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Gamechanger(?): Apixaban to prevent venous thromboembolism in patients with cancer Gamechanger(?): Apixaban to Prevent Venous Thromboembolism in Patients with Cancer – Clinical Correlations Search Gamechanger(?): Apixaban to Prevent Venous Thromboembolism in Patients with Cancer October 24, 2019 6 min read By Jacqueline Heath, MD Peer Reviewed Gamechanger(?) focuses on potentially high-impact articles that often have the intention of changing practice. Given their usual high visibility, we use (...) criteria required participants to have progression of known cancer after complete or partial remission and also be starting a new course of chemotherapy with a minimum treatment intent of 3 months. Other inclusion criteria included having a Khorana score of 2 or higher, an age of 18 years or older, and capacity sufficient to provide written informed consent. Participants were excluded if they had conditions that significantly increased their clinical risk for bleeding (including hepatic disease
Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet (...) there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. This is an update of a Cochrane Review first published in 2005 and last updated in 2014.To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery.For this fourth update, in August 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process
Medication Use to Reduce Risk of Breast Cancer: US Preventive Services Task Force Recommendation Statement. Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races.To update the 2013 US Preventive (...) in women without preexisting breast cancer or ductal carcinoma in situ.The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least
Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general (...) population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases.To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed
Screening for Pancreatic Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. Pancreatic cancer is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years because the prognosis of pancreatic cancer is poor. Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States. Because of the increasing incidence (...) of pancreatic cancer, along with improvements in early detection and treatment of other types of cancer, it is estimated that pancreatic cancer may soon become the second-leading cause of cancer death in the United States.To update the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for pancreatic cancer.The USPSTF reviewed the evidence on the benefits and harms of screening for pancreatic cancer, the diagnostic accuracy of screening tests for pancreatic cancer, and the benefits
Randomized Trial of Lisinopril Versus Carvedilol to Prevent Trastuzumab Cardiotoxicity in Patients With Breast Cancer Trastuzumab is highly effective for human epidermal growth factor receptor type 2 (HER2)-positive breast cancer but is associated with a decline in left ventricular ejection fraction.The purpose of this study was to determine whether angiotensin-converting enzyme inhibitors or beta-blockers reduce the rate of trastuzumab-induced cardiotoxicity (left ventricular ejection fraction (...) . In the whole cohort, as well as in the anthracycline arm, patients on active therapy with either angiotensin-converting enzyme inhibitor or beta-blockers experienced fewer interruptions in trastuzumab than those on placebo.In patients with HER2-positive breast cancer treated with trastuzumab, both lisinopril and carvedilol prevented cardiotoxicity in patients receiving anthracyclines. For such patients, lisinopril or carvedilol should be considered to minimize interruptions of trastuzumab. (Lisinopril
Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Local and Contralateral Recurrence in Breast Intraepithelial Neoplasia Tamoxifen administered for 5 years at 20 mg/d is effective in breast cancer treatment and prevention, but toxicity has limited its broad use. Biomarker trials showed that 5 mg/d is not inferior to 20 mg/d in decreasing breast cancer proliferation. We hypothesized that a lower dose given for a shorter period could be as effective in preventing recurrence (...) from breast intraepithelial neoplasia but have a lower toxicity than the standard dose.We conducted a multicenter randomized trial of tamoxifen, 5 mg/d or placebo administered for 3 years after surgery in women with hormone-sensitive or unknown breast intraepithelial neoplasia, including atypical ductal hyperplasia and lobular or ductal carcinoma in situ. The primary end point was the incidence of invasive breast cancer or ductal carcinoma in situ.Five hundred women 75 years of age or younger were
Medical interventions for the prevention of platinum-induced hearing loss in children with cancer. Platinum-based therapy, including cisplatin, carboplatin, oxaliplatin or a combination of these, is used to treat a variety of paediatric malignancies. One of the most significant adverse effects is the occurrence of hearing loss or ototoxicity. In an effort to prevent this ototoxicity, different otoprotective medical interventions have been studied. This review is the third update of a previously (...) published Cochrane Review.To assess the efficacy of medical interventions to prevent hearing loss and to determine possible effects of these interventions on antitumour efficacy, toxicities other than hearing loss and quality of life in children with cancer treated with platinum-based therapy as compared to placebo, no additional treatment or another protective medical intervention.We searched the Cochrane Central Register of Controlled Trials, MEDLINE (PubMed) and Embase (Ovid) to 8 January 2019. We
Clinical practice guidelines for the prevention, early detection and management of colorectal cancer Clinical practice guidelines for the prevention, early detection and management of colorectal cancer - Cancer Guidelines Wiki Skip Links Personal tools Search Navigation Cancer Council guidelines Methodology Hosted cancer guidelines Adolescents and Young Adult (AYA) guidelines Prevention Policies Social links Page actions The guideline recommendations were approved by the Chief Executive Officer (...) , and developed for health professionals practising in an Australian health care setting. This publication reflects the views of the authors and not necessarily the views of the Australian Government. Cite this guideline Cancer Council Australia Colorectal Referring to the large bowel, comprising the colon and rectum. Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia. [Version URL: , cited
in a randomized skin cancerprevention trial of regular versus discretionary sunscreen use (1992-1996). In 2018, an intention-to-treat analysis was conducted using Cox proportional hazards regression to compare death rates in people who were randomized to apply sunscreen daily for 4.5years, versus randomized to use sunscreen at their usual, discretionary level. All-cause mortality and deaths resulting from cardiovascular disease, cancer, and other causes were considered.In total, 160 deaths occurred (...) Regular Sunscreen Use and Risk of Mortality: Long-Term Follow-up of a Skin CancerPrevention Trial Sunscreen is widely used to protect the skin from harmful effects of sun exposure. However, there are concerns that sunscreens may negatively affect overall health. Evidence of the general safety of long-term regular sunscreen use is therefore needed.The effect of long-term sunscreen use on mortality was assessed over a 21-year period (1993-2014) among 1,621 Australian adults who had participated
