ARTIFICIAL INTELLIGENCE: CREATING NEW PARADIGMS IN THE MANAGEMENT OF NON-COMMUNICABLE DISEASES

The role of Artificial Intelligence (AI) in medical science is growing immensely. Since AI contains features that can address both preventive and therapeutic aspects of non-communicable diseases (NCDs), it can potentially lessen the massive burden of morbidity and mortality associated with NCDs. AI can help in various ways in NCDs including predicting disease occurrence, monitoring, ensuring treatment and follow-up of patients. Low- and middle-income countries can harness the benefit of AI for the management of chronic diseases and effectively address challenges like manpower shortage, accessibility to health care, etc. However, AI needs to be used responsibly and rationally in NCDs for its maximum benefit.

Toxicity of targeted anticancer treatments on the liver in myeloproliferative neoplasms

The liver has a central role in metabolism, therefore, it is susceptible to harmful effects of ingested medications (drugs, herbs, and nutritional supplements). Drug-induced liver injury (DILI) comprises a range of unexpected reactions that occur after exposure to various classes of medication. Even though most cases consist of mild, temporary elevations in liver enzyme markers, DILI can also manifest as acute liver failure in some patients and can be associated with mortality. Herein, we briefly review available data on DILI induced by targeted anticancer agents in managing classical myeloproliferative neoplasms: Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, and myelofibrosis.

A mixed method study to assess notification of tuberculosis patients by private practitioners in New Delhi, India

Background

A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low.

Objectives

The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers.

Methods

This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done.

Results

Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was "don't know how to" and major barrier considered was "lack of training."

Conclusion

Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification.

Psychological impact of Covid-19 pandemic among the Healthcare workers in a North-Eastern state of India

Background:

Previous studies done during SARS 2003 outbreak and early reports related to COVID-19 show that healthcare workers experience considerable anxiety, stress and fear. Although similar studies were done in other parts of India, there is dearth of data on this topic in the Northeastern region.

Aim:

This study aimed to assess the mental health status of Healthcare Workers during Covid-19 pandemic in the region.

Methods:

The study was conducted among the doctors and nurses of a Northeastern state of India through an online survey. PHQ-9, GAD-7 and ISI scales were used to assess depression, anxiety and insomnia among the participants.

Results:

The prevalence of depression, anxiety and insomnia among the HCWs was 74.5%, 42% and 32%, respectively. Moderate to Severe form of depression, anxiety and insomnia was experienced by 15.5%, 20.5% and 8.5%, respectively. Females and those who directly cared for Covid-19 patients were more prone to suffer from depression. Participants who reported having previous history of any psychological problems reported eight-fold, seven-fold and three-fold increased odds of developing depression, anxiety and insomnia, respectively, during the pandemic.

Conclusions:

A large proportion of HCWs reported symptoms of depression, anxiety and insomnia among the healthcare workers. Protecting the mental health of these health workers is paramount to ensure psychological wellbeing, which in turn will ensure a healthy and robust workforce.

Relevance for Patients:

Improves the productivity of Healthcare workers in terms of Patient care and Management.

Burden of iodine deficiency disorders and its association with various sociodemographic variables in a district of North East India

Introduction:

Iodine is one such micronutrient, the deficiency of which can impair the mental growth and development of young children and is the leading cause of preventable mental impairment. The present study has been conducted to study the prevalence of iodine deficiency disorders (IDDs) and its association with various sociodemographic variables among children (6–12 years) residing in the East Khasi Hills district of Meghalaya.

Methods:

The sample size was 2700 with a multistage 30 cluster sampling method. A questionnaire was used to collect data on the various sociodemographic variables. The weight and height of each child were recorded as per the standard procedure. In order to assess goitre, children were examined as per standard procedures prescribed by the National Iodine Deficiency Disorder Control Programme (NIDDCP).

Results:

A total of 2700 children were interviewed in total. Out of these, 1365 (50.5%) were males. The total goitre rate was found to be 195 (7.22%), indicating that IDDs are a mild public health problem in the study area. The median (interquartile range) urinary iodine excretion levels were 150 (108.05–189.37) mg/L. With respect to weight-for-age, it was observed that 93 (3.9%) children were severely underweight and 389 (16.8%) had severe stunting. A significant association was observed between goitre with the age group of children (p <.00001), maternal education (p <.00001), prevalence of stunting (p <.00001), and underweight (p <.05).

