News

Simple exercises performed during chemotherapy may significantly reduce treatment-related cognitive impairment, according to findings from a phase 3 randomized controlled trial.

Among patients with cancer receiving 2-week cycles of chemotherapy, a structured and individualized exercise “prescription” combining walking and resistance band training significantly reduced cognitive impairment and mental fatigue compared with usual care.

The results are “practice-changing,” colead author Karen Mustian, PhD, MPH, with the Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, told Medscape Medical News. “Cancer care providers should consider incorporating structured, home-based exercise programs, such as walking and resistance band exercises, into routine chemotherapy care.”

The findings, published online in the Journal of the National Comprehensive Cancer Network (NCCN), reinforce recommendations by the NCCN that survivors with cancer-related cognitive dysfunction engage in routine physical activity.

“Many patients who need chemotherapy worry that they’ll experience ‘chemo brain,’” Lindsay L. Peterson, MD, medical oncologist at Washington University School of Medicine in St. Louis, who was not involved in this research, added in a statement.

This study offers “encouraging news” — exercise may be something patients can do to reduce their risk for cognitive impairment during chemotherapy, Peterson said.

Less Brain Fog, Mental Fatigue

Up to three-fourth of patients experience cancer-related cognitive impairment during treatment, which often occurs alongside mental fatigue. Research assessing the effects of exercise on cancer-related cognitive impairment during treatment is limited. To investigate, Mustian and colleagues enrolled 687 chemotherapy-naive adults with various cancers as well as Karnofsky performance status scores of at least 70 and no physical limitations, who were scheduled to start chemotherapy with cycles of 2, 3, or 4 weeks. Participants were randomly assigned to either the Exercise for Cancer Patients (EXCAP) intervention or usual care while undergoing chemotherapy. Developed by Mustian and colleagues, EXCAP is a 6-week, home-based, individually tailored walking and resistance band exercise program, introduced during a single in-person training session and reinforced through follow-up calls.

Before chemotherapy began, participants in both groups averaged roughly 2 miles of walking daily. After 6 weeks, patients in the EXCAP group largely maintained their activity levels, while those receiving usual care reduced their daily steps by about half. The exercise group also added resistance-band training three times per week for about 25 minutes per session, while the usual care group did no resistance exercises.

Cognitive function was measured using the Functional Assessment of Cancer Therapy-Cognitive Function questionnaire, and mental fatigue was assessed using the Multidimensional Fatigue Symptom Inventory. Blood samples were collected to measure key inflammatory markers.

Overall, across the study population, cognitive function declined and mental fatigue worsened during chemotherapy, but outcomes differed by treatment group and chemotherapy schedule.

Patients assigned to EXCAP and receiving chemotherapy on 2-week cycles fared best. More specifically, compared with usual care, EXCAP participants undergoing 2-week chemotherapy cycles reported less overall cognitive impairment (mean difference, 7.0; P = .04) and lower perceived cognitive impairment (mean difference, 4.1; P = .05). The exercisers also received fewer perceived comments from others about cognitive difficulties (mean difference, 0.6; P = .02) and reported less mental fatigue (-1.6; P < .01).

These benefits, however, were not observed in patients receiving 3- and 4-week chemotherapy cycles. In the 3-week cohort, there were no significant differences between groups in cognitive impairment (mean difference, 0.5; P = .85) or mental fatigue (mean difference, -0.2; P = .60).

“This was surprising,” Mustian said. “We really don’t know why the patients receiving chemo every 2 weeks were the ones to benefit the most. We do not have the capacity in our current data to answer that question for sure.”

However, Mustian speculated that it’s possible patients who receive their chemotherapy on differing weekly schedules receive different chemotherapy agents that have different toxicity and adverse-effect profiles.

For instance, chemotherapy among patients on a 2-week cycle may come with less severe acute adverse effects, which in turn may allow patients to remain more active throughout their treatments. On the other hand, chemotherapy among patients on a 3-week cycle may come with more severe acute adverse effects, which prevent them from staying as active.

“Once a person starts to lower their activity levels, it is more difficult to get back to their baseline levels and maintain them, and definitely harder to add anything additional to their activity routines,” Mustian said.

Immune Benefits?

Mustian and her team also assessed ties between exercise, cognitive impairment, and inflammation during chemotherapy. Previous work from the team showed that patients who received the EXCAP intervention exhibited higher immunocompetence.

In the current study, the researchers observed that a “healthy inflammatory response” — reflecting balanced increases in both proinflammatory and anti-inflammatory cytokines — was associated with better cognitive outcomes, suggesting that immune regulation may play a role in chemotherapy-related cognitive symptoms.

While chemotherapy may contribute to cognitive impairment by disrupting the body’s inflammatory and immune responses, “exercise may help keep these body systems working more normally, which could explain why patients who exercised had better thinking and less mental fatigue,” Mustian said.

Role for Exercise Oncology

Mustian suggested that oncologists consider referring patients receiving chemotherapy to exercise oncology specialists who can tailor programs for individual capabilities.

There are now > 2000 exercise oncology programs across the US. “Many of them provide both in-person and remote online opportunities for patients to access highly qualified exercise oncology professionals,” Mustian said.

