AVAHO

The initial plan to reduce the US Department of Veterans Affairs (VA) workforce by 15%—roughly 83,000 employees—has been revised. The VA announced that it expected to reduce its workforce by 30,000 positions through normal attrition, early retirements, and resignations by the end of fiscal year 2025, “eliminating the need for a large-scale reduction-in-force.” Most of the positions will not be replaced due to the federal hiring freeze, which has been extended for 3 months.

“Since March, we’ve been conducting a holistic review of the department centered on reducing bureaucracy and improving services to Veterans,” VA Secretary Doug Collins said in a press release. “A department-wide RIF is off the table, but that doesn’t mean we’re done improving VA.”

About 17,000 VA employees have left their jobs as of June 1. From now and Sept. 30, the department expects another reduction of nearly 12,000. Pete Kasperowicz, a VA spokesperson, said there would not be any reductions beyond the 30,000 planned.

The VA says it has multiple safeguards in place to ensure the reductions do not impact veteran care or benefits. All VA mission-critical positions are exempt from the voluntary early retirement authority and deferred resignation program, and > 350,000 positions are exempt from the federal hiring freeze. 

The release noted several other improvements regarding VA performance in 2025, among them that the disability claims backlog has been reduced by 30% and a record 2 million disability claims have been processed by June. More than 60,000 VA employees have also returned to the office, according to the release.

“As a result of our efforts, VA is headed in the right direction – both in terms of staff levels and customer service,” Collins said. “Our review has resulted in a host of new ideas for better serving Veterans that we will continue to pursue.” 

The initial plan to reduce the US Department of Veterans Affairs (VA) workforce by 15%—roughly 83,000 employees—has been revised. The VA announced that it expected to reduce its workforce by 30,000 positions through normal attrition, early retirements, and resignations by the end of fiscal year 2025, “eliminating the need for a large-scale reduction-in-force.” Most of the positions will not be replaced due to the federal hiring freeze, which has been extended for 3 months.

“Since March, we’ve been conducting a holistic review of the department centered on reducing bureaucracy and improving services to Veterans,” VA Secretary Doug Collins said in a press release. “A department-wide RIF is off the table, but that doesn’t mean we’re done improving VA.”

About 17,000 VA employees have left their jobs as of June 1. From now and Sept. 30, the department expects another reduction of nearly 12,000. Pete Kasperowicz, a VA spokesperson, said there would not be any reductions beyond the 30,000 planned.

The VA says it has multiple safeguards in place to ensure the reductions do not impact veteran care or benefits. All VA mission-critical positions are exempt from the voluntary early retirement authority and deferred resignation program, and > 350,000 positions are exempt from the federal hiring freeze. 

The release noted several other improvements regarding VA performance in 2025, among them that the disability claims backlog has been reduced by 30% and a record 2 million disability claims have been processed by June. More than 60,000 VA employees have also returned to the office, according to the release.

“As a result of our efforts, VA is headed in the right direction – both in terms of staff levels and customer service,” Collins said. “Our review has resulted in a host of new ideas for better serving Veterans that we will continue to pursue.” 

The initial plan to reduce the US Department of Veterans Affairs (VA) workforce by 15%—roughly 83,000 employees—has been revised. The VA announced that it expected to reduce its workforce by 30,000 positions through normal attrition, early retirements, and resignations by the end of fiscal year 2025, “eliminating the need for a large-scale reduction-in-force.” Most of the positions will not be replaced due to the federal hiring freeze, which has been extended for 3 months.

“Since March, we’ve been conducting a holistic review of the department centered on reducing bureaucracy and improving services to Veterans,” VA Secretary Doug Collins said in a press release. “A department-wide RIF is off the table, but that doesn’t mean we’re done improving VA.”

About 17,000 VA employees have left their jobs as of June 1. From now and Sept. 30, the department expects another reduction of nearly 12,000. Pete Kasperowicz, a VA spokesperson, said there would not be any reductions beyond the 30,000 planned.

The VA says it has multiple safeguards in place to ensure the reductions do not impact veteran care or benefits. All VA mission-critical positions are exempt from the voluntary early retirement authority and deferred resignation program, and > 350,000 positions are exempt from the federal hiring freeze. 

The release noted several other improvements regarding VA performance in 2025, among them that the disability claims backlog has been reduced by 30% and a record 2 million disability claims have been processed by June. More than 60,000 VA employees have also returned to the office, according to the release.

“As a result of our efforts, VA is headed in the right direction – both in terms of staff levels and customer service,” Collins said. “Our review has resulted in a host of new ideas for better serving Veterans that we will continue to pursue.” 

TOPLINE:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

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:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

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:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

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:

An 8-week smartphone-based mindfulness program using audio-guided meditation reduced anxiety and improved emotional well-being in patients with chronic obstructive pulmonary disease (COPD), also providing relief from stress, anxiety, and dyspnea following each session.

METHODOLOGY:

• A considerable proportion of patients with COPD experience clinically significant anxiety and depressive symptoms; psychological interventions that are easy to implement as add-on treatments can alleviate these symptoms.
• In this pilot study, 30 patients (mean age, 62.68 y; 60.5% women) with COPD and subclinical symptoms of anxiety or depression were enrolled and allocated to an 8-week self-administered digital mindfulness-based intervention (n = 14) or the waitlist control (n = 16).
• Patients in the intervention group had an introductory face-to-face session, followed by daily smartphone audio-guided meditation adapted for patients with COPD. The waitlist group received the same intervention after the study period ended.
• The primary endpoints were the feasibility of the intervention and its effects on anxiety and depression symptoms at baseline, 4 weeks, and 8 weeks.

TAKEAWAY:

• Patients in the intervention group practiced mindfulness on 81.38% of the 56 intervention days.
• After 8 weeks, the intervention group showed a significant reduction in anxiety (P = .010) compared with the waitlist group; however, no significant improvement was observed for depression.
• Similarly, significant improvements were reported for emotional functioning (P = .004), but no significant reductions in perceived stress and hair cortisol levels were observed after 8 weeks.
• Significant reductions were reported for momentary subjective stress (P < .001), anxiety (P = .022), and dyspnea (P < .001) immediately after meditation sessions.

IN PRACTICE:

“The investigated self-administered digital MBI [mindfulness-based intervention], including brief 10- to 15-minute meditations, was feasible and holds potential as low-threshold add-on treatment to alleviate anxiety after 8 weeks and reduce momentary subjective stress, anxiety, and dyspnea in everyday life,” the study authors wrote.

SOURCE:

This study was led by Hannah Tschenett, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria, and was published online in Respiratory Research.

LIMITATIONS:

This study had several limitations including a small sample size, lack of a true control group, and potential selection bias due to recruitment from centers with patients already interested in mindfulness, which may have inflated adherence. Additionally, generalizability to all patients with COPD was limited, as many were either ineligible or declined to participate.

DISCLOSURES:

This study was funded by the Scientific Medical Fund of the City of Vienna and the Karl Landsteiner Institute (KLI) for Lung Research and Pulmonary Oncology. The KLI received funding from AstraZeneca, Boehringer Ingelheim, Chiesi, Linde plc, Menarini Pharma, Novartis, and Vivisol Austria. Three authors reported being employees of KLI or receiving lecture fees from some of these pharmaceutical companies.

