發(fā)布時(shí)間：2018-05-30 23:17

  本文選題：乳腺癌 + 內(nèi)分泌治療��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過了解保定市激素受體陽性乳腺癌患者輔助內(nèi)分泌治療的應(yīng)用率及長期服藥依從性及其影響因素,為如何提高患者輔助內(nèi)分泌治療依從性提供依據(jù)。方法:問卷調(diào)查以保定市第一中心醫(yī)院2007年1月1日至2014年12月31日期間,在該院行乳腺癌手術(shù)治療,并于該院完成后續(xù)化療、放療,受體ER和/或PR陽性的乳腺癌患者為研究對(duì)象。1參考相關(guān)文獻(xiàn),制定調(diào)查問卷,查閱住院病歷及門診電子系統(tǒng),收集資料,包括患者基本信息、聯(lián)系方式、社會(huì)學(xué)因素、腫瘤病理類型分期、治療基本情況、合并疾病、醫(yī)囑內(nèi)分泌藥物種類等,填寫隨訪表,進(jìn)行編號(hào)。2隨訪由乳腺科�？苾擅t(yī)生,電話隨訪患者內(nèi)分泌治療及復(fù)查情況,核對(duì)藥物劑量、用藥時(shí)間與醫(yī)囑的復(fù)合程度,藥物占有比,了解有無藥物副反應(yīng),影響用藥因素等。均為電話隨訪,時(shí)間周一至周日,10:00至11:40,16:00至19:00,每例電話在不同日不同時(shí)間重復(fù)撥打4次,若未能接通,按失訪處理。隨訪截止時(shí)間為2015年12月31日。3主要研究終點(diǎn)為:輔助內(nèi)分泌治療應(yīng)用率、非醫(yī)囑早期停藥率。應(yīng)用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,樣本率的比較采用χ2檢驗(yàn),檢驗(yàn)水準(zhǔn)α=0.05(雙側(cè))。結(jié)果:1共納入研究對(duì)象473例,其中58例失訪,成功隨訪415例,占87.74%。隨訪成功的研究對(duì)象中,男性4例,女性377例,中位年齡51.00歲。2入組的415例研究對(duì)象中,內(nèi)分泌治療的應(yīng)用率83.6%(347/415)。共有68例(16.4%,68/415)患者未啟動(dòng)內(nèi)分泌治療,未啟動(dòng)治療的原因依次為:醫(yī)生未告知(50.0%)、個(gè)人不重視(35.3%)、經(jīng)濟(jì)困難(11.8%)、合并疾病醫(yī)囑未用藥(2.9%)。3剔除醫(yī)生未告知應(yīng)接受治療的研究對(duì)象,分析剩余381例研究對(duì)象接受輔助內(nèi)分泌治療的影響因素。單因素分析表明,絕經(jīng)狀況未絕經(jīng)(p=0.010)、教育程度高(p=0.039)、交通便利(p=0.005)、初診科室為乳腺科(p0.001)、接受重點(diǎn)宣教(p0.001)、接受輔助化療(p0.001)、接受輔助放療(p=0.001)、家庭人均月收入超過3000元(p=0.003)、住院費(fèi)用保險(xiǎn)報(bào)銷(p0.001)、門診費(fèi)用可報(bào)銷(p=0.007),與輔助內(nèi)分泌治療應(yīng)用率呈正相關(guān),有統(tǒng)計(jì)學(xué)意義。logistic多因素分析,顯示:未絕經(jīng)(p=0.048)、初診科室為乳腺科(p=0.047)、住院報(bào)銷(p=0.039),與輔助內(nèi)分泌治療應(yīng)用率呈正相關(guān),有統(tǒng)計(jì)學(xué)差異(p0.05)。4381例醫(yī)囑告知應(yīng)接受治療的研究對(duì)象中,280例患者遵醫(yī)囑未早期停藥,依從性良好;101例出現(xiàn)非醫(yī)囑早期停藥,非醫(yī)囑早期停藥率26.5%(101/381),第1年至第5年非醫(yī)囑早期停藥率分別為:21.2%、27.5%、34.7%、44.8%、52.2%。5非醫(yī)囑早期停藥影響因素的單因素分析表明,居住地在市區(qū)(p=0.028)、教育程度高中及以上(p=0.010)、居住地至醫(yī)院交通便利(p0.001)、有復(fù)查固定陪同(p0.001)、隨診醫(yī)院為原手術(shù)醫(yī)院(p0.001)、復(fù)查接診醫(yī)生為原手術(shù)組醫(yī)生(p0.001)、復(fù)查間隔時(shí)間小于6月(p0.001)、初診科室為乳腺科(p=0.017)、出院前醫(yī)生對(duì)內(nèi)分泌治療重要性做重點(diǎn)宣教(p0.001)、術(shù)后行輔助放療(p0.001)、個(gè)人收入超過3000元(p=0.001)、家庭收入超過3000元(p0.001)、住院費(fèi)用有保險(xiǎn)報(bào)銷者(p0.001)、門診費(fèi)用有保險(xiǎn)報(bào)銷者(p0.001),與乳腺癌患者術(shù)后內(nèi)分泌治療依從性呈正相關(guān),有統(tǒng)計(jì)學(xué)意義。logistic多因素分析,隨診醫(yī)院為原手術(shù)醫(yī)院(p=0.025)、復(fù)查間隔時(shí)間小于6月(p0.001)、出院前醫(yī)生對(duì)內(nèi)分泌治療重要性做重點(diǎn)宣教(p=0.005),與乳腺癌患者術(shù)后內(nèi)分泌治療依從性呈正相關(guān),有統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論:1保定市激素受體陽性可手術(shù)乳腺癌患者輔助內(nèi)分泌治療應(yīng)用率偏低,且長期服藥依從性較差。2大力推進(jìn)乳腺�？平ㄔO(shè),加強(qiáng)醫(yī)護(hù)人員的培訓(xùn),加強(qiáng)患者宣教,是提高應(yīng)用率和依從性的關(guān)鍵措施。3對(duì)于絕經(jīng)后、未做放療、教育程度低、未規(guī)律復(fù)查及經(jīng)濟(jì)困難的患者,給予額外重視,有助于提高輔助內(nèi)分泌治療的應(yīng)用率和長期依從性。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 杜娟;趙秀莉;張文周;;280例乳腺癌患者內(nèi)分泌治療用藥依從性分析[J];中國藥房;2016年26期

