Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.

Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).

Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.

Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260

Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.

Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).

Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.

Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260

Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.

Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).

Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.

Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260

Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.

Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).

Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.

Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.

Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4

Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.

Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).

Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.

Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.

Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4

Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.

Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).

Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.

Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.

Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4

Key clinical point: Multiple bodily symptoms, female sex, and prior use of proton pump inhibitors (PPI) are the risk factors for irritable bowel syndrome (IBS) onset, with prior psychiatric disorder being the strongest risk factor.

Major finding: The presence of ≥2 prior psychiatric disorders was the strongest predictor of subsequent IBS (odds ratio [OR] 2.74; P  =  .006), with other risk factors in patients with prior psychiatric disorders being female sex (OR 1.87) and prior use of PPI (OR 1.73; both P < .001). Among patients without prior psychiatric disorder history, female sex (OR 4.24), fibromyalgia (OR 1.88), and prior PPI use (OR 1.73; all P < .001) most strongly predicted IBS onset.

Study details: Findings are from a prospective, population-based cohort study including 132,922 participants without prior IBS or IBS medication use at baseline who were followed-up twice during subsequent 3 years.

Disclosures: This study did not receive any funding. No conflicts of interest were declared.

Source: Creed F. Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: The Lifelines cohort study. J Neurogastroenterol Motil. 2022;28(3):442-453 (Jul 30). Doi: 10.5056/jnm21041

Key clinical point: Multiple bodily symptoms, female sex, and prior use of proton pump inhibitors (PPI) are the risk factors for irritable bowel syndrome (IBS) onset, with prior psychiatric disorder being the strongest risk factor.

Major finding: The presence of ≥2 prior psychiatric disorders was the strongest predictor of subsequent IBS (odds ratio [OR] 2.74; P  =  .006), with other risk factors in patients with prior psychiatric disorders being female sex (OR 1.87) and prior use of PPI (OR 1.73; both P < .001). Among patients without prior psychiatric disorder history, female sex (OR 4.24), fibromyalgia (OR 1.88), and prior PPI use (OR 1.73; all P < .001) most strongly predicted IBS onset.

Study details: Findings are from a prospective, population-based cohort study including 132,922 participants without prior IBS or IBS medication use at baseline who were followed-up twice during subsequent 3 years.

Disclosures: This study did not receive any funding. No conflicts of interest were declared.

Source: Creed F. Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: The Lifelines cohort study. J Neurogastroenterol Motil. 2022;28(3):442-453 (Jul 30). Doi: 10.5056/jnm21041

Key clinical point: Multiple bodily symptoms, female sex, and prior use of proton pump inhibitors (PPI) are the risk factors for irritable bowel syndrome (IBS) onset, with prior psychiatric disorder being the strongest risk factor.

Major finding: The presence of ≥2 prior psychiatric disorders was the strongest predictor of subsequent IBS (odds ratio [OR] 2.74; P  =  .006), with other risk factors in patients with prior psychiatric disorders being female sex (OR 1.87) and prior use of PPI (OR 1.73; both P < .001). Among patients without prior psychiatric disorder history, female sex (OR 4.24), fibromyalgia (OR 1.88), and prior PPI use (OR 1.73; all P < .001) most strongly predicted IBS onset.

Study details: Findings are from a prospective, population-based cohort study including 132,922 participants without prior IBS or IBS medication use at baseline who were followed-up twice during subsequent 3 years.

Disclosures: This study did not receive any funding. No conflicts of interest were declared.

Source: Creed F. Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: The Lifelines cohort study. J Neurogastroenterol Motil. 2022;28(3):442-453 (Jul 30). Doi: 10.5056/jnm21041

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertension is a global problem that affects poorer countries as much as it affects more affluent ones, a new study suggests.

A cross-sectional study of some 1.2 million adults in low- and middle-income countries (LMICs) found that overall, rates of hypertension were similar across all levels of education and wealth.

The one outlier was Southeast Asia. There, higher levels of education and household wealth were associated with a greater prevalence of hypertension, but the absolute difference was small.

However, the authors of the study caution that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

The study is published online  in the Journal of the American College of Cardiology.
 

Assumptions about hypertension are wrong

“We found that the differences in hypertension prevalence between education and household wealth groups were small in most low- and middle-income countries, so the frequent assumption that hypertension mostly affects the wealthiest and most educated groups in low-and middle-income countries appears to be largely untenable,” senior author Pascal Geldsetzer, MD, MPH, PhD, assistant professor of medicine at Stanford (Calif.) University, told this news organization.

High blood pressure is sometimes assumed to be a result of “Westernized” lifestyles characterized by a high intake of calorie-dense foods and salt and low physical activity. As a result, the condition is frequently thought of as mainly afflicting wealthier segments of society in LMICs, which may in part be responsible for the low degree of funding and attention that hypertension in LMICs has received thus far, Dr. Geldsetzer said.

