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Study quantifies occupational exposure risks of EDT
For trauma patients who are in extremis, but with the high rates of HIV/hepatitis among trauma patients, one that also carries what had been an unknown exposure risk for emergency staff.
“The most important findings of this prospective, multicenter study are that occupational exposures were reported in 7.2% of EDT resuscitations and 1.6% of EDT resuscitation participants and that occupational exposure risk appears to be further mitigated with strict PPE [personal protective equipment] compliance to universal precautions,” lead author Andrew Nunn, MD, and his colleagues wrote. Dr. Nunn is a trauma surgeon with Wake Forest Baptist Health in Winston-Salem, N.C.
The researchers surveyed 1,360 emergency department (ED) personnel after they performed 305 EDTs at 16 academic and community trauma centers nationwide in 2015 and 2016. The patients who had an EDT were mostly men ranging in age from 24 to 41 years (90.5%) with penetrating injuries (77.4%) and arrived at the ED after prehospital CPR (56.7%). Twenty-two occupational exposures occurred during 22 of the EDT resuscitations, with trainees sustaining most of them (68.2%). The most common source of injury was sharps, accounting for 86.4% (scalpels, 38.9%; fractured bone, 27.8%; needles, 16.7%; and scissors, 3%).
“Occupational exposures correlated with PPE utilization, as universal precautions during EDT were more often observed in providers who did not sustain occupational exposures, compared with those sustaining exposures,” Dr. Nunn and his coauthors wrote. For example, 98% of those reporting no exposure were gloved versus 91% of those who were exposed (P greater than .05).
Dr. Nunn and his coauthors called the risk of HIV or hepatitis C virus (HCV) transmission during EDT “extraordinarily low.” Based on data from their study, they determined the risk of blood-borne pathogen transmission during an EDT resuscitation is 6 in 1 million for HIV and 1 in 10,000 for HCV, and the individual risk is 1 in 1 million and 3 in 100,000, respectively. Compliance with PPE precautions further limited exposure risk, but the study found that more than 10% of surveyed personnel did not utilize one of the four components of PPE besides gloves – eyewear, mask, gown or hat.
Most – but not all – survey responders followed up after the incidence of exposure. “[A total of] 91.7% of providers reporting their exposures also reported following up with their institution specific occupational exposure protocol,” the investigators wrote.
“Our findings have particular implications for trainees,” the study authors noted, citing the high percentage of injuries in this group. The findings emphasized the need for universal PPE compliance and enforcement by resuscitation team leaders. Nonetheless, the study found that the exposure rates during EDT are no greater than other surgical procedures.
“Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with PPE is paramount and would further minimize occupational exposure risks to providers during EDT,” Dr. Nunn and his coauthors said.
Dr. Nunn and his coauthors reported having no financial relationships.
SOURCE: Nunn A et al. J Trauma Acute Care Surg. 2018:85;78-84.
For trauma patients who are in extremis, but with the high rates of HIV/hepatitis among trauma patients, one that also carries what had been an unknown exposure risk for emergency staff.
“The most important findings of this prospective, multicenter study are that occupational exposures were reported in 7.2% of EDT resuscitations and 1.6% of EDT resuscitation participants and that occupational exposure risk appears to be further mitigated with strict PPE [personal protective equipment] compliance to universal precautions,” lead author Andrew Nunn, MD, and his colleagues wrote. Dr. Nunn is a trauma surgeon with Wake Forest Baptist Health in Winston-Salem, N.C.
The researchers surveyed 1,360 emergency department (ED) personnel after they performed 305 EDTs at 16 academic and community trauma centers nationwide in 2015 and 2016. The patients who had an EDT were mostly men ranging in age from 24 to 41 years (90.5%) with penetrating injuries (77.4%) and arrived at the ED after prehospital CPR (56.7%). Twenty-two occupational exposures occurred during 22 of the EDT resuscitations, with trainees sustaining most of them (68.2%). The most common source of injury was sharps, accounting for 86.4% (scalpels, 38.9%; fractured bone, 27.8%; needles, 16.7%; and scissors, 3%).
“Occupational exposures correlated with PPE utilization, as universal precautions during EDT were more often observed in providers who did not sustain occupational exposures, compared with those sustaining exposures,” Dr. Nunn and his coauthors wrote. For example, 98% of those reporting no exposure were gloved versus 91% of those who were exposed (P greater than .05).
Dr. Nunn and his coauthors called the risk of HIV or hepatitis C virus (HCV) transmission during EDT “extraordinarily low.” Based on data from their study, they determined the risk of blood-borne pathogen transmission during an EDT resuscitation is 6 in 1 million for HIV and 1 in 10,000 for HCV, and the individual risk is 1 in 1 million and 3 in 100,000, respectively. Compliance with PPE precautions further limited exposure risk, but the study found that more than 10% of surveyed personnel did not utilize one of the four components of PPE besides gloves – eyewear, mask, gown or hat.
Most – but not all – survey responders followed up after the incidence of exposure. “[A total of] 91.7% of providers reporting their exposures also reported following up with their institution specific occupational exposure protocol,” the investigators wrote.
“Our findings have particular implications for trainees,” the study authors noted, citing the high percentage of injuries in this group. The findings emphasized the need for universal PPE compliance and enforcement by resuscitation team leaders. Nonetheless, the study found that the exposure rates during EDT are no greater than other surgical procedures.
“Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with PPE is paramount and would further minimize occupational exposure risks to providers during EDT,” Dr. Nunn and his coauthors said.
Dr. Nunn and his coauthors reported having no financial relationships.
SOURCE: Nunn A et al. J Trauma Acute Care Surg. 2018:85;78-84.
For trauma patients who are in extremis, but with the high rates of HIV/hepatitis among trauma patients, one that also carries what had been an unknown exposure risk for emergency staff.
“The most important findings of this prospective, multicenter study are that occupational exposures were reported in 7.2% of EDT resuscitations and 1.6% of EDT resuscitation participants and that occupational exposure risk appears to be further mitigated with strict PPE [personal protective equipment] compliance to universal precautions,” lead author Andrew Nunn, MD, and his colleagues wrote. Dr. Nunn is a trauma surgeon with Wake Forest Baptist Health in Winston-Salem, N.C.
The researchers surveyed 1,360 emergency department (ED) personnel after they performed 305 EDTs at 16 academic and community trauma centers nationwide in 2015 and 2016. The patients who had an EDT were mostly men ranging in age from 24 to 41 years (90.5%) with penetrating injuries (77.4%) and arrived at the ED after prehospital CPR (56.7%). Twenty-two occupational exposures occurred during 22 of the EDT resuscitations, with trainees sustaining most of them (68.2%). The most common source of injury was sharps, accounting for 86.4% (scalpels, 38.9%; fractured bone, 27.8%; needles, 16.7%; and scissors, 3%).
“Occupational exposures correlated with PPE utilization, as universal precautions during EDT were more often observed in providers who did not sustain occupational exposures, compared with those sustaining exposures,” Dr. Nunn and his coauthors wrote. For example, 98% of those reporting no exposure were gloved versus 91% of those who were exposed (P greater than .05).
Dr. Nunn and his coauthors called the risk of HIV or hepatitis C virus (HCV) transmission during EDT “extraordinarily low.” Based on data from their study, they determined the risk of blood-borne pathogen transmission during an EDT resuscitation is 6 in 1 million for HIV and 1 in 10,000 for HCV, and the individual risk is 1 in 1 million and 3 in 100,000, respectively. Compliance with PPE precautions further limited exposure risk, but the study found that more than 10% of surveyed personnel did not utilize one of the four components of PPE besides gloves – eyewear, mask, gown or hat.
Most – but not all – survey responders followed up after the incidence of exposure. “[A total of] 91.7% of providers reporting their exposures also reported following up with their institution specific occupational exposure protocol,” the investigators wrote.
“Our findings have particular implications for trainees,” the study authors noted, citing the high percentage of injuries in this group. The findings emphasized the need for universal PPE compliance and enforcement by resuscitation team leaders. Nonetheless, the study found that the exposure rates during EDT are no greater than other surgical procedures.
“Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with PPE is paramount and would further minimize occupational exposure risks to providers during EDT,” Dr. Nunn and his coauthors said.
Dr. Nunn and his coauthors reported having no financial relationships.
SOURCE: Nunn A et al. J Trauma Acute Care Surg. 2018:85;78-84.
FROM THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
Key clinical point: Occupational exposure risk of emergency department thoracotomy (EDT) is low for personnel.
Major finding: Occupational exposure rate to HIV/hepatitis in trauma undergoing EDT is 7.2% for personnel.
Study details: Prospective, observational study that included 1,360 personnel surveyed after they performed 305 EDTs in 2015 and 2016.
Disclosures: Dr. Nunn and his coauthors reported having no financial relationships.
Source: Nunn A et al. J Trauma Acute Care Surg. 2018:85;78-84.
