Hormonal Replacement Therapy for Breast Cancer Survivors: A Decision Analysis.

摘要

Since the overall risks and benefits of hormonal replacement therapy (HRT) in breast cancer survivors are not clearly established, and it is unlikely that a definitive answer will be available in the near future, we developed a decision analytic computer model for individualizing decisions, using the best available literature estimates for all currently known or suspected benefits and adverse outcomes. In addition, the model allows input of individual risk factors for breast cancer recurrence, coronary artery disease, osteoporosis, etc., and allows weighting of patients' preferences for these outcomes. We found that women at average risk for coronary heart disease (CHD) and hip fracture lose 4,3 quality-adjusted life months (QALMs) by taking HRT. Women who value the ClID and hip fracture states as having the worst impact on health and breast cancer recurrence as having the mildest impact on health lose the least from HRT, 3.6 QALMs. Women who value the CHD and hip fracture states as having the mildest impact and breast cancer recurrence as having the worst impact on health lose 5. 3 QALMS. Therefore, unless future studies show a larger benefit on CHD mortality or other health states, HRT decisions for breast cancer surivors should include careful consideration of individual preferences for all of the potential outcomes. The model can readily incorporate data on new treatments and other outcomes as they become available.