Traditionally, other global health issues, particularly HIV, tuberculosis, and malaria, have received the lion’s share of government funding. Hypertension, thought to be a condition affecting more affluent countries because it is associated with obesity and a sedentary lifestyle, was ignored, he said.

Knowing the socioeconomic gradients associated with hypertension in LMICs and how these may change in the future is important for policy makers, Dr. Geldsetzer added.

Led by Tabea K. Kirschbaum, MD, Heidelberg Institute of Global Health, University of Heidelberg, Germany, the researchers examined hypertension prevalence by education and household wealth from 76 LMICs in 1,211,386 participants and assessed whether the effect was modified by the country’s gross domestic product (GDP).

Their analysis included 76 surveys, of which 58 were World Health Organization Stepwise Approach to Surveillance surveys. The median age of the participants was 40 years, and 58.5% were women.

Overall, hypertension prevalence tended to be similar across all educational and household wealth levels and across countries with lower and higher GDPs, although there were some “negligible” country and regional variations.

Treatment rates with blood pressure–lowering drugs for participants who had hypertension were higher in countries with higher GDPs.

Women were more likely to be taking medication than were men.

In some countries, the proportion of individuals taking blood pressure–lowering medication was higher in wealthier households.

In Southeast Asia, however, there was a strong association found between the prevalence of hypertension and higher household wealth levels. Compared with the least wealthy, the risk ratio for the wealthiest was 1.28 (95% confidence interval, 1.22-1.34). A similar association was found for education levels as well.

Education was negatively associated with hypertension in the Eastern Mediterranean. Rates were higher among men than among women.

In an accompanying editorial, Yashashwi Pokharel, MBBS, MSCR, from Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues write:

“Now that we know that hypertension prevalence is not different in the poorest, the least educated, or the least economically developed countries, compared with their wealthier and educated counterparts, we should develop, test, and implement effective strategies to enhance global equity in hypertension care.”

Dr. Pokharel told this news organization that, despite the study’s limitations including heterogeneous data, measurement techniques, and blood pressure monitor use across countries, the signal is loud and clear.

“We urgently need to focus on turning off the faucet by addressing the major determinants of increasing hypertension burden, including the sociocultural and political determinants,” he said. “In this regard, setting funding priorities by donors for hypertension, capacity building, and testing and scaling effective population level hypertension prevention and treatment strategies, developed together with local stakeholders, can have a long-lasting effect. If we perpetuate the neglect, we will ineffectively spend more time mopping up the floor.”

Dr. Geldsetzer is a Chan Zuckerberg Biohub investigator. Dr. Pokharel reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

To address the ongoing shortage of available beds in psychiatric facilities, the American Psychiatric Association has developed a computer-simulation model to help estimate the number of beds needed in any specific U.S. community.

The model, introduced in a recent report from the organization, can predict how changes in any component of mental health care in a community, including mobile trauma teams and assertive community treatment, will affect other components and the overall capacity to care for patients with mental illness.

Leaders of the APA task force that drafted the report noted that communities can use the model to confront the ongoing mental health crisis brought about by a lack of inpatient beds, a shortage of mental health professionals, shorter inpatient stays, and a rising number of individuals with mental illness.

The report was first released at the APA’s annual meeting in May 2022 and was discussed in further detail at a press briefing in mid-August.

“Part of the wisdom of the APA leadership of releasing this report in this format now is to keep attention and awareness on the issue and acknowledge that there is a terrible shortage of beds,” Anita Everett, MD, past president of the APA and chair of the report’s task force, told briefing attendees.

“We need to have ongoing conversations about how we can solve this problem,” said Dr. Everett, who is also director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration.
 

A virtual world

The report describes both historic and current psychiatric bed use and discusses how the availability of community resources affects the need for inpatient care. It includes analyses of inpatient medical care spending and describes barriers to accessing inpatient psychiatric care.

Historically, the number of state-operated psychiatric hospital beds in the United States was 337 per 100,000 people in the mid-1950s. Today, that figure is about 11.7 state psychiatric hospital beds per 100,000 people, the report says.

The average length of an inpatient stay has also decreased significantly both for adults and children. Pediatric length of stay declined from 12.2 days to 4.4 days between 1990 and 2000.

Launched in 2020, the APA Presidential Task Force on the Assessment of Psychiatric Bed Needs in the United States includes more than 30 mental health professionals and members of the APA administration.

The group was charged with drafting a report that explains and defines the current mental health crisis. They were also charged with developing a method for calculating the number of psychiatric beds needed in any given community.

Task force leaders said the model considers how individuals enter the mental health care system and are routed to appropriate services, how long they remain in the system, and the capacity of the system to respond to demand.

The model is based on a “virtual world” that has a number of care components. These include mobile crisis teams, intensive team-based outpatient care, community-based crisis beds, psychiatric hospital beds, and residential and step-down programs.

