News

Creating a legacy of giving is easier than you think. As the spring season begins, take some time to start creating your legacy while supporting the AGA Research Foundation.

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. 

Here are two ideas to help you get started.

1. Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

2. Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://foundation.gastro.org/gift-planning/.







 

Creating a legacy of giving is easier than you think. As the spring season begins, take some time to start creating your legacy while supporting the AGA Research Foundation.

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. 

Here are two ideas to help you get started.

1. Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

2. Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://foundation.gastro.org/gift-planning/.







 

Creating a legacy of giving is easier than you think. As the spring season begins, take some time to start creating your legacy while supporting the AGA Research Foundation.

Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime. 

Here are two ideas to help you get started.

1. Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

2. Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://foundation.gastro.org/gift-planning/.







 

Adding combination treatment with simvastatin and rifaximin to standard therapy did not prevent severe complications in patients with decompensated cirrhosis, a European randomized trial found.

Published in JAMA, the double-blind, placebo-controlled, phase 3 LIVERHOPE trial was conducted in 14 European hospitals from January 2019 to December 2022, the last date of follow-up.

Investigators led by Elisa Pose, MD, PhD, a research fellow in the Liver Unit at the Hospital Clínic de Barcelona in Barcelona, Spain, randomly assigned 237 patients with advanced, mostly alcohol-related liver disease to receive either simvastatin 20 mg/d plus rifaximin 1200 mg/d (n = 117) or an identical-appearing placebo (n = 120) for 12 months. Patients also received standard therapy, stratified according to Child-Pugh class B or C.

A previous simvastatin trial demonstrated a benefit in cirrhosis death. And with rifaximin, a large randomized controlled trial (RCT) “showed positive results for prevention of recurrent hepatic encephalopathy in cirrhosis,” Pose told GI & Hepatology News. “Rifaximin targets bacterial translocation from the gut in patients with cirrhosis. Simvastatin lowers portal pressure, the main pathogenetic cause of decompensation in cirrhosis, and may reduce systemic inflammation.”

“Randomized clinical trials showed that not only did 40 mg of simvastatin daily significantly reduce portal hypertension but it also improved survival in patients with cirrhosis who recovered from variceal bleeding compared with placebo,” added study co-author Ruben Hernaez, MD, MPH, PhD, an associate professor of medicine – gastroenterology at Baylor College of Medicine in Houston. “With rifaximin, one could expect not only improvement in hepatic encephalopathy but also a decreased infection rate, the most common trigger of acute-on-chronic liver failure [ACLF].”

In addition to lowering serum cholesterol, statins have pleiotropic effects via their anti-inflammatory properties, which make them an attractive option for decompensated cirrhosis, the authors explained, and their effect on portal hypertension may diminish complications and increase survival.

“The hypothesis is that simvastatin could improve intrahepatic circulation through an increase in nitric oxide synthesis or due to anti-inflammatory effects,” said Hernaez. “Cirrhosis, similar to any other chronic condition, suffers from an enhanced systemic inflammation, which increases as the disease progresses.”

Cirrhosis is also associated with increased gut permeability and bacterial translocation, which can foster hepatic encephalopathy, bacterial infection, and ACLF. Rifaximin has been shown to reduce the risk for recurrent hepatic encephalopathy and modulate the gut microbiome.

Commenting on the study but not involved in it, Meena B. Bansal, MD, a professor of medicine at the Icahn School of Medicine at Mount Sinai and system chief of the Division of Liver Diseases at Mount Sinai Health System, both in New York City, cautioned that previous studies were limited by confounding by indication because those with poor liver function already have low cholesterol and thus may not have been prescribed statins. In the current study, the authors prospectively used a statin independent of cholesterol levels and combined it with an antibiotic, which may help decrease microbial translocation and ACLF.

“There is a great need to prevent ACLF/decompensating events, and thus, the negative results of this study are disappointing,” Bansal said.

 

Study Details

The trial’s primary endpoint was the incidence of severe complications of liver cirrhosis associated with organ failure meeting criteria for ACLF. Secondary outcomes included transplant or death and a composite endpoint of cirrhotic complications, including ascites, hepatic encephalopathy, variceal bleeding, acute kidney injury, and infection.

The 237 participants had Child-Pugh class B (n = 194) or class C (n = 43), 72% were men, more than 90% were White, and 79.8% had alcohol-related cirrhosis.

The study found no significant differences between the treatment and placebo arms in the following outcomes:

• ACLF: 17.9% vs 14.2% (hazard ratio [HR], 1.23, 95% CI, 0.65-2.34; P =.52)
• Transplant or death: 18.8% vs 24.2% (HR, 0.75; 95% CI, 0.43-1.32; P =.32)
• Complications of cirrhosis: 42.7% vs 45.8% (HR, 0.93; 95% CI, 0.63-1.36; P =.70)

Also, the benefits were not observed in any patient subgroup, although this type of analysis was not part of the endpoints. The incidence of adverse events was similar in both arms at 426 vs 419 (P =.59), but three patients in the treatment group (2.6%) developed rhabdomyolysis.

The results suggest, however, that this statin/antibiotic combination is at least not harmful in this patient population, Hernaez said.

The lack of benefit observed likely related to the advanced state of liver disease in the cohort. “When you look at the MELD [Model for End-Stage Liver Disease] score, the most-used measure to assess liver function and prognosis, it is higher in this cohort than in patients from the previous trial showing positive results in survival,” Pose said. “The rest of the studies showing positive results were mostly retrospective cohort studies or small RCTs showing effects on portal pressure. We think it is likely that studies at earlier stages — maybe patients with compensated liver disease — may have more positive results.”

