News

PHOENIX – Medications used in oncology clinical trials pose unique challenges in areas such as labeling, packaging, and administration, a US Department of Veterans Affairs (VA) pharmacist cautioned colleagues, and placebos have special needs too.

Even basic safety protections can be lacking when a drug is investigational, said Emily Hennes, PharmD, BCOP, clinical pharmacy specialist for research at William S. Middleton Memorial Veterans Hospital in Shorewood Hills, Wisconsin, in a presentation at the annual meeting of the Association of VA Hematology/Oncology.

“All of the safety features that we have come to know and love in dispensing commercial drugs are absent. There’s no Tall Man lettering, there's no color differentiation, and there's no barcoding, because these are not registered drugs," she said.

A 2017 report found that 81% of pharmacists surveyed indicated some level of concern regarding the safety risk in using  investigational drugs. At the same time, Hennes noted, the Joint Commission has mandated that pharmacists must control the storage, dispensing, labeling, and distribution of investigational medications.

Here are things to know about the use of investigational cancer drugs:

Drug Interactions Are Common

Hennes highlighted a 2023 study of medication reconciliation of 501 patients in 79 clinical trials that found alarming levels of drug interactions: 

• 360 clinically relevant drug-drug interactions were identified among 189 patients, including 158 therapies that were prohibited by protocols. Of these, 57.7% involved cytochrome P450 enzymes, which are involved in metabolism. 

• Reconciliation revealed that 35.2% of medications were not otherwise known or documented.

• A median of 2 previously unknown therapies per patient was discovered in 74% of patients.

• Alternative medicine products such as supplements and over-the-counter drugs were implicated in 60% of identified drug interactions.

• Only 41% of oncologists discussed alternative medicine use with patients, which Hennes attributed to “lack of familiarity with many alternative medicine products or insufficient training.”

To make things more complicated, “We sometimes don’t know the full pharmacokinetic and pharmacodynamic profile of an investigational agent,” she said. 

Naming and Labeling May Not Be Standard

Investigational products may not have genetic names and instead have an alphanumeric identifier such as INV54826 that can be quite similar to other products, she said. Investigational drugs may even go through name changes, forcing pharmacists to be alerted to protect patients. 

In addition, labeling may not be standardized. Drugs may arrive unlabeled, with the wrong volume and size, and lack of barcoding. In some cases, pharmacists choose to put new, patient-friendly labels on these products, Hennes said. 

Information Distribution is Key

“Something that comes up in our practice quite a bit is that there’s no standard drug reference regarding investigational drugs,” Hennes said. “Finding ways to get key information to staff at the point of care is really critical to make sure we’re able to safely treat our patients.”

Precautions May Be Needed to Maintain Blinding Protocols 

Hennes explained that pharmacists must use opaque brown bag covers to maintain blinding when parenteral products have distinctive colors. Lines may have to be covered too, which can create challenges during administration. 

“Pumps aren’t meant to run lines that are covered,” she said, which can lead to jams. “If you don’t do education with your point of care staff, it can cause a lot of confusion.” 

It’s also important for blinding purposes to keep an eye on how long it takes to prepare a treatment, she said. A study’s integrity, for example, could be violated if a complex investigational product takes an hour to equilibrate to room temperature and 20-30 minutes to prepare, while a placebo only requires “drawing a few mils of saline out of a bag and labeling it.”

Education for Patients Can Be Useful 

Hennes urged colleagues to remind patients to save investigational medication at the end of each cycle and return it to the clinic site for accountability.

She also suggested creating treatment calendars/reminders for patients and discussing adherence strategies with them. 

Hennes reported no disclosures. 

PHOENIX – Medications used in oncology clinical trials pose unique challenges in areas such as labeling, packaging, and administration, a US Department of Veterans Affairs (VA) pharmacist cautioned colleagues, and placebos have special needs too.

Even basic safety protections can be lacking when a drug is investigational, said Emily Hennes, PharmD, BCOP, clinical pharmacy specialist for research at William S. Middleton Memorial Veterans Hospital in Shorewood Hills, Wisconsin, in a presentation at the annual meeting of the Association of VA Hematology/Oncology.

“All of the safety features that we have come to know and love in dispensing commercial drugs are absent. There’s no Tall Man lettering, there's no color differentiation, and there's no barcoding, because these are not registered drugs," she said.

A 2017 report found that 81% of pharmacists surveyed indicated some level of concern regarding the safety risk in using  investigational drugs. At the same time, Hennes noted, the Joint Commission has mandated that pharmacists must control the storage, dispensing, labeling, and distribution of investigational medications.

Here are things to know about the use of investigational cancer drugs:

Drug Interactions Are Common

Hennes highlighted a 2023 study of medication reconciliation of 501 patients in 79 clinical trials that found alarming levels of drug interactions: 

• 360 clinically relevant drug-drug interactions were identified among 189 patients, including 158 therapies that were prohibited by protocols. Of these, 57.7% involved cytochrome P450 enzymes, which are involved in metabolism. 

• Reconciliation revealed that 35.2% of medications were not otherwise known or documented.

• A median of 2 previously unknown therapies per patient was discovered in 74% of patients.

• Alternative medicine products such as supplements and over-the-counter drugs were implicated in 60% of identified drug interactions.

• Only 41% of oncologists discussed alternative medicine use with patients, which Hennes attributed to “lack of familiarity with many alternative medicine products or insufficient training.”

To make things more complicated, “We sometimes don’t know the full pharmacokinetic and pharmacodynamic profile of an investigational agent,” she said. 

Naming and Labeling May Not Be Standard

Investigational products may not have genetic names and instead have an alphanumeric identifier such as INV54826 that can be quite similar to other products, she said. Investigational drugs may even go through name changes, forcing pharmacists to be alerted to protect patients. 

In addition, labeling may not be standardized. Drugs may arrive unlabeled, with the wrong volume and size, and lack of barcoding. In some cases, pharmacists choose to put new, patient-friendly labels on these products, Hennes said. 

Information Distribution is Key

“Something that comes up in our practice quite a bit is that there’s no standard drug reference regarding investigational drugs,” Hennes said. “Finding ways to get key information to staff at the point of care is really critical to make sure we’re able to safely treat our patients.”

Precautions May Be Needed to Maintain Blinding Protocols 

Hennes explained that pharmacists must use opaque brown bag covers to maintain blinding when parenteral products have distinctive colors. Lines may have to be covered too, which can create challenges during administration. 

“Pumps aren’t meant to run lines that are covered,” she said, which can lead to jams. “If you don’t do education with your point of care staff, it can cause a lot of confusion.” 

It’s also important for blinding purposes to keep an eye on how long it takes to prepare a treatment, she said. A study’s integrity, for example, could be violated if a complex investigational product takes an hour to equilibrate to room temperature and 20-30 minutes to prepare, while a placebo only requires “drawing a few mils of saline out of a bag and labeling it.”

Education for Patients Can Be Useful 

Hennes urged colleagues to remind patients to save investigational medication at the end of each cycle and return it to the clinic site for accountability.

She also suggested creating treatment calendars/reminders for patients and discussing adherence strategies with them. 

Hennes reported no disclosures. 

PHOENIX – Medications used in oncology clinical trials pose unique challenges in areas such as labeling, packaging, and administration, a US Department of Veterans Affairs (VA) pharmacist cautioned colleagues, and placebos have special needs too.

Even basic safety protections can be lacking when a drug is investigational, said Emily Hennes, PharmD, BCOP, clinical pharmacy specialist for research at William S. Middleton Memorial Veterans Hospital in Shorewood Hills, Wisconsin, in a presentation at the annual meeting of the Association of VA Hematology/Oncology.

“All of the safety features that we have come to know and love in dispensing commercial drugs are absent. There’s no Tall Man lettering, there's no color differentiation, and there's no barcoding, because these are not registered drugs," she said.

A 2017 report found that 81% of pharmacists surveyed indicated some level of concern regarding the safety risk in using  investigational drugs. At the same time, Hennes noted, the Joint Commission has mandated that pharmacists must control the storage, dispensing, labeling, and distribution of investigational medications.

Here are things to know about the use of investigational cancer drugs:

Drug Interactions Are Common

Hennes highlighted a 2023 study of medication reconciliation of 501 patients in 79 clinical trials that found alarming levels of drug interactions: 

• 360 clinically relevant drug-drug interactions were identified among 189 patients, including 158 therapies that were prohibited by protocols. Of these, 57.7% involved cytochrome P450 enzymes, which are involved in metabolism. 

• Reconciliation revealed that 35.2% of medications were not otherwise known or documented.

• A median of 2 previously unknown therapies per patient was discovered in 74% of patients.

• Alternative medicine products such as supplements and over-the-counter drugs were implicated in 60% of identified drug interactions.

• Only 41% of oncologists discussed alternative medicine use with patients, which Hennes attributed to “lack of familiarity with many alternative medicine products or insufficient training.”

To make things more complicated, “We sometimes don’t know the full pharmacokinetic and pharmacodynamic profile of an investigational agent,” she said. 

Naming and Labeling May Not Be Standard

Investigational products may not have genetic names and instead have an alphanumeric identifier such as INV54826 that can be quite similar to other products, she said. Investigational drugs may even go through name changes, forcing pharmacists to be alerted to protect patients. 

In addition, labeling may not be standardized. Drugs may arrive unlabeled, with the wrong volume and size, and lack of barcoding. In some cases, pharmacists choose to put new, patient-friendly labels on these products, Hennes said. 

Information Distribution is Key

“Something that comes up in our practice quite a bit is that there’s no standard drug reference regarding investigational drugs,” Hennes said. “Finding ways to get key information to staff at the point of care is really critical to make sure we’re able to safely treat our patients.”

Precautions May Be Needed to Maintain Blinding Protocols 

Hennes explained that pharmacists must use opaque brown bag covers to maintain blinding when parenteral products have distinctive colors. Lines may have to be covered too, which can create challenges during administration. 

“Pumps aren’t meant to run lines that are covered,” she said, which can lead to jams. “If you don’t do education with your point of care staff, it can cause a lot of confusion.” 

It’s also important for blinding purposes to keep an eye on how long it takes to prepare a treatment, she said. A study’s integrity, for example, could be violated if a complex investigational product takes an hour to equilibrate to room temperature and 20-30 minutes to prepare, while a placebo only requires “drawing a few mils of saline out of a bag and labeling it.”

Education for Patients Can Be Useful 

Hennes urged colleagues to remind patients to save investigational medication at the end of each cycle and return it to the clinic site for accountability.

She also suggested creating treatment calendars/reminders for patients and discussing adherence strategies with them. 

Hennes reported no disclosures. 

TOPLINE:

High-risk medications defined by the National Comprehensive Cancer Network (NCCN) and captured by the Geriatric Oncology Potentially Inappropriate Medication (GO-PIM) scale were prevalent in > one-third of veterans with solid and hematologic malignancies. Each additional GO-PIM was independently associated with higher risks for frailty at diagnosis, unplanned hospitalizations during follow-up, and death.

METHODOLOGY:

• Patients with cancer often use multiple chronic medications, raising risks for adverse events. Although several tools that identify PIMs have been developed that correlate with adverse cancer outcomes, their use is limited in busy oncology clinics. To improve implementation, researchers developed the GO-PIM scale using the NCCN’s list of high-risk medications.
• Researchers conducted a retrospective cohort study using data from the national Veterans Affairs Cancer Registry and electronic health records, which included 388,113 veterans newly diagnosed with solid or hematologic malignancies (median age, 69.3 years; 97.9% men; 76.1% non-Hispanic White and 17.3% Black individuals) between 2000 and 2022.
• They identified GO-PIMs using outpatient pharmacy records in the 90 days preceding cancer diagnosis. Each prescription for a specific GO-PIM was counted as one, including both individual drugs and drug classes listed in the GO-PIM scale.
• Study outcomes were frailty, hospitalizations, and overall survival. Baseline frailty at diagnosis was measured using the Veterans Affairs Frailty Index. The score ranged from 0 to 1, and higher scores indicated greater frailty. Patients were classified as nonfrail (score, ≤ 0.2), mildly frail (score, > 0.2 to 0.3), or moderate-to-severely frail (score, > 0.3).
• Lung (23.7%), prostate (21.5%), and gastrointestinal (20.5%) cancers were the most common, and the most frequent stages were IV (25.4%) and II (24.4%).