The model factors in the magnitude of the need for beds in many service areas. Factors include population size, estimates of the rate of acute mental health crises per 100,000 population, adequacy of the community mental health system, the intersection between the mental health and criminal justice systems, and outpatient and inpatient capacities.

The model computes the estimated number of patients waiting in the emergency department, crisis receiving centers, and jail, as well as average wait times. It also calculates the percentage of use of the various services.

The model will be continually updated and can be modified to better reflect the current situation in any given community.
 

Real-world testing

A team led by the University of Michigan, Ann Arbor, and two area hospitals is testing the APA model by using it to calculate the number of beds needed in their community.

“Because the model is focused on the continuum of care services, it allows communities to try to focus on what is the right mix of services needed to try to reduce the need for in-patient hospitalization and measure the impact of development of resources across the continuum, including inpatient beds, to try to achieve the right mix,” Gregory Dalack, MD, chair of the department of psychiatry at the University of Michigan Health System, told this news organization.

Ultimately, Dr. Dalack expects that the model will tell the team something they already know: that additional psychiatric beds are needed in their community.

However, meeting the needs of patients and families is not just about beds, he noted. The model will help provide a fuller picture of psychiatric care and will take into account existing services from many aspects of the care field.

“If we put all the focus just on hospital beds, we are only addressing one part of the challenge,” Dr. Dalack said.

The challenge is also about “identifying what resources/services are already in the continuum of care, where expansion of those or development of new programs might be needed, and what the impact is on the system, particularly with folks who arrive in the emergency room who might need inpatient admission,” he added.

Dr. Everett said the APA leadership team is now actively recruiting others to test the model in their communities, which will help to calibrate the system.

A version of this article first appeared on Medscape.com.

To address the ongoing shortage of available beds in psychiatric facilities, the American Psychiatric Association has developed a computer-simulation model to help estimate the number of beds needed in any specific U.S. community.

The model, introduced in a recent report from the organization, can predict how changes in any component of mental health care in a community, including mobile trauma teams and assertive community treatment, will affect other components and the overall capacity to care for patients with mental illness.

Leaders of the APA task force that drafted the report noted that communities can use the model to confront the ongoing mental health crisis brought about by a lack of inpatient beds, a shortage of mental health professionals, shorter inpatient stays, and a rising number of individuals with mental illness.

The report was first released at the APA’s annual meeting in May 2022 and was discussed in further detail at a press briefing in mid-August.

“Part of the wisdom of the APA leadership of releasing this report in this format now is to keep attention and awareness on the issue and acknowledge that there is a terrible shortage of beds,” Anita Everett, MD, past president of the APA and chair of the report’s task force, told briefing attendees.

“We need to have ongoing conversations about how we can solve this problem,” said Dr. Everett, who is also director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration.
 

A virtual world

The report describes both historic and current psychiatric bed use and discusses how the availability of community resources affects the need for inpatient care. It includes analyses of inpatient medical care spending and describes barriers to accessing inpatient psychiatric care.

Historically, the number of state-operated psychiatric hospital beds in the United States was 337 per 100,000 people in the mid-1950s. Today, that figure is about 11.7 state psychiatric hospital beds per 100,000 people, the report says.

The average length of an inpatient stay has also decreased significantly both for adults and children. Pediatric length of stay declined from 12.2 days to 4.4 days between 1990 and 2000.

Launched in 2020, the APA Presidential Task Force on the Assessment of Psychiatric Bed Needs in the United States includes more than 30 mental health professionals and members of the APA administration.

The group was charged with drafting a report that explains and defines the current mental health crisis. They were also charged with developing a method for calculating the number of psychiatric beds needed in any given community.

Task force leaders said the model considers how individuals enter the mental health care system and are routed to appropriate services, how long they remain in the system, and the capacity of the system to respond to demand.

The model is based on a “virtual world” that has a number of care components. These include mobile crisis teams, intensive team-based outpatient care, community-based crisis beds, psychiatric hospital beds, and residential and step-down programs.

The model factors in the magnitude of the need for beds in many service areas. Factors include population size, estimates of the rate of acute mental health crises per 100,000 population, adequacy of the community mental health system, the intersection between the mental health and criminal justice systems, and outpatient and inpatient capacities.

The model computes the estimated number of patients waiting in the emergency department, crisis receiving centers, and jail, as well as average wait times. It also calculates the percentage of use of the various services.

The model will be continually updated and can be modified to better reflect the current situation in any given community.
 

Real-world testing

A team led by the University of Michigan, Ann Arbor, and two area hospitals is testing the APA model by using it to calculate the number of beds needed in their community.

“Because the model is focused on the continuum of care services, it allows communities to try to focus on what is the right mix of services needed to try to reduce the need for in-patient hospitalization and measure the impact of development of resources across the continuum, including inpatient beds, to try to achieve the right mix,” Gregory Dalack, MD, chair of the department of psychiatry at the University of Michigan Health System, told this news organization.

Ultimately, Dr. Dalack expects that the model will tell the team something they already know: that additional psychiatric beds are needed in their community.

However, meeting the needs of patients and families is not just about beds, he noted. The model will help provide a fuller picture of psychiatric care and will take into account existing services from many aspects of the care field.

“If we put all the focus just on hospital beds, we are only addressing one part of the challenge,” Dr. Dalack said.

The challenge is also about “identifying what resources/services are already in the continuum of care, where expansion of those or development of new programs might be needed, and what the impact is on the system, particularly with folks who arrive in the emergency room who might need inpatient admission,” he added.

Dr. Everett said the APA leadership team is now actively recruiting others to test the model in their communities, which will help to calibrate the system.

A version of this article first appeared on Medscape.com.

To address the ongoing shortage of available beds in psychiatric facilities, the American Psychiatric Association has developed a computer-simulation model to help estimate the number of beds needed in any specific U.S. community.

The model, introduced in a recent report from the organization, can predict how changes in any component of mental health care in a community, including mobile trauma teams and assertive community treatment, will affect other components and the overall capacity to care for patients with mental illness.

Leaders of the APA task force that drafted the report noted that communities can use the model to confront the ongoing mental health crisis brought about by a lack of inpatient beds, a shortage of mental health professionals, shorter inpatient stays, and a rising number of individuals with mental illness.

The report was first released at the APA’s annual meeting in May 2022 and was discussed in further detail at a press briefing in mid-August.

“Part of the wisdom of the APA leadership of releasing this report in this format now is to keep attention and awareness on the issue and acknowledge that there is a terrible shortage of beds,” Anita Everett, MD, past president of the APA and chair of the report’s task force, told briefing attendees.

“We need to have ongoing conversations about how we can solve this problem,” said Dr. Everett, who is also director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration.
 

A virtual world

The report describes both historic and current psychiatric bed use and discusses how the availability of community resources affects the need for inpatient care. It includes analyses of inpatient medical care spending and describes barriers to accessing inpatient psychiatric care.

Historically, the number of state-operated psychiatric hospital beds in the United States was 337 per 100,000 people in the mid-1950s. Today, that figure is about 11.7 state psychiatric hospital beds per 100,000 people, the report says.

The average length of an inpatient stay has also decreased significantly both for adults and children. Pediatric length of stay declined from 12.2 days to 4.4 days between 1990 and 2000.

Launched in 2020, the APA Presidential Task Force on the Assessment of Psychiatric Bed Needs in the United States includes more than 30 mental health professionals and members of the APA administration.

The group was charged with drafting a report that explains and defines the current mental health crisis. They were also charged with developing a method for calculating the number of psychiatric beds needed in any given community.

Task force leaders said the model considers how individuals enter the mental health care system and are routed to appropriate services, how long they remain in the system, and the capacity of the system to respond to demand.

The model is based on a “virtual world” that has a number of care components. These include mobile crisis teams, intensive team-based outpatient care, community-based crisis beds, psychiatric hospital beds, and residential and step-down programs.

The model factors in the magnitude of the need for beds in many service areas. Factors include population size, estimates of the rate of acute mental health crises per 100,000 population, adequacy of the community mental health system, the intersection between the mental health and criminal justice systems, and outpatient and inpatient capacities.

The model computes the estimated number of patients waiting in the emergency department, crisis receiving centers, and jail, as well as average wait times. It also calculates the percentage of use of the various services.

The model will be continually updated and can be modified to better reflect the current situation in any given community.
 

Real-world testing

A team led by the University of Michigan, Ann Arbor, and two area hospitals is testing the APA model by using it to calculate the number of beds needed in their community.

“Because the model is focused on the continuum of care services, it allows communities to try to focus on what is the right mix of services needed to try to reduce the need for in-patient hospitalization and measure the impact of development of resources across the continuum, including inpatient beds, to try to achieve the right mix,” Gregory Dalack, MD, chair of the department of psychiatry at the University of Michigan Health System, told this news organization.

Ultimately, Dr. Dalack expects that the model will tell the team something they already know: that additional psychiatric beds are needed in their community.

However, meeting the needs of patients and families is not just about beds, he noted. The model will help provide a fuller picture of psychiatric care and will take into account existing services from many aspects of the care field.

“If we put all the focus just on hospital beds, we are only addressing one part of the challenge,” Dr. Dalack said.

The challenge is also about “identifying what resources/services are already in the continuum of care, where expansion of those or development of new programs might be needed, and what the impact is on the system, particularly with folks who arrive in the emergency room who might need inpatient admission,” he added.

Dr. Everett said the APA leadership team is now actively recruiting others to test the model in their communities, which will help to calibrate the system.

A version of this article first appeared on Medscape.com.

Key clinical point: Women with early-stage invasive breast cancer (BC) who underwent breast-conserving surgery with radiotherapy (BCS) had better overall survival (OS) than those who underwent mastectomy.

Major finding: Compared with mastectomy, BCS was associated with improved OS in the overall population of patients with early-stage invasive BC (relative risk [RR] 0.64; 95% CI 0.55-0.74), with stronger effects observed in women followed-up for <10 years (RR 0.54; 95% CI 0.46-0.64).

Study details: Findings are from a meta-analysis of 30 studies including 1,802,128 women with early-stage invasive BC, of which 1,075,563 and 744,565 patients underwent BCS and mastectomy, respectively, and were followed-up for 4-20 years.

Disclosures: This study did not receive any external funding. Dr. Chatterjee declared serving as a consultant for 3M and Royal.

Source: De la Cruz Ku G et al. Does breast-conserving surgery with radiotherapy have a better survival than mastectomy? A meta-analysis of more than 1,500,000 patients. Ann Surg Oncol. 2022 (Jul 25). Doi: 10.1245/s10434-022-12133-8

Key clinical point: Women with early-stage invasive breast cancer (BC) who underwent breast-conserving surgery with radiotherapy (BCS) had better overall survival (OS) than those who underwent mastectomy.

Major finding: Compared with mastectomy, BCS was associated with improved OS in the overall population of patients with early-stage invasive BC (relative risk [RR] 0.64; 95% CI 0.55-0.74), with stronger effects observed in women followed-up for <10 years (RR 0.54; 95% CI 0.46-0.64).

Study details: Findings are from a meta-analysis of 30 studies including 1,802,128 women with early-stage invasive BC, of which 1,075,563 and 744,565 patients underwent BCS and mastectomy, respectively, and were followed-up for 4-20 years.

Disclosures: This study did not receive any external funding. Dr. Chatterjee declared serving as a consultant for 3M and Royal.

Source: De la Cruz Ku G et al. Does breast-conserving surgery with radiotherapy have a better survival than mastectomy? A meta-analysis of more than 1,500,000 patients. Ann Surg Oncol. 2022 (Jul 25). Doi: 10.1245/s10434-022-12133-8

Key clinical point: Women with early-stage invasive breast cancer (BC) who underwent breast-conserving surgery with radiotherapy (BCS) had better overall survival (OS) than those who underwent mastectomy.

Major finding: Compared with mastectomy, BCS was associated with improved OS in the overall population of patients with early-stage invasive BC (relative risk [RR] 0.64; 95% CI 0.55-0.74), with stronger effects observed in women followed-up for <10 years (RR 0.54; 95% CI 0.46-0.64).

Study details: Findings are from a meta-analysis of 30 studies including 1,802,128 women with early-stage invasive BC, of which 1,075,563 and 744,565 patients underwent BCS and mastectomy, respectively, and were followed-up for 4-20 years.

Disclosures: This study did not receive any external funding. Dr. Chatterjee declared serving as a consultant for 3M and Royal.

Source: De la Cruz Ku G et al. Does breast-conserving surgery with radiotherapy have a better survival than mastectomy? A meta-analysis of more than 1,500,000 patients. Ann Surg Oncol. 2022 (Jul 25). Doi: 10.1245/s10434-022-12133-8

Key clinical point: A live birth (LB) after the diagnosis of breast cancer (BC) does not have a negative impact on a woman’s overall survival.

Major finding: Compared with women with no subsequent LB after BC diagnosis, the overall cohort of women with subsequent LB (hazard ratio [HR] 0.65; P  =  .002), women with only 1 subsequent LB (HR 0.73; P  =  .033), women with subsequent LB and no prior history of pregnancy (HR 0.56; P  =  .003), and women with LB within 5 years of BC diagnosis (HR 0.66; P  =  .006) had improved survival.

Study details: Findings are from a survival analysis in a national cohort of 5181 women diagnosed with BC at the age of 20-39 years, of which 290 had ≥1 LB and 1682 had no LB after BC diagnosis.

Disclosures: This study was partly supported by the MRC Centre for Reproductive Health, UK. Two authors declared serving as consultants or receiving speaker honoraria from several sources.

Source: Anderson RA et al. Survival after breast cancer in women with a subsequent live birth: Influence of age at diagnosis and interval to subsequent pregnancy. Eur J Cancer. 2022;173:113-122 (Jul 19). Doi:  10.1016/j.ejca.2022.06.048

Key clinical point: A live birth (LB) after the diagnosis of breast cancer (BC) does not have a negative impact on a woman’s overall survival.

Major finding: Compared with women with no subsequent LB after BC diagnosis, the overall cohort of women with subsequent LB (hazard ratio [HR] 0.65; P  =  .002), women with only 1 subsequent LB (HR 0.73; P  =  .033), women with subsequent LB and no prior history of pregnancy (HR 0.56; P  =  .003), and women with LB within 5 years of BC diagnosis (HR 0.66; P  =  .006) had improved survival.

