The Oral Endocrine Therapy Decision Making Process in Women with Breast Cancer

poster abstractBackground: Oral endocrine therapy (OET) is life-saving for women with estrogen receptorpositive (ER+) breast cancer because it reduces the incidence of recurrence and mortality. An estimated 75% of women with breast cancer receive a recommendation for life-saving OET such as Tamoxifen or aromatase inhibitors. OET adherence is not a single event decision, but rather is a psychosocial process unfolding over time involving an initial decision to initiate therapy or not, and for those who do initiate OET, several additional decisions. Our understanding of OET decision making is limited, but non-adherence is a common response to OET side effects. By obtaining first-person narratives from women who have been prescribed OET and report experiencing side effects, an explanatory framework can be developed that describes their decision making processes. Purpose: The purpose of this grounded theory study is to develop an explanatory framework of decision making by women with ER+ breast cancer who report experiencing OET side effects. Aims: Specific aims are (1) describe responses to side effects among women with ER+ breast cancer, (2) identify common decisional needs of women with ER+ breast cancer who report experiencing OET side effects, (3) identify common decisional supports sought by and provided to women with ER+ breast cancer who report experiencing OET side effects, and (4) describe how women with ER+ breast cancer who report experiencing OET side effects make decisions about initiating, continuing, switching, and/or discontinuing OET. Methods: In this study, 30 women with ER+ breast cancer who report experiencing OET side effects will take part in a single, face-to-face, audio-recorded interview. Demographic and breast cancer treatment information will be collected and then analyzed using descriptive statistics. A constant comparative method of inductive and deductive processes will be used to discover common patterns and variations in the narrative data. The final products of the analysis will include typologies of responses to side effects, common decisional needs, and common decisional support as well as a framework of common trajectories of decision making related to OET in women who report experiencing side effects. Findings: Findings to date will be discusse

Indirect genetic effects increase heritability estimates for male and female extra-pair reproduction

The question of why females engage in extra-pair behaviors is long-standing in evolutionary biology. One suggestion is that these behaviors are maintained through pleiotropic effects on male extra-pair behaviors (genes controlling extra-pair reproduction are shared between sexes, but only beneficial to one sex, in this case, males). However, for this to evolve extra-pair reproduction must be both heritable and positively genetically correlated between sexes. Previous studies have suggested low heritability with no evidence for between-sex genetic correlations in extra-pair reproduction. However, these have not considered indirect genetic effects (derived from the behavior of others, IGEs) from the social partner, the influence of the social partner’s genotype on the phenotype of an individual, despite the potential of IGEs to uncover hidden heritable variation. Using data from a closed-house sparrow population with a genetic pedigree spanning two decades, we tested the influence of social partner IGEs on heritable variation and genetic correlation estimates of extra-pair reproduction. We found that the inclusion of IGEs resulted in larger heritable genetic variance for both male and female extra-pair heritability. While IGEs did not change between-sex genetic correlations, we found they reduced uncertainty in those estimates. Future studies should consider the effect of IGEs on the mechanisms of sex-specific extra-pair reproduction

Ariel - Volume 6 Number 2

Editors Mark Dembert J.D. Kanofsky Frank Chervenak John Lammie Curt Cummings Entertainment Robert Breckenridge Joe Conti Gary Kaskey Photographer Larry Glazerman Overseas Editor Mike Sinason Humorist Jim McCann Staff Ken Jaffe Bob Skarloff Halley Faust Jim Burk

Applicability of the Environmental Relative Moldiness Index for Quantification of Residential Mold Contamination in an Air Pollution Health Effects Study

