Kulabo besifazane abanesifo somdlavuza we-estrogen-receptor-positive, ukwelashwa kwama-hormone ngokuvamile kunconywa ngemuva kokwelashwa okuyisisekelo nokuhlinzwa kanye nokuthelela kwamakhemikhali kanye / noma ukwelashwa kwemisebe . Izinketho zifaka tamoxifen noma i-aromatase inhibitors njenge-Arimidex, Femora, noma i-Aromasin. Izindleko nokusebenza kwala mithi kuqhathaniswa kanjani, futhi yini okudingeka ukwazi?
Kwenzekani uma unenkinga yokukhokhela le mithi?
I-Hormone Therapy kanye Nengozi Yokuphindaphinda I-Breast Cancer
Siyazi ukuthi ngisho nangemva kokwelashwa okuyinhloko ngomdlavuza webele kunengozi yokuphindaphindiwe . Futhi emuva kokuphela kwesikhathi seminyaka embalwa noma ngisho namashumi eminyaka emva kokwelashwa kuvame kakhulu nezicubu zesifo se-estrogen-receptor-positive. Izindlela zokwelapha ezivuthiwe ziye zaboniswa ukunciphisa ingozi yokuphindaphinda futhi zithuthukise izinga lokusinda.
Indlela yokwelashwa kweHormone Yenza Ukunciphisa Ingozi Yokuphindaphindiwe
Siyazi ukuthi i-estrogen isebenza njenge "isici sokukhula" ukuze kukhuliswe ukukhula kwezibeletho zesifuba se-estrogen-receptor ngokubophezela kwi-estrogen receptors ebusweni bamangqamuzana omdlavuza. Ngakho-ke, kokubili ukunciphisa inani le-estrogen egazini kanye nokuvimbela ama-estrogen receptors kunganciphisa ingozi lawa maseli azokhula futhi abe nokuphindaphindiwe.
I-Tamoxifen ne-aromatase inhibitors isebenza ngezindlela ezahlukene. Ngaphambi kokunqamuka kwesikhashana, ama-ovari ayisisekelo esiyinhloko se-estrogen.
I-Tamoxifen isebenza kubesifazane besimenopausal ngokuvimbela ama-estrogen receptors on amangqamuzana omdlavuza webele ukuze i-estrogen ingakwazi ukubopha futhi ivuselele amangqamuzana. I-Tamoxifen ingabuye isebenze ngemva kokuqeda ukuphuma esikhathini, kodwa i-aromatase inhibitors itholwe ukuthi iphumelela kakhulu ekunciphiseni ukuphindaphinda.
Ngemuva kokumisa esikhathini, umthombo oyinhloko we-estrogen ukuguqulwa kwe-androgens (okwamanje kuma-fat cells) ku-estrogen.
I-enzyme eyenza lokhu ibizwa ngokuthi i-aromatase. I-Aromatase inhibitors ivimbela isenzo se-aromatase ngakho-ke isrogen ayikwazi ukukhiqizwa.
Ukukhetha ukwelashwa kwamahomoni kanye nesimo seMenopausal
Emadodeni ase-pre-menopausal, i-tamoxifen iyadingeka njengoba umthombo oyinhloko we-estrogen emzimbeni uvela kuma-ovari. Kulesi silungiselelo, i-aromatase inhibitors izovimba kuphela umthombo wesibili wokukhiqizwa kwe-estrogen.
Ngakho-ke abesifazane base-Premenopausal baphathwa nge-tamoxifen. I-Aromatase inhibitors ingasetshenziswa kuzilungiselelo ezimbalwa. Uma owesifazane ehamba ngokuya esikhathini semvelo (njengoba kunqunywe ukuhlolwa kwegazi ngoba kungenakuqinisekiswa ngemva kwekhemotherapy) angashintshwa ku-aromatase inhibitors. Angakwazi futhi ukuthola lezi zidakamizwa uma enqamuka esikhathini sokuhlinzwa (ukukhipha ama-ovari) noma ukuthola ukwelashwa kwe-ovarian.
I-Aromatase inhibitors okwamanje itholakala:
- I-Arimidex (i-anastrozole)
- I-Femara (letrozole)
- I-Aromasin (i-exemestane)
Ubude Besikhathi Isikhathi Se-Hormonal Therapy sisetshenziswa
Esikhathini esidlule, i-tamoxifen noma i-inhibitor ye-aromatase yasetshenziselwa iminyaka engu-5. Ucwaningo lwamuva lubonisa ukuthi ukuqhubekela phambili eminye iminyaka engu-5 (ngezinye izikhathi ukushintsha ukusuka ku-tamoxifen kuya ku-inhibitor ye-aromatase) kungabuye kunciphise ingozi yokuphindaphinda.