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:

An 8-week smartphone-based mindfulness program using audio-guided meditation reduced anxiety and improved emotional well-being in patients with chronic obstructive pulmonary disease (COPD), also providing relief from stress, anxiety, and dyspnea following each session.

METHODOLOGY:

• A considerable proportion of patients with COPD experience clinically significant anxiety and depressive symptoms; psychological interventions that are easy to implement as add-on treatments can alleviate these symptoms.
• In this pilot study, 30 patients (mean age, 62.68 y; 60.5% women) with COPD and subclinical symptoms of anxiety or depression were enrolled and allocated to an 8-week self-administered digital mindfulness-based intervention (n = 14) or the waitlist control (n = 16).
• Patients in the intervention group had an introductory face-to-face session, followed by daily smartphone audio-guided meditation adapted for patients with COPD. The waitlist group received the same intervention after the study period ended.
• The primary endpoints were the feasibility of the intervention and its effects on anxiety and depression symptoms at baseline, 4 weeks, and 8 weeks.

TAKEAWAY:

• Patients in the intervention group practiced mindfulness on 81.38% of the 56 intervention days.
• After 8 weeks, the intervention group showed a significant reduction in anxiety (P = .010) compared with the waitlist group; however, no significant improvement was observed for depression.
• Similarly, significant improvements were reported for emotional functioning (P = .004), but no significant reductions in perceived stress and hair cortisol levels were observed after 8 weeks.
• Significant reductions were reported for momentary subjective stress (P < .001), anxiety (P = .022), and dyspnea (P < .001) immediately after meditation sessions.

IN PRACTICE:

“The investigated self-administered digital MBI [mindfulness-based intervention], including brief 10- to 15-minute meditations, was feasible and holds potential as low-threshold add-on treatment to alleviate anxiety after 8 weeks and reduce momentary subjective stress, anxiety, and dyspnea in everyday life,” the study authors wrote.

SOURCE:

This study was led by Hannah Tschenett, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria, and was published online in Respiratory Research.

LIMITATIONS:

This study had several limitations including a small sample size, lack of a true control group, and potential selection bias due to recruitment from centers with patients already interested in mindfulness, which may have inflated adherence. Additionally, generalizability to all patients with COPD was limited, as many were either ineligible or declined to participate.

DISCLOSURES:

This study was funded by the Scientific Medical Fund of the City of Vienna and the Karl Landsteiner Institute (KLI) for Lung Research and Pulmonary Oncology. The KLI received funding from AstraZeneca, Boehringer Ingelheim, Chiesi, Linde plc, Menarini Pharma, Novartis, and Vivisol Austria. Three authors reported being employees of KLI or receiving lecture fees from some of these pharmaceutical companies.

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:

An 8-week smartphone-based mindfulness program using audio-guided meditation reduced anxiety and improved emotional well-being in patients with chronic obstructive pulmonary disease (COPD), also providing relief from stress, anxiety, and dyspnea following each session.

METHODOLOGY:

• A considerable proportion of patients with COPD experience clinically significant anxiety and depressive symptoms; psychological interventions that are easy to implement as add-on treatments can alleviate these symptoms.
• In this pilot study, 30 patients (mean age, 62.68 y; 60.5% women) with COPD and subclinical symptoms of anxiety or depression were enrolled and allocated to an 8-week self-administered digital mindfulness-based intervention (n = 14) or the waitlist control (n = 16).
• Patients in the intervention group had an introductory face-to-face session, followed by daily smartphone audio-guided meditation adapted for patients with COPD. The waitlist group received the same intervention after the study period ended.
• The primary endpoints were the feasibility of the intervention and its effects on anxiety and depression symptoms at baseline, 4 weeks, and 8 weeks.

TAKEAWAY:

• Patients in the intervention group practiced mindfulness on 81.38% of the 56 intervention days.
• After 8 weeks, the intervention group showed a significant reduction in anxiety (P = .010) compared with the waitlist group; however, no significant improvement was observed for depression.
• Similarly, significant improvements were reported for emotional functioning (P = .004), but no significant reductions in perceived stress and hair cortisol levels were observed after 8 weeks.
• Significant reductions were reported for momentary subjective stress (P < .001), anxiety (P = .022), and dyspnea (P < .001) immediately after meditation sessions.

IN PRACTICE:

“The investigated self-administered digital MBI [mindfulness-based intervention], including brief 10- to 15-minute meditations, was feasible and holds potential as low-threshold add-on treatment to alleviate anxiety after 8 weeks and reduce momentary subjective stress, anxiety, and dyspnea in everyday life,” the study authors wrote.

SOURCE:

This study was led by Hannah Tschenett, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria, and was published online in Respiratory Research.

LIMITATIONS:

This study had several limitations including a small sample size, lack of a true control group, and potential selection bias due to recruitment from centers with patients already interested in mindfulness, which may have inflated adherence. Additionally, generalizability to all patients with COPD was limited, as many were either ineligible or declined to participate.

DISCLOSURES:

This study was funded by the Scientific Medical Fund of the City of Vienna and the Karl Landsteiner Institute (KLI) for Lung Research and Pulmonary Oncology. The KLI received funding from AstraZeneca, Boehringer Ingelheim, Chiesi, Linde plc, Menarini Pharma, Novartis, and Vivisol Austria. Three authors reported being employees of KLI or receiving lecture fees from some of these pharmaceutical companies.

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:

A recent study found that 3 months of resistance training did not worsen lymphedema in breast cancer survivors and instead significantly improved fluid balance and increased upper extremity muscle mass. The edema index also improved, suggesting potential therapeutic benefits of intense resistance training for managing lymphedema.

METHODOLOGY:

• Lymphedema is a common adverse effect of breast cancer treatment that can limit mobility. Although strength training can have multiple benefits for breast cancer survivors, such as increased bone density and metabolism, data on whether more intense resistance training exacerbates lymphedema in this population are limited. Worries that more intense training will lead to or worsen lymphedema have typically led to cautious recommendations.
• Researchers conducted a cohort study involving 115 women with breast cancer (median age, 54 years; 96% White; 4% Black) between September 2022 and March 2024. Most (83%) underwent sentinel lymph node biopsy (SLNB), while 12% had axillary lymph node dissection (ALND). At baseline, 13% had clinical lymphedema, including 37% in the ALND group and 8% in the SLNB group.
• Participants attended resistance training sessions three times a week, with intensity escalation over 3 months. Exercises involved hand weights, resistance bands, and body weight (eg, pushups) to promote strength, mobility, and muscle hypertrophy.
• Bioimpedance analysis measured intracellular water, extracellular water, and total body water before and after exercise. Lymphedema was defined as more than a 3% increase in arm circumference discrepancy relative to preoperative ipsilateral arm measurements, along with an elevated edema index (extracellular water to total body water ratio).

TAKEAWAY:

• No participants experienced subjective or clinical worsening of lymphedema after completing the resistance training regimen.
• Lean mass in the affected arm increased from a median of 5.45 lb to 5.64 lb (P < .001), while lean mass in the unaffected arm rose from 5.51 lb to 5.53 lb (P < .001) after the resistance training.
• Overall, participants’ fluid balance improved. The edema index in both arms showed a significant reduction at training completion (mean, 0.383) vs baseline (mean, 0.385), indicating reduced lymphedema. Subgroup analysis of women who underwent SLNB showed similar improvements in the edema index.

IN PRACTICE:

“These findings highlight the safety of strength and resistance training in a large group of patients with breast cancer during and after treatment,” the authors wrote. Beyond that, the authors noted, the results point to a potential role for resistance training in reducing lymphedema.

SOURCE:

This study, led by Parisa Shamsesfandabadi, MD, Allegheny Health Network, Pittsburgh, was published online in JAMA Network Open.

LIMITATIONS:

A major limitation was the absence of a control group, which prevented a direct comparison between the effects of exercise and the natural progression of lymphedema. The 3-month intervention provided limited insight into the long-term sustainability of benefits. Patient-reported outcomes were not included. Additionally, potential confounding variables such as diet, medication use, and baseline physical activity levels were not controlled for in the analysis.

DISCLOSURES:

The authors did not disclose any funding information. Several authors reported having ties with various sources. Additional disclosures are noted in the original article.

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

TOPLINE:

A recent study found that 3 months of resistance training did not worsen lymphedema in breast cancer survivors and instead significantly improved fluid balance and increased upper extremity muscle mass. The edema index also improved, suggesting potential therapeutic benefits of intense resistance training for managing lymphedema.

METHODOLOGY:

• Lymphedema is a common adverse effect of breast cancer treatment that can limit mobility. Although strength training can have multiple benefits for breast cancer survivors, such as increased bone density and metabolism, data on whether more intense resistance training exacerbates lymphedema in this population are limited. Worries that more intense training will lead to or worsen lymphedema have typically led to cautious recommendations.
• Researchers conducted a cohort study involving 115 women with breast cancer (median age, 54 years; 96% White; 4% Black) between September 2022 and March 2024. Most (83%) underwent sentinel lymph node biopsy (SLNB), while 12% had axillary lymph node dissection (ALND). At baseline, 13% had clinical lymphedema, including 37% in the ALND group and 8% in the SLNB group.
• Participants attended resistance training sessions three times a week, with intensity escalation over 3 months. Exercises involved hand weights, resistance bands, and body weight (eg, pushups) to promote strength, mobility, and muscle hypertrophy.
• Bioimpedance analysis measured intracellular water, extracellular water, and total body water before and after exercise. Lymphedema was defined as more than a 3% increase in arm circumference discrepancy relative to preoperative ipsilateral arm measurements, along with an elevated edema index (extracellular water to total body water ratio).

TAKEAWAY:

• No participants experienced subjective or clinical worsening of lymphedema after completing the resistance training regimen.
• Lean mass in the affected arm increased from a median of 5.45 lb to 5.64 lb (P < .001), while lean mass in the unaffected arm rose from 5.51 lb to 5.53 lb (P < .001) after the resistance training.
• Overall, participants’ fluid balance improved. The edema index in both arms showed a significant reduction at training completion (mean, 0.383) vs baseline (mean, 0.385), indicating reduced lymphedema. Subgroup analysis of women who underwent SLNB showed similar improvements in the edema index.

IN PRACTICE:

“These findings highlight the safety of strength and resistance training in a large group of patients with breast cancer during and after treatment,” the authors wrote. Beyond that, the authors noted, the results point to a potential role for resistance training in reducing lymphedema.

SOURCE:

This study, led by Parisa Shamsesfandabadi, MD, Allegheny Health Network, Pittsburgh, was published online in JAMA Network Open.

LIMITATIONS:

A major limitation was the absence of a control group, which prevented a direct comparison between the effects of exercise and the natural progression of lymphedema. The 3-month intervention provided limited insight into the long-term sustainability of benefits. Patient-reported outcomes were not included. Additionally, potential confounding variables such as diet, medication use, and baseline physical activity levels were not controlled for in the analysis.

DISCLOSURES:

The authors did not disclose any funding information. Several authors reported having ties with various sources. Additional disclosures are noted in the original article.

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

TOPLINE:

A recent study found that 3 months of resistance training did not worsen lymphedema in breast cancer survivors and instead significantly improved fluid balance and increased upper extremity muscle mass. The edema index also improved, suggesting potential therapeutic benefits of intense resistance training for managing lymphedema.

METHODOLOGY:

• Lymphedema is a common adverse effect of breast cancer treatment that can limit mobility. Although strength training can have multiple benefits for breast cancer survivors, such as increased bone density and metabolism, data on whether more intense resistance training exacerbates lymphedema in this population are limited. Worries that more intense training will lead to or worsen lymphedema have typically led to cautious recommendations.
• Researchers conducted a cohort study involving 115 women with breast cancer (median age, 54 years; 96% White; 4% Black) between September 2022 and March 2024. Most (83%) underwent sentinel lymph node biopsy (SLNB), while 12% had axillary lymph node dissection (ALND). At baseline, 13% had clinical lymphedema, including 37% in the ALND group and 8% in the SLNB group.
• Participants attended resistance training sessions three times a week, with intensity escalation over 3 months. Exercises involved hand weights, resistance bands, and body weight (eg, pushups) to promote strength, mobility, and muscle hypertrophy.
• Bioimpedance analysis measured intracellular water, extracellular water, and total body water before and after exercise. Lymphedema was defined as more than a 3% increase in arm circumference discrepancy relative to preoperative ipsilateral arm measurements, along with an elevated edema index (extracellular water to total body water ratio).

TAKEAWAY:

• No participants experienced subjective or clinical worsening of lymphedema after completing the resistance training regimen.
• Lean mass in the affected arm increased from a median of 5.45 lb to 5.64 lb (P < .001), while lean mass in the unaffected arm rose from 5.51 lb to 5.53 lb (P < .001) after the resistance training.
• Overall, participants’ fluid balance improved. The edema index in both arms showed a significant reduction at training completion (mean, 0.383) vs baseline (mean, 0.385), indicating reduced lymphedema. Subgroup analysis of women who underwent SLNB showed similar improvements in the edema index.

IN PRACTICE:

“These findings highlight the safety of strength and resistance training in a large group of patients with breast cancer during and after treatment,” the authors wrote. Beyond that, the authors noted, the results point to a potential role for resistance training in reducing lymphedema.

SOURCE:

This study, led by Parisa Shamsesfandabadi, MD, Allegheny Health Network, Pittsburgh, was published online in JAMA Network Open.

LIMITATIONS:

A major limitation was the absence of a control group, which prevented a direct comparison between the effects of exercise and the natural progression of lymphedema. The 3-month intervention provided limited insight into the long-term sustainability of benefits. Patient-reported outcomes were not included. Additionally, potential confounding variables such as diet, medication use, and baseline physical activity levels were not controlled for in the analysis.

DISCLOSURES:

The authors did not disclose any funding information. Several authors reported having ties with various sources. Additional disclosures are noted in the original article.

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

While several cancers associated with immunosuppression are much more common in White men who have sex with men living with HIV (MSMWH) than in the male general population, they are even more frequently seen in Black and Hispanic MSMWH. 

