ABSTRACT
BACKGROUND: Disease-modifying therapies (DMTs) for Alzheimer's disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility, regular infusions and baseline and follow-up MRI scanning. A critical step in planning is provision of real-world estimates of patients likely to be eligible for triaging, but these are challenging to obtain. METHODS: We performed a retrospective service evaluation of patients attending five memory services across North and East London and a national specialist cognitive disorders service. We examined the likely proportion of patients who would (1) be referred for triaging for DMTs and (2) potentially be suitable for treatments. RESULTS: Data from a total of 1017 patients were included, 517 of whom were seen in community memory services and 500 in a specialist clinic. In the memory services, 367/517 (71%) were diagnosed with possible AD. After exclusions of those in whom cognitive and frailty scores, MRI contraindications or anticoagulant use indicated they would be unlikely to be suitable, an estimated 32% would be eligible for triaging. In the specialist cognitive clinic, where additional investigations are available, 14% of those seen (70/500) would be potentially eligible for treatment. CONCLUSIONS: While a sizeable proportion of patients attending memory clinics may be referred for triaging for DMTs for AD, only a minority are likely to be suitable for these, as demonstrated in patients seen in specialist cognitive services. This will need to be considered when designing pathways for DMT delivery.
ABSTRACT
OBJECTIVE: To describe the demographic and clinical features of females presenting with breast malignancies at the Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC), Lahore, Pakistan. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: SKMCH and RC, Lahore, from January 2008 to December 2012. METHODOLOGY: Demographic and clinical features of female breast cancer patients, registered at SKMCH and RC, were studied. Mean values, counts, and percentages were obtained. RESULTS: Four-thousand, three-hundred and sixty-six female breast malignancies were recorded. Nearly 80.4% of the patients belonged to Punjab. Mean age at presentation was 48.6 ±12.2 years, at menarche was 13.2 ±1.2 years, and at first childbirth was 23.7 ±4.8 years. Mean Body Mass Index (BMI) was 29.0 ±5.7 kg/m2. In 60.1%, history of breast feeding was positive. In 55.7%, there was no history of use of any Oral Contraceptive Pills (OCP)/Hormone Replacement Therapy (HRT). Nearly 42.7% were postmenopausal, 85.2% had infiltrating ductal carcinoma, 49.6% had grade 3 tumor, 60.7% had stage II disease, and 37.3% were Estrogen Receptor (ER)/Progesterone Receptor (PR)+, Human Epidermal Growth Factor Receptor 2 (HER2)-. Family history of breast cancer was positive in 16.9% of the cases. CONCLUSION: The mean presenting age is lower than what has been recorded in the West. It may be worthwhile collating results from different institutions in order to study the epidemiology of the disease more extensively and develop cancer control and early detection programs.