Study details: Findings are from a survival analysis in a national cohort of 5181 women diagnosed with BC at the age of 20-39 years, of which 290 had ≥1 LB and 1682 had no LB after BC diagnosis.

Disclosures: This study was partly supported by the MRC Centre for Reproductive Health, UK. Two authors declared serving as consultants or receiving speaker honoraria from several sources.

Source: Anderson RA et al. Survival after breast cancer in women with a subsequent live birth: Influence of age at diagnosis and interval to subsequent pregnancy. Eur J Cancer. 2022;173:113-122 (Jul 19). Doi:  10.1016/j.ejca.2022.06.048

Key clinical point: A live birth (LB) after the diagnosis of breast cancer (BC) does not have a negative impact on a woman’s overall survival.

Major finding: Compared with women with no subsequent LB after BC diagnosis, the overall cohort of women with subsequent LB (hazard ratio [HR] 0.65; P  =  .002), women with only 1 subsequent LB (HR 0.73; P  =  .033), women with subsequent LB and no prior history of pregnancy (HR 0.56; P  =  .003), and women with LB within 5 years of BC diagnosis (HR 0.66; P  =  .006) had improved survival.

Study details: Findings are from a survival analysis in a national cohort of 5181 women diagnosed with BC at the age of 20-39 years, of which 290 had ≥1 LB and 1682 had no LB after BC diagnosis.

Disclosures: This study was partly supported by the MRC Centre for Reproductive Health, UK. Two authors declared serving as consultants or receiving speaker honoraria from several sources.

Source: Anderson RA et al. Survival after breast cancer in women with a subsequent live birth: Influence of age at diagnosis and interval to subsequent pregnancy. Eur J Cancer. 2022;173:113-122 (Jul 19). Doi:  10.1016/j.ejca.2022.06.048

Key clinical point: Adjuvant endocrine therapy (ET) for 2 years showed a long-term (20 years) advantage in premenopausal women with estrogen receptor-positive (ER+) breast cancer (BC), with differential treatment benefit observed in genomic high-risk vs low-risk tumors.

Major finding: Goserelin (hazard ratio [HR] 0.49; 95% CI 0.32-0.75), tamoxifen (HR 0.57; 95% CI 0.38-0.87), and combined goserelin-tamoxifen (HR 0.63; 95% CI 0.42-0.94) vs no adjuvant ET improved long-term distant recurrence-free interval in the overall cohort of patients, with tamoxifen and goserelin benefitting genomic low-risk (HR 0.24; 95% CI 0.10-0.60) and high-risk (HR 0.24; 95% CI 0.10-0.54) patients, respectively.

Study details: Findings are from the secondary analysis of the Stockholm trial including 584 premenopausal patients with ER+ BC who were randomly assigned to receive goserelin, tamoxifen, combined goserelin-tamoxifen, or no adjuvant ET for 2 years.

Disclosures: This study was supported by the Swedish Research Council and other sources. Some authors declared serving as consultants or advisors or leaders for, being employees or stockowners of, or receiving research funding, honoraria, travel, or accommodation expense from several sources.

Source: Johansson A et al. Twenty-year benefit from adjuvant goserelin and tamoxifen in premenopausal patients with breast cancer in a controlled randomized clinical trial. J Clin Oncol. 2022 (Jul 21). Doi: 10.1200/JCO.21.02844

Key clinical point: Adjuvant endocrine therapy (ET) for 2 years showed a long-term (20 years) advantage in premenopausal women with estrogen receptor-positive (ER+) breast cancer (BC), with differential treatment benefit observed in genomic high-risk vs low-risk tumors.

Major finding: Goserelin (hazard ratio [HR] 0.49; 95% CI 0.32-0.75), tamoxifen (HR 0.57; 95% CI 0.38-0.87), and combined goserelin-tamoxifen (HR 0.63; 95% CI 0.42-0.94) vs no adjuvant ET improved long-term distant recurrence-free interval in the overall cohort of patients, with tamoxifen and goserelin benefitting genomic low-risk (HR 0.24; 95% CI 0.10-0.60) and high-risk (HR 0.24; 95% CI 0.10-0.54) patients, respectively.

Study details: Findings are from the secondary analysis of the Stockholm trial including 584 premenopausal patients with ER+ BC who were randomly assigned to receive goserelin, tamoxifen, combined goserelin-tamoxifen, or no adjuvant ET for 2 years.

Disclosures: This study was supported by the Swedish Research Council and other sources. Some authors declared serving as consultants or advisors or leaders for, being employees or stockowners of, or receiving research funding, honoraria, travel, or accommodation expense from several sources.

