Network meta-analysis of randomized controlled trials comparing the effectiveness of different treatments in reducing amniocentesis-associated pain and anxiety
verfasst von:
Abdelrahman Mohamed Mahmoud, Abdallah R. Allam
This network meta-analysis compared different methods to determine which is most efficient at lowering pain and anxiety in women undergoing amniocentesis.
Method
We looked through all published randomized controlled trials in the databases PubMed, Scopus, Web of Science, Cochrane, and EM base. Anxiety and pain were the predominant results. We used the R software version 4.2.1 to analyze the data.
Results
We included a total of 20 studies, with sample sizes ranging from 60 to 570. Virtual reality was the most effective strategy for lowering pain during AC [MD = -1.30, 95% CI (-2.11, -0.49)]. In addition, paracetamol use was the most successful approach for lowering pain following AC [MD = -1.68, 95% CI (-1.99, -1.37)]. The use of H7 acupressure, however, was the strategy that significantly reduced anxiety following AC [SMD = -15.46, 95% CI (-17.77, -13.15)].
Conclusion
The most effective method for reducing pain is the combination of virtual reality with paracetamol. Whereas, the most effective way to reduce anxiety is to combine an ice gel pack with H7 acupressure before applying AC.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
NMA
Network meta-analysis
AC
Amniocentesis
VR
Visual reality
Introduction
Prenatal diagnosis is an approach used by obstetricians to predict possible outcomes for each pregnancy such as congenital infections, alloimmunization, fetal genetic disorders, and fetal lung maturity. Receiving a prenatal diagnosis of congenital defects is momentous and emotionally challenging for women [1]. However, it provides a crucial opportunity for early intervention and informed decision-making regarding the management and care of the fetus [2].
The detection of fetal defects such as aneuploidy, a structural chromosome problem, requires invasive prenatal procedures such as amniocentesis (AC) and chorionic villus sampling (CVS) [1]. Over 190,000 AC procedures were carried out in the United States in 1997, making it a regularly used technique in obstetric practice [3]. The process is performed between 15 – 20 weeks after pregnancy, and the results are available in 7 to 14 days [4]. However, it carries risks such as membrane leakage, infection, and abortion with rates of 1.6%, 0.05%, and 1%, respectively [1, 5, 6]. Therefore, prenatal counseling is essential to prevent avoidable risks and costs for pregnant women [7].
Anzeige
High levels of anxiety have been reported in women undergoing AC [8], which may be due to fear of pain, fetal injury, and abortion, as well as concern about unfavorable results [9]. Moreover, anxiety might prolong the duration of the AC procedure, and contribute to procedure complications [10]. Studies have established a direct correlation between anxiety levels and pain intensity [11], with severe anxiety associated with increased pain during AC and chorionic villus sampling [11‐14].
Even the smallest hint of pain could make the patient uncooperative and prevent a successful prenatal diagnosis. Therefore, several studies looked into various methods to help women getting AC to feel less pain and anxiety. While some of these studies found their method helpful [15‐17], others did not [18‐20].
Therefore, our network meta-analysis (NMA) aims to compare different pain and anxiety management strategies to identify the most effective approach for minimizing discomfort during AC procedures.
Method
We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” standards to carry out this study [21]. Additionally, we strictly followed the steps provided in the “Cochrane Handbook for Systematic Reviews of Interventions” [22].
Anzeige
Literature search strategy
From inception till August 2022, the following keywords were used to search PubMed, Scopus, Web of Science, and Cochrane Central: amniocentesis, amniocenteses, anesthesia, “local anesthesia”, lidocaine, “xylocaine”, EMLA, “lidocaine-prilocaine”, lignocaine, prilocaine, dalcaine, xylocitin, xylesthesin, xyloneural, otocaine, music, cryoanalgesia, “cold therapy”, “virtual reality”, “H7 acupressure”, “ethyl chloride”, “aromatic therapy”, “Light Pressure Effleurage”, education, paracetamol, Panadol, cryotherapy, “cold pack”, “Subfreezing room”, “Subfreezing”, “Light leg rubbing”, massage, analgesia, analgesic. Additionally, manual searches were conducted on Google Scholar, ResearchGate, and clinicaltrials.gov.
Inclusion and exclusion criteria
We took included all randomized controlled trials (RCTs) that enrolled patients undergoing AC, compared various analgesics with one another, with a control, or with a placebo, and reported on pain perception, and anxiety. We excluded in vitro research, overlapping datasets, book chapters, reviews, cohort studies, case–control studies, and non-English articles. Using Endnote software, duplicates were eliminated, and then titles and abstracts of the retrieved references were checked. Eligible articles were then retrieved and underwent full-text screening. Additionally, we manually searched the reference lists of the papers that were included for other potentially qualifying studies.
Data extraction
We extracted the summary data, the population's baseline demographics, and the efficacy outcomes from the included studies.
Outcomes
Effective outcomes included anticipated pain, pain during the procedure, pain after the procedure, anxiety before the procedure, anxiety after the procedure, post-procedure pain, and anxiety, as well as willingness to undergo AC again if necessary.
Risk of bias
We used the Cochrane risk of bias instrument (version 2) as described in chapter 8.5 of the Cochrane Handbook to evaluate the risk of bias [23]. The randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, selection of the reported result, and overall bias were part of the quality assessment process.
Data analysis
We used the meta and netmeta tools in the R program version 4.2.1, to carry out network analysis. For pooling continuous outcomes, we used the mean difference (MD) or standardized mean difference (SMD), and for dichotomous outcomes, we used the risk ratio (RR), both with a 95% confidence interval (CI). Chi-square and I-square tests were used to determine how heterogeneous the pooled studies were, with a heterogeneous connection being defined as one where the I2 > 50% and the Chi-square P-value < 0.1. For pooling homogeneous data, we utilized a common effect model, and for heterogeneous data, we used random-effect model.
Results
Data collection and characteristics of included studies
One thousand seven hundred three articles were found during database searches: 447 from PubMed, 280 from Web of Science, 640 from Scopus, 54 from CENTRAL, and 282 from other databases. We filtered 1019 items and deleted 684 duplicates. 983 were eliminated through the title and abstract screening process, and 20 [15‐20, 24‐37] acceptable studies were found after the full-text screening of the 36 publications that remained. A flowchart of the database search and study selection procedure is shown in Fig. 1.
Fig. 1
Preferred reporting item for systematic review and meta-analysis
×
The sample sizes of the included RCTs ranged from 60 to 570 people. Different approaches were contrasted with one another, with a control group, or with a placebo. The included subjects' average age ranged from 31.3 to 37.7 years, their average gestational age was 15.9 to 21.95 weeks, and their average body mass index was 22.93 to 27 kg/m2. The summary and the baseline characteristics of the included subjects in each study are shown in Tables 1 and 2.