A Community-Based Study on Functional Disability and Its Associated Factors Among Elderly Individuals in a Rural Setting in Northeastern India

Background

Functional disability in older adults is common and adversely impacts the quality of life. Given the paucity of population-based data, the present analysis attempted to determine the prevalence and factors associated with functional disability in basic activities of daily living (ADLs) among the elderly population in a rural setting of Northeastern state of India

Methods

A total of 430 elderly were recruited in a population-based cross-sectional study among elderly individuals (≥60 years) during the period 2013-2016 in rural areas of the Dibrugarh district of Northeastern India. The Barthel index was used to measure ADL. Anyone with a Barthel index score <100 (or having limitations in one or more ADL items) were considered as having a functional disability. The analysis of variance (ANOVA) test and the binary logistic regression analysis were used to examine the factors associated with functional disability.

Results

Overall, 43.7% % (Male 42.9%, Female 44.5%) of the participants had a functional disability. Increasing age, being widowed, having no formal education, being underweight (body mass index (BMI)<18.5 kg/m²), and increasing numbers of morbidities were significantly associated with functional disability among the elderly in this study in age and gender-adjusted logistic regression analysis. Being ≥80 years was associated with a three-fold greater risk (OR=31.72, 95% CI=1.3-6.91) of functional disability than the youngest age group (60-69 years). On the other hand, the presence of more than five morbidities was associated with a nearly 20 times increased risk (OR=19.61, 95% CI=9.01-42.68) than those with zero to two morbidities.

Conclusion

A high proportion of the rural elderly residents of Dibrugarh had a functional disability. The study provides epidemiological evidence of the risk factors of functional disability in this setting. This epidemiological information may be useful for developing prevention strategies to reduce the burden of functional disability.

Introduction of Class-room quality circles among 1st year MBBS students and its effect on students learning

AIM

The aim of this interventional study was to introduce classroom quality circles (QCs) among first-year MBBS students, to assess the effectiveness of QCs on learning experience of the students, and to evaluate the students' satisfaction level during the process of learning.

MATERIALS AND METHODS

A problem pool was created through a questionnaire. The study was carried out in the department of biochemistry, for a period of 6 months. Student's quality circle (SQC) group of five students was created. Then, feedbacks were collected from students by SQC after every class/topic delivered, and fortnightly meeting was held between the SQC group and faculty members of the department, and issues were brought to focus depending on these feedbacks collected by them. Possible initiatives and improvements were done on teaching-learning strategies depending on the outcome of these discussions.

RESULTS

The effectiveness of SQC group was assessed by a pre-post questionnaire (Questionnaire-3) feedback from the students and scoring was done based on 5-point Likert scale. There was a statistically significant difference (P = 0.009) between the mean of pre-post questionnaire. To analyze the students' satisfaction level, a set of questionnaires were given to them and scoring was done. Thirty-four students agreed, 11 students were neutral, and 6 students were disagreed, that introduction of SQC was effective in solving their problems related to teaching and learning of biochemistry.

CONCLUSION

SQC creates an environment of student centric, fairness, student empowerment, improving solving skills. Implementation of student-generated feedback through introduction of SQC has improved the quality of the course as well as its delivery. It complements and supplements in achieving students intended learning outcome and hence may contribute to overall learning quality in the long run.

Introduction of structured feedback for MBBS students: Perception of students and faculty

INTRODUCTION

Feedback is an important part of the assessment process. However, one-to-one structured and constructive feedback to the students is not practiced mostly due to lack of practice and feasibility issues. The present study was conducted to understand the perception of students and faculty toward one-to-one structured feedback.

METHODOLOGY

All the 3^rd MBBS professional students were included in the study. An orientation was given to the faculty regarding the importance of feedback and how to give structured feedback. A standardized format was provided to the faculty for providing the feedback to the students. After completion of the assessments, a one-to-one structured verbal feedback was given to all the students. Thereafter, faculty and student's perception on the feedback process was obtained through questionnaires. A focused group discussion was also conducted among the students.

RESULTS

A total of 42 students participated in the study out of 50. A positive response was received from all the students regarding the feedback. Nearly84.34% of the students acknowledged that feedback is important for understanding their mistakes, 92.84% of the students responded positively that feedback helps to build a good rapport with the teacher, and 92.85% of the students reported that they were satisfied with the overall experience of receiving feedback. Most of the faculty (80%) perceived that giving feedback after the assessment was a good idea. The faculty felt motivated to give feedback to the students after the hands-on experience. However, only 20% of the faculty agreed that the process of feedback was easy to carry out (mean score: 2.2 ± 1.09).

CONCLUSION

The positive responses received from both the students and the faculty highlight that the students are receptive toward feedback provided it is structured, constructive, and helps them to achieve their learning goals.

Iodine Deficiency Disorders in Children in East Khasi Hills District of Meghalaya, India

OBJECTIVE

To assess the prevalence of iodine deficiency disorders among school-going children in Meghalaya.

METHODS

Multi-stage 30 cluster sampling with probability proportionate to size (PPS) method was used. Children (age 6-12years) were examined clinically for goiter. Urinary iodine excretion (UIE) was performed by spectrophotometric method. Iodine content in the salt was analyzed using iodized salt test kits.

RESULTS

A total of 195 (7.22%) out of 2700 children had goiter on examination. Goitre prevalence was significantly associated with wasting (P<0.05) and stunting (P <0.001). The median (IQR) UIE level was 150 (108.05 - 189.37) µg/dL. Nineteen (9.74%) children had severe iodine deficiency (UIE<20µg/L). Iodine content was above the recommended level of 15 ppm in 95.9% salt samples. A positive correlation was observed between household salt consumption and UIE levels (r=0.25; P<0.001).

CONCLUSIONS

Iodine deficiency disorder is a public health problem in Meghalaya, which needs to be addressed.

Impact of palbociclib plus letrozole on patient-reported health-related quality of life: results from the PALOMA-2 trial

Background

Patient-reported outcomes are integral in benefit-risk assessments of new treatment regimens. The PALOMA-2 study provides the largest body of evidence for patient-reported health-related quality of life (QOL) for patients with metastatic breast cancer (MBC) receiving first-line endocrine-based therapy (palbociclib plus letrozole and letrozole alone).

Patients and methods

Treatment-naïve postmenopausal women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) MBC were randomized 2 : 1 to palbociclib plus letrozole (n = 444) or placebo plus letrozole (n = 222). Patient-reported outcomes were assessed at baseline, day 1 of cycles 2 and 3, and day 1 of every other cycle from cycle 5 using the Functional Assessment of Cancer Therapy (FACT)-Breast and EuroQOL 5 dimensions (EQ-5D) questionnaires.

Results

As of 26 February 2016, the median duration of follow-up was 23 months. Baseline scores were comparable between the two treatment arms. No significant between-arm differences were observed in change from baseline in FACT-Breast Total, FACT-General Total, or EQ-5D scores. Significantly greater improvement in pain scores was observed in the palbociclib plus letrozole arm (-0.256 versus -0.098; P = 0.0183). In both arms, deterioration of FACT-Breast Total score was significantly delayed in patients without progression versus those with progression and patients with partial or complete response versus those without. No significant difference was observed in FACT-Breast and EQ-5D index scores in patients with and without neutropenia.

Conclusions

Overall, women with MBC receiving first-line endocrine therapy have a good QOL. The addition of palbociclib to letrozole maintains health-related QOL and improves pain scores in treatment-naïve postmenopausal patients with ER+/HER2- MBC compared with letrozole alone. Significantly greater delay in deterioration of health-related QOL was observed in patients without progression versus those who progressed and in patients with an objective response versus non-responders. ClinicalTrials.gov: NCT01740427 (https://clinicaltrials.gov/ct2/show/NCT01740427).

Adjuvant sunitinib in patients with high-risk renal cell carcinoma: safety, therapy management, and patient-reported outcomes in the S-TRAC trial

Background

Adjuvant sunitinib has significantly improved disease-free survival versus placebo in patients with renal cell carcinoma at high risk of recurrence post-nephrectomy (hazard ratio 0.76; 95% confidence interval, 0.59–0.98; two-sided P = 0.03). We report safety, therapy management, and patient-reported outcomes for patients receiving sunitinib and placebo in the S-TRAC trial.

