News

First, the good news: Fewer Americans aged < 50 years are dying from cancer vs just a decade ago — reflecting progress in prevention, early detection, and treatment. There is, however, one big exception. Colorectal cancer mortality has been steadily inching up, and the disease now stands as the leading cause of cancer death in this age group, up from the fifth-leading in the early 1990s.

Those are the major findings of a recent study by the American Cancer Society (ACS), published as a research letter in JAMA.

Using SEER data, researchers found that the overall age-adjusted cancer death rate among Americans aged < 50 years dropped by 44% between 1990 and 2023 — from 25.5 to 14.2 per 100,000. And for 4 of the 5 leading causes of cancer death, there were mean annual declines from 2014 to 2023. The biggest change was in lung cancer deaths, which fell by an average of 5.7% per year. Meanwhile, leukemia and breast cancer deaths showed annual declines of 2.3% and 1.4%, respectively, despite rising incidences of both diseases among younger Americans.

The outlier is colorectal cancer, where mortality has been rising by about 1% per year since 2005. And it’s a pattern seen in both men and women.

Study coauthor Nikita Sandeep Wagle, PhD, MBBS, principal scientist, Cancer Surveillance Research at the ACS, and Arif Kamal, MD, ACS chief patient officer, discussed the research and its implications with Medscape Medical News.

Can you offer some possible reasons for the declining mortality in most of the cancers you studied?

Wagle: Mortality is going down for most of the cancers because we are getting better at finding cancers earlier and treating them more effectively. We have also seen improvements in screening, imaging, and therapy, and that means more people are being diagnosed at earlier stages and are surviving longer after diagnosis.

Regarding the rise in colorectal cancer mortality, do you think it's due to the rising incidence of early-onset colorectal cancer?

Kamal: Partially, but not completely, because the relationship between incidence and mortality is not always straightforward. For example, breast cancer incidence has been increasing, while mortality is going down. The rising mortality in people younger than 50 years is likely suggestive of more aggressive cancers being diagnosed — potentially secondary to environmental, dietary, or lifestyle factors. The colon is a unique organ because everything we put in our bodies passes through the colon, so food-based risk factors — for example, low fiber intake, red meat, and ultra-processed foods — are increasingly rising to the top as culprits.

Further, we know that only about 25% of people between the ages of 45 and 50 years are up to date with recommended colon cancer screenings, which can lead to later-stage diagnoses and thus higher mortality. So higher mortality speaks to the need to focus on lifestyle and diet changes and get more younger people to complete recommended cancer screenings.

Wagle: I think the “why” of your question is very important. Many researchers are trying to understand possible causes, such as diet, lifestyle, environmental factors, and genetics. But we cannot pinpoint one single cause. We need even more focus on research toward understanding the etiology of early-onset colorectal cancer.

What makes colorectal cancer different is that, unlike some other major cancers in this age group where mortality has declined despite rising incidence, roughly 3 in 4 colorectal cancers diagnosed in people younger than 50 years are [regional or distant], where the outcomes are worse.

Can you contextualize the rise in colorectal cancer mortality? What is the absolute rate among younger Americans now?

Wagle: It is around two deaths per 100,000 population in 2023 for people younger than 50 years. That number may not seem large, but the upward trend — a 1.1% annual increase from 2014 to 2023 — is concerning when you think about how overall mortality in this age group has dropped substantially over the past few decades. Colorectal cancer is moving in the opposite direction. I think the hopeful part is that it is also one of the most preventable cancers. Screening can stop cancer before it starts by removing precancerous polyps. Early-stage disease is highly treatable, and outcomes are better. That means better awareness and timely screening could make a real difference.

How can clinicians use this new information with regard to screening?

Wagle: For cancers with established screening guidelines, such as colorectal cancer, clinicians should continue to emphasize guideline-based screening and individualized risk assessment.

For colorectal cancer, screening now is recommended to start at age 45 for individuals at average risk, and earlier for [some], due to family history or other risk factors. Clinicians can use these findings to remind younger individuals that colorectal cancer is not only a disease of older adults and that screening at the recommended age can save lives.

In addition, red-flag symptoms such as persistent rectal bleeding, unexplained abdominal pain, difficulty in bowel movements, or signs of anemia should prompt appropriate evaluation in younger individuals.

Kamal: Clinicians should continue to emphasize timely completion of regular screening, starting at age 45 [for average-risk people]. Many still believe that the recommended starting age is 50 or that colonoscopy is the only way to get screened. Highlighting home-based screening options often helps patients make cancer screening logistically fit better into their busy lives.

Could you elaborate on the red-flag symptoms you mentioned, and what is an appropriate evaluation in younger individuals?

Kamal: Appropriate evaluation for any suspected bleeding — bright red or black and tarry — starts with an in-office evaluation by a primary care physician. Referral to a specialist, such as a gastroenterologist or surgeon, is done later, typically for direct visualization, such as with a colonoscopy. Rarely, imaging such as CT scans or ultrasounds is performed. Overall, because of the rising incidence of colon cancer in younger people, any concerning symptoms should be reported to a physician for an in-office evaluation as the first step.

Do these findings suggest that the starting age for average-risk people should be lowered—to age 40, for example?

Kamal: ACS screening guidelines for all cancers are part of an ongoing guideline development process by ACS scientists and volunteers. We monitor medical and scientific literature for new evidence that may support a change in current guidelines or the development of new guidelines and for information about cancer screening that should be conveyed to clinicians and target populations.

Keith Mulvihill is a freelance writer based in New York City.

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

First, the good news: Fewer Americans aged < 50 years are dying from cancer vs just a decade ago — reflecting progress in prevention, early detection, and treatment. There is, however, one big exception. Colorectal cancer mortality has been steadily inching up, and the disease now stands as the leading cause of cancer death in this age group, up from the fifth-leading in the early 1990s.

Those are the major findings of a recent study by the American Cancer Society (ACS), published as a research letter in JAMA.

Using SEER data, researchers found that the overall age-adjusted cancer death rate among Americans aged < 50 years dropped by 44% between 1990 and 2023 — from 25.5 to 14.2 per 100,000. And for 4 of the 5 leading causes of cancer death, there were mean annual declines from 2014 to 2023. The biggest change was in lung cancer deaths, which fell by an average of 5.7% per year. Meanwhile, leukemia and breast cancer deaths showed annual declines of 2.3% and 1.4%, respectively, despite rising incidences of both diseases among younger Americans.

The outlier is colorectal cancer, where mortality has been rising by about 1% per year since 2005. And it’s a pattern seen in both men and women.

Study coauthor Nikita Sandeep Wagle, PhD, MBBS, principal scientist, Cancer Surveillance Research at the ACS, and Arif Kamal, MD, ACS chief patient officer, discussed the research and its implications with Medscape Medical News.

Can you offer some possible reasons for the declining mortality in most of the cancers you studied?

Wagle: Mortality is going down for most of the cancers because we are getting better at finding cancers earlier and treating them more effectively. We have also seen improvements in screening, imaging, and therapy, and that means more people are being diagnosed at earlier stages and are surviving longer after diagnosis.

Regarding the rise in colorectal cancer mortality, do you think it's due to the rising incidence of early-onset colorectal cancer?

Kamal: Partially, but not completely, because the relationship between incidence and mortality is not always straightforward. For example, breast cancer incidence has been increasing, while mortality is going down. The rising mortality in people younger than 50 years is likely suggestive of more aggressive cancers being diagnosed — potentially secondary to environmental, dietary, or lifestyle factors. The colon is a unique organ because everything we put in our bodies passes through the colon, so food-based risk factors — for example, low fiber intake, red meat, and ultra-processed foods — are increasingly rising to the top as culprits.

Further, we know that only about 25% of people between the ages of 45 and 50 years are up to date with recommended colon cancer screenings, which can lead to later-stage diagnoses and thus higher mortality. So higher mortality speaks to the need to focus on lifestyle and diet changes and get more younger people to complete recommended cancer screenings.

Wagle: I think the “why” of your question is very important. Many researchers are trying to understand possible causes, such as diet, lifestyle, environmental factors, and genetics. But we cannot pinpoint one single cause. We need even more focus on research toward understanding the etiology of early-onset colorectal cancer.

What makes colorectal cancer different is that, unlike some other major cancers in this age group where mortality has declined despite rising incidence, roughly 3 in 4 colorectal cancers diagnosed in people younger than 50 years are [regional or distant], where the outcomes are worse.

Can you contextualize the rise in colorectal cancer mortality? What is the absolute rate among younger Americans now?

Wagle: It is around two deaths per 100,000 population in 2023 for people younger than 50 years. That number may not seem large, but the upward trend — a 1.1% annual increase from 2014 to 2023 — is concerning when you think about how overall mortality in this age group has dropped substantially over the past few decades. Colorectal cancer is moving in the opposite direction. I think the hopeful part is that it is also one of the most preventable cancers. Screening can stop cancer before it starts by removing precancerous polyps. Early-stage disease is highly treatable, and outcomes are better. That means better awareness and timely screening could make a real difference.

How can clinicians use this new information with regard to screening?

Wagle: For cancers with established screening guidelines, such as colorectal cancer, clinicians should continue to emphasize guideline-based screening and individualized risk assessment.

For colorectal cancer, screening now is recommended to start at age 45 for individuals at average risk, and earlier for [some], due to family history or other risk factors. Clinicians can use these findings to remind younger individuals that colorectal cancer is not only a disease of older adults and that screening at the recommended age can save lives.

In addition, red-flag symptoms such as persistent rectal bleeding, unexplained abdominal pain, difficulty in bowel movements, or signs of anemia should prompt appropriate evaluation in younger individuals.

Kamal: Clinicians should continue to emphasize timely completion of regular screening, starting at age 45 [for average-risk people]. Many still believe that the recommended starting age is 50 or that colonoscopy is the only way to get screened. Highlighting home-based screening options often helps patients make cancer screening logistically fit better into their busy lives.

Could you elaborate on the red-flag symptoms you mentioned, and what is an appropriate evaluation in younger individuals?

Kamal: Appropriate evaluation for any suspected bleeding — bright red or black and tarry — starts with an in-office evaluation by a primary care physician. Referral to a specialist, such as a gastroenterologist or surgeon, is done later, typically for direct visualization, such as with a colonoscopy. Rarely, imaging such as CT scans or ultrasounds is performed. Overall, because of the rising incidence of colon cancer in younger people, any concerning symptoms should be reported to a physician for an in-office evaluation as the first step.

Do these findings suggest that the starting age for average-risk people should be lowered—to age 40, for example?

Kamal: ACS screening guidelines for all cancers are part of an ongoing guideline development process by ACS scientists and volunteers. We monitor medical and scientific literature for new evidence that may support a change in current guidelines or the development of new guidelines and for information about cancer screening that should be conveyed to clinicians and target populations.

Keith Mulvihill is a freelance writer based in New York City.

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

First, the good news: Fewer Americans aged < 50 years are dying from cancer vs just a decade ago — reflecting progress in prevention, early detection, and treatment. There is, however, one big exception. Colorectal cancer mortality has been steadily inching up, and the disease now stands as the leading cause of cancer death in this age group, up from the fifth-leading in the early 1990s.

Those are the major findings of a recent study by the American Cancer Society (ACS), published as a research letter in JAMA.

Using SEER data, researchers found that the overall age-adjusted cancer death rate among Americans aged < 50 years dropped by 44% between 1990 and 2023 — from 25.5 to 14.2 per 100,000. And for 4 of the 5 leading causes of cancer death, there were mean annual declines from 2014 to 2023. The biggest change was in lung cancer deaths, which fell by an average of 5.7% per year. Meanwhile, leukemia and breast cancer deaths showed annual declines of 2.3% and 1.4%, respectively, despite rising incidences of both diseases among younger Americans.

