Avaliação da adesão ao tratamento com Tamoxifeno por mulheres com câncer de mama / Tamoxifen treatment adherence assessment by women breast cancer / Evalución de adherencia al tratamento com Tamoxifeno em mujeres com cáncer de seno

Justificativa e objetivos: A terapia antineoplásica oral apresenta vantagens comparada a outras terapias para o tratamento do câncer, por ser administrada em domicílio, de forma simples e rápida, no entanto, essa terapia aumenta a responsabilidade do paciente em relação ao seu tratamento e a adesão é fundamental para a sua eficácia. Evidenciam-se poucos estudos referente ao acompanhamento farmacoterapêutico na terapia antineoplásica oral, nesses contexto, o presente estudo busca avaliar a adesão ao tratamento com tamoxifeno em mulheres com câncer de mama, antes e após acompanhamento farmacoterapêutico. Métodos: Trata-se de um estudo clínico randomizado e quantitativo. A coleta de dados foi realizada durante seis meses. A randomização aleatória dividiu-se em Grupo Controle e Grupo Acompanhamento, sendo o acompanhamento subdividido: Antes e Após o Acompanhamento. O Grupo acompanhamento recebeu mensalmente intervenções farmacêuticas individuais. A adesão foi avaliada pelo Brief Medication Questionnair e Problemas Relacionados aos Medicamentos quanto Necessidade, Efetividade e Segurança. Resultados: Após acompanhamento farmacêutico observou-se diferença entre os grupos Grupo Acompanhamento e Grupo Controle quanto à prática de atividade física (p=0,043), adesão ao tratamento (p=0,006), redução de efeitos adversos (p=0,003) e doenças associadas (p=0,002). Os Problemas Relacionados a Medicamentos mais frequentes foram de segurança e adesão, para os quais foram realizadas 54 intervenções farmacêuticas. As reações adversas descritas pelas pacientes acometiam principalmente sistema genital e trato gastrintestinal. Conclusão: Evidenciou-se que o acompanhamento farmacoterapêutico contribuiu efetivamente na adesão ao tratamento com tamoxifeno e as intervenções farmacêuticas realizadas contribuíram para prevenção e redução dos problemas associados a farmacoterapia.(AU)

Background and objectives: Oral antineoplastic therapy has advantages compared to other therapies for the treatment of cancer, because it is administered at home, in a simple and fast, however, this therapy increases the responsibility of the patient regarding its treatment and adherence is critical to its effectiveness. There are few studies on pharmacotherapeutic monitoring in oral antineoplastic therapy. In this context, the present study aims to evaluate to adherence with tamoxifen in women with breast cancer, before and after of pharmaceutical care. Methods: It is a randomized and quantitative clinical study. Data collection was performed during six months. Random randomization was divided into Control Group and Monitoring Group. The follow-up was subdivided: Before and After Monitoring. The Monitoring Group received monthly individual pharmaceutical interventions. Adherence was assessed by the Brief Medication Questionnaire and Drug Related Problems as Need, Effectiveness, and Safety. Results: There was a significant difference between the follow-up group and control group regarding physical activity (p = 0.043), adherence to treatment (p = 0.006), reduction of adverse effects (p = 0.003) and associated diseases (p = 0.002). The most frequent drug-related problems were safety and adherence, for which 54 pharmaceutical interventions were performed. The adverse reactions described by the patients mainly affected the genital system and the gastrointestinal tract. Conclusion: It was evidence the pharmaceutical care effectively contributed to the adherence to tamoxifen treatment and the performed pharmaceutical interventions contributed to the prevention and reduction of the problems associated with phamacoterapy.(AU)

Justificación y objetivo: La terapia antineoplásica oral presenta ventajas comparadas a otras terapias para el tratamiento del cáncer, por ser administrada a domicilio, de forma simple y rápida, sin embargo, esta terapia aumenta la responsabilidad del paciente en relación a su tratamiento y la adhesión es fundamental para su eficacia. Se evidencian pocos estudios referentes al seguimiento farmacoterapéutico en la terapia antineoplásica oral, en ese contexto, el presente estudio busca evaluar la adhesión al tratamiento con tamoxifeno en mujeres con cáncer de mama, antes y después de seguimento farmacoterapéutico. Métodos: Se trata de un estudio clínico aleatorizado y cuantitativo. La recolección de datos se realizó durante seis meses. La aleatorización aleatoria se dividió en Grupo Control y Grupo Seguimiento, siendo el acompañamiento subdividido: Antes y Después del Acompañamiento. El Grupo de seguimiento recibió mensualmente intervenciones farmacéuticas individuales. La adhesión fue evaluada por el Brief Medication Questionnair y los problemas relacionados con los medicamentos como la necesidad, la eficacia y la seguridad. Resultados: Después del seguimiento farmacéutico se observó diferencia entre los grupos Grupo Acompañamiento y Grupo Control en cuanto a la práctica de actividad física (p = 0,043), adhesión al tratamiento (p = 0,006), reducción de efectos adversos (p = 0,003) y enfermidades asociadas (p = 0,003) p = 0,002). Los problemas relacionados con los medicamentos más frecuentes fueron de seguridad y adhesión, para los que se realizaron 54 intervenciones farmacéuticas. Las reacciones adversas descritas por las pacientes acometieron principalmente sistema genital y tracto gastrointestinal. Conclusión: Se evidenció que el seguimiento farmacoterapéutico contribuyó efectivamente a la adherencia al tratamiento con tamoxifeno y las intervenciones farmacéuticas realizadas contribuyeron a la prevención y reducción de los problemas asociados con la farmacoterapia.(AU)

Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama / Factors associated with adherence and persistence to hormonal therapy in women with breast cancer

RESUMO: Introdução: A hormonioterapia no câncer de mama é fundamental para a transição do tratamento ativo aos cuidados de sobrevivência, pois melhora significativamente os resultados de sobrevida em longo prazo, além de propiciar melhor qualidade de vida e reduzir os custos de hospitalização. Porém, para atingir resultados desejáveis, são importantes a adesão e a persistência no tratamento recomendado. Metodologia: Estudo de coorte retrospectivo com 182 mulheres em tratamento hormonal identificadas em unidade oncológica de alta complexidade da Região Sudeste do Brasil e acompanhadas até 2014. Foram realizadas análise bivariada, para investigar os fatores associados à adesão, e regressão multivariada de Cox, para identificar variáveis associadas à descontinuidade do tratamento ao longo do tempo. Resultados: A adesão geral foi de 85,2% e a persistência, de 45,4% após 5 anos. Não foi encontrada associação entre as variáveis independentes estudadas e a adesão. Mulheres com estadiamento avançado (hazard ratio - HR = 2,24; intervalo de confiança de 95% - IC95% 1,45 - 3,45), que não realizaram cirurgia (HR = 3,46; IC95% 2,00 - 5,97) e com 3 ou mais internações hospitalares (HR = 6,06; IC95% 2,53 - 14,54) exibiram maior risco de descontinuidade. Discussão: As variáveis associadas à persistência refletem a relação entre a maior gravidade da doença e a interrupção do tratamento hormonal adjuvante. Conclusão: Apesar da alta adesão, observa-se aumento progressivo do número de pacientes que não persistem no tratamento, devido a características relacionadas à gravidade da doença, contribuindo para uma resposta terapêutica inadequada.

ABSTRACT: Introduction: Hormonal therapy in breast cancer is essential to the transition from active treatment to care survival, because it improves long-term survival and provides a better quality of life. reducing hospital costs as well. However, adherence and persistence in the recommended treatment are important to achieve the desirable results. Methodology: This is a cohort retrospective study of 182 women on hormonal treatment identified at a high complexity oncology unit, in the southeastern region of Brazil, and followed-up until 2014. We performed a bivariate analysis to analyze the factors associated with adherence and we conducted the multivariate Cox regression to identify variables associated with discontinuity of treatment over time. Results: Overall adherence was 85.2% and persistence was 45.4% at the end of 5 years. No association was found between the studied independent variables and adherence. Women with advanced stage (HR = 2.24; 95% confidence interval 1.45 - 3.45), who did not undergo surgery (HR = 3.46; 95%CI 2.00 - 5.97), and with three or more hospitalizations (HR = 6.06; 95%CI 2.53 - 14.54) exhibited increased risk of discontinuity. Discussion: The variables associated with persistence reflect the relation between the highest disease severity and the discontinuity of adjuvant hormonal treatment. Conclusion: Despite the high adherence level, there is a progressive increase in non-persistence among women on hormonal therapy, influenced by characteristics related to disease severity, which contributes to an inadequate therapeutic response.

