Is there scope to discontinue non-essential medication in patients with advanced lung cancer?

Focal Points 1. Patients with advanced lung cancer take many ‘non-essential’ medicines 2. A simple audit tool could be used to identify ‘non-essential’ medicines that could be discontinued 3. Pharmacists have a potential role in identifying and reviewing ‘non-essential’ medicines Background Lung cancer patients can present with complex medical histories often taking medications to manage existing conditions and prevent future morbidity e.g. antihypertensives and antiplatelets. Guidelines for discontinuing these medications in life-limiting illnesses, such as advanced lung cancer, have not been produced despite the potential to reduce burden, in terms of cost and, more importantly, discomfort to the patient.1 The objectives of this work was to audit the number of medications in patients taking erlotinib for the treatment of advanced lung cancer; and, develop a draft tool that can be used to identify non-essential medications which could, potentially, be discontinued. Methods This clinical audit was undertaken at an acute NHS Trust in April 2011. A clinical audit tool was used to extract data from medical notes of patients receiving erlotinib for non-small cell lung cancer (NSCLC) and compared to a set of criteria to establish if the medicine is essential, non-essential or uncertain. These criteria were based on a study that defined unnecessary medication as where there is no anticipated short-term benefit to patients with respect to survival, quality of life or symptom control.2 All patients who had received erlotinib in the Trust for the treatment of NSCLC within 18 months were selected for the audit. A consensus group (consultant pharmacist, lung nurse specialist and consultant oncologist) reviewed results and considered which medications they would have stopped. Results Of the 20 patients audited, 19 were taking at least one medication that could have been discontinued. The mean number of medications taken was 8 (range 1–16). Seventeen patients were taking essential medications (e.g. analgesics) necessary for symptom control in cancer. Non-essential medicines were regarded as those which provided no short term benefit to the patients with respect to survival, quality of life or symptom control or any medicine which had potential to cause harm. The focus group concurred that the majority of non-essential medications identified by the criteria could have been discontinued. Medications classified as uncertain were taken by 7 patients. These medications need to be further reviewed. Discussion For patients undergoing treatment for terminal lung cancer the issue of discontinuing medications is not an immediate priority. However, at some point in their treatment pathway a discussion regarding their medications should be instigated. The focus group revealed that timing of this discussion is crucial. The futile use of medication in terminally ill cancer patients has been reported in the literature and this work is in agreement with this by showing that patients with NSCLC taking erlotinib are taking unnecessary medications.2 Patients take medications such as statins and antihypertensives with the belief that they will be taking them for the rest of their lives, therefore if an appropriate explanation for discontinuation is not given the patients and/or their families may misconceive this as a death-hastening intervention. This work also showed that a significant number of patients who are taking erlotinib also take a proton pump inhibitor (PPI) despite the fact there is a clinically significant drug interaction between erlotinib and PPIs where the absorption of erlotinib is reduced.3 In conclusion, patients taking erlotinib for the treatment of advanced NSCLC take many unnecessary medications and written guidelines on what can be withdrawn are needed. There is the potential for pharmacists to become involved in the review of patients with terminal cancer to facilitate discontinuing potentially unnecessary medicines

The Ursinus Weekly, February 23, 1948

AVC-PAC to produce UMT open forum; guests, Dr. Baker to offer both views • Rehearsals begin for production of Gilbert-Sullivan classic • Ray Eberle\u27s band to perform for junior prom on April 16 • Students to attend model convention • Sophs name band for annual dance • Second discussion on U.M.T is chapel service feature • Chem society visits fibre plant, plans other trips this semester • Silent picture melodrama wins plaudits of enthusiastic Curtain Club audience • Debaters triumph in season\u27s first match • IRC guest to talk on on influence of liberalism and third party • English Club hears book review • FTA hears talk by Dr. Sturgis • Red Cross program carded • Bakes elected to athletic council • Women plan card party • Well-stocked library offers student varied, diverting entertainment • Mr. Charles Miller gives up librarian post after serving college since 1938 • Dr. Miller writes article for international journal • Thirteen-game card arranged for grizzly baseballers this season • Bearettes outscore Chestnut Hill five in close tilt, 27-23 • Hoopsters wallop Crusader five, 52-45, as Jaffe, Forsyth pace bruin scorers • Twelve teams open battle in intramural basketball • Belles top Albright 38-37 on Calhoun\u27s last minute tally • F&M turns back second half bruin rush to win, 60-59 • Suburban league pace set by Ursinus grads • Matmen rally to squash Drexel, 21-15; victories by Collins, Mitchell turn tide • Girls JV basketball club beats Chestnut Hill, Albright reserves • Marion Bosler only winner as mermaids lose to Pennhttps://digitalcommons.ursinus.edu/weekly/1632/thumbnail.jp