Taking time to learn about community resources, developing a referral method of referral, or even providing patients with simple handouts on credible exercise programs and NCCN guidelines can help, Mustian added.

Peterson noted that, for many patients, maintaining the ability to think clearly, remember details, and stay mentally engaged during treatment is essential to preserving independence, continuing to work and care for their families, and sustaining overall quality of life.

“Interventions that are accessible and low cost, such as structured physical activity, give us a powerful opportunity not only to support long-term survivorship, but to help patients remain as cognitively sharp and mentally resilient as possible throughout treatment,” Peterson said in a statement.

This study was supported by the National Cancer Institute. Mustian and Peterson reported having no relevant disclosures.

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

Simple exercises performed during chemotherapy may significantly reduce treatment-related cognitive impairment, according to findings from a phase 3 randomized controlled trial.

Among patients with cancer receiving 2-week cycles of chemotherapy, a structured and individualized exercise “prescription” combining walking and resistance band training significantly reduced cognitive impairment and mental fatigue compared with usual care.

The results are “practice-changing,” colead author Karen Mustian, PhD, MPH, with the Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, told Medscape Medical News. “Cancer care providers should consider incorporating structured, home-based exercise programs, such as walking and resistance band exercises, into routine chemotherapy care.”

The findings, published online in the Journal of the National Comprehensive Cancer Network (NCCN), reinforce recommendations by the NCCN that survivors with cancer-related cognitive dysfunction engage in routine physical activity.

“Many patients who need chemotherapy worry that they’ll experience ‘chemo brain,’” Lindsay L. Peterson, MD, medical oncologist at Washington University School of Medicine in St. Louis, who was not involved in this research, added in a statement.

This study offers “encouraging news” — exercise may be something patients can do to reduce their risk for cognitive impairment during chemotherapy, Peterson said.

Less Brain Fog, Mental Fatigue

Up to three-fourth of patients experience cancer-related cognitive impairment during treatment, which often occurs alongside mental fatigue. Research assessing the effects of exercise on cancer-related cognitive impairment during treatment is limited. To investigate, Mustian and colleagues enrolled 687 chemotherapy-naive adults with various cancers as well as Karnofsky performance status scores of at least 70 and no physical limitations, who were scheduled to start chemotherapy with cycles of 2, 3, or 4 weeks. Participants were randomly assigned to either the Exercise for Cancer Patients (EXCAP) intervention or usual care while undergoing chemotherapy. Developed by Mustian and colleagues, EXCAP is a 6-week, home-based, individually tailored walking and resistance band exercise program, introduced during a single in-person training session and reinforced through follow-up calls.

Before chemotherapy began, participants in both groups averaged roughly 2 miles of walking daily. After 6 weeks, patients in the EXCAP group largely maintained their activity levels, while those receiving usual care reduced their daily steps by about half. The exercise group also added resistance-band training three times per week for about 25 minutes per session, while the usual care group did no resistance exercises.

Cognitive function was measured using the Functional Assessment of Cancer Therapy-Cognitive Function questionnaire, and mental fatigue was assessed using the Multidimensional Fatigue Symptom Inventory. Blood samples were collected to measure key inflammatory markers.

Overall, across the study population, cognitive function declined and mental fatigue worsened during chemotherapy, but outcomes differed by treatment group and chemotherapy schedule.

Patients assigned to EXCAP and receiving chemotherapy on 2-week cycles fared best. More specifically, compared with usual care, EXCAP participants undergoing 2-week chemotherapy cycles reported less overall cognitive impairment (mean difference, 7.0; P = .04) and lower perceived cognitive impairment (mean difference, 4.1; P = .05). The exercisers also received fewer perceived comments from others about cognitive difficulties (mean difference, 0.6; P = .02) and reported less mental fatigue (-1.6; P < .01).

These benefits, however, were not observed in patients receiving 3- and 4-week chemotherapy cycles. In the 3-week cohort, there were no significant differences between groups in cognitive impairment (mean difference, 0.5; P = .85) or mental fatigue (mean difference, -0.2; P = .60).

“This was surprising,” Mustian said. “We really don’t know why the patients receiving chemo every 2 weeks were the ones to benefit the most. We do not have the capacity in our current data to answer that question for sure.”

However, Mustian speculated that it’s possible patients who receive their chemotherapy on differing weekly schedules receive different chemotherapy agents that have different toxicity and adverse-effect profiles.

For instance, chemotherapy among patients on a 2-week cycle may come with less severe acute adverse effects, which in turn may allow patients to remain more active throughout their treatments. On the other hand, chemotherapy among patients on a 3-week cycle may come with more severe acute adverse effects, which prevent them from staying as active.

“Once a person starts to lower their activity levels, it is more difficult to get back to their baseline levels and maintain them, and definitely harder to add anything additional to their activity routines,” Mustian said.

Immune Benefits?

Mustian and her team also assessed ties between exercise, cognitive impairment, and inflammation during chemotherapy. Previous work from the team showed that patients who received the EXCAP intervention exhibited higher immunocompetence.

In the current study, the researchers observed that a “healthy inflammatory response” — reflecting balanced increases in both proinflammatory and anti-inflammatory cytokines — was associated with better cognitive outcomes, suggesting that immune regulation may play a role in chemotherapy-related cognitive symptoms.

While chemotherapy may contribute to cognitive impairment by disrupting the body’s inflammatory and immune responses, “exercise may help keep these body systems working more normally, which could explain why patients who exercised had better thinking and less mental fatigue,” Mustian said.

Role for Exercise Oncology

Mustian suggested that oncologists consider referring patients receiving chemotherapy to exercise oncology specialists who can tailor programs for individual capabilities.

There are now > 2000 exercise oncology programs across the US. “Many of them provide both in-person and remote online opportunities for patients to access highly qualified exercise oncology professionals,” Mustian said.

Taking time to learn about community resources, developing a referral method of referral, or even providing patients with simple handouts on credible exercise programs and NCCN guidelines can help, Mustian added.

Peterson noted that, for many patients, maintaining the ability to think clearly, remember details, and stay mentally engaged during treatment is essential to preserving independence, continuing to work and care for their families, and sustaining overall quality of life.

“Interventions that are accessible and low cost, such as structured physical activity, give us a powerful opportunity not only to support long-term survivorship, but to help patients remain as cognitively sharp and mentally resilient as possible throughout treatment,” Peterson said in a statement.

This study was supported by the National Cancer Institute. Mustian and Peterson reported having no relevant disclosures.

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

Simple exercises performed during chemotherapy may significantly reduce treatment-related cognitive impairment, according to findings from a phase 3 randomized controlled trial.

Among patients with cancer receiving 2-week cycles of chemotherapy, a structured and individualized exercise “prescription” combining walking and resistance band training significantly reduced cognitive impairment and mental fatigue compared with usual care.

The results are “practice-changing,” colead author Karen Mustian, PhD, MPH, with the Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, told Medscape Medical News. “Cancer care providers should consider incorporating structured, home-based exercise programs, such as walking and resistance band exercises, into routine chemotherapy care.”

The findings, published online in the Journal of the National Comprehensive Cancer Network (NCCN), reinforce recommendations by the NCCN that survivors with cancer-related cognitive dysfunction engage in routine physical activity.

“Many patients who need chemotherapy worry that they’ll experience ‘chemo brain,’” Lindsay L. Peterson, MD, medical oncologist at Washington University School of Medicine in St. Louis, who was not involved in this research, added in a statement.

This study offers “encouraging news” — exercise may be something patients can do to reduce their risk for cognitive impairment during chemotherapy, Peterson said.

Less Brain Fog, Mental Fatigue

Up to three-fourth of patients experience cancer-related cognitive impairment during treatment, which often occurs alongside mental fatigue. Research assessing the effects of exercise on cancer-related cognitive impairment during treatment is limited. To investigate, Mustian and colleagues enrolled 687 chemotherapy-naive adults with various cancers as well as Karnofsky performance status scores of at least 70 and no physical limitations, who were scheduled to start chemotherapy with cycles of 2, 3, or 4 weeks. Participants were randomly assigned to either the Exercise for Cancer Patients (EXCAP) intervention or usual care while undergoing chemotherapy. Developed by Mustian and colleagues, EXCAP is a 6-week, home-based, individually tailored walking and resistance band exercise program, introduced during a single in-person training session and reinforced through follow-up calls.

Before chemotherapy began, participants in both groups averaged roughly 2 miles of walking daily. After 6 weeks, patients in the EXCAP group largely maintained their activity levels, while those receiving usual care reduced their daily steps by about half. The exercise group also added resistance-band training three times per week for about 25 minutes per session, while the usual care group did no resistance exercises.

Cognitive function was measured using the Functional Assessment of Cancer Therapy-Cognitive Function questionnaire, and mental fatigue was assessed using the Multidimensional Fatigue Symptom Inventory. Blood samples were collected to measure key inflammatory markers.

Overall, across the study population, cognitive function declined and mental fatigue worsened during chemotherapy, but outcomes differed by treatment group and chemotherapy schedule.

Patients assigned to EXCAP and receiving chemotherapy on 2-week cycles fared best. More specifically, compared with usual care, EXCAP participants undergoing 2-week chemotherapy cycles reported less overall cognitive impairment (mean difference, 7.0; P = .04) and lower perceived cognitive impairment (mean difference, 4.1; P = .05). The exercisers also received fewer perceived comments from others about cognitive difficulties (mean difference, 0.6; P = .02) and reported less mental fatigue (-1.6; P < .01).

These benefits, however, were not observed in patients receiving 3- and 4-week chemotherapy cycles. In the 3-week cohort, there were no significant differences between groups in cognitive impairment (mean difference, 0.5; P = .85) or mental fatigue (mean difference, -0.2; P = .60).

“This was surprising,” Mustian said. “We really don’t know why the patients receiving chemo every 2 weeks were the ones to benefit the most. We do not have the capacity in our current data to answer that question for sure.”

However, Mustian speculated that it’s possible patients who receive their chemotherapy on differing weekly schedules receive different chemotherapy agents that have different toxicity and adverse-effect profiles.

For instance, chemotherapy among patients on a 2-week cycle may come with less severe acute adverse effects, which in turn may allow patients to remain more active throughout their treatments. On the other hand, chemotherapy among patients on a 3-week cycle may come with more severe acute adverse effects, which prevent them from staying as active.

“Once a person starts to lower their activity levels, it is more difficult to get back to their baseline levels and maintain them, and definitely harder to add anything additional to their activity routines,” Mustian said.

Immune Benefits?

Mustian and her team also assessed ties between exercise, cognitive impairment, and inflammation during chemotherapy. Previous work from the team showed that patients who received the EXCAP intervention exhibited higher immunocompetence.

In the current study, the researchers observed that a “healthy inflammatory response” — reflecting balanced increases in both proinflammatory and anti-inflammatory cytokines — was associated with better cognitive outcomes, suggesting that immune regulation may play a role in chemotherapy-related cognitive symptoms.

While chemotherapy may contribute to cognitive impairment by disrupting the body’s inflammatory and immune responses, “exercise may help keep these body systems working more normally, which could explain why patients who exercised had better thinking and less mental fatigue,” Mustian said.

Role for Exercise Oncology

Mustian suggested that oncologists consider referring patients receiving chemotherapy to exercise oncology specialists who can tailor programs for individual capabilities.

There are now > 2000 exercise oncology programs across the US. “Many of them provide both in-person and remote online opportunities for patients to access highly qualified exercise oncology professionals,” Mustian said.

Taking time to learn about community resources, developing a referral method of referral, or even providing patients with simple handouts on credible exercise programs and NCCN guidelines can help, Mustian added.

Peterson noted that, for many patients, maintaining the ability to think clearly, remember details, and stay mentally engaged during treatment is essential to preserving independence, continuing to work and care for their families, and sustaining overall quality of life.

“Interventions that are accessible and low cost, such as structured physical activity, give us a powerful opportunity not only to support long-term survivorship, but to help patients remain as cognitively sharp and mentally resilient as possible throughout treatment,” Peterson said in a statement.

This study was supported by the National Cancer Institute. Mustian and Peterson reported having no relevant disclosures.

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

TOPLINE:

Among young adults with suicidal ideation, factors associated with the use of crisis text services were female sex, minoritized sexual orientation, engagement with a mental health provider, and prior hospitalizations. Participants who never texted crisis lines faced barriers such as doubts about effectiveness and embarrassment.

METHODOLOGY:

• Researchers conducted a cross-sectional survey study in Oregon from August to December 2023 to identify characteristics linked to the use of crisis text services and barriers to use in young adults aged 18-24 years with suicidal ideation and financial stress.
• Overall, 118 participants were recruited through community partners and social media advertisements; 76% of them identified having a minoritized gender or sexual orientation.
• Participants completed an online survey with 38 closed-ended and two open-ended items, including questions about hospitalizations for suicidal thoughts, suicide attempts, mental health provider status, service use, decision-making factors for contacting crisis lines, and barriers preventing the use of the service.
• Differences in demographic and health care characteristics between those who had ever texted crisis lines and those who had never were examined.

TAKEAWAY:

• When asked about disclosing suicidal ideation, participants most frequently told no one (69%), told a friend/boyfriend/girlfriend (64%), and texted/chatted with a crisis line (47%).
• Female sex (P = .019) and having a minoritized sexual orientation (P = .048) were significantly associated with the use of crisis text services, whereas minoritized gender status, race, and urbanicity showed no significant association. Having a mental health provider correlated with the use of crisis text services (P = .010), as did prior hospitalization for suicidal ideation or suicide attempt (P = .003).
• Participants who had ever texted crisis lines (n = 55) most often reported using crisis text services because they had no one else to talk to (78%), felt like a burden to others (71%), and preferred anonymity (65%).
• Among 63 participants who never texted crisis lines, 84% had heard of crisis text services but chose not to use them; key reasons for not texting included believing it would not help (46%), embarrassment (41%), and preferring to solve the problem independently (35%).

IN PRACTICE:

"[The study findings] highlight that unique outreach efforts may be necessary to engage young adults reluctant to seek support," the authors wrote, further suggesting that "local and national lines could benefit from improved conversational quality within CTS [crisis text services], possibly including enhanced training for counselors to increase the personalization of counseling and sensitivity to texters' situations."

SOURCE:

The study was led by Kate LaForge, PhD, MPH, of the Center to Improve Veteran Involvement in Care at the VA Portland Healthcare System in Portland, Oregon. It was published online on March 13, 2026, in the Journal of Adolescent Health.

LIMITATIONS:

The cross-sectional design did not allow for determining causal relationships between healthcare characteristics and the use of the crisis text service. Relying on self-reported data may have introduced recall bias. The severity of suicidal ideation was not measured, and the sample size was small.

