Breast cancer molecular subtypes and receptor status among women at Potchefstroom Hospital: a cross-sectional study.

INTRODUCTION: this study aimed to determine the prevalence of receptor status and molecular subtypes in women with breast cancer treated at Potchefstroom Regional Hospital, South Africa and to analyze the association of molecular subtypes with some clinicopathologic characteristics of the tumor. METHODS: the study population for this cross-sectional study consisted of 116 women with primary invasive breast cancer, treated at the hospital from 1st January 2012 to 31st December 2018. Molecular subtypes were classified by immunohistochemical surrogates as luminal A (estrogen receptor (ER) positive and/or progesterone receptor (PR) positive, HER2-; Ki-67 <30%), luminal B HER2- (ER+ and/or PR+, HER2-; Ki-67 ≥30%), luminal B HER2+ (ER+ and/or PR+, HER2+; any Ki-67), HER2 enriched (ER- and PR-, HER2+; any Ki-67), or triple-negative (ER-, PR-, HER2-, any Ki-67). RESULTS: the proportions of breast cancer receptor status of ER+, PR+ and HER2-, were 71.6%, 64.7% and 75.9%, respectively. The molecular subtypes of 29.3% of patients were luminal A-type, 24.1% were luminal B HER2-, 22.4% were triple-negative, 18.1% were luminal B HER2+ and 6% were HER2-enriched. Molecular subtypes were significantly associated with tumor grade (p <0.001; Cramér's V=0.337), but independent of age (p=0.847), menopausal status (p=0.690), histology type (p=0.316), cancer stage (p=0.819), lymph node status (p=0.362), or tumor size (p=0.255). CONCLUSION: the study has revealed that most of the breast cancer in our setting was receptor-positive; approximately one-quarter were triple-negative. Furthermore, the study showed that luminal type A and B are the preponderant molecular subtypes. Molecular subtypes were associated with tumor grade but independent of age and menopausal status. The current study may assist in guiding the therapeutic strategy for patients with breast cancer in the Potchefstroom hospital catchment area.

The incidence of nausea in the absence of vomiting in patients receiving intravenous chemotherapy.

BACKGROUND: The magnitude of the incidence and impact of nausea on patients receiving intravenous chemotherapy seems to be underestimated by healthcare professionals. Development of effective anti-emetic treatment has contributed to the resolution of chemotherapy-induced nausea and vomiting (CINV). However, there is a concern that vomiting has been the initial focus of anti-emetic research and nausea was perceived as a secondary endpoint. Through focusing on the incidence of nausea independently of the incidence of vomiting, valuable information has been gained on this distressing side effect, including identifying patient risk factors contributing to the increased experience of nausea. METHODS: The study followed a prospective, observational study design in a private oncology centre in Johannesburg, South-Africa. Ethical approval was obtained before commencement of the study, followed by the recruitment of one hundred patients over a seven-month period. Patient-reported outcome measures (PROMs) were used to measure nausea with an amended version of the Multinational Association of Supportive Care in Cancer antiemesis tool (MAT). Patients documented information in their diaries on the incidence, duration and severity of nausea, during the acute phase (0-24 hours), the delayed phase (25-120 hours), day 7 and day 10 after infusion of chemotherapy, with episodes of vomiting being recorded as a secondary endpoint. The demographic and clinical variables of the subjects, as well as patient risk factors known to cause CINV, were tabulated and summarised using descriptive statistics. RESULTS: The population consisted of 68 females and 27 males with a mean age of 57 years (25-84 years). The emetogenicity of chemotherapy regimens administered were well represented with 26.3% low emetogenic chemotherapy, 25.3% moderately emetogenic chemotherapy and 48.4% highly emetogenic chemotherapy (HEC). Despite all patients receiving guideline consistent CINV prophylaxis, nausea was still experienced by 57.9% patients during cycle one, 50.6% patients during cycle two and 45.6% patients during cycle three. The incidence of patients experiencing nausea (in the absence of vomiting) was 35%, compared to 2% of patients experiencing vomiting (in the absence of nausea). Patient characteristics with a known risk to impact CINV were documented, and significant impact in this study was found in female gender, age <60 years, history of motion sickness and history of morning sickness. CONCLUSIONS: Guideline consistent CINV prophylaxes seem to have vomiting under control for most patients receiving intravenous chemotherapy. Nausea, however, still seems to be a persistent adverse event during treatment. Female gender, age <60 years, history of motion sickness and history of morning sickness increases the risk of experiencing nausea. A different approach is needed to manage nausea in the clinic setting, along with standardised tools to measure nausea specifically. More studies need to be done with nausea as the primary endpoint to address this ongoing medical need.