TAKEAWAY:

• Overall, 38.0% of veterans were prescribed ≥ 1 GO-PIMs at the time of cancer diagnosis, and the proportion increased to 56.1% among those with moderate-to-severe frailty.
• The most commonly prescribed classes of PIMs were selective serotonin reuptake inhibitors (SSRIs; 12.0%), opioids (10.4%), benzodiazepines (9.2%), and corticosteroids (9.2%). Among individual drugs, sertraline was the most common SSRI (4.3%), tramadol the most common opioid (5.3%), lorazepam the most common benzodiazepine (2.5%), and prednisone the most common corticosteroid (4.9%). Trends over time showed a steady increase in opioid prescriptions, peaking in 2014, followed by a subsequent decline, while prescriptions of benzodiazepines declined during the later years.
• After adjusting for age, cancer type and stage, and other covariates, each additional GO-PIM was associated with a 66% higher odds of mild or moderate-to-severe frailty at diagnosis (adjusted odds ratio, 1.66).
• After adjusting for frailty and covariates, each additional GO-PIM at diagnosis was associated with increased risks for unplanned hospitalizations and death (adjusted hazard ratios, 1.08 and 1.07, respectively). These associations remained stable in sensitivity analyses that restricted GO-PIMs to scheduled medications only, focused on patients who had initiated cancer treatment, and included only those aged ≥ 65 years.

IN PRACTICE:

“Whether prescribed for supportive oncology care or for coexisting medical conditions, high-risk medications identified as PIMs should be reviewed and optimized in patients with cancer,” the authors of the study wrote.

“GO-PIMs offers a streamlined, oncology-specific approach to identifying high-risk prescribing, and complements existing efforts to improve supportive care, especially for older, frail patients,” remarked Mostafa R. Mohamed, MBBCH, PhD, MSc, and Erika E. Ramsdale, MD, University of Rochester Medical Center, Rochester, New York in an invited commentary. “The next step lies in integrating tools such as GO-PIMs into everyday practice not only to flag high risk medications but also to support actionable changes in treatment planning and patient management, such as deprescribing,” they concluded.

SOURCE:

This study, led by Jennifer La, PhD, Harvard Medical School, Boston, was published online in Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

Prescription chronicity before or after follow-up was not measured and actual medication adherence could not be confirmed. Residual confounding by comorbidity could have existed, and the cross-sectional nature of linking GO-PIMs with frailty might have limited causal inference. Additionally, prescriptions were measured within Veterans Affairs pharmacy data, potentially underestimating GO-PIM prevalence, and the predominantly male population limited generalizability to gynecologic cancers.

DISCLOSURES:

This study was supported by grants and rewards from the Veterans Affairs Office of Research and Development, Cooperative Studies Program, National Institutes of Health, and American Heart Association. Some authors declared serving as consultants or receiving grants and having other ties with various sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

High-risk medications defined by the National Comprehensive Cancer Network (NCCN) and captured by the Geriatric Oncology Potentially Inappropriate Medication (GO-PIM) scale were prevalent in > one-third of veterans with solid and hematologic malignancies. Each additional GO-PIM was independently associated with higher risks for frailty at diagnosis, unplanned hospitalizations during follow-up, and death.

METHODOLOGY:

• Patients with cancer often use multiple chronic medications, raising risks for adverse events. Although several tools that identify PIMs have been developed that correlate with adverse cancer outcomes, their use is limited in busy oncology clinics. To improve implementation, researchers developed the GO-PIM scale using the NCCN’s list of high-risk medications.
• Researchers conducted a retrospective cohort study using data from the national Veterans Affairs Cancer Registry and electronic health records, which included 388,113 veterans newly diagnosed with solid or hematologic malignancies (median age, 69.3 years; 97.9% men; 76.1% non-Hispanic White and 17.3% Black individuals) between 2000 and 2022.
• They identified GO-PIMs using outpatient pharmacy records in the 90 days preceding cancer diagnosis. Each prescription for a specific GO-PIM was counted as one, including both individual drugs and drug classes listed in the GO-PIM scale.
• Study outcomes were frailty, hospitalizations, and overall survival. Baseline frailty at diagnosis was measured using the Veterans Affairs Frailty Index. The score ranged from 0 to 1, and higher scores indicated greater frailty. Patients were classified as nonfrail (score, ≤ 0.2), mildly frail (score, > 0.2 to 0.3), or moderate-to-severely frail (score, > 0.3).
• Lung (23.7%), prostate (21.5%), and gastrointestinal (20.5%) cancers were the most common, and the most frequent stages were IV (25.4%) and II (24.4%).

TAKEAWAY:

• Overall, 38.0% of veterans were prescribed ≥ 1 GO-PIMs at the time of cancer diagnosis, and the proportion increased to 56.1% among those with moderate-to-severe frailty.
• The most commonly prescribed classes of PIMs were selective serotonin reuptake inhibitors (SSRIs; 12.0%), opioids (10.4%), benzodiazepines (9.2%), and corticosteroids (9.2%). Among individual drugs, sertraline was the most common SSRI (4.3%), tramadol the most common opioid (5.3%), lorazepam the most common benzodiazepine (2.5%), and prednisone the most common corticosteroid (4.9%). Trends over time showed a steady increase in opioid prescriptions, peaking in 2014, followed by a subsequent decline, while prescriptions of benzodiazepines declined during the later years.
• After adjusting for age, cancer type and stage, and other covariates, each additional GO-PIM was associated with a 66% higher odds of mild or moderate-to-severe frailty at diagnosis (adjusted odds ratio, 1.66).
• After adjusting for frailty and covariates, each additional GO-PIM at diagnosis was associated with increased risks for unplanned hospitalizations and death (adjusted hazard ratios, 1.08 and 1.07, respectively). These associations remained stable in sensitivity analyses that restricted GO-PIMs to scheduled medications only, focused on patients who had initiated cancer treatment, and included only those aged ≥ 65 years.

IN PRACTICE:

“Whether prescribed for supportive oncology care or for coexisting medical conditions, high-risk medications identified as PIMs should be reviewed and optimized in patients with cancer,” the authors of the study wrote.

“GO-PIMs offers a streamlined, oncology-specific approach to identifying high-risk prescribing, and complements existing efforts to improve supportive care, especially for older, frail patients,” remarked Mostafa R. Mohamed, MBBCH, PhD, MSc, and Erika E. Ramsdale, MD, University of Rochester Medical Center, Rochester, New York in an invited commentary. “The next step lies in integrating tools such as GO-PIMs into everyday practice not only to flag high risk medications but also to support actionable changes in treatment planning and patient management, such as deprescribing,” they concluded.

SOURCE:

This study, led by Jennifer La, PhD, Harvard Medical School, Boston, was published online in Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

Prescription chronicity before or after follow-up was not measured and actual medication adherence could not be confirmed. Residual confounding by comorbidity could have existed, and the cross-sectional nature of linking GO-PIMs with frailty might have limited causal inference. Additionally, prescriptions were measured within Veterans Affairs pharmacy data, potentially underestimating GO-PIM prevalence, and the predominantly male population limited generalizability to gynecologic cancers.

DISCLOSURES:

This study was supported by grants and rewards from the Veterans Affairs Office of Research and Development, Cooperative Studies Program, National Institutes of Health, and American Heart Association. Some authors declared serving as consultants or receiving grants and having other ties with various sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

High-risk medications defined by the National Comprehensive Cancer Network (NCCN) and captured by the Geriatric Oncology Potentially Inappropriate Medication (GO-PIM) scale were prevalent in > one-third of veterans with solid and hematologic malignancies. Each additional GO-PIM was independently associated with higher risks for frailty at diagnosis, unplanned hospitalizations during follow-up, and death.

METHODOLOGY:

• Patients with cancer often use multiple chronic medications, raising risks for adverse events. Although several tools that identify PIMs have been developed that correlate with adverse cancer outcomes, their use is limited in busy oncology clinics. To improve implementation, researchers developed the GO-PIM scale using the NCCN’s list of high-risk medications.
• Researchers conducted a retrospective cohort study using data from the national Veterans Affairs Cancer Registry and electronic health records, which included 388,113 veterans newly diagnosed with solid or hematologic malignancies (median age, 69.3 years; 97.9% men; 76.1% non-Hispanic White and 17.3% Black individuals) between 2000 and 2022.
• They identified GO-PIMs using outpatient pharmacy records in the 90 days preceding cancer diagnosis. Each prescription for a specific GO-PIM was counted as one, including both individual drugs and drug classes listed in the GO-PIM scale.
• Study outcomes were frailty, hospitalizations, and overall survival. Baseline frailty at diagnosis was measured using the Veterans Affairs Frailty Index. The score ranged from 0 to 1, and higher scores indicated greater frailty. Patients were classified as nonfrail (score, ≤ 0.2), mildly frail (score, > 0.2 to 0.3), or moderate-to-severely frail (score, > 0.3).
• Lung (23.7%), prostate (21.5%), and gastrointestinal (20.5%) cancers were the most common, and the most frequent stages were IV (25.4%) and II (24.4%).

TAKEAWAY:

• Overall, 38.0% of veterans were prescribed ≥ 1 GO-PIMs at the time of cancer diagnosis, and the proportion increased to 56.1% among those with moderate-to-severe frailty.
• The most commonly prescribed classes of PIMs were selective serotonin reuptake inhibitors (SSRIs; 12.0%), opioids (10.4%), benzodiazepines (9.2%), and corticosteroids (9.2%). Among individual drugs, sertraline was the most common SSRI (4.3%), tramadol the most common opioid (5.3%), lorazepam the most common benzodiazepine (2.5%), and prednisone the most common corticosteroid (4.9%). Trends over time showed a steady increase in opioid prescriptions, peaking in 2014, followed by a subsequent decline, while prescriptions of benzodiazepines declined during the later years.
• After adjusting for age, cancer type and stage, and other covariates, each additional GO-PIM was associated with a 66% higher odds of mild or moderate-to-severe frailty at diagnosis (adjusted odds ratio, 1.66).
• After adjusting for frailty and covariates, each additional GO-PIM at diagnosis was associated with increased risks for unplanned hospitalizations and death (adjusted hazard ratios, 1.08 and 1.07, respectively). These associations remained stable in sensitivity analyses that restricted GO-PIMs to scheduled medications only, focused on patients who had initiated cancer treatment, and included only those aged ≥ 65 years.

IN PRACTICE:

“Whether prescribed for supportive oncology care or for coexisting medical conditions, high-risk medications identified as PIMs should be reviewed and optimized in patients with cancer,” the authors of the study wrote.

“GO-PIMs offers a streamlined, oncology-specific approach to identifying high-risk prescribing, and complements existing efforts to improve supportive care, especially for older, frail patients,” remarked Mostafa R. Mohamed, MBBCH, PhD, MSc, and Erika E. Ramsdale, MD, University of Rochester Medical Center, Rochester, New York in an invited commentary. “The next step lies in integrating tools such as GO-PIMs into everyday practice not only to flag high risk medications but also to support actionable changes in treatment planning and patient management, such as deprescribing,” they concluded.

SOURCE:

This study, led by Jennifer La, PhD, Harvard Medical School, Boston, was published online in Journal of the National Comprehensive Cancer Network.

LIMITATIONS:

Prescription chronicity before or after follow-up was not measured and actual medication adherence could not be confirmed. Residual confounding by comorbidity could have existed, and the cross-sectional nature of linking GO-PIMs with frailty might have limited causal inference. Additionally, prescriptions were measured within Veterans Affairs pharmacy data, potentially underestimating GO-PIM prevalence, and the predominantly male population limited generalizability to gynecologic cancers.

DISCLOSURES:

This study was supported by grants and rewards from the Veterans Affairs Office of Research and Development, Cooperative Studies Program, National Institutes of Health, and American Heart Association. Some authors declared serving as consultants or receiving grants and having other ties with various sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

About 1 in 10 veterans with early-stage cancer developed new persistent opioid use after curative‐intent surgery, though < 1% were diagnosed with opioid use disorder.

METHODOLOGY:

Although effective pain control during cancer treatment is vital, prescribing opioids in this context may contribute to unsafe, long-term use and related adverse outcomes. Veterans, who have higher-than-average rates of mental health and substance use disorders, may be at particular risk for adverse events from opioid use related to cancer treatment.

Researchers conducted a national retrospective cohort study of 9213 US veterans (98% men) with stage 0-III cancer who were opioid-naive and underwent curative-intent surgery at Veterans Affairs medical centers between 2015 and 2016. Prostate (n = 2594; 28%), colorectal (n = 2393; 26%), bladder (n = 2302; 25%), and lung (n = 1252; 14%) cancers were the most common.

Primary outcomes were the number of days of co-prescription of benzodiazepines and opioids (an indicator of unsafe opioid prescribing) and new persistent opioid use, defined as receiving ≥ 1 opioid prescription at 90-180 days postsurgery. Opioid‐related adverse effects, including opioid use disorder and opioid overdose, were also reported.

Overall, 6970 (76%) of the participants were prescribed opioids at some point during the baseline treatment period (30 days before through 14 days after surgery). The mean morphine milligram equivalent (MME) was 172.5.

 

TAKEAWAY:

Overall, 4% of patients received co-prescriptions of benzodiazepines and opioids. The mean number of days of coprescription rose in tandem with opioid doses during the treatment period: from 0.48 days in the lowest MME quartile to 2.1 days in the highest quartile (P < .0001).

