Society News

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

I was honored to be the third Editor-in-Chief of GIHN, from 2016 through 2021. GIHN is the official newspaper of the American Gastroenterological Association and has the widest readership of any AGA publication and is one that readers told us they read cover to cover. As such, each EIC and their Board of Editors must ensure balanced content that holds the interest of a diverse readership. I was privileged to work with a talented editorial board who reviewed articles, attended leadership meetings, and offered terrific suggestions throughout our tenure. I treasured their support and friendship.

Within each of the 60 monthly issues, we sought to highlight science, practice operations, national trends, and opinions and reviews that would be most important to basic scientists, clinical researchers, and academic and community clinicians, primarily from the United States but also from a worldwide readership. I was given a 300-word section to create editorial comments on pertinent topics that were important to gastroenterologists. Having a background in both community and academic practice, I tried to bring a balanced perspective to areas that often seem worlds apart.

The period between 2016 and 2021 also was a time of political upheaval in this country – something we could not ignore. I attempted to write about current events in a balanced way that kept a focus on patients and AGA’s core constituency. Not always an easy task. Sustainability of the Affordable Care Act was very much in question because of judicial and legislative challenges; had the ACA been overturned, our practices would be very different now.

In 2016, the first private equity–backed practice platform was created in south Florida. Little did we know how much that model would change community practice. Then, on Jan. 21, 2020, the first case of COVID 19 was diagnosed in Seattle (although earlier cases likely occurred). By March, many clinics and practices were closing, and we were altering our care delivery infrastructure in ways that would forever change practice. Trying to keep current with ever-changing science and policies was a challenge.

I will always treasure my time as EIC. I was happy (and proud) to pass this baton to Megan A. Adams MD, JD, MSc, my colleague and mentee at the University of Michigan. The partnership between AGA and Frontline Medical Communications has been successful for 15 years and will continue to be so.

Dr. Allen, now retired, was professor of medicine at the University of Michigan, Ann Arbor. He is secretary/treasurer for the American Gastroenterological Association, and declares no relevant conflicts of interest.

Gastroenterology

August 2022
Johnson-Laghi KA, Mattar MC. Integrating cognitive apprenticeship into gastroenterology clinical training. Gastroenterology. 2022 Aug;163(2):364-7. doi: 10.1053/j.gastro.2022.06.013.

Wood LD et al. Pancreatic cancer: Pathogenesis, screening, diagnosis, and treatment. Gastroenterology. 2022 Aug;163(2):386-402.e1. doi: 10.1053/j.gastro.2022.03.056.

Calderwood AH and Robertson DJ. Stopping surveillance in gastrointestinal conditions: Thoughts on the scope of the problem and potential solutions. Gastroenterology. 2022 Aug;163(2):345-9. doi: 10.1053/j.gastro.2022.04.009.
 

September 2022
Donnangelo LL et al. Disclosure and reflection after an adverse event: Tips for training and practice. Gastroenterology. 2022 Sep;163(3):568-71. doi: 10.1053/j.gastro.2022.07.003.

Chey WD et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology. 2022 Sep;163(3):608-19. doi: 10.1053/j.gastro.2022.05.055.

Bushyhead D and Quigley EMM. Small intestinal bacterial overgrowth-pathophysiology and its implications for definition and management. Gastroenterology. 2022 Sep;163(3):593-607. doi: 10.1053/j.gastro.2022.04.002.

Long MT et al. AGA Clinical practice update: Diagnosis and management of nonalcoholic fatty liver disease in lean individuals: Expert review. Gastroenterology. 2022 Sep;163(3):764-74.e1. doi: 10.1053/j.gastro.2022.06.023.
 

CGH

August 2022
Lennon AM and Vege SS. Pancreatic cyst surveillance. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1663-7.e1. doi: 10.1016/j.cgh.2022.03.002.

Crockett SD et al. Large Polyp Study Group Consortium. Clip closure does not reduce risk of bleeding after resection of large serrated polyps: Results from a randomized trial. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1757-17--65.e4. doi: 10.1016/j.cgh.2021.12.036.

