MPH Paula A. Rochon MD

Publications (2)8.51 Total impact

• Article: Association between tamoxifen treatment and diabetes

  MSc Lorraine L. Lipscombe MD, MSc Hadas D. Fischer MD, Lingsong Yun MSc, Andrea Gruneir PhD, Peter Austin PhD, MSc Lawrence Paszat MD, PhD Geoff M. Anderson MD, MPH Paula A. Rochon MD
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  ABSTRACT: BACKGROUND:There is increasing evidence linking breast cancer and diabetes; however, few studies have explored the association between cancer treatments and risk of diabetes. Tamoxifen may increase diabetes incidence through its estrogen-inhibiting effects. This study assessed whether tamoxifen treatment in older breast cancer survivors is associated with an increased risk of diabetes.METHODS:This nested case-control study used population-based health databases in Ontario, Canada to identify women older than 65 years with early stage breast cancer between April 1, 1996 and March 31, 2006. Cases were defined as cohort members diagnosed with diabetes during follow-up (March 31, 2008), and each case was age-matched with up to 5 controls who did not develop diabetes. After adjusting for other risk factors, the authors compared the likelihood of diabetes between current tamoxifen users and tamoxifen nonusers, based on prescriptions at diabetes diagnosis. They also compared diabetes risk in current aromatase inhibitor users versus nonusers.RESULTS:Of 14,360 breast cancer survivors identified, mean age 74.9 years, 1445 (10%) developed diabetes over a mean follow-up of 5.2 years. Current tamoxifen therapy was associated with a significantly higher risk of diabetes compared with no tamoxifen therapy (adjusted odds ratio, 1.24; 95% confidence interval, 1.08-1.42; P = .002). There was no association between aromatase inhibitor therapy and diabetes.CONCLUSIONS:Current tamoxifen therapy is associated with an increased incidence of diabetes in older breast cancer survivors. These findings suggest that tamoxifen treatment may exacerbate an underlying risk of diabetes in susceptible women; further studies are needed to better explore this association. Cancer 2011. © 2011 American Cancer Society.
  Cancer 09/2011; 118(10):2615 - 2622. · 4.77 Impact Factor
• Article: Inappropriate Prescribing Before and After Nursing Home Admission

  Irfan A. Dhalla BASc, PhD Geoffrey M. Anderson MD, Muhammad M. Mamdani PharmD, MA, MPH, PhD Susan E. Bronskill MSc, Kathy Sykora MSc, MPH Paula A. Rochon MD
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  ABSTRACT: OBJECTIVES: To compare the prevalence of inappropriate prescribing before and after nursing home admission and to determine which patient and physician characteristics are associated with inappropriate prescribing in the nursing home setting.DESIGN: A pre/post retrospective, cohort study.SETTING: All licensed nursing homes in Ontario, Canada.PARTICIPANTS: Nineteen thousand nine hundred eleven individuals aged 66 and older, newly admitted to nursing homes in Ontario between April 1, 1997, and March 31, 1999.MEASUREMENTS: For each patient in the cohort, a subset of the Beers criteria was used to characterize and compare the prevalence of inappropriate prescribing (as indicated by the prescription of one of 49 inappropriate drugs) before and after nursing home admission. A logistic regression model was used to study the association between inappropriate prescribing and patient and physician characteristics.RESULTS: The proportion of patients receiving a prescription for at least one inappropriate drug decreased from 25.4% before nursing home admission to 20.8% afterward (P < .001). Most patients who had been prescribed an inappropriate agent before nursing home entry had that agent discontinued after admission. The most commonly prescribed inappropriate drugs after nursing home admission were strongly anticholinergic antidepressants (6.4%) and long-half-life benzodiazepines (5.9%). Patients younger than 85 were more likely to receive inappropriate drug therapy (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.15–1.35) than those aged 85 and older. Other significant predictors were having more than one prescriber (OR = 1.40, 95% CI = 1.29–1.51), having a physician aged 50 or older (OR = 1.14, 95% CI = 1.05–1.23), having a male physician (OR = 1.20, 95% CI = 1.05–1.37), having a nonspecialist physician (OR = 1.23, 95% CI = 1.01–1.49), having a nonurban physician (OR = 1.13, 95% CI = 1.03–1.24), and having a physician practicing outside the greater Ontario metropolitan area (OR = 1.31, 95% CI = 1.19–1.51).CONCLUSIONS: Although a substantial number of nursing home residents receive inappropriate drug therapy, the prevalence of inappropriate prescriptions in our cohort declined after nursing home admission despite an overall increase in drug use. Patient and physician characteristics were associated with inappropriate prescribing. Targeted interventions such as regionally based education programs or drug use restrictions may reduce the prevalence of inappropriate prescribing.
  Journal of the American Geriatrics Society 05/2002; 50(6):995 - 1000. · 3.74 Impact Factor