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There’s been renewed interest in recent years for concentrated essential oils to replace or complement pharmaceutical treatments. This is especially concerning among patients with chronic obstructive pulmonary disease (COPD), who might be eager to turn to alternatives but are unaware that COPD increases sensitivity to lung irritants like essential oils.

Eucalyptus oil might be at or near the top of the essential oils list for these patients, given its storied history in both ancient and modern medicine for treating colds and respiratory illnesses. Its inclusion in the United States and European pharmacopoeias has also reinforced its legitimacy. And, today, patients are at risk of confusing the primary active ingredient in eucalyptus — the monoterpene 1,8-cineole (eucalyptol, which has been shown to reduce COPD exacerbations when used adjunctively) — with concentrated essential oils that can be purchased online and in stores here in the United States.

“The more potent active ingredient, eucalyptol (in capsule form), is approved in Germany — not the essential oil of eucalyptus, which contains other compounds. I recommend against using any sort of inhaled essential oils for patients with chronic respiratory illnesses, mainly because they are unregulated and unstandardized,” explained Ni-Chen Liang, MD, an integrative pulmonologist affiliated with Scripps Memorial Hospital Encinitas in Encinitas, California.

“The substances that come out when you create eucalyptus oil are a ‘gamash’ of all sorts of chemicals — some benign, some which taste good, and some that may be irritating or even dangerous,” said Neil Schachter, MD, pulmonologist and professor of medicine (pulmonary, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai, New York City.

“They can also produce volatile organic compounds (VOCs) related to their formulas, which contain fillers and other constituents,” Liang said.

 

Hidden Dangers

Eucalyptus oil was first used by Aboriginal Australians, who crushed the leaves for their antiseptic properties or steamed them for their expectorant activity. Today, eucalyptus oil can be found in mouthwash and soap, used topically to relieve pain or repel insects, or added to cleaning products due to its disinfectant properties.

However, inhalation via diffusers or directly from the bottle can trigger different respiratory reactions, including cough, wheezing, shortness of breath, as well as respiratory distress. 

“The vapors contain oil, ie, fatty products that can be irritating in and of themselves,” said Schachter. “There are cases where people have inhaled these oils and developed lipid pneumonia, which is very hard to treat,” he said.

Anything inhaled into the lungs is a risk, said Juan Rojas, MD, assistant professor, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine at Rush University Medical Center in Chicago. Rojas compared inhaling essential oils to e-cigarettes, which, in addition to tobacco, contain a variety of chemicals and additives that cause a lung reaction in the short term and create inflammatory patterns in the medium and long term.

“Another problem is that when ingested, eucalyptus oil can be distressing to the gastrointestinal tract. In larger doses, it can actually have some neurological impact as well, including seizures,” said Kalilah L. Gates, MD, associate professor of medicine (pulmonary and critical care) and assistant dean of medical education at Northwestern Feinberg School of Medicine in Chicago.

Clinical trial data have also shown a significant association between long-term exposure to essential oils and cardiopulmonary effects such as increased heart rate and blood pressure and a decline in percentage predicted peak expiratory flow rate in healthy volunteers. In the study of 200 participants (who were homemakers), long-term exposure referred to daily hours (> 4/d) and the study period, which was 10 years.

 

About Eucalyptol

Eucalyptol is rapidly absorbed and quickly distributed throughout the bloodstream, which allows it to reach the bronchial system, where it is expelled by the lungs. It’s been shown in various preclinical studies to have anti-inflammatory, antioxidant, mucolytic, and bronchodilatory activity, as well as antimicrobial effects.

For the past decade, enteric-coated eucalyptol capsules containing 100 mg or 200 mg of 1,8-cineole have been available in Germany for adjunctive treatment of inflammatory respiratory disorders, including asthma and COPD. Due to its limited bioactivity, frequent administration is required.

Clinical evidence of eucalyptol’s effectiveness is somewhat limited. Findings from a 2009 double-blind, placebo-controlled, multicenter study also demonstrated that when used along with beta-agonists, anticholinergics, corticosteroids, or combinations in patients with stable COPD, severity and duration of exacerbations over 6 months were significantly decreased compared with placebo.

However, Liang was quick to point out that studies of oral eucalyptol preparations in pulmonary patients have not been robust enough.

“I haven’t been able to find anything written by a multitude of different authors, which, to me, is a red flag. We want naturally occurring substances to be well tested in multicenter studies across a variety of different patient populations outside of Germany to ensure that results are reproducible,” she said.

Rojas concurred. “Even with the data in Europe, I would say that the studies have been underpowered to support large-scale adoption or suggest that the active ingredient for patients with moderate or severe COPD could be considered an adjunctive therapy with traditional medications,” he said.

“It would be difficult for me to make a recommendation without knowing the full impact,” said Rojas.

 

Open Dialogue

Like many chronic diseases, it’s important to meet patients where they are, including their use of unapproved or unwise treatment strategies.

“More times than not, they’ve already figured out their triggers for worsening respiratory symptoms, what does and doesn’t work for them, and what predicts a good vs a bad day from a respiratory standpoint,” said Liang.

“There’s a lot of popularity and claims related to essential oil use, and ultimately, we need to partner to find healing modalities (which may or may not include essential oils) that are ultimately helpful and minimize harm,” she said.

Gates suggested that when it comes to eucalyptus essential oil vs eucalyptol, education of both patients and doctors is key.

“The issue is that we had a study showing that a particular component — the active ingredient of eucalyptus oil was isolated and put into the capsule form and showed benefit. And then we extrapolated and said, ‘well, let’s just take (or inhale) eucalyptus oil. It’s not the same thing,” she said.

“I feel that it’s my responsibility to make sure that patients have the information they need to make informed decisions. It’s about being willing to communicate and have open conversations about what they may be taking in addition to medications that I prescribe,” said Gates.

Liang, Schachter, Rojas, and Gates reported no relevant financial relationships.

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

There’s been renewed interest in recent years for concentrated essential oils to replace or complement pharmaceutical treatments. This is especially concerning among patients with chronic obstructive pulmonary disease (COPD), who might be eager to turn to alternatives but are unaware that COPD increases sensitivity to lung irritants like essential oils.

Eucalyptus oil might be at or near the top of the essential oils list for these patients, given its storied history in both ancient and modern medicine for treating colds and respiratory illnesses. Its inclusion in the United States and European pharmacopoeias has also reinforced its legitimacy. And, today, patients are at risk of confusing the primary active ingredient in eucalyptus — the monoterpene 1,8-cineole (eucalyptol, which has been shown to reduce COPD exacerbations when used adjunctively) — with concentrated essential oils that can be purchased online and in stores here in the United States.

“The more potent active ingredient, eucalyptol (in capsule form), is approved in Germany — not the essential oil of eucalyptus, which contains other compounds. I recommend against using any sort of inhaled essential oils for patients with chronic respiratory illnesses, mainly because they are unregulated and unstandardized,” explained Ni-Chen Liang, MD, an integrative pulmonologist affiliated with Scripps Memorial Hospital Encinitas in Encinitas, California.

“The substances that come out when you create eucalyptus oil are a ‘gamash’ of all sorts of chemicals — some benign, some which taste good, and some that may be irritating or even dangerous,” said Neil Schachter, MD, pulmonologist and professor of medicine (pulmonary, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai, New York City.

“They can also produce volatile organic compounds (VOCs) related to their formulas, which contain fillers and other constituents,” Liang said.

 

Hidden Dangers

Eucalyptus oil was first used by Aboriginal Australians, who crushed the leaves for their antiseptic properties or steamed them for their expectorant activity. Today, eucalyptus oil can be found in mouthwash and soap, used topically to relieve pain or repel insects, or added to cleaning products due to its disinfectant properties.

However, inhalation via diffusers or directly from the bottle can trigger different respiratory reactions, including cough, wheezing, shortness of breath, as well as respiratory distress. 

“The vapors contain oil, ie, fatty products that can be irritating in and of themselves,” said Schachter. “There are cases where people have inhaled these oils and developed lipid pneumonia, which is very hard to treat,” he said.

Anything inhaled into the lungs is a risk, said Juan Rojas, MD, assistant professor, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine at Rush University Medical Center in Chicago. Rojas compared inhaling essential oils to e-cigarettes, which, in addition to tobacco, contain a variety of chemicals and additives that cause a lung reaction in the short term and create inflammatory patterns in the medium and long term.

“Another problem is that when ingested, eucalyptus oil can be distressing to the gastrointestinal tract. In larger doses, it can actually have some neurological impact as well, including seizures,” said Kalilah L. Gates, MD, associate professor of medicine (pulmonary and critical care) and assistant dean of medical education at Northwestern Feinberg School of Medicine in Chicago.

Clinical trial data have also shown a significant association between long-term exposure to essential oils and cardiopulmonary effects such as increased heart rate and blood pressure and a decline in percentage predicted peak expiratory flow rate in healthy volunteers. In the study of 200 participants (who were homemakers), long-term exposure referred to daily hours (> 4/d) and the study period, which was 10 years.

 

About Eucalyptol

Eucalyptol is rapidly absorbed and quickly distributed throughout the bloodstream, which allows it to reach the bronchial system, where it is expelled by the lungs. It’s been shown in various preclinical studies to have anti-inflammatory, antioxidant, mucolytic, and bronchodilatory activity, as well as antimicrobial effects.

For the past decade, enteric-coated eucalyptol capsules containing 100 mg or 200 mg of 1,8-cineole have been available in Germany for adjunctive treatment of inflammatory respiratory disorders, including asthma and COPD. Due to its limited bioactivity, frequent administration is required.

Clinical evidence of eucalyptol’s effectiveness is somewhat limited. Findings from a 2009 double-blind, placebo-controlled, multicenter study also demonstrated that when used along with beta-agonists, anticholinergics, corticosteroids, or combinations in patients with stable COPD, severity and duration of exacerbations over 6 months were significantly decreased compared with placebo.

However, Liang was quick to point out that studies of oral eucalyptol preparations in pulmonary patients have not been robust enough.

“I haven’t been able to find anything written by a multitude of different authors, which, to me, is a red flag. We want naturally occurring substances to be well tested in multicenter studies across a variety of different patient populations outside of Germany to ensure that results are reproducible,” she said.

Rojas concurred. “Even with the data in Europe, I would say that the studies have been underpowered to support large-scale adoption or suggest that the active ingredient for patients with moderate or severe COPD could be considered an adjunctive therapy with traditional medications,” he said.

“It would be difficult for me to make a recommendation without knowing the full impact,” said Rojas.