DISCLOSURES:

The research was supported by the Office of Academic Affiliations and the Office of Research and Development Health Systems Research Service, US Department of Veterans Affairs. Some authors reported being supported by various sources, including the Agency for Healthcare Research & Quality, National Institute on Drug Abuse, or Department of Veterans Affairs Health Systems Research, and one of them reported being a paid consultant for Google Health. The 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:

Among young adults with suicidal ideation, factors associated with the use of crisis text services were female sex, minoritized sexual orientation, engagement with a mental health provider, and prior hospitalizations. Participants who never texted crisis lines faced barriers such as doubts about effectiveness and embarrassment.

METHODOLOGY:

• Researchers conducted a cross-sectional survey study in Oregon from August to December 2023 to identify characteristics linked to the use of crisis text services and barriers to use in young adults aged 18-24 years with suicidal ideation and financial stress.
• Overall, 118 participants were recruited through community partners and social media advertisements; 76% of them identified having a minoritized gender or sexual orientation.
• Participants completed an online survey with 38 closed-ended and two open-ended items, including questions about hospitalizations for suicidal thoughts, suicide attempts, mental health provider status, service use, decision-making factors for contacting crisis lines, and barriers preventing the use of the service.
• Differences in demographic and health care characteristics between those who had ever texted crisis lines and those who had never were examined.

TAKEAWAY:

• When asked about disclosing suicidal ideation, participants most frequently told no one (69%), told a friend/boyfriend/girlfriend (64%), and texted/chatted with a crisis line (47%).
• Female sex (P = .019) and having a minoritized sexual orientation (P = .048) were significantly associated with the use of crisis text services, whereas minoritized gender status, race, and urbanicity showed no significant association. Having a mental health provider correlated with the use of crisis text services (P = .010), as did prior hospitalization for suicidal ideation or suicide attempt (P = .003).
• Participants who had ever texted crisis lines (n = 55) most often reported using crisis text services because they had no one else to talk to (78%), felt like a burden to others (71%), and preferred anonymity (65%).
• Among 63 participants who never texted crisis lines, 84% had heard of crisis text services but chose not to use them; key reasons for not texting included believing it would not help (46%), embarrassment (41%), and preferring to solve the problem independently (35%).

IN PRACTICE:

"[The study findings] highlight that unique outreach efforts may be necessary to engage young adults reluctant to seek support," the authors wrote, further suggesting that "local and national lines could benefit from improved conversational quality within CTS [crisis text services], possibly including enhanced training for counselors to increase the personalization of counseling and sensitivity to texters' situations."

SOURCE:

The study was led by Kate LaForge, PhD, MPH, of the Center to Improve Veteran Involvement in Care at the VA Portland Healthcare System in Portland, Oregon. It was published online on March 13, 2026, in the Journal of Adolescent Health.

LIMITATIONS:

The cross-sectional design did not allow for determining causal relationships between healthcare characteristics and the use of the crisis text service. Relying on self-reported data may have introduced recall bias. The severity of suicidal ideation was not measured, and the sample size was small.

DISCLOSURES:

The research was supported by the Office of Academic Affiliations and the Office of Research and Development Health Systems Research Service, US Department of Veterans Affairs. Some authors reported being supported by various sources, including the Agency for Healthcare Research & Quality, National Institute on Drug Abuse, or Department of Veterans Affairs Health Systems Research, and one of them reported being a paid consultant for Google Health. The 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:

Among young adults with suicidal ideation, factors associated with the use of crisis text services were female sex, minoritized sexual orientation, engagement with a mental health provider, and prior hospitalizations. Participants who never texted crisis lines faced barriers such as doubts about effectiveness and embarrassment.

METHODOLOGY:

• Researchers conducted a cross-sectional survey study in Oregon from August to December 2023 to identify characteristics linked to the use of crisis text services and barriers to use in young adults aged 18-24 years with suicidal ideation and financial stress.
• Overall, 118 participants were recruited through community partners and social media advertisements; 76% of them identified having a minoritized gender or sexual orientation.
• Participants completed an online survey with 38 closed-ended and two open-ended items, including questions about hospitalizations for suicidal thoughts, suicide attempts, mental health provider status, service use, decision-making factors for contacting crisis lines, and barriers preventing the use of the service.
• Differences in demographic and health care characteristics between those who had ever texted crisis lines and those who had never were examined.

TAKEAWAY:

• When asked about disclosing suicidal ideation, participants most frequently told no one (69%), told a friend/boyfriend/girlfriend (64%), and texted/chatted with a crisis line (47%).
• Female sex (P = .019) and having a minoritized sexual orientation (P = .048) were significantly associated with the use of crisis text services, whereas minoritized gender status, race, and urbanicity showed no significant association. Having a mental health provider correlated with the use of crisis text services (P = .010), as did prior hospitalization for suicidal ideation or suicide attempt (P = .003).
• Participants who had ever texted crisis lines (n = 55) most often reported using crisis text services because they had no one else to talk to (78%), felt like a burden to others (71%), and preferred anonymity (65%).
• Among 63 participants who never texted crisis lines, 84% had heard of crisis text services but chose not to use them; key reasons for not texting included believing it would not help (46%), embarrassment (41%), and preferring to solve the problem independently (35%).