The outlier is colorectal cancer, where mortality has been rising by about 1% per year since 2005. And it’s a pattern seen in both men and women.

Study coauthor Nikita Sandeep Wagle, PhD, MBBS, principal scientist, Cancer Surveillance Research at the ACS, and Arif Kamal, MD, ACS chief patient officer, discussed the research and its implications with Medscape Medical News.

Can you offer some possible reasons for the declining mortality in most of the cancers you studied?

Wagle: Mortality is going down for most of the cancers because we are getting better at finding cancers earlier and treating them more effectively. We have also seen improvements in screening, imaging, and therapy, and that means more people are being diagnosed at earlier stages and are surviving longer after diagnosis.

Regarding the rise in colorectal cancer mortality, do you think it's due to the rising incidence of early-onset colorectal cancer?

Kamal: Partially, but not completely, because the relationship between incidence and mortality is not always straightforward. For example, breast cancer incidence has been increasing, while mortality is going down. The rising mortality in people younger than 50 years is likely suggestive of more aggressive cancers being diagnosed — potentially secondary to environmental, dietary, or lifestyle factors. The colon is a unique organ because everything we put in our bodies passes through the colon, so food-based risk factors — for example, low fiber intake, red meat, and ultra-processed foods — are increasingly rising to the top as culprits.

Further, we know that only about 25% of people between the ages of 45 and 50 years are up to date with recommended colon cancer screenings, which can lead to later-stage diagnoses and thus higher mortality. So higher mortality speaks to the need to focus on lifestyle and diet changes and get more younger people to complete recommended cancer screenings.

Wagle: I think the “why” of your question is very important. Many researchers are trying to understand possible causes, such as diet, lifestyle, environmental factors, and genetics. But we cannot pinpoint one single cause. We need even more focus on research toward understanding the etiology of early-onset colorectal cancer.

What makes colorectal cancer different is that, unlike some other major cancers in this age group where mortality has declined despite rising incidence, roughly 3 in 4 colorectal cancers diagnosed in people younger than 50 years are [regional or distant], where the outcomes are worse.

Can you contextualize the rise in colorectal cancer mortality? What is the absolute rate among younger Americans now?

Wagle: It is around two deaths per 100,000 population in 2023 for people younger than 50 years. That number may not seem large, but the upward trend — a 1.1% annual increase from 2014 to 2023 — is concerning when you think about how overall mortality in this age group has dropped substantially over the past few decades. Colorectal cancer is moving in the opposite direction. I think the hopeful part is that it is also one of the most preventable cancers. Screening can stop cancer before it starts by removing precancerous polyps. Early-stage disease is highly treatable, and outcomes are better. That means better awareness and timely screening could make a real difference.

How can clinicians use this new information with regard to screening?

Wagle: For cancers with established screening guidelines, such as colorectal cancer, clinicians should continue to emphasize guideline-based screening and individualized risk assessment.

For colorectal cancer, screening now is recommended to start at age 45 for individuals at average risk, and earlier for [some], due to family history or other risk factors. Clinicians can use these findings to remind younger individuals that colorectal cancer is not only a disease of older adults and that screening at the recommended age can save lives.

In addition, red-flag symptoms such as persistent rectal bleeding, unexplained abdominal pain, difficulty in bowel movements, or signs of anemia should prompt appropriate evaluation in younger individuals.

Kamal: Clinicians should continue to emphasize timely completion of regular screening, starting at age 45 [for average-risk people]. Many still believe that the recommended starting age is 50 or that colonoscopy is the only way to get screened. Highlighting home-based screening options often helps patients make cancer screening logistically fit better into their busy lives.

Could you elaborate on the red-flag symptoms you mentioned, and what is an appropriate evaluation in younger individuals?

Kamal: Appropriate evaluation for any suspected bleeding — bright red or black and tarry — starts with an in-office evaluation by a primary care physician. Referral to a specialist, such as a gastroenterologist or surgeon, is done later, typically for direct visualization, such as with a colonoscopy. Rarely, imaging such as CT scans or ultrasounds is performed. Overall, because of the rising incidence of colon cancer in younger people, any concerning symptoms should be reported to a physician for an in-office evaluation as the first step.

Do these findings suggest that the starting age for average-risk people should be lowered—to age 40, for example?

Kamal: ACS screening guidelines for all cancers are part of an ongoing guideline development process by ACS scientists and volunteers. We monitor medical and scientific literature for new evidence that may support a change in current guidelines or the development of new guidelines and for information about cancer screening that should be conveyed to clinicians and target populations.

Keith Mulvihill is a freelance writer based in New York City.

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

Diets heavy in ultraprocessed foods (UPFs) are associated with earlier death in cancer survivors, a new study finds — though issues with the research design suggest that the findings should be taken with a grain of salt.

The study, published on February 4 in Cancer Epidemiology, Biomarkers & Prevention, is among the latest to point to health hazards from eating too many foods full of preservatives, dyes, and other industrially made ingredients.

These so-called UPFs have been linked to an increased risk for cancer, but whether they have any relationship to long-term survival after cancer has been unclear.

In the new study, of 802 adults with a previous cancer diagnosis, those in the top third for UPF consumption had a 48% higher rate of death from any cause over 15 years than those in the bottom third. Similarly, heavier UPF consumers had a 57% higher rate of death from cancer.

Those excess risks were seen after adjustment for numerous variables, including age, physical activity, BMI, smoking status, and socioeconomic indicators.

“Clinicians should encourage a shift toward fresh, minimally processed foods, [and] away from heavily industrially processed products,” said lead author Marialaura Bonaccio, PhD, of the Research Unit of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli, Italy.

Oncologists not involved in the work said the findings support what researchers have suspected.

“UPFs have been linked to increased risk of obesity, diabetes, inflammation, cardiovascular disease, and...all-cause mortality and cardiovascular mortality,” said Urvi A. Shah, MD, a myeloma specialist who conducts nutrition research at Memorial Sloan Kettering Cancer Center in New York City. “However, there was limited data on cancer-specific mortality to date until this study.”

The findings also dovetail with recommendations on cancer prevention that emphasize diets rich in plant foods and low in processed foods, particularly those loaded with sugar, starch, and fat.

The study “may make oncologists think twice before assuring patients to ‘eat whatever you want, it doesn’t really matter’ because these investigators show that it does,” said Donald I. Abrams, MD, an integrative oncologist at the UCSF Osher Center for Integrative Health.

However, Gideon Meyerowitz-Katz, PhD, an epidemiologist at the University of Wollongong in Wollongong, Australia, was not impressed by the analysis.

He pointed to several sources of potential bias and noted that the crude results actually showed that cancer survivors with the lowest UPF consumption had a higher rate of death than the heaviest consumers.

“The story of UPFs being bad is consistent with this data, but so is the story of UPFs being fine,” said Meyerowitz-Katz, who has written about prior research on the subject.

The broad questions of whether and how UPFs might be harming human health have been gaining research interest, partly because of their ubiquity. The foods reportedly make up about 60% of the typical American diet.

There’s no universal agreement on the precise definition of “ultraprocessed,” but researchers generally use the NOVA classification system, which assigns foods into one of four groups based on the level and purpose of processing. UPFs contain ingredients not found in the standard home kitchen (such as high-fructose corn syrup) and often have artificial flavors, colors, and other additives.

Examples of UPFs include the usual “junk food,” such as candy, soda, and processed meat, but many healthy-sounding products, such as flavored yogurts and plant-based milk, also qualify.

For their study, Bonaccio and her colleagues identified 802 cancer survivors from the Moli-sani cohort study (476 women and 326 men) who completed food-frequency questionnaires an average of 8 years postdiagnosis.

Using the NOVA system, the team calculated the amount of UPF in participants’ diets as both weight and energy ratios.

Over a median follow-up of nearly 15 years, there were 281 deaths. In the lowest third of UPF consumption (4.3% mean intake by weight), there were 3.3 deaths per 100 patient-years, compared with 2.4 per 100 patient-years in the highest UPF tertile (16.7% mean intake by weight). For cancer-specific deaths, those numbers were 1.5 and 1.4, respectively.

However, after adjustment for age and total energy intake, the top UPF-intake group showed significantly higher death rates. In the final model, which adjusted for > 20 variables, the hazard ratios for the highest versus lowest UPF consumption were 1.48 (95% CI, 1.07-2.03) for all-cause mortality and 1.57 (95% CI, 1.00-2.47) for cancer mortality.

To explore potential biological mechanisms, the researchers also analyzed certain biomarkers. They found that adjustment for inflammatory markers and resting heart rate at baseline attenuated the association between UPF and all-cause deaths by nearly 40%.

The authors acknowledged some limitations of their study, including its use of self-report and potential survivor bias.

But Meyerowitz-Katz found additional weak points. For one, he said the authors “downplayed” the impact of their analysis controlling for inflammation and heart rate.

“Inflammation and heart rate are both strong markers of future cancer risk,” Meyerowitz-Katz said. “In this cohort, there would be people who were already experiencing cancer recurrence, which is important to control for at baseline.”

He also highlighted a little-known but important issue in observational research called collider bias, which can create a false association between an exposure and outcome. In this study, he said, the researchers introduced “a huge potential for collider bias” by controlling for energy intake, because both UPF consumption and cancer recurrence are causally associated with energy intake.

Bonaccio called that particular critique “a fair methodological question” but defended her work.

She pointed out that study participants were long-term survivors, which reduces the chance that their calorie intake was mainly driven by active cancer or treatment side effects.

“And,” she said, “our models include a wide set of baseline covariates that capture major determinants of both mortality and dietary intake.”

For Bonaccio, the take-home message for patients remains the same: “Emphasizing simple, home-cooked meals and traditional dietary patterns might be especially beneficial during the survivorship phase.”

The two US experts agreed that overall diet quality is key, with limits on UPFs being part of that. They also noted that the average American’s diet contains substantially more UPFs than what was seen in this Italian study.

“I spend 20 minutes of my 60-minute new patient consult in integrative oncology advising patients to eat an organic, plant-based, antioxidant-rich, anti-inflammatory, real and whole-foods diet,” Abrams said.

For her part, Shah said that cancer survivors should aim to get at least 25-30 grams of dietary fiber daily. She also suggested they avoid particular types of UPF with little to no nutritional value, such as processed meats, sugar-laden beverages, and fast food.

The study received no commercial funding. Bonaccio, Abrams, and Meyerowitz-Katz reported no financial disclosures. Shah is principle investigator on the NUTRIVENTION trial and reported receiving research funding and/or personal fees from Celgene/BMS, Janssen, and Sanofi.

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

Diets heavy in ultraprocessed foods (UPFs) are associated with earlier death in cancer survivors, a new study finds — though issues with the research design suggest that the findings should be taken with a grain of salt.

The study, published on February 4 in Cancer Epidemiology, Biomarkers & Prevention, is among the latest to point to health hazards from eating too many foods full of preservatives, dyes, and other industrially made ingredients.

These so-called UPFs have been linked to an increased risk for cancer, but whether they have any relationship to long-term survival after cancer has been unclear.

In the new study, of 802 adults with a previous cancer diagnosis, those in the top third for UPF consumption had a 48% higher rate of death from any cause over 15 years than those in the bottom third. Similarly, heavier UPF consumers had a 57% higher rate of death from cancer.

Those excess risks were seen after adjustment for numerous variables, including age, physical activity, BMI, smoking status, and socioeconomic indicators.