Over 1 in 10 patients (10.6%) developed new persistent opioid use. Those in the highest MME quartile had a 1.6-fold greater risk of developing new persistent opioid use than those with no opioid exposure during the treatment period (hazard ratio [HR], 1.6; P < .001). The percentage of patients with opioid prescriptions did decline over the 13-month follow-up, but among those who continued on opioids, the daily MME remained stable (median, 20 for month 1 and 30 for month 12).

Treatment with adjuvant chemotherapy increased the risk for new persistent opioid use (HR, 1.5; 95% CI, 1.2-1.8; P < .001). Additional risk factors included having bladder, colorectal, lung, or other types of cancer (vs prostate cancer); stage I-III disease (vs stage 0); age 45-64 years (vs older); lower socioeconomic status; preoperative use of nonopioid pain medication; and a baseline history of anxiety, depression, or posttraumatic stress disorder.

Over 13 months, 72 patients (0.78%) developed opioid use disorder, 3 (0.03%) experienced nonoverdose adverse events, and no opioid overdose occurred.

 

IN PRACTICE:

“Although a cancer diagnosis, treatment, and associated pain syndromes will require specific pain management strategies,” the authors wrote, “efforts should be taken to mitigate long‐term opioid use and its potential adverse effects in this population. They added that “both system‐level changes that involve preoperative evaluation planning as well as increased knowledge, awareness, and education among providers and patients about the risk of long‐term opioid use can guide strategies for effective and safe pain management.”

SOURCE:

The study, led by Marilyn M. Schapira, MD, MPH, Center for Healthcare Evaluation, Research, and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, was published online in Cancer.

LIMITATIONS:

Opioid prescriptions outside the Veterans Affairs system were not captured. The study was based on filled opioid prescriptions, and actual patient consumption was unknown. Outpatient methadone prescriptions were not included. The study also excluded patients with breast cancer, limiting generalizability.

DISCLOSURES:

The study was funded by grant from the Department of Veterans Affairs. One author reported consulting for Moderna and TriNetX. Another author reported consulting for Genetic Chemistry, Thyme Care, Biofourmis, Onc.Al, Credit Suisse, Main Street Health, ConcertAI, Medscape, and G1 Therapeutics. The other authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

TOPLINE:

About 1 in 10 veterans with early-stage cancer developed new persistent opioid use after curative‐intent surgery, though < 1% were diagnosed with opioid use disorder.

METHODOLOGY:

Although effective pain control during cancer treatment is vital, prescribing opioids in this context may contribute to unsafe, long-term use and related adverse outcomes. Veterans, who have higher-than-average rates of mental health and substance use disorders, may be at particular risk for adverse events from opioid use related to cancer treatment.

Researchers conducted a national retrospective cohort study of 9213 US veterans (98% men) with stage 0-III cancer who were opioid-naive and underwent curative-intent surgery at Veterans Affairs medical centers between 2015 and 2016. Prostate (n = 2594; 28%), colorectal (n = 2393; 26%), bladder (n = 2302; 25%), and lung (n = 1252; 14%) cancers were the most common.

Primary outcomes were the number of days of co-prescription of benzodiazepines and opioids (an indicator of unsafe opioid prescribing) and new persistent opioid use, defined as receiving ≥ 1 opioid prescription at 90-180 days postsurgery. Opioid‐related adverse effects, including opioid use disorder and opioid overdose, were also reported.

Overall, 6970 (76%) of the participants were prescribed opioids at some point during the baseline treatment period (30 days before through 14 days after surgery). The mean morphine milligram equivalent (MME) was 172.5.

 

TAKEAWAY:

Overall, 4% of patients received co-prescriptions of benzodiazepines and opioids. The mean number of days of coprescription rose in tandem with opioid doses during the treatment period: from 0.48 days in the lowest MME quartile to 2.1 days in the highest quartile (P < .0001).

Over 1 in 10 patients (10.6%) developed new persistent opioid use. Those in the highest MME quartile had a 1.6-fold greater risk of developing new persistent opioid use than those with no opioid exposure during the treatment period (hazard ratio [HR], 1.6; P < .001). The percentage of patients with opioid prescriptions did decline over the 13-month follow-up, but among those who continued on opioids, the daily MME remained stable (median, 20 for month 1 and 30 for month 12).

Treatment with adjuvant chemotherapy increased the risk for new persistent opioid use (HR, 1.5; 95% CI, 1.2-1.8; P < .001). Additional risk factors included having bladder, colorectal, lung, or other types of cancer (vs prostate cancer); stage I-III disease (vs stage 0); age 45-64 years (vs older); lower socioeconomic status; preoperative use of nonopioid pain medication; and a baseline history of anxiety, depression, or posttraumatic stress disorder.

Over 13 months, 72 patients (0.78%) developed opioid use disorder, 3 (0.03%) experienced nonoverdose adverse events, and no opioid overdose occurred.

 

IN PRACTICE:

“Although a cancer diagnosis, treatment, and associated pain syndromes will require specific pain management strategies,” the authors wrote, “efforts should be taken to mitigate long‐term opioid use and its potential adverse effects in this population. They added that “both system‐level changes that involve preoperative evaluation planning as well as increased knowledge, awareness, and education among providers and patients about the risk of long‐term opioid use can guide strategies for effective and safe pain management.”

SOURCE:

The study, led by Marilyn M. Schapira, MD, MPH, Center for Healthcare Evaluation, Research, and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, was published online in Cancer.

LIMITATIONS:

Opioid prescriptions outside the Veterans Affairs system were not captured. The study was based on filled opioid prescriptions, and actual patient consumption was unknown. Outpatient methadone prescriptions were not included. The study also excluded patients with breast cancer, limiting generalizability.

DISCLOSURES:

The study was funded by grant from the Department of Veterans Affairs. One author reported consulting for Moderna and TriNetX. Another author reported consulting for Genetic Chemistry, Thyme Care, Biofourmis, Onc.Al, Credit Suisse, Main Street Health, ConcertAI, Medscape, and G1 Therapeutics. The other authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

TOPLINE:

About 1 in 10 veterans with early-stage cancer developed new persistent opioid use after curative‐intent surgery, though < 1% were diagnosed with opioid use disorder.

METHODOLOGY:

Although effective pain control during cancer treatment is vital, prescribing opioids in this context may contribute to unsafe, long-term use and related adverse outcomes. Veterans, who have higher-than-average rates of mental health and substance use disorders, may be at particular risk for adverse events from opioid use related to cancer treatment.

Researchers conducted a national retrospective cohort study of 9213 US veterans (98% men) with stage 0-III cancer who were opioid-naive and underwent curative-intent surgery at Veterans Affairs medical centers between 2015 and 2016. Prostate (n = 2594; 28%), colorectal (n = 2393; 26%), bladder (n = 2302; 25%), and lung (n = 1252; 14%) cancers were the most common.

Primary outcomes were the number of days of co-prescription of benzodiazepines and opioids (an indicator of unsafe opioid prescribing) and new persistent opioid use, defined as receiving ≥ 1 opioid prescription at 90-180 days postsurgery. Opioid‐related adverse effects, including opioid use disorder and opioid overdose, were also reported.

Overall, 6970 (76%) of the participants were prescribed opioids at some point during the baseline treatment period (30 days before through 14 days after surgery). The mean morphine milligram equivalent (MME) was 172.5.

 

TAKEAWAY:

Overall, 4% of patients received co-prescriptions of benzodiazepines and opioids. The mean number of days of coprescription rose in tandem with opioid doses during the treatment period: from 0.48 days in the lowest MME quartile to 2.1 days in the highest quartile (P < .0001).

Over 1 in 10 patients (10.6%) developed new persistent opioid use. Those in the highest MME quartile had a 1.6-fold greater risk of developing new persistent opioid use than those with no opioid exposure during the treatment period (hazard ratio [HR], 1.6; P < .001). The percentage of patients with opioid prescriptions did decline over the 13-month follow-up, but among those who continued on opioids, the daily MME remained stable (median, 20 for month 1 and 30 for month 12).

Treatment with adjuvant chemotherapy increased the risk for new persistent opioid use (HR, 1.5; 95% CI, 1.2-1.8; P < .001). Additional risk factors included having bladder, colorectal, lung, or other types of cancer (vs prostate cancer); stage I-III disease (vs stage 0); age 45-64 years (vs older); lower socioeconomic status; preoperative use of nonopioid pain medication; and a baseline history of anxiety, depression, or posttraumatic stress disorder.

Over 13 months, 72 patients (0.78%) developed opioid use disorder, 3 (0.03%) experienced nonoverdose adverse events, and no opioid overdose occurred.

 

IN PRACTICE:

“Although a cancer diagnosis, treatment, and associated pain syndromes will require specific pain management strategies,” the authors wrote, “efforts should be taken to mitigate long‐term opioid use and its potential adverse effects in this population. They added that “both system‐level changes that involve preoperative evaluation planning as well as increased knowledge, awareness, and education among providers and patients about the risk of long‐term opioid use can guide strategies for effective and safe pain management.”

SOURCE:

The study, led by Marilyn M. Schapira, MD, MPH, Center for Healthcare Evaluation, Research, and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, was published online in Cancer.

LIMITATIONS:

Opioid prescriptions outside the Veterans Affairs system were not captured. The study was based on filled opioid prescriptions, and actual patient consumption was unknown. Outpatient methadone prescriptions were not included. The study also excluded patients with breast cancer, limiting generalizability.

DISCLOSURES:

The study was funded by grant from the Department of Veterans Affairs. One author reported consulting for Moderna and TriNetX. Another author reported consulting for Genetic Chemistry, Thyme Care, Biofourmis, Onc.Al, Credit Suisse, Main Street Health, ConcertAI, Medscape, and G1 Therapeutics. The other authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

Bariatric surgery was associated with higher short-term risks for acute kidney injury (AKI) and nephrolithiasis but lower long-term risks for chronic kidney disease (CKD) and kidney failure with replacement therapy (KFRT), according to a population-based study in Denmark.

Writing in BMC Nephrology, researchers reported patients with bariatric surgery had an increased 1-year risk for AKI and 10-year risk for nephrolithiasis, alongside a decreased 10-year risk for CKD (stages G3-5) and KFRT, compared with matched patients diagnosed with overweight/obesity who did not undergo surgery.

 

A Closer Look

Using national registry data, the team identified all adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2006, and December 31, 2018. Each patient was age- and sex-matched (1:5) to patients with hospital-diagnosed overweight/obesity without bariatric surgery. Researchers also compared results against a population cohort matched solely by age and sex. Outcomes included cumulative risks for AKI, nephrolithiasis, CKD (G3-G5), and KFRT.

The cohort comprised 18,827 surgical patients (17,200 RYGB and 1627 SG) and 94,135 matched comparators. Median age was 41 years, 76% were women, and the median follow-up was 8.1 years. At baseline, the median estimated glomerular filtration rate (eGFR) was comparable (103 mL/min/1.73 m2) between both surgery and overweight/obesity control groups, as were A1c levels. There were fewer comorbidities in the population cohort matched only by age and sex than in the overweight/obesity comparison cohort.

Using multivariable Cox regression analyses, the researchers found the 1-year risk for AKI following bariatric surgery was 2.7%. At 10 years, risks were 3.5% for nephrolithiasis, 0.4% for CKD, and 0.2% for KFRT.

Adjusted hazard ratios (HRs) after bariatric surgery vs without bariatric surgery were higher for AKI (HR, 1.63) and nephrolithiasis (HR, 1.73) and lower for CKD (HR, 0.41) and KFRT (HR, 0.63). Results were consistent when compared against the population cohort.

By procedure, the 1-year AKI risk was 2.7% after RYGB and 2.4% after SG vs 2.5% in the overweight/obesity cohort and 1.1% in the population cohort. At 10 years, the risk for incident nephrolithiasis was 3.6% after RYGB and 1.2% after SG vs 2.4% and 1.3% in the overweight/obese and population cohorts, respectively. KFRT risk at 10 years was 0.2% after RYGB and 1.6% after SG vs 0.4% and 0.1% in the overweight/obesity and population cohorts, respectively. 

“The increased short-term risk of AKI and nephrolithiasis was expected, given the physiological changes after bariatric surgery, but the long-term reduction in CKD and KFRT was both encouraging and clinically important,” said study investigator Christian Goul Sørensen, MD, Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. “It was also noteworthy that the results were consistent not only in the obesity-matched comparison cohort but also in the cohort matched solely on age and sex, which further strengthens the validity of our findings.”

RYGB and SG are known to help mitigate obesity-associated complications, such as hypertension, hyperlipidemia, and type 2 diabetes. Studies have suggested that there are improvements in eGFR after bariatric surgery. However, long-term evidence from routine clinical care has not been well studied. Furthermore, RYGB may lead to AKI due to a combination of preoperative, intraoperative, and postoperative factors.

“Obesity is a major driver of kidney disease, often in combination with comorbidities such as diabetes and hypertension,” Sorensen told GI & Hepatology News. “Patients and clinicians face complex decisions about surgery, and understanding both the short-term surgical risks and the long-term kidney benefits is crucial for informed counseling. As bariatric surgery becomes increasingly common worldwide, population-based evidence like this helps guide clinical practice and supports shared decision-making with patients.”