The trial was open to consecutive women who were going to get an obstetrically indicated mid-trimester AC
Women under the age of eighteen or with numerous pregnancies were not included in the sample. Women who needed pre-procedural anxiolytic or analgesic medication, had a history of motion sickness, epilepsy, or had a hearing or visual impairment were also eliminated
VAS
The study's objective is to compare the effectiveness of a VR intervention to a control group in terms of controlling acute pain and anxiety during amniocentesis
The following conditions had to be met in order to qualify: gestational age of 15 to 18 weeks, literacy, desired pregnancy, score of ≤ 53 on the Spielberger Anxiety Inventory, absence of any obstetrical issues or medical conditions, abstinence from drugs and alcohol, absence of abnormal hand findings, maternal BMI in the range of 18.5 to 30 and absence of any history of recurrent abortions (more than three consecutive abortions), amniocentesis, known mental
Due to their unwillingness to cooperate, active vaginal bleeding, hospitalization, failure to complete the intervention twice weekly or three times intermittently throughout the study, multiple failed attempts at amniocentesis, and unusual sensitivity to pressure point touch, the participants were excluded from the study
-
The purpose of this study was to find out how H7 Acupressure affected pregnant women's anxiety during amniocentesis procedures
The trial was open to all singleton pregnant women who underwent transabdominal CVS between 10 and 13 weeks and 6 days of gestation
Multiple pregnancies, known medication allergies, and hypersensitivity to local anesthetic were among the exclusion criteria
VAS
Therefore, the purpose of this study was to ascertain if topical ethyl chloride anesthetic spray administration compared to 1% lidocaine subdermal injection results in lower pain perception during transabdominal CVS
All of the expectant women who took part in the current study gave their consent to have an AC at the Maternal–Fetal Medicine Unit and were referred for genetic counseling in the second trimester of pregnancy
Multiple pregnancies or severe congenital anomalies found by sonography were excluded, as were known or suspected allergies to lidocaine prilocaine, psychiatric disorders, multiple attempts to insert a needle, and switching the puncture site where the cream was given because of fetal activity
VAS
The current study set out to determine whether local lidocaine-prilocaine cream application did in fact lessen pain during mid-trimester genetic AC
For this study, the singleton pregnant patients undergoing their first genetic AC at Rajavithi Hospital's Department of Obstetrics and Gynecology were considered eligible
Psychiatric disorders, paracetamol allergies, AC in cases of suspected fetal anomalies identified by another prenatal diagnostic procedure, a patient's history of paracetamol use in the 24–48 h prior to the amniocentesis, and participants who declined to enroll in the study were the exclusion criteria
VAS
The study's goal is to determine whether paracetamol can reduce pain scores during AC
Multiple pregnancies, a known or suspected lignocaine allergy, an AC performed right away following the sonographic discovery of a severe fetal abnormality, a psychiatric illness, and a lack of proficiency in Dutch are all factors
VAS and VRS
This study sought to determine whether local anesthesia reduced pain during AC
Participants in this institutionally approved study had to be females aged ≥ 18 who underwent an indicated second trimester genetic amniocentesis, be carrying a singleton, have a normal amniotic fluid volume, and not have had an amniocentesis or chorionic villus sampling (CVS) in the previous pregnancy
Women who had previously undergone AC or CVS in the current pregnancy
VAS
In order to lessen pain associated with second trimester genetic AC, we conducted a randomized single-blinded trial comparing needles that were frozen to those that were at room temperature
Women who had never undergone AC and no fetal gross structural abnormalities detected by ultrasonographic examination were the inclusion criteria
Women who were known to be allergic to colds, ethyl chloride spray, had taken painkillers within the previous four hours, needed more than one puncture during the same procedure, could not follow the study's methodology, or had poor communication skills, were all excluded from the study
VAS
This study's goal was to evaluate the cryo-analgesic impact of ethyl chloride spray on pain management during AC in the second trimester
Pregnancy, being between the ages of 18 and 45, having between 15 and 20 weeks of gestation, being without any ultrasonographic signs of foetal anomalies, and choosing AC as the prenatal diagnosis procedure are the inclusion criteria
Multifetal pregnancy, ultrasound evidence of a severe congenital anomaly, altered puncture site following cold compression during AC, repeated attempts, history of cold urticaria, pregnancy with Raynaud's phenomenon, use of painkillers that impair pain and temperature perception, abdominal skin infection, pregnancy with psychosis, and patients' refusal are all exclusion criteria
VAS
Evaluating the impact of cold therapy on a patient's perceived pain levels before and after an AC surgery
