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Exam 1: Association Between Statin Use After Diagnosis of Esophageal Cancer and Survival: A Population-Based Cohort Study
Gastroenterology 2016;150:e16–e17
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www. gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for learning objective.
Exam 1: Association Between Statin Use After Diagnosis of Esophageal Cancer and Survival: A Population-Based Cohort Study Test ID No.: gastro00249
Contact hours: 1.0
Expiration Date: April 30, 2017
Question 1: In this observational study, statin use after diagnosis of which histologic subtype of esophageal carcinoma was associated with a significant reduction in all-cause and esophageal cancer-specific mortality?
a. b. c. d. e.
Adenocarcinoma. Squamous cell carcinoma. Adenocarcinoma and squamous cell carcinoma. Adenosquamous cell carcinoma. Small cell carcinoma.
a. b. c. d. e.
10%. 14%. 27%. 39%. 52%.
a. b. c. d.
Time-window bias. Immeasurable time bias. Reverse causation bias. Immortal time bias.
Question 2: Statin use after a diagnosis of esophageal adenocarcinoma is associated with which of the following decreases in esophageal carcinoma-specific mortality?
Question 3: Analyses considered participants unexposed from diagnosis until the first statin prescription from which point onwards they were deemed exposed. Cox proportional hazard regression with time-dependent exposures estimated the association between statin use following diagnosis and mortality. Which bias does this approach address?
April 2016
CME Activity
e17
Question 4: Which of the following statements regarding the association between statin use and mortality in patients with esophageal carcinoma is the most accurate?
a. Patients who used statins both before and after diagnosis of esophageal carcinoma had a more favorable prognosis than new users after diagnosis. b. Estimates of risk of mortality associated with postdiagnostic statin use were not significantly influenced by statin use before diagnosis. c. Only high-dose statin use after diagnosis was associated with reduced mortality. d. Only atorvastatin use after diagnosis was associated with reduced mortality. e. The proportion of all statin users after diagnosis who were new users was 50%.
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www. gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for learning objective.
Exam 1: Association Between Statin Use After Diagnosis of Esophageal Cancer and Survival: A Population-Based Cohort Study Test ID No.: gastro00249
Contact hours: 1.0
Expiration Date: April 30, 2017
Question 1: In this observational study, statin use after diagnosis of which histologic subtype of esophageal carcinoma was associated with a significant reduction in all-cause and esophageal cancer-specific mortality?
a. b. c. d. e.
Adenocarcinoma. Squamous cell carcinoma. Adenocarcinoma and squamous cell carcinoma. Adenosquamous cell carcinoma. Small cell carcinoma.
a. b. c. d. e.
10%. 14%. 27%. 39%. 52%.
a. b. c. d.
Time-window bias. Immeasurable time bias. Reverse causation bias. Immortal time bias.
Question 2: Statin use after a diagnosis of esophageal adenocarcinoma is associated with which of the following decreases in esophageal carcinoma-specific mortality?
Question 3: Analyses considered participants unexposed from diagnosis until the first statin prescription from which point onwards they were deemed exposed. Cox proportional hazard regression with time-dependent exposures estimated the association between statin use following diagnosis and mortality. Which bias does this approach address?
April 2016
CME Activity
e17
Question 4: Which of the following statements regarding the association between statin use and mortality in patients with esophageal carcinoma is the most accurate?
a. Patients who used statins both before and after diagnosis of esophageal carcinoma had a more favorable prognosis than new users after diagnosis. b. Estimates of risk of mortality associated with postdiagnostic statin use were not significantly influenced by statin use before diagnosis. c. Only high-dose statin use after diagnosis was associated with reduced mortality. d. Only atorvastatin use after diagnosis was associated with reduced mortality. e. The proportion of all statin users after diagnosis who were new users was 50%.