Source: Johansson A et al. Twenty-year benefit from adjuvant goserelin and tamoxifen in premenopausal patients with breast cancer in a controlled randomized clinical trial. J Clin Oncol. 2022 (Jul 21). Doi: 10.1200/JCO.21.02844

Key clinical point: Adjuvant endocrine therapy (ET) for 2 years showed a long-term (20 years) advantage in premenopausal women with estrogen receptor-positive (ER+) breast cancer (BC), with differential treatment benefit observed in genomic high-risk vs low-risk tumors.

Major finding: Goserelin (hazard ratio [HR] 0.49; 95% CI 0.32-0.75), tamoxifen (HR 0.57; 95% CI 0.38-0.87), and combined goserelin-tamoxifen (HR 0.63; 95% CI 0.42-0.94) vs no adjuvant ET improved long-term distant recurrence-free interval in the overall cohort of patients, with tamoxifen and goserelin benefitting genomic low-risk (HR 0.24; 95% CI 0.10-0.60) and high-risk (HR 0.24; 95% CI 0.10-0.54) patients, respectively.

Study details: Findings are from the secondary analysis of the Stockholm trial including 584 premenopausal patients with ER+ BC who were randomly assigned to receive goserelin, tamoxifen, combined goserelin-tamoxifen, or no adjuvant ET for 2 years.

Disclosures: This study was supported by the Swedish Research Council and other sources. Some authors declared serving as consultants or advisors or leaders for, being employees or stockowners of, or receiving research funding, honoraria, travel, or accommodation expense from several sources.

Source: Johansson A et al. Twenty-year benefit from adjuvant goserelin and tamoxifen in premenopausal patients with breast cancer in a controlled randomized clinical trial. J Clin Oncol. 2022 (Jul 21). Doi: 10.1200/JCO.21.02844

Key clinical point: Vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT) did not increase the risk for recurrence/mortality in postmenopausal women with early-stage, estrogen receptor-positive (ER+) BC; however, the recurrence risk was higher in patients receiving aromatase inhibitors (AI)+VET.

Major finding: The recurrence risk among women receiving VET (adjusted hazard ratio [aHR] 1.08; 95% CI 0.89-1.32) or MHT (aHR 1.05; 95% CI 0.62-1.78) was similar to that among never-users of hormone therapy; however, the risk was elevated in patients receiving VET+AI (aHR 1.39; 95% CI 1.04-1.85). Neither VET (aHR 0.78; 95% CI 0.71-0.87) nor MHT (aHR 0.94; 95% CI 0.70-1.26) was associated with increased overall mortality, irrespective of the receipt of AI.

Study details: Findings are from an observational cohort study including 8461 postmenopausal women with early-stage, invasive, nonmetastatic, ER+ BC who received no endocrine treatment or 5-year adjuvant endocrine therapy.

Disclosures: This study was supported by Breast Friends, a part of the Danish Cancer Society. Some authors declared receiving support, honoraria, or institutional grants from several sources.

Source: Cold S et al. Systemic or vaginal hormone therapy after early breast cancer: A Danish observational cohort study. J Natl Cancer Inst. 2022 (Jul 20). Doi: 10.1093/jnci/djac112

Key clinical point: Vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT) did not increase the risk for recurrence/mortality in postmenopausal women with early-stage, estrogen receptor-positive (ER+) BC; however, the recurrence risk was higher in patients receiving aromatase inhibitors (AI)+VET.

Major finding: The recurrence risk among women receiving VET (adjusted hazard ratio [aHR] 1.08; 95% CI 0.89-1.32) or MHT (aHR 1.05; 95% CI 0.62-1.78) was similar to that among never-users of hormone therapy; however, the risk was elevated in patients receiving VET+AI (aHR 1.39; 95% CI 1.04-1.85). Neither VET (aHR 0.78; 95% CI 0.71-0.87) nor MHT (aHR 0.94; 95% CI 0.70-1.26) was associated with increased overall mortality, irrespective of the receipt of AI.

Study details: Findings are from an observational cohort study including 8461 postmenopausal women with early-stage, invasive, nonmetastatic, ER+ BC who received no endocrine treatment or 5-year adjuvant endocrine therapy.

Disclosures: This study was supported by Breast Friends, a part of the Danish Cancer Society. Some authors declared receiving support, honoraria, or institutional grants from several sources.

Source: Cold S et al. Systemic or vaginal hormone therapy after early breast cancer: A Danish observational cohort study. J Natl Cancer Inst. 2022 (Jul 20). Doi: 10.1093/jnci/djac112

Key clinical point: Vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT) did not increase the risk for recurrence/mortality in postmenopausal women with early-stage, estrogen receptor-positive (ER+) BC; however, the recurrence risk was higher in patients receiving aromatase inhibitors (AI)+VET.