 

Open Dialogue

Like many chronic diseases, it’s important to meet patients where they are, including their use of unapproved or unwise treatment strategies.

“More times than not, they’ve already figured out their triggers for worsening respiratory symptoms, what does and doesn’t work for them, and what predicts a good vs a bad day from a respiratory standpoint,” said Liang.

“There’s a lot of popularity and claims related to essential oil use, and ultimately, we need to partner to find healing modalities (which may or may not include essential oils) that are ultimately helpful and minimize harm,” she said.

Gates suggested that when it comes to eucalyptus essential oil vs eucalyptol, education of both patients and doctors is key.

“The issue is that we had a study showing that a particular component — the active ingredient of eucalyptus oil was isolated and put into the capsule form and showed benefit. And then we extrapolated and said, ‘well, let’s just take (or inhale) eucalyptus oil. It’s not the same thing,” she said.

“I feel that it’s my responsibility to make sure that patients have the information they need to make informed decisions. It’s about being willing to communicate and have open conversations about what they may be taking in addition to medications that I prescribe,” said Gates.

Liang, Schachter, Rojas, and Gates reported no relevant financial relationships.

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

There’s been renewed interest in recent years for concentrated essential oils to replace or complement pharmaceutical treatments. This is especially concerning among patients with chronic obstructive pulmonary disease (COPD), who might be eager to turn to alternatives but are unaware that COPD increases sensitivity to lung irritants like essential oils.

Eucalyptus oil might be at or near the top of the essential oils list for these patients, given its storied history in both ancient and modern medicine for treating colds and respiratory illnesses. Its inclusion in the United States and European pharmacopoeias has also reinforced its legitimacy. And, today, patients are at risk of confusing the primary active ingredient in eucalyptus — the monoterpene 1,8-cineole (eucalyptol, which has been shown to reduce COPD exacerbations when used adjunctively) — with concentrated essential oils that can be purchased online and in stores here in the United States.

“The more potent active ingredient, eucalyptol (in capsule form), is approved in Germany — not the essential oil of eucalyptus, which contains other compounds. I recommend against using any sort of inhaled essential oils for patients with chronic respiratory illnesses, mainly because they are unregulated and unstandardized,” explained Ni-Chen Liang, MD, an integrative pulmonologist affiliated with Scripps Memorial Hospital Encinitas in Encinitas, California.

“The substances that come out when you create eucalyptus oil are a ‘gamash’ of all sorts of chemicals — some benign, some which taste good, and some that may be irritating or even dangerous,” said Neil Schachter, MD, pulmonologist and professor of medicine (pulmonary, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai, New York City.

“They can also produce volatile organic compounds (VOCs) related to their formulas, which contain fillers and other constituents,” Liang said.

 

Hidden Dangers

Eucalyptus oil was first used by Aboriginal Australians, who crushed the leaves for their antiseptic properties or steamed them for their expectorant activity. Today, eucalyptus oil can be found in mouthwash and soap, used topically to relieve pain or repel insects, or added to cleaning products due to its disinfectant properties.

However, inhalation via diffusers or directly from the bottle can trigger different respiratory reactions, including cough, wheezing, shortness of breath, as well as respiratory distress. 

“The vapors contain oil, ie, fatty products that can be irritating in and of themselves,” said Schachter. “There are cases where people have inhaled these oils and developed lipid pneumonia, which is very hard to treat,” he said.

Anything inhaled into the lungs is a risk, said Juan Rojas, MD, assistant professor, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine at Rush University Medical Center in Chicago. Rojas compared inhaling essential oils to e-cigarettes, which, in addition to tobacco, contain a variety of chemicals and additives that cause a lung reaction in the short term and create inflammatory patterns in the medium and long term.

“Another problem is that when ingested, eucalyptus oil can be distressing to the gastrointestinal tract. In larger doses, it can actually have some neurological impact as well, including seizures,” said Kalilah L. Gates, MD, associate professor of medicine (pulmonary and critical care) and assistant dean of medical education at Northwestern Feinberg School of Medicine in Chicago.

Clinical trial data have also shown a significant association between long-term exposure to essential oils and cardiopulmonary effects such as increased heart rate and blood pressure and a decline in percentage predicted peak expiratory flow rate in healthy volunteers. In the study of 200 participants (who were homemakers), long-term exposure referred to daily hours (> 4/d) and the study period, which was 10 years.

 

About Eucalyptol

Eucalyptol is rapidly absorbed and quickly distributed throughout the bloodstream, which allows it to reach the bronchial system, where it is expelled by the lungs. It’s been shown in various preclinical studies to have anti-inflammatory, antioxidant, mucolytic, and bronchodilatory activity, as well as antimicrobial effects.

For the past decade, enteric-coated eucalyptol capsules containing 100 mg or 200 mg of 1,8-cineole have been available in Germany for adjunctive treatment of inflammatory respiratory disorders, including asthma and COPD. Due to its limited bioactivity, frequent administration is required.

Clinical evidence of eucalyptol’s effectiveness is somewhat limited. Findings from a 2009 double-blind, placebo-controlled, multicenter study also demonstrated that when used along with beta-agonists, anticholinergics, corticosteroids, or combinations in patients with stable COPD, severity and duration of exacerbations over 6 months were significantly decreased compared with placebo.

However, Liang was quick to point out that studies of oral eucalyptol preparations in pulmonary patients have not been robust enough.

“I haven’t been able to find anything written by a multitude of different authors, which, to me, is a red flag. We want naturally occurring substances to be well tested in multicenter studies across a variety of different patient populations outside of Germany to ensure that results are reproducible,” she said.

Rojas concurred. “Even with the data in Europe, I would say that the studies have been underpowered to support large-scale adoption or suggest that the active ingredient for patients with moderate or severe COPD could be considered an adjunctive therapy with traditional medications,” he said.

“It would be difficult for me to make a recommendation without knowing the full impact,” said Rojas.

 

Open Dialogue

Like many chronic diseases, it’s important to meet patients where they are, including their use of unapproved or unwise treatment strategies.

“More times than not, they’ve already figured out their triggers for worsening respiratory symptoms, what does and doesn’t work for them, and what predicts a good vs a bad day from a respiratory standpoint,” said Liang.

“There’s a lot of popularity and claims related to essential oil use, and ultimately, we need to partner to find healing modalities (which may or may not include essential oils) that are ultimately helpful and minimize harm,” she said.

Gates suggested that when it comes to eucalyptus essential oil vs eucalyptol, education of both patients and doctors is key.

“The issue is that we had a study showing that a particular component — the active ingredient of eucalyptus oil was isolated and put into the capsule form and showed benefit. And then we extrapolated and said, ‘well, let’s just take (or inhale) eucalyptus oil. It’s not the same thing,” she said.

“I feel that it’s my responsibility to make sure that patients have the information they need to make informed decisions. It’s about being willing to communicate and have open conversations about what they may be taking in addition to medications that I prescribe,” said Gates.

Liang, Schachter, Rojas, and Gates reported no relevant financial relationships.

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

As Hurricane Helene approached western North Carolina, Martin Palmeri, MD, MBA, didn’t anticipate the storm would disrupt practice operations for more than a day or so.

But the massive rainfall and flooding damage last September proved to be far more challenging. Despite best efforts by the 13-physician practice, basic treatments for most patients were interrupted for about a week.

Flooding washed out some of the major roads leading to the main Asheville clinic and affiliated rural sites, limiting travel and slowing delivery of medications, intravenous (IV) fluids, and other supplies, Palmeri said. Some patients and employees weren’t initially reachable due to the loss of the internet and cell phone service. The storm-related fallout even forced patients to relocate elsewhere for weeks or longer.

During the storm, backup generators kept power on at the Asheville clinic, protecting chemotherapy and other refrigerated drugs, but the storm damaged the municipal water supply.

“Water was the number one thing — how do you get water to the office?” Palmeri said. “You can’t give someone an 8-hour infusion if they don’t have means of going to the toilet or having something to drink.”

Hurricanes. Wildfires. Heat waves. As climate-driven extreme weather has become more common, researchers, oncologists, and patients are increasingly being forced to consider the consequences of these disruptions.

Along with preventing patients and providers from reaching treatment sites, experts said, extreme weather can undercut patients’ health and care in other ways. Patients with more limited lung capacity following lung cancer surgery, for instance, may struggle with breathing during wildfires. Extreme heat can prove risky for patients already dehydrated or weakened by treatment-related side effects. Power outages and severe flooding can affect vital infrastructure, disrupting operations at facilities that manufacture essential drugs. Power outages can also impede radiotherapy, which requires machines powered by electricity.

“Any of these [weather] events can disrupt this critical cancer care continuum among a population of people that already are very vulnerable,” said Joan Casey, PhD, an environmental epidemiologist and associate professor at the University of Washington in Seattle.

 

Extreme Weather and Cancer Survival

For patients with cancer, survival often relies on highly regimented protocols, which may require surgery plus frequent visits for radiation, chemotherapy, or immunotherapy that can last months, said Eric Bernicker, MD, a Colorado oncologist and lead author of a 2023 American Society of Clinical Oncology position statement about the impact of climate change on cancer care.

Interruptions to care, regardless of the cause, can lead to worse outcomes for patients, Bernicker said. “If you’re in the middle of your post-lumpectomy radiation and your radiation center shuts for 2 weeks,” he said, “that is not good.”

Research indicated that even short treatment disruptions can affect outcomes for patients with cancer and that delays caused by extreme weather — which may last for weeks — can affect survival for these patients.

One analysis, published in JAMA Oncology in 2023, found that patients exposed to wildfire within the first year after potentially curative lung cancer surgery had worse survival outcomes than those who weren’t exposed during their recovery.

In another study, patients with lung cancer who had their radiation interrupted when a hurricane struck had a 19% greater risk of dying overall compared with similar patients who were not affected. Another analysis found that patients with breast cancer who were partway through treatment when Hurricane Katrina hit the Louisiana coastline had a significantly greater risk of dying over a 10-year period compared with patients who lived elsewhere.

The potential threats to survival highlighted the impacts of extreme weather on carefully orchestrated systems of care that place patients facing already fragile situations in impossible binds, Casey said.

Douglas Flora, MD, a Kentucky oncologist and president-elect of the Association of Cancer Care Centers, Rockville, Maryland, agreed.

“We’ve seen this with an increasing frequency over the last several years,” Flora said. “It’s one thing if it’s routine follow-up or surveillance care, but many cancer patients’ survivals are directly related to not having interruptions in their care.”