“Clinicians should encourage a shift toward fresh, minimally processed foods, [and] away from heavily industrially processed products,” said lead author Marialaura Bonaccio, PhD, of the Research Unit of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli, Italy.

Oncologists not involved in the work said the findings support what researchers have suspected.

“UPFs have been linked to increased risk of obesity, diabetes, inflammation, cardiovascular disease, and...all-cause mortality and cardiovascular mortality,” said Urvi A. Shah, MD, a myeloma specialist who conducts nutrition research at Memorial Sloan Kettering Cancer Center in New York City. “However, there was limited data on cancer-specific mortality to date until this study.”

The findings also dovetail with recommendations on cancer prevention that emphasize diets rich in plant foods and low in processed foods, particularly those loaded with sugar, starch, and fat.

The study “may make oncologists think twice before assuring patients to ‘eat whatever you want, it doesn’t really matter’ because these investigators show that it does,” said Donald I. Abrams, MD, an integrative oncologist at the UCSF Osher Center for Integrative Health.

However, Gideon Meyerowitz-Katz, PhD, an epidemiologist at the University of Wollongong in Wollongong, Australia, was not impressed by the analysis.

He pointed to several sources of potential bias and noted that the crude results actually showed that cancer survivors with the lowest UPF consumption had a higher rate of death than the heaviest consumers.

“The story of UPFs being bad is consistent with this data, but so is the story of UPFs being fine,” said Meyerowitz-Katz, who has written about prior research on the subject.

The broad questions of whether and how UPFs might be harming human health have been gaining research interest, partly because of their ubiquity. The foods reportedly make up about 60% of the typical American diet.

There’s no universal agreement on the precise definition of “ultraprocessed,” but researchers generally use the NOVA classification system, which assigns foods into one of four groups based on the level and purpose of processing. UPFs contain ingredients not found in the standard home kitchen (such as high-fructose corn syrup) and often have artificial flavors, colors, and other additives.

Examples of UPFs include the usual “junk food,” such as candy, soda, and processed meat, but many healthy-sounding products, such as flavored yogurts and plant-based milk, also qualify.

For their study, Bonaccio and her colleagues identified 802 cancer survivors from the Moli-sani cohort study (476 women and 326 men) who completed food-frequency questionnaires an average of 8 years postdiagnosis.

Using the NOVA system, the team calculated the amount of UPF in participants’ diets as both weight and energy ratios.

Over a median follow-up of nearly 15 years, there were 281 deaths. In the lowest third of UPF consumption (4.3% mean intake by weight), there were 3.3 deaths per 100 patient-years, compared with 2.4 per 100 patient-years in the highest UPF tertile (16.7% mean intake by weight). For cancer-specific deaths, those numbers were 1.5 and 1.4, respectively.

However, after adjustment for age and total energy intake, the top UPF-intake group showed significantly higher death rates. In the final model, which adjusted for > 20 variables, the hazard ratios for the highest versus lowest UPF consumption were 1.48 (95% CI, 1.07-2.03) for all-cause mortality and 1.57 (95% CI, 1.00-2.47) for cancer mortality.

To explore potential biological mechanisms, the researchers also analyzed certain biomarkers. They found that adjustment for inflammatory markers and resting heart rate at baseline attenuated the association between UPF and all-cause deaths by nearly 40%.

The authors acknowledged some limitations of their study, including its use of self-report and potential survivor bias.

But Meyerowitz-Katz found additional weak points. For one, he said the authors “downplayed” the impact of their analysis controlling for inflammation and heart rate.

“Inflammation and heart rate are both strong markers of future cancer risk,” Meyerowitz-Katz said. “In this cohort, there would be people who were already experiencing cancer recurrence, which is important to control for at baseline.”

He also highlighted a little-known but important issue in observational research called collider bias, which can create a false association between an exposure and outcome. In this study, he said, the researchers introduced “a huge potential for collider bias” by controlling for energy intake, because both UPF consumption and cancer recurrence are causally associated with energy intake.

Bonaccio called that particular critique “a fair methodological question” but defended her work.

She pointed out that study participants were long-term survivors, which reduces the chance that their calorie intake was mainly driven by active cancer or treatment side effects.

“And,” she said, “our models include a wide set of baseline covariates that capture major determinants of both mortality and dietary intake.”

For Bonaccio, the take-home message for patients remains the same: “Emphasizing simple, home-cooked meals and traditional dietary patterns might be especially beneficial during the survivorship phase.”

The two US experts agreed that overall diet quality is key, with limits on UPFs being part of that. They also noted that the average American’s diet contains substantially more UPFs than what was seen in this Italian study.

“I spend 20 minutes of my 60-minute new patient consult in integrative oncology advising patients to eat an organic, plant-based, antioxidant-rich, anti-inflammatory, real and whole-foods diet,” Abrams said.

For her part, Shah said that cancer survivors should aim to get at least 25-30 grams of dietary fiber daily. She also suggested they avoid particular types of UPF with little to no nutritional value, such as processed meats, sugar-laden beverages, and fast food.

The study received no commercial funding. Bonaccio, Abrams, and Meyerowitz-Katz reported no financial disclosures. Shah is principle investigator on the NUTRIVENTION trial and reported receiving research funding and/or personal fees from Celgene/BMS, Janssen, and Sanofi.

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

Diets heavy in ultraprocessed foods (UPFs) are associated with earlier death in cancer survivors, a new study finds — though issues with the research design suggest that the findings should be taken with a grain of salt.

The study, published on February 4 in Cancer Epidemiology, Biomarkers & Prevention, is among the latest to point to health hazards from eating too many foods full of preservatives, dyes, and other industrially made ingredients.

These so-called UPFs have been linked to an increased risk for cancer, but whether they have any relationship to long-term survival after cancer has been unclear.

In the new study, of 802 adults with a previous cancer diagnosis, those in the top third for UPF consumption had a 48% higher rate of death from any cause over 15 years than those in the bottom third. Similarly, heavier UPF consumers had a 57% higher rate of death from cancer.

Those excess risks were seen after adjustment for numerous variables, including age, physical activity, BMI, smoking status, and socioeconomic indicators.

“Clinicians should encourage a shift toward fresh, minimally processed foods, [and] away from heavily industrially processed products,” said lead author Marialaura Bonaccio, PhD, of the Research Unit of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli, Italy.

Oncologists not involved in the work said the findings support what researchers have suspected.

“UPFs have been linked to increased risk of obesity, diabetes, inflammation, cardiovascular disease, and...all-cause mortality and cardiovascular mortality,” said Urvi A. Shah, MD, a myeloma specialist who conducts nutrition research at Memorial Sloan Kettering Cancer Center in New York City. “However, there was limited data on cancer-specific mortality to date until this study.”

The findings also dovetail with recommendations on cancer prevention that emphasize diets rich in plant foods and low in processed foods, particularly those loaded with sugar, starch, and fat.

The study “may make oncologists think twice before assuring patients to ‘eat whatever you want, it doesn’t really matter’ because these investigators show that it does,” said Donald I. Abrams, MD, an integrative oncologist at the UCSF Osher Center for Integrative Health.

However, Gideon Meyerowitz-Katz, PhD, an epidemiologist at the University of Wollongong in Wollongong, Australia, was not impressed by the analysis.

He pointed to several sources of potential bias and noted that the crude results actually showed that cancer survivors with the lowest UPF consumption had a higher rate of death than the heaviest consumers.

“The story of UPFs being bad is consistent with this data, but so is the story of UPFs being fine,” said Meyerowitz-Katz, who has written about prior research on the subject.

The broad questions of whether and how UPFs might be harming human health have been gaining research interest, partly because of their ubiquity. The foods reportedly make up about 60% of the typical American diet.

There’s no universal agreement on the precise definition of “ultraprocessed,” but researchers generally use the NOVA classification system, which assigns foods into one of four groups based on the level and purpose of processing. UPFs contain ingredients not found in the standard home kitchen (such as high-fructose corn syrup) and often have artificial flavors, colors, and other additives.

Examples of UPFs include the usual “junk food,” such as candy, soda, and processed meat, but many healthy-sounding products, such as flavored yogurts and plant-based milk, also qualify.

For their study, Bonaccio and her colleagues identified 802 cancer survivors from the Moli-sani cohort study (476 women and 326 men) who completed food-frequency questionnaires an average of 8 years postdiagnosis.

Using the NOVA system, the team calculated the amount of UPF in participants’ diets as both weight and energy ratios.

Over a median follow-up of nearly 15 years, there were 281 deaths. In the lowest third of UPF consumption (4.3% mean intake by weight), there were 3.3 deaths per 100 patient-years, compared with 2.4 per 100 patient-years in the highest UPF tertile (16.7% mean intake by weight). For cancer-specific deaths, those numbers were 1.5 and 1.4, respectively.

However, after adjustment for age and total energy intake, the top UPF-intake group showed significantly higher death rates. In the final model, which adjusted for > 20 variables, the hazard ratios for the highest versus lowest UPF consumption were 1.48 (95% CI, 1.07-2.03) for all-cause mortality and 1.57 (95% CI, 1.00-2.47) for cancer mortality.

To explore potential biological mechanisms, the researchers also analyzed certain biomarkers. They found that adjustment for inflammatory markers and resting heart rate at baseline attenuated the association between UPF and all-cause deaths by nearly 40%.

The authors acknowledged some limitations of their study, including its use of self-report and potential survivor bias.

But Meyerowitz-Katz found additional weak points. For one, he said the authors “downplayed” the impact of their analysis controlling for inflammation and heart rate.

“Inflammation and heart rate are both strong markers of future cancer risk,” Meyerowitz-Katz said. “In this cohort, there would be people who were already experiencing cancer recurrence, which is important to control for at baseline.”

He also highlighted a little-known but important issue in observational research called collider bias, which can create a false association between an exposure and outcome. In this study, he said, the researchers introduced “a huge potential for collider bias” by controlling for energy intake, because both UPF consumption and cancer recurrence are causally associated with energy intake.

Bonaccio called that particular critique “a fair methodological question” but defended her work.

She pointed out that study participants were long-term survivors, which reduces the chance that their calorie intake was mainly driven by active cancer or treatment side effects.

“And,” she said, “our models include a wide set of baseline covariates that capture major determinants of both mortality and dietary intake.”

For Bonaccio, the take-home message for patients remains the same: “Emphasizing simple, home-cooked meals and traditional dietary patterns might be especially beneficial during the survivorship phase.”

The two US experts agreed that overall diet quality is key, with limits on UPFs being part of that. They also noted that the average American’s diet contains substantially more UPFs than what was seen in this Italian study.

“I spend 20 minutes of my 60-minute new patient consult in integrative oncology advising patients to eat an organic, plant-based, antioxidant-rich, anti-inflammatory, real and whole-foods diet,” Abrams said.

For her part, Shah said that cancer survivors should aim to get at least 25-30 grams of dietary fiber daily. She also suggested they avoid particular types of UPF with little to no nutritional value, such as processed meats, sugar-laden beverages, and fast food.

The study received no commercial funding. Bonaccio, Abrams, and Meyerowitz-Katz reported no financial disclosures. Shah is principle investigator on the NUTRIVENTION trial and reported receiving research funding and/or personal fees from Celgene/BMS, Janssen, and Sanofi.

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

TOPLINE:

Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.

METHODOLOGY:

• Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
• Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
• Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.

TAKEAWAY:

• Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
• Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
• Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
• History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).

IN PRACTICE:

“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.

SOURCE:

The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.

LIMITATIONS:

The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.

DISCLOSURES:

The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.

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:

Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.

METHODOLOGY:

• Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
• Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
• Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.

TAKEAWAY:

• Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
• Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
• Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
• History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).

IN PRACTICE:

“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.

SOURCE:

The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.

LIMITATIONS:

The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.

DISCLOSURES:

The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.

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:

Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.

METHODOLOGY:

• Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
• Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
• Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.

TAKEAWAY:

• Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
• Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
• Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
• History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).

IN PRACTICE:

“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.

SOURCE:

The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.

LIMITATIONS:

The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.

DISCLOSURES:

The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.

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 pediatric beneficiaries in the Military Health System (MHS), racial and ethnic disparities in asthma care persisted, with Black children having the highest odds of an asthma diagnosis and emergency department (ED) visit among all racial and ethnic groups.

METHODOLOGY:

• This cross-sectional study examined racial and ethnic differences in asthma prevalence and related outcomes among pediatric beneficiaries in the MHS.
• They included 950,896 dependents aged 2-17 years (50.9% boys) who had ≥ 1 inpatient or outpatient encounter during fiscal year 2023.
• Race and ethnicity were self-reported by the beneficiary and derived from the sponsor’s demographic records.
• An asthma diagnosis required at least one inpatient claim or two outpatient claims with an asthma diagnostic code recorded in the primary or secondary diagnosis field.
• Asthma-related outcomes assessed were potentially avoidable hospitalizations, ED visits, specialist visits, and asthma-related prescriptions.

TAKEAWAY:

• Overall, 3.3% of children had an asthma diagnosis; the prevalence was higher among children aged 5-10 or 11-17 years, boys, and those with 1 or 2 siblings.
• The odds of an asthma diagnosis were significantly higher in all racial and ethnic groups than in White children, and were highest in Black children, who had 85% higher odds across all ages (P < .001).
• Similarly, Black children were 39% more likely than White children to have an asthma-related ED visit; Hispanic children were 36% more likely and Native Hawaiian or Pacific Islander children were 25% more likely (P < .05 for all comparisons).
• Black children also had slightly higher odds of an asthma-related specialist visit than White children, and both Black and Hispanic children were more likely to receive any asthma prescription.

IN PRACTICE:

These results highlighted how access to low-cost or no-cost care, consistent insurance coverage, and effective prescription practices within the MHS may have helped to improve asthma outcomes. Still, the persistence of racial and ethnic disparities pointed to the need for further action. Efforts to close these gaps should include expanding access to culturally responsive care, increasing availability of specialists, and continuing to assess and improve how care is delivered across the system,” the authors wrote.

SOURCE:

This study was led by Felicia Yeboah Denteh, DrPH, MHA, Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland. It was published online on January 26, 2026, in JAMA Network Open.

LIMITATIONS:

This study used the sponsor’s race and ethnicity as proxies for children’s race and ethnicity, which could have misclassified multiracial children, adopted children, and wards. It also relied on coding in secondary data and did not include factors such as BMI, pollution, and family history.

DISCLOSURES:

This study was funded by the Department of War, Defense Health Agency. The authors did not report any 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 pediatric beneficiaries in the Military Health System (MHS), racial and ethnic disparities in asthma care persisted, with Black children having the highest odds of an asthma diagnosis and emergency department (ED) visit among all racial and ethnic groups.

METHODOLOGY:

• This cross-sectional study examined racial and ethnic differences in asthma prevalence and related outcomes among pediatric beneficiaries in the MHS.
• They included 950,896 dependents aged 2-17 years (50.9% boys) who had ≥ 1 inpatient or outpatient encounter during fiscal year 2023.
• Race and ethnicity were self-reported by the beneficiary and derived from the sponsor’s demographic records.
• An asthma diagnosis required at least one inpatient claim or two outpatient claims with an asthma diagnostic code recorded in the primary or secondary diagnosis field.
• Asthma-related outcomes assessed were potentially avoidable hospitalizations, ED visits, specialist visits, and asthma-related prescriptions.

TAKEAWAY:

• Overall, 3.3% of children had an asthma diagnosis; the prevalence was higher among children aged 5-10 or 11-17 years, boys, and those with 1 or 2 siblings.
• The odds of an asthma diagnosis were significantly higher in all racial and ethnic groups than in White children, and were highest in Black children, who had 85% higher odds across all ages (P < .001).
• Similarly, Black children were 39% more likely than White children to have an asthma-related ED visit; Hispanic children were 36% more likely and Native Hawaiian or Pacific Islander children were 25% more likely (P < .05 for all comparisons).
• Black children also had slightly higher odds of an asthma-related specialist visit than White children, and both Black and Hispanic children were more likely to receive any asthma prescription.

IN PRACTICE:

These results highlighted how access to low-cost or no-cost care, consistent insurance coverage, and effective prescription practices within the MHS may have helped to improve asthma outcomes. Still, the persistence of racial and ethnic disparities pointed to the need for further action. Efforts to close these gaps should include expanding access to culturally responsive care, increasing availability of specialists, and continuing to assess and improve how care is delivered across the system,” the authors wrote.

SOURCE:

This study was led by Felicia Yeboah Denteh, DrPH, MHA, Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland. It was published online on January 26, 2026, in JAMA Network Open.

LIMITATIONS:

This study used the sponsor’s race and ethnicity as proxies for children’s race and ethnicity, which could have misclassified multiracial children, adopted children, and wards. It also relied on coding in secondary data and did not include factors such as BMI, pollution, and family history.

DISCLOSURES:

This study was funded by the Department of War, Defense Health Agency. The authors did not report any 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 pediatric beneficiaries in the Military Health System (MHS), racial and ethnic disparities in asthma care persisted, with Black children having the highest odds of an asthma diagnosis and emergency department (ED) visit among all racial and ethnic groups.

METHODOLOGY:

• This cross-sectional study examined racial and ethnic differences in asthma prevalence and related outcomes among pediatric beneficiaries in the MHS.
• They included 950,896 dependents aged 2-17 years (50.9% boys) who had ≥ 1 inpatient or outpatient encounter during fiscal year 2023.
• Race and ethnicity were self-reported by the beneficiary and derived from the sponsor’s demographic records.
• An asthma diagnosis required at least one inpatient claim or two outpatient claims with an asthma diagnostic code recorded in the primary or secondary diagnosis field.
• Asthma-related outcomes assessed were potentially avoidable hospitalizations, ED visits, specialist visits, and asthma-related prescriptions.

TAKEAWAY:

• Overall, 3.3% of children had an asthma diagnosis; the prevalence was higher among children aged 5-10 or 11-17 years, boys, and those with 1 or 2 siblings.
• The odds of an asthma diagnosis were significantly higher in all racial and ethnic groups than in White children, and were highest in Black children, who had 85% higher odds across all ages (P < .001).
• Similarly, Black children were 39% more likely than White children to have an asthma-related ED visit; Hispanic children were 36% more likely and Native Hawaiian or Pacific Islander children were 25% more likely (P < .05 for all comparisons).
• Black children also had slightly higher odds of an asthma-related specialist visit than White children, and both Black and Hispanic children were more likely to receive any asthma prescription.

IN PRACTICE:

These results highlighted how access to low-cost or no-cost care, consistent insurance coverage, and effective prescription practices within the MHS may have helped to improve asthma outcomes. Still, the persistence of racial and ethnic disparities pointed to the need for further action. Efforts to close these gaps should include expanding access to culturally responsive care, increasing availability of specialists, and continuing to assess and improve how care is delivered across the system,” the authors wrote.

SOURCE:

This study was led by Felicia Yeboah Denteh, DrPH, MHA, Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland. It was published online on January 26, 2026, in JAMA Network Open.

LIMITATIONS:

This study used the sponsor’s race and ethnicity as proxies for children’s race and ethnicity, which could have misclassified multiracial children, adopted children, and wards. It also relied on coding in secondary data and did not include factors such as BMI, pollution, and family history.

DISCLOSURES:

This study was funded by the Department of War, Defense Health Agency. The authors did not report any 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:

A history of tuberculosis (TB) and a history of chronic bronchitis were associated with an increased risk for lung cancer in individuals who had never smoked, whereas asthma had a positive, nonsignificant association overall and a significant association in women.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of clinical databases from inception to July 2025, to assess the association between asthma, TB, and/or chronic bronchitis and the risk for lung cancer among participants aged 18 years or older who had never smoked.
• They included data from 20 case-control studies involving 54,135 participants and five cohort studies involving 377,983 participants.
• The primary outcome was the risk for lung cancer among participants with a history of TB, asthma, or chronic bronchitis.
• Participants were labeled as “never smokers” if they were explicitly described in the manuscripts as having “never smoked” or reported smoking < 100 cigarettes in their lifetime.

TAKEAWAY:

• In case-control studies, TB (16 studies) and chronic bronchitis (9 studies) were significantly associated with an increased risk for lung cancer (odds ratio [OR], 1.76; P < .001 and OR, 1.36; P = .012, respectively).
• In four case-cohort studies, TB was associated with an increased but nonsignificant risk for lung cancer (hazard ratio, 1.64).
• Eleven case-control studies demonstrated a positive but nonsignificant association between asthma and the risk for lung cancer (OR, 1.34). However, a significant association emerged when analyses were limited to women (five studies; OR, 1.61; P < .01).

IN PRACTICE:

History of TB was especially associated with increased LC [lung cancer] risk, meriting particular attention for prospective CT screening studies,” the authors of the study wrote.

SOURCE:

This study was led by Nishwant Swami, MD, Hospital of the University of Pennsylvania, Philadelphia. It was published online on January 11, 2026, in Chest.

LIMITATIONS:

Most studies lacked uniform adjustment for key confounders, increasing the risk for residual confounding. The inclusion of few cohort studies in the analysis may have limited the assessment of temporality and precision. Additionally, differences in covariate adjustment, variable definitions, and language restrictions may have limited comparability and generalizability.

DISCLOSURES:

No specific funding was reported for this study. One author reported serving as a consultant or advisor for various companies, including AstraZeneca, Merck, and Pfizer. Another author reported receiving funding, in part, through the Prostate Cancer Foundation Young Investigator Award and through the Cancer Center Support Grant from the National Cancer Institute.

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 history of tuberculosis (TB) and a history of chronic bronchitis were associated with an increased risk for lung cancer in individuals who had never smoked, whereas asthma had a positive, nonsignificant association overall and a significant association in women.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of clinical databases from inception to July 2025, to assess the association between asthma, TB, and/or chronic bronchitis and the risk for lung cancer among participants aged 18 years or older who had never smoked.
• They included data from 20 case-control studies involving 54,135 participants and five cohort studies involving 377,983 participants.
• The primary outcome was the risk for lung cancer among participants with a history of TB, asthma, or chronic bronchitis.
• Participants were labeled as “never smokers” if they were explicitly described in the manuscripts as having “never smoked” or reported smoking < 100 cigarettes in their lifetime.

TAKEAWAY:

• In case-control studies, TB (16 studies) and chronic bronchitis (9 studies) were significantly associated with an increased risk for lung cancer (odds ratio [OR], 1.76; P < .001 and OR, 1.36; P = .012, respectively).
• In four case-cohort studies, TB was associated with an increased but nonsignificant risk for lung cancer (hazard ratio, 1.64).
• Eleven case-control studies demonstrated a positive but nonsignificant association between asthma and the risk for lung cancer (OR, 1.34). However, a significant association emerged when analyses were limited to women (five studies; OR, 1.61; P < .01).

IN PRACTICE:

History of TB was especially associated with increased LC [lung cancer] risk, meriting particular attention for prospective CT screening studies,” the authors of the study wrote.

SOURCE:

This study was led by Nishwant Swami, MD, Hospital of the University of Pennsylvania, Philadelphia. It was published online on January 11, 2026, in Chest.