Children’s ‘gluten-free’ foods are no healthier than others
Children’s foods labeled as gluten-free (GF) generally had less sodium and fat than other foods marketed for children, but they also had a higher percentage of calories from sugar, a study in Pediatrics found. Further,
Parents and caregivers who are purchasing gluten-free products should carefully assess product labels. Another positive step would be to serve whole, unprocessed food, she wrote in Pediatrics.
Dr. Elliott purchased all child-targeted packaged foods available at two major supermarket chains in Alberta from February 2017 to March 2017, excluding candy, chocolate, potato chips, cheese-flavored snacks, sugary sodas, and similar “junk food” products. Of the 374 foods purchased, 18% had gluten-free claims.
“The intent was to examine the regular foods that have been repackaged to attract children,” she wrote, which she defined as meeting any of the following criteria qualified:
- Contains the word “child” or “kids’” in the product or brand name.
- Has the word “fun” or “play” on the package.
- The foods are linked to children’s TV programs, toys, or movies.
- The foods are promoted for lunch boxes.
- Contains graphics or activities, or promotional offers, intended for children.
- “Presents unusual or child-oriented shapes, unusual colors, or playful product names or tastes.”
Dr. Elliott compared the nutritional content of products labeled as gluten-free with that of products without a gluten-free label based on 100-g servings. She then compared the same GF-labeled products to their equivalent products without a GF label, when possible.
She used the Pan American Health Organization (PAHO) Nutrient Profile Model to evaluate the foods. PAHO criteria for nutritionally poor qualities include the following when applied to “processed” and “ultraprocessed” foods:
- A ratio between sodium and calories greater than or equal to 1.
- Total calories from sugar (glucose, fructose, and disaccharides) at least 10% or more of total calories.
- Contains other nonsugar sweeteners.
- Total calories from fat are at least 30% or more of total calories.
- Total saturated fat is at least at least 10% or more of total calories.
Nearly all the non-gluten free children’s foods (97%) and 88% of the children’s gluten-free foods were considered to have poor nutritional quality (P less than .001). High sugar content was present in 79% of gluten-free products and 81% of their gluten-containing equivalent products (P less than .001).
These foods can be classified as unhealthy because of “their high levels of sugar, sodium, and/or fat, which means that the options for purchasing healthy packaged foods are limited,” Dr. Elliott wrote.
Gluten free–labeled products did have less sodium, total fat, and saturated fat than did those without gluten-free claims, but sugar levels were higher and protein levels lower (nonstatistically significant) in gluten-free products.
“Such findings echo those in other studies of child-targeted supermarket foods and reveal that products marketed as ‘better for you’ for children are as much about marketing as they are about nutrition,” Dr. Elliott wrote. “Given children’s lower daily caloric intake and the challenges associated with consuming a nutrient-rich, gluten-free diet for children with celiac disease in particular, it is important that the products designed for children are held to a higher nutritional standard.”
The study’s biggest limitations are its inability to represent all child-marketed packaged foods available in stores and the fact that many foods labeled as “gluten-free” would not have gluten in them anyway, such as apple sauce and fruit snacks.
“In this case, the use of a gluten-free claim on products that are inherently free of gluten might be understood as a marketing tool directed at consumers who view gluten-free products as healthier than their regular counterparts,” Dr. Elliott noted
The research was funded by the Canadian Institutes of Health Research’s Canada Research Chairs Program. Dr. Elliott had no relevant financial disclosures.
SOURCE: Elliott C. Pediatrics. 2018 Jul 20. doi: 10.1542/peds.2018-0525.
Children’s foods labeled as gluten-free (GF) generally had less sodium and fat than other foods marketed for children, but they also had a higher percentage of calories from sugar, a study in Pediatrics found. Further,
Parents and caregivers who are purchasing gluten-free products should carefully assess product labels. Another positive step would be to serve whole, unprocessed food, she wrote in Pediatrics.
Dr. Elliott purchased all child-targeted packaged foods available at two major supermarket chains in Alberta from February 2017 to March 2017, excluding candy, chocolate, potato chips, cheese-flavored snacks, sugary sodas, and similar “junk food” products. Of the 374 foods purchased, 18% had gluten-free claims.
“The intent was to examine the regular foods that have been repackaged to attract children,” she wrote, which she defined as meeting any of the following criteria qualified:
- Contains the word “child” or “kids’” in the product or brand name.
- Has the word “fun” or “play” on the package.
- The foods are linked to children’s TV programs, toys, or movies.
- The foods are promoted for lunch boxes.
- Contains graphics or activities, or promotional offers, intended for children.
- “Presents unusual or child-oriented shapes, unusual colors, or playful product names or tastes.”
Dr. Elliott compared the nutritional content of products labeled as gluten-free with that of products without a gluten-free label based on 100-g servings. She then compared the same GF-labeled products to their equivalent products without a GF label, when possible.
She used the Pan American Health Organization (PAHO) Nutrient Profile Model to evaluate the foods. PAHO criteria for nutritionally poor qualities include the following when applied to “processed” and “ultraprocessed” foods:
- A ratio between sodium and calories greater than or equal to 1.
- Total calories from sugar (glucose, fructose, and disaccharides) at least 10% or more of total calories.
- Contains other nonsugar sweeteners.
- Total calories from fat are at least 30% or more of total calories.
- Total saturated fat is at least at least 10% or more of total calories.
Nearly all the non-gluten free children’s foods (97%) and 88% of the children’s gluten-free foods were considered to have poor nutritional quality (P less than .001). High sugar content was present in 79% of gluten-free products and 81% of their gluten-containing equivalent products (P less than .001).
These foods can be classified as unhealthy because of “their high levels of sugar, sodium, and/or fat, which means that the options for purchasing healthy packaged foods are limited,” Dr. Elliott wrote.
Gluten free–labeled products did have less sodium, total fat, and saturated fat than did those without gluten-free claims, but sugar levels were higher and protein levels lower (nonstatistically significant) in gluten-free products.
“Such findings echo those in other studies of child-targeted supermarket foods and reveal that products marketed as ‘better for you’ for children are as much about marketing as they are about nutrition,” Dr. Elliott wrote. “Given children’s lower daily caloric intake and the challenges associated with consuming a nutrient-rich, gluten-free diet for children with celiac disease in particular, it is important that the products designed for children are held to a higher nutritional standard.”
The study’s biggest limitations are its inability to represent all child-marketed packaged foods available in stores and the fact that many foods labeled as “gluten-free” would not have gluten in them anyway, such as apple sauce and fruit snacks.
“In this case, the use of a gluten-free claim on products that are inherently free of gluten might be understood as a marketing tool directed at consumers who view gluten-free products as healthier than their regular counterparts,” Dr. Elliott noted
The research was funded by the Canadian Institutes of Health Research’s Canada Research Chairs Program. Dr. Elliott had no relevant financial disclosures.
SOURCE: Elliott C. Pediatrics. 2018 Jul 20. doi: 10.1542/peds.2018-0525.
Children’s foods labeled as gluten-free (GF) generally had less sodium and fat than other foods marketed for children, but they also had a higher percentage of calories from sugar, a study in Pediatrics found. Further,
Parents and caregivers who are purchasing gluten-free products should carefully assess product labels. Another positive step would be to serve whole, unprocessed food, she wrote in Pediatrics.
Dr. Elliott purchased all child-targeted packaged foods available at two major supermarket chains in Alberta from February 2017 to March 2017, excluding candy, chocolate, potato chips, cheese-flavored snacks, sugary sodas, and similar “junk food” products. Of the 374 foods purchased, 18% had gluten-free claims.
“The intent was to examine the regular foods that have been repackaged to attract children,” she wrote, which she defined as meeting any of the following criteria qualified:
- Contains the word “child” or “kids’” in the product or brand name.
- Has the word “fun” or “play” on the package.
- The foods are linked to children’s TV programs, toys, or movies.
- The foods are promoted for lunch boxes.
- Contains graphics or activities, or promotional offers, intended for children.
- “Presents unusual or child-oriented shapes, unusual colors, or playful product names or tastes.”
Dr. Elliott compared the nutritional content of products labeled as gluten-free with that of products without a gluten-free label based on 100-g servings. She then compared the same GF-labeled products to their equivalent products without a GF label, when possible.
She used the Pan American Health Organization (PAHO) Nutrient Profile Model to evaluate the foods. PAHO criteria for nutritionally poor qualities include the following when applied to “processed” and “ultraprocessed” foods:
- A ratio between sodium and calories greater than or equal to 1.
- Total calories from sugar (glucose, fructose, and disaccharides) at least 10% or more of total calories.
- Contains other nonsugar sweeteners.
- Total calories from fat are at least 30% or more of total calories.
- Total saturated fat is at least at least 10% or more of total calories.
Nearly all the non-gluten free children’s foods (97%) and 88% of the children’s gluten-free foods were considered to have poor nutritional quality (P less than .001). High sugar content was present in 79% of gluten-free products and 81% of their gluten-containing equivalent products (P less than .001).
These foods can be classified as unhealthy because of “their high levels of sugar, sodium, and/or fat, which means that the options for purchasing healthy packaged foods are limited,” Dr. Elliott wrote.
