The impact of endoxifen-guided tamoxifen dose reductions on endocrine side-effects in patients with primary breast cancer.

BACKGROUND: Tamoxifen is important in the adjuvant treatment of hormone-sensitive breast cancer and substantially reduces recurrence; however, almost 50% of patients are non-compliant mainly due to side-effects. The aim of this study was to investigate whether endoxifen-guided tamoxifen dose reduction could lead to fewer side-effects. MATERIALS AND METHODS: Effects of tamoxifen dose reduction were investigated in patients with bothersome side-effects and endoxifen levels ≥32 nM and compared to patients with side-effects who remained on tamoxifen 20 mg. Endocrine symptoms and health-related quality of life (HR-QOL) were assessed after 3 months with the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) questionnaire. RESULTS: Tamoxifen dose was reduced in 20 patients, 17 of whom were assessable for side-effect analyses. A clinically relevant improvement of >6 points was observed in endocrine symptoms and HR-QOL in 41% and 65% of the patients, respectively. In total, there was a significant and clinically relevant improvement in endocrine symptoms [5.7, 95% confidence interval (CI) -0.5-11.5] and HR-QOL (8.2, 95% CI 0.9-15.4) after dose reduction. This was not seen in patients whose doses were not reduced (n = 60). In 21% of patients, endoxifen dropped slightly below the 16-nM threshold (12.8, 15.5, 15.8, 15.9 nM). CONCLUSIONS: Endoxifen-guided dose reduction of tamoxifen significantly improved tamoxifen-related side-effects and HR-QOL. Nearly 80% of patients remained above the most conservative endoxifen threshold.

Barriers to follow-up of abnormal Papanicolaou smears among women in Leon, Nicaragua.

Cervical cancer screening programmes only succeed when the coverage, screening, treatment and follow-up of any abnormal results are of high quality. This study investigates the screening coverage and the quality of the follow-up of cervical cancer screening of women in León, Nicaragua, as well as the factors affecting coverage and barriers to follow-up. Two hundred and thirty-four sexually active women attending a public health centre (54), a public health post (63), or the gynaecology department of the public HEODRA hospital (117), were invited to answer an orally administered questionnaire. The screening coverage of cervical cancer was calculated and the follow-up after finding an abnormal screening result was assessed. The coverage was 60.6% (95% confidence interval 54.4-66.8%). One hundred and sixty-eight women (87%) were informed about the results. Eighteen (10, 7%) of the women who were informed about the results, were advised to have follow-up and 12 (66, 7%) of them did. Barriers to follow-up were financial constraints, pregnancy, postponement and absence of instruments/electricity. This study shows that the screening coverage and cytology services are adequate, but that there is insufficient follow-up and/or treatment after an abnormal screening result. In order to achieve a lower incidence and mortality of cervical cancer, follow-up and treatment after an abnormal screening result need to be improved. A visual inspection with acetic acid may be an attractive alternative.

[No increase in medical consumption in general practice after induced abortion]. / Na een abortus provocatus geen hogere medische consumptie in de huisartsenpraktijk dan ervoor.

OBJECTIVE: To compare medical consumption in general practice between women who underwent an induced abortion and women who did not. DESIGN: Historical cohort study. METHOD: We selected 19o women who underwent an induced abortion in the period 1975-2004 and 145 control patients. Women were selected from the Continuous Morbidity Registration from the University Medical Centre St Radboud in Nijmegen, The Netherlands. Patient records were reviewed to assess socioeconomic background variables and medical consumption in the 3 years before and 3 years after the abortion. Patients were divided into 3 cohorts, based on time period. RESULTS: Patients who underwent an abortion had no increase in medical consumption in general practice after the abortion, compared with before the abortion. They also had no increase in visits to the general practitioner with psychosocial or psychiatric problems after the procedure, nor were they prescribed more medication. Compared with the control group, however, women who elected to have an induced abortion had increased medical consumption and more psychosocial consultations before and after the procedure. During the study period, medical consumption and the number of psychosocial and psychiatric consultations increased in women who had an induced abortion but decreased in those who did not. CONCLUSION: Women who underwent induced abortion had greater medical consumption and more psychosocial problems than those who did not. However, medical consumption and the prevalence of psychosocial problems were similar before and after the procedure. Therefore, induced abortion did not lead to increased medical consumption.