Pose added that statins will not be prescribed at her center beyond the lipid-lowering indication. And in her view, the question of add-on therapy is closed for patients with advanced disease “but may be open for earlier stages of cirrhosis.”

Unanswered questions remain, however, Hernaez said. “For example, patients with metabolic dysfunction–associated steatotic liver disease may have a different intensity of the inflammatory milieu compared to the majority of patients in our study [whose disease] was alcohol-related.” Furthermore, is a simvastatin dose of 20 mg enough, and what would be the effect if patients had less advanced disease or compensated cirrhosis? “Hence, while we proved with a well-conducted negative randomized clinical trial the combination is not affecting this outcome and population, the question is still unanswered for other types of patient populations and/or dose.” Hernaez said.

Bansal, too, pointed to the need for further studies in more diverse populations with varying etiologies of liver disease. “About 80% of this European population had alcohol-associated liver disease,” she said, agreeing that the study population likely had too-advanced disease. “The beneficial effects of these drugs may only be seen in those with less advanced cirrhosis, which warrants further study.” Based on these findings, Bansal added, statins should not be prescribed to prevent ACLF but reserved for patients with eligible cardiovascular risk factors, and rifaximin for those who meet criteria for the treatment of hepatic encephalopathy.

This work was supported by a grant from the Horizon 20/20 program.

Pose, Hernaez, and Bansal had no relevant competing interests to disclose. Multiple coauthors, including co–senior author Pere Ginès, reported having financial ties such as receiving research funding from; receiving advisory, consulting, or speaker’s fees from; and holding stocks and patents in multiple private-sector companies.

A version of this article appeared on Medscape.com.

Adding combination treatment with simvastatin and rifaximin to standard therapy did not prevent severe complications in patients with decompensated cirrhosis, a European randomized trial found.

Published in JAMA, the double-blind, placebo-controlled, phase 3 LIVERHOPE trial was conducted in 14 European hospitals from January 2019 to December 2022, the last date of follow-up.

Investigators led by Elisa Pose, MD, PhD, a research fellow in the Liver Unit at the Hospital Clínic de Barcelona in Barcelona, Spain, randomly assigned 237 patients with advanced, mostly alcohol-related liver disease to receive either simvastatin 20 mg/d plus rifaximin 1200 mg/d (n = 117) or an identical-appearing placebo (n = 120) for 12 months. Patients also received standard therapy, stratified according to Child-Pugh class B or C.

A previous simvastatin trial demonstrated a benefit in cirrhosis death. And with rifaximin, a large randomized controlled trial (RCT) “showed positive results for prevention of recurrent hepatic encephalopathy in cirrhosis,” Pose told GI & Hepatology News. “Rifaximin targets bacterial translocation from the gut in patients with cirrhosis. Simvastatin lowers portal pressure, the main pathogenetic cause of decompensation in cirrhosis, and may reduce systemic inflammation.”

“Randomized clinical trials showed that not only did 40 mg of simvastatin daily significantly reduce portal hypertension but it also improved survival in patients with cirrhosis who recovered from variceal bleeding compared with placebo,” added study co-author Ruben Hernaez, MD, MPH, PhD, an associate professor of medicine – gastroenterology at Baylor College of Medicine in Houston. “With rifaximin, one could expect not only improvement in hepatic encephalopathy but also a decreased infection rate, the most common trigger of acute-on-chronic liver failure [ACLF].”

In addition to lowering serum cholesterol, statins have pleiotropic effects via their anti-inflammatory properties, which make them an attractive option for decompensated cirrhosis, the authors explained, and their effect on portal hypertension may diminish complications and increase survival.

“The hypothesis is that simvastatin could improve intrahepatic circulation through an increase in nitric oxide synthesis or due to anti-inflammatory effects,” said Hernaez. “Cirrhosis, similar to any other chronic condition, suffers from an enhanced systemic inflammation, which increases as the disease progresses.”

Cirrhosis is also associated with increased gut permeability and bacterial translocation, which can foster hepatic encephalopathy, bacterial infection, and ACLF. Rifaximin has been shown to reduce the risk for recurrent hepatic encephalopathy and modulate the gut microbiome.

Commenting on the study but not involved in it, Meena B. Bansal, MD, a professor of medicine at the Icahn School of Medicine at Mount Sinai and system chief of the Division of Liver Diseases at Mount Sinai Health System, both in New York City, cautioned that previous studies were limited by confounding by indication because those with poor liver function already have low cholesterol and thus may not have been prescribed statins. In the current study, the authors prospectively used a statin independent of cholesterol levels and combined it with an antibiotic, which may help decrease microbial translocation and ACLF.

“There is a great need to prevent ACLF/decompensating events, and thus, the negative results of this study are disappointing,” Bansal said.

 

Study Details

The trial’s primary endpoint was the incidence of severe complications of liver cirrhosis associated with organ failure meeting criteria for ACLF. Secondary outcomes included transplant or death and a composite endpoint of cirrhotic complications, including ascites, hepatic encephalopathy, variceal bleeding, acute kidney injury, and infection.

The 237 participants had Child-Pugh class B (n = 194) or class C (n = 43), 72% were men, more than 90% were White, and 79.8% had alcohol-related cirrhosis.

The study found no significant differences between the treatment and placebo arms in the following outcomes:

• ACLF: 17.9% vs 14.2% (hazard ratio [HR], 1.23, 95% CI, 0.65-2.34; P =.52)
• Transplant or death: 18.8% vs 24.2% (HR, 0.75; 95% CI, 0.43-1.32; P =.32)
• Complications of cirrhosis: 42.7% vs 45.8% (HR, 0.93; 95% CI, 0.63-1.36; P =.70)

Also, the benefits were not observed in any patient subgroup, although this type of analysis was not part of the endpoints. The incidence of adverse events was similar in both arms at 426 vs 419 (P =.59), but three patients in the treatment group (2.6%) developed rhabdomyolysis.

The results suggest, however, that this statin/antibiotic combination is at least not harmful in this patient population, Hernaez said.

The lack of benefit observed likely related to the advanced state of liver disease in the cohort. “When you look at the MELD [Model for End-Stage Liver Disease] score, the most-used measure to assess liver function and prognosis, it is higher in this cohort than in patients from the previous trial showing positive results in survival,” Pose said. “The rest of the studies showing positive results were mostly retrospective cohort studies or small RCTs showing effects on portal pressure. We think it is likely that studies at earlier stages — maybe patients with compensated liver disease — may have more positive results.”

Pose added that statins will not be prescribed at her center beyond the lipid-lowering indication. And in her view, the question of add-on therapy is closed for patients with advanced disease “but may be open for earlier stages of cirrhosis.”

Unanswered questions remain, however, Hernaez said. “For example, patients with metabolic dysfunction–associated steatotic liver disease may have a different intensity of the inflammatory milieu compared to the majority of patients in our study [whose disease] was alcohol-related.” Furthermore, is a simvastatin dose of 20 mg enough, and what would be the effect if patients had less advanced disease or compensated cirrhosis? “Hence, while we proved with a well-conducted negative randomized clinical trial the combination is not affecting this outcome and population, the question is still unanswered for other types of patient populations and/or dose.” Hernaez said.

Bansal, too, pointed to the need for further studies in more diverse populations with varying etiologies of liver disease. “About 80% of this European population had alcohol-associated liver disease,” she said, agreeing that the study population likely had too-advanced disease. “The beneficial effects of these drugs may only be seen in those with less advanced cirrhosis, which warrants further study.” Based on these findings, Bansal added, statins should not be prescribed to prevent ACLF but reserved for patients with eligible cardiovascular risk factors, and rifaximin for those who meet criteria for the treatment of hepatic encephalopathy.

This work was supported by a grant from the Horizon 20/20 program.

Pose, Hernaez, and Bansal had no relevant competing interests to disclose. Multiple coauthors, including co–senior author Pere Ginès, reported having financial ties such as receiving research funding from; receiving advisory, consulting, or speaker’s fees from; and holding stocks and patents in multiple private-sector companies.

A version of this article appeared on Medscape.com.

Adding combination treatment with simvastatin and rifaximin to standard therapy did not prevent severe complications in patients with decompensated cirrhosis, a European randomized trial found.

Published in JAMA, the double-blind, placebo-controlled, phase 3 LIVERHOPE trial was conducted in 14 European hospitals from January 2019 to December 2022, the last date of follow-up.

Investigators led by Elisa Pose, MD, PhD, a research fellow in the Liver Unit at the Hospital Clínic de Barcelona in Barcelona, Spain, randomly assigned 237 patients with advanced, mostly alcohol-related liver disease to receive either simvastatin 20 mg/d plus rifaximin 1200 mg/d (n = 117) or an identical-appearing placebo (n = 120) for 12 months. Patients also received standard therapy, stratified according to Child-Pugh class B or C.

A previous simvastatin trial demonstrated a benefit in cirrhosis death. And with rifaximin, a large randomized controlled trial (RCT) “showed positive results for prevention of recurrent hepatic encephalopathy in cirrhosis,” Pose told GI & Hepatology News. “Rifaximin targets bacterial translocation from the gut in patients with cirrhosis. Simvastatin lowers portal pressure, the main pathogenetic cause of decompensation in cirrhosis, and may reduce systemic inflammation.”

“Randomized clinical trials showed that not only did 40 mg of simvastatin daily significantly reduce portal hypertension but it also improved survival in patients with cirrhosis who recovered from variceal bleeding compared with placebo,” added study co-author Ruben Hernaez, MD, MPH, PhD, an associate professor of medicine – gastroenterology at Baylor College of Medicine in Houston. “With rifaximin, one could expect not only improvement in hepatic encephalopathy but also a decreased infection rate, the most common trigger of acute-on-chronic liver failure [ACLF].”

In addition to lowering serum cholesterol, statins have pleiotropic effects via their anti-inflammatory properties, which make them an attractive option for decompensated cirrhosis, the authors explained, and their effect on portal hypertension may diminish complications and increase survival.

“The hypothesis is that simvastatin could improve intrahepatic circulation through an increase in nitric oxide synthesis or due to anti-inflammatory effects,” said Hernaez. “Cirrhosis, similar to any other chronic condition, suffers from an enhanced systemic inflammation, which increases as the disease progresses.”

Cirrhosis is also associated with increased gut permeability and bacterial translocation, which can foster hepatic encephalopathy, bacterial infection, and ACLF. Rifaximin has been shown to reduce the risk for recurrent hepatic encephalopathy and modulate the gut microbiome.

Commenting on the study but not involved in it, Meena B. Bansal, MD, a professor of medicine at the Icahn School of Medicine at Mount Sinai and system chief of the Division of Liver Diseases at Mount Sinai Health System, both in New York City, cautioned that previous studies were limited by confounding by indication because those with poor liver function already have low cholesterol and thus may not have been prescribed statins. In the current study, the authors prospectively used a statin independent of cholesterol levels and combined it with an antibiotic, which may help decrease microbial translocation and ACLF.

“There is a great need to prevent ACLF/decompensating events, and thus, the negative results of this study are disappointing,” Bansal said.

 

Study Details

The trial’s primary endpoint was the incidence of severe complications of liver cirrhosis associated with organ failure meeting criteria for ACLF. Secondary outcomes included transplant or death and a composite endpoint of cirrhotic complications, including ascites, hepatic encephalopathy, variceal bleeding, acute kidney injury, and infection.

The 237 participants had Child-Pugh class B (n = 194) or class C (n = 43), 72% were men, more than 90% were White, and 79.8% had alcohol-related cirrhosis.

The study found no significant differences between the treatment and placebo arms in the following outcomes:

• ACLF: 17.9% vs 14.2% (hazard ratio [HR], 1.23, 95% CI, 0.65-2.34; P =.52)
• Transplant or death: 18.8% vs 24.2% (HR, 0.75; 95% CI, 0.43-1.32; P =.32)
• Complications of cirrhosis: 42.7% vs 45.8% (HR, 0.93; 95% CI, 0.63-1.36; P =.70)

Also, the benefits were not observed in any patient subgroup, although this type of analysis was not part of the endpoints. The incidence of adverse events was similar in both arms at 426 vs 419 (P =.59), but three patients in the treatment group (2.6%) developed rhabdomyolysis.

The results suggest, however, that this statin/antibiotic combination is at least not harmful in this patient population, Hernaez said.

The lack of benefit observed likely related to the advanced state of liver disease in the cohort. “When you look at the MELD [Model for End-Stage Liver Disease] score, the most-used measure to assess liver function and prognosis, it is higher in this cohort than in patients from the previous trial showing positive results in survival,” Pose said. “The rest of the studies showing positive results were mostly retrospective cohort studies or small RCTs showing effects on portal pressure. We think it is likely that studies at earlier stages — maybe patients with compensated liver disease — may have more positive results.”

Pose added that statins will not be prescribed at her center beyond the lipid-lowering indication. And in her view, the question of add-on therapy is closed for patients with advanced disease “but may be open for earlier stages of cirrhosis.”

Unanswered questions remain, however, Hernaez said. “For example, patients with metabolic dysfunction–associated steatotic liver disease may have a different intensity of the inflammatory milieu compared to the majority of patients in our study [whose disease] was alcohol-related.” Furthermore, is a simvastatin dose of 20 mg enough, and what would be the effect if patients had less advanced disease or compensated cirrhosis? “Hence, while we proved with a well-conducted negative randomized clinical trial the combination is not affecting this outcome and population, the question is still unanswered for other types of patient populations and/or dose.” Hernaez said.

Bansal, too, pointed to the need for further studies in more diverse populations with varying etiologies of liver disease. “About 80% of this European population had alcohol-associated liver disease,” she said, agreeing that the study population likely had too-advanced disease. “The beneficial effects of these drugs may only be seen in those with less advanced cirrhosis, which warrants further study.” Based on these findings, Bansal added, statins should not be prescribed to prevent ACLF but reserved for patients with eligible cardiovascular risk factors, and rifaximin for those who meet criteria for the treatment of hepatic encephalopathy.

This work was supported by a grant from the Horizon 20/20 program.

Pose, Hernaez, and Bansal had no relevant competing interests to disclose. Multiple coauthors, including co–senior author Pere Ginès, reported having financial ties such as receiving research funding from; receiving advisory, consulting, or speaker’s fees from; and holding stocks and patents in multiple private-sector companies.

A version of this article appeared on Medscape.com.

A noninvasive clinicopathologic and gene expression profiling (CP-GEP)–based tool, the Merlin assay, shows promise for identifying recurrence risks in patients with early-stage melanoma who do not undergo sentinel lymph node biopsy (SNLB).

This was the conclusion of a retrospective analysis of a large cohort of patients with stage I/II disease, reported by Teresa Amaral, MD, PhD, at the 11th World Congress of Melanoma and 21st European Association of Dermato-Oncology Congress 2025.

Of 930 patients included in the study, the assay identified 879 as having a low risk for recurrence and 51 as having high risk for recurrence. The overall 5-year recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and melanoma-specific survival (MSS) rates were 90.9%, 96.9%, and 97.5%, respectively.

The corresponding rates among those stratified by the assay as having low vs high recurrence risk, respectively, were 94.6% and 26.6% for RFS (hazard ratio [HR], 25.08), 98.6% vs 62.1% for DMFS (HR, 35.39), and 99.4% vs 61.7% for MSS (HR, 71.05), said Amaral, during her presentation at the meeting.

Of 16 melanoma-specific deaths, 12 were stratified as high risk for recurrence by the CP-GEP assay, said Amaral, head of the Skin Cancer Clinical Trials Center at the University of Tübingen, Tübingen, Germany, and first author of the study.

Study participants had stages IA-IIC melanoma, 41% were women, and median age was 64 years. Median melanoma thickness was 0.5 mm, and 94% were not ulcerated. 

No systemic treatment options currently exist for patients with this early-stage disease, the author said.

The CP-GEP model, initially developed by the Mayo Clinic and SkylineDx BV to predict the positivity of SNLB, has been validated in multiple studies.

Amaral and her colleagues previously demonstrated the ability of the CP-GEP model to stratify patients with stages I-II disease as having low or high risk for recurrence — including in a small number of patients without SNLB. Those findings are confirmed in this larger population of patients who did not undergo SNLB, she said.

SkylineDx announced the findings in a press release stating the results validate the prognostic power of the Merlin assay for “identifying tumors at high risk for relapse that would otherwise be missed by traditional clinical and pathological evaluation.”

SNLB is the gold standard for nodal assessment for staging cutaneous melanoma. More than 80% of patients who undergo SNLB are negative for nodal metastases, but most patients who relapse or die from their melanoma are initially stratified by SNLB as having low-risk early-stage disease, Amaral explained. This suggests “SNLB is not enough,” she noted.

The findings suggest that CP-GEP has the potential to risk stratify patients with early-stage melanoma that did not undergo SLNB and help select those who can forgo SLNB, she said.

Without another means of assessing risk, patients considered low risk based on SNLB are closely followed, the author explained.

“If we could identify the very low-risk patient and then allocate the resources to the very high-risk patients who really need a more detailed and more tailored approach…we would be doing a favor to our patients,” the author concluded.

Amaral disclosed personal financial relationships with Delcath, Philogen, Bristol Myers Squibb, NeraCare, Novartis, Pierre Fabre, CeCaVa, and MedTrix.

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

A noninvasive clinicopathologic and gene expression profiling (CP-GEP)–based tool, the Merlin assay, shows promise for identifying recurrence risks in patients with early-stage melanoma who do not undergo sentinel lymph node biopsy (SNLB).

This was the conclusion of a retrospective analysis of a large cohort of patients with stage I/II disease, reported by Teresa Amaral, MD, PhD, at the 11th World Congress of Melanoma and 21st European Association of Dermato-Oncology Congress 2025.

Of 930 patients included in the study, the assay identified 879 as having a low risk for recurrence and 51 as having high risk for recurrence. The overall 5-year recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and melanoma-specific survival (MSS) rates were 90.9%, 96.9%, and 97.5%, respectively.

The corresponding rates among those stratified by the assay as having low vs high recurrence risk, respectively, were 94.6% and 26.6% for RFS (hazard ratio [HR], 25.08), 98.6% vs 62.1% for DMFS (HR, 35.39), and 99.4% vs 61.7% for MSS (HR, 71.05), said Amaral, during her presentation at the meeting.

Of 16 melanoma-specific deaths, 12 were stratified as high risk for recurrence by the CP-GEP assay, said Amaral, head of the Skin Cancer Clinical Trials Center at the University of Tübingen, Tübingen, Germany, and first author of the study.

Study participants had stages IA-IIC melanoma, 41% were women, and median age was 64 years. Median melanoma thickness was 0.5 mm, and 94% were not ulcerated. 

No systemic treatment options currently exist for patients with this early-stage disease, the author said.

The CP-GEP model, initially developed by the Mayo Clinic and SkylineDx BV to predict the positivity of SNLB, has been validated in multiple studies.

Amaral and her colleagues previously demonstrated the ability of the CP-GEP model to stratify patients with stages I-II disease as having low or high risk for recurrence — including in a small number of patients without SNLB. Those findings are confirmed in this larger population of patients who did not undergo SNLB, she said.

SkylineDx announced the findings in a press release stating the results validate the prognostic power of the Merlin assay for “identifying tumors at high risk for relapse that would otherwise be missed by traditional clinical and pathological evaluation.”

SNLB is the gold standard for nodal assessment for staging cutaneous melanoma. More than 80% of patients who undergo SNLB are negative for nodal metastases, but most patients who relapse or die from their melanoma are initially stratified by SNLB as having low-risk early-stage disease, Amaral explained. This suggests “SNLB is not enough,” she noted.

The findings suggest that CP-GEP has the potential to risk stratify patients with early-stage melanoma that did not undergo SLNB and help select those who can forgo SLNB, she said.

Without another means of assessing risk, patients considered low risk based on SNLB are closely followed, the author explained.

“If we could identify the very low-risk patient and then allocate the resources to the very high-risk patients who really need a more detailed and more tailored approach…we would be doing a favor to our patients,” the author concluded.

Amaral disclosed personal financial relationships with Delcath, Philogen, Bristol Myers Squibb, NeraCare, Novartis, Pierre Fabre, CeCaVa, and MedTrix.

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

A noninvasive clinicopathologic and gene expression profiling (CP-GEP)–based tool, the Merlin assay, shows promise for identifying recurrence risks in patients with early-stage melanoma who do not undergo sentinel lymph node biopsy (SNLB).

This was the conclusion of a retrospective analysis of a large cohort of patients with stage I/II disease, reported by Teresa Amaral, MD, PhD, at the 11th World Congress of Melanoma and 21st European Association of Dermato-Oncology Congress 2025.

Of 930 patients included in the study, the assay identified 879 as having a low risk for recurrence and 51 as having high risk for recurrence. The overall 5-year recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and melanoma-specific survival (MSS) rates were 90.9%, 96.9%, and 97.5%, respectively.

The corresponding rates among those stratified by the assay as having low vs high recurrence risk, respectively, were 94.6% and 26.6% for RFS (hazard ratio [HR], 25.08), 98.6% vs 62.1% for DMFS (HR, 35.39), and 99.4% vs 61.7% for MSS (HR, 71.05), said Amaral, during her presentation at the meeting.

Of 16 melanoma-specific deaths, 12 were stratified as high risk for recurrence by the CP-GEP assay, said Amaral, head of the Skin Cancer Clinical Trials Center at the University of Tübingen, Tübingen, Germany, and first author of the study.

Study participants had stages IA-IIC melanoma, 41% were women, and median age was 64 years. Median melanoma thickness was 0.5 mm, and 94% were not ulcerated. 

No systemic treatment options currently exist for patients with this early-stage disease, the author said.

The CP-GEP model, initially developed by the Mayo Clinic and SkylineDx BV to predict the positivity of SNLB, has been validated in multiple studies.

Amaral and her colleagues previously demonstrated the ability of the CP-GEP model to stratify patients with stages I-II disease as having low or high risk for recurrence — including in a small number of patients without SNLB. Those findings are confirmed in this larger population of patients who did not undergo SNLB, she said.

SkylineDx announced the findings in a press release stating the results validate the prognostic power of the Merlin assay for “identifying tumors at high risk for relapse that would otherwise be missed by traditional clinical and pathological evaluation.”

SNLB is the gold standard for nodal assessment for staging cutaneous melanoma. More than 80% of patients who undergo SNLB are negative for nodal metastases, but most patients who relapse or die from their melanoma are initially stratified by SNLB as having low-risk early-stage disease, Amaral explained. This suggests “SNLB is not enough,” she noted.

The findings suggest that CP-GEP has the potential to risk stratify patients with early-stage melanoma that did not undergo SLNB and help select those who can forgo SLNB, she said.

Without another means of assessing risk, patients considered low risk based on SNLB are closely followed, the author explained.

“If we could identify the very low-risk patient and then allocate the resources to the very high-risk patients who really need a more detailed and more tailored approach…we would be doing a favor to our patients,” the author concluded.

Amaral disclosed personal financial relationships with Delcath, Philogen, Bristol Myers Squibb, NeraCare, Novartis, Pierre Fabre, CeCaVa, and MedTrix.

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

Whatever’s ailing you, a vacation might just be the cure. Yes, getting away can improve your health, according to research published in in 2023. It might help combat symptoms of aging, suggested a 2024 study in Journal of Travel Research. But it could also have even more powerful psychological and physical benefits, transforming your life before you pack a bag and long after you return home.

This news organization spoke with two healthcare professionals who believe in the healing power of travel. They shared which personal “diagnoses” they have successfully treated with faraway places and how this therapy might work for you.

Stacey Funt, MD, NBC-HWC, a radiologist at Northwell Health in Long Island, New York, started the boutique wellness adventure travel company, LH Adventure Travel, in 2023. Funt curates and leads small groups to destinations like Peru, Guatemala, Morocco, and Italy. Each tour incorporates tenets of lifestyle medicine, including healthy eating, movement, stress management, and community building.

Kiya Thompson, RN, a surgical trauma nurse for 20 years, was similarly inspired to share her passion for travel. She is now a certified family travel coach who helps parents plan meaningful trips through her company, LuckyBucky, LLC.



Dx: Self-Esteem Deficiency / Rx: Vivaldi in Venice

In June 2015, Thompson found herself at an all-time low. As a nurse, she felt confident that she was “built for the adrenaline rush and could take on anything.” But outside the trauma center, Thompson felt inadequate, her self-esteem eroded by years of abusive relationships. “The daily hardships of my personal life, combined with the mental fortitude it took to endure the demands of caring for the sickest of the sick, were incredibly weighty,” she recalled. 

To escape, Thompson booked her first solo trip: 3 weeks in Italy. But days after she arrived, she felt the need to “escape her escape.” On a bus in Naples, she was pick-pocketed. The man she had been dating before her trip stopped responding to her messages. In her hotel room in Venice, she felt “lost, alone, and helpless.”

One evening, Thompson attended a small orchestral performance of Vivaldi’s “The Four Seasons” in a centuries-old church. The music triggered memories of her Italian grandparents at whose home she’d listened to the same piece.

“A switch flipped, and I changed my whole outlook,” she remembers.

During the concert, she reflected on strangers who had shown her kindness and care. A Canadian man who gave her €50 after her wallet was stolen. A friend-of-a-friend who showed her around Rome. The clerk at her Venice hotel who had offered her a hug.

“In the wake of experiencing the worst of people, I’d experienced so much more of the best of people; strangers who were willing to go above and beyond to help me,” Thompson said.

When Thompson returned home, she brought her new mindset along. “ My ability to problem-solve my way through a solo trip that presented unexpected hardships empowered me,” she explained. “I learned I was much more capable than I’d thought.”



Dx: Wilderness Phobia / Rx: A Safari in Tanzania

On an evening in the mid-1990s, Funt was alone in a tent on a budget camping safari in Tanzania. Animals roared threateningly outside the thin walls. Earlier that day, a vulture had ripped a sandwich out of her hands. Funt was frightened to the core. Worrying that she’d be the next meal for the local wildlife, she started to sob. “This was as raw as I had ever gotten at that point in my life,” she said.

Suddenly, Funt said her brain shifted into problem-solving mode. She made one small decision: To switch to a different Jeep for the next day’s excursion. Having made a seemingly insignificant choice, she felt calmer and no longer like a victim. It brought control. Instead of worrying, she began looking forward to the wildlife she would see.

In the morning, in the new Jeep, she befriended a nurse from Canada. Together, they visited the Maasai Mara tribe and nearby pubs, meeting members of the community.

“It was the most exciting experience of my life,” Funt said. “And it had started with me crying.”



Dx: Parenting-itis / Rx: A Mountain Getaway 

As Thompson pointed out, sometimes the destination is secondary to the intension behind a trip. And the quality of the time away matters more than how long you can stay. After becoming parents 4 years ago, Thompson and her husband hadn’t traveled alone together. Like many parents of young children, they were short on time to relax and reconnect as a couple.

So Thompson planned a weekend trip to an isolated cabin in the Massanutten Mountain Range within the George Washington National Forest, about a 2-hour drive from their Washington, DC, area home.

“We put our devices away and focused on being completely present with one another,” said Thompson. The couple took a walk in the woods, where “all we could hear were drops of water from the snowmelt, the crunch of the snow beneath our feet, and the occasional bird looking for food,” she recalled. “There were no cars, no other people. It was quiet, calm, and incredibly peaceful.”

Whether sitting by the fire, soaking in the outdoor hot tub, or playing card games, “our conversation didn’t surround what we’d have for dinner or who would do baths and bedtime with whom,” Thompson said. “We didn’t talk about work, upcoming commitments, or items on our to-do lists.” The getaway was so refreshing, the couple intend to repeat the trip each year.



Dx: Persistent Grief / Rx: Hiking and Hinduism in Nepal

Nearly 3 years ago, Funt experienced a 2-month period where both of her kids left for college and both her father and father-in-law passed away. Besieged by grief, she found herself questioning whether her best years were behind her. She was also grappling with her mortality, because she was then approaching 59, the age at which her own mother had died. So Funt decided to go trekking in Nepal. “I am a traveler — it’s what I do,” she said.

Having the trip to prepare for changed Funt’s whole outlook, she remembers. Throwing herself into the planning helped her transcend her grief. But being in Nepal was even more impactful. She and her husband spent hours trekking through majestic mountain ranges, which “touched their souls.” At a crematorium, they learned about Hindu beliefs on death, which helped them with the grieving process.

The trip “lifted me so high up on so many levels and brought me back to my authentic self,” Funt said. On her flight home from Kathmandu, she decided to start her travel business.

“I needed something else [in addition to radiology] to put my passion, heart, and creativity into, and it would be another way of doing service,” she explained.



Dx: Couch Potato Syndrome / Rx: Planning an Adventure 

Like all of us, Funt knows exercise is important for health. But that knowledge alone doesn’t motivate her to move, she admitted. What does get her off the couch is scheduling an active trip — and then training for it. “When I have a goal tied to my values of adventure, connection, and community, fear will set in if I don’t start to move,” she said. It was after booking her Nepal trip (which included an 8-mile, 3000-foot trek) that Funt started getting in shape.

Travel has motivated Funt’s clients in similar ways. Last year, 8 months before one of her Morocco trips, Funt spoke over Zoom with a woman who’d just enrolled. This woman told her she’d signed up in order to commit to her health.

By the time Funt saw her again, on day 1 of the trip, the woman had lost 50 pounds. “It was the greatest transformation,” Funt recalled. “On the trip, she was the first one up the mountain and beamed the whole time. It was beautiful to watch her reclaim her power, body, and life.”

 

Getting Lost — Finding Inspiration

Since Thompson’s trip to Italy, she has traveled extensively, visiting nearly 25 countries. “Traveling inspired me to continue exploring the world and myself,” she said.

Since leading her first trip to Morocco in 2023, Funt said she’s received more letters of appreciation from her clients than her patients. The results from this type of travel therapy can be dramatic.

After a trip with Funt, one burned-out physician decided that she needed to find a job with a better work-life balance. An empty nester realized the “feeling of belonging and community” on the trip was what had been missing in her “regular” life. After returning home, she began rekindling relationships with old friends.

To many, a vacation is a treat. But, as Funt and Thompson have learned firsthand, it can also be a prescription — for ennui, sadness, loneliness, and all the physical issues that come with them. Sometimes, going far away helps you come home to yourself.

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

Whatever’s ailing you, a vacation might just be the cure. Yes, getting away can improve your health, according to research published in in 2023. It might help combat symptoms of aging, suggested a 2024 study in Journal of Travel Research. But it could also have even more powerful psychological and physical benefits, transforming your life before you pack a bag and long after you return home.

This news organization spoke with two healthcare professionals who believe in the healing power of travel. They shared which personal “diagnoses” they have successfully treated with faraway places and how this therapy might work for you.

Stacey Funt, MD, NBC-HWC, a radiologist at Northwell Health in Long Island, New York, started the boutique wellness adventure travel company, LH Adventure Travel, in 2023. Funt curates and leads small groups to destinations like Peru, Guatemala, Morocco, and Italy. Each tour incorporates tenets of lifestyle medicine, including healthy eating, movement, stress management, and community building.

Kiya Thompson, RN, a surgical trauma nurse for 20 years, was similarly inspired to share her passion for travel. She is now a certified family travel coach who helps parents plan meaningful trips through her company, LuckyBucky, LLC.



Dx: Self-Esteem Deficiency / Rx: Vivaldi in Venice

In June 2015, Thompson found herself at an all-time low. As a nurse, she felt confident that she was “built for the adrenaline rush and could take on anything.” But outside the trauma center, Thompson felt inadequate, her self-esteem eroded by years of abusive relationships. “The daily hardships of my personal life, combined with the mental fortitude it took to endure the demands of caring for the sickest of the sick, were incredibly weighty,” she recalled. 

To escape, Thompson booked her first solo trip: 3 weeks in Italy. But days after she arrived, she felt the need to “escape her escape.” On a bus in Naples, she was pick-pocketed. The man she had been dating before her trip stopped responding to her messages. In her hotel room in Venice, she felt “lost, alone, and helpless.”

One evening, Thompson attended a small orchestral performance of Vivaldi’s “The Four Seasons” in a centuries-old church. The music triggered memories of her Italian grandparents at whose home she’d listened to the same piece.

“A switch flipped, and I changed my whole outlook,” she remembers.

During the concert, she reflected on strangers who had shown her kindness and care. A Canadian man who gave her €50 after her wallet was stolen. A friend-of-a-friend who showed her around Rome. The clerk at her Venice hotel who had offered her a hug.

“In the wake of experiencing the worst of people, I’d experienced so much more of the best of people; strangers who were willing to go above and beyond to help me,” Thompson said.

When Thompson returned home, she brought her new mindset along. “ My ability to problem-solve my way through a solo trip that presented unexpected hardships empowered me,” she explained. “I learned I was much more capable than I’d thought.”



