Do ovarian cancer patients using statins have better outcomes?

<p><strong>Background:</strong> There is evidence in breast, colorectal and prostate cancer that patients who use statins have better cancer outcomes. There is biological evidence of similar benefits in ovarian tumour cells. We investigated whether stain use was associated with survival in ovarian cancer patients in Ireland.</p> <p><strong>Methods:</strong> Women diagnosed with invasive ovarian cancer (C56) between 2001-2011 were identified from the National Cancer Registry. Those with at least one year medical card history (means tested) pre-diagnosis were identified and linked to community prescription records. Any statin use (ATC code: C10AA,C10B) in the year prior to diagnosis was determined. Association between statin use and cause-specific survival (end of follow-up: 31/12/2012) was estimated using Cox regression (adjusted for: age, smoking, marital status, year of diagnosis, urban/rural, local area deprivation, stage, grade, surgery at diagnosis). Secondary analysis accounting for competing risk was conducted.</p> <p><strong>Results:</strong> Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had had a medical card history for at least one year prior to diagnosis and, of these, 490 (27%) had some exposure to statin in the year prior to diagnosis. 78% of women in the cohort had died by 31/12/2012 (median follow-up=5.8years). Pre-diagnostic statin use was not associated with ovarian cancer-specific survival (HR=1.06, 95%CI 0.92, 1.23) but was associated with better survival for other causes (HR=0.57, 95%CI 0.36, 0.93). When adjusting for competing risks, statin use was significantly associated with increased risk of ovarian cancer-specific death (HR=1.20, 95%CI 1.03, 1.40, p=0.02).</p> <p><strong>Conclusion:</strong> In this, the largest ever study of statin use in ovarian cancer, we observed an association between pre-diagnostic statin use and cancer survival when adjusting for competing risks. Further work is being conducted to verify these results in United Kingdom populations. Research is needed to better understand the mechanisms by which prediagnosis statin use might influence cancer survival.</p> <p> </p

Associations between pre- and post-diagnostic use of beta-blockers and ovarian cancer survival

<p><strong>Background</strong>: There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is some evidence of similar benefits in ovarian tumours. We investigated whether BB use was associated with improved survival within Irish ovarian cancer patients.</p> <p><strong>Method</strong>: Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001–2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to community prescription records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and other causes until follow-up 31/12/2012 was estimated using Cox regression adjusted for: age, smoking, marital status, diagnosis year, urban/rural residence,deprivation, stage, grade, and surgery at diagnosis. Secondary analysis accounting for competing risks was conducted. Time-varying regression with ever/never status (6 month lag) was used to evaluate post-diagnostic BB use.</p> <p><strong>Results</strong>: Of 3097 invasive ovarian cancers diagnosed 2001–2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR = 1.08, 95% CI 0.93,1.23) or other-cause survival (AHR = 1.39, 95% CI 0.92,2.09). Results were similar adjusting for competing risks. Post-diagnostic BB use was associated improved OvCSS (AHR = 0.80, 95% CI 0.65, 0.99) but not other-cause survival(AHR = 1.61, 95% CI 0.85, 3.03).</p> <p><strong>Conclusions</strong>: In this, one of the largest ever studies of beta-blocker use in ovarian cancer, we observed a post- (but not pre-) diagnostic association between exposure and cancer-specific survival.This analysis is being replicated in Northern Ireland and English populations.</p> <p><strong>Acknowledgements</strong>: Project funding, Health Research Board; Registry funding, Department of Health.</p

Using routine prescribing data to identify comorbidities in cancer patients

<p><strong>Background</strong></p> <p>Although certain comorbid conditions may predict treatment receipt and survival in cancer patients, most cancer registries do not routinely collect data on comorbidities. Registries increasingly have access to community prescribing data. A number of algorithms exist for estimation of comorbidities based on prescription history, including RxRisk1 (the updated Chronic Disease Score) and the number of distinct prescription classes2 (DMC). We evaluated the utility of using prescribing data to identify comorbidities in ovarian cancer patients in Ireland.</p> <p><strong>Method</strong></p> <p>Free healthcare within the Irish public healthcare system is restricted to holders of general medical services (GMS) cards, eligibility for which is based on means-test and age. Prescription records were linked, using probabilistic matching methods, to primary ovarian cancers (ICD10 C56) diagnosed 2001-2010. Degree of comorbidities was estimated, using RxRisk and DMC, based on prescriptions in the year prior to cancer diagnosis. The scores were evaluated for prognostic value on treatment (within 12m) and overall survival using logistic and Cox regression respectively.</p> <p><strong>Results</strong></p> <p>1,542 (50%) of the 3,097 incident ovarian cancers had GMS prescriptions in the year prior to diagnosis. Among these women, RxRisk comorbidities with highest prevalence were: gastric acid (39%),hypertension (36%), antiplatelet related (31%) and hyperlipidaemia (31%). Other common categories (>20%) were: pain, inflammatory pain, and ischaemic heart disease. The median simultaneous comorbidity categories was 3 (range 0-12). The median number of DMCs was 11 (range 1-48). Neither the number of conditions nor RxRisk index were associated with chemotherapy receipt or cancer-directed surgery. RxRisk predicted survival (HR=1.03, 95%CI 1.01,1.05) as did DMC (HR=1.01, 95%CI 1.00,1.02). Among common comorbidities, depression, hyperlipidaemia and reactive airway diseases could adversely affect survival.</p> <p><strong>Conclusion</strong></p> <p>Comorbidities can be estimated from linked prescribing data and have some prognostic value in predicting survival after ovarian cancer diagnosis.</p> <p><strong>Acknowledgements</strong></p> <p>Health Research Board (HRA_HSR/2012/30)</p> <p><strong>References</strong></p> <p>1. Fishman, et al. Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003 Jan;41(1):84–99.</p> <p>2. Schneeweiss et al. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol. 2001 Nov 1;154(9):854–64.</p

Bias in prescription data of the Irish ovarian cancer population

<p><strong>Background</strong></p> <p>Ireland has a mixed public-private healthcare system. Free healthcare within the public system is restricted to holders of general medical services (GMS) cards, eligibility for which is based on means-test and age. Cards may also be awarded on discretionary grounds due to extreme hardship (e.g. following cancer diagnosis). One-third of the female population under 70 have a card, and 97% of those aged 70 and older. Community prescribing data is only recorded systematically for card-holders. This restriction likely creates selection bias in pharmacoepidemiological studies conducted in RoI. This study aimed to quantify this bias within women with incident ovarian cancer.</p> <p><strong>Methods</strong></p> <p>Records for all women diagnosed with invasive ovarian cancer (ICD10 C56) 2001-2010 were linked to GMS card records. Characteristics of patients with and without cards (both at diagnosis, and after diagnosis) were compared. Health board of residence, deprivation category, age group at diagnosis, smoking status at diagnosis, employment and marital status were evaluated using logistic regression.</p> <p><strong>Results</strong></p> <p>Of the 3097 women diagnosed with ovarian cancer 1609 (52%) had a GMS card at the time of diagnosis. Most women with cards (92%) had them for at least >12months prior to diagnosis. As expected, age >70 strongly predicts card status (card holders, <70: 32%; 70+, 89%). Within the younger population (<70), all factors evaluated were associated (independently and mutually adjusted) with card status at diagnosis (e.g. adjusted OR smoking 1.23 , 95% CI 1.01, 1.59). Of the women without cards at diagnosis, 54% go on to receive one post-diagnosis, 56% of these within 3 months.</p> <p><strong>Conclusion</strong></p> <p>Medical card coverage at diagnosis within the ovarian cancer population is similar to the general population. Half of patients without a card at diagnosis receive one subsequently. There is selection bias in linked cancer-prescribing datasets which needs to be considered when interpreting pharamcoepidemiological analyses.</p