Imiphumela emibi ye-Tamoxifen vs Aromatase Inhibitors (i-Arimidex, i-Femara, ne-Aromasin)
Kokubili i-tamoxifen ne-aromatase inhibitors ingabangela ama-muscle aches, kodwa ngokuvamile lokhu kubi kakhulu ku-aromatase inhibitor.
I-Tamoxifen inganciphisa ukulahleka kwethambo kanti i-aromatase inhibitors ingaholela ekulahlekelweni kwethambo kanye ne-osteoporosis.
Mayelana nemiphumela emibi kakhulu, i-tamoxifen ngezinye izikhathi ingase ibe nemiphumela emibi kakhulu efana ne-blood clots kanye ne-pulmary emboli. Ama-inhibitors e-Aromatase ahlobene nengozi eyengeziwe yesifo senhliziyo kwabesifazane abanomlando we-block blockages.
Uma imiphumela emibi iba yinkimbinkimbi, tshela udokotela wakho futhi ucele izindlela zokubhekana nayo; kuningi izindlela zokunciphisa le miphumela emibi nokwenza ukwelashwa kube lula. Ngenkathi lokhu kungaba yinkinga enzima, khumbula ukuthi usuqedile ingxenye enkulu yokwelapha futhi uhambela ekuphileni ngemuva komdlavuza webele.
Izindleko ze-Tamoxifen vs Aromatase Inhibitors
Kokubili i-tamoxifen ne-aromatase inhibitors njenge-Arimidex inganciphisa ingozi yakho yokuphindaphinda umdlavuza webele (ngenzuzo ethile ehambisana ne-aromatase inhibitors) kodwa izindleko zingahluka kakhulu. Njengoba i-tamoxifen iyindlela yokwelashwa yama-hormone eyedala kunazo zonke futhi enqunyiwe kakhulu, ijwayele ukuba enye yezindlela ezishibhile kakhulu. Ama-inhibitors e-Aromatase ngokuvamile ayabiza kakhulu kune-tamoxifen.
Zombili izinhlobo zokwelashwa kwe-hormone zisiza ukuvimbela ukuphindaphindiwe komdlavuza wesifuba, kodwa zombili izinhlobo zemithi ziza nezindleko ezithile nemiphumela emibi.
Ukuphatha Izindleko Zokwelashwa Kwe-Hormonal
Ukwelashwa kwama-hormonal kungabiza, kodwa kungasiza ukucabanga njengenqubomgomo yomshuwalense ngokumelene nokuphindaphindiwe.
Izindleko zalo mithi zingahluka kakhulu ngokusekelwe kwomshuwalense wakho. Ngaphezu kwalokho, ezinye izinkampani zomshuwalense zizohlanganisa uhlobo olulodwa lwe-aromatase inhibitor hhayi enye.
Uma unenkinga ngezindleko, kunezinketho eziningi:
- Sebenzisa nodokotela wakho
- Khuluma nenkampani yakho yomshuwalense
- Izinhlelo zokusiza ngezidakamizwa.
Ake sibheke ngayinye yalezi ngokwehlukana.
Sebenza Nodokotela Wakho Nenkampani Yomshuwalense
Isinyathelo sokuqala uma izindleko zemithi yakho ziphakeme kakhulu ukukhuluma nodokotela wakho. Uma ezwa ukuthi kunesizathu sokuthi esinye isidakamizwa singase sikhetheke komunye (njengokunciphisa ingozi enkulu noma imiphumela embalwa emibi) cabanga ngezinyathelo ezilandelayo.
Okwesibili, khuluma nenkampani yakho yomshuwalense. Kungaba lula ukukhuluma ngomuntu phezu kwefoni. Uma imithi udokotela wakho ecabanga ukuthi ingcono akuyona i-formulary, udokotela wakho angakwazi ukuqedela ukugunyazwa kwangaphambili ukuze kuhlanganiswe. Kungakhathaliseki ukuthi unomshuwalense wezempilo wangasese, i-Medicare Part D, noma i-Medicaid, ukufaneleka kwakho kungahluka.
