ABSTRACT
PURPOSE: This pilot study evaluated adherence to anti-estrogen therapy in women with hormone receptor-positive breast cancer utilizing bubble packaging. METHODS: This was a single-arm prospective investigational pilot study that enrolled 86 patients between August 2012 and April 2014. Descriptive statistics for patient age, race, insurance, stage, duration of treatment, and comorbidities were computed. All patients received routine prescriptions in a "bubble" pack or daily blister pack dispensed by one pharmacy. Participants were considered adherent if they had taken ≥ 80% of the dispensed drug. Disease-free survival (DFS) and overall survival (OS) data were obtained at 78 months. RESULTS: Fifty patients were included in the analysis. The overall adherence rate was 97%. None of the variables examined (race, age, insurance status, and stage) had an impact on adherence rate. Only duration of endocrine therapy had a marginal effect on adherence (p value = 0.06). The late cohort (duration of therapy 37-60 months) was least likely to be compliant at 89.53%. Our 5-year DFS was 94% and 5-year OS was 96%. There was no statistically significant difference in DFS and OS between patients with adherence rate > 90% and < 90%. CONCLUSION: Adherence rate to bubble packaging was higher than that in historical studies. Although this is a single-arm pilot study, these data suggest bubble packaging of anti-estrogen may be a reasonable option to improve adherence in hormone receptor-positive breast cancer patients.
Subject(s)
Antineoplastic Agents, Hormonal/administration & dosage , Breast Neoplasms/drug therapy , Breast Neoplasms/metabolism , Medication Adherence , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Adult , Aged , Aged, 80 and over , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Combined Modality Therapy , Comorbidity , Female , Humans , Middle Aged , Neoplasm Staging , Pilot Projects , Receptors, Estrogen/genetics , Receptors, Progesterone/genetics , Treatment OutcomeABSTRACT
BACKGROUND: A database review of 238 admissions for recreational all-terrain vehicle (ATV) accident-related injuries treated over an 11-year period at a level I pediatric trauma center in Central Kentucky was performed. METHODS: Descriptive statistical analysis of patient demographics (age and sex), helmet use, county of residence, county of ATV accident, injury mechanism, injuries sustained, days of hospitalization, days in the intensive care unit, Glasgow Coma Scale (GCS) score, Injury Severity Score, Functional Independence Measure (FIM) score, and discharge disposition was performed. RESULTS: All-terrain vehicle accident-related admissions increased approximately 4.7 times, and overall fracture number increased 4 times over the study period. Most injuries were sustained in the county of residence (81.1% [193 of 238]). The single largest group of patients resided and sustained injuries (48.3% [115 of 238]) in a level I county (metropolitan area population, > or =1 million). Mean Injury Severity Score was 7.3 +/- 5.6, and average hospitalization was 4.3 +/- 4.0 days. Most patients (84% [201 of 238]) were not wearing a helmet, and 18.1% (43 of 238) were admitted to the intensive care unit. Patients were aged 11.4 +/- 3.6 years, predominantly boys (70% [166 of 238]), between the age of 11 and 15 years (59.7% [142 of 238]), and 63% (150 of 238) sustained at least 1 fracture. The lower extremity (32.4% [66 of 204]), upper extremity (25% [51 of 204]), and face-skull (25% [51 of 204]) were the most common fracture sites. The femur (45.5% [30 of 66]) and tibia-fibula (42.4% [28 of 66]) were the most common lower extremity fracture sites. The radius-ulna (39.2% [20 of 51]) and humerus (25% [13 of 51]) were the most common upper extremity fracture sites. Nine patients (4.4% of total fractures) sustained spinal fractures. Most patients (93.7% [223 of 238]) were discharged home, 6.3% (15 of 238) were discharged to a rehabilitation facility or to another hospital. Helmet use was related to higher component GCS and FIM communication scores, and patients with higher component GCS and FIM scores were more likely discharged to home. CONCLUSIONS: Hospital admissions and fractures concurrently increased over the study period, with the greatest increase occurring between 1998 and 1999, shortly after expiration of the 1988 Consent Decrees between the Consumer Product Safety Commission and the ATV industry.