for patients with BRCA mutations demonstrated that 1–5% of those women had early tubal malignancy; in most of these cases of malignancy, an early intraepithelial component was located in the fimbriated end of the fallopian tube ( , ). Tubal ligation has a protective effect specifically against endometrioid and clear cell carcinomas of the ovary, which support the theory that these tumors may be related to retrograde menses of endometrial cells ( ). Results from the Nurses’ Health Studies show that women (...) Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian CancerPrevention Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian CancerPrevention - ACOG Menu ▼ Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian CancerPrevention Page Navigation ▼ Number 774 (Replaces Committee Opinion Number 620, January 2015) Committee on Gynecologic Practice This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee
Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer 1 Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer Interim Guidance from the Kaiser Permanente National Integrated Cardiovascular Health (ICVH) Work Group October 5, 2018 Three randomized clinical trials (ARRIVE 1 , ASCEND 2 , and ASPREE 3 ) recently published results on aspirin use in patients without known Atherosclerotic Cardiovascular Disease (ASCVD). The studies looked at benefits including (...) daily. • There is no recommendation for or against aspirin therapy in adults aged < 50 or = 60 years. • Exclude adults with increased risk of bleeding. This includes those with a history of gastrointestinal (GI) bleeding, GI ulcers, intracranial bleed, bleeding disorders, renal failure, severe liver disease, thrombocytopenia, or using NSAIDS daily, or other medicine to prevent blood clots. The recommendations above reflect a change from initiate to consider in adults aged 50-59 years with 10-year
Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. Patients with active cancer have an increased risk of venous thromboembolism, which results in substantial morbidity, mortality, and health care expenditures. The Khorana score (range, 0 to 6, with higher scores indicating a higher risk of venous thromboembolism) has been validated to identify patients with cancer at elevated risk for this complication and may help select those who could benefit from thromboprophylaxis.We (...) conducted a randomized, placebo-controlled, double-blind clinical trial assessing the efficacy and safety of apixaban (2.5 mg twice daily) for thromboprophylaxis in ambulatory patients with cancer who were at intermediate-to-high risk for venous thromboembolism (Khorana score, ≥2) and were initiating chemotherapy. The primary efficacy outcome was objectively documented venous thromboembolism over a follow-up period of 180 days. The main safety outcome was a major bleeding episode.Of the 574 patients who
Fosaprepitant (IVEMEND) - prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy Fosaprepitant (IVEMEND ® ). Reference number 3789. Page 1 of 3 AWMSG Secretariat Assessment Report – Limited submission Fosaprepitant (IVEMEND ® ) 150 mg powder for solution for infusion Company: Merck Sharp & Dohme Ltd Licensed indication under consideration: Prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy (...) to be of minimal budgetary impact. Clinical effectiveness ? Fosaprepitant has been in use in Wales for adults since 2009. It did not meet the criteria for appraisal by the All Wales Medicines Strategy Group (AWMSG), as its marketing authorisation date for the adult population was granted before 1 October 2010. This submission considers a licence extension for fosaprepitant for the prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy in patients aged from 6
Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. It is unclear whether supplementation with vitamin D reduces the risk of cancer or cardiovascular disease, and data from randomized trials are limited.We conducted a nationwide, randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also called omega-3) fatty acids at a dose of 1 g per day for the prevention of cancer (...) and cardiovascular disease among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were invasive cancer of any type and major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes). Secondary end points included site-specific cancers, death from cancer, and additional cardiovascular events. This article reports the results of the comparison of vitamin D with placebo.A total of 25,871 participants, including
Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer. Higher intake of marine n-3 (also called omega-3) fatty acids has been associated with reduced risks of cardiovascular disease and cancer in several observational studies. Whether supplementation with n-3 fatty acids has such effects in general populations at usual risk for these end points is unclear.We conducted a randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (at a dose (...) of 2000 IU per day) and marine n-3 fatty acids (at a dose of 1 g per day) in the primary prevention of cardiovascular disease and cancer among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes) and invasive cancer of any type. Secondary end points included individual components of the composite cardiovascular end point, the composite
Fosaprepitant (Ivemend) - prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy Published 12 November 2018 1 www.scottishmedicines.org.uk Product update SMC2108 fosaprepitant 150mg powder for solution for infusion (Ivemend) MSD UK Ltd 05 October 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland (...) . The advice is summarised as follows: ADVICE: following an abbreviated submission fosaprepitant (Ivemend 150mg ® ) is accepted for use within NHSScotland. Indication under review: prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy in paediatric patients aged 6 months to 17 years. Fosaprepitant is given as part of a combination therapy. SMC has previously accepted fosaprepitant as part of combination therapy for the prevention of acute and delayed nausea
Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial What are the short-term and long-term preventive effects of manual lymph drainage (MLD), when used in addition to information and exercise therapy, on the development of lymphoedema after axillary dissection for breast cancer?Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.Adults undergoing (...) unilateral dissection for breast cancer were recruited, with 79 allocated to the experimental group and 81 to the control group.The experimental group received guidelines about prevention of lymphoedema, exercise therapy and MLD. The control group received the same guidelines and exercise therapy, but no MLD. The interventions in both groups were delivered for 6 months.The primary outcome was cumulative incidence of arm lymphoedema defined in four ways (≥200ml,≥2cm,≥5%, and≥10% increase), which represent