Martin P et al. Treatment algorithm for managing chronic hepatitis b virus infection in the United States: 2021 update. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1766-75. doi: 10.1016/j.cgh.2021.07.036.
 

September 2022
Pawlak KM et al. How to train the next generation to provide high-quality peer-reviews. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1902-6. doi: 10.1016/j.cgh.2022.05.018.

Choung RS et al. Collagenous gastritis: Characteristics and response to topical budesonide. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1977-85.e1. doi: 10.1016/j.cgh.2021.11.033.

Basnayake C et al. Long-term outcome of multidisciplinary versus standard gastroenterologist care for functional gastrointestinal disorders: A randomized trial. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2102-11.e9. doi: 10.1016/j.cgh.2021.12.005.

Deutsch-Link S et al. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2142-4.e2. doi: 10.1016/j.cgh.2022.03.017.
 

TIGE

Nakamatsu, Dai et al. Safety of cold snare polypectomy for small colorectal polyps in patients receiving antithrombotic therapy. Tech Innov Gastrointest Endosc. 2022 Apr 8;24[3]:246-53. doi: 10.1016/j.tige.2022.03.008.

Gastro Hep Advances

Brindusa Truta et al. Outcomes of continuation vs. discontinuation of adalimumab therapy during third trimester of pregnancy in inflammatory bowel disease. Gastro Hep Advances. 2022 Jan 1;1[5]:785-91. doi: 10.1016/j.gastha.2022.04.009.

Gastroenterology

August 2022
Johnson-Laghi KA, Mattar MC. Integrating cognitive apprenticeship into gastroenterology clinical training. Gastroenterology. 2022 Aug;163(2):364-7. doi: 10.1053/j.gastro.2022.06.013.

Wood LD et al. Pancreatic cancer: Pathogenesis, screening, diagnosis, and treatment. Gastroenterology. 2022 Aug;163(2):386-402.e1. doi: 10.1053/j.gastro.2022.03.056.

Calderwood AH and Robertson DJ. Stopping surveillance in gastrointestinal conditions: Thoughts on the scope of the problem and potential solutions. Gastroenterology. 2022 Aug;163(2):345-9. doi: 10.1053/j.gastro.2022.04.009.
 

September 2022
Donnangelo LL et al. Disclosure and reflection after an adverse event: Tips for training and practice. Gastroenterology. 2022 Sep;163(3):568-71. doi: 10.1053/j.gastro.2022.07.003.

Chey WD et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology. 2022 Sep;163(3):608-19. doi: 10.1053/j.gastro.2022.05.055.

Bushyhead D and Quigley EMM. Small intestinal bacterial overgrowth-pathophysiology and its implications for definition and management. Gastroenterology. 2022 Sep;163(3):593-607. doi: 10.1053/j.gastro.2022.04.002.

Long MT et al. AGA Clinical practice update: Diagnosis and management of nonalcoholic fatty liver disease in lean individuals: Expert review. Gastroenterology. 2022 Sep;163(3):764-74.e1. doi: 10.1053/j.gastro.2022.06.023.
 

CGH

August 2022
Lennon AM and Vege SS. Pancreatic cyst surveillance. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1663-7.e1. doi: 10.1016/j.cgh.2022.03.002.

Crockett SD et al. Large Polyp Study Group Consortium. Clip closure does not reduce risk of bleeding after resection of large serrated polyps: Results from a randomized trial. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1757-17--65.e4. doi: 10.1016/j.cgh.2021.12.036.

Martin P et al. Treatment algorithm for managing chronic hepatitis b virus infection in the United States: 2021 update. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1766-75. doi: 10.1016/j.cgh.2021.07.036.
 

September 2022
Pawlak KM et al. How to train the next generation to provide high-quality peer-reviews. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1902-6. doi: 10.1016/j.cgh.2022.05.018.

Choung RS et al. Collagenous gastritis: Characteristics and response to topical budesonide. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1977-85.e1. doi: 10.1016/j.cgh.2021.11.033.

Basnayake C et al. Long-term outcome of multidisciplinary versus standard gastroenterologist care for functional gastrointestinal disorders: A randomized trial. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2102-11.e9. doi: 10.1016/j.cgh.2021.12.005.

Deutsch-Link S et al. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2142-4.e2. doi: 10.1016/j.cgh.2022.03.017.
 

TIGE

Nakamatsu, Dai et al. Safety of cold snare polypectomy for small colorectal polyps in patients receiving antithrombotic therapy. Tech Innov Gastrointest Endosc. 2022 Apr 8;24[3]:246-53. doi: 10.1016/j.tige.2022.03.008.

Gastro Hep Advances

Brindusa Truta et al. Outcomes of continuation vs. discontinuation of adalimumab therapy during third trimester of pregnancy in inflammatory bowel disease. Gastro Hep Advances. 2022 Jan 1;1[5]:785-91. doi: 10.1016/j.gastha.2022.04.009.

Gastroenterology

August 2022
Johnson-Laghi KA, Mattar MC. Integrating cognitive apprenticeship into gastroenterology clinical training. Gastroenterology. 2022 Aug;163(2):364-7. doi: 10.1053/j.gastro.2022.06.013.

Wood LD et al. Pancreatic cancer: Pathogenesis, screening, diagnosis, and treatment. Gastroenterology. 2022 Aug;163(2):386-402.e1. doi: 10.1053/j.gastro.2022.03.056.

Calderwood AH and Robertson DJ. Stopping surveillance in gastrointestinal conditions: Thoughts on the scope of the problem and potential solutions. Gastroenterology. 2022 Aug;163(2):345-9. doi: 10.1053/j.gastro.2022.04.009.
 

September 2022
Donnangelo LL et al. Disclosure and reflection after an adverse event: Tips for training and practice. Gastroenterology. 2022 Sep;163(3):568-71. doi: 10.1053/j.gastro.2022.07.003.

Chey WD et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology. 2022 Sep;163(3):608-19. doi: 10.1053/j.gastro.2022.05.055.

Bushyhead D and Quigley EMM. Small intestinal bacterial overgrowth-pathophysiology and its implications for definition and management. Gastroenterology. 2022 Sep;163(3):593-607. doi: 10.1053/j.gastro.2022.04.002.

Long MT et al. AGA Clinical practice update: Diagnosis and management of nonalcoholic fatty liver disease in lean individuals: Expert review. Gastroenterology. 2022 Sep;163(3):764-74.e1. doi: 10.1053/j.gastro.2022.06.023.
 

CGH

August 2022
Lennon AM and Vege SS. Pancreatic cyst surveillance. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1663-7.e1. doi: 10.1016/j.cgh.2022.03.002.

Crockett SD et al. Large Polyp Study Group Consortium. Clip closure does not reduce risk of bleeding after resection of large serrated polyps: Results from a randomized trial. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1757-17--65.e4. doi: 10.1016/j.cgh.2021.12.036.

Martin P et al. Treatment algorithm for managing chronic hepatitis b virus infection in the United States: 2021 update. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1766-75. doi: 10.1016/j.cgh.2021.07.036.
 

September 2022
Pawlak KM et al. How to train the next generation to provide high-quality peer-reviews. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1902-6. doi: 10.1016/j.cgh.2022.05.018.

Choung RS et al. Collagenous gastritis: Characteristics and response to topical budesonide. Clin Gastroenterol Hepatol. 2022 Sep;20(9):1977-85.e1. doi: 10.1016/j.cgh.2021.11.033.

Basnayake C et al. Long-term outcome of multidisciplinary versus standard gastroenterologist care for functional gastrointestinal disorders: A randomized trial. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2102-11.e9. doi: 10.1016/j.cgh.2021.12.005.

Deutsch-Link S et al. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol. 2022 Sep;20(9):2142-4.e2. doi: 10.1016/j.cgh.2022.03.017.
 

TIGE

Nakamatsu, Dai et al. Safety of cold snare polypectomy for small colorectal polyps in patients receiving antithrombotic therapy. Tech Innov Gastrointest Endosc. 2022 Apr 8;24[3]:246-53. doi: 10.1016/j.tige.2022.03.008.

Gastro Hep Advances

Brindusa Truta et al. Outcomes of continuation vs. discontinuation of adalimumab therapy during third trimester of pregnancy in inflammatory bowel disease. Gastro Hep Advances. 2022 Jan 1;1[5]:785-91. doi: 10.1016/j.gastha.2022.04.009.

Do you want to support the AGA Research Foundation, but feel overwhelmed by everyday living costs, such as the latest home repair, food expenses, and escalating gas prices?

There’s a solution that doesn’t involve writing a check. You can designate a gift in your estate plan. There are two main benefits to this meaningful step:

• Your current income or assets remain the same.
• You can change your mind at any time.

The easiest and most popular way to support the AGA Research Foundation while putting your current financial needs first is to include a gift in your will or revocable living trust. It takes as little as one sentence to complete your gift.

Best of all, you have the option to leave a percentage of your estate or an asset so that no matter how the size of your estate changes, gifts to your family and nonprofits remain proportional.

Your gift directly supports the talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.

Do you want to support the AGA Research Foundation, but feel overwhelmed by everyday living costs, such as the latest home repair, food expenses, and escalating gas prices?

There’s a solution that doesn’t involve writing a check. You can designate a gift in your estate plan. There are two main benefits to this meaningful step:

• Your current income or assets remain the same.
• You can change your mind at any time.

The easiest and most popular way to support the AGA Research Foundation while putting your current financial needs first is to include a gift in your will or revocable living trust. It takes as little as one sentence to complete your gift.

Best of all, you have the option to leave a percentage of your estate or an asset so that no matter how the size of your estate changes, gifts to your family and nonprofits remain proportional.

Your gift directly supports the talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.

Do you want to support the AGA Research Foundation, but feel overwhelmed by everyday living costs, such as the latest home repair, food expenses, and escalating gas prices?

There’s a solution that doesn’t involve writing a check. You can designate a gift in your estate plan. There are two main benefits to this meaningful step:

• Your current income or assets remain the same.
• You can change your mind at any time.

The easiest and most popular way to support the AGA Research Foundation while putting your current financial needs first is to include a gift in your will or revocable living trust. It takes as little as one sentence to complete your gift.

Best of all, you have the option to leave a percentage of your estate or an asset so that no matter how the size of your estate changes, gifts to your family and nonprofits remain proportional.

Your gift directly supports the talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.

Obstructive sleep apnea is a prevalent and underdiagnosed sleep-related breathing disorder. The estimated prevalence of OSA in the general population of North America ranges from 9% to 38%. This prevalence is higher in men, with a roughly 2:1 male to female ratio, and it also increases with age (Senaratna CV, et al. Sleep Med Rev. 2017;34:70-81). In large epidemiologic studies, the association between OSA and atrial fibrillation (AF) has been well established. The prevalence of OSA in patients with AF is high, with estimates ranging from 21% to 74%. In the OSA population, the Sleep Heart Health Study (Mehra R, et al. Am J Respir Crit Care Med. 2006;173[8]:910-16) and the Multi Ethnic Study of Atherosclerosis (Lin GM, et al. Am J Epidemiol. 2015;182[1]:49-57) found that patients with OSA had a twofold to fourfold increased risk of AF compared with those who did not have OSA. Therefore, the most current American Heart Association guidelines recommend assessing OSA symptoms in all patients with AF and screening for OSA in recurrent patients with AF.

The pathophysiology of OSA involves multiple physiologic stressors that may contribute to an increased propensity for atrial arrhythmias in this population. Among these factors are large changes in intrathoracic pressures that may cause atrial and ventricular wall stretching, recurrent oxidative stress, and a sympathetic surge associated with shortening atrial refractory periods and atrial extrasystoles. By occurring nightly over many years, these physiologic stressors may lead to permanent atrial dilation and structural remodeling, eventually affecting the conduction system and producing a substrate conducive to reentrant circuits. Other common comorbidities in patients with OSA–such as hypertension, obesity, and metabolic syndrome–may also contribute to arrhythmogenicity (Linz D, et al. JAMA Cardiol. 2018;3[6]:532).

Does treating OSA with CPAP prevent the development of AF?

Previous case-control and retrospective observational studies suggested that having OSA makes treating AF more difficult. Patients with OSA had lower response rates to antiarrhythmic drugs, with the lowest in those with more severe OSA. Rhythm control with cardioversion and catheter-based pulmonary vein isolation was also less successful in patients with OSA due to higher rates of AF recurrence. According to one meta-analysis, patients with OSA had a 31% higher rate of AF recurrence after pulmonary vein isolation (Li L, et al. Europace. 2014;16[9]:1309-14).

Prospective studies using CPAP to treat OSA have not demonstrated a reduced risk of adverse cardiovascular outcomes. The SAVE trial is the most well-known of these studies. The primary endpoint was death from cardiovascular causes (myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack). There was no difference in this outcome between the CPAP and usual care groups. A secondary outcome in this study was new-onset AF detected by electrocardiography, and there was no difference between the CPAP and the usual care group. The low amount of CPAP usage in the treatment group was a commonly cited shortcoming of the SAVE trial–mean usage was 4.4 hours per night during the first month of treatment and subsequently decreased to 3.3 hours per night by the 12-month time point (McEvoy RD, et al. N Engl J Med. 2016;375[10]:919-31).

Caples and colleagues screened patients undergoing direct current cardioversion or catheter ablation. They chose those who were also positive for OSA by polysomnography (apnea-hypopnea index – AHI greater than five events per hour). Twenty-five patients were included in the study and were randomly assigned to either CPAP treatment or usual care. Body mass index, blood pressure, ejection fraction, AHI, and nocturnal desaturation levels were comparable between the two groups. The rate of recurrence of AF and the time point following randomization at which the AF recurred did not differ between the two groups (Caples SM, et al. Int J Cardiol. 2019;278:133-6).

A Norwegian trial by Traaen and colleagues included a larger sample of 108 patients with moderate to severe sleep apnea and paroxysmal AF who underwent catheter ablation. Patients were followed for 5 months before and 12 months after ablation. They were randomly assigned to either CPAP therapy plus usual care or usual care alone. The primary goal was to assess AF burden using implanted loop recorders. There was no significant difference in AF burden between the two groups from baseline to the final 3 months of the study (Traaen GM, et al. Am J Respir Crit Care Med. 2021;204[5]:573-82). These two prospective trials, which had AF recurrence or burden as primary outcomes, found no interaction between AF burden and CPAP use, at least within the first year of therapy. Both trials found that their participants used CPAP for more extended periods of time than the SAVE trial, with over 6 hours in the Caples and coworkers’ trial and nearly 5 hours in the Traaen and coworkers’ study.
 

Is the lack of efficacy due to starting CPAP too late in the course of OSA?

It has been proposed that there may be a critical early period after the onset of OSA when intervention with CPAP (or alternative therapies) will be most effective in preventing adverse cardiovascular outcomes. An answer will almost certainly necessitate a long-term prospective study enrolling people before they develop OSA. Additionally, the AHI is used in most trials to determine the presence and severity of OSA. However, the AHI has been shown to have a poor correlation with sleep-related symptoms, and it may fail to capture key OSA pathophysiologic stressors (e.g., hyperadrenergic drive, cyclical hypoxemia, etc), which may increase the risk of AF. Other disease characteristics and polysomnographic features may better capture disease severity and the cardiovascular risk factors associated with it. The respiratory arousal threshold, arousal index, degree of loop gain, hypoxic burden, heart rate variability, and cardiopulmonary coupling are some examples of such features.

