Title Kvaliteta života pri adjuvantnom endokrinom liječenju žena koje su preboljele hormonski ovisan rak dojke Title (english) Life quality of adjuvant endocrine therapy in patients who suffered from hormone dependent breast cancer Author Petrik Pavličić Mentor Iva Mucalo (mentor)Committee member Iva Mucalo (predsjednik povjerenstva)Committee member Lidija Bach-Rojecky (član povjerenstva)Committee member Ivan Pepić (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-19, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract U hormonski ovisnom tipu ranog raka dojke visoko preživljenje je posljedica vrlo učinkovitog endokrinog liječenja.
Međutim, dugotrajno AEL koje obuhvaća aromatazne inhibitore (anastrozol, letrozol i ekesemestan) i tamoksifen dovodi
do brojnih nuspojava koje su posljedica antiestrogenskog djelovanja tih lijekova. U premenopauzalnih žena nuspojave
AEL mogu biti jače izražene zbog nagle i snažne supresije estrogena uslijed intenzivne endokrine terapije. Prema
podacima iz literature nuspojave AEL utječu na kvalitetu života i adherenciju pacijentica. Obzirom da se radi o kroničnoj
terapiji koja se uzima kroz razbolje od 5 do 10 godina, vrlo je bitno identificirati žene s visokim rizikom za pojavu
određenih nuspojava te one kod kojih se očekuju teži oblici nuspojava. Mnoge od najčešćih nuspojava moguće je ublažiti
nefarmakološkim i farmakološkim pristupima s ciljem održavanja visoke adherencije i ustrajnosti u liječenju obzirom
da su oni nužan preduvjet za smanjenje rizika od povrata bolesti i visoku stopu preživljenja ove skupine pacijentica.
Cilj ovog diplomskog rada bio je istražiti vrstu, učestalost i težinu nuspojava koje se javljaju pri AEL žena koje su
bolovale od ranog raka dojke. Nadalje, ovim istraživanjem istražen je i utjecaj komedikacije GnRH na vrstu, prevalenciju
i težinu nuspojava AEL. Sudionice ovog istraživanja bile su isključivo žene koje su bolovale od hormonski ovisnog
karcinoma dojke stadija I-III te koje su započele AEL barem tri mjeseca prije ispunjavanja upitnika. Uključeno je 329
pacijentica prosječne životne dobi 57 godina. Ispitanice na tamoksifenu imale su statistički značajno veću prevalenciju
krvožilnih (navale vrućine, hladan znoj i noćno znojenje) i vaginalnih (vaginalni iscjedak, vaginalna iritacija) nuspojava
u odnosu na ispitanice na AI, dok su ispitanice na AI imale statistički značajno veću prevalenciju i jače bolove u kostima.
Također, komedikacija GnRH uz AEL značajno je pridonijela prevalenciji i težini nuspojava u odnosu na liječenje samo
endokrinim lijekovima. Nadalje, prevalencija i težina svih najčešćih nuspojava, osim bolova u kostima, bila je veća u
žena liječenih kombinacijom GnRH + AEL. Istraživanje ovog tipa prvi je puta provedeno na populaciji pacijentica
oboljelih od hormonski ovisnog karcinoma dojke u Hrvatskoj te može doprinijeti boljem razumijevanju čimbenika koji
doprinose adherenciji. Identifikacija subpopulacije žena s najvećim rizikom od teških nuspojava AEL važna je kako bi
se razvile specifične intervencije i intenzivirala farmaceutska skrb za žene čija će kvaliteta života vjerojatno biti značajno
narušena tijekom AEL i posljedično kod kojih postoji rizik od neadherencije i neustrajanja u kroničnom liječenju.
Abstract (english) In hormone type of early breast cancer, high survival is the result of very effective endocrine treatment options. However,
long-term adjuvant endocrine therapy (AET) which includes aromatase inhibitors (anastrozole, letrozole, and
exemestane) and tamoxifen leads to a number of side effects resulting from the antiestrogenic effects of these drugs. In
premenopausal women, the side effects of AET may be even more pronounced due to a sudden and strong estrogen
suppression which is the consequence of intensive endocrine therapy. According to the literature, the side effects of AET
affect the quality of life and adherence of patients. Since AET is a chronic therapy taken through the period from 5 to
10 years, it is very important to identify women at high risk for certain side effects and the women who are expected to
have more severe forms of certain side effects. Many of the most common side effects can be alleviated by nonpharmacological
and pharmacological approaches with an aim of maintaining high adherence and persistence as they
are necessary for reducing the risk of disease recurrence and high survival rates of this group of patients.
The aim of this diploma thesis was to investigate the type, frequency and severity of side effects that occur due to AET
in women suffering from early breast cancer. Furthermore, this study also investigated the impact of gonadotropinreleasing
hormone (GnRH) comedication on the type, prevalence, and severity of side effects that occur in AET.
Participants in this study were women who suffered from stage I-III hormone-dependent breast cancer and who started
AET at least three months before completing the questionnaire. This research included 329 women with an average age
of 57 years. Subjects on tamoxifen had a statistically significant higher prevalence of vascular (hot flashes, cold sweat
and night sweats) and vaginal (vaginal discharge, vaginal irritation) side effects compared to subjects on AI, while
subjects on AI had a statistically higher prevalence of stronger bone pain. Also, the comedication with GnRH and AET
significantly contributed to the prevalence and severity of side effects compared to treatment with endocrine drugs alone.
Furthermore, the prevalence and severity of all the most common side effects, except bone pain, was higher in women
treated with the GnRH + AET combination. This type of research was conducted for the first time on the population of
patients with hormone positive breast cancer in Croatia and can contribute to a better understanding of adherence factors.
The identification of the subpopulation of women with the highest risk of severe AET side effects is important as to
target specific interventions and intensify pharmaceutical care for women whose quality of life is likely to be
significantly impaired during AET and consequently at risk of nonadherence and failure in chronic treatment.
Keywords
rak dojke
hormonski ovisan rak dojke
kvaliteta života
nuspojave lijekova
endokrina terapija
Keywords (english)
breast cancer
hormone dependent breast cancer
quality of life
drug side effects
endocrine therapy
Language croatian URN:NBN urn:nbn:hr:163:973362 Study programme Title: Pharmacy Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-07-22 08:54:07
