EFFICACY AND SAFETY OF EVEROLIMUS-EXEMESTANE COMBINATION IN BREAST CANCER PATIENTS

Breast cancer is the second leading cause of cancer death in women worldwide. In Lebanon, hormone positive patients resistant to endocrine treatments account for most of the cases. These two facts directed the attention to evaluate everolimus-exemestane use in hormonal receptor positive metastatic breast cancer patients, in Lebanon. A multi-center, observational, retrospective cohort study was carried out by screening 69 metastatic breast cancer patient’s files in order to determine the progression free survival (PFS), overall survival (OS) and side effects of everolimus. This study revealed that across different therapy lines, the median PFS for patients on everolimus-exemestane combination was 5.87 ± 10.84 months at a median follow up of 5.135 ± 6.375, and the median survival was 23.83 months with minimum and maximum survival, at 0.26 months and 30.5 months, respectively. Everolimus-exemestane has been shown to be effective in overcoming hormonal resistance in Lebanese breast cancer patients. Stomatitis, as a side effect of everolimus, accounted for 30.84% of the cases. Medical intervention, dose modification, dose postponing, drug discontinuation, and spontaneous resolution were used to manage all side effects. In comparison to previous studies, the current work demonstrated lower stomatitis percentages reflecting the preventives measures taken by oncologists. As a conclusion, everolimus-exemestane co-administration has proven to be an effective combination in overcoming hormonal resistance in Lebanon and a better tolerance is attributed to preventive measures in order to control drugs side effects

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely