Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

It is widely known that low-dose aspirin treatment greatly decreases the risks of cardiovascular events such as stroke and heart attack. Aside from improving heart health and treating pain, aspirin has the potential to provide other health benefits as well, including reducing the risk of cancer.

This study used data from two ongoing studies from the Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) that looked at US female nurses and male health care professionals, respectively. The participants filled out questionnaires at enrollment and every 2 years following that describe their lifestyles, medical history, and disease states. They also filled out questionnaires every 4 years that described their diets. Aspirin consumption and cancer rates were assessed as well.

The researchers analyzed data from the studies beginning in 1980 and compared aspirin use to risk for all types of cancer. They also compared its use to risks for any cancers of the gastrointestinal tract including colorectal, pancreatic, and liver, as well as the risk of non-gastrointestinal cancers such as lung, prostate, and breast.

Regular aspirin use, defined by the study as consuming aspirin at least twice a week, was related to a 3% lower risk of all types of cancer than nonregular aspirin use (less than 2 times weekly). Regular aspirin use showed a 15% lower risk of gastrointestinal cancers, and a 19% lower risk of colorectal cancers specifically. It was not associated with a lower risk of non-gastrointestinal cancers.

While a 3% lower risk and even 15% and 19% lower risks may seem quite low, they are still decreased risks of cancer. These lowered risks can prevent thousands of tumors yearly in patients who regularly take aspirin. Pharmacists can help communicate this benefit to patients who are on aspirin or may benefit from starting therapy. Since low-dose aspirin seems to work most effectively in lowering one’s risk of colon and rectal cancers, that may be an important counseling point to a patient who is at a great risk for gastrointestinal cancer. When a pharmacist is working with a patient with a risk of these cancers, they could recommend adding or continuing aspirin supplementation to help decrease such a risk.

Cao Y, Nishihara R, Wu K, et al. Population-wide impact of long-term use of aspirin and the risk for cancer. JAMA Oncol. doi:10.1001/jamaoncol.2015.6396 (published 03 Mar 2016). 

 

Incidence of Sexually Transmitted Infections After Human Papillomavirus Vaccination Among Adolescent Females

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases in the United States. While the virus itself rarely causes symptoms it causes the vast majority of cervical cancer cases among women. It also causes other genital cancers in both men and women, and is responsible for causing a number of head and neck cancers as well. Upon approval of the first HPV vaccine for adolescents, many parents were skeptical as they believed it would promote unsafe sex, since their children would be protected against an STD. Because of this along with a number of other factors, vaccination rates in the US among adolescent males and females remains very low.

This study compiled pharmacy and medical insurance claims from 2005 to 2010 among 41 employers across the country to assess whether or not females between the ages of 12 and 18 were more likely to contract STIs as a result of receiving an HPV vaccine. The study compared the STI rates among vaccinated females before and after vaccination and compared them to females of the same age who had not been vaccinated.

Prior to vaccination, STI rates among vaccinated females was 4.3 per 1000, and after vaccination they were 6.8 per 1000. However, the STI rates increased nearly as much in the same time period among non-vaccinated females (2.8 per 1000 during the first assessment and 4.2 per 1000 during the second). This proves that HPV vaccination is not associated with increased STI rates and therefore does not promote unsafe sexual activity.

Pharmacists can be integral in helping improve vaccination rates not only among adolescent females but also adolescent males. We can promote the numerous benefits to being vaccinated and emphasize that the primary goal is cancer prevention. We can also put our patients at ease knowing that it does not promote unsafe sex and has very few risks associated. It’s crucial for pharmacists to know why HPV vaccination is important and to educate and encourage as many patients as possible to receive it.

Jena AB, Goldman DP, and Seabury SA. Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females. JAMA Intern Med. 2015;175:617-623.

Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study

Motor vehicle accidents are among the most common causes of death and disability worldwide. Syncope is a medical condition associated with a loss of consciousness with a spontaneous recovery. Operating a vehicle while experiencing syncope can potentially lead to an accident that may even be fatal.

This study assessed the risk of experiencing a serious motor vehicle crash in people 18 years and older who had been diagnosed with syncope from a hospital or emergency department between 2008 and 2012 across Denmark. 41,039 patients were identified and after 2 years since the study began, 1,791 patients (4.4%) were involved in an accident that required medical attention.

From the data collected during the study, the risk of motor vehicle crashes among patients with syncope was calculated to be 2-fold higher for these patients than for the general population. This risk varied slightly between age, sex, and comorbidity (men are at a higher risk than women, and the risk increases with age among men but decreases with age among women).

