未告知(50.0%)、个人不重视(35.3%)、经济困难(11.8%)、合并疾病医嘱未用药(2.9%)。3剔除医生未告知应接受治疗的研究对象,分析剩余381例研究对象接受辅助内分泌治疗的影响因素。单因素分析表明,绝经状况未绝经(p=0.010)、教育程度高(p=0.039)、交通便利(p=0.005)、初诊科室为乳腺科(p0.001)、接受重点宣教(p0.001)、接受辅助化疗(p0.001)、接受辅助放疗(p=0.001)、家庭人均月收入超过3000元(p=0.003)、住院费用保险报销(p0.001)、门诊费用可报销(p=0.007),与辅助内分泌治疗应用率呈正相关,有统计学意义。logistic多因素分析,显示:未绝经(p=0.048)、初诊科室为乳腺科(p=0.047)、住院报销(p=0.039),与辅助内分泌治疗应用率呈正相关,有统计学差异(p0.05)。4381例医嘱告知应接受治疗的研究对象中,280例患者遵医嘱未早期停药,依从性良好;101例出现非医嘱早期停药,非医嘱早期停药率26.5%(101/381),第1年至第5年非医嘱早期停药率分别为:21.2%、27.5%、34.7%、44.8%、52.2%。5非医嘱早期停药影响因素的单因素分析表明,居住地在市区(p=0.028)、教育程度高中及以上(p=0.010)、居住地至医院交通便利(p0.001)、有复查固定陪同(p0.001)、随诊医院为原手术医院(p0.001)、复查接诊医生为原手术组医生(p0.001)、复查间隔时间小于6月(p0.001)、初诊科室为乳腺科(p=0.017)、出院前医生对内分泌治疗重要性做重点宣教(p0.001)、术后行辅助放疗(p0.001)、个人收入超过3000元(p=0.001)、家庭收入超过3000元(p0.001)、住院费用有保险报销者(p0.001)、门诊费用有保险报销者(p0.001),与乳腺癌患者术后内分泌治疗依从性呈正相关,有统计学意义。logistic多因素分析,随诊医院为原手术医院(p=0.025)、复查间隔时间小于6月(p0.001)、出院前医生对内分泌治疗重要性做重点宣教(p=0.005),与乳腺癌患者术后内分泌治疗依从性呈正相关,有统计学差异(p0.05)。结论:1保定市激素受体阳性可手术乳腺癌患者辅助内分泌治疗应用率偏低,且长期服药依从性较差。2大力推进乳腺专科建设,加强医护人员的培训,加强患者宣教,是提高应用率和依从性的关键措施。3对于绝经后、未做放疗、教育程度低、未规律复查及经济困难的患者,给予额外重视,有助于提高辅助内分泌治疗的应用率和长期依从性。
[Abstract]:Objective: To investigate the application rate of adjuvant endocrine therapy in the patients with steroid receptor positive breast cancer in Baoding, and to provide the basis for improving the compliance of the patients with endocrine therapy. Methods: a questionnaire survey was conducted in Baoding First Central Hospital from January 1, 2007 to December 31, 2014. Breast cancer surgery was performed in the hospital, and the follow-up chemotherapy, radiotherapy, receptor ER and / or PR positive breast cancer patients were selected as the reference related literature of.1. The questionnaire was developed, the medical records and the outpatient electronic system were consulted, and the data were collected, including the basic information of the patients, the way of contact, the sociological factors, the stages of the tumor pathological type, and the treatment of the tumor. The basic situation, the combination of the disease, the type of medical advice and endocrine drugs and so on, fill in the follow-up list, carry out the number.2 follow-up by two doctors in the breast department, follow up the endocrine therapy and reexamination of the patients by telephone, check the dose of drugs, the combination of the time of medication and the doctor's order, the ratio of drug possession, and understand the side effects of drugs and the factors that affect the drug use. All cases were followed up by telephone, from Monday to Sunday, from 10:00 to 19:00 11:40,16:00 to 19:00. Each case was repeated 4 times at different times in different days. If it failed to connect, the end time of the follow-up was the main end point of.3 in December 31, 2015: the application rate of adjuvant endocrine therapy, the rate of early withdrawal of non doctor's order. The application of SPSS 22 statistical software Data analysis, sample rate comparison using chi 2 test, test level alpha =0.05 (bilateral). Results: 1 a total of 473 subjects were included in the study, of which 58 cases were lost, 415 cases were followed up successfully, which accounted for 4 men, 377 women, 377 cases of the middle age of 51 years.2, and the application rate of endocrine therapy. 