 

Consistent With Clinical Experience

Panduranga S. Rao, MD, professor of nephrology at the University of Michigan, Ann Arbor, Michigan, who was not involved in the study, called the results consistent with prior clinical experience. He highlighted the strong follow-up and detailed lab and comorbidity data, while noting that the decreasing use of RYGB may limit applicability going forward.

“However, one has to remain vigilant to the risk of nephrolithiasis in the patients who have undergone Roux-en-Y in the past,” he said.

The observation of decreasing risk for CKD with weight loss is particularly relevant, given the growing use of GLP-1s for weight loss, Rao added.

Srinivasan Beddhu, MD, professor of internal medicine and the scientific director of the Cardio-Renal & Metabolism Center at the University of Utah Health in Salt Lake City, said the large national cohort design and outcomes data offer further reassurance about the long-term kidney health effects of bariatric surgery.

“The message that the risks of AKI and nephrolithiasis are outweighed by the long-term kidney protective effects of bariatric surgery is important,” said Beddhu.

Alexander Chang, MD, associate professor and a practicing nephrologist at the Geisinger Health System in Danville, Pennsylvania, noted that the study provided more evidence about RYGB-associated kidney stone risk via fat malabsorption, which raises the levels of fatty acids that bind dietary calcium.

“Calcium normally precipitates with dietary oxalate, and thus, there can be an increase in urinary oxalate,” Chang explained. “There did not appear to be increased risk of nephrolithiasis with sleeve gastrectomy, consistent with other studies.

“This study emphasizes the importance of multidisciplinary care post-bariatric surgery to try to prevent complications such as kidney stones,” Chang added. “This can be tricky but requires trying different strategies to increase fluid intake and calcium citrate supplements with meals.”

The study was partly funded by a grant from the Novo Nordisk Foundation and the Independent Research Fund Denmark. One author reported receiving a speaking fee support from Novo Nordisk for conference attendance. The other authors declared no competing interests. Sørensen, Rao, Beddhu, and Chang had no financial disclosures.

 

A version of this article appeared on Medscape.com.

Bariatric surgery was associated with higher short-term risks for acute kidney injury (AKI) and nephrolithiasis but lower long-term risks for chronic kidney disease (CKD) and kidney failure with replacement therapy (KFRT), according to a population-based study in Denmark.

Writing in BMC Nephrology, researchers reported patients with bariatric surgery had an increased 1-year risk for AKI and 10-year risk for nephrolithiasis, alongside a decreased 10-year risk for CKD (stages G3-5) and KFRT, compared with matched patients diagnosed with overweight/obesity who did not undergo surgery.

 

A Closer Look

Using national registry data, the team identified all adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2006, and December 31, 2018. Each patient was age- and sex-matched (1:5) to patients with hospital-diagnosed overweight/obesity without bariatric surgery. Researchers also compared results against a population cohort matched solely by age and sex. Outcomes included cumulative risks for AKI, nephrolithiasis, CKD (G3-G5), and KFRT.

The cohort comprised 18,827 surgical patients (17,200 RYGB and 1627 SG) and 94,135 matched comparators. Median age was 41 years, 76% were women, and the median follow-up was 8.1 years. At baseline, the median estimated glomerular filtration rate (eGFR) was comparable (103 mL/min/1.73 m2) between both surgery and overweight/obesity control groups, as were A1c levels. There were fewer comorbidities in the population cohort matched only by age and sex than in the overweight/obesity comparison cohort.

Using multivariable Cox regression analyses, the researchers found the 1-year risk for AKI following bariatric surgery was 2.7%. At 10 years, risks were 3.5% for nephrolithiasis, 0.4% for CKD, and 0.2% for KFRT.

Adjusted hazard ratios (HRs) after bariatric surgery vs without bariatric surgery were higher for AKI (HR, 1.63) and nephrolithiasis (HR, 1.73) and lower for CKD (HR, 0.41) and KFRT (HR, 0.63). Results were consistent when compared against the population cohort.

By procedure, the 1-year AKI risk was 2.7% after RYGB and 2.4% after SG vs 2.5% in the overweight/obesity cohort and 1.1% in the population cohort. At 10 years, the risk for incident nephrolithiasis was 3.6% after RYGB and 1.2% after SG vs 2.4% and 1.3% in the overweight/obese and population cohorts, respectively. KFRT risk at 10 years was 0.2% after RYGB and 1.6% after SG vs 0.4% and 0.1% in the overweight/obesity and population cohorts, respectively. 

“The increased short-term risk of AKI and nephrolithiasis was expected, given the physiological changes after bariatric surgery, but the long-term reduction in CKD and KFRT was both encouraging and clinically important,” said study investigator Christian Goul Sørensen, MD, Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. “It was also noteworthy that the results were consistent not only in the obesity-matched comparison cohort but also in the cohort matched solely on age and sex, which further strengthens the validity of our findings.”

RYGB and SG are known to help mitigate obesity-associated complications, such as hypertension, hyperlipidemia, and type 2 diabetes. Studies have suggested that there are improvements in eGFR after bariatric surgery. However, long-term evidence from routine clinical care has not been well studied. Furthermore, RYGB may lead to AKI due to a combination of preoperative, intraoperative, and postoperative factors.

“Obesity is a major driver of kidney disease, often in combination with comorbidities such as diabetes and hypertension,” Sorensen told GI & Hepatology News. “Patients and clinicians face complex decisions about surgery, and understanding both the short-term surgical risks and the long-term kidney benefits is crucial for informed counseling. As bariatric surgery becomes increasingly common worldwide, population-based evidence like this helps guide clinical practice and supports shared decision-making with patients.”

 

Consistent With Clinical Experience

Panduranga S. Rao, MD, professor of nephrology at the University of Michigan, Ann Arbor, Michigan, who was not involved in the study, called the results consistent with prior clinical experience. He highlighted the strong follow-up and detailed lab and comorbidity data, while noting that the decreasing use of RYGB may limit applicability going forward.

“However, one has to remain vigilant to the risk of nephrolithiasis in the patients who have undergone Roux-en-Y in the past,” he said.

The observation of decreasing risk for CKD with weight loss is particularly relevant, given the growing use of GLP-1s for weight loss, Rao added.

Srinivasan Beddhu, MD, professor of internal medicine and the scientific director of the Cardio-Renal & Metabolism Center at the University of Utah Health in Salt Lake City, said the large national cohort design and outcomes data offer further reassurance about the long-term kidney health effects of bariatric surgery.

“The message that the risks of AKI and nephrolithiasis are outweighed by the long-term kidney protective effects of bariatric surgery is important,” said Beddhu.

Alexander Chang, MD, associate professor and a practicing nephrologist at the Geisinger Health System in Danville, Pennsylvania, noted that the study provided more evidence about RYGB-associated kidney stone risk via fat malabsorption, which raises the levels of fatty acids that bind dietary calcium.

“Calcium normally precipitates with dietary oxalate, and thus, there can be an increase in urinary oxalate,” Chang explained. “There did not appear to be increased risk of nephrolithiasis with sleeve gastrectomy, consistent with other studies.

“This study emphasizes the importance of multidisciplinary care post-bariatric surgery to try to prevent complications such as kidney stones,” Chang added. “This can be tricky but requires trying different strategies to increase fluid intake and calcium citrate supplements with meals.”

The study was partly funded by a grant from the Novo Nordisk Foundation and the Independent Research Fund Denmark. One author reported receiving a speaking fee support from Novo Nordisk for conference attendance. The other authors declared no competing interests. Sørensen, Rao, Beddhu, and Chang had no financial disclosures.

 

A version of this article appeared on Medscape.com.

Bariatric surgery was associated with higher short-term risks for acute kidney injury (AKI) and nephrolithiasis but lower long-term risks for chronic kidney disease (CKD) and kidney failure with replacement therapy (KFRT), according to a population-based study in Denmark.

Writing in BMC Nephrology, researchers reported patients with bariatric surgery had an increased 1-year risk for AKI and 10-year risk for nephrolithiasis, alongside a decreased 10-year risk for CKD (stages G3-5) and KFRT, compared with matched patients diagnosed with overweight/obesity who did not undergo surgery.

 

A Closer Look

Using national registry data, the team identified all adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2006, and December 31, 2018. Each patient was age- and sex-matched (1:5) to patients with hospital-diagnosed overweight/obesity without bariatric surgery. Researchers also compared results against a population cohort matched solely by age and sex. Outcomes included cumulative risks for AKI, nephrolithiasis, CKD (G3-G5), and KFRT.

The cohort comprised 18,827 surgical patients (17,200 RYGB and 1627 SG) and 94,135 matched comparators. Median age was 41 years, 76% were women, and the median follow-up was 8.1 years. At baseline, the median estimated glomerular filtration rate (eGFR) was comparable (103 mL/min/1.73 m2) between both surgery and overweight/obesity control groups, as were A1c levels. There were fewer comorbidities in the population cohort matched only by age and sex than in the overweight/obesity comparison cohort.

Using multivariable Cox regression analyses, the researchers found the 1-year risk for AKI following bariatric surgery was 2.7%. At 10 years, risks were 3.5% for nephrolithiasis, 0.4% for CKD, and 0.2% for KFRT.

Adjusted hazard ratios (HRs) after bariatric surgery vs without bariatric surgery were higher for AKI (HR, 1.63) and nephrolithiasis (HR, 1.73) and lower for CKD (HR, 0.41) and KFRT (HR, 0.63). Results were consistent when compared against the population cohort.

By procedure, the 1-year AKI risk was 2.7% after RYGB and 2.4% after SG vs 2.5% in the overweight/obesity cohort and 1.1% in the population cohort. At 10 years, the risk for incident nephrolithiasis was 3.6% after RYGB and 1.2% after SG vs 2.4% and 1.3% in the overweight/obese and population cohorts, respectively. KFRT risk at 10 years was 0.2% after RYGB and 1.6% after SG vs 0.4% and 0.1% in the overweight/obesity and population cohorts, respectively. 

“The increased short-term risk of AKI and nephrolithiasis was expected, given the physiological changes after bariatric surgery, but the long-term reduction in CKD and KFRT was both encouraging and clinically important,” said study investigator Christian Goul Sørensen, MD, Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. “It was also noteworthy that the results were consistent not only in the obesity-matched comparison cohort but also in the cohort matched solely on age and sex, which further strengthens the validity of our findings.”

RYGB and SG are known to help mitigate obesity-associated complications, such as hypertension, hyperlipidemia, and type 2 diabetes. Studies have suggested that there are improvements in eGFR after bariatric surgery. However, long-term evidence from routine clinical care has not been well studied. Furthermore, RYGB may lead to AKI due to a combination of preoperative, intraoperative, and postoperative factors.

“Obesity is a major driver of kidney disease, often in combination with comorbidities such as diabetes and hypertension,” Sorensen told GI & Hepatology News. “Patients and clinicians face complex decisions about surgery, and understanding both the short-term surgical risks and the long-term kidney benefits is crucial for informed counseling. As bariatric surgery becomes increasingly common worldwide, population-based evidence like this helps guide clinical practice and supports shared decision-making with patients.”

 

Consistent With Clinical Experience

Panduranga S. Rao, MD, professor of nephrology at the University of Michigan, Ann Arbor, Michigan, who was not involved in the study, called the results consistent with prior clinical experience. He highlighted the strong follow-up and detailed lab and comorbidity data, while noting that the decreasing use of RYGB may limit applicability going forward.

“However, one has to remain vigilant to the risk of nephrolithiasis in the patients who have undergone Roux-en-Y in the past,” he said.

The observation of decreasing risk for CKD with weight loss is particularly relevant, given the growing use of GLP-1s for weight loss, Rao added.

Srinivasan Beddhu, MD, professor of internal medicine and the scientific director of the Cardio-Renal & Metabolism Center at the University of Utah Health in Salt Lake City, said the large national cohort design and outcomes data offer further reassurance about the long-term kidney health effects of bariatric surgery.

“The message that the risks of AKI and nephrolithiasis are outweighed by the long-term kidney protective effects of bariatric surgery is important,” said Beddhu.

Alexander Chang, MD, associate professor and a practicing nephrologist at the Geisinger Health System in Danville, Pennsylvania, noted that the study provided more evidence about RYGB-associated kidney stone risk via fat malabsorption, which raises the levels of fatty acids that bind dietary calcium.

“Calcium normally precipitates with dietary oxalate, and thus, there can be an increase in urinary oxalate,” Chang explained. “There did not appear to be increased risk of nephrolithiasis with sleeve gastrectomy, consistent with other studies.

“This study emphasizes the importance of multidisciplinary care post-bariatric surgery to try to prevent complications such as kidney stones,” Chang added. “This can be tricky but requires trying different strategies to increase fluid intake and calcium citrate supplements with meals.”

