Background Aspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin. Methods In a systematic literature review we identified reports of randomised controlled trials of aspirin in which both total GI bleeding events and bleeds that led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. A meta-analyses was then performed to estimate the risk of fatal gastrointestinal bleeding attributable to low-dose aspirin. Results Eleven randomised trials were identified in the literature search. In these the relative risk (RR) of 'major' incident GI bleeding in subjects who had been randomised to low-dose aspirin was 1.55 (95% CI 1.33, 1.83), and the risk of a bleed attributable to aspirin being fatal was 0.45 (95% CI 0.25, 0.80). In all the subjects randomised to aspirin, compared with those randomised not to receive aspirin, there was no significant increase in the risk of a fatal bleed (RR 0.77; 95% CI 0.41, 1.43). Conclusions The majority of the adverse events caused by aspirin are GI bleeds, and there appears to be no valid evidence that the overall frequency of fatal GI bleeds is increased by aspirin. The substantive risk for prophylactic aspirin is therefore cerebral haemorrhage which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer.
Acetylsalicylic acid was first synthesised by Dr FeIix Hoffman on 10th August 1897 and Aspirin was born.It quickly became the best-known pain killer in the world and in the 120 years since this event, aspirin has continued to attract interest, innovation and excitement.Set within the walls of the preserved ruins of Rudolf Virchow's lecture hall at Charité, within Berlin's Museum of Medical History, the International Aspirin Foundation's 28th Scientific Conference served to facilitate international, multi-disease, multidisciplinary discussion about the current understanding of aspirin's mechanisms of action and its utility in modern medicine as well as ideas for future research into its multifaceted applications to enhance global health. Conference Report 2www.ecancer.org
10095 Background: LMS is a narrowly defined subset of soft tissue sarcoma with heterogeneous clinical presentation. Recent reports suggest differences in treatment responses between uterine (uLMS) and extrauterine (euLMS) disease. We sought to identify prognostic factors in LMS patients (pts) and study the impact of primary site on clinical outcomes. Methods: Single centre retrospective study. 97 eligible LMS pts seen in our centre from 2002 - 2010 with complete medical records were identified from our sarcoma database of 790 pts. Results: Median follow-up was 20.7 months (mths), 51% of pts had uLMS. Although median age in uLMS and euLMS was similar (49 vs 54 yrs), uLMS was less common beyond 60 yrs (10% vs 38%, p=0.002). Surgical resection rates (92% vs 79%), adjuvant therapy use (56% vs 42%) and metastatic disease at diagnosis (25% vs 27%) were not significantly different between uLMS and euLMS respectively. Amongst pts who underwent resection of disease, more uLMS pts had negative surgical margins (90% vs 48%, p=0.004). More lung (81% vs 48%, p=0.009) but fewer liver metastases (13% vs 41%, p=0.019) were seen in uLMS vs euLMS respectively. 57% of metastatic pts received palliative chemotherapy, of whom 55% had an anthracycline-based regimen in first line. No significant difference in response rate to first line chemotherapy was seen between uLMS and euLMS (19% vs 29%, p=0.621). In univariate analysis of clinicopathologic factors for the overall cohort, metastatic disease at presentation (p<0.001) was associated with inferior overall survival (OS). For non-metastatic pts who had surgery, a positive surgical margin was associated with a trend towards inferior relapse free survival (RFS) (p=0.062) that did not translate into a difference in OS. Median RFS and OS was 26.8 mths and 40.5 mths respectively. Both RFS (29.7 mths vs 25.5 mths) and OS (50.9 mths and 33.5 mths) were numerically superior in uLMS vs euLMS. Conclusions: This study demonstrates interesting clinicopathologic differences between uLMS and euLMS. While primary LMS site did not significantly impact on survival outcomes in this heterogeneously treated cohort of pts, the 17 mth OS difference in favour of uLMS is noteworthy. Disease stage remains the most vital prognostic factor in LMS.
The quality of life of family caregivers of patients with advanced cancers is an important concern in oncology care. Yet, there are few suitable measurement scales available for use in Asia. This study aims to develop and evaluate a locally derived measurement scale in English and Chinese to assess the quality of life of family caregivers of patients with advanced cancers in Singapore. Scale contents were generated from qualitative research that solicited inputs from family caregivers. Six hundred and twelve family caregivers of patients with advanced cancers were recruited, of whom 304 and 308 chose to complete the English and Chinese versions of the quality of life scale, respectively. A follow-up survey was conducted for test-retest reliability assessment. Analyses began with pooling all observations, followed by analyses stratified by language samples and ethnic groups (among English-speaking participants). Factor analysis identified 5 domains of quality of life. The Root Mean Square Error of Approximation was 0.041 and Comparative Fit Index was 0.948. Convergent and divergent validity of the total and domain scores were demonstrated in terms of correlation with the Brief Assessment Scale for Caregiver and its sub-scales and a measure of financial concern; known-group validity was demonstrated in terms of differences between groups defined by patient's performance status. Internal consistency (Cronbach's alpha) of the total and domain scores ranged from 0.86 to 0.93. Test-retest reliability (intraclass correlation coefficient) ranged from 0.74 to 0.89. Separate analyses of the English- and Chinese-speaking samples and ethnic groups gave similar results. A new, validated, multi-domain quality of life measurement scale for caregivers of patients with advanced cancers that is developed with inputs from family caregivers is now available in two languages. We call this the Singapore Caregiver Quality Of Life Scale (SCQOLS).
Background: Multilingual outcome measures are used so that research studies are more generalizable across language contexts. Objective: To determine the score equivalence of the English and Chinese versions of Brief Assessment Scale for Caregivers (BASC) in Singapore. Method: Caregivers of patients with advanced cancer completed the BASC in either English or Chinese. Multivariable linear regression analysis was used to compare the mean BASC total and factor scores between the 2 language versions, with adjustment for possible confounding variables. Equivalence was declared if the 90% confidence interval of the mean scores fell entirely within an equivalence zone of ±0.5 standard deviation. Results: There were 521 ethnic Chinese participants, of whom 214 answered the English version and 307 answered the Chinese version. The BASC total and factor scores met the criteria for equivalence. Cronbach α coefficients were similar and exploratory factor analysis showed similar 2-factor structures for both language versions. Conclusion: The English and Chinese versions of the BASC were found to be equivalent in terms of similar adjusted mean scores, Cronbach α, and factor structures.
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