LIMITATIONS:

Most studies lacked uniform adjustment for key confounders, increasing the risk for residual confounding. The inclusion of few cohort studies in the analysis may have limited the assessment of temporality and precision. Additionally, differences in covariate adjustment, variable definitions, and language restrictions may have limited comparability and generalizability.

DISCLOSURES:

No specific funding was reported for this study. One author reported serving as a consultant or advisor for various companies, including AstraZeneca, Merck, and Pfizer. Another author reported receiving funding, in part, through the Prostate Cancer Foundation Young Investigator Award and through the Cancer Center Support Grant from the National Cancer Institute.

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 history of tuberculosis (TB) and a history of chronic bronchitis were associated with an increased risk for lung cancer in individuals who had never smoked, whereas asthma had a positive, nonsignificant association overall and a significant association in women.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of clinical databases from inception to July 2025, to assess the association between asthma, TB, and/or chronic bronchitis and the risk for lung cancer among participants aged 18 years or older who had never smoked.
• They included data from 20 case-control studies involving 54,135 participants and five cohort studies involving 377,983 participants.
• The primary outcome was the risk for lung cancer among participants with a history of TB, asthma, or chronic bronchitis.
• Participants were labeled as “never smokers” if they were explicitly described in the manuscripts as having “never smoked” or reported smoking < 100 cigarettes in their lifetime.

TAKEAWAY:

• In case-control studies, TB (16 studies) and chronic bronchitis (9 studies) were significantly associated with an increased risk for lung cancer (odds ratio [OR], 1.76; P < .001 and OR, 1.36; P = .012, respectively).
• In four case-cohort studies, TB was associated with an increased but nonsignificant risk for lung cancer (hazard ratio, 1.64).
• Eleven case-control studies demonstrated a positive but nonsignificant association between asthma and the risk for lung cancer (OR, 1.34). However, a significant association emerged when analyses were limited to women (five studies; OR, 1.61; P < .01).

IN PRACTICE:

History of TB was especially associated with increased LC [lung cancer] risk, meriting particular attention for prospective CT screening studies,” the authors of the study wrote.

SOURCE:

This study was led by Nishwant Swami, MD, Hospital of the University of Pennsylvania, Philadelphia. It was published online on January 11, 2026, in Chest.

LIMITATIONS:

Most studies lacked uniform adjustment for key confounders, increasing the risk for residual confounding. The inclusion of few cohort studies in the analysis may have limited the assessment of temporality and precision. Additionally, differences in covariate adjustment, variable definitions, and language restrictions may have limited comparability and generalizability.

DISCLOSURES:

No specific funding was reported for this study. One author reported serving as a consultant or advisor for various companies, including AstraZeneca, Merck, and Pfizer. Another author reported receiving funding, in part, through the Prostate Cancer Foundation Young Investigator Award and through the Cancer Center Support Grant from the National Cancer Institute.

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:

Healthy donor fecal microbiota transplantation (FMT) combined with immune checkpoint inhibitors (ICI) in metastatic renal cell carcinoma demonstrated safety with a 50% objective response rate and no grade 4-5 toxicities. Successful engraftment of diverse, anti-inflammatory microbiota correlated with improved clinical response and reduced immune-related adverse events.

METHODOLOGY:

• Many patients with metastatic renal cell carcinoma who take ICI experience immune-related adverse events that may require treatment interruption. Recent studies have provided proof of concept for microbiome modulation as a therapeutic adjunct in metastatic renal cell carcinoma, with FMT showing efficacy in resolving TKI-induced toxicities. However, the safety and clinical activity of healthy donor FMT in metastatic renal cell carcinoma remained unexplored, and its mechanism of action was unclear prior to this study.
• The new phase 1 trial enrolled 20 treatment-naive patients with metastatic renal cell carcinoma classified as intermediate-risk or poor-risk disease, who received encapsulated healthy donor FMT (LND101) combined with ipilimumab plus nivolumab (n = 16), pembrolizumab plus axitinib (n = 3), or pembrolizumab plus lenvatinib (n = 1).
• Participants underwent polyethylene glycol bowel preparation before receiving one full dose (36-40 capsules containing 80-100 g of stool) and two half-doses (20-25 capsules each containing 50-60 g of stool) of FMT from rigorously screened healthy donors.
• The primary endpoint was safety assessed through incidence and severity of immune-related adverse events, while secondary endpoints included objective response rate by response evaluation criteria in solid tumors version 1.1, gut microbiome changes, immune correlates, and quality of life.
• Analysis included longitudinal monitoring of stool and blood samples at five timepoints: baseline, week 1 post-FMT, week 4, week 7, and week 10, with a median follow-up of 21.9 months.

TAKEAWAY:

• The safety endpoint was met, with half (10 of 20) of patients experiencing grade 3 immune-related adverse events and no serious FMT-related toxicities or grade 4-5 immune-related adverse events. One patient (5%) reported experiencing an FMT-related grade 1 gastrointestinal event.
• Among evaluable patients (n = 18), the objective response rate was 50% (9 of 18), including two complete responses (11%; 2 of 18), while 67% (12 of 18) achieved clinical benefit defined as complete response, partial response, or stable disease for at least 6 months.
• Higher alpha diversity and greater functional engraftment of short-chain fatty acid-producing and anti-inflammatory taxa correlated with protection from severe immune-related adverse events (P = .041) and improved therapeutic response (P = .006).
• Expansion of Segatella copri above 10 counts per million at 10 weeks post-FMT predicted severe toxicity in patients receiving ipilimumab plus nivolumab, regardless of donor or recipient microbiota origin.

IN PRACTICE:

These findings demonstrate the safety and potential for functional microbiome engraftment to optimize response and minimize toxicity in ICI-treated [metastatic renal cell carcinoma]. Together, our results underscore the importance of functional donor screening and targeted modulation of the microbiome in optimizing the safety and efficacy of next-generation immune-based therapies,” wrote the authors of the study.

SOURCE:

The study was led by Ricardo Fernandes, Behnam Jabbarizadeh, and Adnan Rajeh, London Health Sciences Centre, London, Ontario, Canada. It was published online on January 28 in Nature Medicine.

LIMITATIONS:

According to the authors, the study’s primary limitation was its small sample size, which was not powered to define the ideal donor microbiome composition for enhancing immunotherapy efficacy without additional toxicities. The single-center design and highly selected patient population may limit external generalizability, requiring validation in larger, multicenter trials to refine donor selection criteria and clarify microbiome-immunity mechanisms.

DISCLOSURES:

The clinical trial was primarily funded through philanthropic donations to co-authors Saman Maleki Vareki and Fernandes through the London Health Sciences Foundation clinical trials program. Vareki and Michael Silverman, another co-author, reported having US Patent application no. 63/913,940 related to FMT donor screening. Vareki reported receiving grants from the Lotte and John Hecht Memorial Foundation, the Weston Family Foundation, and the Canadian Institutes of Health Research. 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:

Healthy donor fecal microbiota transplantation (FMT) combined with immune checkpoint inhibitors (ICI) in metastatic renal cell carcinoma demonstrated safety with a 50% objective response rate and no grade 4-5 toxicities. Successful engraftment of diverse, anti-inflammatory microbiota correlated with improved clinical response and reduced immune-related adverse events.

METHODOLOGY:

• Many patients with metastatic renal cell carcinoma who take ICI experience immune-related adverse events that may require treatment interruption. Recent studies have provided proof of concept for microbiome modulation as a therapeutic adjunct in metastatic renal cell carcinoma, with FMT showing efficacy in resolving TKI-induced toxicities. However, the safety and clinical activity of healthy donor FMT in metastatic renal cell carcinoma remained unexplored, and its mechanism of action was unclear prior to this study.
• The new phase 1 trial enrolled 20 treatment-naive patients with metastatic renal cell carcinoma classified as intermediate-risk or poor-risk disease, who received encapsulated healthy donor FMT (LND101) combined with ipilimumab plus nivolumab (n = 16), pembrolizumab plus axitinib (n = 3), or pembrolizumab plus lenvatinib (n = 1).
• Participants underwent polyethylene glycol bowel preparation before receiving one full dose (36-40 capsules containing 80-100 g of stool) and two half-doses (20-25 capsules each containing 50-60 g of stool) of FMT from rigorously screened healthy donors.
• The primary endpoint was safety assessed through incidence and severity of immune-related adverse events, while secondary endpoints included objective response rate by response evaluation criteria in solid tumors version 1.1, gut microbiome changes, immune correlates, and quality of life.
• Analysis included longitudinal monitoring of stool and blood samples at five timepoints: baseline, week 1 post-FMT, week 4, week 7, and week 10, with a median follow-up of 21.9 months.

TAKEAWAY:

• The safety endpoint was met, with half (10 of 20) of patients experiencing grade 3 immune-related adverse events and no serious FMT-related toxicities or grade 4-5 immune-related adverse events. One patient (5%) reported experiencing an FMT-related grade 1 gastrointestinal event.
• Among evaluable patients (n = 18), the objective response rate was 50% (9 of 18), including two complete responses (11%; 2 of 18), while 67% (12 of 18) achieved clinical benefit defined as complete response, partial response, or stable disease for at least 6 months.
• Higher alpha diversity and greater functional engraftment of short-chain fatty acid-producing and anti-inflammatory taxa correlated with protection from severe immune-related adverse events (P = .041) and improved therapeutic response (P = .006).
• Expansion of Segatella copri above 10 counts per million at 10 weeks post-FMT predicted severe toxicity in patients receiving ipilimumab plus nivolumab, regardless of donor or recipient microbiota origin.

IN PRACTICE:

These findings demonstrate the safety and potential for functional microbiome engraftment to optimize response and minimize toxicity in ICI-treated [metastatic renal cell carcinoma]. Together, our results underscore the importance of functional donor screening and targeted modulation of the microbiome in optimizing the safety and efficacy of next-generation immune-based therapies,” wrote the authors of the study.

SOURCE:

The study was led by Ricardo Fernandes, Behnam Jabbarizadeh, and Adnan Rajeh, London Health Sciences Centre, London, Ontario, Canada. It was published online on January 28 in Nature Medicine.

LIMITATIONS:

According to the authors, the study’s primary limitation was its small sample size, which was not powered to define the ideal donor microbiome composition for enhancing immunotherapy efficacy without additional toxicities. The single-center design and highly selected patient population may limit external generalizability, requiring validation in larger, multicenter trials to refine donor selection criteria and clarify microbiome-immunity mechanisms.

DISCLOSURES:

The clinical trial was primarily funded through philanthropic donations to co-authors Saman Maleki Vareki and Fernandes through the London Health Sciences Foundation clinical trials program. Vareki and Michael Silverman, another co-author, reported having US Patent application no. 63/913,940 related to FMT donor screening. Vareki reported receiving grants from the Lotte and John Hecht Memorial Foundation, the Weston Family Foundation, and the Canadian Institutes of Health Research. 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:

Healthy donor fecal microbiota transplantation (FMT) combined with immune checkpoint inhibitors (ICI) in metastatic renal cell carcinoma demonstrated safety with a 50% objective response rate and no grade 4-5 toxicities. Successful engraftment of diverse, anti-inflammatory microbiota correlated with improved clinical response and reduced immune-related adverse events.