This suggests that racial and ethnic disparities in access to antiretroviral therapy and viral suppression are playing a role, said the authors of an analysis published last month in AIDS.

“Disparities in cancer risk may serve as an important proxy for disparities in HIV care,” they wrote.

The researchers at the National Cancer Institute leveraged data from the HIV/AIDS Cancer Match Study, which covers 13 US states and the District of Columbia. For this analysis, they examined cancer incidence in over 350,000 MSMWH followed for 3.2 million person years, between 2001 and 2019.

They focused on Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, anal cancer, and liver cancer — all malignancies that are associated with viral infections and immunosuppression. They restricted their analysis to MSM because behavioral factors (such as anal sex) contribute to increased exposure to viral infections in this population.

The study’s intersectional lens is valuable, Gita Suneja, MD, said in an interview. “It is looking at racial and ethnic disparities within an already minoritized group, which is men who have sex with men living with HIV,” said the professor of radiation oncology at the University of Utah, Salt Lake City, Utah, who was not involved in the study.

“It’s really profound to me to sit back and think about how these disparities intersect, and how somebody can be so marginalized: it’s not just race or ethnicity, it’s not just having a stigmatized medical condition, it’s the confluence of all of these factors that leads to exclusion from care and poor outcomes.”

Standardized incidence ratios (SIRs), using men of the same ethnicity and age in the general population as the comparator, were reported for MSMWH of different racial/ethnic groups. For non-Hodgkin lymphoma, the SIR was 3.11 for White MSMWH, rising to 4.84 for Black MSMWH and 5.46 for Hispanic MSMWH. 

For Hodgkin lymphoma, the SIRs were 6.35, 7.69, and 11.5, respectively. For Kaposi sarcoma, they were many orders of magnitude higher, at 417 for White MSMWH, 772 for Black MSMWH, and 887 for Hispanic MSMWH.

In contrast, for anal cancer and liver cancer, the highest SIRs were among White MSMWH.

Given the role of immunosuppression, the researchers wanted to see whether cancer incidence differed according to prior AIDS diagnosis. However, they found that within each racial/ethnic group, there were no statistically significant differences in SIR according to AIDS status.

“There were disparities across the board for [racially minoritized] groups, regardless of immunosuppression status, which leads us to believe that it isn’t just about the diagnosis of AIDS, but about many other factors that we’re not capturing in the paper,” first author Benton Meldrum, MPH, told this news organization.

One study limitation is that AIDS diagnosis is an imprecise proxy for immunosuppression. It does not capture the duration and severity of immunosuppression, nor the extent of immune restoration. Many people with a previous AIDS diagnosis are now virally suppressed.

Database studies have inherent limitations in terms of the range of parameters recorded. In an ideal world, Meldrum said, they would have had access to information on CD4 count and viral suppression over time, as well as socioeconomic factors such as income and insurance status.

Differences in timely HIV diagnosis, viral suppression, and continued engagement in care are thought to drive the differences in cancer incidence. “HIV control today helps mitigate the risk of cancer development down the road,” Suneja said.

While not addressed by this study, there may be additional differences in cancer survival. Differences in cancer care, including prompt diagnosis and access to effective treatment, could play a role.

In terms of practical interventions to address these disparities, Suneja highlights the value of programs which help patients navigate a complex healthcare system. This may include care coordination navigation, peer navigation, and delivering services in community settings.

Such interventions don’t only benefit marginalized groups but help improve healthcare access and outcomes for everyone, she said. Even people with insurance and high health literacy often struggle to remain engaged.

“When we design healthcare systems to best serve those that have been left furthest behind, we all do better,” Suneja said.



The study was funded by the Intramural Research Program of the National Cancer Institute. Suneja and Meldrum reported having no relevant financial relationships.

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

While several cancers associated with immunosuppression are much more common in White men who have sex with men living with HIV (MSMWH) than in the male general population, they are even more frequently seen in Black and Hispanic MSMWH. 

This suggests that racial and ethnic disparities in access to antiretroviral therapy and viral suppression are playing a role, said the authors of an analysis published last month in AIDS.

“Disparities in cancer risk may serve as an important proxy for disparities in HIV care,” they wrote.

The researchers at the National Cancer Institute leveraged data from the HIV/AIDS Cancer Match Study, which covers 13 US states and the District of Columbia. For this analysis, they examined cancer incidence in over 350,000 MSMWH followed for 3.2 million person years, between 2001 and 2019.

They focused on Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, anal cancer, and liver cancer — all malignancies that are associated with viral infections and immunosuppression. They restricted their analysis to MSM because behavioral factors (such as anal sex) contribute to increased exposure to viral infections in this population.

The study’s intersectional lens is valuable, Gita Suneja, MD, said in an interview. “It is looking at racial and ethnic disparities within an already minoritized group, which is men who have sex with men living with HIV,” said the professor of radiation oncology at the University of Utah, Salt Lake City, Utah, who was not involved in the study.

“It’s really profound to me to sit back and think about how these disparities intersect, and how somebody can be so marginalized: it’s not just race or ethnicity, it’s not just having a stigmatized medical condition, it’s the confluence of all of these factors that leads to exclusion from care and poor outcomes.”

Standardized incidence ratios (SIRs), using men of the same ethnicity and age in the general population as the comparator, were reported for MSMWH of different racial/ethnic groups. For non-Hodgkin lymphoma, the SIR was 3.11 for White MSMWH, rising to 4.84 for Black MSMWH and 5.46 for Hispanic MSMWH. 

For Hodgkin lymphoma, the SIRs were 6.35, 7.69, and 11.5, respectively. For Kaposi sarcoma, they were many orders of magnitude higher, at 417 for White MSMWH, 772 for Black MSMWH, and 887 for Hispanic MSMWH.

In contrast, for anal cancer and liver cancer, the highest SIRs were among White MSMWH.

Given the role of immunosuppression, the researchers wanted to see whether cancer incidence differed according to prior AIDS diagnosis. However, they found that within each racial/ethnic group, there were no statistically significant differences in SIR according to AIDS status.

“There were disparities across the board for [racially minoritized] groups, regardless of immunosuppression status, which leads us to believe that it isn’t just about the diagnosis of AIDS, but about many other factors that we’re not capturing in the paper,” first author Benton Meldrum, MPH, told this news organization.

One study limitation is that AIDS diagnosis is an imprecise proxy for immunosuppression. It does not capture the duration and severity of immunosuppression, nor the extent of immune restoration. Many people with a previous AIDS diagnosis are now virally suppressed.

Database studies have inherent limitations in terms of the range of parameters recorded. In an ideal world, Meldrum said, they would have had access to information on CD4 count and viral suppression over time, as well as socioeconomic factors such as income and insurance status.

Differences in timely HIV diagnosis, viral suppression, and continued engagement in care are thought to drive the differences in cancer incidence. “HIV control today helps mitigate the risk of cancer development down the road,” Suneja said.

While not addressed by this study, there may be additional differences in cancer survival. Differences in cancer care, including prompt diagnosis and access to effective treatment, could play a role.

In terms of practical interventions to address these disparities, Suneja highlights the value of programs which help patients navigate a complex healthcare system. This may include care coordination navigation, peer navigation, and delivering services in community settings.

