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This Week in JAMA
January 17, 2007

This Week in JAMA

JAMA. 2007;297(3):239. doi:10.1001/jama.297.3.239
Adjuvant Gemcitabine in Pancreatic Cancer

There has been little evidence that adjuvant chemotherapy improves survival in patients with resectable pancreatic cancer. In a multicenter, randomized controlled trial, Oettle and colleaguesArticle tested the hypothesis that adjuvant chemotherapy with gemcitabine after macroscopic complete resection of pancreatic cancer would improve disease-free survival by 6 months or more. The authors found that patients who were randomly assigned to receive gemcitabine had a median 13.4-month disease-free survival compared with 6.9 months for patients randomly assigned to observation. In an editorial, BensonArticle reviews the outcomes of this trial and those from 2 other recent trials of adjuvant therapy for pancreatic cancer and important considerations in the design of future treatment strategies.

Observational Studies and Treatment Selection Bias

Results of observational studies that compare the outcomes of treated and untreated patients may be biased because of failure to take into account clinically relevant differences between patients in the comparison groups. Using data from a large cohort of elderly patients who were hospitalized with acute myocardial infarction (AMI) and eligible for cardiac catheterization, Stukel and colleaguesArticle compared risk-adjusted relative mortality rates following cardiac catheterization using 4 analytic methods for removing the effects of selection bias in observational studies. The authors found that estimates of the association of cardiac catheterization with long-term AMI mortality were highly sensitive to the method used to minimize selection bias. Of the 4 methods assessed, the authors identified instrumental variable analysis as the method least likely to provide biased estimates of treatment effects. In an editorial, D’Agostino and D’AgostinoArticle discuss sources of bias in observational studies and the advantages and disadvantages of the analytical approaches commonly used to minimize selection bias in observational data.

Risk Factors for Early AMI Among South Asians

A number of studies document that South Asians have higher rates of acute myocardial infarction (AMI) at younger ages compared with other populations. To investigate reasons for this, Joshi and colleagues conducted a case-control study comparing cardiac risk factors in South Asians with those in persons from 47 other countries. The authors found that among South Asians, the prevalence of protective factors (leisure-time physical activity, regular alcohol intake, and daily fruit and vegetable intake) were significantly lower and harmful risk factors (smoking, diabetes, elevated apolipoprotein B100:apolipoprotein A-I ratio) were significantly higher compared with persons from other countries. In an analysis stratified by age, South Asians had higher levels of risk factors for AMI at younger ages compared with persons from other countries.

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CLINICIAN'S CORNER

Mrs D is an 82-year-old woman with multiple chronic illnesses and a 3-year history of profound and debilitating fatigue. Her fatigue has not responded to a variety of symptomatic interventions or to therapies to control concurrent symptoms of her medical conditions. Yennurajalingam and Bruera discuss the prevalence and causes of fatigue and its assessment and palliative treatment at the close of life.

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Medical News & Perspectives

As prescriptions for opioids soar, physicians and public policy makers must balance the provision of adequate pain control for patients with the need to stem abuse and diversion of these drugs.

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Genetics of Intraocular Pressure

An article in the January issue of the Archives of Ophthalmology reports identification of several gene loci that may control intraocular pressure. Pasquale discusses the implications of these findings for understanding the pathogenesis of primary open-angle glaucoma.

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Role of Litigation in Defining Drug Risks

Recent litigation has revealed new data on adverse effects of medications, exposed questionable corporate practices, and influenced drug regulation.

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Author in the Room Teleconference

Join David Ganz, MD, MPH, February 21, 2007, from 2 to 3 PM eastern time to discuss The Rational Clinical Examination “Will My Patient Fall?” To register, go to http://www.ihi.org/AuthorintheRoom.

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page

For your patients: Information about pancreatic cancer.

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