IN PRACTICE:

"[The study findings] highlight that unique outreach efforts may be necessary to engage young adults reluctant to seek support," the authors wrote, further suggesting that "local and national lines could benefit from improved conversational quality within CTS [crisis text services], possibly including enhanced training for counselors to increase the personalization of counseling and sensitivity to texters' situations."

SOURCE:

The study was led by Kate LaForge, PhD, MPH, of the Center to Improve Veteran Involvement in Care at the VA Portland Healthcare System in Portland, Oregon. It was published online on March 13, 2026, in the Journal of Adolescent Health.

LIMITATIONS:

The cross-sectional design did not allow for determining causal relationships between healthcare characteristics and the use of the crisis text service. Relying on self-reported data may have introduced recall bias. The severity of suicidal ideation was not measured, and the sample size was small.

DISCLOSURES:

The research was supported by the Office of Academic Affiliations and the Office of Research and Development Health Systems Research Service, US Department of Veterans Affairs. Some authors reported being supported by various sources, including the Agency for Healthcare Research & Quality, National Institute on Drug Abuse, or Department of Veterans Affairs Health Systems Research, and one of them reported being a paid consultant for Google Health. The 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.

Semaglutide is linked to a small but significantly elevated risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to the results of a new study.

The risk for NAION was approximately twofold greater among people taking semaglutide than among those using an SGLT2 inhibitor, but the absolute risk was still only about 29 per 10,000 people, study author Jennifer S. Lee, MD, PhD, professor of medicine at Stanford School of Medicine in Palo Alto, California, told Medscape Medical News.

In NAION, the optic nerve suddenly loses its blood supply, leading to vision loss, sometimes described as a “stroke of the eye.”

“Clinicians should balance this rare but serious vision-loss risk against semaglutide’s meaningful cardiometabolic benefits,” said Lee, who is also chief of Research and Clinical Innovations and director of the VA National Center for Collaborative Healthcare Innovation at the VA Palo Alto Healthcare System, US Department of Veterans Affairs.

“We recommend counseling patients to seek prompt evaluation if they experience visual symptoms, particularly sudden vision changes,” she added.

The new findings, recently published in JAMA Ophthalmology, are the latest from several studies examining a possible association between NAION and semaglutide, some of which have been negative.

In the current study, the investigators analyzed US Veterans Health Administration data for a total of 11,478 veterans with type 2 diabetes (T2D) who initiated semaglutide and 90,883 who initiated an SGLT2 inhibitor (mostly empagliflozin) between March 1, 2018, and March 1, 2025. Overlap weighting was used to balance the two groups by age, BMI, A1c, sex, and race.

Over a median follow-up of 2.1 years, NAION developed in 123 initiating semaglutide vs 143 initiating SGLT2 inhibitors, with rates of 123 vs 67 per 100,000 person-years. After overlap weighting, the risk for NAION was 2.3-fold higher with semaglutide (hazard ratio [HR], 2.33, P < .001).

Over a maximum of 7.5 years of follow-up, the overlap-weighted NAION incidence was 0.29% vs 0.13% for semaglutide initiators vs SGLT2 initiators.

While the mechanism(s) for the association remains unclear, hypotheses include hypotension, volume depletion from gastrointestinal side effects, rapid glucose improvement leading to stress on the eye microvasculature, and impaired vascular autoregulation at the head of the optic nerve, Lee said.

Different Studies, Different Answers

“Growing observational evidence links GLP-1 receptor agonists, particularly semaglutide, to NAION, with similar twofold to threefold risks reported in several large analyses,” Lee told Medscape Medical News.

“However, other studies have observed attenuated or null associations,” she said. “The mechanism remains unknown and requires further investigation. More research is needed to determine whether this is a class effect or specific to semaglutide.”

A possible reason that some other studies have not found an association may be due to methodological differences, particularly in how NAION cases are identified, noted Joseph F. Rizzo III, MD, professor of ophthalmology and director of the Neuro-ophthalmology Service at Harvard Medical School in Boston.

Rizzo and colleagues were the first to conduct a study looking at this association in their own neuro-ophthalmology population, thereby guaranteeing that the diagnosis was correct but also introducing selection bias. Database studies rely on International Classification of Diseases, 10th Revision codes, and there isn’t one specifically for NAION — only for the broader category of ischemic optic neuropathy (H47.01), Rizzo told Medscape Medical News.

“There are ways to mitigate that effect, but they’re imperfect…so you may get different answers.” Rizzo previously conducted a similar large database study in people with T2D that also produced a twofold difference, although in a shorter follow-up time (6.7 months). Of the new study, he said, “It’s an active comparator study, and it’s beautiful. This SGLT2 approach is so good because GLP-1 and SGLT2 drugs tend to be used for patients with the same level of diabetes, so you’re minimizing residual confounding. I think it’s a great approach.”

Lee added that her team is looking at whether some patients “are at greater risk of NAION than others. To do this, we are refining our definition of NAION and evaluating the risks of other eye conditions that cause impaired vision. We are evaluating the risk of NAION related to other GLP-1s as well.”

Consider Ocular Risk Factors

“These [GLP-1] medicines have generally been really helpful for a lot of people. I never discourage patients from taking them,” said Rizzo.