Patients and methods

Patients were stratified by the University of California, Los Angeles Integrated Staging System and Eastern Cooperative Oncology Group performance status score, and randomized (1 : 1) to receive sunitinib (50 mg/day) or placebo. Single dose reductions to 37.5 mg, dose delays, and dose interruptions were used to manage adverse events (AEs). Patients’ health-related quality of life, including key symptoms typically associated with sunitinib, were evaluated with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

Results

Patients maintained treatment for 9.5 (mean, SD 4.4) and 10.3 (mean, SD 3.7) months in the sunitinib and placebo arms, respectively. In the sunitinib arm, key AEs occurred ∼1 month (median) after start of treatment and resolved within ∼3.5 weeks (median). Many (40.6%) AEs leading to permanent discontinuation were grade 1/2, and most (87.2%) resolved or were resolving by 28 days after last treatment. Patients taking sunitinib showed a significantly lower EORTC QLQ-C30 overall health status score versus placebo, although this reduction was not clinically meaningful. Patients reported symptoms typically related to sunitinib treatment with diarrhea and loss of appetite showing clinically meaningful increases.

Conclusions

In S-TRAC, AEs were predictable, manageable, and reversible via dose interruptions, dose reductions, and/or standard supportive medical therapy. Patients on sunitinib did report increased symptoms and reduced HRQoL, but these changes were generally not clinically meaningful, apart from appetite loss and diarrhea, and were expected in the context of known sunitinib effects.

Clinical trial registration

ClinicalTrials.gov, NCT00375674.

Pattern of ocular morbidities: A cross-sectional study on school-going children in Shillong city

Introduction:

India is plagued by ocular morbidities in school-children. However, there exists paucity of studies, school health check-ups, and health education in the north-eastern region. This study aimed at estimating the prevalence and pattern of various ocular morbidities in school-going children of Shillong.

Methodology:

It was a school-based cross-sectional study done in Shillong, Meghalaya among 540 school-going children from class VI to X. Data were analyzed using SPSS version 23.

Results:

The most common ocular morbidity was refractive error (57.4%) followed by vitamin A deficiency (38.1%), color blindness (3.1%), nevus (3%), manifest squint (2.2%), ptosis (2.2%), conjunctivitis (0.9%), stye (0.4%), etc., There was statistically significant association (P = 0.0192) among the variations of presence of ocular morbidities in the various age groups, among students attending Government or Private schools (P = 0.0430), and socio-economic status (P = 0.012). The prevalence of ocular morbidities was found to have highly significant association with the educational status of both the father (P = 0.0001) and mother (P = 0.001). In addition, the occupational status of the father (P = 0.0472) and the mother (P = 0.0251) were significantly associated with the prevalence too.

Conclusion:

The prevalence of ocular morbidities was found to be much higher than in other places of the country, which may be because of environmental factors and lifestyle combined with a lack of awareness and timely diagnosis and an absence of robust school health program. A regular screening along with specific health education campaigns can go a long way in decreasing the same.

Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India

Background:

Elderly population is growing rapidly in India. To direct public health actions to improve quality of life among elderly, it is important to understand the sociodemographic factors associated with quality of life. The aim of study was to assess health-related quality of life (HRQOL) among urban elderly in a setting of Assam, India, and to examine how HRQOL varied across different sociodemographic groups among the elderly populations.

Materials and Methods:

A cross-sectional study was carried among elderly aged ≥60 involving 300 participants. Eight domains of HRQOL of participants were measured using RAND SF-36. Analysis of variance test was used to examine sociodemographic differences in HRQOL.

Results:

The BP domain had highest (71.78 ± 22.25) and GH had lowest mean HRQOL score (48 ± 16.93). Males had significantly higher HRQOL score than females only in BP domain. Age gradients were observed with respect to HRQOl scores in five domains, with youngest age group having the best and oldest age group having the poorest HRQOL. Financially dependent subjects had lower HRQOL in five domains than those who were financially independent. Significant associations between education and HRQOL were found only in physical components of HRQOL, with lowest educated group being the most disadvantaged in terms of HRQOL. Marital status was found to be significantly associated with lower HRQOL scores.