Such interventions don’t only benefit marginalized groups but help improve healthcare access and outcomes for everyone, she said. Even people with insurance and high health literacy often struggle to remain engaged.

“When we design healthcare systems to best serve those that have been left furthest behind, we all do better,” Suneja said.



The study was funded by the Intramural Research Program of the National Cancer Institute. Suneja and Meldrum reported having no relevant financial relationships.

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

While several cancers associated with immunosuppression are much more common in White men who have sex with men living with HIV (MSMWH) than in the male general population, they are even more frequently seen in Black and Hispanic MSMWH. 

This suggests that racial and ethnic disparities in access to antiretroviral therapy and viral suppression are playing a role, said the authors of an analysis published last month in AIDS.

“Disparities in cancer risk may serve as an important proxy for disparities in HIV care,” they wrote.

The researchers at the National Cancer Institute leveraged data from the HIV/AIDS Cancer Match Study, which covers 13 US states and the District of Columbia. For this analysis, they examined cancer incidence in over 350,000 MSMWH followed for 3.2 million person years, between 2001 and 2019.

They focused on Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, anal cancer, and liver cancer — all malignancies that are associated with viral infections and immunosuppression. They restricted their analysis to MSM because behavioral factors (such as anal sex) contribute to increased exposure to viral infections in this population.

The study’s intersectional lens is valuable, Gita Suneja, MD, said in an interview. “It is looking at racial and ethnic disparities within an already minoritized group, which is men who have sex with men living with HIV,” said the professor of radiation oncology at the University of Utah, Salt Lake City, Utah, who was not involved in the study.

“It’s really profound to me to sit back and think about how these disparities intersect, and how somebody can be so marginalized: it’s not just race or ethnicity, it’s not just having a stigmatized medical condition, it’s the confluence of all of these factors that leads to exclusion from care and poor outcomes.”

Standardized incidence ratios (SIRs), using men of the same ethnicity and age in the general population as the comparator, were reported for MSMWH of different racial/ethnic groups. For non-Hodgkin lymphoma, the SIR was 3.11 for White MSMWH, rising to 4.84 for Black MSMWH and 5.46 for Hispanic MSMWH. 

For Hodgkin lymphoma, the SIRs were 6.35, 7.69, and 11.5, respectively. For Kaposi sarcoma, they were many orders of magnitude higher, at 417 for White MSMWH, 772 for Black MSMWH, and 887 for Hispanic MSMWH.

In contrast, for anal cancer and liver cancer, the highest SIRs were among White MSMWH.

Given the role of immunosuppression, the researchers wanted to see whether cancer incidence differed according to prior AIDS diagnosis. However, they found that within each racial/ethnic group, there were no statistically significant differences in SIR according to AIDS status.

“There were disparities across the board for [racially minoritized] groups, regardless of immunosuppression status, which leads us to believe that it isn’t just about the diagnosis of AIDS, but about many other factors that we’re not capturing in the paper,” first author Benton Meldrum, MPH, told this news organization.

One study limitation is that AIDS diagnosis is an imprecise proxy for immunosuppression. It does not capture the duration and severity of immunosuppression, nor the extent of immune restoration. Many people with a previous AIDS diagnosis are now virally suppressed.

Database studies have inherent limitations in terms of the range of parameters recorded. In an ideal world, Meldrum said, they would have had access to information on CD4 count and viral suppression over time, as well as socioeconomic factors such as income and insurance status.

Differences in timely HIV diagnosis, viral suppression, and continued engagement in care are thought to drive the differences in cancer incidence. “HIV control today helps mitigate the risk of cancer development down the road,” Suneja said.

While not addressed by this study, there may be additional differences in cancer survival. Differences in cancer care, including prompt diagnosis and access to effective treatment, could play a role.

In terms of practical interventions to address these disparities, Suneja highlights the value of programs which help patients navigate a complex healthcare system. This may include care coordination navigation, peer navigation, and delivering services in community settings.

Such interventions don’t only benefit marginalized groups but help improve healthcare access and outcomes for everyone, she said. Even people with insurance and high health literacy often struggle to remain engaged.

“When we design healthcare systems to best serve those that have been left furthest behind, we all do better,” Suneja said.



The study was funded by the Intramural Research Program of the National Cancer Institute. Suneja and Meldrum reported having no relevant financial relationships.

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

TOPLINE:

Posttraumatic stress disorder (PTSD) among veterans living with HIV significantly increased the risk for AIDS and multiple comorbidities, particularly arthritis, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and multimorbidity — with the greatest impact seen in the first decade after diagnosis.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess whether PTSD is associated with increased risk for adverse clinical outcomes in veterans with HIV who received care at the Department of Veterans Affairs.
• They included 3206 veterans (97.4% men; median age at HIV diagnosis, 31.7 years; 42.1% with PTSD) who were deployed in Iraq and Afghanistan while serving in the military and initiated antiretroviral therapy before December 31, 2020.
• Participants were followed-up until December 2022, with censoring at death, the last health care visit, or study termination. The association between PTSD with morbidity and mortality, considering the number of deployments and levels of combat exposure were determined.

TAKEAWAY:

• PTSD significantly increased the overall risks for AIDS by 11% (adjusted hazard ratio [aHR], 1.11), CKD by 21% (aHR, 1.21), COPD by 46% (aHR, 1.46), multimorbidity by 49% (aHR, 1.49), CVD by 57% (aHR, 1.57), and arthritis by two folds (aHR, 1.95; P <.05 for all).
• Among veterans with a single deployment, those with PTSD had 92%, 87%, 80%, 53%, 44%, 32%, and 27% higher risks for asthma, CVD, arthritis, multimorbidity, COPD, liver disease, and AIDS, respectively, than those without PTSD.
• Veterans with PTSD and combat exposure had a lower risk for AIDS but higher risks for multimorbidity, asthma, CVD, and arthritis than those never diagnosed with PTSD and unexposed to combat.
• The associations of PTSD with mortality and morbidity appeared most pronounced in the first decade post-diagnosis, followed by a gradual decline in association strength; however, risks remained elevated.

IN PRACTICE:

“It is recommended that providers who work with VWH [veterans with HIV] consider adopting a trauma-informed model of HIV care and that providers screen veterans for PTSD, so that their unique trauma history can help guide medical decisions and treatment,” the authors wrote.

SOURCE:

This study was led by Kartavya J. Vyas, PhD, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta. It was published online in AIDS .

LIMITATIONS:

The data could not capture each individual’s true index trauma or the severity of their PTSD. Additionally, the study was limited by considerable loss to follow-up, potential uncontrolled confounding related to homelessness, and a lack of generalizability to veterans with HIV who were not receiving antiretroviral therapy.

DISCLOSURES:

The study did not receive any specific funding. Two authors reported receiving federal research support — one from the Emory Center for AIDS Research and the National Institute of Allergy and Infectious Diseases, and the other from the National Institutes of Health and the CDC — in addition to investigator-initiated grants and consulting fees from various pharmaceutical companies.