 

Challenging Realities

Following Helene, the most pressing issue was the lack of water, Palmeri said.

The lack of reliable clean water created challenges for patients receiving radiation or chemotherapy infusions, which can cause vomiting and diarrhea that leave patients dehydrated. Toilets were also unusable.

Even when the city of Asheville said the water was likely safe enough to bathe in, local leaders still reported potential risks from bacteria and other contaminants in the water, Palmeri said. Those with a fragile immune system or breaks in the skin “could get serious and life-threatening infections,” he explained.

To make matters worse, damage to a North Carolina facility manufacturing IV fluids left the United States in shortage for months. IV fluids are key not only for providing hydration but also for easing nausea, fatigue, and other issues caused by cancer therapies.

With wildfires, as occurred in southern California early this year, patients undergoing cancer treatment might feel they have no option but to remain near home to continue getting care, Casey said. “It’s restricting their agency in the kinds of choices that they have to make during these severe weather events.”

Meanwhile, thick wildfire smoke can confine patients to their homes, said Lawrence Wagman, MD, a surgical oncologist and a regional medical director at the City of Hope network, who described its main facility in Duarte, California, coming within a dozen miles of the Eaton fire. “One of the biggest problems was so much smoke in the air,” he said. “And the air quality was so low that it was, in many ways, dangerous for patients to travel.”

“These fires were so aggressive, and they kept popping up,” Wagman said. Plus, the emotional strain of looming wildfires persisted for both patients and cancer clinicians for weeks on end, he added.

For those who evacuate, the logistics can be complex.

Not only are cancer treatment plans highly structured, but switching care to another facility is far from easy, Bernicker said. The new facility will likely need to submit a treatment plan and get insurance coverage before moving forward.

“I’m not saying that takes forever,” he said. “But what I’m saying is that it’s not like you just roll in and they hang the [infusion] bag.”

Neither is a shelter typically an option for patients during treatment, said Seth Berkowitz, a licensed clinical social worker and director of Strategic Healthcare Partnerships at The Leukemia & Lymphoma Society. “They have to have a place to go that’s safe and germ-free.”

In western North Carolina, the strain on already ill patients and their caregivers could be overwhelming, Palmeri said. He recounted how the husband of one patient with advanced cancer died after the storm came through.

“He tried to go out there with a chainsaw to clear a way out so that they could get out of their house in case he needed to take her to the hospital,” Palmeri said. “And he had a heart attack there in the driveway.”

 

Rebuilding and Planning Ahead

Experts are only at the early stages of grasping the magnitude of extreme weather on cancer care and developing strategies to curtail care gaps and potential harm to patients, said Katie Lichter, MD, a radiation oncologist at the University of California San Francisco, who studies extreme weather and cancer treatment.

“How does it impact health care delivery services at every step, from prevention to screening to treatment and survivorship?” Lichter asked. “We’re just starting to understand and to even quantify that,” she said, which included identifying patients who are most vulnerable. She worries, in particular, about patients living in rural areas who already travel longer distances and often face more difficulties accessing care.

The gap between research and reality still looms large. A recent analysis, led by Lichter, looked at 176 California radiation oncology clinics and found that all of them were located within 25 miles of a wildfire that had occurred within the prior 5 years. Yet among the 51 clinics that responded to a 2022 survey,just 47% reported that their clinic had a wildfire emergency preparedness plan.

The American Cancer Society does provide some guidance on how patients can prepare for a weather-related crisis, including having extra supplies of medications or special equipment on hand.

Still, providers are often in reaction mode when extreme weather strikes.

Without adequate clean water after Helene, leaders at Palmeri’s practice moved swiftly, purchasing 40,000-50,000 bottles of water and bringing in porta potties from elsewhere. 

“I think we were able to get things up and going very quickly,” said Palmeri, who noted that full services resumed about 10 days after the storm. “For most patients, missing a week of treatment would not do a disservice to their well-being or outcome.”

Going forward, to provide a more comprehensive strategy, Lichter is working with colleagues to develop clinical tool kits to help oncology practices and patients prepare for severe weather events, such as outlining backup treatment contingency plans, ensuring early medication refills, and boosting communication with patient alert systems.

Clinicians are also implementing their own strategies. To limit communication gaps during power outages, Palmeri said that, since Helene, his practice has made sure that their clinic sites, physicians, and other key people now have cell phone service through satellite via Starlink.

“No one has phone books anymore,” he said, so cancer clinicians should keep crucial contact information on paper, such as details about businesses that distribute water and porta potties, given that online searches may not be feasible.

Clinicians should also advise patients to keep a hard copy of recent medical findings handy, including medications and lab results, in case they arrive at an emergency room far from home and physicians can’t access their electronic health record, Bernicker said.

When there is enough advance warning of an approaching weather event, clinicians can help patients keep at least a week’s worth of medication on hand for symptom-related issues, such as nausea or pain, as well as antibiotics so patients don’t have to seek out emergency care during the crisis, Bernicker said. However, Bernicker noted, some insurers may be reluctant to fill certain prescriptions in advance, like those for opioids.

Making headway on more robust preparedness strategies may be slowed. As of March, the National Institutes of Health will no longer fund research about the health effects of climate change.

Bernicker hoped that such cutbacks would be rolled back. What’s on the line, he stressed, is maintaining the highest quality of care for patients with cancer.

“We really are in a golden age of oncology therapeutics,” he said. “We have patients living longer than anyone would have predicted 20 or 25 years ago. But all those advances are contingent on people having access to their centers and not having that interrupted.”

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

As Hurricane Helene approached western North Carolina, Martin Palmeri, MD, MBA, didn’t anticipate the storm would disrupt practice operations for more than a day or so.

But the massive rainfall and flooding damage last September proved to be far more challenging. Despite best efforts by the 13-physician practice, basic treatments for most patients were interrupted for about a week.

Flooding washed out some of the major roads leading to the main Asheville clinic and affiliated rural sites, limiting travel and slowing delivery of medications, intravenous (IV) fluids, and other supplies, Palmeri said. Some patients and employees weren’t initially reachable due to the loss of the internet and cell phone service. The storm-related fallout even forced patients to relocate elsewhere for weeks or longer.

During the storm, backup generators kept power on at the Asheville clinic, protecting chemotherapy and other refrigerated drugs, but the storm damaged the municipal water supply.

“Water was the number one thing — how do you get water to the office?” Palmeri said. “You can’t give someone an 8-hour infusion if they don’t have means of going to the toilet or having something to drink.”

Hurricanes. Wildfires. Heat waves. As climate-driven extreme weather has become more common, researchers, oncologists, and patients are increasingly being forced to consider the consequences of these disruptions.

Along with preventing patients and providers from reaching treatment sites, experts said, extreme weather can undercut patients’ health and care in other ways. Patients with more limited lung capacity following lung cancer surgery, for instance, may struggle with breathing during wildfires. Extreme heat can prove risky for patients already dehydrated or weakened by treatment-related side effects. Power outages and severe flooding can affect vital infrastructure, disrupting operations at facilities that manufacture essential drugs. Power outages can also impede radiotherapy, which requires machines powered by electricity.

“Any of these [weather] events can disrupt this critical cancer care continuum among a population of people that already are very vulnerable,” said Joan Casey, PhD, an environmental epidemiologist and associate professor at the University of Washington in Seattle.

 

Extreme Weather and Cancer Survival

For patients with cancer, survival often relies on highly regimented protocols, which may require surgery plus frequent visits for radiation, chemotherapy, or immunotherapy that can last months, said Eric Bernicker, MD, a Colorado oncologist and lead author of a 2023 American Society of Clinical Oncology position statement about the impact of climate change on cancer care.

Interruptions to care, regardless of the cause, can lead to worse outcomes for patients, Bernicker said. “If you’re in the middle of your post-lumpectomy radiation and your radiation center shuts for 2 weeks,” he said, “that is not good.”

Research indicated that even short treatment disruptions can affect outcomes for patients with cancer and that delays caused by extreme weather — which may last for weeks — can affect survival for these patients.

One analysis, published in JAMA Oncology in 2023, found that patients exposed to wildfire within the first year after potentially curative lung cancer surgery had worse survival outcomes than those who weren’t exposed during their recovery.

In another study, patients with lung cancer who had their radiation interrupted when a hurricane struck had a 19% greater risk of dying overall compared with similar patients who were not affected. Another analysis found that patients with breast cancer who were partway through treatment when Hurricane Katrina hit the Louisiana coastline had a significantly greater risk of dying over a 10-year period compared with patients who lived elsewhere.

The potential threats to survival highlighted the impacts of extreme weather on carefully orchestrated systems of care that place patients facing already fragile situations in impossible binds, Casey said.

Douglas Flora, MD, a Kentucky oncologist and president-elect of the Association of Cancer Care Centers, Rockville, Maryland, agreed.

“We’ve seen this with an increasing frequency over the last several years,” Flora said. “It’s one thing if it’s routine follow-up or surveillance care, but many cancer patients’ survivals are directly related to not having interruptions in their care.”

 

Challenging Realities

Following Helene, the most pressing issue was the lack of water, Palmeri said.

The lack of reliable clean water created challenges for patients receiving radiation or chemotherapy infusions, which can cause vomiting and diarrhea that leave patients dehydrated. Toilets were also unusable.

Even when the city of Asheville said the water was likely safe enough to bathe in, local leaders still reported potential risks from bacteria and other contaminants in the water, Palmeri said. Those with a fragile immune system or breaks in the skin “could get serious and life-threatening infections,” he explained.

To make matters worse, damage to a North Carolina facility manufacturing IV fluids left the United States in shortage for months. IV fluids are key not only for providing hydration but also for easing nausea, fatigue, and other issues caused by cancer therapies.

With wildfires, as occurred in southern California early this year, patients undergoing cancer treatment might feel they have no option but to remain near home to continue getting care, Casey said. “It’s restricting their agency in the kinds of choices that they have to make during these severe weather events.”

Meanwhile, thick wildfire smoke can confine patients to their homes, said Lawrence Wagman, MD, a surgical oncologist and a regional medical director at the City of Hope network, who described its main facility in Duarte, California, coming within a dozen miles of the Eaton fire. “One of the biggest problems was so much smoke in the air,” he said. “And the air quality was so low that it was, in many ways, dangerous for patients to travel.”

“These fires were so aggressive, and they kept popping up,” Wagman said. Plus, the emotional strain of looming wildfires persisted for both patients and cancer clinicians for weeks on end, he added.