Another possible explanation is that AF is not causally related, and the demonstrated association between the two is because both conditions share risk factors such as age and BMI, among others. Or, if they are causally linked, OSA may be a minor contributor, and the magnitude of that contribution is insufficient to reduce the risk of AF significantly by treating OSA. More research is needed to define the salient intervenable aspects of OSA better and design the optimal timing and duration of intervention.

Dr. Mudrakola is with the Department of Pulmonary & Critical Care Medicine, Summa Health, Akron, Ohio. Dr. Selim is with the Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.

Obstructive sleep apnea is a prevalent and underdiagnosed sleep-related breathing disorder. The estimated prevalence of OSA in the general population of North America ranges from 9% to 38%. This prevalence is higher in men, with a roughly 2:1 male to female ratio, and it also increases with age (Senaratna CV, et al. Sleep Med Rev. 2017;34:70-81). In large epidemiologic studies, the association between OSA and atrial fibrillation (AF) has been well established. The prevalence of OSA in patients with AF is high, with estimates ranging from 21% to 74%. In the OSA population, the Sleep Heart Health Study (Mehra R, et al. Am J Respir Crit Care Med. 2006;173[8]:910-16) and the Multi Ethnic Study of Atherosclerosis (Lin GM, et al. Am J Epidemiol. 2015;182[1]:49-57) found that patients with OSA had a twofold to fourfold increased risk of AF compared with those who did not have OSA. Therefore, the most current American Heart Association guidelines recommend assessing OSA symptoms in all patients with AF and screening for OSA in recurrent patients with AF.

The pathophysiology of OSA involves multiple physiologic stressors that may contribute to an increased propensity for atrial arrhythmias in this population. Among these factors are large changes in intrathoracic pressures that may cause atrial and ventricular wall stretching, recurrent oxidative stress, and a sympathetic surge associated with shortening atrial refractory periods and atrial extrasystoles. By occurring nightly over many years, these physiologic stressors may lead to permanent atrial dilation and structural remodeling, eventually affecting the conduction system and producing a substrate conducive to reentrant circuits. Other common comorbidities in patients with OSA–such as hypertension, obesity, and metabolic syndrome–may also contribute to arrhythmogenicity (Linz D, et al. JAMA Cardiol. 2018;3[6]:532).

Does treating OSA with CPAP prevent the development of AF?

Previous case-control and retrospective observational studies suggested that having OSA makes treating AF more difficult. Patients with OSA had lower response rates to antiarrhythmic drugs, with the lowest in those with more severe OSA. Rhythm control with cardioversion and catheter-based pulmonary vein isolation was also less successful in patients with OSA due to higher rates of AF recurrence. According to one meta-analysis, patients with OSA had a 31% higher rate of AF recurrence after pulmonary vein isolation (Li L, et al. Europace. 2014;16[9]:1309-14).

Prospective studies using CPAP to treat OSA have not demonstrated a reduced risk of adverse cardiovascular outcomes. The SAVE trial is the most well-known of these studies. The primary endpoint was death from cardiovascular causes (myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack). There was no difference in this outcome between the CPAP and usual care groups. A secondary outcome in this study was new-onset AF detected by electrocardiography, and there was no difference between the CPAP and the usual care group. The low amount of CPAP usage in the treatment group was a commonly cited shortcoming of the SAVE trial–mean usage was 4.4 hours per night during the first month of treatment and subsequently decreased to 3.3 hours per night by the 12-month time point (McEvoy RD, et al. N Engl J Med. 2016;375[10]:919-31).

Caples and colleagues screened patients undergoing direct current cardioversion or catheter ablation. They chose those who were also positive for OSA by polysomnography (apnea-hypopnea index – AHI greater than five events per hour). Twenty-five patients were included in the study and were randomly assigned to either CPAP treatment or usual care. Body mass index, blood pressure, ejection fraction, AHI, and nocturnal desaturation levels were comparable between the two groups. The rate of recurrence of AF and the time point following randomization at which the AF recurred did not differ between the two groups (Caples SM, et al. Int J Cardiol. 2019;278:133-6).

A Norwegian trial by Traaen and colleagues included a larger sample of 108 patients with moderate to severe sleep apnea and paroxysmal AF who underwent catheter ablation. Patients were followed for 5 months before and 12 months after ablation. They were randomly assigned to either CPAP therapy plus usual care or usual care alone. The primary goal was to assess AF burden using implanted loop recorders. There was no significant difference in AF burden between the two groups from baseline to the final 3 months of the study (Traaen GM, et al. Am J Respir Crit Care Med. 2021;204[5]:573-82). These two prospective trials, which had AF recurrence or burden as primary outcomes, found no interaction between AF burden and CPAP use, at least within the first year of therapy. Both trials found that their participants used CPAP for more extended periods of time than the SAVE trial, with over 6 hours in the Caples and coworkers’ trial and nearly 5 hours in the Traaen and coworkers’ study.
 

Is the lack of efficacy due to starting CPAP too late in the course of OSA?

It has been proposed that there may be a critical early period after the onset of OSA when intervention with CPAP (or alternative therapies) will be most effective in preventing adverse cardiovascular outcomes. An answer will almost certainly necessitate a long-term prospective study enrolling people before they develop OSA. Additionally, the AHI is used in most trials to determine the presence and severity of OSA. However, the AHI has been shown to have a poor correlation with sleep-related symptoms, and it may fail to capture key OSA pathophysiologic stressors (e.g., hyperadrenergic drive, cyclical hypoxemia, etc), which may increase the risk of AF. Other disease characteristics and polysomnographic features may better capture disease severity and the cardiovascular risk factors associated with it. The respiratory arousal threshold, arousal index, degree of loop gain, hypoxic burden, heart rate variability, and cardiopulmonary coupling are some examples of such features.

Another possible explanation is that AF is not causally related, and the demonstrated association between the two is because both conditions share risk factors such as age and BMI, among others. Or, if they are causally linked, OSA may be a minor contributor, and the magnitude of that contribution is insufficient to reduce the risk of AF significantly by treating OSA. More research is needed to define the salient intervenable aspects of OSA better and design the optimal timing and duration of intervention.

Dr. Mudrakola is with the Department of Pulmonary & Critical Care Medicine, Summa Health, Akron, Ohio. Dr. Selim is with the Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.

Obstructive sleep apnea is a prevalent and underdiagnosed sleep-related breathing disorder. The estimated prevalence of OSA in the general population of North America ranges from 9% to 38%. This prevalence is higher in men, with a roughly 2:1 male to female ratio, and it also increases with age (Senaratna CV, et al. Sleep Med Rev. 2017;34:70-81). In large epidemiologic studies, the association between OSA and atrial fibrillation (AF) has been well established. The prevalence of OSA in patients with AF is high, with estimates ranging from 21% to 74%. In the OSA population, the Sleep Heart Health Study (Mehra R, et al. Am J Respir Crit Care Med. 2006;173[8]:910-16) and the Multi Ethnic Study of Atherosclerosis (Lin GM, et al. Am J Epidemiol. 2015;182[1]:49-57) found that patients with OSA had a twofold to fourfold increased risk of AF compared with those who did not have OSA. Therefore, the most current American Heart Association guidelines recommend assessing OSA symptoms in all patients with AF and screening for OSA in recurrent patients with AF.

The pathophysiology of OSA involves multiple physiologic stressors that may contribute to an increased propensity for atrial arrhythmias in this population. Among these factors are large changes in intrathoracic pressures that may cause atrial and ventricular wall stretching, recurrent oxidative stress, and a sympathetic surge associated with shortening atrial refractory periods and atrial extrasystoles. By occurring nightly over many years, these physiologic stressors may lead to permanent atrial dilation and structural remodeling, eventually affecting the conduction system and producing a substrate conducive to reentrant circuits. Other common comorbidities in patients with OSA–such as hypertension, obesity, and metabolic syndrome–may also contribute to arrhythmogenicity (Linz D, et al. JAMA Cardiol. 2018;3[6]:532).

Does treating OSA with CPAP prevent the development of AF?