Ages between 18 and 45, consent for participation, singleton pregnancies, and gestational ages between 15 and 23 weeks were all inclusion criteria
We disqualified multiple-gestational women, people taking painkillers or other analgesics, people who declined to participate, and people who have a known lidocaine hypersensitivity. Additionally, we didn't include cases in which amnioinfusion or amnioreduction were advised
VAS and NRS
Assessing how local anaesthetic affects how much pain the mother feels during AC
Women who had second-trimester genetic AC due to advanced maternal age who were between 15 and 21 weeks pregnant (according to the latest menstrual period or ultrasonographic-biometric measurement)
Multiple pregnancies, a history of AC during a prior or ongoing pregnancy, the presence of foetal structural malformation, more than one attempt at needle insertion, participants who were unable to read or understand the questionnaire, or participants who declined to participate in our study were all exclusion criteria
VAS
Determining whether cryoanalgesia reduces the level of pain experienced during genetic AC in the second trimester
Expectant women scheduled for genetic AC between 15 and 20 weeks of gestation because of advanced maternal age
A foetal structural malformation, multiple pregnancies, AC experience during the current or a previous pregnancy, multiple needle insertion attempts, a history of smell or taste perception issues, a history of an upper respiratory infection or a diagnosis of allergic rhinitis within two weeks of the procedure, an inability to read or understand the questionnaire, and a refusal to participate in the study were all grounds for exclusion
VAS
Assessing the effectiveness of menthol-based aromatic treatment to reduce AC-related pain
Women who had a second trimester genetic AC due to advanced maternal age and were between 15 and 21 weeks pregnant based on their previous period or an ultrasonographic biometric measurement
Multiple pregnancies, foetal structural malformations, history of AC in a prior or ongoing pregnancy, multiple attempts at needle insertion, a history of hearing impairment, and participants who were illiterate, incapable of understanding the questionnaires, or who refused to participate in the study were all disqualified
VAS
Determining whether listening to music during genetic AC in the second trimester reduced pain perception
Patients had to be pregnant adults (over 18), have gestational ages between 11 and 16 weeks, be receiving transabdominal CVS, have no contraindications to using N2O or local anaesthetic, and have no contraindications to transabdominal CVS
-
VAS
Our goal was to assess how well nitrous gas and local anaesthetic managed pain and anxiety during transabdominal CVS
The present study included pregnant women who had genetic AC between 15 and 22 weeks of gestation
Multifetal pregnancy, severe congenital anomaly previously detected by ultrasonography, cases of multiple needle puncture attempts during the procedure, cases of changing the puncture site due to foetal behavior, maternal psychiatric disorder, those who were contraindicated to cold therapy, and cases of refusal to participate in the current study were excluded
VAS
Assessing the impact of cryotherapy on pain management during genetic AC in the second trimester
Singleton pregnancy and gestational ages of 16 to 20 weeks based on a trustworthy last menstrual cycle and sonographic biometry in the first half of pregnancy were the inclusion criteria
Pregnant women who (1) had a history of Xylocaine allergy, (2) had aberrant sensory function based on history, (3) couldn’t rate their pain using a visual analogue scale, and (4) couldn’t do an AC were excluded
VAS
Evaluating the impact of Xylocaine spray on the AC pain score
The purpose of this study is to investigate how psychological psychotherapy can reduce pregnancy-related anxiety and dread in pregnant women as well as the surgical success rate
Muslim and Iranian ethnicity, written informed consent to participate in the study, a minimal level of literacy, AC eligibility, gestational age of 15–20 weeks, a single pregnancy with a viable fetus, and a positive foetal screening test were the inclusion criteria
The study's initial exclusion criteria included pregnancy after infertility treatment and assisted reproductive techniques, history of AC, history of recurrent miscarriages, presence of major abnormalities in ultrasound, awareness of the specifics of amniocentesis, use of hookah, cigarettes, drugs, alcohol, psychotropic drugs, history of consulting a psychiatrist or psychologist for mood and mental disorders, taking medication, or hospitalization
-
The purpose of this study was to ascertain how schooling affected moms who were amniocentesis candidates' perceptions of stress
Abbreviations: RCT Randomized controlled trial, VR Virtual reality, BMI Body mass index, VAS Visual analogue scale, NRS Numerical rating scale, AC Amniocentesis, CVS Chorionic villous sampling, N2O Nitrous oxide
Abbreviations: VR Virtual reality, BMI Body mass index, M Mean, SD Standard deviation, m meter, n number
Anzeige
Risk of bias assessment
High to low-quality studies were included. The majority of the examined studies exhibited a high risk of bias across the board. In Supplementary Materials, Figs. S1 and S2 depict a risk of bias graph and a risk of bias summary, respectively.