Conclusion:

The study highlights sociodemographic inequalities in HRQOL among urban elderly in an Indian setting. The results may help reducing sociodemographic health inequalities among elderly in this region initiating public health actions paying more attention toward more vulnerable sections of populations.

Evaluation of thyroid function in type 2 diabetes in north-eastern part of India: A hospital-based study

Background

Diabetes mellitus (DM) and thyroid dysfunctions are the two most common endocrine disorders to come across in any clinical practice. Both thyroid hormones and insulin act antagonistically in metabolic pathways or cycles of cells. The aim of our study is to look for thyroid dysfunction in patients with type 2 DM and its correlation with insulin resistance (IR).

Methods

A cross-sectional study was carried out among 80 newly diagnosed type 2 diabetic patients. Thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, and insulin were measured in fasting serum sample. Homeostasis model assessment for IR was calculated as per formula.

Results

Among 80 diabetic patients, 20 were hypothyroid, 4 were hyperthyroid, and 56 were found to be euthyroid. IR was found to be significantly higher in hypothyroid as compared to euthyroid patients. A positive association was found between TSH and IR (r = 0.230) among hypothyroid patients though association was not significant. In hyperthyroid patients, a strong negative correlation (r = -0.94933) was found between TSH and IR, but no association was found among euthyroid patients.

Conclusion

The inability to recognize the presence of thyroid hormone dysfunction may be one of the important causes of poor management of type 2 DM. Therefore, there is a need for routine assay of thyroid hormones in type 2 diabetic patients to improve the medical management as well as to reduce the morbidity in them.

Abstract P5-19-01: Impact of palbociclib plus letrozole on patient-reported general health status compared with letrozole alone in ER+/HER2- advanced/metastatic breast cancer

BACKGROUND: Palbociclib plus letrozole significantly improved progression-free survival (PFS) compared with letrozole plus placebo in treatment-naive postmenopausal patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in the phase 3 PALOMA-2 trial. Here, we compare patient-reported general health status with extended (max 53 cycles) follow-up (data cut off May31st, 2017) (Pfizer: NCT01740427).

METHODS: PALOMA-2 randomized patients 2:1 to palbociclib + letrozole (n=444) or placebo + letrozole (n=222). Patient-reported outcomes were assessed at baseline, day 1 of cycles 1, 2, and 3, and day 1 of every other cycle from cycle 5 until the end of treatment using the EuroQol 5-Dimension Questionnaire (EQ-5D). The EQ-5D is a standardized measure of health status that consists of a descriptive system comprising the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression rated at 3 levels (no, some, or extreme problems) and a single index score for health status (ranges generally from 0 [dead] to 1 [full health]) calculated using a standard algorithm. In addition, a visual analog scale (VAS) measured self-rated health status from 0 (worst imaginable) to 100 (best imaginable). Repeated measures mixed-effects analyses were performed to compare overall index and VAS scores between treatments, controlling for baseline.

RESULTS: Completion rates at baseline were &gt;95% in each group. The mean (SD) scores at baseline were comparable between palbociclib plus letrozole and letrozole alone for the VAS (71.3 [21.2] vs 72.3 [19.8]) and the EQ-5D index scores (0.70 [0.25]) vs (0.73 [0.21]). Median follow up was 38 months for palbociclib plus letrozole and 37 months for letrozole only. No statistically significant difference in overall change from baseline in general health status was observed between the treatment arms. The proportion of patients reporting the presence of a problem at baseline was similar for palbociclib plus letrozole and letrozole, respectively: mobility (39% vs 39%), self-care (12% vs 12%), usual activities (44% vs 39%), pain (69% vs 65%), and anxiety/depression (54% vs 54%). No statistically significant difference in overall mean EQ-5D index scores (0.73 vs. 0.71) was observed between the treatment arms.

CONCLUSION: Addition of palbociclib to letrozole maintained general health status and EQ-5D index scores in ER+ HER2- advanced/metastatic breast cancer with no statistically significant differences observed compared to letrozole alone.

