Compliance analysis of adjuvant therapy in elderly patients with breast cancer under case-management model / 上海交通大学学报（医学版）

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 designed by multidisciplinary 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. By 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 from 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.