Anticipated pain was reported by 10 studies [17, 19, 20, 25‐27, 29, 31, 32, 34]. However, we removed WAX et al. [25], because their study resulted in two isolated networks. The most efficient method for reducing anticipated pain when compared to control was using an ice gel pack before AC; this method was significantly better [MD = -0.30, 95% CI (-0.54, -0.06)]. Figure 2 displays the NMA forest plot.
Fig. 2
Network meta-analysis forest plot of anticipated pain
Pain during AC was reported by six studies [15, 17, 18, 27, 34, 35]. However, we excluded Rekawek et al. [18], because their study resulted in two isolated networks. Virtual reality (VR) was the most effective approach for lowering pain during AC when compared to control [MD = -1.30, 95% CI (-2.11, -0.49)] after which ice gel pack before and after AC was the next most effective [MD = -0.93, 95% CI (-1.62, -0.23)]. Figure 3 displays the NMA forest plot.
Fig. 3
Network meta-analysis forest plot of pain during amniocentesis
Pain after AC was reported by 14 studies [17‐19, 24‐30, 33‐36]. However, WAX et al. [25], was excluded because their study resulted in two isolated networks. Paracetamol was the most effective approach for lowering pain after AC when compared to control [MD = -1.68, 95% CI (-1.99, -1.37)] after which ice gel pack before and after AC was the next most effective [MD = -0.91, 95% CI (-1.30, -0.51)] Fig. 4 displays the NMA forest plot.
Fig. 4
Network meta-analysis forest plot of pain after amniocentesis
Eight studies reported anxiety before AC outcome [16, 19, 20, 29, 31, 32, 36, 37] Ice gel pack before AC was the most effective approach for lowering anxiety before AC when compared to control [SMD = -2.30, 95% CI (-2.43, -2.17)] after which menthol was the next most effective [SMD = -2.00, 95% CI (-2.37, -1.63)]. Figure 5 displays the NMA forest plot.
Fig. 5
Network meta-analysis forest plot of anxiety before amniocentesis
Anxiety after AC was reported in five studies [16, 29, 33, 36, 37]. Katsogiannou et al. [33], were excluded because their study resulted in two isolated networks. H7-Acupressure was the most effective approach for lowering anxiety after AC when compared to control [SMD = -15.46, 95% CI (-17.77, -13.15)] after which psychological intervention was the next most effective [SMD = -6.78, 95% CI (-10.47, -3.09)]. Figure 6 displays the NMA forest plot.
Fig. 6
Network meta-analysis forest plot of anxiety after amniocentesis
Post-procedure pain and anxiety were reported in three studies [20, 31, 32]. The use of Ice gel pack before AC was the most effective method for reducing post-procedure pain and anxiety when compared to the control [MD = -0.60, 95% CI (-0.92, -0.28)]. Figure 7 displays the NMA forest plot.
Fig. 7
Network meta-analysis forest plot of post-procedure pain and anxiety
This outcome was reported in three studies [20, 24, 26]. Compared to the control group, the available strategies were not significant. Figure 8 displays the NMA forest plot.
Fig. 8
Network meta-analysis forest plot of Undergoing amniocentesis again if indicated
×
Table 3 Summarizes the findings of the main outcomes.