For those who evacuate, the logistics can be complex.

Not only are cancer treatment plans highly structured, but switching care to another facility is far from easy, Bernicker said. The new facility will likely need to submit a treatment plan and get insurance coverage before moving forward.

“I’m not saying that takes forever,” he said. “But what I’m saying is that it’s not like you just roll in and they hang the [infusion] bag.”

Neither is a shelter typically an option for patients during treatment, said Seth Berkowitz, a licensed clinical social worker and director of Strategic Healthcare Partnerships at The Leukemia & Lymphoma Society. “They have to have a place to go that’s safe and germ-free.”

In western North Carolina, the strain on already ill patients and their caregivers could be overwhelming, Palmeri said. He recounted how the husband of one patient with advanced cancer died after the storm came through.

“He tried to go out there with a chainsaw to clear a way out so that they could get out of their house in case he needed to take her to the hospital,” Palmeri said. “And he had a heart attack there in the driveway.”

 

Rebuilding and Planning Ahead

Experts are only at the early stages of grasping the magnitude of extreme weather on cancer care and developing strategies to curtail care gaps and potential harm to patients, said Katie Lichter, MD, a radiation oncologist at the University of California San Francisco, who studies extreme weather and cancer treatment.

“How does it impact health care delivery services at every step, from prevention to screening to treatment and survivorship?” Lichter asked. “We’re just starting to understand and to even quantify that,” she said, which included identifying patients who are most vulnerable. She worries, in particular, about patients living in rural areas who already travel longer distances and often face more difficulties accessing care.

The gap between research and reality still looms large. A recent analysis, led by Lichter, looked at 176 California radiation oncology clinics and found that all of them were located within 25 miles of a wildfire that had occurred within the prior 5 years. Yet among the 51 clinics that responded to a 2022 survey,just 47% reported that their clinic had a wildfire emergency preparedness plan.

The American Cancer Society does provide some guidance on how patients can prepare for a weather-related crisis, including having extra supplies of medications or special equipment on hand.

Still, providers are often in reaction mode when extreme weather strikes.

Without adequate clean water after Helene, leaders at Palmeri’s practice moved swiftly, purchasing 40,000-50,000 bottles of water and bringing in porta potties from elsewhere. 

“I think we were able to get things up and going very quickly,” said Palmeri, who noted that full services resumed about 10 days after the storm. “For most patients, missing a week of treatment would not do a disservice to their well-being or outcome.”

Going forward, to provide a more comprehensive strategy, Lichter is working with colleagues to develop clinical tool kits to help oncology practices and patients prepare for severe weather events, such as outlining backup treatment contingency plans, ensuring early medication refills, and boosting communication with patient alert systems.

Clinicians are also implementing their own strategies. To limit communication gaps during power outages, Palmeri said that, since Helene, his practice has made sure that their clinic sites, physicians, and other key people now have cell phone service through satellite via Starlink.

“No one has phone books anymore,” he said, so cancer clinicians should keep crucial contact information on paper, such as details about businesses that distribute water and porta potties, given that online searches may not be feasible.

Clinicians should also advise patients to keep a hard copy of recent medical findings handy, including medications and lab results, in case they arrive at an emergency room far from home and physicians can’t access their electronic health record, Bernicker said.

When there is enough advance warning of an approaching weather event, clinicians can help patients keep at least a week’s worth of medication on hand for symptom-related issues, such as nausea or pain, as well as antibiotics so patients don’t have to seek out emergency care during the crisis, Bernicker said. However, Bernicker noted, some insurers may be reluctant to fill certain prescriptions in advance, like those for opioids.

Making headway on more robust preparedness strategies may be slowed. As of March, the National Institutes of Health will no longer fund research about the health effects of climate change.

Bernicker hoped that such cutbacks would be rolled back. What’s on the line, he stressed, is maintaining the highest quality of care for patients with cancer.

“We really are in a golden age of oncology therapeutics,” he said. “We have patients living longer than anyone would have predicted 20 or 25 years ago. But all those advances are contingent on people having access to their centers and not having that interrupted.”

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

As Hurricane Helene approached western North Carolina, Martin Palmeri, MD, MBA, didn’t anticipate the storm would disrupt practice operations for more than a day or so.

But the massive rainfall and flooding damage last September proved to be far more challenging. Despite best efforts by the 13-physician practice, basic treatments for most patients were interrupted for about a week.

Flooding washed out some of the major roads leading to the main Asheville clinic and affiliated rural sites, limiting travel and slowing delivery of medications, intravenous (IV) fluids, and other supplies, Palmeri said. Some patients and employees weren’t initially reachable due to the loss of the internet and cell phone service. The storm-related fallout even forced patients to relocate elsewhere for weeks or longer.

During the storm, backup generators kept power on at the Asheville clinic, protecting chemotherapy and other refrigerated drugs, but the storm damaged the municipal water supply.

“Water was the number one thing — how do you get water to the office?” Palmeri said. “You can’t give someone an 8-hour infusion if they don’t have means of going to the toilet or having something to drink.”

Hurricanes. Wildfires. Heat waves. As climate-driven extreme weather has become more common, researchers, oncologists, and patients are increasingly being forced to consider the consequences of these disruptions.

Along with preventing patients and providers from reaching treatment sites, experts said, extreme weather can undercut patients’ health and care in other ways. Patients with more limited lung capacity following lung cancer surgery, for instance, may struggle with breathing during wildfires. Extreme heat can prove risky for patients already dehydrated or weakened by treatment-related side effects. Power outages and severe flooding can affect vital infrastructure, disrupting operations at facilities that manufacture essential drugs. Power outages can also impede radiotherapy, which requires machines powered by electricity.

“Any of these [weather] events can disrupt this critical cancer care continuum among a population of people that already are very vulnerable,” said Joan Casey, PhD, an environmental epidemiologist and associate professor at the University of Washington in Seattle.

 

Extreme Weather and Cancer Survival

For patients with cancer, survival often relies on highly regimented protocols, which may require surgery plus frequent visits for radiation, chemotherapy, or immunotherapy that can last months, said Eric Bernicker, MD, a Colorado oncologist and lead author of a 2023 American Society of Clinical Oncology position statement about the impact of climate change on cancer care.

Interruptions to care, regardless of the cause, can lead to worse outcomes for patients, Bernicker said. “If you’re in the middle of your post-lumpectomy radiation and your radiation center shuts for 2 weeks,” he said, “that is not good.”

Research indicated that even short treatment disruptions can affect outcomes for patients with cancer and that delays caused by extreme weather — which may last for weeks — can affect survival for these patients.

One analysis, published in JAMA Oncology in 2023, found that patients exposed to wildfire within the first year after potentially curative lung cancer surgery had worse survival outcomes than those who weren’t exposed during their recovery.

In another study, patients with lung cancer who had their radiation interrupted when a hurricane struck had a 19% greater risk of dying overall compared with similar patients who were not affected. Another analysis found that patients with breast cancer who were partway through treatment when Hurricane Katrina hit the Louisiana coastline had a significantly greater risk of dying over a 10-year period compared with patients who lived elsewhere.

The potential threats to survival highlighted the impacts of extreme weather on carefully orchestrated systems of care that place patients facing already fragile situations in impossible binds, Casey said.

Douglas Flora, MD, a Kentucky oncologist and president-elect of the Association of Cancer Care Centers, Rockville, Maryland, agreed.

“We’ve seen this with an increasing frequency over the last several years,” Flora said. “It’s one thing if it’s routine follow-up or surveillance care, but many cancer patients’ survivals are directly related to not having interruptions in their care.”

 

Challenging Realities

Following Helene, the most pressing issue was the lack of water, Palmeri said.

The lack of reliable clean water created challenges for patients receiving radiation or chemotherapy infusions, which can cause vomiting and diarrhea that leave patients dehydrated. Toilets were also unusable.

Even when the city of Asheville said the water was likely safe enough to bathe in, local leaders still reported potential risks from bacteria and other contaminants in the water, Palmeri said. Those with a fragile immune system or breaks in the skin “could get serious and life-threatening infections,” he explained.

To make matters worse, damage to a North Carolina facility manufacturing IV fluids left the United States in shortage for months. IV fluids are key not only for providing hydration but also for easing nausea, fatigue, and other issues caused by cancer therapies.

With wildfires, as occurred in southern California early this year, patients undergoing cancer treatment might feel they have no option but to remain near home to continue getting care, Casey said. “It’s restricting their agency in the kinds of choices that they have to make during these severe weather events.”

Meanwhile, thick wildfire smoke can confine patients to their homes, said Lawrence Wagman, MD, a surgical oncologist and a regional medical director at the City of Hope network, who described its main facility in Duarte, California, coming within a dozen miles of the Eaton fire. “One of the biggest problems was so much smoke in the air,” he said. “And the air quality was so low that it was, in many ways, dangerous for patients to travel.”

“These fires were so aggressive, and they kept popping up,” Wagman said. Plus, the emotional strain of looming wildfires persisted for both patients and cancer clinicians for weeks on end, he added.

For those who evacuate, the logistics can be complex.

Not only are cancer treatment plans highly structured, but switching care to another facility is far from easy, Bernicker said. The new facility will likely need to submit a treatment plan and get insurance coverage before moving forward.

“I’m not saying that takes forever,” he said. “But what I’m saying is that it’s not like you just roll in and they hang the [infusion] bag.”

Neither is a shelter typically an option for patients during treatment, said Seth Berkowitz, a licensed clinical social worker and director of Strategic Healthcare Partnerships at The Leukemia & Lymphoma Society. “They have to have a place to go that’s safe and germ-free.”

In western North Carolina, the strain on already ill patients and their caregivers could be overwhelming, Palmeri said. He recounted how the husband of one patient with advanced cancer died after the storm came through.

“He tried to go out there with a chainsaw to clear a way out so that they could get out of their house in case he needed to take her to the hospital,” Palmeri said. “And he had a heart attack there in the driveway.”

 

Rebuilding and Planning Ahead

Experts are only at the early stages of grasping the magnitude of extreme weather on cancer care and developing strategies to curtail care gaps and potential harm to patients, said Katie Lichter, MD, a radiation oncologist at the University of California San Francisco, who studies extreme weather and cancer treatment.

“How does it impact health care delivery services at every step, from prevention to screening to treatment and survivorship?” Lichter asked. “We’re just starting to understand and to even quantify that,” she said, which included identifying patients who are most vulnerable. She worries, in particular, about patients living in rural areas who already travel longer distances and often face more difficulties accessing care.

