Search Results for: FANS e Rischio Cardiovascolare (Rischio CV)

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Textual Representation in Poetry—And at the End of Life

Poetry conveys meaning not just via the definitions of words, but also in its intentional arrangement of words on the page, and even in the very letters that comprise them. In “DO NOT RESUS_ITATE,” set at the bedside of a patient at the end of life, this almost alchemical property of poetry is immediately apparent in the title: the all-capitals DNR order not only proclaims that the speaker’s father’s death is imminent, but also suggests in its missing silent “C” that perhaps, if medicine can be mistaken, there is still reason to hope. The mutability of text is further entertained as the poem depicts an unlikely birthday celebration, in the consuming of a cake meant for another patient who has already died. We watch the ephemeral happy birthday message (“squiggled in red and green on frosty white”) disappear bite by bite, each vanishing letter sequence an existential question. “I ate ‘Y B.’ Then ‘B I’,” the speaker flatly notes, the literal instability of the written word a kind of wondering at life’s meaning, amidst the irony of juxtaposing a birthday with death. Meanwhile, a football game’s “sudden death overtime” on the radio in the background underscores the poem’s sense that our time is fleeting. By the conclusion, “R A H was no more,” we are suspended between the sweetness suggested by “I licked the frosting off my plate” and distant cheering as “the fans went wild.” Even as words fail us, and lives fade, poetry insists we can yet rejoice.

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HER-SAFE study design: an open-label, randomised controlled trial to investigate the safety of withdrawal of pharmacological treatment for recovered HER2-targeted therapy-related cardiac dysfunction

Introduction
A quarter of breast cancers show human epidermal growth factor-2 (HER2) overexpression, where targeted therapy dramatically improves survival. However, cancer therapy-related cardiac dysfunction (CTRCD) occurs in up to 15% of patients. With the interruption of HER2 therapy, if necessary, and the initiation of heart failure therapy (HFT), HER2 CTRCD recovers in over 80% of cases. The need to continue HFT in ‘recovered’ HER2 CTRCD following completion of HER2 therapy is unclear and there are potential significant impacts on patient’s quality of life (QoL). The Randomised Controlled Trial for the Safety of Withdrawal of Pharmacological Treatment for Recovered HER2 Targeted Therapy Related Cardiac Dysfunction (HER-SAFE) aims to evaluate whether HFT can be safely withdrawn in non-high cardiovascular (CV) risk patients with ‘recovered’ HER2 CTRCD.

Methods and analysis
This is a multicentre, open-label randomised controlled trial investigating whether withdrawal of HFT is non-inferior to continuation in non-high CV risk, breast cancer survivors with recovered HER2 CTRCD after cancer treatment completion. The primary endpoint is the incidence of guideline-defined cardiac dysfunction or clinical heart failure. Secondary endpoints include changes in cardiac blood biomarkers, cardiovascular magnetic resonance (CMR)-derived strain and tissue mapping and heart failure symptom questionnaires. The study will recruit 90 participants who will undergo serial clinical assessment over 12 months with advanced cardiovascular imaging (CMR scans with automated analysis at baseline, 6 and 12 months), cardiac biomarker measurement (six time points over 12 months), plus complete heart failure QoL and medication disutility questionnaires. This is the first multicentre study to address this significant clinical issue.

Ethics and dissemination
This study was approved by the research ethics committee (London—London Bridge, 23/LO/0152). The results will be disseminated in peer-reviewed scientific journals.

Trial registration number
NCT05880160.

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