Clinical Knowledge Summaries (CKS) has been updated in November for the following clinical areas:
Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.
The British Journal of Cancer has published the results of a retrospective cohort study that aimed to assess whether women prescribed tamoxifen after surgery for breast cancer adhered to their prescription and whether adherence influenced survival.
The study identified 2,080 women diagnosed with breast cancer in the Tayside region of Scotland between 1993 and 2002. 79% (1,633) of these women were prescribed tamoxifen with the median duration of treatment being 2.4 years.
The study found an association between longer treatment and better survival. There was also a statistically significant increase in the risk of death for patients who had less than 80% compliance (missing more than one tablet in five). The study also found that less than half (49%) of patients completed the recommended 5 years of treatment with tamoxifen.
The authors conclude that, "a significant proportion of women have low adherence to tamoxifen and are at increased risk of death".
Action: Clinicians should be aware of the potential for poor compliance. Patients should be informed that better compliance with treatment improves survival.
The Journal of Health Services Research and Policy has published a research article that aimed to identify whether primary care trusts (PCTs) that used a high proportion of low-cost generic statins performed as well on the Quality and Outcome Framework (QOF) targets related to cholesterol as those PCTs that used less.
QOF data for 2005-06 was cross-referenced with prescribing data for statins for the same time period. Achievement for QOF indicators for CHD, stroke and diabetes were 78% (range 66–88%), 72% (58–82%) and 79% (67–88%), respectively. The average percentage use of simvastatin and pravastatin was 57% (range 18%-84%).
There was no evidence of an association between QOF achievement and use of low cost statins. The authors therefore conclude that, "PCTs that had a high proportion of simvastatin and pravastatin use were just as successful achieving cholesterol targets" however they also note that future research should look at longer time periods and the recently introduced tighter cholesterol targets.
Action: Clinicians can be reassured that low-cost generic statins are effective in delivering cholesterol targets in a high proportion of patients.
Thanks to Kevin Ashworth for spotting this article
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