METHODOLOGY:

• Many patients with metastatic renal cell carcinoma who take ICI experience immune-related adverse events that may require treatment interruption. Recent studies have provided proof of concept for microbiome modulation as a therapeutic adjunct in metastatic renal cell carcinoma, with FMT showing efficacy in resolving TKI-induced toxicities. However, the safety and clinical activity of healthy donor FMT in metastatic renal cell carcinoma remained unexplored, and its mechanism of action was unclear prior to this study.
• The new phase 1 trial enrolled 20 treatment-naive patients with metastatic renal cell carcinoma classified as intermediate-risk or poor-risk disease, who received encapsulated healthy donor FMT (LND101) combined with ipilimumab plus nivolumab (n = 16), pembrolizumab plus axitinib (n = 3), or pembrolizumab plus lenvatinib (n = 1).
• Participants underwent polyethylene glycol bowel preparation before receiving one full dose (36-40 capsules containing 80-100 g of stool) and two half-doses (20-25 capsules each containing 50-60 g of stool) of FMT from rigorously screened healthy donors.
• The primary endpoint was safety assessed through incidence and severity of immune-related adverse events, while secondary endpoints included objective response rate by response evaluation criteria in solid tumors version 1.1, gut microbiome changes, immune correlates, and quality of life.
• Analysis included longitudinal monitoring of stool and blood samples at five timepoints: baseline, week 1 post-FMT, week 4, week 7, and week 10, with a median follow-up of 21.9 months.

TAKEAWAY:

• The safety endpoint was met, with half (10 of 20) of patients experiencing grade 3 immune-related adverse events and no serious FMT-related toxicities or grade 4-5 immune-related adverse events. One patient (5%) reported experiencing an FMT-related grade 1 gastrointestinal event.
• Among evaluable patients (n = 18), the objective response rate was 50% (9 of 18), including two complete responses (11%; 2 of 18), while 67% (12 of 18) achieved clinical benefit defined as complete response, partial response, or stable disease for at least 6 months.
• Higher alpha diversity and greater functional engraftment of short-chain fatty acid-producing and anti-inflammatory taxa correlated with protection from severe immune-related adverse events (P = .041) and improved therapeutic response (P = .006).
• Expansion of Segatella copri above 10 counts per million at 10 weeks post-FMT predicted severe toxicity in patients receiving ipilimumab plus nivolumab, regardless of donor or recipient microbiota origin.

IN PRACTICE:

These findings demonstrate the safety and potential for functional microbiome engraftment to optimize response and minimize toxicity in ICI-treated [metastatic renal cell carcinoma]. Together, our results underscore the importance of functional donor screening and targeted modulation of the microbiome in optimizing the safety and efficacy of next-generation immune-based therapies,” wrote the authors of the study.

SOURCE:

The study was led by Ricardo Fernandes, Behnam Jabbarizadeh, and Adnan Rajeh, London Health Sciences Centre, London, Ontario, Canada. It was published online on January 28 in Nature Medicine.

LIMITATIONS:

According to the authors, the study’s primary limitation was its small sample size, which was not powered to define the ideal donor microbiome composition for enhancing immunotherapy efficacy without additional toxicities. The single-center design and highly selected patient population may limit external generalizability, requiring validation in larger, multicenter trials to refine donor selection criteria and clarify microbiome-immunity mechanisms.

DISCLOSURES:

The clinical trial was primarily funded through philanthropic donations to co-authors Saman Maleki Vareki and Fernandes through the London Health Sciences Foundation clinical trials program. Vareki and Michael Silverman, another co-author, reported having US Patent application no. 63/913,940 related to FMT donor screening. Vareki reported receiving grants from the Lotte and John Hecht Memorial Foundation, the Weston Family Foundation, and the Canadian Institutes of Health Research. 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:

An artificial intelligence (AI) model, developed using stool images, accurately assessed whether a patient’s bowel preparation was sufficient for colonoscopy. The best version of the model achieved an area under the receiver operating characteristic curve (AUC) of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86.

METHODOLOGY:

• Patients often need help during bowel preparation for colonoscopy, which increases staff workload; up to 20%-25% of colonoscopies are reported to be inadequately prepared. Researchers developed and tested an AI tool (AI-PREPOO) using stool images to assess whether patients were ready for colonoscopy.
• They conducted a multicenter observational study in Japan between 2022 and 2023 that included 37 patients scheduled for colonoscopy (median age, 57 years; 45.9% women).
• After starting consumption of a 2-liter polyethylene glycol solution, patients used smartphones to take photos of their stool in the toilet after each bowel movement and uploaded the images to a secure web server.
• The images were divided into training and test sets. Images were classified as “ready” for colonoscopy when the stool was clear or light yellow and watery with no solid content.
• Four image-recognition models based on different deep learning architectures were developed using transfer learning to classify readiness for colonoscopy.

TAKEAWAY:

• Researchers collected 282 stool images, with 141 classified as ready and 141 as not ready. Of these, 224 images were used for training (the number augmented to 2240 images) and 58 for testing.
• All four AI-PREPOO models showed high performance, with AUCs ranging from 0.92 to 0.95; pairwise differences in AUCs were not significant.
• The AI-PREPOO 1 model, based on the MobileNetV3-Small architecture, showed the most balanced performance, with an AUC of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86 on the test set.
• During colonoscopy, all patients had a Boston Bowel Preparation Scale score of 6 or higher, indicating that “ready” images corresponded to an adequately prepared bowel.

IN PRACTICE:

“If implemented as a mobile application, our model would allow patients to quickly and independently assess bowel preparation adequacy, reducing reliance on nurses and alleviating embarrassment associated with sharing stool images. This approach could also lessen nurses’ workload by minimizing unnecessary inquiries and preventing excessive or insufficient bowel preparation due to uncertainty,” the authors wrote.

SOURCE:

This study was led by Kosuke Kojima, Graduate School of Medical and Dental Sciences, Niigata University in Niigata, Japan. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The small dataset limited generalizability and increased the risk for overfitting. In real-world practice, stool images might vary in lighting, angle, focus, zoom, and background; thus, a larger and more diverse dataset was needed. The model lacked external validation in an independent or prospective cohort.

DISCLOSURES:

This study received support from the Japanese Foundation for Research and Promotion of Endoscopy. The authors reported 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:

An artificial intelligence (AI) model, developed using stool images, accurately assessed whether a patient’s bowel preparation was sufficient for colonoscopy. The best version of the model achieved an area under the receiver operating characteristic curve (AUC) of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86.

METHODOLOGY:

• Patients often need help during bowel preparation for colonoscopy, which increases staff workload; up to 20%-25% of colonoscopies are reported to be inadequately prepared. Researchers developed and tested an AI tool (AI-PREPOO) using stool images to assess whether patients were ready for colonoscopy.
• They conducted a multicenter observational study in Japan between 2022 and 2023 that included 37 patients scheduled for colonoscopy (median age, 57 years; 45.9% women).
• After starting consumption of a 2-liter polyethylene glycol solution, patients used smartphones to take photos of their stool in the toilet after each bowel movement and uploaded the images to a secure web server.
• The images were divided into training and test sets. Images were classified as “ready” for colonoscopy when the stool was clear or light yellow and watery with no solid content.
• Four image-recognition models based on different deep learning architectures were developed using transfer learning to classify readiness for colonoscopy.

TAKEAWAY:

• Researchers collected 282 stool images, with 141 classified as ready and 141 as not ready. Of these, 224 images were used for training (the number augmented to 2240 images) and 58 for testing.
• All four AI-PREPOO models showed high performance, with AUCs ranging from 0.92 to 0.95; pairwise differences in AUCs were not significant.
• The AI-PREPOO 1 model, based on the MobileNetV3-Small architecture, showed the most balanced performance, with an AUC of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86 on the test set.
• During colonoscopy, all patients had a Boston Bowel Preparation Scale score of 6 or higher, indicating that “ready” images corresponded to an adequately prepared bowel.

IN PRACTICE:

“If implemented as a mobile application, our model would allow patients to quickly and independently assess bowel preparation adequacy, reducing reliance on nurses and alleviating embarrassment associated with sharing stool images. This approach could also lessen nurses’ workload by minimizing unnecessary inquiries and preventing excessive or insufficient bowel preparation due to uncertainty,” the authors wrote.

SOURCE:

This study was led by Kosuke Kojima, Graduate School of Medical and Dental Sciences, Niigata University in Niigata, Japan. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The small dataset limited generalizability and increased the risk for overfitting. In real-world practice, stool images might vary in lighting, angle, focus, zoom, and background; thus, a larger and more diverse dataset was needed. The model lacked external validation in an independent or prospective cohort.

DISCLOSURES:

This study received support from the Japanese Foundation for Research and Promotion of Endoscopy. The authors reported 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:

An artificial intelligence (AI) model, developed using stool images, accurately assessed whether a patient’s bowel preparation was sufficient for colonoscopy. The best version of the model achieved an area under the receiver operating characteristic curve (AUC) of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86.

METHODOLOGY:

• Patients often need help during bowel preparation for colonoscopy, which increases staff workload; up to 20%-25% of colonoscopies are reported to be inadequately prepared. Researchers developed and tested an AI tool (AI-PREPOO) using stool images to assess whether patients were ready for colonoscopy.
• They conducted a multicenter observational study in Japan between 2022 and 2023 that included 37 patients scheduled for colonoscopy (median age, 57 years; 45.9% women).
• After starting consumption of a 2-liter polyethylene glycol solution, patients used smartphones to take photos of their stool in the toilet after each bowel movement and uploaded the images to a secure web server.
• The images were divided into training and test sets. Images were classified as “ready” for colonoscopy when the stool was clear or light yellow and watery with no solid content.
• Four image-recognition models based on different deep learning architectures were developed using transfer learning to classify readiness for colonoscopy.

TAKEAWAY:

• Researchers collected 282 stool images, with 141 classified as ready and 141 as not ready. Of these, 224 images were used for training (the number augmented to 2240 images) and 58 for testing.
• All four AI-PREPOO models showed high performance, with AUCs ranging from 0.92 to 0.95; pairwise differences in AUCs were not significant.
• The AI-PREPOO 1 model, based on the MobileNetV3-Small architecture, showed the most balanced performance, with an AUC of 0.95, accuracy of 0.90, sensitivity of 0.93, and specificity of 0.86 on the test set.
• During colonoscopy, all patients had a Boston Bowel Preparation Scale score of 6 or higher, indicating that “ready” images corresponded to an adequately prepared bowel.

IN PRACTICE:

“If implemented as a mobile application, our model would allow patients to quickly and independently assess bowel preparation adequacy, reducing reliance on nurses and alleviating embarrassment associated with sharing stool images. This approach could also lessen nurses’ workload by minimizing unnecessary inquiries and preventing excessive or insufficient bowel preparation due to uncertainty,” the authors wrote.

SOURCE:

This study was led by Kosuke Kojima, Graduate School of Medical and Dental Sciences, Niigata University in Niigata, Japan. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The small dataset limited generalizability and increased the risk for overfitting. In real-world practice, stool images might vary in lighting, angle, focus, zoom, and background; thus, a larger and more diverse dataset was needed. The model lacked external validation in an independent or prospective cohort.

DISCLOSURES:

This study received support from the Japanese Foundation for Research and Promotion of Endoscopy. The authors reported 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.

France has authorized Ricimed, the first antibody-based treatment specifically indicated for acute ricin intoxication, providing clinicians with a targeted option beyond supportive care for exposure to one of the most lethal naturally occurring toxins.

Fabentech is a French biopharmaceutical company specializing in medical countermeasures against biological threats and infectious diseases.

The polyclonal antibody technology used in the development of Ricimed has received marketing authorization in France as a treatment for ricin poisoning. Ricin is a highly toxic natural substance that can cause death within hours to a few days of exposure.