Gluten free–labeled products did have less sodium, total fat, and saturated fat than did those without gluten-free claims, but sugar levels were higher and protein levels lower (nonstatistically significant) in gluten-free products.
“Such findings echo those in other studies of child-targeted supermarket foods and reveal that products marketed as ‘better for you’ for children are as much about marketing as they are about nutrition,” Dr. Elliott wrote. “Given children’s lower daily caloric intake and the challenges associated with consuming a nutrient-rich, gluten-free diet for children with celiac disease in particular, it is important that the products designed for children are held to a higher nutritional standard.”
The study’s biggest limitations are its inability to represent all child-marketed packaged foods available in stores and the fact that many foods labeled as “gluten-free” would not have gluten in them anyway, such as apple sauce and fruit snacks.
“In this case, the use of a gluten-free claim on products that are inherently free of gluten might be understood as a marketing tool directed at consumers who view gluten-free products as healthier than their regular counterparts,” Dr. Elliott noted
The research was funded by the Canadian Institutes of Health Research’s Canada Research Chairs Program. Dr. Elliott had no relevant financial disclosures.
SOURCE: Elliott C. Pediatrics. 2018 Jul 20. doi: 10.1542/peds.2018-0525.
FROM PEDIATRICS
Key clinical point: Most prepackaged gluten-free foods marketed for children are unhealthy.
Major finding: Of gluten-free packaged children’s foods, 88% had poor nutritional quality, as did 97% of children’s food not labeled as gluten-free.
Study details: The findings are based on a comparison of 374 child-marketed packaged foods, including 66 gluten free–labeled foods and their non-gluten free equivalents and other non-gluten free foods.
Disclosures: The research was funded by the Canadian Institutes of Health Research’s Canada Research Chairs Program. Dr. Elliott had no relevant financial disclosures.
Source: Elliott C. Pediatrics. 2018 Jul 20. doi: 10.1542/peds.2018-0525.
Breast cancer patients don’t get the financial counseling they want from their clinicians
About half of medical oncologists – and even fewer surgeons and radiation oncologists – have someone in their practice to discuss the financial implications of treating breast cancer, a physician-patient survey has found.
Patients are feeling that lack of service, too; 73% of women in the survey said their providers didn’t offer much, or even any, help in tackling the potentially devastating financial impact of their cancer. Women reported a variety of these issues, including increased debt, lost time at work, skimping on their food budget, and even losing their homes as the medical bills added up.
“The privations observed in the current study are sobering and consistent with studies published before the widespread awareness of the potential for financial toxicity after the diagnosis and treatment of cancer,” wrote Reshma Jagsi, MD, and coauthors. The report was published in Cancer. 
“… Unfortunately, unmet needs for discussion persist, as does unresolved worry. The percentage of patients who perceive meaningful clinician engagement is low, with far fewer than one-quarter of respondents reporting more than a little discussion of these issues, which is strikingly lower than the percentage of providers who perceive routinely making services available,” they wrote.
Dr. Jagsi, of the University of Michigan, Ann Arbor, and her colleagues used the Surveillance, Epidemiology, and End Results (SEER) database to identify 2,502 women in Georgia and Los Angeles County who were diagnosed with early-stage breast cancer from 2013 to 2015. They contacted these women, who were at least 1 year out from diagnosis, and their oncology providers with a survey designed to determine how both groups communicated about financial issues, and how those issues affected patients’ day-to-day lives.
Most of the clinicians were surgeons (370); the rest were medical oncologists (306) or radiation oncologists (169). About a quarter of each group was in a teaching practice.
Among the medical oncologists, 50.9% reported that someone in their practice often or always discussed financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Medical oncologists were also more likely to respond that they were very aware of out-of-pocket costs for patients, as did 27.3% of surgeons and 34.3% of radiation oncologists.
About 57% of medical oncologists thought it was quite or extremely important to save their patients money; 35.3% of surgeons and 55.8% of radiation oncologists also responded so.
Many women reported at least some measure of financial toxicity related to their cancer and its treatment, and this varied widely by ethnicity and race. Debt was common, noted by 58.9% of black patients, 33.5% of Latina patients, and about 28% of both white and Asian patients.
“Many patients also had substantial lost income and out-of-pocket expenses that they attributed to breast cancer,” the authors wrote. “Overall, 14% of patients reported lost income that was [at least] 10% of their household income, 17% of patients reported spending [at least] 10% of household income on out-of-pocket medical expenses, and 7% of patients reported spending [at least] 10% of household income on out-of-pocket nonmedical expenses.
Housing loss attributed to breast cancer was most common among blacks (6%) and Latinas (4.7%), and less so among whites and Asians (about 1% each).
Blacks and Latinas also were more likely to report a utility disconnection due to unpaid bills (5.9% and 3.2%, respectively) compared with whites and Asians (1.7% and 0.5%).
One way women financially coped, the survey found, was to cut the food budget. “One in five whites [21.5%] and Asians [22.5%] cut down spending on food, as did nearly one-half of black individuals [45.2%] and greater than one-third of Latinas [35.8%].”
Worry about finances was most common among blacks and Latinas (about 50%), but about a third of white and Asian women also reported worry. Survey results suggested that clinicians were not addressing these issues.
Women – especially nonwhite women – wanted to have these talks, with 15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians reporting this desire.
“Unmet patient needs for engagement with physicians regarding financial concerns were common. Of the 945 women who expressed worrying at least somewhat, 679 (72.8%) indicated that cancer physicians and their staff did not help at least somewhat,” the authors said.
More than half of the 523 women who expressed a desire to talk to health care providers regarding the impact of breast cancer on employment or finances (55.4%) reported that this discussion never took place, either with the oncologist, primary care provider, social worker, or any other professional involved in their care.
A multivariate analysis examined patient characteristics associated with the desire to discuss financial toxicity with a health care provider. Younger age, nonwhite race, lower income, being employed, receiving chemotherapy, and living in Georgia all showed significant, independent interaction.
“Given these findings, it is clear that thoughtfully designed, prospective interventions are necessary to address the remarkably common experiences of financial burden that patients report even in the modern era,” the investigators wrote. “These interventions might include training for physicians and their staff regarding how to have effective conversations in this context, in ways that are sensitive to cultural differences and needs. Other promising approaches might include the use of advanced technology to engage patients in interactive exercises that elicit their financial concerns and experiences and alert providers to their needs.”
The study was largely funded by a grant from the National Cancer Institute and the University of Michigan. Dr. Jagsi disclosed that she has been a consultant for Amgen but not relative to this study.
SOURCE: Jagsi R et al. Cancer 2018 Jul 23. doi: 10.1002/cncr.31532.
About half of medical oncologists – and even fewer surgeons and radiation oncologists – have someone in their practice to discuss the financial implications of treating breast cancer, a physician-patient survey has found.
Patients are feeling that lack of service, too; 73% of women in the survey said their providers didn’t offer much, or even any, help in tackling the potentially devastating financial impact of their cancer. Women reported a variety of these issues, including increased debt, lost time at work, skimping on their food budget, and even losing their homes as the medical bills added up.
“The privations observed in the current study are sobering and consistent with studies published before the widespread awareness of the potential for financial toxicity after the diagnosis and treatment of cancer,” wrote Reshma Jagsi, MD, and coauthors. The report was published in Cancer.
“… Unfortunately, unmet needs for discussion persist, as does unresolved worry. The percentage of patients who perceive meaningful clinician engagement is low, with far fewer than one-quarter of respondents reporting more than a little discussion of these issues, which is strikingly lower than the percentage of providers who perceive routinely making services available,” they wrote.
Dr. Jagsi, of the University of Michigan, Ann Arbor, and her colleagues used the Surveillance, Epidemiology, and End Results (SEER) database to identify 2,502 women in Georgia and Los Angeles County who were diagnosed with early-stage breast cancer from 2013 to 2015. They contacted these women, who were at least 1 year out from diagnosis, and their oncology providers with a survey designed to determine how both groups communicated about financial issues, and how those issues affected patients’ day-to-day lives.
Most of the clinicians were surgeons (370); the rest were medical oncologists (306) or radiation oncologists (169). About a quarter of each group was in a teaching practice.
Among the medical oncologists, 50.9% reported that someone in their practice often or always discussed financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Medical oncologists were also more likely to respond that they were very aware of out-of-pocket costs for patients, as did 27.3% of surgeons and 34.3% of radiation oncologists.
About 57% of medical oncologists thought it was quite or extremely important to save their patients money; 35.3% of surgeons and 55.8% of radiation oncologists also responded so.
Many women reported at least some measure of financial toxicity related to their cancer and its treatment, and this varied widely by ethnicity and race. Debt was common, noted by 58.9% of black patients, 33.5% of Latina patients, and about 28% of both white and Asian patients.
“Many patients also had substantial lost income and out-of-pocket expenses that they attributed to breast cancer,” the authors wrote. “Overall, 14% of patients reported lost income that was [at least] 10% of their household income, 17% of patients reported spending [at least] 10% of household income on out-of-pocket medical expenses, and 7% of patients reported spending [at least] 10% of household income on out-of-pocket nonmedical expenses.