While this risk is not drastically higher than it is for the general population, it is still important for patients with syncope to be aware of it. Pharmacists should be aware of this risk as well, since many medications cause syncope. It can be beneficial for pharmacists to explain this risk when counseling patients on new medications that cause syncope; patients should be aware of this side effect and be cautious of driving until they know how their medication works for them.

Numé AK, Gislason G, Christiansen CB, et al. Syncope and motor vehicle crash risk: a Danish nationwide study. JAMA Intern Med. doi:10.1001/jamainternmed.2015.8606 (published 29 Feb 2016). 

Changes in Retail Prices of Prescription Dermatologic Drugs From 2009 to 2015

The United States is home to the most costly prescription medications in the world. Most drugs are available in other countries for a fraction of what they cost here in the U.S. Additionally, health insurance policies are continuously tightening their formularies, making it more costly for patients to get the same medications with each passing year. For these reasons especially, analyzing drug prices is critically important.

This study looks at the price changes of certain prescription dermatologic medications sold at retail pharmacies over the course of six years. Surveys were sent out to four major chain pharmacies in the same county in Florida, each asking the prices of certain brand-name medications. A survey was sent out four times  over 6 years in 2009, 2011, 2014 and 2015, and 19 drugs were recorded across all 4 surveys and were therefore analyzed.

The mean increase of drug prices between 2009 and 2015 was 401%. Topical drugs used for cancer treatment had the greatest price increase at 1,240% where drugs for psoriasis had the lowest price increase of 180%. Overall, the most dramatic increase seemed to occur after 2011.

It is obvious that newer drugs tend to be priced higher due to research and development costs; but some drugs evaluated had been available for years, with no true justification for their dramatic price increases. Also due to inflation and other economic factors, drug prices are expected to increase with every passing year; but these price increases far surpassed these factors, with the reason for their price increases still unknown. Some medications such as doxycycline had been put on a drug shortage due to inability of certain ingredients, therefore resulting in a higher cost. However even after being removed from the drug shortage list, the prices of these medications remained high. The reason for these price increases had not been investigated by the study, so further research is needed to determine such causes.

Being aware of dramatically increasing drug costs is important for pharmacists as well as all health care providers. Pharmacists can play a vital role in keeping doctors as well as patients informed about drug prices and can aid in saving patients money. There are a number of programs available to patients to help alleviate drug costs, and pharmacists should be knowledgable on them and willing to help their patients access this help. They can also communicate with physicians and encourage them to prescribe more cost-effective medications to struggling patients whenever possible.

 

Rosenberg ME, Rosenberg SP. Changes in retail prices of prescription dermatologic drugs from 2009 to 2015. JAMA Dermatol. 2016;152:158-163. 

HPV9: Combating HPV-associated cancers by strengthening serotype defenses

Human Papillomavirus (HPV) is one of the most common sexually transmitted diseases in the United States. Most cases of HPV show no symptoms, at most causing genital warts. The major health risk HPV poses is its link to various types of cancers. HPV can cause cervical, vaginal, penile and head and neck cancers in both men and women.

There are 3 vaccines currently available for the prevention of HPV–HPV 9 (Gardasil 9), HPV 4 (Gardasil), and HPV2 (Cervarix). They are administered in 3 doses over the course of 6 months. Females may receive any of the three vaccines but males should not receive Cervarix. All 3 vaccines protect against the types of HPV responsible for 70% of cancers caused by HPV. HPV9 provides the broadest coverage against HPV types, and HPV4 provides protection from the types of HPV responsible for 90% of genital warts.

The Centers for Disease Control and Prevention advise administering the vaccines between 11 and 12 years of age. Females who have not been vaccinated may still do so between 13 and 26 years of age, and males may do so between 13 and 21 years of age. The vaccine has been proven to be safe and effective, but still very small numbers of adolescents are being protected against this disease.

There are a number of reasons causing low vaccination rates among adolescents. A major reason is that HPV vaccines are extremely expensive. Many doctors fail to provide parents with information about the vaccines, and many parents simply do not know enough about it to be willing to have their children vaccinated (especially since it is a relatively new medication). Stigmas surround the vaccine as well since it is technically an STD prevention and is viewed as such.

These and other barriers explained by this article are where a pharmacist can make a huge impact. Since pharmacists are seen by most as trustworthy and knowledgable when it comes to medications, many parents would trust a pharmacist’s recommendation to get their child vaccinated. Pharmacists can educate their patients on the great risks associated with not getting vaccinated, and assure the safety and efficacy of the immunization. Pharmacists can also remind patients to receive their second and third doses, as many people receive the first but not the following two doses. As student pharmacists, we can help educate our peers and bring awareness to the vaccine. Pharmacists as well as all health care providers should also work to emphasize that the major goal of HPV vaccination is cancer prevention.