Effect of drug class on association of beta-blocker with ovarian cancer survival

<p><strong>Background:</strong> There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is conflicting evidence of similar benefits in ovarian tumours. We investigated whether type of drug effected association between BB use and survival within Irish ovarian cancer patients.</p> <p><strong>Method:</strong> Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001-2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to pharmacy claim records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and all other causes was estimated using Cox regression (until follow-up 31/12/2012) adjusted for age, smoking, marital status, diagnosis year, urban/rural residence, deprivation, stage, grade, and surgery at diagnosis. Adjusted hazard ratios (AHR) and 95% CI are presented. Class of medication was a pre-planned subgroup and patients were classified as having exposure to: selective, non-selective, neither (reference category) or both.</p> <p><strong>Results:</strong> Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR=1.08, 95%CI 0.93,1.23) or other-cause survival. Exposure to selective drugs (AHR=1.11, 95%CI 0.95,1.30) was not significantly different to that of non-selective drugs (AHR=0.88, 95%CI 0.56,1.38), drug class interaction p=0.55.</p> <p><strong>Conclusions:</strong> In this large study of beta-blocker use in ovarian cancer, we observed no modification of association by drug class on cancer-specific survival.</p

Additional file 1 of Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020

Additional file 1

Prescribing patterns of glucosamine in an older population: a national cohort study

Background: Glucosamine is commonly prescribed as a disease modulating agent in osteoarthritis. However, the evidence to date suggests that it has a limited impact on the clinical symptoms of the disease including joint pain, radiological progression, function and quality of life. The aim of this study was to examine the prescribing patterns of glucosamine from 2002–2011 in an elderly Irish national population cohort using data from the Health Service Executive Primary Care Reimbursement (HSE-PCRS) General medical services (GMS) Scheme. Methods: Patients aged ≥ 70 years on the HSE-PCRS pharmacy claims database between January 2002 and December 2011 were included. ATC code M01AX05 (glucosamine) was extracted. Prevalence rates per 1000 eligible population with 95% confidence intervals were calculated for all years and age groups (70–74 years, ≥75 years). A negative binomial regression analysis was used to determine longitudinal usage trends and compare prevalence rates across years, sex and age groups. Results: The annual patient rate of glucosamine prescribing increased significantly from 13.0/1000 eligible population (95% CI 12.6-13.4) in 2002 to 68.7/1000 population (95% CI 67.8-69.5) in 2009 before decreasing to 62.4/1000 population (95% CI 61.6-63.2) in 2011. The rate of prescribing of glucosamine varied with sex, with women receiving significantly more prescriptions than men. The cost of glucosamine also increased from 2002–2008. In 2008 total expenditure reached a high of €4.6 million before decreasing to €2.6 million in 2011. Conclusion: The national trend in prescribing of glucosamine increased significantly from 2002 to 2009 before decreasing in 2010 and 2011, in keeping with current international guidelines. There is a need for awareness among healthcare professionals and patients alike of the best available evidence to inform decision making relating to the prescription and consumption of such supplements

Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke

<div><p>Background</p><p>While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke.</p><p>Methods</p><p>A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO.</p><p>Results</p><p>From 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [<i>I</i>² = 90.9%, <i>p</i> < .001], and the overall evidence quality was low.</p><p>Conclusions</p><p>Few studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.</p></div

Summary of the fall in CHD mortality attributable to risk factor changes in people with and without diagnosed CHD in Sweden 1986–2002.

<p>^aAll numbers are rounded to the nearest 5</p><p>^bHypertension therapy in CHD patients is already quantified within secondary prevention medication</p><p>Summary of the fall in CHD mortality attributable to risk factor changes in people with and without diagnosed CHD in Sweden 1986–2002.</p

Risk factor levels in CHD patients and individuals without CHD in 1986 and 2002.

<p>Risk factor levels in CHD patients and individuals without CHD in 1986 and 2002.</p