(HealthDay News) — As a result of the Philadelphia Prostate Cancer Consensus Conference, hosted by Sidney Kimmel Cancer Center-Jefferson Health and the Department of Urology at Jefferson, recommendations have been developed for implementing germline testing for prostate cancer. The consensus framework was recently published in the Journal of Clinical Oncology.
Veda N. Giri, M.D., from the Sidney Kimmel Cancer Center in Philadelphia, and colleagues recommend large germline panels and somatic testing for metastatic prostate cancer. For multiple scenarios, they suggest reflex testing: initial testing of priority genes followed by expanded testing. Germline testing is recommended for metastatic disease or family history suggestive of hereditary prostate cancer. There is moderate consensus for additional family history and pathologic criteria. For metastatic disease treatment, priority genes to test include BRCA2, BRCA1, and mismatch repair genes; broader testing is recommended for clinical trial eligibility. For active surveillance discussion, BRCA2 gene testing is recommended. For BRCA2 carriers, screening starting at age 40 years or 10 years before the youngest prostate cancer diagnosis in the family is recommended.
To address the shortage of genetic counseling, the authors endorse collaborative evaluation models between health care and genetic providers. Optimal pretest informed consent, posttest discussion, cascade testing, and technology-based approaches should be included in the genetic evaluation.
“Models of genetic evaluation that incorporate technology to enhance access to genetic testing, such as telehealth or use of videos for pretest genetic education, were also endorsed, along with key elements of informed consent,” Giri said in a statement.
Denosumab (DEN) vs alendronate (ALN) is not significantly associated with increased risk for serious infection, according to study results presented at the American Society for Bone and Mineral Research (ASBMR) Annual Meeting, held virtually from September 11 to 15, 2020.
Researchers extracted data from a 20% representative sample of Medicare beneficiaries between 2011 and 2017. Patients with osteoporosis aged ≥66 years who were initiated with DEN or ALN between 2012 and 2016 were eligible for inclusion in the study. Primary outcomes were hospitalization due to any serious infection, including cellulitis, infectious endocarditis, gastroenteritis, diverticulitis, labyrinthitis, osteomyelitis, urinary tract infection, and respiratory infection. Adjusted 2-year infection probabilities were calculated separately for DEN and ALN users. Probabilities were adjusted for patient demographic data, previous zoledronic acid use, and previous serious and mild infections. Analyses were also stratified by sex.
The study cohort included 73,750 patients receiving DEN and 103,790 patients receiving ALN. Mean follow-up time was 20.9 and 19.2 months for the DEN and ALN cohorts, respectively. Compared with patients receiving ALN, those receiving DEN had a higher mean age (78.1 vs 76.7 years, respectively), were a greater percentage of women (93.3% vs 89.7%, respectively), and were more often White (87.2% vs 80.5%, respectively).
Previous serious infection rates were comparable between groups, though patients receiving DEN vs ALN had a higher rate of previous mild infections (59.1% vs 53.9%, respectively). Overall, 5.9% and 4.9% of patients receiving DEN and ALN, respectively, experienced serious infections during follow-up. Adjusted 2-year infection probability was 6.8% (95% CI, 6.50%-7.05%) in the DEN group, compared to 6.3% (95% CI, 6.13%-6.55%) in the ALN group; however, the difference was not clinically significant. Adjusted probabilities for cause-specific serious infections varied but were also comparable between groups.
In real-world practice, serious infection risk was not significantly higher with DEN compared to ALN in osteoporosis. However, the small percentage of men in the study prevented accurate estimates for this cohort; results were better generalized to women.
(HealthDay News) — Patient visitation policies and clinician communication methods in hospitals have undergone a major overhaul, according to a letter to the editor published online July 20 in the American Journal of Respiratory and Critical Care Medicine.
Thomas S. Valley, M.D., of the University of Michigan in Ann Arbor, and colleagues studied how COVID-19 has impacted patient visitation polices by surveying 89 Michigan hospitals containing intensive care units. Of those surveyed, 49 hospitals (55 percent) responded to the authors’ query, while 40 hospitals (45 percent) did not respond.
The researchers found that 100 percent of the responding hospitals said they had instituted some type of change to their visitation policies due to COVID-19. Two percent of hospitals had implemented a restriction of one visitor per patient, whereas 98 percent implemented a “no visitor” policy. Fifty-nine percent (a total of 29) of the hospitals that upheld the “no visitor” policy did allow for some exceptions, including visitation at the end of life only (31 percent), visitation at the end of life and for certain procedures and conditions (26 percent), and visitation on a case-by-case basis (2 percent). Eighty-two percent of responding hospitals said they also changed their methods of communication with the families of patients. While only 17 hospitals (35 percent) provided additional details regarding what mode of communication was currently being used, the investigators found that 23 percent of clinician-to-patient family conversations were performed via telephone and 12 percent were done through video conferencing. As for patient-to-family communication, 69 percent of hospitals encouraged video communication between patients and family members via the use of a smartphone or tablet.
“In the context of uncertainties related to the future of COVID-19 and other pandemics, we must consider whether ‘no visitor’ policies are essential for continued infection prevention and to what extent restricted visitation and changes in communication practices might unintentionally foster poor health outcomes, inequity, and animosity towards health care,” the authors write.
Liu J, Guo H, Niewan K. Infection among denosumab and alendronate users for osteoporosis. Presented at: ASBMR 2020 Virtual Annual Meeting; September 11-15, 2020. Poster #P-637.
This article originally appeared on Rheumatology Advisor