Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.
Breast cancer is the second most common cancer among women, causing 40,000 deaths a year. For women with a close family history of the disease, physicians may prescribe drugs to help reduce their risk of getting breast cancer. However, these medications carry their own potential health risks. Researchers reviewed seven placebo-controlled, randomized clinical trials and one head-to-head trial to assess the benefits and harms of three medications for preventing invasive breast cancer in women who had not previously had breast cancer. They found that the medications tamoxifen citrate, raloxifene, and tibolone reduced the risk of invasive breast cancer but increased the risk for thromboembolic events (tamoxifen and raloxifene), endometrial cancer (tamoxifen), or stroke (tibolone). The researchers suggest caution in prescribing these drugs to prevent breast cancer, as more research is needed to determine which patients would benefit the most, while suffering the least amount of harm.
Radiation therapy plays a pivotal role in cancer treatment. However, radiotherapy does not always eradicate tumors, as physicians aim to balance damage to the tumor with the undesired effect of causing radiation damage to surrounding healthy tissue. Radiotherapy with charged particles, or particle beam radiation, can potentially deliver maximum doses of radiation to the tumor while minimizing damage to other areas. For this reason, particle beam radiation may be more effective or less harmful than other forms of radiotherapy. Researchers reviewed available evidence about the benefits and harms of particle beam radiotherapy for cancer patients. They found that more evidence on the comparative effectiveness and safety of charged particle beam therapy in cancers is needed to assess the benefits, risks, and costs of treatment.
In this Issue:
As the debate over health care reform continues, the nation has become more focused on the growing cost of health care. While health care spending has increased substantially, so have longevity and quality of life for patients. However, some question whether improved outcomes justify the high costs of care. Researchers conducted an economic analysis on 613 patients with type 2 diabetes being treated at the Mayo Clinic in Rochester continuously for eight years. The researchers found that the value of prevention of future mortality and morbidity for patients exceeded the increased cost of managing their illness. The researchers concluded that while the outcome is worth the extra cost, value for money spent can still be enhanced in diabetes management.
Most patients with depression seek treatment in primary care. Typically, primary care physicians collaborate with mental health case workers to provide self-management and follow-up support to their patients. Researchers studied 74 small primary care practices in Germany over one year to determine whether case management provided by health care assistants would be more effective than usual care for patients with major depression. The researchers randomly assigned 626 adults with depression to either case management by a health care assistant (310) or usual care (316). Health care assistants contacted their patients via telephone twice a week in the first month and then once a month for the next 11 months to monitor depression symptoms and adherence to medication. They also encouraged patients to follow self-management activities. At one year, researchers found that patients assigned to receive case management by health assistants reported slightly greater improvements in depression symptoms, better adherence to antidepressant therapies, and more favorable assessments of the quality of their care than did the usual care patients. The health assistant approach to depression management could be an effective and cost-effective option for small primary care offices.