The study was partly funded by a grant from the Novo Nordisk Foundation and the Independent Research Fund Denmark. One author reported receiving a speaking fee support from Novo Nordisk for conference attendance. The other authors declared no competing interests. Sørensen, Rao, Beddhu, and Chang had no financial disclosures.

 

A version of this article appeared on Medscape.com.

Early-onset gastrointestinal (GI) cancers are climbing among those younger than 50 years, in the US and globally. Although colorectal cancer accounts for approximately half of such cases, rates are also increasing for gastric, esophageal, pancreatic, and several rarer GI malignancies.

Because most in this age group are not included in screening protocols and may present with vague symptoms, diagnosis and treatment is frequently delayed. According to experts in the field, counteracting this trend requires establishing a lower threshold for evaluation, attention to modifiable risk factors, and embracing emerging noninvasive diagnostic tools.

 

Diagnostic Dilemmas

“Colorectal cancer in particular is often diagnosed later in life,” said Nicholas DeVito, MD, assistant professor at Duke University Medical Center, Durham, North Carolina, and a specialist in GI malignancies. “When the patient is too young for routine screening colonoscopy (< 45 years), they aren’t screened at all, they do not have alarming symptoms, or their symptoms are overlooked.” Other increasingly common GI cancers in young people (esophageal, gastric, pancreatic) lack routine screening guidelines due to limited evidence, he added.

Symptoms such as nausea, weight loss, upset stomach, and abdominal pain are often nonspecific and have many other potential causes, so GI cancers may not be high on the list of possible diagnoses in patients younger than 50 years, said DeVito.

“Insurance coverage, socioeconomic status, appointment availability, and awareness of symptoms and screening methods are all barriers to diagnosis as well, which affect the diagnostic timeline of many cancers,” he added.“While there are multiple factors that contribute to a cancer diagnosis, it seems that obesity, a Western diet, a sedentary lifestyle are all major contributors to the rise in early GI cancers,” DeVito told GI & Hepatology News. “There is no blame or judgement to go around as cancer can happen to anyone at any time, with none of these factors present,” he emphasized.

When counseling patients about GI cancer risk, DeVito recommends keeping advice simple and specific. In general, they should restrict red meat to once a week, emphasize fresh fruits and vegetables, cap alcohol to ≤ 1 serving per day, and limit ultraprocessed foods (e.g., packaged snacks, preprepared meals, and sugary beverages).

Exercise is another pillar. “Find an activity you enjoy and work toward 30 minutes of aerobic exercise three times a week,” he advised. He also encourages finding opportunities to incorporate physical activity in daily lives, such as using a standing desk at work, while keeping patients’ socioeconomic constraints in mind.

Evidence around GI cancer prevention interventions is still evolving. However, a randomized phase 3 trial presented at American Society of Clinical Oncology’s 2025 meeting found significant improvement in disease-free survival among adults with resected stage III or high-risk stage II colon cancer (median age, 61 years) who reported higher intake of anti-inflammatory foods and greater exercise than a comparator group.

“In general, clinicians should be aware of the risk factors, make referrals to physical therapy, weight-loss specialists, endocrinologists, and nutritionists when appropriate, and be consistent and clear with patients about recommendations and what’s achievable,” DeVito said. “Meeting patients where they are can help make incremental progress, as these interventions take time and patience, and we should be understanding of that.” 

Identifying at-risk younger adults goes beyond discussing family history and obesity to include diet, exercise, and daily lifestyle, he added.

“Symptoms of potential GI cancer need to be taken seriously in all patients, and there should be a lower threshold in 2025 to get a colonoscopy, endoscopy, or CT scan than in previous years given all that we know today. We then need to establish through clinical studies who needs screening tests and who doesn’t, and what interventions work best to reduce risk.” 

 

Vigilance in the Absence of Screening

“Most GI cancers, unfortunately, can grow a fair amount before symptoms arise, so many patients present with symptoms only when a tumor has grown enough to affect organ function,” said Miguel Burch, MD, chief of minimally invasive and GI surgery at Cedars-Sinai Medical Center, Los Angeles.

Early screening improves outcomes in gastric cancer, Burch noted, and survival benefits are reflected in several East Asian countries that offer gastric cancer screening starting at age 40. In one study from Korea, a single upper endoscopy was associated with an approximate 40% reduction in gastric cancer mortality compared with no screening.

In the US, lack of funding for GI cancer screening remains a barrier to early identification, Burch emphasized. The impact is wide-ranging, contributing to increased morbidity and mortality in younger adults often in their most productive years, leading to lost wages and emotional strains upon patients and their families.Routine endoscopic or imaging screening is not typically performed in the US, and newer blood-based tests such as circulating tumor DNA are not yet sensitive enough to reliably detect very early-stage disease. Nonetheless, there is evidence that noninvasive biomarkers could soon help expand GI cancer screening.

In a study published in JAMA Surgery, Sui and colleagues tested a 10-microRNA signature assay (Destinex) for early detection of gastric cancer and reported robust identification rates above 95%.

“In recent years, the liquid biopsy has gained momentum with the hope of augmenting cancer detection from peripheral blood, even indicating potential as a screening test for healthy populations,” wrote Max R. Coffey, MD, and Vivian E. Strong, MD, both of the Memorial Sloan Kettering Cancer Center in New York City, in an accompanying editorial.

“Early detection is absolutely critical; when gastric cancer is found early, outcomes are dramatically better,” Strong told GI & Hepatology News. Subtle symptoms — reflux, persistent GI discomfort, or unexplained weight loss — should never be ignored, she added.

Early detection should also focus on additional risk factors such as prior Helicobacter pylori infection, smoking, and family history.

“Anyone with a personal or family history of H pylori should have very careful follow-up, and if one household member tests positive, all should be checked,” Strong said. “Just as importantly, if one or more family members have had stomach cancer, that should be discussed with a healthcare provider, as it may warrant higher-level surveillance and genetic testing.” 

Individuals concerned about increased risk for GI cancer should proactively ask their doctors whether they might benefit from testing or surveillance, Strong added.

“Lifestyle changes, timely medical evaluation, and tailored surveillance all play a vital role in prevention.”

DeVito disclosed clinical trial funding from the Gateway foundation, Xilio, Phanes, Astellas, GSK, as well as consulting fees/advisory board participation for Guardant, Agenus, and Xilio. Strong disclosed speaking honoraria for Merck and Astra Zeneca.

The study by Sui and colleagues was supported by the National Cancer Institute, National Institutes of Health, as well as by a grant from the American Gastroenterological Association Robert & Sally Funderburg Research Award in Gastric Cancer, and the Stupid Strong Foundation.

Burch had no financial conflicts to disclose.

 

A version of this article appeared on Medscape.com.

Early-onset gastrointestinal (GI) cancers are climbing among those younger than 50 years, in the US and globally. Although colorectal cancer accounts for approximately half of such cases, rates are also increasing for gastric, esophageal, pancreatic, and several rarer GI malignancies.

Because most in this age group are not included in screening protocols and may present with vague symptoms, diagnosis and treatment is frequently delayed. According to experts in the field, counteracting this trend requires establishing a lower threshold for evaluation, attention to modifiable risk factors, and embracing emerging noninvasive diagnostic tools.

 

Diagnostic Dilemmas

“Colorectal cancer in particular is often diagnosed later in life,” said Nicholas DeVito, MD, assistant professor at Duke University Medical Center, Durham, North Carolina, and a specialist in GI malignancies. “When the patient is too young for routine screening colonoscopy (< 45 years), they aren’t screened at all, they do not have alarming symptoms, or their symptoms are overlooked.” Other increasingly common GI cancers in young people (esophageal, gastric, pancreatic) lack routine screening guidelines due to limited evidence, he added.

Symptoms such as nausea, weight loss, upset stomach, and abdominal pain are often nonspecific and have many other potential causes, so GI cancers may not be high on the list of possible diagnoses in patients younger than 50 years, said DeVito.

“Insurance coverage, socioeconomic status, appointment availability, and awareness of symptoms and screening methods are all barriers to diagnosis as well, which affect the diagnostic timeline of many cancers,” he added.“While there are multiple factors that contribute to a cancer diagnosis, it seems that obesity, a Western diet, a sedentary lifestyle are all major contributors to the rise in early GI cancers,” DeVito told GI & Hepatology News. “There is no blame or judgement to go around as cancer can happen to anyone at any time, with none of these factors present,” he emphasized.

When counseling patients about GI cancer risk, DeVito recommends keeping advice simple and specific. In general, they should restrict red meat to once a week, emphasize fresh fruits and vegetables, cap alcohol to ≤ 1 serving per day, and limit ultraprocessed foods (e.g., packaged snacks, preprepared meals, and sugary beverages).

Exercise is another pillar. “Find an activity you enjoy and work toward 30 minutes of aerobic exercise three times a week,” he advised. He also encourages finding opportunities to incorporate physical activity in daily lives, such as using a standing desk at work, while keeping patients’ socioeconomic constraints in mind.

Evidence around GI cancer prevention interventions is still evolving. However, a randomized phase 3 trial presented at American Society of Clinical Oncology’s 2025 meeting found significant improvement in disease-free survival among adults with resected stage III or high-risk stage II colon cancer (median age, 61 years) who reported higher intake of anti-inflammatory foods and greater exercise than a comparator group.

“In general, clinicians should be aware of the risk factors, make referrals to physical therapy, weight-loss specialists, endocrinologists, and nutritionists when appropriate, and be consistent and clear with patients about recommendations and what’s achievable,” DeVito said. “Meeting patients where they are can help make incremental progress, as these interventions take time and patience, and we should be understanding of that.” 

Identifying at-risk younger adults goes beyond discussing family history and obesity to include diet, exercise, and daily lifestyle, he added.

“Symptoms of potential GI cancer need to be taken seriously in all patients, and there should be a lower threshold in 2025 to get a colonoscopy, endoscopy, or CT scan than in previous years given all that we know today. We then need to establish through clinical studies who needs screening tests and who doesn’t, and what interventions work best to reduce risk.” 

 

Vigilance in the Absence of Screening

“Most GI cancers, unfortunately, can grow a fair amount before symptoms arise, so many patients present with symptoms only when a tumor has grown enough to affect organ function,” said Miguel Burch, MD, chief of minimally invasive and GI surgery at Cedars-Sinai Medical Center, Los Angeles.

Early screening improves outcomes in gastric cancer, Burch noted, and survival benefits are reflected in several East Asian countries that offer gastric cancer screening starting at age 40. In one study from Korea, a single upper endoscopy was associated with an approximate 40% reduction in gastric cancer mortality compared with no screening.

In the US, lack of funding for GI cancer screening remains a barrier to early identification, Burch emphasized. The impact is wide-ranging, contributing to increased morbidity and mortality in younger adults often in their most productive years, leading to lost wages and emotional strains upon patients and their families.Routine endoscopic or imaging screening is not typically performed in the US, and newer blood-based tests such as circulating tumor DNA are not yet sensitive enough to reliably detect very early-stage disease. Nonetheless, there is evidence that noninvasive biomarkers could soon help expand GI cancer screening.

In a study published in JAMA Surgery, Sui and colleagues tested a 10-microRNA signature assay (Destinex) for early detection of gastric cancer and reported robust identification rates above 95%.

“In recent years, the liquid biopsy has gained momentum with the hope of augmenting cancer detection from peripheral blood, even indicating potential as a screening test for healthy populations,” wrote Max R. Coffey, MD, and Vivian E. Strong, MD, both of the Memorial Sloan Kettering Cancer Center in New York City, in an accompanying editorial.

“Early detection is absolutely critical; when gastric cancer is found early, outcomes are dramatically better,” Strong told GI & Hepatology News. Subtle symptoms — reflux, persistent GI discomfort, or unexplained weight loss — should never be ignored, she added.

Early detection should also focus on additional risk factors such as prior Helicobacter pylori infection, smoking, and family history.

“Anyone with a personal or family history of H pylori should have very careful follow-up, and if one household member tests positive, all should be checked,” Strong said. “Just as importantly, if one or more family members have had stomach cancer, that should be discussed with a healthcare provider, as it may warrant higher-level surveillance and genetic testing.” 

Individuals concerned about increased risk for GI cancer should proactively ask their doctors whether they might benefit from testing or surveillance, Strong added.

“Lifestyle changes, timely medical evaluation, and tailored surveillance all play a vital role in prevention.”

DeVito disclosed clinical trial funding from the Gateway foundation, Xilio, Phanes, Astellas, GSK, as well as consulting fees/advisory board participation for Guardant, Agenus, and Xilio. Strong disclosed speaking honoraria for Merck and Astra Zeneca.

The study by Sui and colleagues was supported by the National Cancer Institute, National Institutes of Health, as well as by a grant from the American Gastroenterological Association Robert & Sally Funderburg Research Award in Gastric Cancer, and the Stupid Strong Foundation.

Burch had no financial conflicts to disclose.

 

A version of this article appeared on Medscape.com.

