Journals Watch - Lung cancer, heart failure and falls

Too busy to keep up with the latest research? Dr Bryan Palmer updates you on the latest papers.

Treatment for non-small cell lung cancer - Lancet, doi:10.1016/S0140-6736(10)60059-1

Non-small cell lung cancer remains a disease that is easy to prevent but difficult to treat. Two meta-analyses from UK researchers looked at the net benefit of adding chemotherapy after surgery alone or after surgery and radiotherapy. The first meta-analysis included 34 trials (8,447 patients) of surgery alone versus surgery and chemotherapy and the results showed a 4 per cent benefit on five year survival (from 60 to 64 per cent).

The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy alone was based on 13 trial comparisons and 2,660 patients.

They recorded a benefit of adding chemotherapy to surgery plus radiotherapy, representing an absolute improvement in survival of 4 per cent at five years, from 29 to 33 per cent.

In both meta-analyses, the authors noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup.

The benefits of measuring estimated glomerular filtration rate - JAMA 2010; 303 (12): 1151-8
What has the widespread introduction of estimated glomerular filtration rate (eGFR) changed in clinical practice and outcomes? This study from Canada looked to answer this question and paints a fairly bleak picture.

They used a community-based cohort study with time-series analysis. Participants were identified from a laboratory registry, and followed up from May 2003 to March 2007.

The results showed that eGFR was associated with an increase in first nephrologist visits, particularly among patients with more severe kidney dysfunction, women, middle-aged and very elderly patients, and those with comorbidities. No increase was seen in any outcomes including GP visits or the use of ACEs/ARBs. I suspect it is an area, at least in Canada, for improved education but if no useful outcome is seen you have to question its measurement.

Heart failure treatment trends - Med J Aust 2010; 192 (6): 306-10
How well do hospitals follow evidence-based medicine and what is the effect on mortality? This study from Perth, Australia took a retrospective look at heart failure (HF) treatment from 1996 to 2006 across several centres.

The main outcome measures were the proportion of patients prescribed evidence-based therapy for HF on discharge from hospital; and one-year all-cause mortality.

Over that time period they followed a thousand patients who had no admission for HF in the previous five years. The prescription rate of ACE inhibitors/ARBs (74.3 per cent) and loop diuretics (85.5 per cent) remained high over the study period. That of beta-blockers and spironolactone increased (10.5 per cent to 51.3 per cent and 1.4 per cent to 23.3 per cent, respectively), and digoxin prescription decreased (38.1 per cent to 20.7 per cent). These trends were in line with clinical trial evidence.

Fall prevention strategies - Med J Aust 2010; 192 (6): 319-22
Does having a liaison nurse reduce the incidence and consequences of falls in aged care facilities? This RCT involved 5,391 residents in 88 aged care facilities. Residents were followed for 545 days or until death or discharge. Data were collected from July 2005 to June 2007.

A liaison nurse was employed to encourage falls and injury prevention strategies during the 17 month intervention period.

Despite increases in the provision of hip protectors and use of vitamin D supplementation in both intervention and control facilities, there was no difference in the number of falls between the intervention and control groups.

A new antihypertensive class? - Lancet, doi:10.1016/S0140-6736(09)61966-8
This drug trial may herald a new class of antihypertensive. LCZ696, a combined ARB and neprilysin (membrane bound protein) inhibitor shows promise.

This trial by Novartis compared it with their existing product valsartan, 1,328 patients aged 18-75 years with mild-to-moderate hypertension were randomly assigned to eight weeks treatment in one of eight groups: 100mg, 200mg or 400mg (LCZ696) 80mg, 160mg or 320mg (valsartan); 200mg AHU377; or placebo.

LCZ696 produced consistently lower BP at all comparative doses with an excellent side effect and safety profile.

Although, I note the extra reduction at the 400mg dose was lower than the 200mg dose and even then the 200mg dose only added a reduction of about 3mmHg over 160mg valsartan.

Exercise in women - JAMA 2010; 303 (12): 1173-9
There have been various suggestions of how much exercise is required to remain healthy. The Harvard authors examined the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

They used a prospective cohort study involving 34,079 healthy US women (mean age, 54.2 years) from 1992-2007.

At baseline and at three, six, eight, 10, 12 and 13 years, women reported their physical activity and body weight.

Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET (metabolic equivalent time) hours per week of activity.

Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25.

Women successful in maintaining normal weight averaged approximately 60 minutes a day of moderate activity throughout the study.

  • Dr Palmer is a GP in Fareham, Hampshire, and a member of our team who regularly review the journals
The Quick Study

Non-small cell lung cancer treatment benefits from adjuvant chemotherapy.

Estimated glomerular filtration rate is currently not associated with measurable outcomes.

Hospital heart failure treatment still has room for improvement.

Falls in the elderly not prevented by specialist liaison nurses.

New antihypertensive class on the horizon.

Women with BMI under 25 need to exercise one hour a day to maintain weight.

 

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