Is guideline-driven prophylaxis for venous thromboembolism common practice in the South African private hospital setting?

BACKGROUND: Prophylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalised patients. However, studies have reported that these measures are routinely under-prescribed. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups. METHODS: A quantitative, retrospective analysis of the hospital group's patient database was conducted for patients admitted between 01 September 2015 and 31 August 2016. Those younger than 18 years with trauma or suffering from contraindications to anticoagulation were excluded. Additionally, patients with warfarin billed were also excluded as they possibly required therapeutic anticoagulation. Included prophylactic measures were compared with published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients' VTE risk ratings. RESULTS: Amongst the 373 020 patients included as the study population, 77% required prophylaxis. Of these, 38.36% (n = 85 486) received guideline-appropriate prophylactic measures during their hospital stay. Patients in whom prophylaxis was indicated, only 24.56% (n = 42 715) complied with the SA guidelines. The most commonly used prophylactic measures were enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per speciality, with the most compliant amongst intensivists. A low uptake of the risk assessment model use (n = 222 860, 59.75%) was, however, reported for this data set. CONCLUSION: Less than 24.56% of patients who required prophylaxis received guideline-appropriate interventions. Further studies should focus on understanding differences in practice and improving acceptance and application of guideline-driven care.

Epidemiological, clinical and diagnostic profile of breast cancer patients treated at Potchefstroom regional hospital, South Africa, 2012-2018: an open-cohort study.

INTRODUCTION: Breast cancer is the second most diagnosed cancer worldwide. We aimed to depict the diagnostic approach as well as the epidemiological and clinical profile of patients with breast cancer at Potchefstroom regional hospital, South Africa. METHODS: This descriptive open-cohort study included patients with primary invasive breast cancer, confirmed by histology results and treated at the hospital from 01 January 2012 to 31 December 2018. Data such as demographics, patient history, histology, breast clinical findings, physical mass description and diagnostic investigations were captured from hospital registries and patient files. RESULT: One-hundred thirty-eight patients (mean age 56.2 (SD: 14.4) (95% CI 54.6-59.7) years) met inclusion criteria. Most patients were female (98.6%), from African (67.4%) or Caucasian (23.9%) descent. Findings included mostly left-sided breast involvement (51.8%), lesions in the upper-outer quadrant (43.1%), extensions to the skin (25.6%, N = 39), and tumour size of 2 ≤ 5 cm (49.3%), or > 5 cm (39.1%). Most patients (57.9%, N = 135) were categorised as BIRADS-5, with a ductal pattern (89.6%) (p < 0.01). Patients mostly presented in stages II to IV of disease (89.1%; p < 0.05). Late-stage (stages III-IV) at time of diagnosis (n = 84) was significantly associated with mass location (p = 0.006; Cramér's V = 0.280), tumour size (p < 0.001, Cramér's V = 0.239), and skin changes (p = 0.027, Cramér's V = 0.492). CONCLUSION: Most patients consulted at a late-stage of the disease, indicating a need for the promotion of breast awareness campaigns, early detection, and timeous referral.

Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study.

