Adjuvant treatment for endometrial cancer: literature review and recommendations by the Comité de l'évolution des pratiques en oncologie (CEPO).

OBJECTIVE: Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this review is to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patients with resectable endometrial cancer and to develop evidence-based recommendations. METHODS: A review of the scientific literature published between January 1990 and June 2012 was performed. The search was limited to published phase III clinical trials and meta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified. RESULTS: The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beam radiotherapy, chemotherapy, or a combination of these. CONCLUSIONS: Considering the evidence available to date, the CEPO recommends the following: (1)post-surgical observation for most patients with a low recurrence risk; (2)adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk; (3)adjuvant pelvic radiotherapy with or without vaginal brachytherapy for patients with a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors); (4)adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease;

Clinical effects of home telemonitoring in the context of diabetes, asthma, heart failure and hypertension: a systematic review.

BACKGROUND: Home telemonitoring figures among the various solutions that could help attenuate some of the problems associated with aging populations, rates of chronic illness, and shortages of health professionals. OBJECTIVE: The primary aim of this study was to further our understanding of the clinical effects associated with home telemonitoring programs in the context of chronic diseases. METHODS: We conducted a systematic review which covered studies published between January 1966 and December 2008. MEDLINE, The Cochrane Library, and the INAHTA (International Network of Agencies for Health Technology Assessment) database were consulted. Our inclusion criteria consisted of: (1) English language publications in peer-reviewed journals or conference proceedings and (2) studies involving patients with diabetes, asthma, heart failure, or hypertension, and presenting results on the clinical effects of home telemonitoring. RESULTS: In all, 62 empirical studies were analyzed. The results from studies involving patients with diabetes indicated a trend toward patients with home telemonitoring achieving better glycemic control. In most trials in which patients with asthma were enrolled, results showed significant improvements in patients' peak expiratory flows, significant reductions in the symptoms associated with this illness, and improvements in perceived quality of life. Virtually all studies involving patients with hypertension demonstrated the ability of home telemonitoring to reduce systolic and/or diastolic blood pressure. Lastly, due to the equivocal nature of current findings of home telemonitoring involving patients with heart failure, larger trials are still needed to confirm the clinical effects of this technology for these patients. CONCLUSIONS: Although home telemonitoring appears to be a promising approach to patient management, designers of future studies should consider ways to make this technology more effective as well as controlling possible mediating variables.

Role of pharmacological aids and social supports in smoking cessation associated with Quebec's 2000 Quit and Win campaign.

BACKGROUND: This evaluation of the 2000 Quit and Win campaign in the province of Quebec, Canada, assessed the use and effectiveness of pharmacological aids, social support, and support resources (clinic program, support groups, books, telephone support) among contest participants. The reach of the contest was 1.3% of adult smokers: 20,400 participants. METHODS: Six months after the contest ended, 3,033 randomly selected participants completed telephone interviews about their smoking status and their use of nonform aids, social support, support resources, and pharmacological aids during their cessation attempt. Those who were abstinent from smoking were then reinterviewed 6 months later, that is, 12 months after the contest. RESULTS: Cessation rates were 66% at contest end, 36% at 6 months, and 22% at 12 months. Heavier smokers were somewhat more likely to have quit. Overall, 41% of respondents used any form of aid (support resources and pharmacological aids) in the first 6 months; among these, 42% used bupropion and 38% used nicotine patches. Those using bupropion were more likely to successfully quit smoking. Successful quitters rated the social support received from their buddy as more useful than did relapsers, and social support was unrelated to the use of pharmacological aids. CONCLUSIONS: The results suggest that adequate investment in population-wide Quit and Win programs that provide a variety of appropriate aids to smokers, including social support and pharmacological products, can improve the reach of smokers.