Housing loss attributed to breast cancer was most common among blacks (6%) and Latinas (4.7%), and less so among whites and Asians (about 1% each).
Blacks and Latinas also were more likely to report a utility disconnection due to unpaid bills (5.9% and 3.2%, respectively) compared with whites and Asians (1.7% and 0.5%).
One way women financially coped, the survey found, was to cut the food budget. “One in five whites [21.5%] and Asians [22.5%] cut down spending on food, as did nearly one-half of black individuals [45.2%] and greater than one-third of Latinas [35.8%].”
Worry about finances was most common among blacks and Latinas (about 50%), but about a third of white and Asian women also reported worry. Survey results suggested that clinicians were not addressing these issues.
Women – especially nonwhite women – wanted to have these talks, with 15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians reporting this desire.
“Unmet patient needs for engagement with physicians regarding financial concerns were common. Of the 945 women who expressed worrying at least somewhat, 679 (72.8%) indicated that cancer physicians and their staff did not help at least somewhat,” the authors said.
More than half of the 523 women who expressed a desire to talk to health care providers regarding the impact of breast cancer on employment or finances (55.4%) reported that this discussion never took place, either with the oncologist, primary care provider, social worker, or any other professional involved in their care.
A multivariate analysis examined patient characteristics associated with the desire to discuss financial toxicity with a health care provider. Younger age, nonwhite race, lower income, being employed, receiving chemotherapy, and living in Georgia all showed significant, independent interaction.
“Given these findings, it is clear that thoughtfully designed, prospective interventions are necessary to address the remarkably common experiences of financial burden that patients report even in the modern era,” the investigators wrote. “These interventions might include training for physicians and their staff regarding how to have effective conversations in this context, in ways that are sensitive to cultural differences and needs. Other promising approaches might include the use of advanced technology to engage patients in interactive exercises that elicit their financial concerns and experiences and alert providers to their needs.”
The study was largely funded by a grant from the National Cancer Institute and the University of Michigan. Dr. Jagsi disclosed that she has been a consultant for Amgen but not relative to this study.
SOURCE: Jagsi R et al. Cancer 2018 Jul 23. doi: 10.1002/cncr.31532.
About half of medical oncologists – and even fewer surgeons and radiation oncologists – have someone in their practice to discuss the financial implications of treating breast cancer, a physician-patient survey has found.
Patients are feeling that lack of service, too; 73% of women in the survey said their providers didn’t offer much, or even any, help in tackling the potentially devastating financial impact of their cancer. Women reported a variety of these issues, including increased debt, lost time at work, skimping on their food budget, and even losing their homes as the medical bills added up.
“The privations observed in the current study are sobering and consistent with studies published before the widespread awareness of the potential for financial toxicity after the diagnosis and treatment of cancer,” wrote Reshma Jagsi, MD, and coauthors. The report was published in Cancer.
“… Unfortunately, unmet needs for discussion persist, as does unresolved worry. The percentage of patients who perceive meaningful clinician engagement is low, with far fewer than one-quarter of respondents reporting more than a little discussion of these issues, which is strikingly lower than the percentage of providers who perceive routinely making services available,” they wrote.
Dr. Jagsi, of the University of Michigan, Ann Arbor, and her colleagues used the Surveillance, Epidemiology, and End Results (SEER) database to identify 2,502 women in Georgia and Los Angeles County who were diagnosed with early-stage breast cancer from 2013 to 2015. They contacted these women, who were at least 1 year out from diagnosis, and their oncology providers with a survey designed to determine how both groups communicated about financial issues, and how those issues affected patients’ day-to-day lives.
Most of the clinicians were surgeons (370); the rest were medical oncologists (306) or radiation oncologists (169). About a quarter of each group was in a teaching practice.
Among the medical oncologists, 50.9% reported that someone in their practice often or always discussed financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Medical oncologists were also more likely to respond that they were very aware of out-of-pocket costs for patients, as did 27.3% of surgeons and 34.3% of radiation oncologists.
About 57% of medical oncologists thought it was quite or extremely important to save their patients money; 35.3% of surgeons and 55.8% of radiation oncologists also responded so.
Many women reported at least some measure of financial toxicity related to their cancer and its treatment, and this varied widely by ethnicity and race. Debt was common, noted by 58.9% of black patients, 33.5% of Latina patients, and about 28% of both white and Asian patients.
“Many patients also had substantial lost income and out-of-pocket expenses that they attributed to breast cancer,” the authors wrote. “Overall, 14% of patients reported lost income that was [at least] 10% of their household income, 17% of patients reported spending [at least] 10% of household income on out-of-pocket medical expenses, and 7% of patients reported spending [at least] 10% of household income on out-of-pocket nonmedical expenses.
Housing loss attributed to breast cancer was most common among blacks (6%) and Latinas (4.7%), and less so among whites and Asians (about 1% each).
Blacks and Latinas also were more likely to report a utility disconnection due to unpaid bills (5.9% and 3.2%, respectively) compared with whites and Asians (1.7% and 0.5%).
One way women financially coped, the survey found, was to cut the food budget. “One in five whites [21.5%] and Asians [22.5%] cut down spending on food, as did nearly one-half of black individuals [45.2%] and greater than one-third of Latinas [35.8%].”
Worry about finances was most common among blacks and Latinas (about 50%), but about a third of white and Asian women also reported worry. Survey results suggested that clinicians were not addressing these issues.
Women – especially nonwhite women – wanted to have these talks, with 15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians reporting this desire.
“Unmet patient needs for engagement with physicians regarding financial concerns were common. Of the 945 women who expressed worrying at least somewhat, 679 (72.8%) indicated that cancer physicians and their staff did not help at least somewhat,” the authors said.
More than half of the 523 women who expressed a desire to talk to health care providers regarding the impact of breast cancer on employment or finances (55.4%) reported that this discussion never took place, either with the oncologist, primary care provider, social worker, or any other professional involved in their care.
A multivariate analysis examined patient characteristics associated with the desire to discuss financial toxicity with a health care provider. Younger age, nonwhite race, lower income, being employed, receiving chemotherapy, and living in Georgia all showed significant, independent interaction.
“Given these findings, it is clear that thoughtfully designed, prospective interventions are necessary to address the remarkably common experiences of financial burden that patients report even in the modern era,” the investigators wrote. “These interventions might include training for physicians and their staff regarding how to have effective conversations in this context, in ways that are sensitive to cultural differences and needs. Other promising approaches might include the use of advanced technology to engage patients in interactive exercises that elicit their financial concerns and experiences and alert providers to their needs.”
The study was largely funded by a grant from the National Cancer Institute and the University of Michigan. Dr. Jagsi disclosed that she has been a consultant for Amgen but not relative to this study.
SOURCE: Jagsi R et al. Cancer 2018 Jul 23. doi: 10.1002/cncr.31532.
FROM CANCER
Key clinical point: Oncology care providers aren’t providing adequate financial counseling for patients with breast cancer.
Major finding: Half of medical oncologists say they don’t have a staff member routinely discuss the financial impact of breast cancer, and 73% of patients say they’ve never had this discussion with their doctor.
Study details: The survey comprised 2,502 patients and 845 physicians.
Disclosures: The study was largely funded by a grant from the National Cancer Institute and the University of Michigan. Dr. Jagsi disclosed that she has been a consultant for Amgen but not relative to this study.
Source: Jagsi R et al. Cancer 2018 Jul 23. doi: 10.1002/cncr.31532.
FDA approves biosimilar filgrastim
The US Food and Drug Administration (FDA) has approved the leukocyte growth factor Nivestym™ (filgrastim-aafi), a biosimilar to Neupogen (filgrastim).
Nivestym is approved to treat patients with nonmyeloid malignancies who are receiving myelosuppressive chemotherapy or undergoing bone marrow transplant, acute myeloid leukemia patients receiving induction or consolidation chemotherapy, patients undergoing autologous peripheral blood progenitor cell collection, and patients with severe chronic neutropenia.
The FDA’s approval of Nivestym was based on a review of evidence suggesting the drug is highly similar to Neupogen, according to Pfizer, the company developing Nivestym.
The full approved indication for Nivestym is as follows:
- To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a significant incidence of severe neutropenia with fever
- To reduce the time to neutrophil recovery and the duration of fever following induction or consolidation chemotherapy in patients with acute myeloid leukemia
- To reduce the duration of neutropenia and neutropenia-related clinical sequelae (eg, febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplant
- For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis
- For chronic administration to reduce the incidence and duration of sequelae of severe neutropenia (eg, fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia.
For more details on Nivestym, see the full prescribing information.
The US Food and Drug Administration (FDA) has approved the leukocyte growth factor Nivestym™ (filgrastim-aafi), a biosimilar to Neupogen (filgrastim).
Nivestym is approved to treat patients with nonmyeloid malignancies who are receiving myelosuppressive chemotherapy or undergoing bone marrow transplant, acute myeloid leukemia patients receiving induction or consolidation chemotherapy, patients undergoing autologous peripheral blood progenitor cell collection, and patients with severe chronic neutropenia.
The FDA’s approval of Nivestym was based on a review of evidence suggesting the drug is highly similar to Neupogen, according to Pfizer, the company developing Nivestym.
The full approved indication for Nivestym is as follows:
- To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a significant incidence of severe neutropenia with fever
- To reduce the time to neutrophil recovery and the duration of fever following induction or consolidation chemotherapy in patients with acute myeloid leukemia
- To reduce the duration of neutropenia and neutropenia-related clinical sequelae (eg, febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplant
- For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis
- For chronic administration to reduce the incidence and duration of sequelae of severe neutropenia (eg, fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia.
For more details on Nivestym, see the full prescribing information.
The US Food and Drug Administration (FDA) has approved the leukocyte growth factor Nivestym™ (filgrastim-aafi), a biosimilar to Neupogen (filgrastim).
Nivestym is approved to treat patients with nonmyeloid malignancies who are receiving myelosuppressive chemotherapy or undergoing bone marrow transplant, acute myeloid leukemia patients receiving induction or consolidation chemotherapy, patients undergoing autologous peripheral blood progenitor cell collection, and patients with severe chronic neutropenia.
The FDA’s approval of Nivestym was based on a review of evidence suggesting the drug is highly similar to Neupogen, according to Pfizer, the company developing Nivestym.
The full approved indication for Nivestym is as follows:
- To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a significant incidence of severe neutropenia with fever
- To reduce the time to neutrophil recovery and the duration of fever following induction or consolidation chemotherapy in patients with acute myeloid leukemia
- To reduce the duration of neutropenia and neutropenia-related clinical sequelae (eg, febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplant
- For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis
- For chronic administration to reduce the incidence and duration of sequelae of severe neutropenia (eg, fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia.
For more details on Nivestym, see the full prescribing information.
Tool may reveal optimal time for SCT in MF
A new tool can help patients with myelofibrosis (MF) decide when to pursue stem cell transplant (SCT), according to the MPN Research Foundation.
The SCT Spectrum Transplant Timing tool (SSTT) is an online MF risk calculator.
It is designed to inform patients of their risk status in a timely manner so they can be proactive in speaking to their doctors about SCT.
“There is an optimal time to start SCT, simply because the odds of success soar in our favor when we start early rather than late in the game,” said Zhenya Senyak, editor of MPN Forum, an MF patient, and creator of the SSTT.
“The SCT Spectrum Timing Tool can help inform the timing of that decision.”
The SSTT incorporates the Dynamic International Prognostic Scoring System (DIPSS), asking patients about their age, white blood cell count, hemoglobin level, peripheral blood blast percentage, and constitutional symptoms.
Patients’ answers are used to create a color signal that indicates their current MF risk level. Accompanying information explains what the risk level means, provides median survival times for that level, and alerts patients of the relative urgency of SCT.
Patients can review these results with their hematologist to ensure accuracy and incorporate risk factors not measured by the SSTT.
The SSTT also includes resources to support SCT discussions between patients and hematologists.
Senyak created SSTT with help from the MPN SCT Transplantation Timing Taskforce, a group of 18 MPN and transplant specialists, patient advocates, and SCT survivors. The work was sponsored by the MPN Research Foundation.
“The decision of whether or not to pursue a stem cell transplant is incredibly fraught for any person,” said Ruben Mesa, MD, a member of the MPN SCT Transplantation Timing Taskforce.
“Our hope in assisting with this effort is to lend our knowledge and experience to create a guide to assist with patient-doctor communication around this very complicated issue.”
A new tool can help patients with myelofibrosis (MF) decide when to pursue stem cell transplant (SCT), according to the MPN Research Foundation.
The SCT Spectrum Transplant Timing tool (SSTT) is an online MF risk calculator.
It is designed to inform patients of their risk status in a timely manner so they can be proactive in speaking to their doctors about SCT.
“There is an optimal time to start SCT, simply because the odds of success soar in our favor when we start early rather than late in the game,” said Zhenya Senyak, editor of MPN Forum, an MF patient, and creator of the SSTT.
“The SCT Spectrum Timing Tool can help inform the timing of that decision.”
The SSTT incorporates the Dynamic International Prognostic Scoring System (DIPSS), asking patients about their age, white blood cell count, hemoglobin level, peripheral blood blast percentage, and constitutional symptoms.
Patients’ answers are used to create a color signal that indicates their current MF risk level. Accompanying information explains what the risk level means, provides median survival times for that level, and alerts patients of the relative urgency of SCT.
Patients can review these results with their hematologist to ensure accuracy and incorporate risk factors not measured by the SSTT.
The SSTT also includes resources to support SCT discussions between patients and hematologists.
Senyak created SSTT with help from the MPN SCT Transplantation Timing Taskforce, a group of 18 MPN and transplant specialists, patient advocates, and SCT survivors. The work was sponsored by the MPN Research Foundation.
“The decision of whether or not to pursue a stem cell transplant is incredibly fraught for any person,” said Ruben Mesa, MD, a member of the MPN SCT Transplantation Timing Taskforce.
“Our hope in assisting with this effort is to lend our knowledge and experience to create a guide to assist with patient-doctor communication around this very complicated issue.”
A new tool can help patients with myelofibrosis (MF) decide when to pursue stem cell transplant (SCT), according to the MPN Research Foundation.
The SCT Spectrum Transplant Timing tool (SSTT) is an online MF risk calculator.
It is designed to inform patients of their risk status in a timely manner so they can be proactive in speaking to their doctors about SCT.
“There is an optimal time to start SCT, simply because the odds of success soar in our favor when we start early rather than late in the game,” said Zhenya Senyak, editor of MPN Forum, an MF patient, and creator of the SSTT.
“The SCT Spectrum Timing Tool can help inform the timing of that decision.”
The SSTT incorporates the Dynamic International Prognostic Scoring System (DIPSS), asking patients about their age, white blood cell count, hemoglobin level, peripheral blood blast percentage, and constitutional symptoms.
Patients’ answers are used to create a color signal that indicates their current MF risk level. Accompanying information explains what the risk level means, provides median survival times for that level, and alerts patients of the relative urgency of SCT.
Patients can review these results with their hematologist to ensure accuracy and incorporate risk factors not measured by the SSTT.
The SSTT also includes resources to support SCT discussions between patients and hematologists.
Senyak created SSTT with help from the MPN SCT Transplantation Timing Taskforce, a group of 18 MPN and transplant specialists, patient advocates, and SCT survivors. The work was sponsored by the MPN Research Foundation.
“The decision of whether or not to pursue a stem cell transplant is incredibly fraught for any person,” said Ruben Mesa, MD, a member of the MPN SCT Transplantation Timing Taskforce.
“Our hope in assisting with this effort is to lend our knowledge and experience to create a guide to assist with patient-doctor communication around this very complicated issue.”
Greening intervention tied to self-reported improved mental health
Living close to an urban greening program improved mental health in low-income city dwellers, according to results from a randomized trial, in which the greening intervention consisted of removing trash from vacant lots, grading the land, planting new grass and trees, installing wooden fences, and performing maintenance.
Options for depression treatment are limited, and this has led researchers to consider environmental factors that might contribute to the condition. Vacant or dilapidated neighborhood spaces are a known factor for depression.
The researchers performed a citywide cluster randomized trial in Philadelphia, which included 541 vacant lots in 110 clusters. A total of 37 clusters were assigned to the greening intervention, 36 to the trash cleanup intervention, and 37 clusters were left alone. The researchers interviewed local residents near each cluster, using the short-form Kessler-6 Psychological Distress Scale to assess mental health outcomes, wrote Dr. South, of the University of Pennsylvania, Philadelphia.
The researchers interviewed 442 participants (mean age 44.6 years, 59.7% female) in the preintervention period, and 342 (77.4%) during the postintervention period. The researchers conducted a neighborhood poverty subset analysis that included 139 participants.
Intention-to-treat analyses showed that, compared with no intervention, those in the greening intervention experienced a significant decrease in reporting feeling depressed (–41.5%; 95% confidence interval, –63.6 to –5.9; P = .03) and feeling worthless (–50.9%; 95% CI, –74.7 to –4.7; P = .04). The investigators also found a trend toward a reduction in participants who self-reported being in poor mental health (–62.8%; 95% CI, –86.5 to –27.5; P = .051).
When the analysis was restricted to neighborhoods below the poverty line, the greening intervention led to a significant decrease in participants feeling depressed (–68.7%; 95% CI, –86.5 to –27.5; P =.007), but no statistically significant difference was found in participants with self-reported poor mental health.
The trash cleanup intervention had no significant associations with changes in mental health outcomes, compared with no intervention.
Dr. South reported having no disclosures. The study was funded by the National Institutes of Health, and the Centers for Disease Control and Prevention.
SOURCE: South EC et al. JAMA Network Open. 2018 Jul 20. doi: 10.1001/jamanetworkopen.2018.0298.
Living close to an urban greening program improved mental health in low-income city dwellers, according to results from a randomized trial, in which the greening intervention consisted of removing trash from vacant lots, grading the land, planting new grass and trees, installing wooden fences, and performing maintenance.
Options for depression treatment are limited, and this has led researchers to consider environmental factors that might contribute to the condition. Vacant or dilapidated neighborhood spaces are a known factor for depression.
The researchers performed a citywide cluster randomized trial in Philadelphia, which included 541 vacant lots in 110 clusters. A total of 37 clusters were assigned to the greening intervention, 36 to the trash cleanup intervention, and 37 clusters were left alone. The researchers interviewed local residents near each cluster, using the short-form Kessler-6 Psychological Distress Scale to assess mental health outcomes, wrote Dr. South, of the University of Pennsylvania, Philadelphia.
The researchers interviewed 442 participants (mean age 44.6 years, 59.7% female) in the preintervention period, and 342 (77.4%) during the postintervention period. The researchers conducted a neighborhood poverty subset analysis that included 139 participants.
Intention-to-treat analyses showed that, compared with no intervention, those in the greening intervention experienced a significant decrease in reporting feeling depressed (–41.5%; 95% confidence interval, –63.6 to –5.9; P = .03) and feeling worthless (–50.9%; 95% CI, –74.7 to –4.7; P = .04). The investigators also found a trend toward a reduction in participants who self-reported being in poor mental health (–62.8%; 95% CI, –86.5 to –27.5; P = .051).
When the analysis was restricted to neighborhoods below the poverty line, the greening intervention led to a significant decrease in participants feeling depressed (–68.7%; 95% CI, –86.5 to –27.5; P =.007), but no statistically significant difference was found in participants with self-reported poor mental health.
The trash cleanup intervention had no significant associations with changes in mental health outcomes, compared with no intervention.
Dr. South reported having no disclosures. The study was funded by the National Institutes of Health, and the Centers for Disease Control and Prevention.
SOURCE: South EC et al. JAMA Network Open. 2018 Jul 20. doi: 10.1001/jamanetworkopen.2018.0298.
Living close to an urban greening program improved mental health in low-income city dwellers, according to results from a randomized trial, in which the greening intervention consisted of removing trash from vacant lots, grading the land, planting new grass and trees, installing wooden fences, and performing maintenance.
Options for depression treatment are limited, and this has led researchers to consider environmental factors that might contribute to the condition. Vacant or dilapidated neighborhood spaces are a known factor for depression.
The researchers performed a citywide cluster randomized trial in Philadelphia, which included 541 vacant lots in 110 clusters. A total of 37 clusters were assigned to the greening intervention, 36 to the trash cleanup intervention, and 37 clusters were left alone. The researchers interviewed local residents near each cluster, using the short-form Kessler-6 Psychological Distress Scale to assess mental health outcomes, wrote Dr. South, of the University of Pennsylvania, Philadelphia.
The researchers interviewed 442 participants (mean age 44.6 years, 59.7% female) in the preintervention period, and 342 (77.4%) during the postintervention period. The researchers conducted a neighborhood poverty subset analysis that included 139 participants.
Intention-to-treat analyses showed that, compared with no intervention, those in the greening intervention experienced a significant decrease in reporting feeling depressed (–41.5%; 95% confidence interval, –63.6 to –5.9; P = .03) and feeling worthless (–50.9%; 95% CI, –74.7 to –4.7; P = .04). The investigators also found a trend toward a reduction in participants who self-reported being in poor mental health (–62.8%; 95% CI, –86.5 to –27.5; P = .051).
When the analysis was restricted to neighborhoods below the poverty line, the greening intervention led to a significant decrease in participants feeling depressed (–68.7%; 95% CI, –86.5 to –27.5; P =.007), but no statistically significant difference was found in participants with self-reported poor mental health.
The trash cleanup intervention had no significant associations with changes in mental health outcomes, compared with no intervention.
Dr. South reported having no disclosures. The study was funded by the National Institutes of Health, and the Centers for Disease Control and Prevention.
SOURCE: South EC et al. JAMA Network Open. 2018 Jul 20. doi: 10.1001/jamanetworkopen.2018.0298.
FROM JAMA NETWORK OPEN
Key clinical point: Treating blighted physical environments in addition to traditional patient treatments may help lift self-reported depression.
Major finding: Low-income residents reported a 68% reduction in feeling depressed.
Study details: Randomized, controlled trial of 442 individuals living near vacant lots.
Disclosures: Dr. South reported having no disclosures. The study was funded by the National Institutes of Health, and the Centers for Disease Control and Prevention.
Source: South EC et al. JAMA Network Open. 2018 Jul 20. doi: 10.1001/jamanetworkopen.2018.0298.
FDA approves Nivestym, second biosimilar to Neupogen
Nivestym (filgrastim-aafi), a biosimilar to Neupogen (filgrastim) was approved July 20 by the Food and Drug Administration, according to a statement provided by the agency. Nivestym is the second biosimilar to Neupogen to be approved in the United States.
- Patients with cancer receiving myelosuppressive chemotherapy.
- Patients with acute myeloid leukemia receiving induction or consolidation chemotherapy.
- Patients with cancer undergoing bone marrow transplantation.
- Patients undergoing autologous peripheral blood progenitor cell collection and therapy.
- Patients with severe chronic neutropenia.
According to a press release from Pfizer, the manufacturer of the biosimilar, Nivestym is expected to be available in the United States at a significant discount to the current wholesale acquisition cost of Neupogen, which is not inclusive of discounts to payers, providers, distributors, and other purchasing organizations.
The FDA statement notes that a biosimilar is approved based on a showing that it is highly similar to an already approved biologic product, known as a reference product. The biosimilar also must be shown to have no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowable in biosimilar products.
Prescribing information is available here.
Nivestym (filgrastim-aafi), a biosimilar to Neupogen (filgrastim) was approved July 20 by the Food and Drug Administration, according to a statement provided by the agency. Nivestym is the second biosimilar to Neupogen to be approved in the United States.
- Patients with cancer receiving myelosuppressive chemotherapy.
- Patients with acute myeloid leukemia receiving induction or consolidation chemotherapy.
- Patients with cancer undergoing bone marrow transplantation.
- Patients undergoing autologous peripheral blood progenitor cell collection and therapy.
- Patients with severe chronic neutropenia.
According to a press release from Pfizer, the manufacturer of the biosimilar, Nivestym is expected to be available in the United States at a significant discount to the current wholesale acquisition cost of Neupogen, which is not inclusive of discounts to payers, providers, distributors, and other purchasing organizations.
The FDA statement notes that a biosimilar is approved based on a showing that it is highly similar to an already approved biologic product, known as a reference product. The biosimilar also must be shown to have no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowable in biosimilar products.
Prescribing information is available here.
Nivestym (filgrastim-aafi), a biosimilar to Neupogen (filgrastim) was approved July 20 by the Food and Drug Administration, according to a statement provided by the agency. Nivestym is the second biosimilar to Neupogen to be approved in the United States.
- Patients with cancer receiving myelosuppressive chemotherapy.
- Patients with acute myeloid leukemia receiving induction or consolidation chemotherapy.
- Patients with cancer undergoing bone marrow transplantation.
- Patients undergoing autologous peripheral blood progenitor cell collection and therapy.
- Patients with severe chronic neutropenia.
According to a press release from Pfizer, the manufacturer of the biosimilar, Nivestym is expected to be available in the United States at a significant discount to the current wholesale acquisition cost of Neupogen, which is not inclusive of discounts to payers, providers, distributors, and other purchasing organizations.
The FDA statement notes that a biosimilar is approved based on a showing that it is highly similar to an already approved biologic product, known as a reference product. The biosimilar also must be shown to have no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowable in biosimilar products.
Prescribing information is available here.
Researchers identify potential sickle cell disease target
Researchers have identified a repressor of fetal hemoglobin (HbF), which they assert could offer a therapeutic target for patients with sickle cell disease (SCD) and some forms of beta thalassemia, according to a new paper published in Science.
Strategies to boost HbF have so far been limited to gene therapy and hydroxyurea, which has been shown to have limited efficacy.
The finding was made using a tailored CRISPR screen of adult human erythroid cells; the CRISPR screen targeted protein kinases, which are controllable by small molecules, which makes them more feasible for treatment therapeutically, researchers wrote.
“Using an improved CRISPR-Cas9 domain-focused screening approach, we identified the erythroid-specific kinase HRI [heme-regulated inhibitor] as a potentially druggable target that is involved in HbF silencing,” wrote Gerd A. Blobel, MD, PhD, of Children’s Hospital of Philadelphia and his colleagues.
HRI is an erythroid-specific kinase that controls protein translation. Once identified, depleting HRI resulted in an increase of HbF production and reduced sickling in cultured erythroid cells. Researchers said that diminished expression of the transcription factor BCL11A, an HbF repressor, accounted for the effects of HRI depletion.