BACKGROUND AND AIM: Patients struggle to adhere to prescribed pain medication after surgery because of, inter alia, side effects, sleep disturbances and pain severity. This study aimed to determine the influence of various factors on, the extent of adherence to prescribed post-operative pain medication (POPM) measured by participant-reported pill count (PRPC) following day case orthopaedic surgery at a private South African hospital. METHODS: This prospective, quantitative cross-sectional study involving 120 participants (51 males, 69 females), used a structured questionnaire completed through a telephonic survey, 4 days after orthopaedic surgery. Measurements included PRPC adherence (adherent vs. non-adherent), in relation to post-operative adherence behaviour (POAB), normal medicine adherence behaviour (NMAB), pain severity affecting sleep and mobility, treatment side effects and patient demographic characteristics. RESULTS: Based on PRPC measurement 56.7% (n = 68) of participants were adherent. PRPC was significantly associated with severe pain affecting falling sleep (p = .001), pain causing awakening from sleep (p = .035) and POAB (p < .001, Cramér's V = 0.5). PRPC adherence was independent from gender (p = .140), age (p = .822), smoking status (p = 1.000), type and event of side effects (p > .300), NMAB (p = .601) and the treatment regimen (i.e. unimodal vs. bimodal or multimodal) (p = .511). CONCLUSION: Non-adherence (overuse or misuse) of prescribed POPM can be a result of severe pain, influencing sleep and movement after orthopaedic surgery, indicating a need for the review of these regimens in order to optimise care.

Acute changes in haematocrit leading to polycythaemia in late-onset hypogonadism patients that receive testosterone replacement therapy: a South African study

Background: According to the literature, parenteral testosterone replacement therapy (TRT)-induced polycythaemia is associated with cardiovascular events. No or minimal data exist for the prevalence of TRT-induced polycythaemia in late- onset hypogonadism (LOH) patients from South Africa. Polycythaemia is the side effect most frequently associated with parental TRT formulations. Design: This was a quantitative, observational, descriptive, retrospective study. Setting: The study setting was a private practice male clinic in Emalahleni. Subject: An all-inclusive sampling method was used. Outcome measures:The main outcome measure for polycythaemia was haematocrit (Hct). An Hct percentage of > 50% at month 3 (post-treatment initiation) constituted a positive diagnosis for polycythaemia. For the rise in total testosterone (TT) and Hct, the variance was used as documented between pre- and post-treatment initiation. Results:The prevalence of polycythaemia was 34%. A statistically significant increase in both TT and Hct was observed. The Cohen'sdeffect size was 0.68 and 0.73, respectively, for TT and Hct. Conclusion: Depot-testosterone undecanoate parenteral formulation induces polycythaemia in LOH patients, where the rise in TT demonstrates the effectiveness of therapy

Hypertriglyceridaemia and the risk of pancreatitis six months post lopinavir/ritonavir initiation.

BACKGROUND: Hypertriglyceridaemia (HTG) is an important risk factor for pancreatitis and cardiovascular disease (CVD), depending on severity. Hypertriglyceridaemia is common in human immunodeficiency virus (HIV) infection and is also a common complication of lopinavir/ritonavir (LPV/r). OBJECTIVES: To evaluate the risk of pancreatitis associated with HTG in patients six months post initiation of LPV/r-based therapy in a regional public hospital. METHODS: Triglyceride (TG), serum amylase (s-amylase) and CD4+ count values were retrospectively investigated six months post LPV/r-based initiation. Age, gender, previous antiretroviral regimen and period since HIV diagnosis were also recorded. RESULTS: The final sample consisted of 194 patients, 50 males and 144 females; mean (± standard deviation [s.d.]) age was 39.52 (± 9.98) years, and the mean (± s.d.) period since HIV diagnosis was 91.32 (± 25.18) months. Normal TG levels (< 1.70 mmol/L) were detected in only 55% of patients and the rest presented with some degree of HTG. The mean (± s.d.) TG for the entire sample was elevated at 1.94 (± 1.30) mmol/L with the mean (± s.d.) of the males at 2.36 (± 1.74) - statistically higher compared to the females at 1.79 (± 1.08) mmol/L (p = 0.034). No cases of pancreatitis were recorded and the time since HIV diagnosis did not indicate any statistically significant differences in the means of the TG, serum amylase or CD4 count values. CONCLUSION: Triglyceride levels were not substantially elevated to induce pancreatitis at six months post initiation of LPV/r, but were elevated above the accepted upper normal limit of 1.70 mmol/L which may have implications for cardiovascular risk.