“But if they’ve had visual loss for whatever reason…I really feel a moral responsibility to say, ‘Look, just so you’re aware, here’s what we found. The absolute risk is low, but I just want to inform you.’ Then they can make their own judgement about the level of risk.”

Lee noted that “clinicians should consider ocular risk factors such as preexisting optic nerve disease or prior NAION when prescribing.”

Rizzo extended that consideration to any patient who has experienced any type of vision loss in the past, such as due to glaucoma, diabetic retinopathy, or injury.

The study was conducted by the US Veterans Affairs with support from the VA Cooperative Studies Program. Lee reported having no further disclosures, and Rizzo reported having no relevant disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.

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

Semaglutide is linked to a small but significantly elevated risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to the results of a new study.

The risk for NAION was approximately twofold greater among people taking semaglutide than among those using an SGLT2 inhibitor, but the absolute risk was still only about 29 per 10,000 people, study author Jennifer S. Lee, MD, PhD, professor of medicine at Stanford School of Medicine in Palo Alto, California, told Medscape Medical News.

In NAION, the optic nerve suddenly loses its blood supply, leading to vision loss, sometimes described as a “stroke of the eye.”

“Clinicians should balance this rare but serious vision-loss risk against semaglutide’s meaningful cardiometabolic benefits,” said Lee, who is also chief of Research and Clinical Innovations and director of the VA National Center for Collaborative Healthcare Innovation at the VA Palo Alto Healthcare System, US Department of Veterans Affairs.

“We recommend counseling patients to seek prompt evaluation if they experience visual symptoms, particularly sudden vision changes,” she added.

The new findings, recently published in JAMA Ophthalmology, are the latest from several studies examining a possible association between NAION and semaglutide, some of which have been negative.

In the current study, the investigators analyzed US Veterans Health Administration data for a total of 11,478 veterans with type 2 diabetes (T2D) who initiated semaglutide and 90,883 who initiated an SGLT2 inhibitor (mostly empagliflozin) between March 1, 2018, and March 1, 2025. Overlap weighting was used to balance the two groups by age, BMI, A1c, sex, and race.

Over a median follow-up of 2.1 years, NAION developed in 123 initiating semaglutide vs 143 initiating SGLT2 inhibitors, with rates of 123 vs 67 per 100,000 person-years. After overlap weighting, the risk for NAION was 2.3-fold higher with semaglutide (hazard ratio [HR], 2.33, P < .001).

Over a maximum of 7.5 years of follow-up, the overlap-weighted NAION incidence was 0.29% vs 0.13% for semaglutide initiators vs SGLT2 initiators.

While the mechanism(s) for the association remains unclear, hypotheses include hypotension, volume depletion from gastrointestinal side effects, rapid glucose improvement leading to stress on the eye microvasculature, and impaired vascular autoregulation at the head of the optic nerve, Lee said.

Different Studies, Different Answers

“Growing observational evidence links GLP-1 receptor agonists, particularly semaglutide, to NAION, with similar twofold to threefold risks reported in several large analyses,” Lee told Medscape Medical News.

“However, other studies have observed attenuated or null associations,” she said. “The mechanism remains unknown and requires further investigation. More research is needed to determine whether this is a class effect or specific to semaglutide.”

A possible reason that some other studies have not found an association may be due to methodological differences, particularly in how NAION cases are identified, noted Joseph F. Rizzo III, MD, professor of ophthalmology and director of the Neuro-ophthalmology Service at Harvard Medical School in Boston.

Rizzo and colleagues were the first to conduct a study looking at this association in their own neuro-ophthalmology population, thereby guaranteeing that the diagnosis was correct but also introducing selection bias. Database studies rely on International Classification of Diseases, 10th Revision codes, and there isn’t one specifically for NAION — only for the broader category of ischemic optic neuropathy (H47.01), Rizzo told Medscape Medical News.

“There are ways to mitigate that effect, but they’re imperfect…so you may get different answers.” Rizzo previously conducted a similar large database study in people with T2D that also produced a twofold difference, although in a shorter follow-up time (6.7 months). Of the new study, he said, “It’s an active comparator study, and it’s beautiful. This SGLT2 approach is so good because GLP-1 and SGLT2 drugs tend to be used for patients with the same level of diabetes, so you’re minimizing residual confounding. I think it’s a great approach.”

Lee added that her team is looking at whether some patients “are at greater risk of NAION than others. To do this, we are refining our definition of NAION and evaluating the risks of other eye conditions that cause impaired vision. We are evaluating the risk of NAION related to other GLP-1s as well.”

Consider Ocular Risk Factors

“These [GLP-1] medicines have generally been really helpful for a lot of people. I never discourage patients from taking them,” said Rizzo.

“But if they’ve had visual loss for whatever reason…I really feel a moral responsibility to say, ‘Look, just so you’re aware, here’s what we found. The absolute risk is low, but I just want to inform you.’ Then they can make their own judgement about the level of risk.”

Lee noted that “clinicians should consider ocular risk factors such as preexisting optic nerve disease or prior NAION when prescribing.”

Rizzo extended that consideration to any patient who has experienced any type of vision loss in the past, such as due to glaucoma, diabetic retinopathy, or injury.