The gap between research and reality still looms large. A recent analysis, led by Lichter, looked at 176 California radiation oncology clinics and found that all of them were located within 25 miles of a wildfire that had occurred within the prior 5 years. Yet among the 51 clinics that responded to a 2022 survey,just 47% reported that their clinic had a wildfire emergency preparedness plan.

The American Cancer Society does provide some guidance on how patients can prepare for a weather-related crisis, including having extra supplies of medications or special equipment on hand.

Still, providers are often in reaction mode when extreme weather strikes.

Without adequate clean water after Helene, leaders at Palmeri’s practice moved swiftly, purchasing 40,000-50,000 bottles of water and bringing in porta potties from elsewhere. 

“I think we were able to get things up and going very quickly,” said Palmeri, who noted that full services resumed about 10 days after the storm. “For most patients, missing a week of treatment would not do a disservice to their well-being or outcome.”

Going forward, to provide a more comprehensive strategy, Lichter is working with colleagues to develop clinical tool kits to help oncology practices and patients prepare for severe weather events, such as outlining backup treatment contingency plans, ensuring early medication refills, and boosting communication with patient alert systems.

Clinicians are also implementing their own strategies. To limit communication gaps during power outages, Palmeri said that, since Helene, his practice has made sure that their clinic sites, physicians, and other key people now have cell phone service through satellite via Starlink.

“No one has phone books anymore,” he said, so cancer clinicians should keep crucial contact information on paper, such as details about businesses that distribute water and porta potties, given that online searches may not be feasible.

Clinicians should also advise patients to keep a hard copy of recent medical findings handy, including medications and lab results, in case they arrive at an emergency room far from home and physicians can’t access their electronic health record, Bernicker said.

When there is enough advance warning of an approaching weather event, clinicians can help patients keep at least a week’s worth of medication on hand for symptom-related issues, such as nausea or pain, as well as antibiotics so patients don’t have to seek out emergency care during the crisis, Bernicker said. However, Bernicker noted, some insurers may be reluctant to fill certain prescriptions in advance, like those for opioids.

Making headway on more robust preparedness strategies may be slowed. As of March, the National Institutes of Health will no longer fund research about the health effects of climate change.

Bernicker hoped that such cutbacks would be rolled back. What’s on the line, he stressed, is maintaining the highest quality of care for patients with cancer.

“We really are in a golden age of oncology therapeutics,” he said. “We have patients living longer than anyone would have predicted 20 or 25 years ago. But all those advances are contingent on people having access to their centers and not having that interrupted.”

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

Rates of certain cancers in the United States — including breast, colorectal, and thyroid cancers — increased between 2010 and 2019 among patients aged less than 50 years, while overall cancer incidence and mortality rates did not increase, a new study found. 

Among the more than two million cases of early-onset cancer diagnosed during this period, 63.2% were in women, researchers reported recently in Cancer Discovery.

Breast cancer, thyroid cancer, and melanoma were the most common early-onset cancers in women. Among men, the most common were colorectal cancer, testicular cancer, and melanoma. 

Researchers from the National Cancer Institute analyzed cancer incidence data from the United States Cancer Statistics database for 2010-2019 and national death certificate data from the National Center for Health Statistics from 2010 to 2022. The team excluded incidence data from 2020 and 2021, which was artificially low due to COVID.

The researchers divided the data according to age groups: The early-onset age groups were 15-29, 30-39, and 40-49 years, and the late-onset groups were 50-59, 60-69, and 70-79 years. The team also estimated the expected number of early-onset cases in 2019 by multiplying 2010 age-specific cancer incidence rates by population counts for 2019. 

First author Meredith Shiels, of the National Cancer Institute, and colleagues found that the largest absolute increase in incidence of early-onset cancers, compared with expected incidence, were for breast (n = 4834 additional cancers), colorectal (n = 2099), kidney (n = 1793), and uterine cancers (n = 1209). These diagnoses accounted for 80% of the additional cancer diagnoses in 2019 vs 2010.

Looking at increases by age group, Shiels and colleagues reported that 1.9% of all cancers occurred in overall early-onset cohort 15- to 49-year-olds (age-standardized incidence rate of 39.8 per 100,000), and the incidence was greater in the older cohorts: 3.6% for 30- to 39-year-olds (123.5 per 100,000) and 8.8% for 40- to 49-year-olds (293.9 per 100,000).

Overall, 14 of 33 cancer types significantly increased in incidence in at least one early-onset age group. Among these 14 cancer types, five — melanoma, plasma cell neoplasms, cervical cancer, stomach cancer, and cancer of the bones and joints — showed increases only in early-onset age groups, not in late-onset age groups. For example, between 2010 and 2019, cervical cancer rates increased by 1.39% per year among 30- to 39-year-olds, melanoma rates increased by 0.82% per year among 40- to 49-year-olds, and stomach cancer rates increased by 1.38% per year. 

The remaining nine cancer types increased in at least one early-onset and one late-onset group. These included female breast, colorectal, kidney, testicular, uterine, pancreatic cancers as well as precursor B-cell non-Hodgkin lymphoma, diffuse large B-cell lymphoma, and mycosis fungoides/Sézary syndrome.

For four of the 14 cancer types with increasing incidence rates — testicular cancer, uterine cancer, colorectal cancer, and cancer of the bones and joints — mortality also increased in at least one early-onset age group, whereas the remaining 10 cancer types increased in incidence without an increase in mortality for any age group.

Shiels and her colleagues aren’t the first to address the rising incidence of early-onset cancers. In a keynote lecture at the European Society of Medical Oncology (ESMO) 2024 Annual Meeting, Irit Ben-Aharon, MD, PhD, from the Rambam Health Care Campus in Haifa, Israel, noted that from 1990-2019, the global incidence of early-onset cancer increased by 79%.

Although the current study doesn’t identify drivers of rising cancer rates in younger patients, “descriptive data like these provide a critical starting point for understanding the drivers of rising rates of cancer in early-onset age groups and could translate to effective cancer prevention and early detection efforts,” Shiels said in a press release. For instance, “recent guidelines have lowered the age of initiation for breast and colorectal cancer screening based, at least partially, on observations that rates for these cancers are increasing at younger ages.”

This study is “a great step forward” toward understanding the increasing incidence of early-onset cancers, agreed Shuji Ogino, MD, PhD, from Harvard Medical School and Brigham and Women’s Hospital in Boston, who wasn’t involved in the research.

The investigators provide new details, particularly by breaking down the early- and late-onset age groups into subcategories and by comparing incidence and mortality rates, Ogino noted.

“Mortality is a great endpoint because if the increased in early incidence is just an effect of [increased] screening we won’t see a mortality increase,” Ogino said. But “we need more data and some way to tease out the screening effect.” Plus, he added, “we need more mechanistic studies and tissue-based analyses to determine if early-onset cancers that are increasing in incidence are a different beast, rather than just an earlier beast.”

This study was funded by the Intramural Research Program of the National Cancer Institute of the National Institutes of Health and the Institute of Cancer Research. Shiels declared no conflicts of interest.

version of this article first appeared on Medscape.com.

Rates of certain cancers in the United States — including breast, colorectal, and thyroid cancers — increased between 2010 and 2019 among patients aged less than 50 years, while overall cancer incidence and mortality rates did not increase, a new study found. 

Among the more than two million cases of early-onset cancer diagnosed during this period, 63.2% were in women, researchers reported recently in Cancer Discovery.

Breast cancer, thyroid cancer, and melanoma were the most common early-onset cancers in women. Among men, the most common were colorectal cancer, testicular cancer, and melanoma. 

Researchers from the National Cancer Institute analyzed cancer incidence data from the United States Cancer Statistics database for 2010-2019 and national death certificate data from the National Center for Health Statistics from 2010 to 2022. The team excluded incidence data from 2020 and 2021, which was artificially low due to COVID.

The researchers divided the data according to age groups: The early-onset age groups were 15-29, 30-39, and 40-49 years, and the late-onset groups were 50-59, 60-69, and 70-79 years. The team also estimated the expected number of early-onset cases in 2019 by multiplying 2010 age-specific cancer incidence rates by population counts for 2019. 

First author Meredith Shiels, of the National Cancer Institute, and colleagues found that the largest absolute increase in incidence of early-onset cancers, compared with expected incidence, were for breast (n = 4834 additional cancers), colorectal (n = 2099), kidney (n = 1793), and uterine cancers (n = 1209). These diagnoses accounted for 80% of the additional cancer diagnoses in 2019 vs 2010.

Looking at increases by age group, Shiels and colleagues reported that 1.9% of all cancers occurred in overall early-onset cohort 15- to 49-year-olds (age-standardized incidence rate of 39.8 per 100,000), and the incidence was greater in the older cohorts: 3.6% for 30- to 39-year-olds (123.5 per 100,000) and 8.8% for 40- to 49-year-olds (293.9 per 100,000).

Overall, 14 of 33 cancer types significantly increased in incidence in at least one early-onset age group. Among these 14 cancer types, five — melanoma, plasma cell neoplasms, cervical cancer, stomach cancer, and cancer of the bones and joints — showed increases only in early-onset age groups, not in late-onset age groups. For example, between 2010 and 2019, cervical cancer rates increased by 1.39% per year among 30- to 39-year-olds, melanoma rates increased by 0.82% per year among 40- to 49-year-olds, and stomach cancer rates increased by 1.38% per year. 

The remaining nine cancer types increased in at least one early-onset and one late-onset group. These included female breast, colorectal, kidney, testicular, uterine, pancreatic cancers as well as precursor B-cell non-Hodgkin lymphoma, diffuse large B-cell lymphoma, and mycosis fungoides/Sézary syndrome.

For four of the 14 cancer types with increasing incidence rates — testicular cancer, uterine cancer, colorectal cancer, and cancer of the bones and joints — mortality also increased in at least one early-onset age group, whereas the remaining 10 cancer types increased in incidence without an increase in mortality for any age group.

Shiels and her colleagues aren’t the first to address the rising incidence of early-onset cancers. In a keynote lecture at the European Society of Medical Oncology (ESMO) 2024 Annual Meeting, Irit Ben-Aharon, MD, PhD, from the Rambam Health Care Campus in Haifa, Israel, noted that from 1990-2019, the global incidence of early-onset cancer increased by 79%.

Although the current study doesn’t identify drivers of rising cancer rates in younger patients, “descriptive data like these provide a critical starting point for understanding the drivers of rising rates of cancer in early-onset age groups and could translate to effective cancer prevention and early detection efforts,” Shiels said in a press release. For instance, “recent guidelines have lowered the age of initiation for breast and colorectal cancer screening based, at least partially, on observations that rates for these cancers are increasing at younger ages.”

This study is “a great step forward” toward understanding the increasing incidence of early-onset cancers, agreed Shuji Ogino, MD, PhD, from Harvard Medical School and Brigham and Women’s Hospital in Boston, who wasn’t involved in the research.

The investigators provide new details, particularly by breaking down the early- and late-onset age groups into subcategories and by comparing incidence and mortality rates, Ogino noted.

“Mortality is a great endpoint because if the increased in early incidence is just an effect of [increased] screening we won’t see a mortality increase,” Ogino said. But “we need more data and some way to tease out the screening effect.” Plus, he added, “we need more mechanistic studies and tissue-based analyses to determine if early-onset cancers that are increasing in incidence are a different beast, rather than just an earlier beast.”

This study was funded by the Intramural Research Program of the National Cancer Institute of the National Institutes of Health and the Institute of Cancer Research. Shiels declared no conflicts of interest.

version of this article first appeared on Medscape.com.

Rates of certain cancers in the United States — including breast, colorectal, and thyroid cancers — increased between 2010 and 2019 among patients aged less than 50 years, while overall cancer incidence and mortality rates did not increase, a new study found. 

Among the more than two million cases of early-onset cancer diagnosed during this period, 63.2% were in women, researchers reported recently in Cancer Discovery.

Breast cancer, thyroid cancer, and melanoma were the most common early-onset cancers in women. Among men, the most common were colorectal cancer, testicular cancer, and melanoma. 

Researchers from the National Cancer Institute analyzed cancer incidence data from the United States Cancer Statistics database for 2010-2019 and national death certificate data from the National Center for Health Statistics from 2010 to 2022. The team excluded incidence data from 2020 and 2021, which was artificially low due to COVID.

The researchers divided the data according to age groups: The early-onset age groups were 15-29, 30-39, and 40-49 years, and the late-onset groups were 50-59, 60-69, and 70-79 years. The team also estimated the expected number of early-onset cases in 2019 by multiplying 2010 age-specific cancer incidence rates by population counts for 2019. 

First author Meredith Shiels, of the National Cancer Institute, and colleagues found that the largest absolute increase in incidence of early-onset cancers, compared with expected incidence, were for breast (n = 4834 additional cancers), colorectal (n = 2099), kidney (n = 1793), and uterine cancers (n = 1209). These diagnoses accounted for 80% of the additional cancer diagnoses in 2019 vs 2010.

Looking at increases by age group, Shiels and colleagues reported that 1.9% of all cancers occurred in overall early-onset cohort 15- to 49-year-olds (age-standardized incidence rate of 39.8 per 100,000), and the incidence was greater in the older cohorts: 3.6% for 30- to 39-year-olds (123.5 per 100,000) and 8.8% for 40- to 49-year-olds (293.9 per 100,000).

Overall, 14 of 33 cancer types significantly increased in incidence in at least one early-onset age group. Among these 14 cancer types, five — melanoma, plasma cell neoplasms, cervical cancer, stomach cancer, and cancer of the bones and joints — showed increases only in early-onset age groups, not in late-onset age groups. For example, between 2010 and 2019, cervical cancer rates increased by 1.39% per year among 30- to 39-year-olds, melanoma rates increased by 0.82% per year among 40- to 49-year-olds, and stomach cancer rates increased by 1.38% per year. 

The remaining nine cancer types increased in at least one early-onset and one late-onset group. These included female breast, colorectal, kidney, testicular, uterine, pancreatic cancers as well as precursor B-cell non-Hodgkin lymphoma, diffuse large B-cell lymphoma, and mycosis fungoides/Sézary syndrome.

For four of the 14 cancer types with increasing incidence rates — testicular cancer, uterine cancer, colorectal cancer, and cancer of the bones and joints — mortality also increased in at least one early-onset age group, whereas the remaining 10 cancer types increased in incidence without an increase in mortality for any age group.

Shiels and her colleagues aren’t the first to address the rising incidence of early-onset cancers. In a keynote lecture at the European Society of Medical Oncology (ESMO) 2024 Annual Meeting, Irit Ben-Aharon, MD, PhD, from the Rambam Health Care Campus in Haifa, Israel, noted that from 1990-2019, the global incidence of early-onset cancer increased by 79%.

Although the current study doesn’t identify drivers of rising cancer rates in younger patients, “descriptive data like these provide a critical starting point for understanding the drivers of rising rates of cancer in early-onset age groups and could translate to effective cancer prevention and early detection efforts,” Shiels said in a press release. For instance, “recent guidelines have lowered the age of initiation for breast and colorectal cancer screening based, at least partially, on observations that rates for these cancers are increasing at younger ages.”

This study is “a great step forward” toward understanding the increasing incidence of early-onset cancers, agreed Shuji Ogino, MD, PhD, from Harvard Medical School and Brigham and Women’s Hospital in Boston, who wasn’t involved in the research.

The investigators provide new details, particularly by breaking down the early- and late-onset age groups into subcategories and by comparing incidence and mortality rates, Ogino noted.

“Mortality is a great endpoint because if the increased in early incidence is just an effect of [increased] screening we won’t see a mortality increase,” Ogino said. But “we need more data and some way to tease out the screening effect.” Plus, he added, “we need more mechanistic studies and tissue-based analyses to determine if early-onset cancers that are increasing in incidence are a different beast, rather than just an earlier beast.”

This study was funded by the Intramural Research Program of the National Cancer Institute of the National Institutes of Health and the Institute of Cancer Research. Shiels declared no conflicts of interest.

version of this article first appeared on Medscape.com.

Fewer than 1 in 3 children with hepatitis C (HCV) see a clinician for care, and fewer than 1 in 8 receive treatment.

HCV cases in children are rising, yet access to treatment is limited, especially for Black children, according to a new retrospective cohort analysis published in Pediatrics. Treatment entails direct-acting antiviral agents, for which 95% of patients have no detectable trace of the virus 12 weeks after treatment.

“HCV is a silent killer,” said Megan Rose Curtis, MD, MS, the lead author of the study. “It can be asymptomatic for many years until the third decade of life if a child is infected perinatally” and does not receive treatment.

The prevalence of HCV in pregnant people jumped 16-fold between 1998 and 2018 to 5.3 cases per every 1000 pregnancies, and these patients can transmit the disease perinatally. Many people are unaware they are infected.

Curtis, based at Washington University in St. Louis School of Medicine, St. Louis, Missouri, and her team analyzed electronic medical records of children diagnosed with HCV born over an 18-year period starting in 2000 using the TriNetX Research Network. They also included data on prescriptions for direct-acting antivirals, appointments with healthcare providers, and race and ethnicity.

The sample included 928 children with HCV (52.3% women; 55.9% White) and excluded children whose HCV had spontaneously cleared.

A little over one third (32%) of children had seen a clinician for HCV care, which was defined as having in their record an antiviral prescription, a fibrosis stage, an order for an HCV genotype test, or a diagnosis of the disease.

Even fewer children (12%) were prescribed an antiviral.

Children with certain characteristics were more likely to receive care, the researchers found. For instance, children born between 2014 and 2018 (P = .008) and those diagnosed at age 0-3 years (P = .03) were most likely to see a clinician and receive treatment.

The current recommended treatment regimen for pediatric HCV — glecaprevir/pibrentasvir (Mavyret) or sofosbuvir/velpatasvir (Epclusa) — became available in 2017.

Hispanic/Latinx and White children were 120% and 240% more likely than Black children, respectively, to have received care (odds ratio [OR], 2.20; 95% CI, 1.05-4.59 and OR, 3.44; 95% CI, 1.89-6.28). Children living in southern states were less likely to have seen a doctor for HCV treatment.

Curtis said children might not receive treatment because their caregivers do not bring them to follow-up appointments, possibly because they struggle with stable housing or transportation. Insurance companies also sometimes will not pay for the treatment.

“If you have a golden opportunity to see someone in your office, it might be the only chance someone offers them HCV treatment. It can have a huge and transformative impact on someone’s life,” she said.

Jenelle Ferry, MD, a neonatologist at Pediatrix Medical Group in Tampa, Florida, said clinicians should routinely screen children and refer caregivers to a pediatric hepatologist for further management.

Pediatricians who suspect HCV in their patients should order a test for viral nucleic acid or viral load or request a polymerase chain reaction test.

Curtis noted that more than half of children clear the infection on their own by age 3, the age at which treatment can also begin. Treatment may also not be the right option for those who cannot swallow the medicine, which is available in oral pellets for children.

Greg Marchand, MD, an OB/GYN at the Marchand Institute for Minimally Invasive Surgery in Mesa, Arizona, said the research illuminates a “huge missed opportunity” to help children.

“If left untreated, these children risk serious liver complications like cirrhosis, liver cancer, high medical costs, and even death,” he said.

Marchand said clinicians must be aware of the guidelines for testing people who are pregnant and infants. In 2020, the US Centers for Disease Control and Prevention recommended universal HCV antibody screening during every pregnancy.

“There’s still hope that treatment rates will improve as both doctors and families become more familiar with” the newer drugs, he said.

No financial disclosures were reported.

The authors of this study were supported by various grants and awards, including from the National Institutes of Health, the James and Audrey Foster MGH Research Scholar Award, the Charles A. King Trust Postdoctoral Research Fellowship, and the Boston University Clinical and Translational Science Institute.

A version of this article appeared on Medscape.com. 

Fewer than 1 in 3 children with hepatitis C (HCV) see a clinician for care, and fewer than 1 in 8 receive treatment.

HCV cases in children are rising, yet access to treatment is limited, especially for Black children, according to a new retrospective cohort analysis published in Pediatrics. Treatment entails direct-acting antiviral agents, for which 95% of patients have no detectable trace of the virus 12 weeks after treatment.

“HCV is a silent killer,” said Megan Rose Curtis, MD, MS, the lead author of the study. “It can be asymptomatic for many years until the third decade of life if a child is infected perinatally” and does not receive treatment.

The prevalence of HCV in pregnant people jumped 16-fold between 1998 and 2018 to 5.3 cases per every 1000 pregnancies, and these patients can transmit the disease perinatally. Many people are unaware they are infected.

Curtis, based at Washington University in St. Louis School of Medicine, St. Louis, Missouri, and her team analyzed electronic medical records of children diagnosed with HCV born over an 18-year period starting in 2000 using the TriNetX Research Network. They also included data on prescriptions for direct-acting antivirals, appointments with healthcare providers, and race and ethnicity.