The Near-Road Exposures and Effects of Urban Air Pollutants Study (NEXUS) investigated the impact of exposure to traffic-related air pollution on the respiratory health of asthmatic children in Detroit, Michigan. Since indoor mold exposure may also contribute to asthma, floor dust samples were collected in participants homes (n=112) to assess mold contamination using the Environmental Relative Moldiness Index (ERMI). The repeatability of the ERMI over time, as well as ERMI differences between rooms and dust collection methods, was evaluated for insights into the application of the ERMI metric. ERMI values for the standard settled floor dust samples had a mean ± standard deviation of 14.5±7.9, indicating high levels of mold contamination. ERMI values for samples collected from the same home 1 to 7 months apart (n=52) were consistent and without systematic bias. ERMI values for separate bedroom and living room samples were highly correlated (r=0.69, n=66). Vacuum bag dust ERMI values were lower than for floor dust but correlated (r=0.58, n=28). These results support the use of the ERMI to evaluate residential mold exposure as a confounder in air pollution health effects studies

CYP2D6 drug-gene and drug-drug-gene interactions among patients prescribed pharmacogenetically actionable opioids

Purpose When codeine and tramadol are used for pain management, it is imperative that nurses are able to assess for potential drug-gene and drug-drug-gene interactions that could adversely impact drug metabolism and ultimately pain relief. Both drugs are metabolized through the CYP2D6 metabolic pathway which can be affected by medications as well the patient's own pharmacogenotype. The purpose of this brief report is to identify drug-gene and drug-drug-gene interactions in 30 adult patients prescribed codeine or tramadol for pain. Methods We used three data sources: (1) six months of electronic health record data on the number and types of medications prescribed to each patient; (2) each patient's CYP2D6 pharmacogenotype, and (3) published data on known CYP2D6 gene-drug and drug-drug-gene interactions. Results Ten patients (33%) had possible drug-gene or drug-drug-gene interactions. Five patients had CYP2D6 drug-gene interactions indicating they were not good candidates for codeine or tramadol. In addition, five patients had potential CYP2D6 drug-drug-gene interactions with either codeine or tramadol. Conclusion Our findings from this exploratory study underscores the importance of assessing and accounting for drug-gene and drug-drug-gene interactions in patients prescribed codeine or tramadol

Medication Exposure Patterns in Primary Care Patients Prescribed Pharmacogenetically Actionable Opioids

Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study’s purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups had one of five opioid prescription patterns (i.e., singular, episodic, switching, sustained, multiplex), and one of three types of primary foci of medical care (i.e., pain, comorbidities, both). The findings reveal medication exposure patterns that are dynamic, multidimensional, and complex, and the typology offers an innovative approach to assessing medication exposure

Story in health and social care

This paper offers a brief consideration of how narrative, in the form of people‟s own stories, potentially figures in health and social care provision as part of the impulse towards patient-centred care. The rise of the epistemological legitimacy of patients‟ stories is sketched here. The paper draws upon relevant literature and original writing to consider the ways in which stories can mislead as well as illuminate the process of making individual treatment care plans

Altered Lung Morphogenesis, Epithelial Cell Differentiation and Mechanics in Mice Deficient in the Wnt/β-Catenin Antagonist Chibby

The canonical Wnt/β-catenin pathway plays crucial roles in various aspects of lung morphogenesis and regeneration/repair. Here, we examined the lung phenotype and function in mice lacking the Wnt/β-catenin antagonist Chibby (Cby). In support of its inhibitory role in canonical Wnt signaling, expression of β-catenin target genes is elevated in the Cby−/− lung. Notably, Cby protein is prominently associated with the centrosome/basal body microtubule structures in embryonic lung epithelial progenitor cells, and later enriches as discrete foci at the base of motile cilia in airway ciliated cells. At birth, Cby−/− lungs are grossly normal but spontaneously develop alveolar airspace enlargement with reduced proliferation and abnormal differentiation of lung epithelial cells, resulting in altered pulmonary function. Consistent with the Cby expression pattern, airway ciliated cells exhibit a marked paucity of motile cilia with apparent failure of basal body docking. Moreover, we demonstrate that Cby is a direct downstream target for the master ciliogenesis transcription factor Foxj1. Collectively, our results demonstrate that Cby facilitates proper postnatal lung development and function