Citation Format: Harbeck N, Dieras V, Finn R, Gelmon KA, Walshe JM, Shparyk Y, Mori A, Lui DR, Bhattacharyya H, Iyer S, Johnston S, Rugo HS. Impact of palbociclib plus letrozole on patient-reported general health status compared with letrozole alone in ER+/HER2- advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-01.

Tobacco: Consumption pattern and risk factors in selected areas of Shillong, Meghalaya

Background:

The percentage of adults above 15 years who consume tobacco in Meghalaya as per the Global Adult Tobacco survey is 55.2%.

Aim:

In the context of the high burden of tobacco use in Meghalaya, this study aims to study the consumption pattern and the sociodemographic correlates of tobacco use in the urban slums of Shillong, Meghalaya.

Materials and Methods:

This study is a cross-sectional study conducted in adults over 15 years of age. Data collection was done by personal interview using a pretested questionnaire during house-to-house visit after taking informed verbal consent.

Results:

A total of 400 people were included in this study. Most of the study population belonged to the age group 15–24 years (120, 30%). The majority of the study population (322, 80.5%) were aware of the health hazards of tobacco consumption. Most of the population (287, 71.75%) were tobacco consumers with 265 (76.4%) of them having co-addictions. In the study, 35% consumed smokeless forms, 30% were into smoking, and 35% consumed both forms. A significant association was observed between the status of tobacco consumption and knowledge of second-hand smoke harm (P = 0.019) as well as knowledge of any law regulating tobacco consumption (P = 0.026).

Conclusion:

It was observed that despite having a basic knowledge of the ill effects of tobacco, its consumption is still widely prevalent in the region. There is a need for stringent laws regarding tobacco consumption and proper measures should be taken to enforce these laws.

Impact of palbociclib plus letrozole on pain severity and pain interference with daily activities in patients with estrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer as first-line treatment

Background Palbociclib is a recently approved drug for use in combination with letrozole as initial endocrine-based therapy for the treatment of postmenopausal women with advanced estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer. This report assesses the impact of palbociclib in combination with letrozole versus letrozole alone on patient-reported outcomes of pain. Methods Palbociclib was evaluated in an open-label, randomized, phase II study (PALOMA-1/TRIO-18) among postmenopausal women with advanced ER+/HER2- breast cancer who had not received prior systemic treatment for their advanced disease. Patients received continuous oral letrozole 2.5 mg daily alone or the same letrozole dose and schedule plus oral palbociclib 125 mg, given once daily for 3 weeks followed by 1 week off over repeated 28-day cycles. The primary study endpoint was investigator-assessed progression-free survival in the intent-to-treat population, and these results have recently been published (Finn et al., Lancet Oncol 2015;16:25-35). One of the key secondary endpoints was the evaluation of pain, as measured using the Brief Pain Inventory (BPI) patient-reported outcome tool. The BPI was administered at baseline and on day 1 of every cycle thereafter until disease progression and/or treatment discontinuation. Clinical trial registration This study is registered with ClinicalTrials.gov (NCT00721409). Results There were no statistically significant differences in Pain Severity or Pain Interference scores of the BPI between the two treatment groups for the overall population or among those with any bone disease at baseline. A limitation of the study is that results were not adjusted for the concomitant use of opioids or other medications used to control pain. Conclusions The addition of palbociclib to letrozole was associated with increased efficacy without negatively impacting pain severity or pain interference with daily activities.

Quality of life with palbociclib plus fulvestrant in previously treated hormone receptor-positive, HER2-negative metastatic breast cancer: patient-reported outcomes from the PALOMA-3 trial

In treating HR+, HER2− metastatic breast cancer, novel agents that enhance endocrine therapy activity but do not worsen quality of life (QoL) are clinically desired. Patient-reported outcomes data from the PALOMA-3 study suggest palbociclib plus fulvestrant allow patients to maintain good QoL in the endocrine resistance setting while experiencing a substantially delayed disease progression.

Background

In the PALOMA-3 study, palbociclib plus fulvestrant demonstrated improved progression-free survival compared with fulvestrant plus placebo in hormone receptor-positive, HER2− endocrine-resistant metastatic breast cancer (MBC). This analysis compared patient-reported outcomes (PROs) between the two treatment groups.