2 ;中國抗癌協(xié)會(huì)乳腺癌診治指南與規(guī)范(2015版)[J];中國癌癥雜志;2015年09期

3 楊穎;李歡;劉沖;胡崇珠;;乳房外傷后巨大張力性血腫一例[J];中華乳腺病雜志(電子版);2015年01期

4 李麗;秦建偉;韋達(dá);吳建中;唐金海;;乳腺癌內(nèi)分泌治療依從性研究[J];中華內(nèi)分泌外科雜志;2014年05期

5 郭曄;王曉輝;康寧;劉安陽;羅斌;;乳腺癌患者內(nèi)分泌治療的依從性調(diào)查[J];中國醫(yī)刊;2014年07期

6 宋玫瑰;梁英;;乳腺癌術(shù)后患者內(nèi)分泌治療依從性的調(diào)查及分析[J];腫瘤預(yù)防與治療;2014年03期

7 姚曉冬;林哲瑩;;105例乳腺癌輔助內(nèi)分泌治療依從性分析[J];國際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2014年10期

8 朱葉卉;胡雁;吳密彬;陸箴琦;黃嘉玲;裘佳佳;;提高乳腺癌患者內(nèi)分泌治療服藥依從性的深度訪談[J];護(hù)士進(jìn)修雜志;2014年07期

9 朱葉卉;黃嘉玲;胡雁;陸箴琦;裘佳佳;顧榮豐;徐蓓峗;嚴(yán)霞;吳密彬;;乳腺癌患者內(nèi)分泌治療的服藥依從性研究[J];護(hù)理學(xué)雜志;2013年16期

10 王靜雅;王惠仙;王凌;;乳腺癌術(shù)后患者內(nèi)分泌治療依從性及影響因素調(diào)查與分析[J];護(hù)理與康復(fù);2013年06期

，

本文編號(hào)：1957256