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得了乳腺癌还要对付“伴随疾病”?

2019-07-20 14:32:53   来源:未知
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得了乳腺癌还要对付伴随疾病?首部管理指南来啦! 乳腺癌是中国女性最常见的恶性肿瘤,近年来因治疗引起的副作用等,导致患者常伴随心血管疾

  得了乳腺癌还要对付“伴随疾病”?首部管理指南来啦!

  乳腺癌是中国女性最常见的恶性肿瘤,近年来因治疗引起的副作用等,导致患者常伴随心血管疾病、骨代谢异常及焦虑抑郁等疾病。如何提高患者生存及生活质量?全球首部《乳腺癌随访及伴随疾病全方位管理指南》来了!

  乳腺癌是中国女性最常见的恶性肿瘤,近年来,随着乳腺癌患者生存时间的延长,更多患者进入到漫长的慢病期。但因治疗引起的副作用或乳腺癌患者本身由于年龄、激素水平等自身因素的变化,导致伴随疾病逐渐凸显,乳腺癌的常见伴随疾病主要有心血管疾病、骨代谢异常以及焦虑抑郁等。在3月30日举行的“2019中国肿瘤健康管理大会暨第三届乳腺癌两全管理首席专家论坛”期间,全球首部《乳腺癌随访及伴随疾病全方位管理指南》发布,旨在进一步降低乳腺癌患者疾病复发风险,减少伴随疾病对患者生存及生活质量的影响,及时发现药物相关不良反应并进行管理。

  得了乳腺癌,心血管等疾病可能接踵而至

  目前,乳腺癌是国内治愈率最高,生存期最长的恶性肿瘤之一,2010年-2014年中国乳腺癌患者的5年生存率为83.2%,乳腺癌患者的生存时间显著延长,这也就意味着,作为肿瘤中代表性的慢病,更多乳腺癌患者进入漫长的慢病期。但因治疗引起的副作用或乳腺癌患者本身由于年龄、激素水平等自身因素的变化,导致伴随疾病却逐渐凸显,这不仅影响到患者的生活质量,甚至转化为疾病复发和死亡风险。“肿瘤伴随疾病“是指非直接与肿瘤相关的,由于患者年龄及内在微环境改变、生活方式改变及药物不良反应影响等多因素导致的疾病,乳腺癌的常见伴随疾病主要有心血管疾病、骨代谢异常以及焦虑抑郁等。

  一项大型肿瘤登记注册数据显示,63566例绝经后早期乳腺癌患者的十年心脏事件死亡高达15.9%,这已经超过了乳腺癌死亡的15.1%,乳腺癌患者常可能同时伴随心血管疾病,特别是卵巢缺失和绝经后女性,在自身卵巢功能抑制或衰退,芳香化酶抑制剂治疗的作用下,引起雌激素水平的大幅下降,导致血脂异常发生率和心血管死亡风险显著增加。

  另外,绝经后治疗激素受体(HR)+乳腺癌内分泌治疗患者会遇到严重的骨健康问题,在绝经后雌激素水平降低的影响下,自然绝经的女性骨密度每年下降1.9%,出现骨量减少即骨组织结构变化,骨质疏松在绝经后女性中较为常见。大量乳腺癌患者在慢病期将接受5到10年的内分泌治疗,此过程常伴随出现骨代谢异常、骨质疏松,甚至增加患者承重骨骨折风险。有研究显示,绝经后乳腺癌患者骨质疏松导致的骨折发生率达17.6%;针对早期HR+乳腺癌患者骨代谢管理可以降低远期骨转移发生率。

  首部“乳腺癌伴随疾病管理指南”来了!

  对于乳腺癌患者的预后及长期管理,专家认为,应在乳腺癌治疗随访期间,特别关注患者伴随疾病的主动管理。在3月30日举行的“2019中国肿瘤健康管理大会暨第三届乳腺癌两全管理首席专家论坛”期间,全球首部《乳腺癌随访及伴随疾病全方位管理指南》发布,这也填补了国内外乳腺癌患者健康管理的空白。

  指南通过路径图的形式,分别阐述了激素受体阳性、HER2阳性及三阴性乳腺癌患者的不同随访项目(包括乳腺癌疾病随访、伴随疾病随访及不良反应随访)及不同随访结果的处理原则,从而协助临床医生明确掌握不同类型乳腺癌患者的长期随访管理,以进一步降低乳腺癌患者疾病复发风险,减少伴随疾病对患者生存及生活质量的影响,及时发现药物相关不良反应并进行管理。

  中国医学科学院肿瘤医院内科徐兵河教授表示,指南的发布,为全国范围各级医院分级落实乳腺癌急慢分治与康复管理提供了专业指导。指南明确要求临床医生在接受患者内分泌治疗前,应特别关注患者术前血脂检测数据及骨基线检测标准,并提示医患双方要严格依据指南进行肿瘤预后及整体健康水平随访评估,进行生活方式干预,戒烟戒酒,注意防止跌倒和身体猛烈撞击等。指南同时建议,应结合患者个体情况,合理选择用药。

  中国医学科学院肿瘤医院内科马飞教授认为,乳腺癌患者不但要活得长而且要活得好,在诊断治疗规范化的同时,就应该注重整体健康管理的规范化与精细化。“以疾病为核心的诊疗模式转变为以患者为中心的全方位跨学科管理模式,我们有理由相信,乳腺癌将可能成为第一个被治愈的实体肿瘤。”

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