The sample included 928 children with HCV (52.3% women; 55.9% White) and excluded children whose HCV had spontaneously cleared.

A little over one third (32%) of children had seen a clinician for HCV care, which was defined as having in their record an antiviral prescription, a fibrosis stage, an order for an HCV genotype test, or a diagnosis of the disease.

Even fewer children (12%) were prescribed an antiviral.

Children with certain characteristics were more likely to receive care, the researchers found. For instance, children born between 2014 and 2018 (P = .008) and those diagnosed at age 0-3 years (P = .03) were most likely to see a clinician and receive treatment.

The current recommended treatment regimen for pediatric HCV — glecaprevir/pibrentasvir (Mavyret) or sofosbuvir/velpatasvir (Epclusa) — became available in 2017.

Hispanic/Latinx and White children were 120% and 240% more likely than Black children, respectively, to have received care (odds ratio [OR], 2.20; 95% CI, 1.05-4.59 and OR, 3.44; 95% CI, 1.89-6.28). Children living in southern states were less likely to have seen a doctor for HCV treatment.

Curtis said children might not receive treatment because their caregivers do not bring them to follow-up appointments, possibly because they struggle with stable housing or transportation. Insurance companies also sometimes will not pay for the treatment.

“If you have a golden opportunity to see someone in your office, it might be the only chance someone offers them HCV treatment. It can have a huge and transformative impact on someone’s life,” she said.

Jenelle Ferry, MD, a neonatologist at Pediatrix Medical Group in Tampa, Florida, said clinicians should routinely screen children and refer caregivers to a pediatric hepatologist for further management.

Pediatricians who suspect HCV in their patients should order a test for viral nucleic acid or viral load or request a polymerase chain reaction test.

Curtis noted that more than half of children clear the infection on their own by age 3, the age at which treatment can also begin. Treatment may also not be the right option for those who cannot swallow the medicine, which is available in oral pellets for children.

Greg Marchand, MD, an OB/GYN at the Marchand Institute for Minimally Invasive Surgery in Mesa, Arizona, said the research illuminates a “huge missed opportunity” to help children.

“If left untreated, these children risk serious liver complications like cirrhosis, liver cancer, high medical costs, and even death,” he said.

Marchand said clinicians must be aware of the guidelines for testing people who are pregnant and infants. In 2020, the US Centers for Disease Control and Prevention recommended universal HCV antibody screening during every pregnancy.

“There’s still hope that treatment rates will improve as both doctors and families become more familiar with” the newer drugs, he said.

No financial disclosures were reported.

The authors of this study were supported by various grants and awards, including from the National Institutes of Health, the James and Audrey Foster MGH Research Scholar Award, the Charles A. King Trust Postdoctoral Research Fellowship, and the Boston University Clinical and Translational Science Institute.

A version of this article appeared on Medscape.com. 

Fewer than 1 in 3 children with hepatitis C (HCV) see a clinician for care, and fewer than 1 in 8 receive treatment.

HCV cases in children are rising, yet access to treatment is limited, especially for Black children, according to a new retrospective cohort analysis published in Pediatrics. Treatment entails direct-acting antiviral agents, for which 95% of patients have no detectable trace of the virus 12 weeks after treatment.

“HCV is a silent killer,” said Megan Rose Curtis, MD, MS, the lead author of the study. “It can be asymptomatic for many years until the third decade of life if a child is infected perinatally” and does not receive treatment.

The prevalence of HCV in pregnant people jumped 16-fold between 1998 and 2018 to 5.3 cases per every 1000 pregnancies, and these patients can transmit the disease perinatally. Many people are unaware they are infected.

Curtis, based at Washington University in St. Louis School of Medicine, St. Louis, Missouri, and her team analyzed electronic medical records of children diagnosed with HCV born over an 18-year period starting in 2000 using the TriNetX Research Network. They also included data on prescriptions for direct-acting antivirals, appointments with healthcare providers, and race and ethnicity.

The sample included 928 children with HCV (52.3% women; 55.9% White) and excluded children whose HCV had spontaneously cleared.

A little over one third (32%) of children had seen a clinician for HCV care, which was defined as having in their record an antiviral prescription, a fibrosis stage, an order for an HCV genotype test, or a diagnosis of the disease.

Even fewer children (12%) were prescribed an antiviral.

Children with certain characteristics were more likely to receive care, the researchers found. For instance, children born between 2014 and 2018 (P = .008) and those diagnosed at age 0-3 years (P = .03) were most likely to see a clinician and receive treatment.

The current recommended treatment regimen for pediatric HCV — glecaprevir/pibrentasvir (Mavyret) or sofosbuvir/velpatasvir (Epclusa) — became available in 2017.

Hispanic/Latinx and White children were 120% and 240% more likely than Black children, respectively, to have received care (odds ratio [OR], 2.20; 95% CI, 1.05-4.59 and OR, 3.44; 95% CI, 1.89-6.28). Children living in southern states were less likely to have seen a doctor for HCV treatment.

Curtis said children might not receive treatment because their caregivers do not bring them to follow-up appointments, possibly because they struggle with stable housing or transportation. Insurance companies also sometimes will not pay for the treatment.

“If you have a golden opportunity to see someone in your office, it might be the only chance someone offers them HCV treatment. It can have a huge and transformative impact on someone’s life,” she said.

Jenelle Ferry, MD, a neonatologist at Pediatrix Medical Group in Tampa, Florida, said clinicians should routinely screen children and refer caregivers to a pediatric hepatologist for further management.

Pediatricians who suspect HCV in their patients should order a test for viral nucleic acid or viral load or request a polymerase chain reaction test.

Curtis noted that more than half of children clear the infection on their own by age 3, the age at which treatment can also begin. Treatment may also not be the right option for those who cannot swallow the medicine, which is available in oral pellets for children.

Greg Marchand, MD, an OB/GYN at the Marchand Institute for Minimally Invasive Surgery in Mesa, Arizona, said the research illuminates a “huge missed opportunity” to help children.

“If left untreated, these children risk serious liver complications like cirrhosis, liver cancer, high medical costs, and even death,” he said.

Marchand said clinicians must be aware of the guidelines for testing people who are pregnant and infants. In 2020, the US Centers for Disease Control and Prevention recommended universal HCV antibody screening during every pregnancy.

“There’s still hope that treatment rates will improve as both doctors and families become more familiar with” the newer drugs, he said.

No financial disclosures were reported.

The authors of this study were supported by various grants and awards, including from the National Institutes of Health, the James and Audrey Foster MGH Research Scholar Award, the Charles A. King Trust Postdoctoral Research Fellowship, and the Boston University Clinical and Translational Science Institute.

A version of this article appeared on Medscape.com. 

US Department of Veterans Affairs (VA) Secretary Doug Collins testified in US House of Representatives and US Senate committees hearings that bringing staff numbers down to fiscal year 2019 figures was simply a goal: “Our goal, as we look at it, as everything goes forward, is a 15% decrease,” he told the senators. “It’s a goal. You have to start somewhere.”

“It’s a process we’re going through and I’m not going to work out a process in front of a committee or anywhere else,” Collins testified in the Senate on May 6, adding that it would be “incompetence” or “malpractice” to do so before time. “[When] we’re doing something as large as we are in an organization as sensitive on this Hill, it would not be right for us to do that in public. It would not be right for us to just come out and say here’s everything that we got and then have everybody scared because in the end it may not be the final decision.”

“We’re going to come to the best possible decision we can for the veterans in this country so they can have a VA system that actually works,” Collins argued in the Senate. “The VA’s been an issue for a long time. We’re trying to not make it an issue anymore.”

Collins later told a House committee on May 15 that VA was conducting a thorough review of department structure and staffing across the enterpise. "Our goal is to increase productivity and efficiency and to eliminate waste and bureaucracy improving health care delivery and benefits to our veterans. We are going to maintain VA essential jobs like doctors and nurses and claims processors" but eliminate positions it deemed "nonmission-critical" and consolidating areas of "overlap and waste."

Senate ranking member Richard Blumenthal (D-CT) and Chairman Jerry Moran (R-KS) both placed an emphasis on accountability for responsible resizing at the hearing. 

“The department is at a critical juncture,” Moran said. “Perhaps that’s always true, and I want to hear from you that the changes under way at the VA are backed by data, informed by veteran demand, focused on improving outcomes for men and women the VA serves, and will be carried out in close coordination with this committee, as well as with veterans, VA staff, and veteran organizations.” Moran stressed that cutting should be about right-sizing, done carefully, and while treating people “with gratitude and respect.”

Blumenthal was more direct in his criticism of the approach: “You cannot slash and trash the VA without eliminating those essential positions which provide access and availability of health care. It simply cannot be done,” he told Collins.

In response, Collins replied, “You have stated on several occasions already that I am saying we are going to fire 83,000 employees. That is wrong.” Collins insisted that the VA was “looking at a goal of how many employees we have and how many employees that are actually working in the front line taking care. I have doctors and nurses right now that do not see patients. Is that helping veteran health care?”

Collins defended the actions of the VA and spoke about challenges he was “constantly fighting” in the early weeks of his tenure. “We’ve been hit by a barrage of false rumors, innuendo, disinformation, speculation implying firing doctors and nurses, and forcing staff to work in closets and showers and that there’s chaos in the department, none of which have been backed up. Why? Because we canceled some contracts that worked for the VA that we should be doing in-house and we let go of less than one half of one percent of nonmission critical employees.”

The Trump Administration offered federal employees the option of resigning, which purportedly will go toward meeting the 15% target. NPR reported that VA employees have since shared data showing that 11,273 agency employees nationwide have applied for deferred resignation. Most of those employees are nurses (about 1300), medical support assistants (about 800), and social workers (about 300). 

Collins stressed that the aim of restructuring was to protect veterans’ health care. By getting rid of DEI initiatives, the VA saved $14 million, which he said was redirected to veterans with disabilities who need prosthetics.

Sen. Bernie Sanders (D-VT) addressed concerns about the existing shortage of clinicians at the VA, asking Collins what he was doing to bring in more doctors, nurses, and social workers. In addition to moving doctors and nurses from nonpatient care to patient care, Collins said, he planned to work with Congress to make salaries more competitive.

But money and adding more employees are not always the solution, Collins said. For example, he said, the VA has been spending $588 million a year veteran suicide research, its top clinical priority. Yet, he said there has not been a significant decrease in veteran suicide rates since 2008. 

