Love the salacious takes from JAMA with respect to health care and its inherit controversies. This article through JAMA highlights the threat of greed in the US healthcare system and is a good example of their provocative takes. (https://jamanetwork.com/journals/jama/fullarticle/2801097)
Do the rich get richer and the poorer get poorer???? In this systematic review and meta-analysis, the pooled rate of financial toxicity for patients with breast cancer was 78.8% in low- and middle-income countries and 35.3% in high-income countries. These findings suggest that patients with breast cancer worldwide are at risk for financial toxicity; policies designed to offset the burden of direct medical costs, through expansion of health care coverage, and direct nonmedical as well as indirect costs, through interventions such as transportation and childcare facilities, are required to improve the financial health of vulnerable patients with breast cancer. Find the article here (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801099).
This is well overdue, however it will be equally very hard to implement depending on the indication, recruitment areas, and study design. There is a difference between requiring the plan and implementing it.
As a practitioner in Radiation Oncology it is very difficult to treat oral mucositis when treating malignancies of the head and neck. The optimal regimen to control oral mucositis pain remains unclear. While national guidelines allow consideration of prophylactic gabapentin, prior trials show improved pain control with venlafaxine among patients with diabetic neuropathy. In a single institution Phase II randomized trial of 62 patients the addition of venlafaxine to prophylactic gabapentin did not result in improvements in pain control and quality of life among patients with head and neck cancer. (https://www.redjournal.org/article/S0360-3016(23)00084-6/fulltext).
Lymphocyte-activation gene 3 (LAG-3) and programmed death 1 (PD-1) are distinct inhibitory immune checkpoints that contribute to T-cell exhaustion. The combination of relatlimab, a LAG-3–blocking antibody, and nivolumab, a PD-1–blocking antibody, has been shown to be safe and to have antitumor activity in patients with previously treated melanoma, but the safety and activity in patients with previously untreated melanoma need investigation. The inhibition of two immune checkpoints, LAG-3 and PD-1, provided a greater benefit with regard to progression-free survival than inhibition of PD-1 alone in patients with previously untreated metastatic or unresectable melanoma. Relatlimab and nivolumab in combination showed no new safety signals. (https://www.nejm.org/doi/full/10.1056/nejmoa2109970).
PRIME II was a randomized phase 3 trial in which 1326 women 65 and older with low risk breast cancer were randomized to radiation or no radiation after breast conservation surgery. Low risk criteria included hormone receptor positive, node negative, ≤3 cm tumor, and negative margins. Grade 3 histology or LVI (but not both) were allowed, but this was a small minority (<5%) of cases. Everyone received the obligatory 5 years +of adjuvant endocrine therapy. In the radiation arm, everyone received 40-50 Gy in 15-20 fractions whole breast RT +/- a boost. Recent results demonstrate that in women 65 or older with low-grade, hormone receptor positive breast cancer that is ≤3 cm, the risk of breast cancer recurrence at 10 years is roughly 1% with adjuvant radiation and 10% without with no difference in survival.
(https://www.nejm.org/doi/full/10.1056/NEJMoa2207586).
Nature Communications has initiated a Community Voices series that aims to highlight the challenges faced by under-represented groups in scientific research and to provide a platform to share possible solutions, to work towards a more diverse and equitable research landscape. The collection of stories and articles aim to enable people reflect on their own practices that aim to achieve better inclusion of diverse voices in the peer review process. Find the collection here (https://www.nature.com/collections/jcjajbheeb).
This is a very interesting policy being adopted in Malaysia as a way to prevent the spread of non-communicable disease in the country. Data demonstrates that about one in five adults aged 15 years and older in Malaysia smoke, with an estimated 4.9 million current smokers. It will be interesting to see what occurs if this policy passes and persists over the next decade with respect to social determinants of health in the country.
This is a very interesting article that highlights the selection pressures that ensured following the Black Death. However, I am a bit perplexed that the DNA that was extracted and final results of the analysis stem from a homogenous population of people from Europe (London) when those populations from Africa are equally important. It is possible that the selection pressures different by race and ethnicity and it would have been interesting to understand and evaluate that fact.
Journal of Clinical Oncology recognizes that readers do not always have time to review an article in depth, and yet they still wish to understand how the results will influence their clinical practice or research. To address this need, they offer podcasts that will enhance the readership experience by presenting the key results of high-profile publications in a convenient audio format. JCO After Hours is a podcast intended to enhance the readership experience by presenting key results of high-profile publications in a convenient audio format, placing selected articles into a clinically useful perspective that you can listen to in the office or on the road. Check it out here (https://jcopodcast.libsyn.com/).
The NEJM always does its unbiased and objective due diligence to highlight the most paradigm changing studies across the globe. Take a look at the NEJM Catalyst Editor Picks of 2022. (https://store.nejm.org/signup/catalyst/lead/epicks22?promo=OCFQNEPH&query=cm-homepromo&utm_source=ncat&utm_medium=cm&utm_campaign=epicks22). Download your copy!
This is a prestigious publication that never bats an eye at tackling the most racy international topics to date. Here is a current article from the publishers at Nature highlighting the need and utilization of high altitude balloons in response to the most recent shooting down of 4 high flying objects in the US. (https://www.nature.com/articles/d41586-023-00482-7).
Prophylactic cranial irradiation (PCI) is still the standard for limited stage small cell lung cancer (LS-SCLC), at least until MAVERICK reports at the end of the decade, although there is now a “consider MRI brain surveillance” caveat in the NCCN algorithm. In the meantime, here’s a small series from Henry Ford looking at the last 14 patients treated with SBRT or surgery typically followed by chemo for T1-2N0 LS-SCLC. The point is that none of them got PCI and none have evidence of brain mets on close interval surveillance MRI at a median of 14 months (range 2.4 months to over 5 years). Find the article here (https://www.advancesradonc.org/article/S2452-1094(23)00019-2/fulltext).
Patients with favorable prostate cancer and a low risk of non-cancer mortality may derive a greater benefit from short course ADT than predicted by their risk category alone. Find the article here (https://www.sciencedirect.com/science/article/abs/pii/S0302283823000568?via%3Dihub).
This retrospective look at 792 patients with localized nasopharyngeal carcinoma demonstrating a glaring relationship between EBV-DNA levels and subsequent development of mets, but only among the 18% of patients with HBsAg. In fact, those with HBsAg and EBV-DNA levels surpassing 6 × 1000 copies/mL had a nearly 10-fold risk of developing mets, more than those with any other clinical risk factor. Find the article here (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801196).
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