Utjecaj stavova i uvjerenja o lijekovima na adherenciju bolesnica s uznapredovalim rakom dojke

master's thesis

• Title (english): The influence of patients' attitudes and beliefs about medicines on the adherence in women with advanced breast cancer
• Author: Lucija Benić
• Mentor: Maja Ortner Hadžiabdić (mentor)
• Mentor: Tajana Silovski (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Tajana Silovski (član povjerenstva)
• Committee member: Miranda Sertić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2023-04-06, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Rak dojke najraširenija je zloćudna bolest na svijetu. Svaka četvrta žena s karcinomom ima rak dojke. Vjerojatnost razvitka metastaza iz primarnog tumora je 23-30%. Cilj je terapije uznapredovalog raka dojke usporiti ili potpuno prevenirati progresiju bolesti uz olakšanje simptoma i nuspojava liječenja. Pojavom djelotvornih oralnih antitumorskih lijekova, adherencija na terapiju postala je jedan od temeljnih uvjeta za uspješnost ishoda liječenja. Cilj ovog rada bio je ustanoviti adherenciju bolesnica s uznapredovalim rakom dojke na oralne antitumorske lijekove te istražiti socio-demografske i kliničke čimbenike koji utječu na adherenciju. S obzirom na to da je dokazano kako adherencija također ovisi o osobnoj percepciji bolesnika prema lijekovima i bolesti, dodatno su istraženi stavovi i uvjerenja bolesnika o lijekovima te njihova povezanost s adherencijom. Provedeno je presječno, opservacijsko istraživanje u koje su bile uključene žene s metastatskim rakom dojke (stadij IV), a koje primaju oralnu antitumorsku terapiju. Adherencija je mjerena pomoću Upitnika za procjenu adherencije (MARS-5), a stavovi i uvjerenja bolesnika pomoću BMQ upitnika (engl. Beliefs about Medicines Questionnaire). Sudjelovalo je 89 žena starijih od 18 godina, medijana dobi 60 godina (interkvartilni raspon 47-70). Bolesnice su pokazale iznimno visok stupanj adherencije na terapiju oralnim antitumorski lijekovima, srednja vrijednost bodova na MARS-5 skali iznosila je 24,16 ± 1,563 od mogućih 25 bodova. Utvrđena je statistički značajna povezanost maksimalne adherencije s terapijom inhibitorima CDK4/6 (p=0,018). Žene koje su na terapiji inhibitorima CDK4/6 pokazale su viši stupanj adherencije u odnosu na one koje su bile na drugoj oralnoj antitumorskoj terapiji. Općeniti i specifični stavovi i uvjerenja bolesnica o njihovim lijekovima pokazali su se izrazito pozitivnima. Također je uočena povezanost s adherencijom na tri skale BMQ upitnika: Opći dio – Prekomjerna uporaba lijekova, Opći dio – Osjetljivost na lijekove te Specifični dio – Zabrinutost zbog lijekova (p=0,024; p=0,043; p=0,036). Ovim su istraživanjem ustanovljeni neki od čimbenika koji utječu na adherenciju bolesnica s uznapredovalim rakom dojke te smo time pridonijeli razumijevanju adherencije u populaciji koja dosad nije bila istraživana u Hrvatskoj. Prvi su puta proučeni stavovi i uvjerenja navedenih bolesnica o lijekovima te povezani s adherencijom. Bolje razumijevanje istraživanih čimbenika i uzroka potencijalne neadherencije može poslužiti u razvoju intervencija za povećanje adherencije.

Abstract (english)

Breast cancer is the most widespread malignant disease in the world. Every fourth woman with cancer has breast cancer. The probability of developing metastases from the primary tumor is 23-30%. The goal of advanced breast cancer therapy is to slow down or completely prevent the progression of the disease while relieving the symptoms and side effects of the treatment. With the invention of effective oral antitumor drugs, adherence to therapy has become one of the fundamental conditions for successful treatment outcomes. The aim of this work was to establish the adherence of patients with advanced breast cancer to oral antitumor drugs and to investigate socio-demographic and clinical factors that influence adherence. Given that it has been proven that adherence also depends on the patient's personal perception of medication and disease, the patient's attitudes and beliefs about medicine and their association with adherence were additionally investigated. A cross-sectional, observational study was conducted in which women with advanced breast cancer (stage IV) and receiving oral antitumor therapy were included. Adherence was measured using The Medication Adherence Report Scale (MARS-5), and patients' attitudes and beliefs were measured using the Beliefs about Medicines Questionnaire (BMQ). 89 women over the age of 18 participated, median age 60 (IQR 47-70). The patients showed a very high degree of adherence to oral antitumor therapy, the mean value of the MARS-5 questionnaire was 24,16 ± 1,563 out of a possible 25 points. A statistically significant association between adherence and CDK4/6 inhibitors was observed (p=0.018). Women taking CDK4/6 inhibitors therapy showed a higher degree of adherence compared to those who were taking other oral antitumor therapy. The general and specific attitudes and beliefs about medicines turned out to be very positive. The association was also found between adherence and three BMQ scales: General - Overuse, General – Perceived Sensitivity to Medicines and Specific - Concerns (p=0.024; p=0.043; p=0.036). This research established some of the factors that influence the adherence of patients with advanced breast cancer, and thus we contributed to the understanding of adherence in a population that had not been studied in Croatia before. For the first time, the attitudes and beliefs of the above-mentioned patients about medication were studied and related to adherence. A better understanding of the researched factors and causes of potential non-adherence can help in the development of interventions to increase adherence.

• Keywords: adherencija; rak dojke; antitumorski lijekovi; stavovi bolesnika
• Keywords (english): adherence; breast cancer; antitumor drugs; patients attitudes
• Language: croatian
• URN:NBN: urn:nbn:hr:163:090332
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Embargoed access; Embargo expiration date: 2025-04-06
• Created on: 2023-04-13 11:49:39