ASH Clinical News ACN_5.1_Digital - Page 20

Data Stream Take Two Placebos a Day For decades, daily aspirin has been purported to prevent cardiovascular disease, but new research published in the New England Journal of Medicine suggests that there is no added benefit – and even potential detri- ment – for older people who take aspirin 100 mg daily. The study followed 9,525 seniors who took daily aspirin and 9,589 seniors who took a daily placebo for nearly 5 years. At the end of the trial, survival was similar But the risk of 90.3% of aspirin-treated patients vs. 90.5% in the placebo group major hemorrhage was higher in the aspirin group (3.8% vs. 2.8%). 4.0% 100% 3.5% 80% 3.0% 2.5% 60% 2.0% 40% 1.5% 1.0% 20% 0.5% 0% 0.0% ASPIRIN-TREATED PATIENTS PLACEBO PATIENTS ASPIRIN-TREATED PATIENTS PLACEBO PATIENTS While the authors noted that this risk was “expected,” they were surprised to find a small increase in the number of deaths overall in the aspirin group, with the largest proportion of deaths due to cancer. Source: McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379:1499-1508. $50 42.1 billion $ Listen Up! During patient encounters, clinicians seldom elicit the patient’s agenda. When they do, they tend to interrupt patients frequently, according to a study published in the Journal of General Internal Medicine. The researchers analyzed the initial few minutes of consul- tations between 112 patients and their doctors that were recorded for training sessions. On average, patients get about 11 seconds to explain the reasons for their visit before they are inter- rupted by their doctors. $40 $30 26.8 billion $ $20 | | | | | | 2011 2012 2013 2014 2015 2016 How Much Is Too Much? Between 2011 and 2016, the U.S. Food and Drug Administration approved 52 new cancer treatments, which led to a hike in expenditures for cancer drugs, according to a report from the Journal of Oncology Practice. During this 5-year period, the U.S. health-care system’s spending jumped from $26.8 billion to $42.1 billion. Specialists spent less time than primary-care doctors elicit- ing the patient’s agenda –presumably because they already know why a patient has been referred. The cancer drugs with the largest growth in spending were immune-based therapies, like checkpoint inhibi- tors. But the 3 drugs with the largest average annual spending were biologics that have been approved for years: rituximab ($3.5 billion), bevacizumab ($2.9 billion), and trastuzumab ($2.2 billion). Source: Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, et al. Eliciting the patient’s agenda: secondary analysis of recorded clinical encounters. J Gen Intern Med. 2018 July 2. [Epub ahead of print]. “The reasons for growth in cancer drug expenditures include technology advancements, increasing prices, changing patient demographics, and changes in duration of therapy,” the study authors wrote. Source: Hong SJ, Li EC, Matusiak LM, et al. Spending on antineoplastic agents in the United States, 2011 to 2016. J Oncol Pract. 2018 Sep- tember 18. [Epub ahead of print] 18 ASH Clinical News January 2019