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This Week in JAMA
JAMA. 2004;291:2407.
Use of Aspirin and NSAIDs and Risk of Breast Cancer
Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with a reduced risk of breast cancer, but the importance of factors such as frequency of use and hormone receptor status is not clear. Terry and colleagues (SEE ARTICLE) examined data on aspirin and NSAID use collected in a case-control study of women with breast cancer to determine whether frequency and duration of use influence breast cancer risk and to assess for a relationship with tumor hormone receptor characteristics. The authors found that use of aspirin alone or aspirin with other NSAIDs was associated with a reduced risk of breast cancer, particularly among frequent ( 7 tablets per week) and current users, and among women with hormone receptor–positive tumors. In an editorial, DuBois (SEE ARTICLE) discusses the role of cyclooxygenase and prostaglandins in breast cancer.
Influence of Comorbid Conditions on Cancer Survival
Coexisting illnesses may influence treatment planning or survival in patients with cancer, but data on comorbid conditions are not systematically collected or considered when estimating prognosis from cancer registry data. To determine whether information on comorbidities provides important prognostic information, Piccirillo and colleagues reviewed comorbidity data abstracted from the medical records of patients with new diagnoses of cancer. The authors classified the comorbidities by severity and found that severity of comorbidity was associated with survival in a dose-dependent fashion, and decrements in survival were independent of cancer stage.
(SEE ARTICLE)
Cognitive Outcomes of Cocaine-Exposed Children
Fetal cocaine exposure is believed to affect neurodevelopment and cognitive outcomes, but prior studies of exposed children have yielded inconsistent results. Singer and colleagues assessed the association between prenatal cocaine exposure and the quality of the caregiving environment on cognitive outcomes in a longitudinal, case-control study with follow-up through 4 years of age. The authors found that exposed and nonexposed children had equivalent full-scale, performance, and summary verbal IQ scores, but prenatal cocaine exposure was related to lower scores on several IQ subscales and to a lower likelihood of above average IQ. The quality of the home environment was an important contributing factor. Cocaine-exposed children who lived in a more stimulating environment had cognitive scores equivalent to nonexposed children.
(SEE ARTICLE)
Selective Reporting of Outcomes in Clinical Trials
The possibility of bias in the reporting of clinical trial outcomes has been suspected but not demonstrated through systematic study. Chan and colleagues reviewed the trial protocols and related publications for 102 randomized trials to assess the extent and nature of outcome reporting bias. They found substantial evidence of incomplete reporting of efficacy and harm outcomes in publications, with statistically significant outcomes more likely to be fully reported than nonsignificant outcomes. The authors also found evidence of alteration, introduction, or omission of primary outcomes in published articles compared with the outcomes prespecified in the trial protocols.
(SEE ARTICLE)
Lessons From SARS Epidemic
Naylor and colleagues participated in a review of the public health system's response to the 2003 SARS epidemic, report on the challenges encountered, and make recommendations to guide the response to future epidemics.
(SEE ARTICLE)
A Piece of My Mind
"A generation of patients grew up with him, and then he saw their children, and they grew up with him too." From "Twilight on North Second."
(SEE ARTICLE)
Medical News & Perspectives
Researchers are seeking ways to disseminate state-of-the-art findings and promote public health initiatives to address untreated sleep disorders.
(SEE ARTICLE)
Defining Quality Health Care
Pitfalls of defining quality as adherence to practice guidelines.
(SEE ARTICLE)
Pediatric Leukemia in Resource-Poor Areas
Outcomes improve with multidisciplinary care teams and protocol-based treatment.
(SEE ARTICLE)
CLINICIAN'S CORNER
Palliative Care for Heart Failure
Strategies for optimizing symptom management and addressing prognosis, advance directives, and hospice care for patients with advanced heart failure.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about preventing cancer.
(SEE ARTICLE)
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