83.6% (347/415). A total of 68 patients (16.4%, 68/415) did not start the endocrine therapy. The reasons for uninitiated treatment were as follows: doctors did not inform (50%), individuals did not pay attention to (35.3%), economic difficulties (11.8%), and the medical orders of the combined diseases were not used (2.9%).3 culling doctors did not inform the subject of the treatment, and the remaining 381 subjects received the supplementary study. Factors contributing to endocrine therapy. Single factor analysis showed that menopause was not Menopause (p=0.010), education was high (p=0.039), traffic convenience (p=0.005), primary clinic was p0.001, p0.001, adjuvant chemotherapy (p0.001), adjuvant radiotherapy (p=0.001), per capita monthly income of more than 3000 yuan (p=0.003), and hospitalization. Cost insurance reimbursement (p0.001) and outpatient cost reimbursable (p=0.007) were positively correlated with the application rate of adjuvant endocrine therapy. The statistical significance of.Logistic multiple factors analysis showed that there was no Menopause (p=0.048), the first diagnosis department was the mammary gland (p=0.047) and the Hospitalization Reimbursement (p= 0.039), which had a positive correlation with the application rate of adjuvant endocrine therapy, and there were statistically significant differences (P0.05 Among the.4381 cases, 280 patients who had been treated with medical advice had not stopped medicine early and had good compliance, 101 cases were stopped at early stage and 26.5% (101/381), and the early withdrawal rates of non medical advice from first to fifth years were 21.2%, 27.5%, 34.7%, 44.8%, and 52.2%.5, respectively. The single factor analysis showed that the place of residence was in the city (p=0.028), the education level was high and above (p=0.010), the place of residence to the hospital traffic convenience (p0.001), the recheck fixed accompanying (p0.001), the follow-up hospital as the original operation hospital (p0.001), the recheck doctor as the original hand operation group (p0.001), the reexamination interval less than the June (p0.001), and the first clinic department for milk. Adenosine (p=0.017), prior to discharge, doctors focused on the importance of Endocrinology (p0.001), postoperative adjuvant radiotherapy (p0.001), personal income exceeding 3000 yuan (p=0.001), family income exceeding 3000 yuan (p0.001), hospitalization expenses with insurance reimbursement (p0.001), insurance reimbursement for outpatient expenses (p0.001), and postoperative endocrine therapy for patients with breast cancer. There was a positive correlation between compliance, statistical significance.Logistic multi factor analysis, the follow-up hospital was the primary operation hospital (p=0.025), the interval time of reexamination was less than June (p0.001), the importance of the endocrine therapy was the key education (p=0.005) before discharge, and there was a positive correlation with the compliance of postoperative endocrine therapy in the patients with breast cancer, and there was a statistical difference (P0.05). 1 in Baoding, the application rate of adjuvant endocrine therapy for breast cancer patients with steroid receptor positive can be low, and the long-term drug compliance is poor.2 to promote the construction of breast specialty, strengthen the training of the medical staff and strengthen the patient education. It is the key measure to improve the application rate and compliance of.3. After menopause, no radiotherapy is done, and the education is low, and the degree of education is low. Additional attention should be given to patients with regular review and financial difficulties, which will help improve the application rate and long-term compliance of adjuvant endocrine therapy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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