The study was conducted by the US Veterans Affairs with support from the VA Cooperative Studies Program. Lee reported having no further disclosures, and Rizzo reported having no relevant disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.

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

Semaglutide is linked to a small but significantly elevated risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to the results of a new study.

The risk for NAION was approximately twofold greater among people taking semaglutide than among those using an SGLT2 inhibitor, but the absolute risk was still only about 29 per 10,000 people, study author Jennifer S. Lee, MD, PhD, professor of medicine at Stanford School of Medicine in Palo Alto, California, told Medscape Medical News.

In NAION, the optic nerve suddenly loses its blood supply, leading to vision loss, sometimes described as a “stroke of the eye.”

“Clinicians should balance this rare but serious vision-loss risk against semaglutide’s meaningful cardiometabolic benefits,” said Lee, who is also chief of Research and Clinical Innovations and director of the VA National Center for Collaborative Healthcare Innovation at the VA Palo Alto Healthcare System, US Department of Veterans Affairs.

“We recommend counseling patients to seek prompt evaluation if they experience visual symptoms, particularly sudden vision changes,” she added.

The new findings, recently published in JAMA Ophthalmology, are the latest from several studies examining a possible association between NAION and semaglutide, some of which have been negative.

In the current study, the investigators analyzed US Veterans Health Administration data for a total of 11,478 veterans with type 2 diabetes (T2D) who initiated semaglutide and 90,883 who initiated an SGLT2 inhibitor (mostly empagliflozin) between March 1, 2018, and March 1, 2025. Overlap weighting was used to balance the two groups by age, BMI, A1c, sex, and race.

Over a median follow-up of 2.1 years, NAION developed in 123 initiating semaglutide vs 143 initiating SGLT2 inhibitors, with rates of 123 vs 67 per 100,000 person-years. After overlap weighting, the risk for NAION was 2.3-fold higher with semaglutide (hazard ratio [HR], 2.33, P < .001).

Over a maximum of 7.5 years of follow-up, the overlap-weighted NAION incidence was 0.29% vs 0.13% for semaglutide initiators vs SGLT2 initiators.

While the mechanism(s) for the association remains unclear, hypotheses include hypotension, volume depletion from gastrointestinal side effects, rapid glucose improvement leading to stress on the eye microvasculature, and impaired vascular autoregulation at the head of the optic nerve, Lee said.

Different Studies, Different Answers

“Growing observational evidence links GLP-1 receptor agonists, particularly semaglutide, to NAION, with similar twofold to threefold risks reported in several large analyses,” Lee told Medscape Medical News.

“However, other studies have observed attenuated or null associations,” she said. “The mechanism remains unknown and requires further investigation. More research is needed to determine whether this is a class effect or specific to semaglutide.”

A possible reason that some other studies have not found an association may be due to methodological differences, particularly in how NAION cases are identified, noted Joseph F. Rizzo III, MD, professor of ophthalmology and director of the Neuro-ophthalmology Service at Harvard Medical School in Boston.

Rizzo and colleagues were the first to conduct a study looking at this association in their own neuro-ophthalmology population, thereby guaranteeing that the diagnosis was correct but also introducing selection bias. Database studies rely on International Classification of Diseases, 10th Revision codes, and there isn’t one specifically for NAION — only for the broader category of ischemic optic neuropathy (H47.01), Rizzo told Medscape Medical News.

“There are ways to mitigate that effect, but they’re imperfect…so you may get different answers.” Rizzo previously conducted a similar large database study in people with T2D that also produced a twofold difference, although in a shorter follow-up time (6.7 months). Of the new study, he said, “It’s an active comparator study, and it’s beautiful. This SGLT2 approach is so good because GLP-1 and SGLT2 drugs tend to be used for patients with the same level of diabetes, so you’re minimizing residual confounding. I think it’s a great approach.”

Lee added that her team is looking at whether some patients “are at greater risk of NAION than others. To do this, we are refining our definition of NAION and evaluating the risks of other eye conditions that cause impaired vision. We are evaluating the risk of NAION related to other GLP-1s as well.”

Consider Ocular Risk Factors

“These [GLP-1] medicines have generally been really helpful for a lot of people. I never discourage patients from taking them,” said Rizzo.

“But if they’ve had visual loss for whatever reason…I really feel a moral responsibility to say, ‘Look, just so you’re aware, here’s what we found. The absolute risk is low, but I just want to inform you.’ Then they can make their own judgement about the level of risk.”

Lee noted that “clinicians should consider ocular risk factors such as preexisting optic nerve disease or prior NAION when prescribing.”

Rizzo extended that consideration to any patient who has experienced any type of vision loss in the past, such as due to glaucoma, diabetic retinopathy, or injury.

The study was conducted by the US Veterans Affairs with support from the VA Cooperative Studies Program. Lee reported having no further disclosures, and Rizzo reported having no relevant disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.

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

TOPLINE:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full 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:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full 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:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full 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:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant 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:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant 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:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant 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.

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

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

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

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

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

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

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

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

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

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

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

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

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant 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.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant 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.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant 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.