Major finding: The recurrence risk among women receiving VET (adjusted hazard ratio [aHR] 1.08; 95% CI 0.89-1.32) or MHT (aHR 1.05; 95% CI 0.62-1.78) was similar to that among never-users of hormone therapy; however, the risk was elevated in patients receiving VET+AI (aHR 1.39; 95% CI 1.04-1.85). Neither VET (aHR 0.78; 95% CI 0.71-0.87) nor MHT (aHR 0.94; 95% CI 0.70-1.26) was associated with increased overall mortality, irrespective of the receipt of AI.

Study details: Findings are from an observational cohort study including 8461 postmenopausal women with early-stage, invasive, nonmetastatic, ER+ BC who received no endocrine treatment or 5-year adjuvant endocrine therapy.

Disclosures: This study was supported by Breast Friends, a part of the Danish Cancer Society. Some authors declared receiving support, honoraria, or institutional grants from several sources.

Source: Cold S et al. Systemic or vaginal hormone therapy after early breast cancer: A Danish observational cohort study. J Natl Cancer Inst. 2022 (Jul 20). Doi: 10.1093/jnci/djac112

Key clinical point: Postmenopausal patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) who achieve a preoperative endocrine prognostic index (PEPI) score of 0-1/pathological complete response (pCR) with only neoadjuvant endocrine therapy (NET) can be safely treated without adjuvant chemotherapy.

Major finding: After a median follow-up of 60 months, the 5-year recurrence-free survival (RFS) improved significantly in patients who had PEPI 0-1/pCR without chemotherapy vs PEPI ≥2 (hazard ratio 0.18; P  =  .028). In patients who had PEPI ≥2, the 5-year RFS was similar regardless of the receipt of adjuvant chemotherapy (P  =  .432).

Study details: Findings are from a phase 2 trial including 352 postmenopausal women with early-stage, strongly ER+ and HER2− BC who received NET for 4 months before surgery; after surgery, patients with PEPI 0-1/pCR and PEPI ≥2 were recommended only adjuvant ET and adjuvant ET±chemotherapy, respectively.

Disclosures: This study was supported by Novartis. The authors declared no conflicts of interest.

Source: Wang X et al. Neoadjuvant endocrine therapy for strongly hormone receptor-positive and HER2-negative early breast cancer: results of a prospective multi-center study. Breast Cancer Res Treat. 2022 (Aug 2(. Doi: 10.1007/s10549-022-06686-1

Key clinical point: Postmenopausal patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) who achieve a preoperative endocrine prognostic index (PEPI) score of 0-1/pathological complete response (pCR) with only neoadjuvant endocrine therapy (NET) can be safely treated without adjuvant chemotherapy.

Major finding: After a median follow-up of 60 months, the 5-year recurrence-free survival (RFS) improved significantly in patients who had PEPI 0-1/pCR without chemotherapy vs PEPI ≥2 (hazard ratio 0.18; P  =  .028). In patients who had PEPI ≥2, the 5-year RFS was similar regardless of the receipt of adjuvant chemotherapy (P  =  .432).

Study details: Findings are from a phase 2 trial including 352 postmenopausal women with early-stage, strongly ER+ and HER2− BC who received NET for 4 months before surgery; after surgery, patients with PEPI 0-1/pCR and PEPI ≥2 were recommended only adjuvant ET and adjuvant ET±chemotherapy, respectively.

Disclosures: This study was supported by Novartis. The authors declared no conflicts of interest.

Source: Wang X et al. Neoadjuvant endocrine therapy for strongly hormone receptor-positive and HER2-negative early breast cancer: results of a prospective multi-center study. Breast Cancer Res Treat. 2022 (Aug 2(. Doi: 10.1007/s10549-022-06686-1

Key clinical point: Postmenopausal patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) who achieve a preoperative endocrine prognostic index (PEPI) score of 0-1/pathological complete response (pCR) with only neoadjuvant endocrine therapy (NET) can be safely treated without adjuvant chemotherapy.

Major finding: After a median follow-up of 60 months, the 5-year recurrence-free survival (RFS) improved significantly in patients who had PEPI 0-1/pCR without chemotherapy vs PEPI ≥2 (hazard ratio 0.18; P  =  .028). In patients who had PEPI ≥2, the 5-year RFS was similar regardless of the receipt of adjuvant chemotherapy (P  =  .432).

Study details: Findings are from a phase 2 trial including 352 postmenopausal women with early-stage, strongly ER+ and HER2− BC who received NET for 4 months before surgery; after surgery, patients with PEPI 0-1/pCR and PEPI ≥2 were recommended only adjuvant ET and adjuvant ET±chemotherapy, respectively.

Disclosures: This study was supported by Novartis. The authors declared no conflicts of interest.

Source: Wang X et al. Neoadjuvant endocrine therapy for strongly hormone receptor-positive and HER2-negative early breast cancer: results of a prospective multi-center study. Breast Cancer Res Treat. 2022 (Aug 2(. Doi: 10.1007/s10549-022-06686-1