编者按：在乳腺癌治疗中，长期毒性管理对患者生存质量的影响日益受到关注。在近日举行的第19届圣加伦国际乳腺癌大会（SGBCC 2025），墨西哥TecSalud乳腺癌中心肿瘤内科主任Cynthia Villarreal-Garza教授带来了题为“Ensuring long-term healthy survival of breast cancer patients”演讲。她指出，年轻乳腺癌患者由于治疗强度高、周期长，面临着诸多独特的毒性问题，不仅影响患者的身体健康，还对其心理、社会功能和生活质量产生深远影响。为监测和干预这些长期毒性，Cynthia教授提出了“基于循证的健康生活方式”和远程监测应用程序的应用，以有效管理毒性，改善患者生活质量。

 

Cynthia Villarreal-Garza教授：年轻乳腺癌患者是一个非常重要的群体，大约7%的乳腺癌患者年龄在40岁及以下。这些患者因接受时间较长且强度较高的治疗方案，往往面临特有的毒性问题。

 

首先，心血管疾病是乳腺癌治疗中常见的长期毒性之一。某些化疗药物（如蒽环类药物）和靶向治疗药物（如曲妥珠单抗）可能增加心血管事件的风险，包括心肌病、心力衰竭和冠状动脉疾病。这些心血管疾病可能在治疗后数年甚至数十年内持续存在，对患者的长期生存和生活质量构成威胁。

 

其次，继发性肿瘤也是需要重点关注的长期毒性。放疗和某些化疗药物可能增加患者发生继发性恶性肿瘤的风险，如白血病、肺癌和软组织肉瘤。这些继发性肿瘤的发病时间通常较晚，且预后较差，给患者带来了额外的治疗负担。

 

第三，免疫治疗相关毒性也逐渐成为乳腺癌治疗中的重要问题。免疫检查点抑制剂虽然在部分患者中取得了显著的疗效，但也可能引发一系列免疫相关不良事件，如免疫性肺炎、免疫性肝炎、免疫性肠炎和甲状腺功能异常。这些毒性反应可能影响多个器官系统，需要及时监测和干预。

 

最后，骨健康问题、心理社会问题和性功能障碍也是不能忽视的长期毒性。内分泌治疗（如芳香化酶抑制剂）可能导致骨质疏松和骨折风险增加，尤其是在绝经前女性中。乳腺癌的诊断和治疗过程本身可能给患者带来巨大的心理压力，导致焦虑、抑郁等。此外，性功能障碍和生育能力的丧失也是年轻患者面临的独特挑战。需要特别强调的是，生育能力对年轻乳腺癌患者至关重要。许多患者在确诊时仍处于生育年龄，治疗可能导致卵巢功能衰竭或永久性不孕，治疗后还可能面临职业发展和伴侣关系方面的挑战。

 

因此，从确诊到治疗的整个过程中，我们需要综合考虑这些因素，给予足够的关注和支持。

 

Oncology Frontier:What impacts do long-term toxicities from breast cancer treatments have onpatients’quality of life?Which long-term toxicities currently lack effectivemonitoring and intervention strategies?

 

Dr.Cynthia Villarreal-Garza:I’m Cynthia Villarreal，a breast medical oncologist in Mexico.It’s very important to understand that young breast cancer patients represent a very important set of patients.Around 7%of all breast cancer patients are very young，40 years or under，and these patients have unique toxicities because they have very prolonged and intensive treatments.These patients can have several toxicities related to cardiovascular problems，secondary malignancies，immunotherapy-related toxicities，bone health problems，psychosocial issues，and also sexual problems.Fertility aspects are very important for these patients，as well as career and partner-related problems.We have to consider all of these factors in the survivorship era，from diagnosis through treatment.

 

Cynthia Villarreal-Garza教授：针对年轻乳腺癌患者的症状管理，目前已有多种被循证医学证实有效的干预措施，不仅能有效缓解症状，还能提高治疗依从性。

 

运动已被证实是改善患者疲劳和整体健康状况的重要手段。其次，心理干预措施，如正念训练、瑜伽、针灸以及认知行为疗法（CBT）等方法能够有效缓解心理压力，减少患者对疾病复发的焦虑情绪，并提升整体心理健康水平。此外，对于更年期相关症状（如潮热、抑郁、失眠），部分抗抑郁药物也被证实能够发挥积极作用。

 

然而，尽管这些干预措施已被证实有效，但许多年轻乳腺癌患者仍未能充分受益。主要原因包括时间紧张、经济负担重以及医疗资源紧张等。因此，我们需要探索更便捷、更易于整合到日常生活中的干预方式。例如，临床医生可以通过数字化远程干预和监测工具实时监测患者病情，及时调整治疗方案，确保患者能够更便捷地获得有效的支持和干预。

 

Oncology Frontier:What"evidence based approaches for healthy living"have been proposed?How dothey improve patients’quality of life?