Prescribing patterns of non-steroidal anti-inflammatory drugs in chronic kidney disease patients in the South African private sector.

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are considered nephrotoxic and should therefore be used with caution or be avoided completely in high risk patients, such as chronic kidney disease (CKD) patients. Objective This study aimed to investigate the prescribing of NSAIDs in CKD patients in order to generate awareness and improve the outcome of these patients. Setting The study was conducted using medicine claims data in the private health sector of South Africa. Method A descriptive, quantitative study was performed, using retrospective data obtained from a Pharmaceutical Benefit Management company. Data from 1 January 2009 to 31 December 2013 were analysed. The study population consisted of all patients with an ICD-10 code for a CKD (N18), in association with a paid claim for an NSAID. Main outcome measure The stratification of NSAID prescribing volume among the CKD population in terms of gender, age, NSAID type, dosage and prescriber type. Results The prescribing of NSAIDs in CKD patients varied between 26 and 40 % over the 5 year study period. No association between gender and CKD patients who received NSAIDs versus those who did not was found, with p > 0.05 and Cramer's V < 0.1 for each year of the study. The association between age groups and CKD patients who received NSAIDs versus those who did not was statistically significant, but practically weak (p < 0.05; Cramer's V ≥ 0.1). Most NSAID prescriptions (52-63 %) were for patients aged 35-64 years. Diclofenac (34.25 %) was the single most frequently prescribed NSAID, but the COX-2-inhibitors (celecoxib, meloxicam and etoricoxib) were the preferred NSAID class to be prescribed. The majority (61.6 %) of the NSAIDs were prescribed by general medical practitioners in dosages meeting and even exceeding the recommended daily dosage of patients with normal kidney function. Conclusions Even though NSAIDs are regarded as nephrotoxic drugs, they are still being prescribed to at-risk CKD patients, in particular, the elderly.

Managing asthma in primary care through imperative outcomes.

RATIONALE, AIMS AND OBJECTIVES: To evaluate asthma management and control in primary care clinics so as to design improvements based on guideline-directed outcomes. METHODS: In this study, all medical records of asthma-diagnosed patients (children as well as adults, entire lifespan, asthma-related visits or not) were retrospectively reviewed as a basis for assessing the level of guideline adherence and asthma control. Six primary health care clinics were visited in the Dr Kenneth Kaunda Municipal District, Potchefstroom, South Africa during May to July 2008, 2009 and 2010. RESULTS: A total of 323 asthma patient records were reviewed over the three time slots, resulting in 125, 87, and 111 patients respectively. A suboptimal clinical asthma control picture, with a mere 16% (n = 20) of females and 2% (n = 3) of males with Peak Expiratory Flow (PEF) percentages above 60%, were observed in the initial assessment. Improvement in control was observed during the following time slot, but with an end result in 2010 of no PEF percentages above 60% for males and only 9% (n = 7) for females. CONCLUSION: Over all three of the data collection periods adherence to effectively applied management of asthma guidelines proved to be below the minimum recommended clinical evaluation work-up as set out by the Expert Panel Report 3 (EPR3) of the National Asthma Education and Prevention Program (NAEPP). Applying a greater focus on essential outcomes through different disease management documents resulted in an improved quality of managed care, but still requires dedicated and continuous education and motivation. (NWU-0052-08-A5).