Patients and methods

Patients were randomized 2 : 1 to receive palbociclib 125 mg/day orally for 3 weeks followed by 1 week off (n = 347) plus fulvestrant (500 mg i.m. per standard of care) or placebo plus fulvestrant (n = 174). PROs were assessed on day 1 of cycles 1–4 and of every other subsequent cycle starting with cycle 6 using the EORTC QLQ-C30 and its breast cancer module, QLQ-BR23. High scores (range 0–100) could indicate better functioning/quality of life (QoL) or worse symptom severity. Repeated-measures mixed-effect analyses were carried out to compare on-treatment overall scores and changes from baseline between treatment groups while controlling for baseline. Between-group comparisons of time to deterioration in global QoL and pain were made using an unstratified log-rank test and Cox proportional hazards model.

Results

Questionnaire completion rates were high at baseline and during treatment (from baseline to cycle 14, ≥95.8% in each group completed ≥1 question on the EORTC QLQ-C30). On treatment, estimated overall global QoL scores significantly favored the palbociclib plus fulvestrant group [66.1, 95% confidence interval (CI) 64.5–67.7 versus 63.0, 95% CI 60.6–65.3; P = 0.0313]. Significantly greater improvement from baseline in pain was also observed in this group (−3.3, 95% CI −5.1 to −1.5 versus 2.0, 95% CI −0.6 to 4.6; P = 0.0011). No significant differences were observed for other QLQ-BR23 functioning domains, breast or arm symptoms. Treatment with palbociclib plus fulvestrant significantly delayed deterioration in global QoL (P < 0.025) and pain (P < 0.001) compared with fulvestrant alone.

Conclusion

Palbociclib plus fulvestrant allowed patients to maintain good QoL in the endocrine resistance setting while experiencing substantially delayed disease progression.

Clinical Trial Registration

NCT01942135.

Randomized phase II study of axitinib versus placebo plus best supportive care in second-line treatment of advanced hepatocellular carcinoma

BACKGROUND

The efficacy and safety of axitinib, a potent and selective vascular endothelial growth factor receptors 1-3 inhibitor, combined with best supportive care (BSC) was evaluated in a global, randomized, placebo-controlled phase II trial in patients with locally advanced or metastatic hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

Patients with HCC and Child-Pugh Class A who progressed on or were intolerant to one prior antiangiogenic therapy were stratified by tumour invasion (presence/absence of extrahepatic spread and/or vascular invasion) and region (Asian/non-Asian) and randomized (2:1) to axitinib/BSC (starting dose 5 mg twice-daily) or placebo/BSC. The primary end point was overall survival (OS).

RESULTS

The estimated hazard ratio for OS was 0.907 [95% confidence interval (CI) 0.646-1.274; one-sided stratified P = 0.287] for axitinib/BSC (n = 134) versus placebo/BSC (n = 68), with the median (95% CI) of 12.7 (10.2-14.9) versus 9.7 (5.9-11.8) months, respectively. Results of prespecified subgroup analyses in Asian versus non-Asian patients or presence versus absence of tumour invasion were consistent with the overall population. Improvements favouring axitinib/BSC (P < 0.01) were observed in secondary efficacy end point analyses [progression-free survival (PFS), time to tumour progression (TTP), and clinical benefit rate (CBR)], and were retained among Asian patients in the prespecified subgroup analyses. Overall response rate did not differ significantly between treatments and patient-reported outcomes favoured placebo/BSC. Most common all-causality adverse events with axitinib/BSC were diarrhoea (54%), hypertension (54%), and decreased appetite (47%). Baseline serum analyses identified potential new prognostic (interleukin-6, E-selectin, interleukin-8, angiopoietin-2, migration inhibitory factor, and c-MET) or predictive (E-selectin and stromal-derived factor-1) factors for survival.

CONCLUSIONS

Axitinib/BSC did not improve OS over placebo/BSC in the overall population or in stratification subgroups. However, axitinib/BSC resulted in significantly longer PFS and TTP and higher CBR, with acceptable toxicity in patients with advanced HCC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01210495.

Association of secondary hyperparathyroidism with hemoglobin level in patients with chronic kidney disease

PURPOSE

Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients.

METHODS

This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA).

RESULTS

Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level.

CONCLUSIONS

A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.