Informing women about letrozole after tamoxifen. Is there an easier way?
Bibliographic record
Abstract
898 Background: Letrozole reduces breast cancer recurrences in postmenopausal women following completion of 5 years of tamoxifen. Providing informed decision-making for the large number of women eligible, now and in the future, creates a considerable burden on oncology physician resources. This may result in delays in information dissemination and treatment. Objectives of this study are to develop a self-administered decision-making guide for women eligible to take letrozole post tamoxifen and to determine the effect of this guide when included with a letter of invitation to discuss letrozole therapy. Methods: Women currently over 50 years of age, who had stage I-III, ER/PR positive or unknown breast cancer diagnosed between 1997 and 1999 and without recurrences, were identified from the Manitoba Cancer Registry. All women received a letter of invitation to make an appointment with an oncologist to discuss letrozole. They were randomized to receive a decision-making guide either with the letter (G1) or just prior to meeting with the oncologist (G2). The guide was developed with input from both health care professionals and two focus groups of women with breast cancer experieence. The number of oncology appointments and prescriptions for letrozole were compared between the two groups using chi-squared tests. Results: 159 women were sent letters and 44 (27%) requested appointments. Of these, 17 of 76 (22.4%) were in G1 and 27 of 83 (32.5%) were in G2. The 10.1% difference in appointment requests was not significant (p= 0.15, 95% CI 0 to 34%). Of the 30 women seen so far, 16.7% took letrozole, 46.7% declined and 36.6% were undecided. The numbers are too small to further compare the two groups. Conclusions: A decision-guide was developed that was acceptable to both clinicians and focus groups of breast cancer survivors. Interest in letrozole was surprisingly low overall, even in women who saw an oncologist. Timing of the decision-guide did not appear to affect the numbers of appointments requested nor prescriptions for letrozole. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".