Dougherty SA, Hayney MS. HPV9: Combating HPV-associated cancers by strengthening serotype defenses. J Am Pharm Assoc. 2015;55:670-2.

Students as catalysts to increase community pharmacy-led direct patient care service

This study analyzed the effectiveness of an advanced pharmacy practice experience (APPE) elective at 5 colleges of pharmacy in the U.S. that promotes patient care in a community setting. Partner for Promotion (PFP) is an elective that provides student pharmacists with the chance to learn and build patient-centered practice skills that are most often used in community pharmacies.

Over the course of 3 years, 15 different patient care services were implemented, such as MTM, immunizations and prevention services, under PFP by 38 student pharmacists. Faculty at the schools of pharmacy were trained on the PFP program, who recruited local pharmacies to implement it. Each year a survey was completed by the faculty members at the school evaluating the program and its efficacy. The study found that the faculty thought components that were most successful were things such as ease of access to materials for the program and communication among the faculty networks. 100% of the faculty who completed the surveys found PFP to be “very useful” (highest on a scale from 1 to 4).

While the University of Pittsburgh does an incredible job preparing us student pharmacists to be patient care providers, many other schools of pharmacy do not do as much. Programs like this can help prepare more students to be patient-centered practitioners. By training as many student pharmacists as possible in a manner that promotes direct patient care, pharmacists and especially students can greatly help shift our health care from quantity to quality.

Rodin JL, Ulbrich TR, Jennings BT, et al. Students as catalysts to increase community pharmacy-led direct patient care services. J Am Pharm Assoc. 2015;55:642-8.

The adherence impact of a program offering specialty pharmacy services to patients using retail pharmacies

This study looks at a program called Specialty Connect utilized by specialty pharmacies in retail pharmacies. It looked at patient adherence over a 12-month period in 115 CVS Pharmacies in the Philadelphia, PA area.

Patients with “specialty conditions” such as cancer, cystic fibrosis, and pulmonary arterial hypertension were recognized in the Specialty Connect system and pharmacists were prompted to talk with such patients. The patient was given the option of utilizing the service and, if he or she agreed, the choice of having the medication delivered to their home or physician’s office, or available for in-store pick up. The patient was also told the pharmacist was available for counseling 24 hours a day, were counseled on their medications and adherence, and were given the option of refill reminders. The control group followed standard procedures for dispensing and counseling.

Refills of patients who were new to therapy were monitored over the 12-month period as well as those who had previously been receiving specialty medications. Compared to control groups, patients who were new to therapy had an increase of 17.5% in the rate of obtaining a refill on their specialty medications. Patients previously receiving specialty medications had an increase between 6.6% and 10.8% in refill rates.

This study shows how impactful a pharmacist’s interventions truly can be. Especially in the case of specialty mediations, adherence is very important in not only the treatment of the conditions but the costs of the treatments and resolving of issues related to nonadherence. A program like Specialty Connect can help patients with specialty conditions gain better access to and knowledge of their medications.

Moore JM, Matlin OS, Lotvin AM, et al. The adherence impact of a program offering specialty pharmacy serviced to patients using retail pharmacies. J Am Pharm Assoc. 2016;56:47-53.

Pharmacist-led screening program for an inner-city pediatric population

This study was conducted to see how inner city children are affected by asthma, hypertension, obesity, and environmental tobacco smoke (ETS) exposure. This study took place in lower socioeconomic communities throughout Pittsburgh and pharmacists and student pharmacists ran 12 health screenings on 144 children over the course of 2 years.

The study found that 16% of the children were already diagnosed with asthma before the screenings, and 18% had potential asthma. More than half of the children were not at a healthy weight (0.7% were underweight and the remaining were either overweight or obese), and 24% had abnormal blood pressure. 26% of the children had exposure to ETS comparable to that of smokers.

Over the course of this study, nearly 200 referrals were made by the pharmacists. This study is important because it shows how at risk the children in our own community are for conditions that could greatly affect their health outcomes. It also shows how critical of a role pharmacists could play in screening and preventing diseases among children who face numerous health disparities. Screening programs such as this can be implemented by pharmacists in other communities, especially those of even lower socioeconomic status than the one studied, to help lower health disparities among inner city populations of children.

Elliott JP, Harrison C, Konopka C, et al. Pharmacist-led screening program for an inner-city pediatric population. J Am Pharm Assoc. 2003;55:413-8.