The Ursinus Weekly, October 27, 1947

Thespians to stage New York success • Sophs plan dances, class doggie roast • Gen. Arnold makes demand for greater accent on sciences in college curricula • AVC appoints leaders; starts campus clean-up • Ye good olde days in prospect again as school spirit re-appears on campus • Legal society fetes new members; Vice-president Helfferich speaks • May queen to be selected early this semester, Nov. 6 • Gym construction near end; plans for interior finished • Beardwood chemical group elects Pfeiffer president • Reporters added to staff; Lois Cain new sports assistant • Y commission slate opens with discussions, address • New Spanish Club elects officers • Dorms vote to fill WSGA berths • Pre-meds to hear psychiatrist • Aid for Europe? • Grizzlies to play host to victory-hungry PMC • Soccer team bows to Rutgers \u2711\u27, 6-2 • Three teams tied for first in campus football league • Swarthmore interception sets up tally; first frame score gives Garnet 7-0 win • JV hockey team tops Moravian • JV booters thump Hill School • Snell\u27s belles win third straight, 6-1 • Dr. Child addresses English Club • German Club organizes for 1947 • French Club plans activities • New FTA members to be inductedhttps://digitalcommons.ursinus.edu/weekly/1624/thumbnail.jp

Pre-notification letter type and response rate to a postal survey among women who have recently given birth

Background: Surveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper reports on a postal satisfaction survey conducted with women who had recently given birth, and explores the effect of two strategies on response rates. Methods: A sample of 2048 Australian women who had recently given birth were invited to participate in a postal survey about their recent experiences with maternity care. The study design included two different strategies intended to increase response rates: a randomised controlled trial testing two types of pre-notification letter (with or without the option of opting out of the survey), and a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). Results: The survey had an overall response rate of 46%. Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97% gave consent to link their survey data with existing health data. Conclusions: Seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.NHMR

The Ursinus Weekly, May 26, 1947

Dr. T. A. Distler\u27s speech to highlight seventy-seventh annual commencement • Negro recital ends varied Y programs presented in \u2746-\u2747 • WAA names M. Bosler, H. Anderson, E. Moyer as top junior athletes • Athletic Committee chairman addresses letter winners at Varsity Club banquet • Alumni form Washington unit • Gym to be completed within three months; Construction has begun • Hobo hop attracts enthusiastic crowd • Lantern will include increased material • Holiday runs Pennsylvania-Dutch article • A. Ivins chosen Rosicrucian president at final meeting • K. Kron voted pre-med president • Students hear Romeo and Juliet • M. Sare to head Alpha Psi; Six new members initiated • Debating Club elects officers; Dorothy Dean chosen president • Campus briefs: French Club banquet; Men\u27s May pageant • Students may observe unique bio specimens • Commendation • On sports and bus-rides • At the Library • Alumni-Society notes • Juniata rips Bears; Five miscues cost Landes pitching win • Tennis team trounces tribe racquetmen, 8-1; Loses to Swarthmore • Albright cindermen swamped, 79 1/2-46 1/2; Gurzynski crew nabs ten first places • Owlettes crush Bear coeds in return net engagement • Muhlenberg game cancelled • Kennedy stars again • New grid mentor addresses large group of candidates • Erma Keyes one-hitter tops Garnet for fifth straight • Bearette golfers finish season • Cricket team stunned by Fords in match at victors\u27 grounds • Final examination schedule: Spring term, 1947https://digitalcommons.ursinus.edu/weekly/3122/thumbnail.jp

