Risk prediction models for antineoplastic-associated cardiotoxicity in treatment of breast cancer: A systematic review.

PURPOSE: The objective of this systematic review is to assess methodology of published models to predict the risk of antineoplastic-associated cardiotoxicity in patients with breast cancer. METHODS: We searched PubMed and Embase for studies that developed or validated a multivariable risk prediction model. Data extraction and quality assessments were performed according to the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: We identified 2,816 unique publications and included 8 eligible studies (7 new risk models and 1 validation of a risk stratification tool) that modeled risk with trastuzumab (n = 5), anthracyclines (n = 2), and anthracyclines with or without trastuzumab (n = 1). The most common final predictors were previous or concomitant chemotherapy (n = 5) and age (n = 4). Three studies incorporated measures of myocardial mechanics that may not be frequently available. Model discrimination was reported in 7 studies (range of area under the receiver operating characteristic curve, 0.56-0.88), while calibration was reported in 1 study. Internal and external validation were performed in 4 studies and 1 study, respectively. Using the PROBAST methodology, we rated the overall risk of bias as high for 7 of 8 studies and unclear for 1 study. Concerns for applicability were low for all studies. CONCLUSION: Among 8 models to predict the risk of cardiotoxicity of antineoplastic agents for breast cancer, 7 were rated as having a high risk of bias and all had low concerns for clinical applicability. Most evaluated studies reported positive measures of model performance but did not perform external validation. Efforts to improve development and reporting of these models to facilitate their use in practice are warranted.

Hormonal contraception prescribing by pharmacists: 2019 update.

OBJECTIVES: Empowering pharmacists to prescribe contraceptives could help alleviate barriers such as the accessibility of medical centers and the availability, inconvenience, and cost of appointments. Several states have enacted legislation authorizing pharmacists to prescribe hormonal contraceptives. This manuscript provides an overview of each of the states' laws and highlights differences among the states. The objectives of this study were to (1) list the states in which pharmacists currently have the authority to prescribe contraceptives and (2) compare the differences among those states. DATA SOURCES: The authors assembled state statutes and regulations on pharmacist prescribing of contraceptives and conducted a literature review for research on pharmacist prescribing of contraceptives using PubMed. SUMMARY: Nine states, plus the District of Columbia, authorize pharmacists to prescribe hormonal contraceptives autonomously under a statewide authority, and each state differs in their policy. CONCLUSION: For pharmacists to take full advantage of this opportunity and to expand their clinical role, the quality, consistency, and sustainability of these initiatives must be assessed.