The most recent VA suicide report, released in 2024, indicates suicide rates have remained steady since 2001. However, in 2022, the number of suicides among veterans (6407) was actually lower than in 12 of the previous 14 years. 

According to media reports, congressional lawmakers, and union officials, Veteran Crisis Line (VCL) staff were among the 2400 probationary employees fired in February. In a Feb. 20 video, Collins accused Democrats of spreading lies and insisted no one who answered the phone was fired.

Later, in a letter to senators, Collins admitted that 24 VCL support staff were “erroneously” sent termination notices. The firings were later reversed, Collins said, and all VCL employees had been reinstated at the same position they previously held. “Ensuring the VCL is always accessible 24/7 is one of the department’s top priorities,” Collins insisted.

Collins shared his approval of keeping and expanding VA programs and studies on psychedelic treatments for patients with posttraumatic stress disorder and traumatic brain injury. He also spoke to the proposed 2026 budget calling for a $5.4 billion increase for the VA. If approved, that money would be targeted for medical care and homelessness. 

US Department of Veterans Affairs (VA) Secretary Doug Collins testified in US House of Representatives and US Senate committees hearings that bringing staff numbers down to fiscal year 2019 figures was simply a goal: “Our goal, as we look at it, as everything goes forward, is a 15% decrease,” he told the senators. “It’s a goal. You have to start somewhere.”

“It’s a process we’re going through and I’m not going to work out a process in front of a committee or anywhere else,” Collins testified in the Senate on May 6, adding that it would be “incompetence” or “malpractice” to do so before time. “[When] we’re doing something as large as we are in an organization as sensitive on this Hill, it would not be right for us to do that in public. It would not be right for us to just come out and say here’s everything that we got and then have everybody scared because in the end it may not be the final decision.”

“We’re going to come to the best possible decision we can for the veterans in this country so they can have a VA system that actually works,” Collins argued in the Senate. “The VA’s been an issue for a long time. We’re trying to not make it an issue anymore.”

Collins later told a House committee on May 15 that VA was conducting a thorough review of department structure and staffing across the enterpise. "Our goal is to increase productivity and efficiency and to eliminate waste and bureaucracy improving health care delivery and benefits to our veterans. We are going to maintain VA essential jobs like doctors and nurses and claims processors" but eliminate positions it deemed "nonmission-critical" and consolidating areas of "overlap and waste."

Senate ranking member Richard Blumenthal (D-CT) and Chairman Jerry Moran (R-KS) both placed an emphasis on accountability for responsible resizing at the hearing. 

“The department is at a critical juncture,” Moran said. “Perhaps that’s always true, and I want to hear from you that the changes under way at the VA are backed by data, informed by veteran demand, focused on improving outcomes for men and women the VA serves, and will be carried out in close coordination with this committee, as well as with veterans, VA staff, and veteran organizations.” Moran stressed that cutting should be about right-sizing, done carefully, and while treating people “with gratitude and respect.”

Blumenthal was more direct in his criticism of the approach: “You cannot slash and trash the VA without eliminating those essential positions which provide access and availability of health care. It simply cannot be done,” he told Collins.

In response, Collins replied, “You have stated on several occasions already that I am saying we are going to fire 83,000 employees. That is wrong.” Collins insisted that the VA was “looking at a goal of how many employees we have and how many employees that are actually working in the front line taking care. I have doctors and nurses right now that do not see patients. Is that helping veteran health care?”

Collins defended the actions of the VA and spoke about challenges he was “constantly fighting” in the early weeks of his tenure. “We’ve been hit by a barrage of false rumors, innuendo, disinformation, speculation implying firing doctors and nurses, and forcing staff to work in closets and showers and that there’s chaos in the department, none of which have been backed up. Why? Because we canceled some contracts that worked for the VA that we should be doing in-house and we let go of less than one half of one percent of nonmission critical employees.”

The Trump Administration offered federal employees the option of resigning, which purportedly will go toward meeting the 15% target. NPR reported that VA employees have since shared data showing that 11,273 agency employees nationwide have applied for deferred resignation. Most of those employees are nurses (about 1300), medical support assistants (about 800), and social workers (about 300). 

Collins stressed that the aim of restructuring was to protect veterans’ health care. By getting rid of DEI initiatives, the VA saved $14 million, which he said was redirected to veterans with disabilities who need prosthetics.

Sen. Bernie Sanders (D-VT) addressed concerns about the existing shortage of clinicians at the VA, asking Collins what he was doing to bring in more doctors, nurses, and social workers. In addition to moving doctors and nurses from nonpatient care to patient care, Collins said, he planned to work with Congress to make salaries more competitive.

But money and adding more employees are not always the solution, Collins said. For example, he said, the VA has been spending $588 million a year veteran suicide research, its top clinical priority. Yet, he said there has not been a significant decrease in veteran suicide rates since 2008. 

The most recent VA suicide report, released in 2024, indicates suicide rates have remained steady since 2001. However, in 2022, the number of suicides among veterans (6407) was actually lower than in 12 of the previous 14 years. 

According to media reports, congressional lawmakers, and union officials, Veteran Crisis Line (VCL) staff were among the 2400 probationary employees fired in February. In a Feb. 20 video, Collins accused Democrats of spreading lies and insisted no one who answered the phone was fired.

Later, in a letter to senators, Collins admitted that 24 VCL support staff were “erroneously” sent termination notices. The firings were later reversed, Collins said, and all VCL employees had been reinstated at the same position they previously held. “Ensuring the VCL is always accessible 24/7 is one of the department’s top priorities,” Collins insisted.

Collins shared his approval of keeping and expanding VA programs and studies on psychedelic treatments for patients with posttraumatic stress disorder and traumatic brain injury. He also spoke to the proposed 2026 budget calling for a $5.4 billion increase for the VA. If approved, that money would be targeted for medical care and homelessness. 

US Department of Veterans Affairs (VA) Secretary Doug Collins testified in US House of Representatives and US Senate committees hearings that bringing staff numbers down to fiscal year 2019 figures was simply a goal: “Our goal, as we look at it, as everything goes forward, is a 15% decrease,” he told the senators. “It’s a goal. You have to start somewhere.”

“It’s a process we’re going through and I’m not going to work out a process in front of a committee or anywhere else,” Collins testified in the Senate on May 6, adding that it would be “incompetence” or “malpractice” to do so before time. “[When] we’re doing something as large as we are in an organization as sensitive on this Hill, it would not be right for us to do that in public. It would not be right for us to just come out and say here’s everything that we got and then have everybody scared because in the end it may not be the final decision.”

“We’re going to come to the best possible decision we can for the veterans in this country so they can have a VA system that actually works,” Collins argued in the Senate. “The VA’s been an issue for a long time. We’re trying to not make it an issue anymore.”

Collins later told a House committee on May 15 that VA was conducting a thorough review of department structure and staffing across the enterpise. "Our goal is to increase productivity and efficiency and to eliminate waste and bureaucracy improving health care delivery and benefits to our veterans. We are going to maintain VA essential jobs like doctors and nurses and claims processors" but eliminate positions it deemed "nonmission-critical" and consolidating areas of "overlap and waste."

Senate ranking member Richard Blumenthal (D-CT) and Chairman Jerry Moran (R-KS) both placed an emphasis on accountability for responsible resizing at the hearing. 

“The department is at a critical juncture,” Moran said. “Perhaps that’s always true, and I want to hear from you that the changes under way at the VA are backed by data, informed by veteran demand, focused on improving outcomes for men and women the VA serves, and will be carried out in close coordination with this committee, as well as with veterans, VA staff, and veteran organizations.” Moran stressed that cutting should be about right-sizing, done carefully, and while treating people “with gratitude and respect.”

Blumenthal was more direct in his criticism of the approach: “You cannot slash and trash the VA without eliminating those essential positions which provide access and availability of health care. It simply cannot be done,” he told Collins.

In response, Collins replied, “You have stated on several occasions already that I am saying we are going to fire 83,000 employees. That is wrong.” Collins insisted that the VA was “looking at a goal of how many employees we have and how many employees that are actually working in the front line taking care. I have doctors and nurses right now that do not see patients. Is that helping veteran health care?”

Collins defended the actions of the VA and spoke about challenges he was “constantly fighting” in the early weeks of his tenure. “We’ve been hit by a barrage of false rumors, innuendo, disinformation, speculation implying firing doctors and nurses, and forcing staff to work in closets and showers and that there’s chaos in the department, none of which have been backed up. Why? Because we canceled some contracts that worked for the VA that we should be doing in-house and we let go of less than one half of one percent of nonmission critical employees.”

The Trump Administration offered federal employees the option of resigning, which purportedly will go toward meeting the 15% target. NPR reported that VA employees have since shared data showing that 11,273 agency employees nationwide have applied for deferred resignation. Most of those employees are nurses (about 1300), medical support assistants (about 800), and social workers (about 300). 

Collins stressed that the aim of restructuring was to protect veterans’ health care. By getting rid of DEI initiatives, the VA saved $14 million, which he said was redirected to veterans with disabilities who need prosthetics.

Sen. Bernie Sanders (D-VT) addressed concerns about the existing shortage of clinicians at the VA, asking Collins what he was doing to bring in more doctors, nurses, and social workers. In addition to moving doctors and nurses from nonpatient care to patient care, Collins said, he planned to work with Congress to make salaries more competitive.

But money and adding more employees are not always the solution, Collins said. For example, he said, the VA has been spending $588 million a year veteran suicide research, its top clinical priority. Yet, he said there has not been a significant decrease in veteran suicide rates since 2008. 

The most recent VA suicide report, released in 2024, indicates suicide rates have remained steady since 2001. However, in 2022, the number of suicides among veterans (6407) was actually lower than in 12 of the previous 14 years. 

According to media reports, congressional lawmakers, and union officials, Veteran Crisis Line (VCL) staff were among the 2400 probationary employees fired in February. In a Feb. 20 video, Collins accused Democrats of spreading lies and insisted no one who answered the phone was fired.

Later, in a letter to senators, Collins admitted that 24 VCL support staff were “erroneously” sent termination notices. The firings were later reversed, Collins said, and all VCL employees had been reinstated at the same position they previously held. “Ensuring the VCL is always accessible 24/7 is one of the department’s top priorities,” Collins insisted.

Collins shared his approval of keeping and expanding VA programs and studies on psychedelic treatments for patients with posttraumatic stress disorder and traumatic brain injury. He also spoke to the proposed 2026 budget calling for a $5.4 billion increase for the VA. If approved, that money would be targeted for medical care and homelessness.