Supported by the Ministry of Armed Forces and Veterans Affairs (Directorate General of Armaments [DGA] and Armed Forces Health Service) in France, Ricimed is the first approved antidote for ricin poisoning, a condition for which treatment was previously limited to supportive measures alone.

Historical Incident

One incident, in particular, remains etched in espionage history. On September 7, 1978 in London during the Cold War, Bulgarian dissident writer Georgi Markov, living in exile, was struck by the umbrella of a passer-by while waiting at a bus stop. He felt a slight sting. Four days later, he died in the hospital due to a sudden and unexplained illness. An autopsy revealed that he had been poisoned by a tiny metal pellet implanted at the tip of an umbrella containing ricin, a lethal toxin. The legend of the “Bulgarian umbrella,” later invoked in other assassination attempts, was born.

Since then, although Markov remains the only known individual to have been killed by ricin poisoning, this theoretically extremely toxic substance, which can be manufactured relatively easily from castor beans, a widely available plant, has continued to fascinate authors of thrillers and spy novels.

Numerous works of fiction depict characters who succumb to ricin poisoning. The toxin is notably portrayed as a favored weapon of the main character in the hit television series Breaking Bad.

However, ricin is not confined to the realm of science fiction. For several years, authorities in various countries have feared that extremist groups could carry out attacks using ricin. The threat has been taken particularly seriously since 2018, when a clandestine ricin laboratory operated by members of the Islamic State was dismantled in Germany. Since then, several similar attack plots have been thwarted.

This context triggered a race among major powers to develop an effective antidote as quickly as possible. In this effort, Fabentech has risen to a challenge.

“Having demonstrated its ability to target and then neutralize ricin before it causes irreparable damage, Ricimed is a treatment that works based on polyclonal antibodies and compensates for the absence of a vaccine or specific treatment,” Fabentech said in a press release.

The polyclonal antibody technology used by Fabentech offers potential for the development of antidotes against bioterrorist attacks and for the treatment of many infectious diseases.

Ricimed contributed to the deployment of a European health shield against intentional biological threats in France.

Military Backing

Speaking to Le Figaro, France’s oldest national newspaper, Fabentech CEO Sébastien Iva explained that ricin disrupts the body by halting cell function, while noting several other drug candidates in development at the firm.

Typically, the lungs sustain fatal damage. Our treatment interrupts this toxic process. In animals administered the antidote, we observed pulmonary function recovery, allowing survival.

Given that the possibility of terrorist attacks using ricin is considered a national security issue, Fabentech benefited from the support by the Ministry of the Armed Forces and the DGA and lasted nearly a decade of research and development work.

The granting of marketing authorisation was also supported by the French Armed Forces and welcomed by the French Minister of the Armed Forces, Catherine Vautrin, who previously served as France’s Minister of Labour, Health, and Solidarity.

“Supporting the development of companies in France capable of manufacturing antidotes against certain biological agents helps guarantee the operational superiority of our armed forces. Developing and producing such drugs when they do not yet exist on the market is also serving the nation and the public interest,” she said.

Although the threat posed by ricin remains hypothetical, Fabentech reports a strong interest from potential clients, with many countries seeking protection against possible bioterrorist attacks.

The DGA had already placed an order for several doses of Ricimed for deployment in France. For optimal effectiveness, the antidote must be administered within 6 hours of poisoning. Iva confirmed that multiple countries had already expressed interest in acquiring the antidote.

This story was translated from JIM, part of the Medscape Professional Network.

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

France has authorized Ricimed, the first antibody-based treatment specifically indicated for acute ricin intoxication, providing clinicians with a targeted option beyond supportive care for exposure to one of the most lethal naturally occurring toxins.

Fabentech is a French biopharmaceutical company specializing in medical countermeasures against biological threats and infectious diseases.

The polyclonal antibody technology used in the development of Ricimed has received marketing authorization in France as a treatment for ricin poisoning. Ricin is a highly toxic natural substance that can cause death within hours to a few days of exposure.

Supported by the Ministry of Armed Forces and Veterans Affairs (Directorate General of Armaments [DGA] and Armed Forces Health Service) in France, Ricimed is the first approved antidote for ricin poisoning, a condition for which treatment was previously limited to supportive measures alone.

Historical Incident

One incident, in particular, remains etched in espionage history. On September 7, 1978 in London during the Cold War, Bulgarian dissident writer Georgi Markov, living in exile, was struck by the umbrella of a passer-by while waiting at a bus stop. He felt a slight sting. Four days later, he died in the hospital due to a sudden and unexplained illness. An autopsy revealed that he had been poisoned by a tiny metal pellet implanted at the tip of an umbrella containing ricin, a lethal toxin. The legend of the “Bulgarian umbrella,” later invoked in other assassination attempts, was born.

Since then, although Markov remains the only known individual to have been killed by ricin poisoning, this theoretically extremely toxic substance, which can be manufactured relatively easily from castor beans, a widely available plant, has continued to fascinate authors of thrillers and spy novels.

Numerous works of fiction depict characters who succumb to ricin poisoning. The toxin is notably portrayed as a favored weapon of the main character in the hit television series Breaking Bad.

However, ricin is not confined to the realm of science fiction. For several years, authorities in various countries have feared that extremist groups could carry out attacks using ricin. The threat has been taken particularly seriously since 2018, when a clandestine ricin laboratory operated by members of the Islamic State was dismantled in Germany. Since then, several similar attack plots have been thwarted.

This context triggered a race among major powers to develop an effective antidote as quickly as possible. In this effort, Fabentech has risen to a challenge.

“Having demonstrated its ability to target and then neutralize ricin before it causes irreparable damage, Ricimed is a treatment that works based on polyclonal antibodies and compensates for the absence of a vaccine or specific treatment,” Fabentech said in a press release.

The polyclonal antibody technology used by Fabentech offers potential for the development of antidotes against bioterrorist attacks and for the treatment of many infectious diseases.

Ricimed contributed to the deployment of a European health shield against intentional biological threats in France.

Military Backing

Speaking to Le Figaro, France’s oldest national newspaper, Fabentech CEO Sébastien Iva explained that ricin disrupts the body by halting cell function, while noting several other drug candidates in development at the firm.

Typically, the lungs sustain fatal damage. Our treatment interrupts this toxic process. In animals administered the antidote, we observed pulmonary function recovery, allowing survival.

Given that the possibility of terrorist attacks using ricin is considered a national security issue, Fabentech benefited from the support by the Ministry of the Armed Forces and the DGA and lasted nearly a decade of research and development work.

The granting of marketing authorisation was also supported by the French Armed Forces and welcomed by the French Minister of the Armed Forces, Catherine Vautrin, who previously served as France’s Minister of Labour, Health, and Solidarity.

“Supporting the development of companies in France capable of manufacturing antidotes against certain biological agents helps guarantee the operational superiority of our armed forces. Developing and producing such drugs when they do not yet exist on the market is also serving the nation and the public interest,” she said.

Although the threat posed by ricin remains hypothetical, Fabentech reports a strong interest from potential clients, with many countries seeking protection against possible bioterrorist attacks.

The DGA had already placed an order for several doses of Ricimed for deployment in France. For optimal effectiveness, the antidote must be administered within 6 hours of poisoning. Iva confirmed that multiple countries had already expressed interest in acquiring the antidote.

This story was translated from JIM, part of the Medscape Professional Network.

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

France has authorized Ricimed, the first antibody-based treatment specifically indicated for acute ricin intoxication, providing clinicians with a targeted option beyond supportive care for exposure to one of the most lethal naturally occurring toxins.

Fabentech is a French biopharmaceutical company specializing in medical countermeasures against biological threats and infectious diseases.

The polyclonal antibody technology used in the development of Ricimed has received marketing authorization in France as a treatment for ricin poisoning. Ricin is a highly toxic natural substance that can cause death within hours to a few days of exposure.

Supported by the Ministry of Armed Forces and Veterans Affairs (Directorate General of Armaments [DGA] and Armed Forces Health Service) in France, Ricimed is the first approved antidote for ricin poisoning, a condition for which treatment was previously limited to supportive measures alone.

Historical Incident

One incident, in particular, remains etched in espionage history. On September 7, 1978 in London during the Cold War, Bulgarian dissident writer Georgi Markov, living in exile, was struck by the umbrella of a passer-by while waiting at a bus stop. He felt a slight sting. Four days later, he died in the hospital due to a sudden and unexplained illness. An autopsy revealed that he had been poisoned by a tiny metal pellet implanted at the tip of an umbrella containing ricin, a lethal toxin. The legend of the “Bulgarian umbrella,” later invoked in other assassination attempts, was born.

Since then, although Markov remains the only known individual to have been killed by ricin poisoning, this theoretically extremely toxic substance, which can be manufactured relatively easily from castor beans, a widely available plant, has continued to fascinate authors of thrillers and spy novels.

Numerous works of fiction depict characters who succumb to ricin poisoning. The toxin is notably portrayed as a favored weapon of the main character in the hit television series Breaking Bad.

However, ricin is not confined to the realm of science fiction. For several years, authorities in various countries have feared that extremist groups could carry out attacks using ricin. The threat has been taken particularly seriously since 2018, when a clandestine ricin laboratory operated by members of the Islamic State was dismantled in Germany. Since then, several similar attack plots have been thwarted.

This context triggered a race among major powers to develop an effective antidote as quickly as possible. In this effort, Fabentech has risen to a challenge.

“Having demonstrated its ability to target and then neutralize ricin before it causes irreparable damage, Ricimed is a treatment that works based on polyclonal antibodies and compensates for the absence of a vaccine or specific treatment,” Fabentech said in a press release.

The polyclonal antibody technology used by Fabentech offers potential for the development of antidotes against bioterrorist attacks and for the treatment of many infectious diseases.

Ricimed contributed to the deployment of a European health shield against intentional biological threats in France.

Military Backing

Speaking to Le Figaro, France’s oldest national newspaper, Fabentech CEO Sébastien Iva explained that ricin disrupts the body by halting cell function, while noting several other drug candidates in development at the firm.

Typically, the lungs sustain fatal damage. Our treatment interrupts this toxic process. In animals administered the antidote, we observed pulmonary function recovery, allowing survival.

Given that the possibility of terrorist attacks using ricin is considered a national security issue, Fabentech benefited from the support by the Ministry of the Armed Forces and the DGA and lasted nearly a decade of research and development work.

The granting of marketing authorisation was also supported by the French Armed Forces and welcomed by the French Minister of the Armed Forces, Catherine Vautrin, who previously served as France’s Minister of Labour, Health, and Solidarity.

“Supporting the development of companies in France capable of manufacturing antidotes against certain biological agents helps guarantee the operational superiority of our armed forces. Developing and producing such drugs when they do not yet exist on the market is also serving the nation and the public interest,” she said.

Although the threat posed by ricin remains hypothetical, Fabentech reports a strong interest from potential clients, with many countries seeking protection against possible bioterrorist attacks.

The DGA had already placed an order for several doses of Ricimed for deployment in France. For optimal effectiveness, the antidote must be administered within 6 hours of poisoning. Iva confirmed that multiple countries had already expressed interest in acquiring the antidote.

This story was translated from JIM, part of the Medscape Professional Network.

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

TOPLINE:

Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
• The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.

TAKEAWAY:

• Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
• ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
• Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
• Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).

IN PRACTICE:

"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."

SOURCE:

The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.

LIMITATIONS:

The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.

DISCLOSURES:

The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed 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:

Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
• The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.

TAKEAWAY:

• Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
• ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
• Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
• Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).

IN PRACTICE:

"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."

SOURCE:

The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.

LIMITATIONS:

The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.

