We are pleased to highlight in this issue our Cancer theme and thank Charles L. Bennett, MD, PhD, Editorial Board Member, for serving as Guest Editor for these articles.
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This meta-analysis evaluated the potential clinical benefits of B-type natriuretic peptide (BNP)-guided therapy in chronic systolic heart failure. Porapakkham et al found that BNP-guided therapy reduces all-cause mortality in patients with chronic heart failure when compared with usual clinical care, specifically in patients younger than 75 years. However, there does not appear to be a reduction in all-cause hospitalization or increase in survival free of hospitalization using this approach. The cost-effectiveness of BNP-guided therapy also needs to be ascertained before it can be considered for routine use in clinical practice.
Fraenkel and Fried present the clinical scenario of anticoagulation in nonvalvular atrial fibrillation (NVAF), in which benefits (ie, stroke risk reduction) and harms (ie, increased bleeding risk) of treatment vary considerably, such that the benefit to harm ratio can reverse according to the patients' specific comorbid conditions. Despite the wealth of studies in NVAF, many assumptions are necessary to calculate patient-specific outcomes, and these assumptions may lead to substantial overestimation or underestimation of benefits and harms. The ability to provide accurate and comprehensive individualized outcome assessments will require substantive increases in the efforts and resources allocated toward the collection and dissemination of outcome data for patients with varying comorbidities.
Cancer receives a great deal of news media attention. Although approximately half of US patients with cancer will die of their illness or related complications, it is not known whether reports in the news media reflect this reality. This study examined newspapers and national magazines to determine how news coverage reports on cancer care and outcomes. Fishman et al found that news reports frequently discuss aggressive cancer treatment and survival but rarely discuss treatment failure, adverse events, mortality, or end-of-life care. These portrayals of cancer care may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis.
Interest in expanding health insurance to all Americans has placed new emphasis on the benefit of existing public health programs for low-income, underinsured populations. In a time-to-event analysis, with pre-post comparisons, Lobb et al examined timely follow-up after an abnormal mammogram for 2252 participants in the Massachusetts National Breast and Cervical Cancer Early Detection Program. After the introduction of case management, adjusted risk of diagnostic delay (>60 days) decreased by 35%, and the decrease did not differ by race/ethnicity. The adjusted risk of treatment delay (>90 days) was not associated with case management, and implementation of free treatment was not associated with diagnostic or treatment delay beyond improvements following the introduction of case management. These findings suggest that services to coordinate care, in addition to providing coverage for care, may be required to improve health outcomes for low-income women.
There is evidence that women's concerns about weight gain negatively affect smoking cessation efforts. Cognitive behavioral therapy for smoking-related weight concerns has been shown to improve cessation rates, but the impact of combining this treatment with cessation medication is unknown. In a randomized controlled trial, Levine et al examined whether medication (bupropion hydrochloride [B] or placebo [P]) enhanced the effect of a smoking cessation intervention that incorporated treatment for weight concerns. Women (N = 349) who received the weight concerns counseling (CONCERNS) + B were more likely to be abstinent during 24 weeks of treatment than were women who received either standard smoking cessation intervention (STANDARD) + B or CONCERNS + P. The combination of CONCERNS + B is efficacious for weight-concerned women smokers.
Time to relapse by treatment group.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2010;170(6):506. doi:10.1001/archinternmed.2010.19