The primary and secondary benefits of tamoxifen as adjuvant therapy in women with hormone-receptor-positive breast cancer are substantial: a 1% decrease in the risk of death each year for 10 years with each additional year of treatment during the first 5 years. Considerable data, however, indicate that these benefits are lost to many patients because of treatment nonadherence. Nonadherence is examined within the framework of the Common-Sense Model of Self-Regulation to describe patients' models of disease and treatment that organize their thinking and behavior, and the crucial role of the practitioner in addressing and altering these models. Common patient education and social communications about patients' hormone-receptor-positive breast cancer and tamoxifen treatment promote an acute disease paradigm in which cancer occurs within specific locations and is either present or absent. We recommend that clinicians communicate the concepts of hormone-receptor-positive breast cancer as follows: i. a non-dichotomous systemic disorder entailing a treatment goal of homeostasis and disease quiescence and ii. a disorder undetectable by currently available tests in subclinical states. Equally important, the clinician can provide a comprehensive picture of the well-documented secondary effects of tamoxifen, noting in particular the beneficial effects. Specific action plans, grounded in individual patient understanding, can be developed and reinforced, in an ongoing process that validates and integrates patient values and goals as they change over time.

中文翻译：

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解决他莫昔芬不依从性的临床实践。

他莫昔芬作为激素受体阳性乳腺癌女性的辅助治疗的主要和次要益处是巨大的：前 5 年每增加一年治疗，10 年中每年死亡风险降低 1%。然而，大量数据表明，由于治疗不依从，许多患者失去了这些益处。在自我调节常识模型的框架内检查不依从性，以描述患者组织其思维和行为的疾病和治疗模型，以及从业者在解决和改变这些模型中的关键作用。关于患者的常见患者教育和社会交流 激素受体阳性乳腺癌和他莫昔芬治疗促进了一种急性疾病范式，其中癌症发生在特定位置并且存在或不存在。我们建议临床医生按如下方式传达激素受体阳性乳腺癌的概念：一种非二分类的全身性疾病，需要以体内平衡和疾病静止为治疗目标，以及 ii. 在亚临床状态下通过目前可用的测试无法检测到的疾病。同样重要的是，临床医生可以全面了解他莫昔芬的有据可查的次要作用，特别是其有益作用。可以在持续的过程中制定和加强基于个体患者理解的具体行动计划，该过程验证和整合患者价值观和目标随着时间的推移而变化。