DISCLOSURES:

The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed 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:

Veterans with dementia experienced significant reductions in time spent at home following emergency department (ED) visits, with a mean of 21.7 days away from home within 180 days of the index visit. ED admission was the strongest predictor of extended time away from home, followed by high frailty, an unmarried status, and lack of housing.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services administrative data of 51,707 veterans with dementia (mean age, 79.9 years; 97.6% men; 52.2% married individuals; 73% White individuals) who had an eligible Veterans Health Administration ED visit between October 2016 and September 2018.
• The primary outcome was home time, defined as days alive and not spent in institutional care settings during the 180 days following the index ED visit; secondary outcomes included ED revisits within 30 days of the index visit and 30-day mortality.

TAKEAWAY:

• Veterans experienced a mean of 21.7 days away from home within 180 days after the ED visit; 4.5% never returned home, and 18.2% spent the entire 180-day follow-up period at home. Patients admitted from the ED spent a mean of 34.2 days away from home within 180 days, whereas those discharged directly spent a mean of 13.6 days.
• ED admission had the strongest association with increased days away from home (rate ratio [RR], 3.18), followed by patient factors such as unhoused status (RR, 1.50), very high frailty (RR, 1.27), unmarried status — never married (RR, 1.24) or divorced, separated, or widowed (RR, 1.24) — and depression (RR, 1.13).
• Compared with the overall cohort, veterans with psychiatric concerns had the highest risk for extended time away from home (RR, 1.31), followed by those with nonspecific concerns and geriatric syndromes.
• Among all participants, 27.6% had a 30-day ED revisit, and 4% died within 30 days of the index visit. An admission was associated with a lower likelihood of a 30-day ED revisit (hazard ratio [HR], 0.75) but an increased likelihood of 30-day mortality (HR, 4.87).

IN PRACTICE:

"Home time offers a promising, patient-centered measure to align emergency care with patients' and care partners' goals and preferences to remain at home," the authors wrote. However, they emphasized that "refining its application — particularly in accounting for index hospitalizations and long-term care transitions — is critical to accurately capturing quality of care and long-term well-being."

SOURCE:

The study was led by Justine Seidenfeld, MD, MHs, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on December 29, 2025, in JAMA Network Open.

LIMITATIONS:

The study population of veterans aged 65-66 years may have had incomplete dementia confirmation as Medicare data were limited, and the predominantly male cohort limited generalizability. Marriage status served as an imperfect proxy for social and care partner support. The varying severity of dementia among participants could not be fully assessed using VA administrative data. Additionally, some highly emergent ED visits may have been inadvertently included if patients were not properly triaged, and very low-acuity visits could not be reliably identified due to the lack of validated approaches.

DISCLOSURES:

The study was supported by the National Institute on Aging-Veterans Affairs Mentored Physician and Clinical Psychologist Scientist Award in Alzheimer's Disease (AD) and AD-Related Dementias, a project grant from the National Institute on Aging, and a grant from the Veterans Affairs Office of Health Systems Research, Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System. Several authors reported receiving grants, personal fees, and payments for literature reviews from or serving as consultants for various organizations. Detailed 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 new analysis found that high-deductible health plans were associated with worse overall survival and cancer-specific survival among cancer survivors. High-deductible plans, however, were not associated with worse overall survival among adults without a history of cancer.

METHODOLOGY:

• Previous studies have linked high-deductible health plans with decreased or delayed health utilization among cancer survivors and higher out-of-pocket costs. However, it’s not clear whether these plans influence cancer outcomes.
• In a cross-sectional study, researchers analyzed data from 147,254 respondents (aged 18 to 84 years) in the National Health Interview Survey from 2011 to 2018 and identified individuals with high-deductible plans — 2331 cancer survivors and 37,473 people without a history of cancer.
• The researchers acquired linked mortality files from the National Death Index, which included data on mortality events through the end of 2019.
• High-deductible health plans were identified through survey responses and defined as plans with yearly deductibles of at least $1200-$1350 for individuals or at least $2400-$2700 for families.
• The primary endpoints included overall survival and cancer-specific survival. Researchers adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, cancer site, and time since diagnosis.

TAKEAWAY:

• Among cancer survivors, having a high-deductible health plan was associated with worse overall survival (hazard ratio [HR], 1.46) and cancer-specific survival (HR, 1.34). However, sensitivity analyses incorporating time since diagnosis slightly attenuated the cancer-specific survival association (HR, 1.20; 95% CI, 0.92-1.55).
• Among adults without a history of cancer, having a high-deductible health plan was not associated with significantly worse overall survival (HR, 1.08; 95% CI, 0.96-1.21).
• General concerns over finances, worry about medical bills, cost-related delays, or forgone care, as well as cost-related underuse of medications were significant mediators of the associations between high-deductible health plan status and mortality outcomes among cancer survivors.
• High-deductible health plan status was also associated with worse cancer-specific survival among cancer survivors with incomes at least 400% of the federal poverty level (HR, 1.65; P for interaction = .03).

IN PRACTICE:

“These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes,” the study authors wrote. “This danger appears to be unique to cancer survivors, as [high-deductible health plans] were not associated with survival among adults without a cancer history.”

SOURCE:

The study, led by Justin M. Barnes, MD, MS, Department of Radiation Oncology, Mayo Clinic in Rochester, Minnesota, was published online on January 29 in JAMA Network Open.

LIMITATIONS:

High-deductible health plan status was self-reported and may have been inaccurate for some individuals, with more than half of consumers being unsure about their annual deductible amount. The study lacked specific plan details and exact deductible amounts, and high-deductible health plan status was based on a single time point during survey participation. Additionally, researchers lacked information about cancer stage, cancer-directed therapies, recurrences, or complications, and cancer mortality could be from cancers diagnosed after survey participation.

DISCLOSURES:

Meera Ragavan, MD, MPH, disclosed receiving personal fees from Trial Library and AstraZeneca and grants from Merck, outside the submitted work. Other authors reported receiving personal fees from Costs of Care during the study. 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 new analysis found that high-deductible health plans were associated with worse overall survival and cancer-specific survival among cancer survivors. High-deductible plans, however, were not associated with worse overall survival among adults without a history of cancer.

METHODOLOGY:

• Previous studies have linked high-deductible health plans with decreased or delayed health utilization among cancer survivors and higher out-of-pocket costs. However, it’s not clear whether these plans influence cancer outcomes.
• In a cross-sectional study, researchers analyzed data from 147,254 respondents (aged 18 to 84 years) in the National Health Interview Survey from 2011 to 2018 and identified individuals with high-deductible plans — 2331 cancer survivors and 37,473 people without a history of cancer.
• The researchers acquired linked mortality files from the National Death Index, which included data on mortality events through the end of 2019.
• High-deductible health plans were identified through survey responses and defined as plans with yearly deductibles of at least $1200-$1350 for individuals or at least $2400-$2700 for families.
• The primary endpoints included overall survival and cancer-specific survival. Researchers adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, cancer site, and time since diagnosis.

TAKEAWAY:

• Among cancer survivors, having a high-deductible health plan was associated with worse overall survival (hazard ratio [HR], 1.46) and cancer-specific survival (HR, 1.34). However, sensitivity analyses incorporating time since diagnosis slightly attenuated the cancer-specific survival association (HR, 1.20; 95% CI, 0.92-1.55).
• Among adults without a history of cancer, having a high-deductible health plan was not associated with significantly worse overall survival (HR, 1.08; 95% CI, 0.96-1.21).
• General concerns over finances, worry about medical bills, cost-related delays, or forgone care, as well as cost-related underuse of medications were significant mediators of the associations between high-deductible health plan status and mortality outcomes among cancer survivors.
• High-deductible health plan status was also associated with worse cancer-specific survival among cancer survivors with incomes at least 400% of the federal poverty level (HR, 1.65; P for interaction = .03).

IN PRACTICE:

“These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes,” the study authors wrote. “This danger appears to be unique to cancer survivors, as [high-deductible health plans] were not associated with survival among adults without a cancer history.”

SOURCE:

The study, led by Justin M. Barnes, MD, MS, Department of Radiation Oncology, Mayo Clinic in Rochester, Minnesota, was published online on January 29 in JAMA Network Open.

LIMITATIONS:

High-deductible health plan status was self-reported and may have been inaccurate for some individuals, with more than half of consumers being unsure about their annual deductible amount. The study lacked specific plan details and exact deductible amounts, and high-deductible health plan status was based on a single time point during survey participation. Additionally, researchers lacked information about cancer stage, cancer-directed therapies, recurrences, or complications, and cancer mortality could be from cancers diagnosed after survey participation.

DISCLOSURES:

Meera Ragavan, MD, MPH, disclosed receiving personal fees from Trial Library and AstraZeneca and grants from Merck, outside the submitted work. Other authors reported receiving personal fees from Costs of Care during the study. 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 new analysis found that high-deductible health plans were associated with worse overall survival and cancer-specific survival among cancer survivors. High-deductible plans, however, were not associated with worse overall survival among adults without a history of cancer.

METHODOLOGY:

• Previous studies have linked high-deductible health plans with decreased or delayed health utilization among cancer survivors and higher out-of-pocket costs. However, it’s not clear whether these plans influence cancer outcomes.
• In a cross-sectional study, researchers analyzed data from 147,254 respondents (aged 18 to 84 years) in the National Health Interview Survey from 2011 to 2018 and identified individuals with high-deductible plans — 2331 cancer survivors and 37,473 people without a history of cancer.
• The researchers acquired linked mortality files from the National Death Index, which included data on mortality events through the end of 2019.
• High-deductible health plans were identified through survey responses and defined as plans with yearly deductibles of at least $1200-$1350 for individuals or at least $2400-$2700 for families.
• The primary endpoints included overall survival and cancer-specific survival. Researchers adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, cancer site, and time since diagnosis.

TAKEAWAY:

• Among cancer survivors, having a high-deductible health plan was associated with worse overall survival (hazard ratio [HR], 1.46) and cancer-specific survival (HR, 1.34). However, sensitivity analyses incorporating time since diagnosis slightly attenuated the cancer-specific survival association (HR, 1.20; 95% CI, 0.92-1.55).
• Among adults without a history of cancer, having a high-deductible health plan was not associated with significantly worse overall survival (HR, 1.08; 95% CI, 0.96-1.21).
• General concerns over finances, worry about medical bills, cost-related delays, or forgone care, as well as cost-related underuse of medications were significant mediators of the associations between high-deductible health plan status and mortality outcomes among cancer survivors.
• High-deductible health plan status was also associated with worse cancer-specific survival among cancer survivors with incomes at least 400% of the federal poverty level (HR, 1.65; P for interaction = .03).

IN PRACTICE:

“These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes,” the study authors wrote. “This danger appears to be unique to cancer survivors, as [high-deductible health plans] were not associated with survival among adults without a cancer history.”

SOURCE:

The study, led by Justin M. Barnes, MD, MS, Department of Radiation Oncology, Mayo Clinic in Rochester, Minnesota, was published online on January 29 in JAMA Network Open.

LIMITATIONS:

High-deductible health plan status was self-reported and may have been inaccurate for some individuals, with more than half of consumers being unsure about their annual deductible amount. The study lacked specific plan details and exact deductible amounts, and high-deductible health plan status was based on a single time point during survey participation. Additionally, researchers lacked information about cancer stage, cancer-directed therapies, recurrences, or complications, and cancer mortality could be from cancers diagnosed after survey participation.

DISCLOSURES:

Meera Ragavan, MD, MPH, disclosed receiving personal fees from Trial Library and AstraZeneca and grants from Merck, outside the submitted work. Other authors reported receiving personal fees from Costs of Care during the study. 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.