Lidija Bošković

Ime i prezime: dr. sc. LIDIJA BOŠKVIĆ , dr. med.
 
Naslov disertacije: „SURADLJIVOST NA AROMATAZNE INHIBITORE, VITAMIN D I KALCIJ POSTMENOPAUZALNIH BOLESNICA S RANIM INVAZIVNIM RAKOM DOJKE TE ONKOLOGA NA SAVJETE IZ SMJERNICA“
 
Mentor:  prof. dr. sc. Eduard Vrdoljak 
 
Datum obrane: 12. listopada 2018.
 
Poveznica: https://library.foi.hr/dbook/index.php?B=1&item=X02141
 
Kvalifikacijski znanstveni radovi za doktorsku disertaciju:


Bošković L, Gašparić M, Petković M, Gugić D, Lovasić IB, Soldić Ž, Miše BP, Dabelić N, Vazdar L, Vrdoljak E. Bone health and adherence to vitamin D andcalcium therapy in early breast cancer patients on endocrine therapy with aromatase inhibitors. Breast.2017;31:16-9.
 
Bošković L, Gašparić M, Petrić Miše B, Petković M, Gugić D, Ban M, Jazvić M, Dabelić N, Belac Lovasić I, Vrdoljak E. Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries. Eur J Cancer Care. 2017;26(4):e12514.
 
SAŽETAK
 
Cilj ovog istraživanja je bio utvrditi suradljivost postmenopauzalnih bolesnica s ranim invazivnim hormonski osjetljivim rakom dojke na adjuvantnu terapiju s nesteroidnim aromataznim inhibitorima, vitaminom D i kalcijem (ako je to propisano od onkologa) u svakodnevnoj kliničkoj praksi u Hrvatskoj. Cilj je također bio utvrditi da li se onkolozi u Hrvatskoj pridržavaju smjernica o koštanom zdravlju te smjernica o kliničkom praćenju bolesnica s ranim rakom dojke. U prospektivno, neintervencijsko istraživanje je uključeno 438 bolesnica koje su uzimale nesteroidni aromatazni inhibitor anastrozol ili letrozol te su praćene u prosjeku 23.5 (±4.9) mjeseci. Tijekom istraživanja, bolesnic su u prosjeku imale 5.3 pregleda. Suradljivost bolesnica procijenjena je primjenom metode samoizvještaja. Bolesnica se smatrala suradljivom ako je prema samoizvještaju uzela ≥80% propisane doze inhibitora aromataze, vitamina D i kalcija. U našem istraživanju utvrdili smo visoki stupanj suradljivosti na aromatazne inhibitore, odnosno od ukupnog broja bolesnica suradljivo na aromatazne inhibitore je bilo 425/438 (97%) bolesnica, a nesuradljivo je bilo njih 13 (3%). Kalcij i vitamin D su propisani od strane onkologa u samo 329/438 (75.1%) bolesnica. Bolesnica suradljivih na kalcij i vitamin D je bilo 291/329 (88.4%), a nesuradljivih 38/329 (11.6%). Denzitometrija skeleta je napravljena kod samo 180/438 (41.1%) bolesnica. Osteoporoza je utvrđena kod 24 bolesnice (5.5%), imajući na umu da 258/438 (59%) bolesnica nije imalo napravljenu denzitometriju. Bifosfonati su propisani kod 54/438 (12.3%) bolesnica, dok je samo 19 (35.2%) imalo osteoporozu. S druge strane, neke bolesnice s osteoporozom nisu primale bifosfonate. Ovi rezultati pokazuju da je kod značajnog dijela bolesnica u našem istraživanju (36.5%) ugroženo koštano zdravlje zbog nepridržavanja smjernica sa strane onkologa (24.9% bolesnica nije imalo propisanu terapiju s kalcijem i vitaminom D) te, s druge strane, zbog loše suradljivosti samih bolesnica na kalcij i vitamin D (11.6% onih kojima je propisan kalcij i vitamin D nisu bile suradljive). Podatak da je samo 41.1% bolesnica imalo napravljenu denzitometriju skeleta, koja je obvezna kod svih bolesnica koje uzimaju aromatazne inhibitore, te da neke bolesnice s osteoporozom ne uzimaju bifosfonate, također pokazuje da se onkolozi slabo pridržavaju smjernica o koštanom zdravlju. Kompromitirano koštano zdravlje povezano je sa značajnim smanjenjem kvalitete 58 života te značajno povećava troškove liječenja. Analiza je također pokazala da se onkolozi slabo pridržavaju smjernica o praćenju bolesnica s ranim rakom dojke jer su se tijekom kliničkog praćenja redovito radile suvišne i nepotrebne pretrage: RTG pluća, ultrazvuk abdomena i tumorski biljezi CEA i CA 15-3, iako to nije propisano u hrvatskim niti u međunarodnim smjernicama. Bolje pridržavanje smjernica sa strane onkologa o praćenju može značajno smanjiti troškove, te poboljšati kvalitetu života bolesnika, a bez negativnog utjecaja na preživljenje.
 
SUMMARY
 
The aim of this analysis was to evaluate adherence of postmenopausal patients with early invasive hormone-dependent breast cancer to treatment with adjuvant nonsteroidal aromatase inhibitors, vitamin D and calcium (if they were prescribed by their oncologists) in every day clinical practice in Croatia. The aim of this analysis was also to evaluate adherence of Croatian oncologists to the bone health guidelines and to the follow-up criteria as suggested by the current national and international guidelines for women with breast cancer receiving adjuvant endocrine therapy. In this prospective, noninterventional study a total of 438 postmenopausal patients receiving adjuvant endocrine treatment with non-steroidal aromatase inhibitors anastrozol or letrozol were included. Patients were followed up for an average 23.5± 4.9 months. Average number of oncological visits was 5.3. Patients who took ≥80% of the prescribed dose were considered adherent. In our study self-reported adherence to aromatase inhibitors was 97% (425/438 patients) and there were only 13 (3%) non-adherent patients. Vitamin D and calcium were prescribed to only 329/438 (75.1%) patients at some point during the study. Self-reported adherence to vitamin D and calcium was 88.4%, and there were 38/329 (11.6%) non-adherent patients. Osteoporosis was diagnosed in 24 patients (5.5%) of the total study population, bearing in mind that 258/438 (59%) patients did not have densitometry. Bisphosphonates were prescribed to 54/438 (12.3%) patients, whilst only 19 (35.2%) of those had osteoporosis. On the other hand, there were still patients with osteoporosis who were not treated with bisphosphonates. These results shows that in significant number of our patients (36.5%) bone health was compromised because of lack of oncologists' adherence to the bone health guidelines (24.9% of patients did not have vitamin D and calcium prescription) and because of patientsʼ non-adherence to vitamin D and calcium (11.6%). Densitometry was performed in only 180/438 patients (41.1%) and this data also shows as above, bad compliance to the bone health guidelines by oncologists. Compromised bone health is often associated with deteriorated patients' quality of life, and increased medical costs what is important issue in already overstretch health care budgets in transitional countries. 60 Our analysis among postmenopausal women with breast cancer receiving adjuvant endocrine therapy also shows that more unnecessary and unproven follow-up procedures (chest radiograph, abdominal ultrasound, tumor markers CEA and CA 15-3) were done compared to the guidelines’ recommendations. The use of diagnostic tests not proven to increase survival during standard follow-up of early breast cancer patients, is not cost-effective and has become a large, unnecessary burden for overstretched and limited transitional countriesʼ budgets. Improved adherence to the current guidelines can substantially cut medical costs, reduce risks and improve patient quality of life without adversely affecting outcome. Ispiši stranicu