Nine-Week Versus One-Year Trastuzumab for Early Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: 10-Year Update of the ShortHER Phase III Randomized Trial.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned coprimary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We present the final analysis of the phase III noninferiority, randomized ShortHER trial comparing 9 weeks versus 1 year of adjuvant trastuzumab with chemotherapy in patients with human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC). Women with HER2+ BC were randomly assigned to anthracycline-taxane combinations plus 1-year trastuzumab (arm A, long) or 9-week trastuzumab (arm B, short). Here, we report the second coprimary end point overall survival (OS), updated disease-free survival (DFS), and outcomes according to hormone receptor status, age, and nodal status. At a median follow-up of 9 years, 10-year DFS is 77% versus 78% in the long versus short arm, respectively. Ten-year OS is 89% versus 88% in the long versus short arm, respectively. 10-year DFS rates in the long versus short arm according to nodal status are N0 81% versus 85%; N1-3 77% versus 79%; and N4+ 63% versus 53%. Ten-year OS rates in long versus short arm according to nodal status are N0 89% versus 95%%; N1-3 92% versus 89%; and N4+ 84% versus 64%. The updated analysis of the ShortHER trial shows that 1-year trastuzumab is the standard treatment for patients with HER2+ early BC as noninferiority cannot be claimed. However, numerically, the differences for the patients at low or intermediate risk (N0/N1-3) is negligible, while patients with N4+ have a clear benefit with 1-year trastuzumab.

Prevalence of musculoskeletal symptoms among Canadian firefighters.

BACKGROUND: Musculoskeletal symptoms (MSSs) remain the most frequently reported type of injuries sustained during fire-ground operations in firefighters. However, there is a paucity of reports concerning the prevalence estimates of MSSs among female firefighters and different fire services across Canada. OBJECTIVES: To assess the point prevalence of self-reported MSSs, stratified by age and sex in a cohort of active duty firefighters from across Canada, and to determine whether age, sex or length of service can be used to predict the likelihood of the number of MSSs sustained. METHODS: We recruited 390 firefighters (272 males, 118 females). To identify the prevalence of self-reported rates of MSSs, firefighters were asked to complete a standardized 11-item questionnaire that asked, "Please indicate whether you have experienced pain in any body region within the last week", with response options that included "Yes", "No", and "Head", "Neck", "Shoulder", "Arm/Elbow/Hand", "Back", "Stomach/Abdomen", "Upper Thigh", "Knee", "Lower Leg", "Foot", "Other, please specify". RESULTS: Among the 390 full-time firefighters, 212 (54%) indicated to have experienced some type of MSSs within the last week. The most prevalent region-specific MSSs included, 123 (32%) in the back region, 92 (24%) in the shoulder region, 74 (19%) in the neck region and 70 (18%) in the knee region. In addition, women indicated a 1.6 times greater likelihood of sustaining ≥2 MSSs when controlling for individual differences in age and years of service. CONCLUSIONS: The point prevalence of MSSs in a cohort of full-time firefighters was 54% (55% males; 53% females). Women experienced a 1.4-1.6 times greater likelihood of sustaining MSSs when controlling for individual differences in age and years of service.

Prevalence of exposure to critical incidents in firefighters across Canada.

BACKGROUND: Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. OBJECTIVE: To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate. METHODS: We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service. RESULTS: Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a "respond to incident involving one or two deaths", and 314 (81%) reported a "respond to incident involving multiple serious injuries". Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 -99.30). CONCLUSIONS: Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.

Work Functioning Among Firefighters: A Comparison Between Self-Reported Limitations and Functional Task Performance.

Purpose Performance-based and disease indicators have been widely studied in firefighters; self-reported work role limitations have not. The aim of this study was to describe the distributions and correlations of a generic self-reported Work Limitations Questionnaire (WLQ-26) and firefighting-specific task performance-based tests. Methods Active firefighters from the City of Hamilton Fire Services (n = 293) were recruited. Participants completed the WLQ-26 to quantify on-the-job difficulties over five work domains: work scheduling (4 items), output demands (7 items), physical demands (8 items), mental demands (4 items), and social demands (3 items). A subset of participants (n = 149) were also assessed on hose drag and stair climb with a high-rise pack performance-based tests. Descriptive statistics and correlations were used to compare item/subscale performance; and to describe the inter-relationships between tests. Results The mean WLQ-26 item scores (/5) ranged from 4.1 to 4.4 (median = 5 for all items); most firefighters (54.5-80.5%) selected "difficult none of the time" response option on all items. A substantial ceiling effect was observed across all five WLQ-26 subscales as 44.0-55.6% were in the highest category. Subscale means ranged from 61.8 (social demands) to 78.7 (output demands and physical demands). Internal consistency exceeded 0.90 on all subscales. For the hose drag task, the mean time-to-completion was 48.0 s (SD = 14.5; range 20.4-95.0). For the stair climb task, the mean time-to-completion was 76.7 s (SD = 37.2; range 21.0-218.0). There were no significant correlations between self-report work limitations and performance of firefighting tasks. Conclusions The WLQ-26 measured five domains, but had ceiling effects in firefighters. Performance-based testing showed wider score range, lacked ceiling effects and did not correlate to the WLQ-26. A firefighter-specific, self-report role functioning scale may be needed to identify compromised work role capabilities in firefighters.