Fatores associados à persistência à terapia hormonal em mulheres com câncer de mama / Factors associated to persistence with hormonal therapy in women with breast cancer

OBJETIVO Analisar os fatores associados à persistência à hormonioterapia para câncer de mama visando à melhoria da qualidade do cuidado prestado. MÉTODOS Estudo longitudinal a partir de dados secundários. Foi analisada uma coorte de 5.861 mulheres com câncer de mama registradas em diferentes bancos de dados do Instituto Nacional de Câncer e do Sistema Único de Saúde. Todas as pacientes foram tratadas nesse hospital, que dispensa a medicação gratuitamente, e o período de seguimento foi de janeiro de 2004 a outubro de 2010. Variáveis sociodemográficas, comportamentais, clínicas, de estilos de vida e de aspectos do serviço de saúde integraram-se à análise para testar associação com a persistência ao tratamento hormonal, pelo método de Kaplan-Meier e Riscos Proporcionais de Cox. RESULTADOS A persistência geral à hormonioterapia foi de 79,0% ao final do primeiro ano e 31,0% em cinco anos de tratamento. O risco de descontinuidade à hormonioterapia mostrou-se maior entre mulheres com idade inferior a 35 anos, com estadiamento mais grave (III e IV), usuárias de álcool, que realizaram quimioterapia, e para cada hospitalização, cada exame e cada mês, entre o diagnóstico e o início do tratamento adicional. Na direção oposta, o risco de descontinuidade mostrou-se menor entre as mulheres com nível médio e superior de escolaridade, com companheiro, com história familiar de câncer, submetidas à cirurgia e que tiveram consultas com mastologista e com oncologista clínico. CONCLUSÕES Das mulheres com câncer de mama, 69,0% não persistiram ao término de cinco anos do tratamento hormonal, aumentando o risco de uma resposta clínica inadequada. Os resultados mostram aspectos do cuidado que podem conduzir a melhores ...

OBJECTIVE To analyze factors associated with persistence to breast cancer hormone therapy in order to contribute to the quality of care improvement. METHODS Retrospective 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. RESULTS Overall 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. CONCLUSIONS The 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. .

Endocrine Therapy for Breast Cancer / 이화의대지

Breast cancer is the second most common cancer in Korean women and its mortality rate has increased steadily. Although breast cancer is heterogeneous tumor, hormone receptor-positive tumors comprise about 75 percent of all breast cancers. Therefore endocrine therapy that works by targeting estrogen receptor is a pivotal treatment for breast cancers. There are selective estrogen receptor modulators, such as tamoxifen and raloxifene, aromatase inhibitors, such as anastrozole, letrozole and exemestane, fulvestrant and luteinizing hormone-releasing hormone agonists used in endocrine therapy. Endocrine therapy is effective in treating early breast cancer as an adjuvant therapy and metastatic breast cancer as a palliative therapy. Also in women who are at high risk for breast cancer, tamoxifen or raloxifene can prevent breast cancer. Studies for neoadjuvant endocrine therapy are emerging. Considering side effects of each drug and overcoming drug resistance are needed to maximize effectiveness of treatment and advance endocrine therapy.

Clinical study on intermittent hormonal therapy for patients with prostate cancer / 北京大学学报(医学版)

Objective:To investigate the effect of intermittent hormonal therapy(IHT) for patients with different stage/grade prostate cancer(PCa).Methods:The number of cycles and the duration of ON/OFF therapy for 45 PCa patients receiving IHT were observed.Maximal androgen blockade(MAB) the-rapies were used for six to nine months,and then stopped until the serum prostate specific antigen(PSA) was decreased below 0.2 ?g/L,which lasted for three months.It was decided whether MAB went on according to the level of PSA.Results:The average follow-up time was 40.7?13.4 months.Forty-one patients started the second cycle of treatment,of whom,8 became androgen-independent and 7 were at T3-4M0 or M1 stages and the Gleason scores were above 8.Sixteen patients entered the third cycle,of whom,14 were at lower than stage Ⅲ and 13 had the Gleason scores below 7.From the first to the fourth courses of treatment,the average intervals were 8.7?5.4(47.1%),8.4?4.9(49.3%),7.0?3.4(43.7%),and 3.7?0.6(42.5%)months respectively.Five patients developed bone metastasis.No one died up to now.According to the evaluation criteria,patients were divided into tolerance(n=16) and intolerance groups(n=29).Compared with the intolerance group,the patients who tolerated the treatment well had lower Gleason scores(P=0.002),lower PSA levels(P=0.053) and lower tumor stages(P=0.001).There was no evidence that age,lymph node metastasis,bone metastasis and the state of recurrence were associated with an increased risk of the outcome.Non-conditional Logistic regression analysis showed that the proportion of patients at stage Ⅳ was the only independent risk factor for the tolerance of the treatment(OR=12.113,95%CI 1.330-110.312,P=0.027).Conclusion:Intermittent hormonal therapy is more effective and proper for the patient with highly differentiated tumor and at lower stages(≤Ⅲ).The patients who progressed to hormone-independence are mostly at stage Ⅳ with poorly differentiated tumor.Intermittent hormone therapy could be more adaptive for the patients at lower than stage Ⅲ.