Previous case-control and retrospective observational studies suggested that having OSA makes treating AF more difficult. Patients with OSA had lower response rates to antiarrhythmic drugs, with the lowest in those with more severe OSA. Rhythm control with cardioversion and catheter-based pulmonary vein isolation was also less successful in patients with OSA due to higher rates of AF recurrence. According to one meta-analysis, patients with OSA had a 31% higher rate of AF recurrence after pulmonary vein isolation (Li L, et al. Europace. 2014;16[9]:1309-14).

Prospective studies using CPAP to treat OSA have not demonstrated a reduced risk of adverse cardiovascular outcomes. The SAVE trial is the most well-known of these studies. The primary endpoint was death from cardiovascular causes (myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack). There was no difference in this outcome between the CPAP and usual care groups. A secondary outcome in this study was new-onset AF detected by electrocardiography, and there was no difference between the CPAP and the usual care group. The low amount of CPAP usage in the treatment group was a commonly cited shortcoming of the SAVE trial–mean usage was 4.4 hours per night during the first month of treatment and subsequently decreased to 3.3 hours per night by the 12-month time point (McEvoy RD, et al. N Engl J Med. 2016;375[10]:919-31).

Caples and colleagues screened patients undergoing direct current cardioversion or catheter ablation. They chose those who were also positive for OSA by polysomnography (apnea-hypopnea index – AHI greater than five events per hour). Twenty-five patients were included in the study and were randomly assigned to either CPAP treatment or usual care. Body mass index, blood pressure, ejection fraction, AHI, and nocturnal desaturation levels were comparable between the two groups. The rate of recurrence of AF and the time point following randomization at which the AF recurred did not differ between the two groups (Caples SM, et al. Int J Cardiol. 2019;278:133-6).

A Norwegian trial by Traaen and colleagues included a larger sample of 108 patients with moderate to severe sleep apnea and paroxysmal AF who underwent catheter ablation. Patients were followed for 5 months before and 12 months after ablation. They were randomly assigned to either CPAP therapy plus usual care or usual care alone. The primary goal was to assess AF burden using implanted loop recorders. There was no significant difference in AF burden between the two groups from baseline to the final 3 months of the study (Traaen GM, et al. Am J Respir Crit Care Med. 2021;204[5]:573-82). These two prospective trials, which had AF recurrence or burden as primary outcomes, found no interaction between AF burden and CPAP use, at least within the first year of therapy. Both trials found that their participants used CPAP for more extended periods of time than the SAVE trial, with over 6 hours in the Caples and coworkers’ trial and nearly 5 hours in the Traaen and coworkers’ study.
 

Is the lack of efficacy due to starting CPAP too late in the course of OSA?

It has been proposed that there may be a critical early period after the onset of OSA when intervention with CPAP (or alternative therapies) will be most effective in preventing adverse cardiovascular outcomes. An answer will almost certainly necessitate a long-term prospective study enrolling people before they develop OSA. Additionally, the AHI is used in most trials to determine the presence and severity of OSA. However, the AHI has been shown to have a poor correlation with sleep-related symptoms, and it may fail to capture key OSA pathophysiologic stressors (e.g., hyperadrenergic drive, cyclical hypoxemia, etc), which may increase the risk of AF. Other disease characteristics and polysomnographic features may better capture disease severity and the cardiovascular risk factors associated with it. The respiratory arousal threshold, arousal index, degree of loop gain, hypoxic burden, heart rate variability, and cardiopulmonary coupling are some examples of such features.

Another possible explanation is that AF is not causally related, and the demonstrated association between the two is because both conditions share risk factors such as age and BMI, among others. Or, if they are causally linked, OSA may be a minor contributor, and the magnitude of that contribution is insufficient to reduce the risk of AF significantly by treating OSA. More research is needed to define the salient intervenable aspects of OSA better and design the optimal timing and duration of intervention.

Dr. Mudrakola is with the Department of Pulmonary & Critical Care Medicine, Summa Health, Akron, Ohio. Dr. Selim is with the Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.