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:

Posttraumatic stress disorder (PTSD) among veterans living with HIV significantly increased the risk for AIDS and multiple comorbidities, particularly arthritis, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and multimorbidity — with the greatest impact seen in the first decade after diagnosis.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess whether PTSD is associated with increased risk for adverse clinical outcomes in veterans with HIV who received care at the Department of Veterans Affairs.
• They included 3206 veterans (97.4% men; median age at HIV diagnosis, 31.7 years; 42.1% with PTSD) who were deployed in Iraq and Afghanistan while serving in the military and initiated antiretroviral therapy before December 31, 2020.
• Participants were followed-up until December 2022, with censoring at death, the last health care visit, or study termination. The association between PTSD with morbidity and mortality, considering the number of deployments and levels of combat exposure were determined.

TAKEAWAY:

• PTSD significantly increased the overall risks for AIDS by 11% (adjusted hazard ratio [aHR], 1.11), CKD by 21% (aHR, 1.21), COPD by 46% (aHR, 1.46), multimorbidity by 49% (aHR, 1.49), CVD by 57% (aHR, 1.57), and arthritis by two folds (aHR, 1.95; P <.05 for all).
• Among veterans with a single deployment, those with PTSD had 92%, 87%, 80%, 53%, 44%, 32%, and 27% higher risks for asthma, CVD, arthritis, multimorbidity, COPD, liver disease, and AIDS, respectively, than those without PTSD.
• Veterans with PTSD and combat exposure had a lower risk for AIDS but higher risks for multimorbidity, asthma, CVD, and arthritis than those never diagnosed with PTSD and unexposed to combat.
• The associations of PTSD with mortality and morbidity appeared most pronounced in the first decade post-diagnosis, followed by a gradual decline in association strength; however, risks remained elevated.

IN PRACTICE:

“It is recommended that providers who work with VWH [veterans with HIV] consider adopting a trauma-informed model of HIV care and that providers screen veterans for PTSD, so that their unique trauma history can help guide medical decisions and treatment,” the authors wrote.

SOURCE:

This study was led by Kartavya J. Vyas, PhD, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta. It was published online in AIDS .

LIMITATIONS:

The data could not capture each individual’s true index trauma or the severity of their PTSD. Additionally, the study was limited by considerable loss to follow-up, potential uncontrolled confounding related to homelessness, and a lack of generalizability to veterans with HIV who were not receiving antiretroviral therapy.

DISCLOSURES:

The study did not receive any specific funding. Two authors reported receiving federal research support — one from the Emory Center for AIDS Research and the National Institute of Allergy and Infectious Diseases, and the other from the National Institutes of Health and the CDC — in addition to investigator-initiated grants and consulting fees from various pharmaceutical companies.

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:

Posttraumatic stress disorder (PTSD) among veterans living with HIV significantly increased the risk for AIDS and multiple comorbidities, particularly arthritis, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and multimorbidity — with the greatest impact seen in the first decade after diagnosis.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess whether PTSD is associated with increased risk for adverse clinical outcomes in veterans with HIV who received care at the Department of Veterans Affairs.
• They included 3206 veterans (97.4% men; median age at HIV diagnosis, 31.7 years; 42.1% with PTSD) who were deployed in Iraq and Afghanistan while serving in the military and initiated antiretroviral therapy before December 31, 2020.
• Participants were followed-up until December 2022, with censoring at death, the last health care visit, or study termination. The association between PTSD with morbidity and mortality, considering the number of deployments and levels of combat exposure were determined.

TAKEAWAY:

• PTSD significantly increased the overall risks for AIDS by 11% (adjusted hazard ratio [aHR], 1.11), CKD by 21% (aHR, 1.21), COPD by 46% (aHR, 1.46), multimorbidity by 49% (aHR, 1.49), CVD by 57% (aHR, 1.57), and arthritis by two folds (aHR, 1.95; P <.05 for all).
• Among veterans with a single deployment, those with PTSD had 92%, 87%, 80%, 53%, 44%, 32%, and 27% higher risks for asthma, CVD, arthritis, multimorbidity, COPD, liver disease, and AIDS, respectively, than those without PTSD.
• Veterans with PTSD and combat exposure had a lower risk for AIDS but higher risks for multimorbidity, asthma, CVD, and arthritis than those never diagnosed with PTSD and unexposed to combat.
• The associations of PTSD with mortality and morbidity appeared most pronounced in the first decade post-diagnosis, followed by a gradual decline in association strength; however, risks remained elevated.

IN PRACTICE:

“It is recommended that providers who work with VWH [veterans with HIV] consider adopting a trauma-informed model of HIV care and that providers screen veterans for PTSD, so that their unique trauma history can help guide medical decisions and treatment,” the authors wrote.

SOURCE:

This study was led by Kartavya J. Vyas, PhD, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta. It was published online in AIDS .

LIMITATIONS:

The data could not capture each individual’s true index trauma or the severity of their PTSD. Additionally, the study was limited by considerable loss to follow-up, potential uncontrolled confounding related to homelessness, and a lack of generalizability to veterans with HIV who were not receiving antiretroviral therapy.

DISCLOSURES:

The study did not receive any specific funding. Two authors reported receiving federal research support — one from the Emory Center for AIDS Research and the National Institute of Allergy and Infectious Diseases, and the other from the National Institutes of Health and the CDC — in addition to investigator-initiated grants and consulting fees from various pharmaceutical companies.

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.

Adding the poly (ADP-ribose) polymerase (PARP) inhibitor niraparib to abiraterone acetate plus prednisone delayed disease progression and postponed the onset of symptoms in patients with metastatic castration-sensitive prostate cancer with homologous recombination repair (HRR) genetic alterations, according to findings from the AMPLITUDE trial.

An interim analysis also demonstrated an early trend toward improved overall survival in patients who received niraparib.

These findings support adding niraparib to abiraterone acetate plus prednisone “as a new treatment option” in patients with HRR alterations, said Study Chief Gerhardt Attard, MD, PhD, chair of medical oncology, University College London Cancer Institute, London, England, speaking at the American Society of Clinical Oncology (ASCO) 2025 annual meeting.

The findings also highlight that “it’s going to be incredibly important that patients who get diagnosed with hormone-sensitive prostate cancer are tested to see if they have these mutations, so they can be offered the right therapy at the right time,” Outside Expert Bradley McGregor, MD, with Dana-Farber Cancer Institute in Boston, said during a press briefing.

Ultimately, “you don’t know if you don’t test,” McGregor added.

About one quarter of patients with metastatic castration-sensitive prostate cancer have alterations in HRR genes, about half of which are BRCA mutations. These patients typically experience faster disease progression and worse outcomes. An androgen receptor pathway inhibitor, such as abiraterone, alongside androgen deprivation therapy with or without docetaxel, is standard therapy for these patients, but “there is still a need for treatments that are tailored to patients whose tumors harbor HRR alterations,” Attard said in a press release.

Adding niraparib to this standard regimen could help improve survival in these patients.

In 2023, the FDA approved niraparib and abiraterone acetate to treat BRCA-mutated metastatic castration-resistant prostate cancer, after findings from the MAGNITUDE study demonstrated improved progression-free survival (PFS).

The phase 3 AMPLITUDE trial set out to evaluate whether this combination would yield similar survival benefits in metastatic castration-sensitive prostate cancer with HRR mutations.