 

Dr.Cynthia Villarreal-Garza:There have been several interventions that have proven to be helpful for young women experiencing symptoms and that also help improve adherence to treatment.For example，it has been proven that exercise can improve fatigue and overall wellness.Additionally，mindfulness，yoga，acupuncture，and cognitive behavioral therapy can be used to improve psychological symptoms，fear of recurrence，and overall mental health.Some medications，such as antidepressants，can also be used to treat menopausal symptoms，including hot flushes，depression，and insomnia.

 

The issue is that many young women do not end up receiving these interventions for various reasons—whether it’s lack of time，financial difficulties，or healthcare saturation.We must provide patients with interventions that are more accessible and easier to integrate into their daily lives，such as web-based interventions or digital symptom tracking tools that their physicians can monitor.That way，we can ensure that they receive these beneficial interventions in a more readily available way.

 

Cynthia Villarreal-Garza教授：主动询问患者的症状和需求是毒性管理的关键。在生存期管理中，持续追踪患者的健康状况和症状至关重要。美国社区癌症中心协会开展的一项有关远程监测技术（RPM）的调查结果显示，远程监测的主要优势是及时将患者症状告知医疗团队、在需要医疗干预时收到警报、改善患者治疗效果和降低住院和急诊室就诊的风险。使用数字化应用程序远程监测患者的症状，能够帮助医疗团队及时对患者进行干预，保障患者安全，从而更有效地管理治疗副作用。

 

建立多学科团队是管理长期毒性的另一项关键措施。多学科团队不仅包含肿瘤科医生，还应涵盖心理学家、精神科医生、运动康复专家和物理治疗师等，追踪患者症状，反映患者需求，协调后续随访，进而改善生活质量。

 

随着数字化健康干预和教育资源的不断发展，将会有更多工具来帮助患者更好地管理长期毒性，使干预更加可及、有效。

 

Oncology Frontier:When formulating treatment plans for breast cancer patients，how to balance therisks of anti-cancer efficacy and long-term toxicities?How to establish a long-termtoxicity management plan for patients from the outset?

 

Dr.Cynthia Villarreal-Garza:In a very practical way，if we don’t ask，we might not know.During the survivorship phase，it’s critical to track patient health outcomes and symptoms.Studies have shown that using electronic apps to monitor symptoms and needs allows for real-time interventions，helping us address issues as they arise.If we know that a patient is experiencing a problem，we can provide the necessary interventions.

 

The second key factor is establishing a multidisciplinary team that includes not only physicians but also psychologists，psychiatrists，exercise trainers，and rehabilitation specialists.A patient navigator who tracks patients’needs and coordinates follow-ups can also make a significant difference.Enhancing quality of life requires interventions that are easy for patients to access.With web-based interventions and educational resources，we now have more tools available to help patients manage long-term toxicities effectively.

 

Cynthia Villarreal-Garza教授：未来，随着技术的不断进步，用于症状追踪和干预的数字化应用程序将得到更广泛的应用。刚才提到，这些应用程序通过实时监测患者的症状，能够有效减少急诊就诊次数、减少不必要的门诊随访、提高治疗依从性，并显著改善患者的整体生活质量。因此，我们需要进一步推动这类应用程序的普及，使其能够惠及更多患者。

 

此外，针对不同患者群体的个性化干预也极为重要。目前，许多患者教育资源主要以英语为主，并不一定适用于非英语国家。例如，在一些资源相对有限的国家，本地语言的教育资源匮乏。在这种情况下，我们可以借鉴其他国家已经开发的成熟材料，并根据本地患者的具体需求进行调整，使其更符合特定人群的使用习惯，从而真正发挥其作用。

 

目前，许多患者教育资源以英语为主，这在一定程度上限制了其在非英语国家的应用。以我的国家墨西哥为例，当地可用于乳腺癌患者教育的西班牙语资源相对匮乏。鉴于此，我们可借鉴其他国家已开发的成熟教育资源，并结合本地患者的具体需求进行适当调整，使其更贴合特定人群的使用习惯，从而切实发挥其在患者教育中的作用。

 

Oncology Frontier:Regarding the comprehensive management of long-term toxicities in breast cancerpatients，what patient management and education experiences can be shared?

 

Dr.Cynthia Villarreal-Garza:I think we are going to see much more development in the coming years when it comes to apps that help track symptoms and provide interventions.Data has shown that when we monitor symptoms in real time，we can reduce emergency visits，decrease the number of unnecessary consultations，improve treatment adherence，and enhance overall quality of life.We need to make these applications more widely available so that all patients can benefit from them.

 

It is also important to tailor these interventions—whether through apps or educational resources—to specific populations.A lot of resources exist in English，but they are not always applicable in non-English-speaking countries.For example，in Mexico，we don’t have as many resources available in Spanish.Instead of starting from scratch，we can adapt materials that have already been developed by other groups，modifying them to fit the needs of our population so they can be effectively used by our patients.

 

Cynthia Villarreal-Garza教授

墨西哥TecSalud乳腺癌中心肿瘤内科主任