Evaluation of an Online Platform for Cancer Patient Self-reporting of Chemotherapy Toxicities

The current mechanism for monitoring toxicity symptoms in cancer trials depends on a complex paper-based process. Electronic collection of patient-reported outcomes (PROs) may be more efficient and accurate. An online PRO platform was created including a simple data entry interface, real-time report generation, and an alert system to e-mail clinicians when patients self-report serious toxicities. Feasibility assessment involving 180 chemotherapy patients demonstrated high levels of use at up to 40 follow-up clinic visits per patient over 16 months (85% of patients at any given visit), with high levels of patient and clinician acceptance and satisfaction (>95%). Alerts were used as the basis for delayed chemotherapy treatments, dose modifications, and scheduling changes. These results demonstrate that online patient-reporting is a feasible strategy for chemotherapy toxicity symptom monitoring, and may improve safety and satisfaction with care. Ongoing multi-center research will evaluate the impact of this approach on clinical and administrative outcomes.     

Waist-to-hip ratio and breast cancer mortality

High insulin levels have been associated with increased risk of breast cancer and poorer survival after a breast cancer diagnosis. Waist-to-hip ratio (WHR) is a marker for insulin resistance and hyperinsulinemia. In this study, the authors tested the hypothesis that elevated WHR is directly related to breast cancer mortality. For identification of modifiable factors affecting survival, data were collected on 603 patients with incident breast cancer who visited the Vancouver Cancer Centre of the British Columbia Cancer Agency (Vancouver, British Columbia, Canada) in 1991-1992, including body measurements and information on demographic, medical, reproductive, and dietary factors. These patients were followed for up to 10 years. Cox proportional hazards regression models were used to relate the variables to breast cancer mortality (n = 112). After adjustment for age, body mass index, family history, estrogen receptor (ER) status, tumor stage at diagnosis, and systemic treatment (chemotherapy or tamoxifen), WHR was directly related to breast cancer mortality in postmenopausal women (for highest quartile vs. lowest, relative risk = 3.3, 95% confidence interval: 1.1, 10.4) but not in premenopausal women (relative risk = 1.2, 95% confidence interval: 0.4, 3.4). Stratification according to ER status showed that the increased mortality was restricted to ER-positive postmenopausal women. Elevated WHR was confirmed as a predictor of breast cancer mortality, with menopausal status and ER status at diagnosis found to be important modifiers of that relation.     

Changing patterns in women seeking terminations of pregnancy: A trend analysis of data from one service provider 1996–2006

Objectives: The purpose of this study was to assess emerging trends in five characteristics: age, first ever pregnancy, contraception at time of conception, contraception choices post-operatively and referral source of women presenting for a termination of pregnancy (1996–2006) from a southern service in Adelaide, South Australia.
Method: A time-series study, from 1996 to 2006, using 3,434 cases from a termination of pregnancy service provider. Five characteristics associated with women attending for a termination of pregnancy were examined. Data were analysed using simple linear regression analyses and one-way ANOVA.
Results: There was a significant increase in women aged 30–50 years having a pregnancy terminated (ANOVA F1,9 = 5.901, p=0.041), with 67% of women using contraception at the time of conception. An increasing percentage of women chose not to use any contraception post-operatively (ANOVA F1,9 = 14.409, p=0.006), although 90% of women left the service with contraception. Additionally, there was a significant decline in women using natural family planning methods (ANOVA F1,9 = 13.654, p=0.006). Referral patterns changed significantly over the ten years, with fewer women being referred by a general practitioner (ANOVA F1,9 = 46.492, p=0.000) and family planning clinics (ANOVA F1,9 = 13.011, p=0.007).
Conclusions and implications: Termination of pregnancy patterns from a hospital based regional termination service have changed over the past ten years in this study population. There are implications for policy, strategic plans and health promotion activities in the southern region of Adelaide.     

Detection and prevention of medication misadventures in general practice.

BACKGROUND: Adverse drug events are leading categories of iatrogenic patient injury. Development of preventive strategies for general practice setting depends on effective detection of events. OBJECTIVE: The aim of the study is to compare the strengths and weaknesses of voluntary reporting, chart review and patient survey in measuring medication misadventures in general practice and to analyze the events by severity and preventability, drug groups and patients' and doctors' characteristics, for the formulation of preventive strategies. METHOD: In the 2-month study period, we applied voluntary report, chart review and patient survey to collect data related to medication misadventures and compared their detection rate. RESULTS: The chart review demonstrated the highest yield for detecting overall medication misadventures (2.03% medication orders), followed by patient survey (1.46% medication orders) and voluntary reporting (0.52% medication orders). Chart review and patient survey were better than voluntary reporting in uncovering preventable adverse drug events. However, voluntary reporting was pivotal in capturing sentinel events. Beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin and non-steroidal anti-inflammatory drugs had caused 82.0% of all adverse drug events. These events were more common with advanced age of patients, greater number of consultation problems and prescribed drug items. Additional resources implicated were minimal. CONCLUSION: We suggested a complementary approach using chart review and voluntary reporting in measuring and monitoring medication misadventures in general practice. Close monitoring of the events was necessary for older patients, multiple medical problems and poly-pharmacy and for patients using beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin or non-steroidal anti-inflammatory drugs on a long-term basis.     

Caffeine reduction education to improve urinary symptoms

Caffeine reduction is an internationally accepted treatment strategy for patients with urinary symptoms. However, there is little trial evidence in support of a caffeine/urinary symptom effect. A prospective randomized trial was conducted among 95 consecutive adult patients with urinary symptoms presenting to two nurse continence advisers. Frequency, urgency and leakage outcomes were tested 1 month postenrolment. Trial findings indicate that caffeine intake was reduced (P<0.0001) in the experimental group and that urgency (P=0.002) and frequency (P=0.037) outcomes were significantly improved. Caffeine practices and habits were surveyed and self-reports of caffeine effects indicate that urinary symptoms figured prominently as a reported effects but less so as a driver of caffeine reduction.     

Medroxyprogesterone and conjugated oestrogen are equivalent for hot flushes: a 1-year randomized double-blind trial following premenopausal ovariectomy

Oestrogen therapy is the gold standard treatment for hot flushes/night sweats, but it and oestrogen/progestin are not suitable for all women. MPA (medroxyprogesterone acetate) reduces hot flushes, but its effectiveness compared with oestrogen is unknown. In the present study, oral oestrogen [CEE (conjugated equine oestrogen)] and MPA were compared for their effects on hot flushes in a planned analysis of a secondary outcome for a 1-year randomized double-blind parallel group controlled trial in an urban academic medical centre. Participants were healthy menstruating women prior to hysterectomy/ovariectomy for benign disease. A total of 41 women {age, 45 (5) years [value is mean (S.D.)]} were enrolled; 38 women were included in this analysis of daily identical capsules containing CEE (0.6 mg/day) or MPA (10 mg/day). Demographic variables did not differ at baseline. Daily data provided the number of night and day flushes compared by group. The vasomotor symptom day-to-day intensity change was assessed by therapy assignment. Hot flushes/night sweats were well controlled in both groups, one occurred on average every third day and every fourth night. Mean/day daytime occurrences were 0.363 and 0.187 with CEE and MPA respectively, but were not significantly different (P=0.156). Night sweats also did not differ significantly (P=0.766). Therapies were statistically equivalent (within one event/24 h) in the control of vasomotor symptoms. Day-to-day hot flush intensity decreased with MPA and tended to remain stable with CEE (P<0.001). In conclusion, this analysis demonstrates that MPA and CEE are equivalent and effective in the control of the number of hot flushes/night sweats immediately following premenopausal ovariectomy.