The results with erythroid cell cultures suggest that HRI loss is well tolerated, but the mechanism of inducing fetal hemoglobin is still not fully understood, the researchers noted. Also, while HRI may be targetable, the extent of the benefits of this targeting are not yet known.
“It remains to be seen whether HRI inhibition in SCD patients would elevate HbF levels sufficiently to improve outcomes,” the researchers wrote. “HRI inhibition elevated HbF levels to a point at which it reduced cell sickling in culture, suggesting that pharmacologic HRI inhibitors may provide clinical benefit in SCD patients. Moreover, in light of our results, combining HRI inhibition with an additional pharmacologic HbF inducer may improve the therapeutic index. "Funding was provided by NIH training grants and Cold Spring Harbor Laboratory. Three of the authors reported that they are inventors on a patent submitted by the Children’s Hospital of Philadelphia that covers the therapeutic targeting of HRI for hemoglobinopathies.
SOURCE: Grevet J et al. Science. 2018 Jul 20. doi: 10.1126/science.aao0932.
Researchers have identified a repressor of fetal hemoglobin (HbF), which they assert could offer a therapeutic target for patients with sickle cell disease (SCD) and some forms of beta thalassemia, according to a new paper published in Science.
Strategies to boost HbF have so far been limited to gene therapy and hydroxyurea, which has been shown to have limited efficacy.
The finding was made using a tailored CRISPR screen of adult human erythroid cells; the CRISPR screen targeted protein kinases, which are controllable by small molecules, which makes them more feasible for treatment therapeutically, researchers wrote.
“Using an improved CRISPR-Cas9 domain-focused screening approach, we identified the erythroid-specific kinase HRI [heme-regulated inhibitor] as a potentially druggable target that is involved in HbF silencing,” wrote Gerd A. Blobel, MD, PhD, of Children’s Hospital of Philadelphia and his colleagues.
HRI is an erythroid-specific kinase that controls protein translation. Once identified, depleting HRI resulted in an increase of HbF production and reduced sickling in cultured erythroid cells. Researchers said that diminished expression of the transcription factor BCL11A, an HbF repressor, accounted for the effects of HRI depletion.
The results with erythroid cell cultures suggest that HRI loss is well tolerated, but the mechanism of inducing fetal hemoglobin is still not fully understood, the researchers noted. Also, while HRI may be targetable, the extent of the benefits of this targeting are not yet known.
“It remains to be seen whether HRI inhibition in SCD patients would elevate HbF levels sufficiently to improve outcomes,” the researchers wrote. “HRI inhibition elevated HbF levels to a point at which it reduced cell sickling in culture, suggesting that pharmacologic HRI inhibitors may provide clinical benefit in SCD patients. Moreover, in light of our results, combining HRI inhibition with an additional pharmacologic HbF inducer may improve the therapeutic index. "Funding was provided by NIH training grants and Cold Spring Harbor Laboratory. Three of the authors reported that they are inventors on a patent submitted by the Children’s Hospital of Philadelphia that covers the therapeutic targeting of HRI for hemoglobinopathies.
SOURCE: Grevet J et al. Science. 2018 Jul 20. doi: 10.1126/science.aao0932.
Researchers have identified a repressor of fetal hemoglobin (HbF), which they assert could offer a therapeutic target for patients with sickle cell disease (SCD) and some forms of beta thalassemia, according to a new paper published in Science.
Strategies to boost HbF have so far been limited to gene therapy and hydroxyurea, which has been shown to have limited efficacy.
The finding was made using a tailored CRISPR screen of adult human erythroid cells; the CRISPR screen targeted protein kinases, which are controllable by small molecules, which makes them more feasible for treatment therapeutically, researchers wrote.
“Using an improved CRISPR-Cas9 domain-focused screening approach, we identified the erythroid-specific kinase HRI [heme-regulated inhibitor] as a potentially druggable target that is involved in HbF silencing,” wrote Gerd A. Blobel, MD, PhD, of Children’s Hospital of Philadelphia and his colleagues.
HRI is an erythroid-specific kinase that controls protein translation. Once identified, depleting HRI resulted in an increase of HbF production and reduced sickling in cultured erythroid cells. Researchers said that diminished expression of the transcription factor BCL11A, an HbF repressor, accounted for the effects of HRI depletion.
The results with erythroid cell cultures suggest that HRI loss is well tolerated, but the mechanism of inducing fetal hemoglobin is still not fully understood, the researchers noted. Also, while HRI may be targetable, the extent of the benefits of this targeting are not yet known.
“It remains to be seen whether HRI inhibition in SCD patients would elevate HbF levels sufficiently to improve outcomes,” the researchers wrote. “HRI inhibition elevated HbF levels to a point at which it reduced cell sickling in culture, suggesting that pharmacologic HRI inhibitors may provide clinical benefit in SCD patients. Moreover, in light of our results, combining HRI inhibition with an additional pharmacologic HbF inducer may improve the therapeutic index. "Funding was provided by NIH training grants and Cold Spring Harbor Laboratory. Three of the authors reported that they are inventors on a patent submitted by the Children’s Hospital of Philadelphia that covers the therapeutic targeting of HRI for hemoglobinopathies.
SOURCE: Grevet J et al. Science. 2018 Jul 20. doi: 10.1126/science.aao0932.
REPORTING FROM SCIENCE
CDC reports Salmonella outbreak
A total of 90 people in 26 states have been infected with multidrug-resistant Salmonella in an outbreak linked to raw turkey products, according to the Centers for Disease Control and Prevention.
As of July 11, 2018, 40 of the 78 people with available information who were infected with the outbreak strain of Salmonella Reading have been hospitalized, but no deaths have been reported. Of the 61 ill people who have been interviewed, most have reported preparing or eating turkey products from a number of sources, although two lived in households where raw turkey was given to pets: No common supplier has been identified, the CDC reported in an investigation notice posted July 19.
The first illness in this outbreak started on Nov. 20, 2017, and the most recent one started on June 29, 2018. The U.S. Department of Agriculture’s Food Safety Inspection Service is monitoring the outbreak, and public health and regulatory agency efforts are being coordinated by the CDC through its PulseNet national subtyping network. DNA fingerprinting “performed on Salmonella from ill people in this outbreak showed that they are closely related genetically. This means that the ill people are more likely to share a common source of infection,” the CDC said.
Consumers should handle raw turkey carefully and cook it thoroughly to prevent Salmonella, the CDC advised. Raw food of any type should not be given to pets. At this time, the CDC said that it is “not advising that consumers avoid eating properly cooked turkey products, or that retailers stop selling raw turkey products.”
A total of 90 people in 26 states have been infected with multidrug-resistant Salmonella in an outbreak linked to raw turkey products, according to the Centers for Disease Control and Prevention.
As of July 11, 2018, 40 of the 78 people with available information who were infected with the outbreak strain of Salmonella Reading have been hospitalized, but no deaths have been reported. Of the 61 ill people who have been interviewed, most have reported preparing or eating turkey products from a number of sources, although two lived in households where raw turkey was given to pets: No common supplier has been identified, the CDC reported in an investigation notice posted July 19.
The first illness in this outbreak started on Nov. 20, 2017, and the most recent one started on June 29, 2018. The U.S. Department of Agriculture’s Food Safety Inspection Service is monitoring the outbreak, and public health and regulatory agency efforts are being coordinated by the CDC through its PulseNet national subtyping network. DNA fingerprinting “performed on Salmonella from ill people in this outbreak showed that they are closely related genetically. This means that the ill people are more likely to share a common source of infection,” the CDC said.
Consumers should handle raw turkey carefully and cook it thoroughly to prevent Salmonella, the CDC advised. Raw food of any type should not be given to pets. At this time, the CDC said that it is “not advising that consumers avoid eating properly cooked turkey products, or that retailers stop selling raw turkey products.”
A total of 90 people in 26 states have been infected with multidrug-resistant Salmonella in an outbreak linked to raw turkey products, according to the Centers for Disease Control and Prevention.
As of July 11, 2018, 40 of the 78 people with available information who were infected with the outbreak strain of Salmonella Reading have been hospitalized, but no deaths have been reported. Of the 61 ill people who have been interviewed, most have reported preparing or eating turkey products from a number of sources, although two lived in households where raw turkey was given to pets: No common supplier has been identified, the CDC reported in an investigation notice posted July 19.
The first illness in this outbreak started on Nov. 20, 2017, and the most recent one started on June 29, 2018. The U.S. Department of Agriculture’s Food Safety Inspection Service is monitoring the outbreak, and public health and regulatory agency efforts are being coordinated by the CDC through its PulseNet national subtyping network. DNA fingerprinting “performed on Salmonella from ill people in this outbreak showed that they are closely related genetically. This means that the ill people are more likely to share a common source of infection,” the CDC said.
Consumers should handle raw turkey carefully and cook it thoroughly to prevent Salmonella, the CDC advised. Raw food of any type should not be given to pets. At this time, the CDC said that it is “not advising that consumers avoid eating properly cooked turkey products, or that retailers stop selling raw turkey products.”
