ABSTRACT
BACKGROUND: In ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab), alirocumab was compared with placebo, added to high-intensity or maximum tolerated statin treatment after acute coronary syndrome in 18 924 patients. Alirocumab reduced first occurrence of the primary composite end point-coronary heart disease death, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or hospitalization for unstable angina-as well as total nonfatal cardiovascular events and all-cause deaths. The present analysis determined whether alirocumab reduced total (first and subsequent) hospitalizations and death and increased days alive and out of hospital (DAOH) and percent DAOH in ODYSSEY OUTCOMES. METHODS AND RESULTS: In prespecified analyses, hazard functions for total hospitalizations and death were jointly estimated by a semiparametric model, while in post hoc analyses, DAOH and percent DAOH were compared between treatment groups with Poisson regression and one-inflated beta regression, respectively. With 16 629 total hospitalizations and 726 deaths, 331 fewer hospitalizations, and 58 fewer deaths were observed with alirocumab compared with placebo, translating to 15.6 total hospitalizations or deaths avoided with alirocumab per 1000 patient-years of assigned treatment. Alirocumab reduced total hospitalizations (hazard ratio, 0.96 [95% CI, 0.92-1.00]; P=0.04) and increased DAOH relative to placebo (rate ratio, 1.003 [95% CI, 1.000-1.007]; P=0.05), primarily through a reduction in days dead (rate ratio, 0.847 [95% CI, 0.728-0.986]; P=0.03). Patients randomized to alirocumab were also more likely to survive to the end of the study without hospitalization (odds ratio, 1.06 [95% CI, 1.00-1.13]; P=0.03). CONCLUSIONS: Alirocumab reduced total hospitalizations with corresponding small increases in DAOH and percent DAOH. These outcomes provide alternative patient-centered metrics to capture the totality of alirocumab clinical efficacy after acute coronary syndrome. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01663402.
Subject(s)
Acute Coronary Syndrome/drug therapy , Angina, Unstable/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Anticholesteremic Agents/therapeutic use , Dyslipidemias/drug therapy , Myocardial Infarction/drug therapy , Patient Admission , Patient Readmission , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Angina, Unstable/blood , Angina, Unstable/diagnosis , Angina, Unstable/mortality , Antibodies, Monoclonal, Humanized/adverse effects , Anticholesteremic Agents/adverse effects , Biomarkers/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Drug Therapy, Combination , Dyslipidemias/blood , Dyslipidemias/diagnosis , Dyslipidemias/mortality , Hospital Mortality , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Myocardial Infarction/blood , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
: Breast cancer patients are living longer with the disease than ever before. According to the National Cancer Institute, more than 3 million women in the United States are currently living with a breast cancer diagnosis, and many seek care in nononcology settings, whether for treatment, acute symptoms and complaints related to their cancer diagnosis, or unrelated concerns. Yet many nononcology providers are unfamiliar with the various oral agents used to treat breast cancer, and their possible adverse effects and drug interactions. It is imperative that all providers be aware of these agents and know when a patient is currently taking or has taken them. This article provides an overview of the most common oral treatments for breast cancer and discusses common adverse effects and management.
Subject(s)
Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Patient Safety , Administration, Oral , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/classification , Education, Continuing , Female , Humans , United StatesABSTRACT
PURPOSE/OBJECTIVES: To examine oncology care providers' knowledge of tattooing options for patients who have elected to have breast reconstruction as part of their breast cancer treatment. â©. DESIGN: Cross-sectional survey. SETTING: A large metropolitan cancer center in New York and various locations across the United Statesâ©. SAMPLE: 68 oncology care providers who work with women with breast cancer, distributed into two groups. METHODS: Descriptive statistics were used to summarize online survey responses for the two groups, with inferential comparisons made with logistic regression modelsâ©. MAIN RESEARCH VARIABLES: Healthcare profession, discussion of reconstructive tattoo options with patients, knowledge of providers of reconstructive tattoos outside of traditional healthcare settings, and recommendations made to patientsâ©. FINDINGS: RNs were significantly less likely to recommend a professional tattoo artist to a patient than non-RNs, despite a similar proportion of both groups believing that a tattoo artist would provide the patient with a better tattoo than healthcare providers (HCPs). CONCLUSIONS: Additional research is needed to identify education deficits in HCPs regarding tattoo reconstruction options. HCPs are recommending potentially substandard options for nipple-areola tattooing, even though many believe that tattoo artists, who are outside of the traditional healthcare setting, could provide better outcomes for patients. IMPLICATIONS FOR NURSING: Nurses and other HCPs require additional education about nipple-areola tattoo options for patients following breast cancer surgeryâ©.