Early-onset gastrointestinal (GI) cancers are climbing among those younger than 50 years, in the US and globally. Although colorectal cancer accounts for approximately half of such cases, rates are also increasing for gastric, esophageal, pancreatic, and several rarer GI malignancies.

Because most in this age group are not included in screening protocols and may present with vague symptoms, diagnosis and treatment is frequently delayed. According to experts in the field, counteracting this trend requires establishing a lower threshold for evaluation, attention to modifiable risk factors, and embracing emerging noninvasive diagnostic tools.

 

Diagnostic Dilemmas

“Colorectal cancer in particular is often diagnosed later in life,” said Nicholas DeVito, MD, assistant professor at Duke University Medical Center, Durham, North Carolina, and a specialist in GI malignancies. “When the patient is too young for routine screening colonoscopy (< 45 years), they aren’t screened at all, they do not have alarming symptoms, or their symptoms are overlooked.” Other increasingly common GI cancers in young people (esophageal, gastric, pancreatic) lack routine screening guidelines due to limited evidence, he added.

Symptoms such as nausea, weight loss, upset stomach, and abdominal pain are often nonspecific and have many other potential causes, so GI cancers may not be high on the list of possible diagnoses in patients younger than 50 years, said DeVito.

“Insurance coverage, socioeconomic status, appointment availability, and awareness of symptoms and screening methods are all barriers to diagnosis as well, which affect the diagnostic timeline of many cancers,” he added.“While there are multiple factors that contribute to a cancer diagnosis, it seems that obesity, a Western diet, a sedentary lifestyle are all major contributors to the rise in early GI cancers,” DeVito told GI & Hepatology News. “There is no blame or judgement to go around as cancer can happen to anyone at any time, with none of these factors present,” he emphasized.

When counseling patients about GI cancer risk, DeVito recommends keeping advice simple and specific. In general, they should restrict red meat to once a week, emphasize fresh fruits and vegetables, cap alcohol to ≤ 1 serving per day, and limit ultraprocessed foods (e.g., packaged snacks, preprepared meals, and sugary beverages).

Exercise is another pillar. “Find an activity you enjoy and work toward 30 minutes of aerobic exercise three times a week,” he advised. He also encourages finding opportunities to incorporate physical activity in daily lives, such as using a standing desk at work, while keeping patients’ socioeconomic constraints in mind.

Evidence around GI cancer prevention interventions is still evolving. However, a randomized phase 3 trial presented at American Society of Clinical Oncology’s 2025 meeting found significant improvement in disease-free survival among adults with resected stage III or high-risk stage II colon cancer (median age, 61 years) who reported higher intake of anti-inflammatory foods and greater exercise than a comparator group.

“In general, clinicians should be aware of the risk factors, make referrals to physical therapy, weight-loss specialists, endocrinologists, and nutritionists when appropriate, and be consistent and clear with patients about recommendations and what’s achievable,” DeVito said. “Meeting patients where they are can help make incremental progress, as these interventions take time and patience, and we should be understanding of that.” 

Identifying at-risk younger adults goes beyond discussing family history and obesity to include diet, exercise, and daily lifestyle, he added.

“Symptoms of potential GI cancer need to be taken seriously in all patients, and there should be a lower threshold in 2025 to get a colonoscopy, endoscopy, or CT scan than in previous years given all that we know today. We then need to establish through clinical studies who needs screening tests and who doesn’t, and what interventions work best to reduce risk.” 

 

Vigilance in the Absence of Screening

“Most GI cancers, unfortunately, can grow a fair amount before symptoms arise, so many patients present with symptoms only when a tumor has grown enough to affect organ function,” said Miguel Burch, MD, chief of minimally invasive and GI surgery at Cedars-Sinai Medical Center, Los Angeles.

Early screening improves outcomes in gastric cancer, Burch noted, and survival benefits are reflected in several East Asian countries that offer gastric cancer screening starting at age 40. In one study from Korea, a single upper endoscopy was associated with an approximate 40% reduction in gastric cancer mortality compared with no screening.

In the US, lack of funding for GI cancer screening remains a barrier to early identification, Burch emphasized. The impact is wide-ranging, contributing to increased morbidity and mortality in younger adults often in their most productive years, leading to lost wages and emotional strains upon patients and their families.Routine endoscopic or imaging screening is not typically performed in the US, and newer blood-based tests such as circulating tumor DNA are not yet sensitive enough to reliably detect very early-stage disease. Nonetheless, there is evidence that noninvasive biomarkers could soon help expand GI cancer screening.

In a study published in JAMA Surgery, Sui and colleagues tested a 10-microRNA signature assay (Destinex) for early detection of gastric cancer and reported robust identification rates above 95%.

“In recent years, the liquid biopsy has gained momentum with the hope of augmenting cancer detection from peripheral blood, even indicating potential as a screening test for healthy populations,” wrote Max R. Coffey, MD, and Vivian E. Strong, MD, both of the Memorial Sloan Kettering Cancer Center in New York City, in an accompanying editorial.

“Early detection is absolutely critical; when gastric cancer is found early, outcomes are dramatically better,” Strong told GI & Hepatology News. Subtle symptoms — reflux, persistent GI discomfort, or unexplained weight loss — should never be ignored, she added.

Early detection should also focus on additional risk factors such as prior Helicobacter pylori infection, smoking, and family history.

“Anyone with a personal or family history of H pylori should have very careful follow-up, and if one household member tests positive, all should be checked,” Strong said. “Just as importantly, if one or more family members have had stomach cancer, that should be discussed with a healthcare provider, as it may warrant higher-level surveillance and genetic testing.” 

Individuals concerned about increased risk for GI cancer should proactively ask their doctors whether they might benefit from testing or surveillance, Strong added.

“Lifestyle changes, timely medical evaluation, and tailored surveillance all play a vital role in prevention.”

DeVito disclosed clinical trial funding from the Gateway foundation, Xilio, Phanes, Astellas, GSK, as well as consulting fees/advisory board participation for Guardant, Agenus, and Xilio. Strong disclosed speaking honoraria for Merck and Astra Zeneca.

The study by Sui and colleagues was supported by the National Cancer Institute, National Institutes of Health, as well as by a grant from the American Gastroenterological Association Robert & Sally Funderburg Research Award in Gastric Cancer, and the Stupid Strong Foundation.

Burch had no financial conflicts to disclose.

 

A version of this article appeared on Medscape.com.

Routine use of artificial intelligence (AI) may lead to a loss of skills among clinicians who perform colonoscopies, thereby affecting patient outcomes, a large observational study suggested.

“The extent and consistency of the adenoma detection rate (ADR) drop after long-term AI use were not expected,” study authors Krzysztof Budzyń, MD, and Marcin Romańczyk, MD, of the Academy of Silesia, Katowice, Poland, told GI & Hepatology News. “We thought there might be a small effect, but the 6% absolute decrease — observed in several centers and among most endoscopists — points to a genuine change in behavior. This was especially notable because all participants were very experienced, with more than 2000 colonoscopies each.”

Another unexpected result, they said, “was that the decrease was stronger in centers with higher starting ADRs and in certain patient groups, such as women under 60. We had assumed experienced clinicians would be less affected, but our results show that even highly skilled practitioners can be influenced.”

The study was published online in The Lancet Gastroenterology & Hepatology.

 

ADR Reduced After AI Use

To assess how endoscopists who used AI regularly performed colonoscopy when AI was not in use, researchers conducted a retrospective, observational study at four endoscopy centers in Poland taking part in the ACCEPT trial.

These centers introduced AI tools for polyp detection at the end of 2021, after which colonoscopies were randomly assigned to be done with or without AI assistance.

The researchers assessed colonoscopy quality by comparing two different phases: 3 months before and 3 months after AI implementation. All diagnostic colonoscopies were included, except for those involving intensive anticoagulant use, pregnancy, or a history of colorectal resection or inflammatory bowel disease.

The primary outcome was the change in the ADR of standard, non-AI-assisted colonoscopy before and after AI exposure.

Between September 2021 and March 2022, a total of 2177 colonoscopies were conducted, including 1443 without AI use and 734 with AI. The current analysis focused on the 795 patients who underwent non-AI-assisted colonoscopy before the introduction of AI and the 648 who underwent non-AI-assisted colonoscopy after.

Participants’ median age was 61 years, and 59% were women. The colonoscopies were performed by 19 experienced endoscopists who had conducted over 2000 colonoscopies each.

The ADR of standard colonoscopy decreased significantly from 28.4% (226 of 795) before the introduction of AI to 22.4% (145 of 648) after, corresponding to a 20% relative and 6% absolute reduction in the ADR.

The ADR for AI-assisted colonoscopies was 25.3% (186 of 734).

The number of adenomas per colonoscopy (APC) in patients with at least one adenoma detected did not change significantly between the groups before and after AI exposure, with a mean of 1.91 before vs 1.92 after. Similarly, the number of mean advanced APC was comparable between the two periods (0.062 vs 0.063).

The mean advanced APC detection on standard colonoscopy in patients with at least one adenoma detected was 0.22 before AI exposure and 0.28 after AI exposure.

Colorectal cancers were detected in 6 (0.8%) of 795 colonoscopies before AI exposure and in 8 (1.2%) of 648 after AI exposure.

In multivariable logistic regression analysis, exposure to AI (odds ratio [OR], 0.69), patient’s male sex (OR, 1.78), and patient age at least 60 years (OR, 3.60) were independent factors significantly associated with ADR.

In all centers, the ADR for standard, non-AI-assisted colonoscopy was reduced after AI exposure, although the magnitude of ADR reduction varied greatly between centers, according to the authors.

“Clinicians should be aware that while AI can boost detection rates, prolonged reliance may subtly affect their performance when the technology is not available,” Budzyń and Romańczyk said. “This does not mean AI should be avoided — rather, it highlights the need for conscious engagement with the task, even when AI is assisting. Monitoring one’s own detection rates in both AI-assisted and non-AI-assisted procedures can help identify changes early.”

“Endoscopists should view AI as a collaborative partner, not a replacement for their vigilance and judgment,” they concluded. “Integrating AI effectively means using it to complement, not substitute, core observational and diagnostic skills. In short, enjoy the benefits of AI, but keep your skills sharp — your patients depend on both.”

Omer Ahmed, MD, of University College London, London, England, gives a similar message in a related editorial. The study “compels us to carefully consider the effect of AI integration into routine endoscopic practice,” he wrote. “Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy.”

 

‘Certainly a Signal’

Commenting on the study for GI & Hepatology News, Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, said, “On the face of it, these findings would seem to correlate with all our lived experiences as humans. Any skill or task that we give to a machine will inherently ‘de-skill’ or weaken our ability to perform it.”

“The only way to miss a polyp is either due to lack of attention/recognition of a polyp in the field of view or a lack of fold exposure and cleansing,” said Bhuta, who was not involved in the study. “For AI to specifically de-skill polyp detection, it would mean the AI is conditioning physicians to pay less active attention during the procedure, similar to the way a driver may pay less attention in a car that has self-driving capabilities.”

That said, he noted that this is a small retrospective observational study with a short timeframe and an average of fewer than 100 colonoscopies per physician.

“My own ADR may vary by 8% or more by random chance in such a small dataset,” he said. “It’s hard to draw any real conclusions, but it is certainly a signal.”

The issue of de-skilling goes beyond gastroenterology and medicine, Bhuta noted. “We have invented millions of machines that have ‘de-skilled’ us in thousands of small ways, and mostly, we have benefited as a society. However, we’ve never had a machine that can de-skill our attention, our creativity, and our reason.”

“The question is not whether AI will de-skill us but when, where, and how do we set the boundaries of what we want a machine to do for us,” he said. “What is lost and what is gained by AI taking over these roles, and is that an acceptable trade-off?”

The study was funded by the European Commission and the Japan Society for the Promotion of Science. Budzyń, Romańczyk, and Bhuta declared having no competing interests. Ahmed declared receiving medical consultancy fees from Olympus, Odin Vision, Medtronic, and Norgine.

A version of this article appeared on Medscape.com.

Routine use of artificial intelligence (AI) may lead to a loss of skills among clinicians who perform colonoscopies, thereby affecting patient outcomes, a large observational study suggested.

“The extent and consistency of the adenoma detection rate (ADR) drop after long-term AI use were not expected,” study authors Krzysztof Budzyń, MD, and Marcin Romańczyk, MD, of the Academy of Silesia, Katowice, Poland, told GI & Hepatology News. “We thought there might be a small effect, but the 6% absolute decrease — observed in several centers and among most endoscopists — points to a genuine change in behavior. This was especially notable because all participants were very experienced, with more than 2000 colonoscopies each.”

Another unexpected result, they said, “was that the decrease was stronger in centers with higher starting ADRs and in certain patient groups, such as women under 60. We had assumed experienced clinicians would be less affected, but our results show that even highly skilled practitioners can be influenced.”

The study was published online in The Lancet Gastroenterology & Hepatology.

