Oncology Frontier:  You also touched on Kaiser Permanente’s meta analysis that really seemed to indicate that there was maybe some compliance issues when it comes to such a long term therapy. Can you talk about that?

　　《肿瘤瞭望》：您还曾谈到了凯撒医疗中心的荟萃分析，分析显示长期内分泌治疗的患者依从性不太好。能否请您再详细谈一下？

　　Dr. Davidson: No therapy works unless it is taken. There are 2 parts to that equation. One is that doctors have to prescribe therapy in an appropriate way， and in an evidence-based way and then patients have to take it. With oral pills， that can be extraordinarily difficult， there are a lot of reasons why people might be non compliant ranging from symptoms to price – if they have to pay for the medication. I think that we need to encourage women to complete their full course of endocrine therapy. Every bit of information that we have suggests that the best outcomes are going to be associated with that and we worry if patients unilaterally make the decision to stop earlier. We would like to encourage them to continue and in the United States and perhaps elsewhere in the world， we would also like to make sure that the economics of healthcare delivery do not make it difficult for women to receive these life saving therapies.

　　Davidson教授：如果不实施的话，任何治疗都无法起效。这个问题涉及两方面，即医生应循证选择正确的治疗方案，而患者要坚持治疗。就内分泌药物口服治疗而言，从药物并发症到价格（若患者需要自费的话）很多因素都会导致依从性差。我们需要鼓励患者完成全部内分泌治疗，因为这有助于使其获得最佳预后。我们担心患者会自行提前停药。为此我们需要鼓励患者坚持用药，美国及世界其他地方还要确保医疗成本不能太高，以便使患者负担得起能拯救生命的内分泌治疗。

　　Oncology Frontier: How to post-menopausal breast cancer patients change their perspective on endocrine therapy during their course of treatment?

　　《肿瘤瞭望》：绝经后乳腺癌患者为什么在治疗期间会转变对内分泌治疗的态度？

　　Dr. Davidson: I think that most post-menopausal women are very much complaint with their endocrine therapy. One can imagine that with other health problems intervene， they may be less worried about their breast cancer therapy and certainly if they have particular side effects it may be more problematic for them. But I think that we try very hard to work with all our patients to ensure that they understand what the best possible treatment is and to make it as easy as possible for them to complete that course of therapy.

　　Davidson教授：大多数绝经后女性可能会对内分泌治疗感到非常不适。如果服药带来了健康问题，她们就不会把注意力放在乳腺癌治疗上了，如果服药导致某种不良反应，她们就更担心了。我认为，我们应非常努力地与所有患者沟通，确保其了解对其而言最佳的治疗方法是什么，尽量确保其能够完成治疗。

　　Oncology Frontier:  For pre-menopausal women， is it necessary to inhibit the function of their ovaries during endocrine therapy?

　　《肿瘤瞭望》：对绝经前女性而言，是否有必要在内分泌治疗期间抑制其卵巢功能？

　　Dr. Davidson: I think that the results have come out over the last couple of years from several large trials suggesting that some pre-menopausal women might benefit from suppressing ovarian function in addition to using a drug like tamoxifen or an aromatase inhibitor. But I think it is also clear from these same trials that some women do extremely well with tamoxifen alone and so we should not mandate ovarian function suppression for every pre-menopausal woman.

　　Davidson教授：过去几年开展的一些大型临床试验表明，有些绝经前女性可从他莫昔芬或芳香化酶抑制剂治疗基础上进一步抑制卵巢功能中获益。但是，这些试验也同时表明，有些绝经前女性单用他莫昔芬即可获得非常好的效果。因此，我们不应对所有绝经前女性进行卵巢功能抑制治疗。