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Dr Hamish Osborne Senior Lecturer and Physician in Sport and Exercise Medicine

Dr Hamish Osborne Senior Lecturer and Physician in Sport and Exercise Medicine. The Pill That Only 3% Of General Practitioners Prescribe Despite The Fact That It Prevents 30% Of Breast Cancer And Helps Stop Half The Women With Breast Cancer From Dying. Tamoxifen.

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Dr Hamish Osborne Senior Lecturer and Physician in Sport and Exercise Medicine

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  1. Dr Hamish Osborne Senior Lecturer and Physician in Sport and Exercise Medicine The Pill That Only 3% Of General Practitioners Prescribe Despite The Fact That It Prevents 30% Of Breast Cancer And Helps Stop Half The Women With Breast Cancer From Dying.

  2. Tamoxifen • About 75% breast cancers are ER +ve • 5 years of treatment in ER +ve early disease • 61% (Tamoxifen) vs 51% (Placebo) 10 year survival • Not clear that it works in ER-ve early disease • Late cancer only helps ER+ve • $108M per annum

  3. Herceptin • About 1 in 5 breast cancers are HER2 +ve • 70% of HER2 +ve tumours don’t respond • 9% relapse vs 17% • However 5/6 wouldn’t have relapsed • 1/10 relapsed anyway • For each life saved 1/25 die of heart disease • $35M per annum Fenton E. Making Fair Funding Decisions for High-Cost Cancer Care: The Case of Herceptin in New Zealand. Public Health Ethics 2010.

  4. Breast Cancer Prevention There are no drugs that do this!Thune I, Brenn T, Lund E, and Gaard M. Physical Activity and the Risk of Breast Cancer. New England Journal of Medicine 336: 1269-1275, 1997.

  5. What if you still get breast cancer? Recurrence Total Deaths Breast Cancer Deaths Holmes MD, Chen WY, Feskanich D, Kroenke CH, and Colditz GA. Physical Activity and Survival After Breast Cancer Diagnosis. JAMA: The Journal of the American Medical Association 293: 2479-2486, 2005.

  6. Just how good? • In women with stage III breast cancer • Doing at least 30 min brisk walk 4-5x/week • Relative risk of death 0.36 (95% CI 0.19-0.71) Holmes MD, Chen WY, Feskanich D, Kroenke CH, and Colditz GA. Physical Activity and Survival After Breast Cancer Diagnosis. JAMA: The Journal of the American Medical Association 293: 2479-2486, 2005.

  7. Physical activity advice in the primary care setting: results of a population study in New Zealand • 13% received physical activity advice • 3% received a green prescription Croteau K, Schofield G, and McLean G. Physical activity advice in the primary care setting: results of a population study in New Zealand. Australian and New Zealand Journal of Public Health 30: 262-267, 2006.

  8. Physical activity advice in the primary care setting: results of a population study in New Zealand More likely to receive Ex Rx • Maori or Pacific Islander • Overweight/obese • Sedentary • Suffering chronic disease Lack of Physical Activity not a reason Croteau K, Schofield G, and McLean G. Physical activity advice in the primary care setting: results of a population study in New Zealand. Australian and New Zealand Journal of Public Health 30: 262-267, 2006.

  9. Green Prescription for Everyone • Tamoxifen $108M / yr • Herceptin $35M / Year • If everysedentary adult received a green prescription… • COST NEUTRAL after 2 years (cardiovascular disease savings alone) Elley R, Kerse N, Arroll B, Swinburn B, Ashton T, and Robinson E. Cost-effectiveness of physical activity counselling in general practice. N Z Med J 117: U1216, 2004.

  10. To fix this we need to… • PC • HxPC • RoS • Past Hx • Family Hx • Social Hx • Medications • Allergies • Examination • Inx • Diff Dx • Problem List • Plan

  11. To fix this we need to… • PC • HxPC • RoS • Past Hx • Family Hx • Social Hx • Medications • Allergies • Examination • Inx • Diff Dx • Problem List • Plan • PC • HxPC • RoS • Past Hx • Family Hx • Social Hx • Physical Activity Hx • Inactivity Hx • Medications • Allergies • Examination • Inx • Diff Dx • Problem List • Plan

  12. To fix this we need to… • PC • HxPC • RoS • Past Hx • Family Hx • Social Hx • Medications • Allergies • Examination • Inx • Diff Dx • Problem List • Plan • PC • HxPC • RoS • Past Hx • Family Hx • Social Hx • Physical Activity Hx • Inactivity Hx • Medications • Allergies • Examination • Inx • Diff Dx • Problem List • Plan Do they meet Ex Rx guidelines? Do they watch > 2hrs TV daily or sedentary job? Lack of regular exercise Too much inactivity Prescribe Exercise Safely

  13. Prescribing Exercise Safely • History, Examination, Problem List • Risk Stratification • Assessment of current physical activity capacity • Safe exercise prescription

  14. Motivational Interviewing • How important is it to you to prescribe more physical activity than you currently do, If 1 were ‘not at all’ and 10 was ‘very important’ • If you decided right now to do more exercise prescription, how confident do you feel about succeeding with this? 1 = no confidence 10 = extreme confidence

  15. How do I learn ? • Workshop tomorrow • Delivering lifestyle prevention in primary practice - we can provide it! An innovative new programme aimed to support GPs in providing primary prevention in primary practice - Elizabeth Harris • Greys D2 2.30pm – 3.30pm • SPMX711 Prescribing Exercise for Health • Distance taught via audiovisual conference • Evenings Hamish.Osborne@otago.ac.nz

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