 

ADR Reduced After AI Use

To assess how endoscopists who used AI regularly performed colonoscopy when AI was not in use, researchers conducted a retrospective, observational study at four endoscopy centers in Poland taking part in the ACCEPT trial.

These centers introduced AI tools for polyp detection at the end of 2021, after which colonoscopies were randomly assigned to be done with or without AI assistance.

The researchers assessed colonoscopy quality by comparing two different phases: 3 months before and 3 months after AI implementation. All diagnostic colonoscopies were included, except for those involving intensive anticoagulant use, pregnancy, or a history of colorectal resection or inflammatory bowel disease.

The primary outcome was the change in the ADR of standard, non-AI-assisted colonoscopy before and after AI exposure.

Between September 2021 and March 2022, a total of 2177 colonoscopies were conducted, including 1443 without AI use and 734 with AI. The current analysis focused on the 795 patients who underwent non-AI-assisted colonoscopy before the introduction of AI and the 648 who underwent non-AI-assisted colonoscopy after.

Participants’ median age was 61 years, and 59% were women. The colonoscopies were performed by 19 experienced endoscopists who had conducted over 2000 colonoscopies each.

The ADR of standard colonoscopy decreased significantly from 28.4% (226 of 795) before the introduction of AI to 22.4% (145 of 648) after, corresponding to a 20% relative and 6% absolute reduction in the ADR.

The ADR for AI-assisted colonoscopies was 25.3% (186 of 734).

The number of adenomas per colonoscopy (APC) in patients with at least one adenoma detected did not change significantly between the groups before and after AI exposure, with a mean of 1.91 before vs 1.92 after. Similarly, the number of mean advanced APC was comparable between the two periods (0.062 vs 0.063).

The mean advanced APC detection on standard colonoscopy in patients with at least one adenoma detected was 0.22 before AI exposure and 0.28 after AI exposure.

Colorectal cancers were detected in 6 (0.8%) of 795 colonoscopies before AI exposure and in 8 (1.2%) of 648 after AI exposure.

In multivariable logistic regression analysis, exposure to AI (odds ratio [OR], 0.69), patient’s male sex (OR, 1.78), and patient age at least 60 years (OR, 3.60) were independent factors significantly associated with ADR.

In all centers, the ADR for standard, non-AI-assisted colonoscopy was reduced after AI exposure, although the magnitude of ADR reduction varied greatly between centers, according to the authors.

“Clinicians should be aware that while AI can boost detection rates, prolonged reliance may subtly affect their performance when the technology is not available,” Budzyń and Romańczyk said. “This does not mean AI should be avoided — rather, it highlights the need for conscious engagement with the task, even when AI is assisting. Monitoring one’s own detection rates in both AI-assisted and non-AI-assisted procedures can help identify changes early.”

“Endoscopists should view AI as a collaborative partner, not a replacement for their vigilance and judgment,” they concluded. “Integrating AI effectively means using it to complement, not substitute, core observational and diagnostic skills. In short, enjoy the benefits of AI, but keep your skills sharp — your patients depend on both.”

Omer Ahmed, MD, of University College London, London, England, gives a similar message in a related editorial. The study “compels us to carefully consider the effect of AI integration into routine endoscopic practice,” he wrote. “Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy.”

 

‘Certainly a Signal’

Commenting on the study for GI & Hepatology News, Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, said, “On the face of it, these findings would seem to correlate with all our lived experiences as humans. Any skill or task that we give to a machine will inherently ‘de-skill’ or weaken our ability to perform it.”

“The only way to miss a polyp is either due to lack of attention/recognition of a polyp in the field of view or a lack of fold exposure and cleansing,” said Bhuta, who was not involved in the study. “For AI to specifically de-skill polyp detection, it would mean the AI is conditioning physicians to pay less active attention during the procedure, similar to the way a driver may pay less attention in a car that has self-driving capabilities.”

That said, he noted that this is a small retrospective observational study with a short timeframe and an average of fewer than 100 colonoscopies per physician.

“My own ADR may vary by 8% or more by random chance in such a small dataset,” he said. “It’s hard to draw any real conclusions, but it is certainly a signal.”

The issue of de-skilling goes beyond gastroenterology and medicine, Bhuta noted. “We have invented millions of machines that have ‘de-skilled’ us in thousands of small ways, and mostly, we have benefited as a society. However, we’ve never had a machine that can de-skill our attention, our creativity, and our reason.”

“The question is not whether AI will de-skill us but when, where, and how do we set the boundaries of what we want a machine to do for us,” he said. “What is lost and what is gained by AI taking over these roles, and is that an acceptable trade-off?”

The study was funded by the European Commission and the Japan Society for the Promotion of Science. Budzyń, Romańczyk, and Bhuta declared having no competing interests. Ahmed declared receiving medical consultancy fees from Olympus, Odin Vision, Medtronic, and Norgine.

A version of this article appeared on Medscape.com.

Routine use of artificial intelligence (AI) may lead to a loss of skills among clinicians who perform colonoscopies, thereby affecting patient outcomes, a large observational study suggested.

“The extent and consistency of the adenoma detection rate (ADR) drop after long-term AI use were not expected,” study authors Krzysztof Budzyń, MD, and Marcin Romańczyk, MD, of the Academy of Silesia, Katowice, Poland, told GI & Hepatology News. “We thought there might be a small effect, but the 6% absolute decrease — observed in several centers and among most endoscopists — points to a genuine change in behavior. This was especially notable because all participants were very experienced, with more than 2000 colonoscopies each.”

Another unexpected result, they said, “was that the decrease was stronger in centers with higher starting ADRs and in certain patient groups, such as women under 60. We had assumed experienced clinicians would be less affected, but our results show that even highly skilled practitioners can be influenced.”

The study was published online in The Lancet Gastroenterology & Hepatology.

 

ADR Reduced After AI Use

To assess how endoscopists who used AI regularly performed colonoscopy when AI was not in use, researchers conducted a retrospective, observational study at four endoscopy centers in Poland taking part in the ACCEPT trial.

These centers introduced AI tools for polyp detection at the end of 2021, after which colonoscopies were randomly assigned to be done with or without AI assistance.

The researchers assessed colonoscopy quality by comparing two different phases: 3 months before and 3 months after AI implementation. All diagnostic colonoscopies were included, except for those involving intensive anticoagulant use, pregnancy, or a history of colorectal resection or inflammatory bowel disease.

The primary outcome was the change in the ADR of standard, non-AI-assisted colonoscopy before and after AI exposure.

Between September 2021 and March 2022, a total of 2177 colonoscopies were conducted, including 1443 without AI use and 734 with AI. The current analysis focused on the 795 patients who underwent non-AI-assisted colonoscopy before the introduction of AI and the 648 who underwent non-AI-assisted colonoscopy after.

Participants’ median age was 61 years, and 59% were women. The colonoscopies were performed by 19 experienced endoscopists who had conducted over 2000 colonoscopies each.

The ADR of standard colonoscopy decreased significantly from 28.4% (226 of 795) before the introduction of AI to 22.4% (145 of 648) after, corresponding to a 20% relative and 6% absolute reduction in the ADR.

The ADR for AI-assisted colonoscopies was 25.3% (186 of 734).

The number of adenomas per colonoscopy (APC) in patients with at least one adenoma detected did not change significantly between the groups before and after AI exposure, with a mean of 1.91 before vs 1.92 after. Similarly, the number of mean advanced APC was comparable between the two periods (0.062 vs 0.063).

The mean advanced APC detection on standard colonoscopy in patients with at least one adenoma detected was 0.22 before AI exposure and 0.28 after AI exposure.

Colorectal cancers were detected in 6 (0.8%) of 795 colonoscopies before AI exposure and in 8 (1.2%) of 648 after AI exposure.

In multivariable logistic regression analysis, exposure to AI (odds ratio [OR], 0.69), patient’s male sex (OR, 1.78), and patient age at least 60 years (OR, 3.60) were independent factors significantly associated with ADR.

In all centers, the ADR for standard, non-AI-assisted colonoscopy was reduced after AI exposure, although the magnitude of ADR reduction varied greatly between centers, according to the authors.

“Clinicians should be aware that while AI can boost detection rates, prolonged reliance may subtly affect their performance when the technology is not available,” Budzyń and Romańczyk said. “This does not mean AI should be avoided — rather, it highlights the need for conscious engagement with the task, even when AI is assisting. Monitoring one’s own detection rates in both AI-assisted and non-AI-assisted procedures can help identify changes early.”

“Endoscopists should view AI as a collaborative partner, not a replacement for their vigilance and judgment,” they concluded. “Integrating AI effectively means using it to complement, not substitute, core observational and diagnostic skills. In short, enjoy the benefits of AI, but keep your skills sharp — your patients depend on both.”

Omer Ahmed, MD, of University College London, London, England, gives a similar message in a related editorial. The study “compels us to carefully consider the effect of AI integration into routine endoscopic practice,” he wrote. “Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy.”

 

‘Certainly a Signal’

Commenting on the study for GI & Hepatology News, Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at Temple University and a gastroenterologist at Temple University Hospital, both in Philadelphia, said, “On the face of it, these findings would seem to correlate with all our lived experiences as humans. Any skill or task that we give to a machine will inherently ‘de-skill’ or weaken our ability to perform it.”

“The only way to miss a polyp is either due to lack of attention/recognition of a polyp in the field of view or a lack of fold exposure and cleansing,” said Bhuta, who was not involved in the study. “For AI to specifically de-skill polyp detection, it would mean the AI is conditioning physicians to pay less active attention during the procedure, similar to the way a driver may pay less attention in a car that has self-driving capabilities.”

That said, he noted that this is a small retrospective observational study with a short timeframe and an average of fewer than 100 colonoscopies per physician.

“My own ADR may vary by 8% or more by random chance in such a small dataset,” he said. “It’s hard to draw any real conclusions, but it is certainly a signal.”

The issue of de-skilling goes beyond gastroenterology and medicine, Bhuta noted. “We have invented millions of machines that have ‘de-skilled’ us in thousands of small ways, and mostly, we have benefited as a society. However, we’ve never had a machine that can de-skill our attention, our creativity, and our reason.”

“The question is not whether AI will de-skill us but when, where, and how do we set the boundaries of what we want a machine to do for us,” he said. “What is lost and what is gained by AI taking over these roles, and is that an acceptable trade-off?”

The study was funded by the European Commission and the Japan Society for the Promotion of Science. Budzyń, Romańczyk, and Bhuta declared having no competing interests. Ahmed declared receiving medical consultancy fees from Olympus, Odin Vision, Medtronic, and Norgine.

A version of this article appeared on Medscape.com.

TOPLINE:

The incidence of skin cancer in England varied by ethnicity: White individuals had higher rates of melanoma, cutaneous squamous cell carcinoma, and basal cell carcinoma than Asian or Black individuals. In contrast, acral lentiginous melanoma was most common among Black individuals, whereas cutaneous T-cell lymphoma and Kaposi sarcoma were highest among those in the "Other" ethnic group.

METHODOLOGY:

• Researchers analysed all cases of cutaneous melanoma (melanoma and acral lentiginous melanoma), basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous T-cell lymphoma, and Kaposi sarcoma using data from the NHS National Disease Registration Service cancer registry between 2013 and 2020.
• Data collection incorporated ethnicity information from multiple health care datasets, including Clinical Outcomes and Services Dataset, Patient Administration System, Radiotherapy Dataset, Diagnostic Imaging Dataset, and Hospital Episode Statistics.
• A population analysis categorised patients into 7 standardised ethnic groups (on the basis of Office for National Statistics classifications): White, Asian, Chinese, Black, mixed, other, and unknown groups, with ethnicity data being self-reported by patients.
• Outcomes included European age-standardised rates calculated using the 2013 European Standard Population and reported per 100,000 person-years (PYs).

TAKEAWAY:

• White Individuals had 13-fold higher rates of cutaneous squamous cell carcinoma (61.75 per 100,000 PYs), 26-fold and 27-fold higher rates of basal cell carcinoma (153.69 per 100,000 PYs), and 33-fold and 16-fold higher rates of cutaneous melanoma (27.29 per 100,000 PYs) than Asian and Black individuals, respectively.
• Black individuals had the highest incidence of acral lentiginous melanoma (0.85 per 100,000 PYs), and those in the other ethnic group had the highest incidence of cutaneous T-cell lymphoma (1.74 per 100,000 PYs) and Kaposi sarcoma (1.57 per 100,000 PYs).
• The presentation of early-stage melanoma was low among Asian (53.5%), Black (62.4%), mixed (62.5%), and other (76.4%) ethnic groups compared to that among White ethnicities (79.8%).
• Acral lentiginous melanomas were less likely to get urgent suspected cancer pathway referrals than overall melanoma (40.1% vs 44.6%; P < .001) and more likely to be diagnosed late than overall melanoma (stage I/II at diagnosis; 72% vs 80%; P < .0001).