Ungase ufise ukukhuluma nomuntu wemithi yakho. Izinguqulo ezijwayelekile zezinye zalezi mithi ziyatholakala futhi zingabiza kakhulu.
Izinhlelo zosizo zosizo lwe-prescription
Uma usenenkinga yokufaka udokotela wakho udokotela uzizwa kangcono, kunezinketho eziningi. Ezinye zazo zihlanganisa:
- Izinhlelo Zokusizwa Ngamaphesenti Eziguli : Funda kabanzi mayelana nezinhlelo ezahlukene zosizo lwezinyathelo zesiguli ezitholakalayo futhi uhlole nabakhiqizi bezidakamizwa ukuze uthole usizo nezinhlelo zokulondoloza.
- Izinhlelo zokunciphisa izidakamizwa zemithi: Funda kabanzi mayelana nokuthi ubani ongazuza ekhadini lesaphulelo lesidakamizwa nalapho angasiza.
- Cela ama-sampuli: Ezinye ze-oncologists zinikezwa amasampula we-aromatase inhibitors. Awukwazi ukulimaza ukubuza.
- Hlola ukukhubazeka: Uma ungakabi khona 65 kodwa ungakwazi ukuthola ukukhubazeka, ungathola imithi yakho ngeMedare.
- Ama-pharmacy e-inthanethi: Ngaphambi kokuba uhambe ku-inthanethi, funda ukuthi ungayilalisa kanjani ngokuphepha izidakamizwa ku-intanethi .
- Izinhlelo zosizo lwezokwelapha zikahulumeni: Amazwe amaningi aseMelika anezinhlelo zokunciphisa noma zokusiza. Hlola ukuze ubone ukuthi ngabe isimo sakho sinikeza kanjani.
- Usizo olungelona usizo: Buza udokotela wakho noma umtholampilo ngezinhlangano zendawo ezinikeza usizo ngezindleko zemigomo. Ungabheka futhi nezinhlangano ezinikezela ukukhuthaza umdlavuza webele. Khumbula ukuthi izinhlangano ezahlukene zinemigomo ehlukile. Abanye bazama ukwenza ushintsho ezingeni likazwelonke. Abanye bahlose ukucwaninga ngemali. Abanye banomgomo wokusiza abantu ngabanye ukuba babhekane nomdlavuza namuhla; njengokufaka izindleko zemithi kadokotela.
Gcina amarekhodi aqaphele
Ngezinguquko zomshuwalense ngokuvamile okudinga iminikelo emikhulu evela kulabo abathintekayo, ukugcina amarekhodi aqaphele kubaluleke kakhulu kunanini ngaphambili. Izindleko eziningi zokwelashwa komdlavuza zikhishwa intela , kuhlanganise nezindleko ezingaphandle kwe-hormonal therapy.
Izwi elivela
Ukwelashwa kwamahomoni kunconywa iminyaka emihlanu kuya kwengu-10 egcwele ngemuva kokwelashwa okuyisisekelo komdlavuza wesifuba, ngakho-ke kubalulekile ukucabangela izinzuzo ngokuphathelene nokuvimbela ukuphindaphindiwe, iphrofayili yethonya lomuthi othile, kanye nezindleko.
Uma unemiphumela emibi kubalulekile ukunquma ukuthi inkinobho ingase iphumelele yini. Ngokusobala, abantu abaningi bayeka lezi zidakamizwa bese behluleka ukuthola inzuzo ephelele abayinikezayo. Izindleko zingabuye zibe yisivimbela, kodwa izinketho eziningana zichazwe ngenhla.
Njengombhalo wokugcina, eminye yemiphumela emibi kakhulu emilonyeni ye-hormonal therapy yizimpawu ze-menopausal. Kodwa ukukhanya okushisayo kuhlotshaniswa nokuphila komdlavuza wesifuba okungcono . Linye nje lezinsimbi zesiliva.
> Imithombo
> National Cancer Institute. Ukwelashwa Kwemdlavuza Webele (PDQ) -Health Professional Version.
> Tjan-Hejinen, V., Hellemond, I., Ontanga, uP. Et al. I-Adjuvant Extended Aromatase Inhibition Ngemuva kokutheleleka kwe-Endocrine ehlukile (DATA): Isikhathi Esingahleliwe, Isigaba Sesi-3. I-Lancet Oncology . 2017. 18 (11): 1502-1511.