A Novel Approach to Better Characterize Medication Adherence in Oral Anticancer Treatments.

Purpose: This study aims to describe a 12-month medication adherence with oral anticancer medications (OAMs) in a routine care medication adherence program, and to better characterize non-persistence. Patients and methods:In this observational, one-centered, longitudinal study, medication adherence was monitored electronically while patients were taking part in a medication adherence program for 12 months or until treatment stop. Patients were >18 years and starting or taking one of the following OAMs: letrozole, exemestane, imatinib, sunitinib, capecitabine, or temozolomide. Non-persistence was defined as any premature treatment interruption due to patient's unilateral decision or to a medical decision because of adverse effects. The Kaplan Meier survival function estimate was used to characterize persistence, and Generalized Estimating Equations (GEE) were adopted to fit implementation. Statistical analyses were performed using the R software package. Results: Forty-three outpatients with various tumor entities were enrolled. Reasons for quitting the medication adherence program and/or OAM medication were characterized as OAM discontinuation due to adverse effects or toxicity (n = 5), planned OAM completion time (n = 10), OAM failure (cancer relapse) (n = 5) and non-compliance to the adherence program (n = 3). In persistent patients, the implementation rates were high (from 98% at baseline to 97% at 12 months). The probability of being persistent at 12 months was estimated at 85%. Conclusion: A better characterization of both persistence and implementation to OAMs in real life settings is crucial for understanding and optimizing medication adherence to OAMs. The complex identification of non-persistence underlines the need to carefully and prospectively assess OAM interruption or treatment switch reasons. The GEE analysis for describing implementation to OAMs will allow researchers and professionals to take advantage of the richness of longitudinal real-time data, to avoid reducing such data through thresholds and to put them into perspective with OAM blood levels.

An outbreak of scabies: a forgotten parasitic disease still present in Switzerland.

INTRODUCTION: Scabies, a contagious parasitic dermatosis, has a worldwide distribution but is considered a "disease of the poor" in resourcerich countries. However, it can cause major public health problems following outbreaks in industrialised countries. The following study describes a large outbreak of scabies involving several health care institutions in the canton of Neuchâtel, Switzerland. PATIENTS AND METHODS: After reporting a case of crusted scabies hospitalised for several months (for other comorbidities) in various health care institutions, a "scabies task force" was created in order to detect further cases by contact tracing. Suspected cases were reported to public health authorities, with notification of the health care institutions where cases or exposed patients had been transferred, and information to general practitioners and dermatologists of the entire area (100,000 inhabitants), RESULTS: Three health care institutions (a rehabilitation clinic, a 200-bed acute care hospital, a small hospital with a haemodialysis unit) were involved. Overall, 24 cases of scabies were detected, 12 among inpatients after exposure within the health care institutions, and 12 among household or other close contacts. 116 health care providers exposed to cases within the health care institutions were investigated with negative results for scabies. After the creation of the task force, no further transmission of scabies was observed. Prolonged misdiagnosis of crusted scabies as well as frequent transfers of cases between various health care institutions facilitated the outbreak. Barrier precautions for health care workers caring for patients with skin lesions even in the absence of a diagnosis of transmissible disease appeared to be efficacious since no transmission to health care workers could be detected. CONCLUSIONS: This is the first reported observation of a large scabies outbreak involving health care institutions in Switzerland. Our outbreak demonstrates that it is not an obsolete disease and that a high index of suspicion must be maintained in order to promptly detect difficult cases and to curb potential outbreaks.