In the study, 696 patients (median age, 68 years) with metastatic castration-sensitive prostate cancer and one or more HRR gene alterations were randomly allocated (1:1) to niraparib with abiraterone acetate plus prednisone or placebo with abiraterone acetate plus prednisone.

Exclusion criteria included any prior PARP inhibitor therapy or androgen receptor pathway inhibitor other than abiraterone. Eligible patients could have received at most 6 months of androgen deprivation therapy, ≤ 6 cycles of docetaxel, ≤ 45 days of abiraterone acetate plus prednisone and palliative radiation.

Baseline characteristics were well balanced between the groups. Just over half the patients in each group had BRCA1 or BRCA2 alterations. The majority had an electrocorticogram performance status of 0, but high-risk features with a predominance for synchronous metastatic disease and metastatic high volume. About 16% had received prior docetaxel, in keeping with real world data, Attard noted.

At a median follow-up of 30.8 months, niraparib plus standard therapy led to a significant 37% reduction in the risk for radiographic progression or death. The median radiographic PFS (rPFS) was not reached in the niraparib group vs 29.5 months in the placebo group (hazard ratio [HR], 0.63; P = .0001).

Patients with BRCA alterations, in particular, showed the greatest benefit, with niraparib reducing the risk for radiographic progression or death by 48% compared to placebo (median rPFS not reached vs 26 months; HR, 0.52; P < .0001).

On the key secondary endpoint of time to symptomatic progression, adding niraparib led to a “statistically and clinically” significant benefit — a 50% lower in the risk for symptomatic progression in the full population (HR, 0.50), and a 56% lower risk in BRCA-mutant group (HR, 0.44).

The first interim analysis also showed an early trend toward improved overall survival favoring the niraparib combination, with a reduction in the risk for death of 21% in the HRR-mutant population (HR, 0.79; P = .10) and 25% (HR, 0.75; P = .15) in the BRCA-mutant population.

Grade 3/4 adverse events were more common with the niraparib combination group compared to the placebo group (75% vs 59%), with anemia and hypertension being the most common. However, treatment discontinuations due to adverse remained low (15% with niraparib vs 10% with placebo).

Attard noted, however, that half the target number of patients required for the final analysis died. Still, “in my view, there’s a clear trend for favoring survival in the patients randomized to niraparib,” he told attendees.

 

‘Exciting News’ for Patients 

The AMPLITUDE results are “really exciting news for our patients,” McGregor said.

Considering the poor prognosis of patients with metastatic castration-sensitive prostate cancer, “it is reasonable to prioritize early access to PARP inhibitors for these men, at least for the ones with BRCA mutations,” added ASCO discussant Joaquin Mateo, MD, PhD, with Vall d’Hebron Institute of Oncology, Barcelona, Spain.

However, Mateo explained, “I think that for patients with mutations in the other genes, I will be more prudent, and I’ll be on the lookout for the overall survival data to mature.”

The other key conclusion, Mateo said, is that genomic profiling “should be moved earlier into the patient course, and I am confident that embedding genomic profiling into the diagnostic evaluations of metastatic prostate cancer is also going to result in better quality of testing, more efficacious testing, and also a more equitable framework of access to testing for patients.”



This study was funded by Janssen Research & Development, LLC. Attard and Mateo disclosed relationships with Janssen and other pharmaceutical companies. McGregor disclosed relationships with Arcus Biosciences, Astellas, AVEO, Bristol Myers Squibb, Daiichi Sankyo, AstraZeneca, and other companies.

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

Adding the poly (ADP-ribose) polymerase (PARP) inhibitor niraparib to abiraterone acetate plus prednisone delayed disease progression and postponed the onset of symptoms in patients with metastatic castration-sensitive prostate cancer with homologous recombination repair (HRR) genetic alterations, according to findings from the AMPLITUDE trial.

An interim analysis also demonstrated an early trend toward improved overall survival in patients who received niraparib.

These findings support adding niraparib to abiraterone acetate plus prednisone “as a new treatment option” in patients with HRR alterations, said Study Chief Gerhardt Attard, MD, PhD, chair of medical oncology, University College London Cancer Institute, London, England, speaking at the American Society of Clinical Oncology (ASCO) 2025 annual meeting.

The findings also highlight that “it’s going to be incredibly important that patients who get diagnosed with hormone-sensitive prostate cancer are tested to see if they have these mutations, so they can be offered the right therapy at the right time,” Outside Expert Bradley McGregor, MD, with Dana-Farber Cancer Institute in Boston, said during a press briefing.

Ultimately, “you don’t know if you don’t test,” McGregor added.

About one quarter of patients with metastatic castration-sensitive prostate cancer have alterations in HRR genes, about half of which are BRCA mutations. These patients typically experience faster disease progression and worse outcomes. An androgen receptor pathway inhibitor, such as abiraterone, alongside androgen deprivation therapy with or without docetaxel, is standard therapy for these patients, but “there is still a need for treatments that are tailored to patients whose tumors harbor HRR alterations,” Attard said in a press release.

Adding niraparib to this standard regimen could help improve survival in these patients.

In 2023, the FDA approved niraparib and abiraterone acetate to treat BRCA-mutated metastatic castration-resistant prostate cancer, after findings from the MAGNITUDE study demonstrated improved progression-free survival (PFS).

The phase 3 AMPLITUDE trial set out to evaluate whether this combination would yield similar survival benefits in metastatic castration-sensitive prostate cancer with HRR mutations.

In the study, 696 patients (median age, 68 years) with metastatic castration-sensitive prostate cancer and one or more HRR gene alterations were randomly allocated (1:1) to niraparib with abiraterone acetate plus prednisone or placebo with abiraterone acetate plus prednisone.

Exclusion criteria included any prior PARP inhibitor therapy or androgen receptor pathway inhibitor other than abiraterone. Eligible patients could have received at most 6 months of androgen deprivation therapy, ≤ 6 cycles of docetaxel, ≤ 45 days of abiraterone acetate plus prednisone and palliative radiation.

Baseline characteristics were well balanced between the groups. Just over half the patients in each group had BRCA1 or BRCA2 alterations. The majority had an electrocorticogram performance status of 0, but high-risk features with a predominance for synchronous metastatic disease and metastatic high volume. About 16% had received prior docetaxel, in keeping with real world data, Attard noted.

At a median follow-up of 30.8 months, niraparib plus standard therapy led to a significant 37% reduction in the risk for radiographic progression or death. The median radiographic PFS (rPFS) was not reached in the niraparib group vs 29.5 months in the placebo group (hazard ratio [HR], 0.63; P = .0001).

Patients with BRCA alterations, in particular, showed the greatest benefit, with niraparib reducing the risk for radiographic progression or death by 48% compared to placebo (median rPFS not reached vs 26 months; HR, 0.52; P < .0001).

On the key secondary endpoint of time to symptomatic progression, adding niraparib led to a “statistically and clinically” significant benefit — a 50% lower in the risk for symptomatic progression in the full population (HR, 0.50), and a 56% lower risk in BRCA-mutant group (HR, 0.44).