IN PRACTICE:

"The findings emphasise the need for better, targeted ethnicity data collection strategies to address incidence, outcomes and health care equity for not just skin cancer but all health conditions in underserved populations," the authors wrote. "While projects like the Global Burden of Disease have improved global health care reporting, continuous audit and improvement of collected data are essential to provide better care across people of all ethnicities."

SOURCE:

This study was led by Shehnaz Ahmed, British Association of Dermatologists, London, England. It was published online on September 10, 2025, in the British Journal of Dermatology.

LIMITATIONS:

Census data collection after every 10 years could have contributed to inaccurate population estimates and incidence rates. Small sample sizes in certain ethnic groups could have led to potential confounders, requiring a cautious interpretation of relative incidence. The NHS data included only self-reported ethnicity data with no available details of skin phototypes, skin tones, or racial ancestry. This study lacked granular ethnicity census data and stage data for basal cell carcinoma, cutaneous small cell carcinoma, and Kaposi sarcoma.

DISCLOSURES:

This research was supported through a partnership between the British Association of Dermatologists and NHS England's National Disease Registration Service. Two authors reported being employees of the British Association of Dermatologists.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

The incidence of skin cancer in England varied by ethnicity: White individuals had higher rates of melanoma, cutaneous squamous cell carcinoma, and basal cell carcinoma than Asian or Black individuals. In contrast, acral lentiginous melanoma was most common among Black individuals, whereas cutaneous T-cell lymphoma and Kaposi sarcoma were highest among those in the "Other" ethnic group.

METHODOLOGY:

• Researchers analysed all cases of cutaneous melanoma (melanoma and acral lentiginous melanoma), basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous T-cell lymphoma, and Kaposi sarcoma using data from the NHS National Disease Registration Service cancer registry between 2013 and 2020.
• Data collection incorporated ethnicity information from multiple health care datasets, including Clinical Outcomes and Services Dataset, Patient Administration System, Radiotherapy Dataset, Diagnostic Imaging Dataset, and Hospital Episode Statistics.
• A population analysis categorised patients into 7 standardised ethnic groups (on the basis of Office for National Statistics classifications): White, Asian, Chinese, Black, mixed, other, and unknown groups, with ethnicity data being self-reported by patients.
• Outcomes included European age-standardised rates calculated using the 2013 European Standard Population and reported per 100,000 person-years (PYs).

TAKEAWAY:

• White Individuals had 13-fold higher rates of cutaneous squamous cell carcinoma (61.75 per 100,000 PYs), 26-fold and 27-fold higher rates of basal cell carcinoma (153.69 per 100,000 PYs), and 33-fold and 16-fold higher rates of cutaneous melanoma (27.29 per 100,000 PYs) than Asian and Black individuals, respectively.
• Black individuals had the highest incidence of acral lentiginous melanoma (0.85 per 100,000 PYs), and those in the other ethnic group had the highest incidence of cutaneous T-cell lymphoma (1.74 per 100,000 PYs) and Kaposi sarcoma (1.57 per 100,000 PYs).
• The presentation of early-stage melanoma was low among Asian (53.5%), Black (62.4%), mixed (62.5%), and other (76.4%) ethnic groups compared to that among White ethnicities (79.8%).
• Acral lentiginous melanomas were less likely to get urgent suspected cancer pathway referrals than overall melanoma (40.1% vs 44.6%; P < .001) and more likely to be diagnosed late than overall melanoma (stage I/II at diagnosis; 72% vs 80%; P < .0001).

IN PRACTICE:

"The findings emphasise the need for better, targeted ethnicity data collection strategies to address incidence, outcomes and health care equity for not just skin cancer but all health conditions in underserved populations," the authors wrote. "While projects like the Global Burden of Disease have improved global health care reporting, continuous audit and improvement of collected data are essential to provide better care across people of all ethnicities."

SOURCE:

This study was led by Shehnaz Ahmed, British Association of Dermatologists, London, England. It was published online on September 10, 2025, in the British Journal of Dermatology.

LIMITATIONS:

Census data collection after every 10 years could have contributed to inaccurate population estimates and incidence rates. Small sample sizes in certain ethnic groups could have led to potential confounders, requiring a cautious interpretation of relative incidence. The NHS data included only self-reported ethnicity data with no available details of skin phototypes, skin tones, or racial ancestry. This study lacked granular ethnicity census data and stage data for basal cell carcinoma, cutaneous small cell carcinoma, and Kaposi sarcoma.

DISCLOSURES:

This research was supported through a partnership between the British Association of Dermatologists and NHS England's National Disease Registration Service. Two authors reported being employees of the British Association of Dermatologists.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

The incidence of skin cancer in England varied by ethnicity: White individuals had higher rates of melanoma, cutaneous squamous cell carcinoma, and basal cell carcinoma than Asian or Black individuals. In contrast, acral lentiginous melanoma was most common among Black individuals, whereas cutaneous T-cell lymphoma and Kaposi sarcoma were highest among those in the "Other" ethnic group.

METHODOLOGY:

• Researchers analysed all cases of cutaneous melanoma (melanoma and acral lentiginous melanoma), basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous T-cell lymphoma, and Kaposi sarcoma using data from the NHS National Disease Registration Service cancer registry between 2013 and 2020.
• Data collection incorporated ethnicity information from multiple health care datasets, including Clinical Outcomes and Services Dataset, Patient Administration System, Radiotherapy Dataset, Diagnostic Imaging Dataset, and Hospital Episode Statistics.
• A population analysis categorised patients into 7 standardised ethnic groups (on the basis of Office for National Statistics classifications): White, Asian, Chinese, Black, mixed, other, and unknown groups, with ethnicity data being self-reported by patients.
• Outcomes included European age-standardised rates calculated using the 2013 European Standard Population and reported per 100,000 person-years (PYs).

TAKEAWAY:

• White Individuals had 13-fold higher rates of cutaneous squamous cell carcinoma (61.75 per 100,000 PYs), 26-fold and 27-fold higher rates of basal cell carcinoma (153.69 per 100,000 PYs), and 33-fold and 16-fold higher rates of cutaneous melanoma (27.29 per 100,000 PYs) than Asian and Black individuals, respectively.
• Black individuals had the highest incidence of acral lentiginous melanoma (0.85 per 100,000 PYs), and those in the other ethnic group had the highest incidence of cutaneous T-cell lymphoma (1.74 per 100,000 PYs) and Kaposi sarcoma (1.57 per 100,000 PYs).
• The presentation of early-stage melanoma was low among Asian (53.5%), Black (62.4%), mixed (62.5%), and other (76.4%) ethnic groups compared to that among White ethnicities (79.8%).
• Acral lentiginous melanomas were less likely to get urgent suspected cancer pathway referrals than overall melanoma (40.1% vs 44.6%; P < .001) and more likely to be diagnosed late than overall melanoma (stage I/II at diagnosis; 72% vs 80%; P < .0001).

IN PRACTICE:

"The findings emphasise the need for better, targeted ethnicity data collection strategies to address incidence, outcomes and health care equity for not just skin cancer but all health conditions in underserved populations," the authors wrote. "While projects like the Global Burden of Disease have improved global health care reporting, continuous audit and improvement of collected data are essential to provide better care across people of all ethnicities."

SOURCE:

This study was led by Shehnaz Ahmed, British Association of Dermatologists, London, England. It was published online on September 10, 2025, in the British Journal of Dermatology.

LIMITATIONS:

Census data collection after every 10 years could have contributed to inaccurate population estimates and incidence rates. Small sample sizes in certain ethnic groups could have led to potential confounders, requiring a cautious interpretation of relative incidence. The NHS data included only self-reported ethnicity data with no available details of skin phototypes, skin tones, or racial ancestry. This study lacked granular ethnicity census data and stage data for basal cell carcinoma, cutaneous small cell carcinoma, and Kaposi sarcoma.

DISCLOSURES:

This research was supported through a partnership between the British Association of Dermatologists and NHS England's National Disease Registration Service. Two authors reported being employees of the British Association of Dermatologists.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with inactive patterns, weekend warrior (moderate-to-vigorous physical activity [MVPA] condensed into 1-2 days per week) and regular physical activity patterns were found to be equally effective at reducing the risk for lung cancer. Neither pattern showed significant associations with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

METHODOLOGY:

• This analysis included 80,896 participants (mean age, 55.5 years; 56% women) with valid accelerometer data collected between June 2013 and December 2015.
• Participants were classified into three groups: 32,213 active weekend warriors (≥ 150 minutes of weekly MVPA with ≥ 50% achieved in 1-2 days), 22,162 active regular participants (≥ 150 minutes of MVPA but not meeting a weekend warrior pattern), and 26,521 inactive participants (< 150 minutes of MVPA).
• Researchers tracked associations between physical activity patterns and incident cases of all types of cancer plus specific cases of prostate, breast, colorectal, and lung cancer over a median follow-up duration of 6 years.

TAKEAWAY:

• Compared with inactive patterns, active weekend warrior patterns showed a significant inverse association with the risk for lung cancer (hazard ratio [HR], 0.77; 95% CI, 0.61-0.98).
• Active regular activity patterns demonstrated similar protective effects against lung cancer as inactive patterns (HR, 0.73; 95% CI, 0.56-0.96).
• Neither of the physical activity patterns showed any significant association with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

IN PRACTICE:

"Physical activity condensed into one to two days per week compared with a more balanced weekly distribution was associated with similar risk reductions of incident lung cancer, while neither pattern was associated with reduced overall, prostate, breast, and colorectal cancers," the authors of the study wrote.

SOURCE:

This study was led by Rubén López-Bueno, Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain. It was published online on September 06, 2025, in Annals of Medicine.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with inactive patterns, weekend warrior (moderate-to-vigorous physical activity [MVPA] condensed into 1-2 days per week) and regular physical activity patterns were found to be equally effective at reducing the risk for lung cancer. Neither pattern showed significant associations with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

METHODOLOGY:

• This analysis included 80,896 participants (mean age, 55.5 years; 56% women) with valid accelerometer data collected between June 2013 and December 2015.
• Participants were classified into three groups: 32,213 active weekend warriors (≥ 150 minutes of weekly MVPA with ≥ 50% achieved in 1-2 days), 22,162 active regular participants (≥ 150 minutes of MVPA but not meeting a weekend warrior pattern), and 26,521 inactive participants (< 150 minutes of MVPA).
• Researchers tracked associations between physical activity patterns and incident cases of all types of cancer plus specific cases of prostate, breast, colorectal, and lung cancer over a median follow-up duration of 6 years.

TAKEAWAY:

• Compared with inactive patterns, active weekend warrior patterns showed a significant inverse association with the risk for lung cancer (hazard ratio [HR], 0.77; 95% CI, 0.61-0.98).
• Active regular activity patterns demonstrated similar protective effects against lung cancer as inactive patterns (HR, 0.73; 95% CI, 0.56-0.96).
• Neither of the physical activity patterns showed any significant association with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

IN PRACTICE:

"Physical activity condensed into one to two days per week compared with a more balanced weekly distribution was associated with similar risk reductions of incident lung cancer, while neither pattern was associated with reduced overall, prostate, breast, and colorectal cancers," the authors of the study wrote.

SOURCE:

This study was led by Rubén López-Bueno, Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain. It was published online on September 06, 2025, in Annals of Medicine.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with inactive patterns, weekend warrior (moderate-to-vigorous physical activity [MVPA] condensed into 1-2 days per week) and regular physical activity patterns were found to be equally effective at reducing the risk for lung cancer. Neither pattern showed significant associations with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

METHODOLOGY:

• This analysis included 80,896 participants (mean age, 55.5 years; 56% women) with valid accelerometer data collected between June 2013 and December 2015.
• Participants were classified into three groups: 32,213 active weekend warriors (≥ 150 minutes of weekly MVPA with ≥ 50% achieved in 1-2 days), 22,162 active regular participants (≥ 150 minutes of MVPA but not meeting a weekend warrior pattern), and 26,521 inactive participants (< 150 minutes of MVPA).
• Researchers tracked associations between physical activity patterns and incident cases of all types of cancer plus specific cases of prostate, breast, colorectal, and lung cancer over a median follow-up duration of 6 years.

TAKEAWAY:

• Compared with inactive patterns, active weekend warrior patterns showed a significant inverse association with the risk for lung cancer (hazard ratio [HR], 0.77; 95% CI, 0.61-0.98).
• Active regular activity patterns demonstrated similar protective effects against lung cancer as inactive patterns (HR, 0.73; 95% CI, 0.56-0.96).
• Neither of the physical activity patterns showed any significant association with the overall risk for cancer or specific risks for prostate, breast, and colorectal cancers.

IN PRACTICE:

"Physical activity condensed into one to two days per week compared with a more balanced weekly distribution was associated with similar risk reductions of incident lung cancer, while neither pattern was associated with reduced overall, prostate, breast, and colorectal cancers," the authors of the study wrote.

SOURCE:

This study was led by Rubén López-Bueno, Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain. It was published online on September 06, 2025, in Annals of Medicine.

A version of this article first appeared on Medscape.com.