The impact of risk status, preexisting morbidity, and polypharmacy on treatment decisions concerning menopausal symptoms

AbstractCanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis–free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.

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Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2016-001101 ◽

2017 ◽

Vol 10 (2) ◽

pp. e12-e12 ◽

Cited By ~ 2

Author(s):

Alexandra C Malyon ◽

Julia R Forman ◽

Jonathan P Fuld ◽

Zoë Fritz

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

Treatment Decisions ◽

Care Planning ◽

New Approach ◽

Significance Level ◽

Oncology Ward ◽

Future Care ◽

Advance Care ◽

The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

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Impact of premature ovarian insufficiency on cardiovascular health

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183804 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3837

Author(s):

Kavitha Abraham ◽

Vaibhav Londhe ◽

Tunny Sebastian ◽

Thomas Paul ◽

Aruna Kekre

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Health ◽

Menopausal Symptoms ◽

Premature Ovarian Insufficiency ◽

P Value ◽

Ovarian Insufficiency ◽

Hs Crp ◽

Artery Disease ◽

The Impact

Background: The objectives of the study were to identify the causes of premature ovarian insufficiency (POI) and to assess the severity of menopausal symptoms as well as the impact on cardiovascular health in these patients.Methods: Authors did a cross sectional case control study with 100 cases and 100 age matched controls. Women <40years of age with amenorrhoea >4months and FSH >25mIU/ml were identified with POI. Women <40years with normal cycles were the controls. Causes were identified from medical records and menopausal symptoms were categorized using menopause rating score questionnaire. Hypercholesterolemia (≥200mg/dl), hypoalbuminemia (<3.5g/dl) and high sensitive C reactive protein (HS-CRP ≥3mg/dl) were assessed as the early markers of coronary artery disease. Statistical methods included Chi square test and logistic regression analysis. P value <0.05 was considered significant.Results: 64% of the patients were between 31-40 years. 66% of them were into menopause for <5 years. The cause was idiopathic in 62%. 91% had no or minimal menopausal symptoms. Hypoalbuminemia (6 versus 1, 95% CI 1.8-2.4, OR 2.1, p=0.01) and hypercholesterolemia (75 versus 51, 95%CI 2.5-3.1, OR 2.8, p= 0.001) were significantly high in cases. HS-CRP was not found to be different between the groups (59 versus 49, OR 1.5, 95%CI 0.8-2.6, p=0.2).Conclusions: In majority with POI the cause is idiopathic and menopausal symptoms are minimal. Hypoalbuminemia and hypercholesterolemia, markers of coronary artery disease, were significantly elevated in POI. Early screening for these variables within 5 years of menopause would reduce the cardiovascular mortality in these patients.

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Improvement of menopausal symptoms and the impact on work ability: A retrospective cohort pilot study

Maturitas ◽

10.1016/j.maturitas.2018.10.015 ◽

2019 ◽

Vol 120 ◽

pp. 23-28 ◽

Cited By ~ 7

Author(s):

Marije Geukes ◽

Johannes R. Anema ◽

Mariëlle P. van Aalst ◽

Renee X. de Menezes ◽

Henk Oosterhof

Keyword(s):

Pilot Study ◽

Work Ability ◽

Retrospective Cohort ◽

Menopausal Symptoms ◽

The Impact

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The impact of a fourteen-gene molecular assay on physician treatment decisions in non-small-cell lung cancer

International Journal of Clinical Oncology ◽

10.1007/s10147-014-0700-8 ◽

2014 ◽

Vol 20 (1) ◽

pp. 59-69 ◽

Cited By ~ 2

Author(s):

Shane Dormady ◽

Michael S. Broder ◽

Girish V. Putcha ◽

Robert H. Dumanois ◽

Alison H. DeCristofaro ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Treatment Decisions ◽

Small Cell ◽

Molecular Assay ◽

Small Cell Lung ◽

The Impact

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278: The Impact of Hexvix Based Fluorescence Cystoscopy in Treatment Decisions of Bladder Cancer - Results of a Prospective Phase III Multicenter Study

The Journal of Urology ◽

10.1016/s0022-5347(18)37540-2 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 73-73 ◽

Cited By ~ 1

Author(s):

Christoph Durek ◽

Sigrid Wagner ◽

Bram Zeijlemaker ◽

Jeroen Van Moorselaar ◽

J. Alfred Witjes ◽

...

Keyword(s):

Bladder Cancer ◽

Multicenter Study ◽

Treatment Decisions ◽

Phase Iii ◽

Fluorescence Cystoscopy ◽

Prospective Phase ◽

The Impact

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Evolving Role of Genomics in Genitourinary Neoplasms

Acta Medica Academica ◽

10.5644/ama2006-124.243 ◽

2019 ◽

Vol 48 (1) ◽

pp. 68

Author(s):

Michael E. Devitt ◽

Robert Dreicer

Keyword(s):

Dna Damage ◽

Genomic Data ◽

Treatment Decisions ◽

Response To Therapy ◽

Genomic Alterations ◽

Dna Damage And Repair ◽

Genitourinary Cancer ◽

Genitourinary Cancers ◽

The Impact

The aim of this article is to review the current role of genomic testing in the risk, prognosis, and treatment of genitourinary malignancies. The authors selected guidelines, publications, and abstracts relevant to the current and emerging role of genomics in genitourinary cancers. The risk of developing genitourinary cancer can be stratified based on genomic data. Prostate cancer has the strongest degree of heritability, with BRCA1/2 and HOXB13 mutations playing a role in familial disease. Genomic data is on the verge of informing treatment decisions across genitourinary cancers. mCRPC has diverse genomic alterations that represent potential therapeutic targets, including alterations in the AR pathway, DNA damage and repair pathways, cell cycle pathways, PI3K pathway, and Wnt signaling. Genomic alterations in clear cell renal cell carcinoma can inform prognosis and mutations in mTOR pathways predict response to mTOR inhibitors. Urothelial carcinoma can be classified into different subtypes based on gene expression profiling, which provides prognostic information and predicts response to chemotherapy and immunotherapy. Specific mutations have been identified that predict response to therapy including ERCC2 mutations and cisplatin, DNA damage and repair mutations and checkpoint inhibitors, and FGFR3 mutations and FGFR tyrosine kinase inhibitors such as erdafitinib.Conclusion. Genitourinary malignancies have not felt the impact of genomic data as greatly as other cancer types. The majority of benefit lies in identifying patients at high risk of genitourinary cancer. Fortunately, breakthroughs are on the horizon that will result in a greater incorporation of genomic information into treatment decisions for patients with genitourinary cancer.

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