The Ursinus Weekly, May 12, 1947

Broadway comedy achieves new glory in Ursinus star-studded presentation • Dr. Philip to lead Bay State concert • May Queen crowned in colorful pageant given on east campus • Grizzlies whip feeble PMC nine, 7-4; Landes fans nine, gives up eight hits • Y cabinet and officers installed last evening at candlelight vespers • Eight co-eds to model in Ruby fashion show • Forum series ends with labor question • Pre-meds hear Dr. G. B. Keefer • Club to elect officers at banquet • Mass meeting of all vets scheduled; Discussion of vital matters on slate • Notice to all P. L. 16 veterans • Campus briefs: I.R.C. meeting; Varsity Club banquet; F.B.I. agent to speak; A.V.C. meeting • Commentator: A reciprocal visit • Student government • Alumni-Society notes • Bruin nine tripped by Blue Hens, 1-0; Ziegler out-pitched • Diplomats trim Bruins on cinderpath; Kennedy, Turner, Gradwohl scintillate • Brodbeck unit rolls to first half crown in softball tourney • Basketball players win letters • Explorers stopped by Wallickmen, 5-4 • Girls attend Penn clinic for softball instructions • Bear netmen drop 5-4 tilt to Delaware in first loss • Four golf tilts booked for girls • WSGA to install new officers at Wednesday evening banquet • Brotherhood of St. Paul elects Edward Rettew as new president • Evelyn Moyer elected chairman • FTA plans panel on Horace Mannhttps://digitalcommons.ursinus.edu/weekly/3121/thumbnail.jp

The Ursinus Weekly, October 13, 1947

Bears chalk up second straight win, defeat Haverford 6-0: Blydenburg takes pass for touchdown; Gridders maintain unscored-upon pace • General Arnold visits Ursinus for Founders\u27 Day ceremony • Leroy Grayson heads new inter-frat council • Nite game bus tickets available • Swarthmore man guest at AVC meeting tonite • Indian will address forum, Y, on relief • Annex student directs new campus orchestra • Dance and pep rally boost morale on eve before game • Curtain Club holds reception; New members admitted to ranks • Beaver students in food-saving plan similar to Ursinus\u27 • Philosophy student discovers panacea for all problems after two-week study • Hohlfeld to discuss problems of education in British Guiana • Campus briefs: Recorded concerts; Zeta Chi meeting; Inter-frat Council • Annex-dotes • Alumni-society notes • Radium expert enlivens address with experiments, illustrations • Bears to face heavy Moravian 11 Friday • Soccer team bows to Lafayette, 4-1, in opening contest • Campus football resumes, Luther Wilt heads league • Bearettes win practice match • Brotherhood to lead services • Player of the week • Speakers obtained by pre-legal group • Debates start next month • Former Army nurse returns to campus after extensive service in Europe, Asia • Betsy Greene heads English Clubhttps://digitalcommons.ursinus.edu/weekly/3123/thumbnail.jp

The Ursinus Weekly, November 10, 1947

Guest speaker pictures university life in Czechoslovakia and rest of Europe • Ruby subscriptions aid supply store queen obtain new ensemble • F & M football game, Varsity Club hop headline varied old timers\u27 day doings • Mary Carter voted annual May queen • Cast for coming production announced by Curtain Club • Noted educator to address forum on World in action • Campus sororities bid thirty-five initiates during rushing week • Musicians begin rehearsals as swing band plans debut • WSSF opens annual drive for funds; to benefit students in war-torn lands • Frosh women introduced to feminine sports by WAA • Dr. Rice to address German Club at November meeting • New gym nears completion; seats for 800 to be constructed • Views on the Marshall Plan • English Club hears book review • WSGA purchases records • Dr. Child well-known as mountaineer; arrived\u27 with conquest of Matterhorn • Steamship line offers trips to Scandinavia in new essay contest • Student from Iraq finds our grammar easier than Arabic • Pre-meds hear psychiatrist lecture on mental illness • Officers of Newman Club chosen • FTA plans monthly meeting with visual education film • French Club has social meeting • Spanish Club plans activities • Court squad prepares for season\u27s opening • Wrestlers to face six-match schedule • Bruins to meet F & M here Saturday; long-time rivals first tangled in 1894 • JV booters bow to Valley Forge • Golfers plan for 1948 season; to face Princeton, Swarthmore • Co-eds notch win over Chestnut Hill • Second half surge gives Juniata 31-14 victory over bears • Ursinus representatives on girls\u27 all-college team • Haverford defeats bruin booters, 6-1 • Graduation losses promise headaches for coach Wieneke\u27s eleven next fall • Brodbeck, Curtis play off to determine campus champ • JVs swamp Chestnut Hill • Brotherhood plans service • Harriers in Muhlenberg meet • Dorm representatives selectedhttps://digitalcommons.ursinus.edu/weekly/1626/thumbnail.jp