Meet our 2018 AGA Research Scholar Award Recipients
In 2018, the AGA Research Foundation was proud to provide more than $2 million in research funding to 41 investigators.
AGA’s flagship award, the AGA Research Scholar Award, was given to five exceptional early-career investigators who represent the future of GI research. In addition, one researcher was awarded the AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease. Read about the 2018 awardees’ research projects below.
Sarah Andres, PhD
University of Pennsylvania, Philadelphia
Project title: The mRNA-binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis
Dr. Andres will use this award to delve more deeply into understanding how RNA-binding proteins regulate exosomes within the intestinal and colonic epithelium and how this plays a part in health and disease. RNA-binding proteins provide an exquisite layer of biological regulation to gene expression and downstream cellular processes, which is only beginning to be appreciated. Dr. Andres’ long-term hope is that her work will improve the diagnosis, treatment and ultimately survival of patients with colon cancer.
Swathi Eluri, MD, MSCR
University North Carolina at Chapel Hill
Project title: Improving Barrett’s esophagus screening practices in primary care
Dr. Eluri’s AGA-funded project will gather data to develop and test a multilevel screening intervention for Barrett’s esophagus to be implemented in primary care. The ultimate goal of her work is to improve esophageal adenocarcinoma detection. Given our highly effective endoscopic therapies for early neoplasia in Barrett’s esophagus, early detection has the potential to yield substantial benefits for patients.
Jill Hoffman, PhD
University of California, Los Angeles
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease
Project title: Characterization of CRHR2-mediated enteric glial cell function during colitis
Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function and determine CRHR2-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aimed at understanding the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
Elizabeth Jensen, MPH, PhD
Wake Forest University, Winston-Salem, N.C.
Project title: Early-life factors, gene-environment interaction and eosinophilic esophagitis (EoE)
With this funding, Dr. Jensen will conduct the largest study to date on early-life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
Sumera Rizvi, MD
Mayo Clinic, Rochester, Minn.
Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade
Dr. Rizvi’s research is focused on elucidating immunogenic cell death mechanisms and exploring novel, immune-mediated therapeutic approaches in cholangiocarcinoma. This work has the potential to open novel therapeutic avenues for treatment of cholangiocarcinoma, which will ultimately improve the outcomes of patients with this devastating malignancy.
Niels Vande Casteele, PhD
University of California, San Diego
Project title: Identifying optimal thresholds & personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis
Dr. Vande Casteele’s research project is all about determining the right drug for the right patient at the right time using the right dose. By studying optimal thresholds and personalized dosing regimens of infliximab, Dr. Vande Casteele will build the basis for exposure-based dosing regimens that can be applied to other anti-TNF antibodies and antibodies with other targets used in the treatment of patients with IBD, as well as other chronic inflammatory diseases and/or oncology. Dr. Vande Casteele’s goal is for his work to have a direct impact on patients by allowing us to achieve better treatment outcomes with minimal side effects.
View the 2019 AGA research funding opportunities. Please review the deadlines as application deadlines have shifted. Research Scholar Award applications open Sept. 7, 2018.
In 2018, the AGA Research Foundation was proud to provide more than $2 million in research funding to 41 investigators.
AGA’s flagship award, the AGA Research Scholar Award, was given to five exceptional early-career investigators who represent the future of GI research. In addition, one researcher was awarded the AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease. Read about the 2018 awardees’ research projects below.
Sarah Andres, PhD
University of Pennsylvania, Philadelphia
Project title: The mRNA-binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis
Dr. Andres will use this award to delve more deeply into understanding how RNA-binding proteins regulate exosomes within the intestinal and colonic epithelium and how this plays a part in health and disease. RNA-binding proteins provide an exquisite layer of biological regulation to gene expression and downstream cellular processes, which is only beginning to be appreciated. Dr. Andres’ long-term hope is that her work will improve the diagnosis, treatment and ultimately survival of patients with colon cancer.
Swathi Eluri, MD, MSCR
University North Carolina at Chapel Hill
Project title: Improving Barrett’s esophagus screening practices in primary care
Dr. Eluri’s AGA-funded project will gather data to develop and test a multilevel screening intervention for Barrett’s esophagus to be implemented in primary care. The ultimate goal of her work is to improve esophageal adenocarcinoma detection. Given our highly effective endoscopic therapies for early neoplasia in Barrett’s esophagus, early detection has the potential to yield substantial benefits for patients.
Jill Hoffman, PhD
University of California, Los Angeles
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease
Project title: Characterization of CRHR2-mediated enteric glial cell function during colitis
Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function and determine CRHR2-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aimed at understanding the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
Elizabeth Jensen, MPH, PhD
Wake Forest University, Winston-Salem, N.C.
Project title: Early-life factors, gene-environment interaction and eosinophilic esophagitis (EoE)
With this funding, Dr. Jensen will conduct the largest study to date on early-life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
Sumera Rizvi, MD
Mayo Clinic, Rochester, Minn.
Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade
Dr. Rizvi’s research is focused on elucidating immunogenic cell death mechanisms and exploring novel, immune-mediated therapeutic approaches in cholangiocarcinoma. This work has the potential to open novel therapeutic avenues for treatment of cholangiocarcinoma, which will ultimately improve the outcomes of patients with this devastating malignancy.
Niels Vande Casteele, PhD
University of California, San Diego
Project title: Identifying optimal thresholds & personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis
Dr. Vande Casteele’s research project is all about determining the right drug for the right patient at the right time using the right dose. By studying optimal thresholds and personalized dosing regimens of infliximab, Dr. Vande Casteele will build the basis for exposure-based dosing regimens that can be applied to other anti-TNF antibodies and antibodies with other targets used in the treatment of patients with IBD, as well as other chronic inflammatory diseases and/or oncology. Dr. Vande Casteele’s goal is for his work to have a direct impact on patients by allowing us to achieve better treatment outcomes with minimal side effects.
View the 2019 AGA research funding opportunities. Please review the deadlines as application deadlines have shifted. Research Scholar Award applications open Sept. 7, 2018.
In 2018, the AGA Research Foundation was proud to provide more than $2 million in research funding to 41 investigators.
AGA’s flagship award, the AGA Research Scholar Award, was given to five exceptional early-career investigators who represent the future of GI research. In addition, one researcher was awarded the AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease. Read about the 2018 awardees’ research projects below.
Sarah Andres, PhD
University of Pennsylvania, Philadelphia
Project title: The mRNA-binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis
Dr. Andres will use this award to delve more deeply into understanding how RNA-binding proteins regulate exosomes within the intestinal and colonic epithelium and how this plays a part in health and disease. RNA-binding proteins provide an exquisite layer of biological regulation to gene expression and downstream cellular processes, which is only beginning to be appreciated. Dr. Andres’ long-term hope is that her work will improve the diagnosis, treatment and ultimately survival of patients with colon cancer.
Swathi Eluri, MD, MSCR
University North Carolina at Chapel Hill
Project title: Improving Barrett’s esophagus screening practices in primary care
Dr. Eluri’s AGA-funded project will gather data to develop and test a multilevel screening intervention for Barrett’s esophagus to be implemented in primary care. The ultimate goal of her work is to improve esophageal adenocarcinoma detection. Given our highly effective endoscopic therapies for early neoplasia in Barrett’s esophagus, early detection has the potential to yield substantial benefits for patients.
Jill Hoffman, PhD
University of California, Los Angeles
AGA-Takeda Pharmaceuticals Research Scholar Award in Inflammatory Bowel Disease
Project title: Characterization of CRHR2-mediated enteric glial cell function during colitis
Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function and determine CRHR2-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aimed at understanding the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
Elizabeth Jensen, MPH, PhD
Wake Forest University, Winston-Salem, N.C.
Project title: Early-life factors, gene-environment interaction and eosinophilic esophagitis (EoE)
With this funding, Dr. Jensen will conduct the largest study to date on early-life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
Sumera Rizvi, MD
Mayo Clinic, Rochester, Minn.
Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade
Dr. Rizvi’s research is focused on elucidating immunogenic cell death mechanisms and exploring novel, immune-mediated therapeutic approaches in cholangiocarcinoma. This work has the potential to open novel therapeutic avenues for treatment of cholangiocarcinoma, which will ultimately improve the outcomes of patients with this devastating malignancy.
Niels Vande Casteele, PhD
University of California, San Diego
Project title: Identifying optimal thresholds & personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis
Dr. Vande Casteele’s research project is all about determining the right drug for the right patient at the right time using the right dose. By studying optimal thresholds and personalized dosing regimens of infliximab, Dr. Vande Casteele will build the basis for exposure-based dosing regimens that can be applied to other anti-TNF antibodies and antibodies with other targets used in the treatment of patients with IBD, as well as other chronic inflammatory diseases and/or oncology. Dr. Vande Casteele’s goal is for his work to have a direct impact on patients by allowing us to achieve better treatment outcomes with minimal side effects.
View the 2019 AGA research funding opportunities. Please review the deadlines as application deadlines have shifted. Research Scholar Award applications open Sept. 7, 2018.