The first interim analysis also showed an early trend toward improved overall survival favoring the niraparib combination, with a reduction in the risk for death of 21% in the HRR-mutant population (HR, 0.79; P = .10) and 25% (HR, 0.75; P = .15) in the BRCA-mutant population.

Grade 3/4 adverse events were more common with the niraparib combination group compared to the placebo group (75% vs 59%), with anemia and hypertension being the most common. However, treatment discontinuations due to adverse remained low (15% with niraparib vs 10% with placebo).

Attard noted, however, that half the target number of patients required for the final analysis died. Still, “in my view, there’s a clear trend for favoring survival in the patients randomized to niraparib,” he told attendees.

 

‘Exciting News’ for Patients 

The AMPLITUDE results are “really exciting news for our patients,” McGregor said.

Considering the poor prognosis of patients with metastatic castration-sensitive prostate cancer, “it is reasonable to prioritize early access to PARP inhibitors for these men, at least for the ones with BRCA mutations,” added ASCO discussant Joaquin Mateo, MD, PhD, with Vall d’Hebron Institute of Oncology, Barcelona, Spain.

However, Mateo explained, “I think that for patients with mutations in the other genes, I will be more prudent, and I’ll be on the lookout for the overall survival data to mature.”

The other key conclusion, Mateo said, is that genomic profiling “should be moved earlier into the patient course, and I am confident that embedding genomic profiling into the diagnostic evaluations of metastatic prostate cancer is also going to result in better quality of testing, more efficacious testing, and also a more equitable framework of access to testing for patients.”



This study was funded by Janssen Research & Development, LLC. Attard and Mateo disclosed relationships with Janssen and other pharmaceutical companies. McGregor disclosed relationships with Arcus Biosciences, Astellas, AVEO, Bristol Myers Squibb, Daiichi Sankyo, AstraZeneca, and other companies.

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

Adding the poly (ADP-ribose) polymerase (PARP) inhibitor niraparib to abiraterone acetate plus prednisone delayed disease progression and postponed the onset of symptoms in patients with metastatic castration-sensitive prostate cancer with homologous recombination repair (HRR) genetic alterations, according to findings from the AMPLITUDE trial.

An interim analysis also demonstrated an early trend toward improved overall survival in patients who received niraparib.

These findings support adding niraparib to abiraterone acetate plus prednisone “as a new treatment option” in patients with HRR alterations, said Study Chief Gerhardt Attard, MD, PhD, chair of medical oncology, University College London Cancer Institute, London, England, speaking at the American Society of Clinical Oncology (ASCO) 2025 annual meeting.

The findings also highlight that “it’s going to be incredibly important that patients who get diagnosed with hormone-sensitive prostate cancer are tested to see if they have these mutations, so they can be offered the right therapy at the right time,” Outside Expert Bradley McGregor, MD, with Dana-Farber Cancer Institute in Boston, said during a press briefing.

Ultimately, “you don’t know if you don’t test,” McGregor added.

About one quarter of patients with metastatic castration-sensitive prostate cancer have alterations in HRR genes, about half of which are BRCA mutations. These patients typically experience faster disease progression and worse outcomes. An androgen receptor pathway inhibitor, such as abiraterone, alongside androgen deprivation therapy with or without docetaxel, is standard therapy for these patients, but “there is still a need for treatments that are tailored to patients whose tumors harbor HRR alterations,” Attard said in a press release.

Adding niraparib to this standard regimen could help improve survival in these patients.

In 2023, the FDA approved niraparib and abiraterone acetate to treat BRCA-mutated metastatic castration-resistant prostate cancer, after findings from the MAGNITUDE study demonstrated improved progression-free survival (PFS).

The phase 3 AMPLITUDE trial set out to evaluate whether this combination would yield similar survival benefits in metastatic castration-sensitive prostate cancer with HRR mutations.

In the study, 696 patients (median age, 68 years) with metastatic castration-sensitive prostate cancer and one or more HRR gene alterations were randomly allocated (1:1) to niraparib with abiraterone acetate plus prednisone or placebo with abiraterone acetate plus prednisone.

Exclusion criteria included any prior PARP inhibitor therapy or androgen receptor pathway inhibitor other than abiraterone. Eligible patients could have received at most 6 months of androgen deprivation therapy, ≤ 6 cycles of docetaxel, ≤ 45 days of abiraterone acetate plus prednisone and palliative radiation.

Baseline characteristics were well balanced between the groups. Just over half the patients in each group had BRCA1 or BRCA2 alterations. The majority had an electrocorticogram performance status of 0, but high-risk features with a predominance for synchronous metastatic disease and metastatic high volume. About 16% had received prior docetaxel, in keeping with real world data, Attard noted.

At a median follow-up of 30.8 months, niraparib plus standard therapy led to a significant 37% reduction in the risk for radiographic progression or death. The median radiographic PFS (rPFS) was not reached in the niraparib group vs 29.5 months in the placebo group (hazard ratio [HR], 0.63; P = .0001).

Patients with BRCA alterations, in particular, showed the greatest benefit, with niraparib reducing the risk for radiographic progression or death by 48% compared to placebo (median rPFS not reached vs 26 months; HR, 0.52; P < .0001).

On the key secondary endpoint of time to symptomatic progression, adding niraparib led to a “statistically and clinically” significant benefit — a 50% lower in the risk for symptomatic progression in the full population (HR, 0.50), and a 56% lower risk in BRCA-mutant group (HR, 0.44).

The first interim analysis also showed an early trend toward improved overall survival favoring the niraparib combination, with a reduction in the risk for death of 21% in the HRR-mutant population (HR, 0.79; P = .10) and 25% (HR, 0.75; P = .15) in the BRCA-mutant population.

Grade 3/4 adverse events were more common with the niraparib combination group compared to the placebo group (75% vs 59%), with anemia and hypertension being the most common. However, treatment discontinuations due to adverse remained low (15% with niraparib vs 10% with placebo).

Attard noted, however, that half the target number of patients required for the final analysis died. Still, “in my view, there’s a clear trend for favoring survival in the patients randomized to niraparib,” he told attendees.

 

‘Exciting News’ for Patients 

The AMPLITUDE results are “really exciting news for our patients,” McGregor said.

Considering the poor prognosis of patients with metastatic castration-sensitive prostate cancer, “it is reasonable to prioritize early access to PARP inhibitors for these men, at least for the ones with BRCA mutations,” added ASCO discussant Joaquin Mateo, MD, PhD, with Vall d’Hebron Institute of Oncology, Barcelona, Spain.

However, Mateo explained, “I think that for patients with mutations in the other genes, I will be more prudent, and I’ll be on the lookout for the overall survival data to mature.”

The other key conclusion, Mateo said, is that genomic profiling “should be moved earlier into the patient course, and I am confident that embedding genomic profiling into the diagnostic evaluations of metastatic prostate cancer is also going to result in better quality of testing, more efficacious testing, and also a more equitable framework of access to testing for patients.”



This study was funded by Janssen Research & Development, LLC. Attard and Mateo disclosed relationships with Janssen and other pharmaceutical companies. McGregor disclosed relationships with Arcus Biosciences, Astellas, AVEO, Bristol Myers Squibb, Daiichi Sankyo, AstraZeneca, and other companies.

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