Table 3
Summary of the main findings of the NMA
Main outcomes
Number of studies included in the NMA
The best therapeutic option
MD and 95% CI
Before the procedure
Anticipated pain
Ten studies
Ice gel pack
-0.30, (-0.54, -0.06)
Anxiety before AC
Eight studies
Ice gel pack
-2.30, (-2.43, -2.17)
Pain during AC
Five studies
Virtual reality
-1.30, (-2.11, -0.49)
After the procedure
Pain after AC
14 studies
Paracetamol
-1.68, (-1.99, -1.37)
Anxiety after AC
Five studies
H7 Acupressure
-15.46, (-17.77, -13.15)
Abbreviations: AC Amniocentesis, MD Mean difference, CI Confidence interval
Discussion
The present network meta-analysis compared different strategies to reduce pain and anxiety in prenatal diagnostic procedures. The VR intervention was the most successful in reducing pain during AC. The literature reported that paying attention to pain might affect the pain experience, can be used to explain this. It implies that deflecting attention away from pain can lower perceived pain levels [38]. Distraction is to make a painful stimulus seem less intense since people can’t focus on several sensory inputs at once [39]. Additionally, the VR’s multiple senses may impede nociception flow and lessen pain perception [40]. With a VR headset on, patients can leave the clinical setting and visit another world unconnected to the treatment and any potential pain [41]. Although the exact method by which VR relieves pain is yet unknown, given the well-known connection between pain and emotions, the analgesic impact of VR may be mediated by brain systems [40]. Additionally, VR is simple to use, reasonably priced, and has the benefit of no negative side effects.
The popular pain reliever paracetamol is safe for use during pregnancy [42]. It was successful in lowering pain following AC; however, it was ineffective during AC. The timing of drug intake before the surgery may help to explain this [17]. Further research is needed to determine the ideal premedication period. However, paracetamol has a number of benefits including broad therapeutic applicability, good tolerability, and good absorption after oral administration [43].
The anti-swelling and analgesic effects of cold therapy are widely established for treating soft tissue injuries [44], postoperative pain from gynecologic surgery [45], and perineal pain following vaginal delivery [46]. Reduced soft tissue temperature can have an analgesic effect by slowing the speed at which pain is transmitted. Therefore, applying an ice gel pack before and after receiving AC was useful in lowering pain only after receiving AC, not during receiving AC. Additionally, applying an ice gel pack prior to the AC helped to lower anxiousness. However, a prolonged or excessive exposure might have negative effects like burns and ulcers [46].
Anzeige
H7 Acupressure proved to be successful in lowering anxiety after AC. The results can be explained by a number of various mechanisms. Cortisol and stress are associated in that as stress rises, cortisol also rises. In the hypothalamic–pituitary–adrenal axis, the stimulation of acupressure points alters hormonal-neuronal responses, which in turn controls cortisol output and induces calm. Additionally, by activating the anterior pituitary, acupressure can boost serotonin and dopamine release [47]. Serotonin and dopamine levels in the plasma rise, which reduces cortisol synthesis [48]. In addition, the stimulation of the acupressure point releases endorphins, which peak 30 min after the stimulation begins and remain elevated for 10 h. Similarly, serotonin levels are raised, and endorphins are released when the H7 acupoint is stimulated vigorously and repeatedly [49]. However, other factors must be taken into account while using this method as they may have an impact on the outcomes, such as the target population, the acupressure points employed, and the length of the acupressure.
Limitations
The majority of the included studies had a high overall risk of bias, which could have an impact on the study’s findings. We exclude some trials to conduct a single network meta-analysis.
Conclusion
VR was the most effective method for reducing pain during AC, whereas paracetamol was the best method for reducing pain following AC. Additionally, H7 Acupressure was the most effective for reducing anxiety after AC, while an ice gel pack was the best for reducing anxiety before AC. By combining and integrating these methods, healthcare workers will have the potential to significantly aid women who are having AC.
Acknowledgements
No acknowledgment.
Anzeige
Declarations
Ethics approval and consent to participate
Not available.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Network meta-analysis of randomized controlled trials comparing the effectiveness of different treatments in reducing amniocentesis-associated pain and anxiety
Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.
Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.
Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.
In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.
Update Gynäkologie
Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.