Dx: Wilderness Phobia / Rx: A Safari in Tanzania

On an evening in the mid-1990s, Funt was alone in a tent on a budget camping safari in Tanzania. Animals roared threateningly outside the thin walls. Earlier that day, a vulture had ripped a sandwich out of her hands. Funt was frightened to the core. Worrying that she’d be the next meal for the local wildlife, she started to sob. “This was as raw as I had ever gotten at that point in my life,” she said.

Suddenly, Funt said her brain shifted into problem-solving mode. She made one small decision: To switch to a different Jeep for the next day’s excursion. Having made a seemingly insignificant choice, she felt calmer and no longer like a victim. It brought control. Instead of worrying, she began looking forward to the wildlife she would see.

In the morning, in the new Jeep, she befriended a nurse from Canada. Together, they visited the Maasai Mara tribe and nearby pubs, meeting members of the community.

“It was the most exciting experience of my life,” Funt said. “And it had started with me crying.”



Dx: Parenting-itis / Rx: A Mountain Getaway 

As Thompson pointed out, sometimes the destination is secondary to the intension behind a trip. And the quality of the time away matters more than how long you can stay. After becoming parents 4 years ago, Thompson and her husband hadn’t traveled alone together. Like many parents of young children, they were short on time to relax and reconnect as a couple.

So Thompson planned a weekend trip to an isolated cabin in the Massanutten Mountain Range within the George Washington National Forest, about a 2-hour drive from their Washington, DC, area home.

“We put our devices away and focused on being completely present with one another,” said Thompson. The couple took a walk in the woods, where “all we could hear were drops of water from the snowmelt, the crunch of the snow beneath our feet, and the occasional bird looking for food,” she recalled. “There were no cars, no other people. It was quiet, calm, and incredibly peaceful.”

Whether sitting by the fire, soaking in the outdoor hot tub, or playing card games, “our conversation didn’t surround what we’d have for dinner or who would do baths and bedtime with whom,” Thompson said. “We didn’t talk about work, upcoming commitments, or items on our to-do lists.” The getaway was so refreshing, the couple intend to repeat the trip each year.



Dx: Persistent Grief / Rx: Hiking and Hinduism in Nepal

Nearly 3 years ago, Funt experienced a 2-month period where both of her kids left for college and both her father and father-in-law passed away. Besieged by grief, she found herself questioning whether her best years were behind her. She was also grappling with her mortality, because she was then approaching 59, the age at which her own mother had died. So Funt decided to go trekking in Nepal. “I am a traveler — it’s what I do,” she said.

Having the trip to prepare for changed Funt’s whole outlook, she remembers. Throwing herself into the planning helped her transcend her grief. But being in Nepal was even more impactful. She and her husband spent hours trekking through majestic mountain ranges, which “touched their souls.” At a crematorium, they learned about Hindu beliefs on death, which helped them with the grieving process.

The trip “lifted me so high up on so many levels and brought me back to my authentic self,” Funt said. On her flight home from Kathmandu, she decided to start her travel business.

“I needed something else [in addition to radiology] to put my passion, heart, and creativity into, and it would be another way of doing service,” she explained.



Dx: Couch Potato Syndrome / Rx: Planning an Adventure 

Like all of us, Funt knows exercise is important for health. But that knowledge alone doesn’t motivate her to move, she admitted. What does get her off the couch is scheduling an active trip — and then training for it. “When I have a goal tied to my values of adventure, connection, and community, fear will set in if I don’t start to move,” she said. It was after booking her Nepal trip (which included an 8-mile, 3000-foot trek) that Funt started getting in shape.

Travel has motivated Funt’s clients in similar ways. Last year, 8 months before one of her Morocco trips, Funt spoke over Zoom with a woman who’d just enrolled. This woman told her she’d signed up in order to commit to her health.

By the time Funt saw her again, on day 1 of the trip, the woman had lost 50 pounds. “It was the greatest transformation,” Funt recalled. “On the trip, she was the first one up the mountain and beamed the whole time. It was beautiful to watch her reclaim her power, body, and life.”

 

Getting Lost — Finding Inspiration

Since Thompson’s trip to Italy, she has traveled extensively, visiting nearly 25 countries. “Traveling inspired me to continue exploring the world and myself,” she said.

Since leading her first trip to Morocco in 2023, Funt said she’s received more letters of appreciation from her clients than her patients. The results from this type of travel therapy can be dramatic.

After a trip with Funt, one burned-out physician decided that she needed to find a job with a better work-life balance. An empty nester realized the “feeling of belonging and community” on the trip was what had been missing in her “regular” life. After returning home, she began rekindling relationships with old friends.

To many, a vacation is a treat. But, as Funt and Thompson have learned firsthand, it can also be a prescription — for ennui, sadness, loneliness, and all the physical issues that come with them. Sometimes, going far away helps you come home to yourself.

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

Whatever’s ailing you, a vacation might just be the cure. Yes, getting away can improve your health, according to research published in in 2023. It might help combat symptoms of aging, suggested a 2024 study in Journal of Travel Research. But it could also have even more powerful psychological and physical benefits, transforming your life before you pack a bag and long after you return home.

This news organization spoke with two healthcare professionals who believe in the healing power of travel. They shared which personal “diagnoses” they have successfully treated with faraway places and how this therapy might work for you.

Stacey Funt, MD, NBC-HWC, a radiologist at Northwell Health in Long Island, New York, started the boutique wellness adventure travel company, LH Adventure Travel, in 2023. Funt curates and leads small groups to destinations like Peru, Guatemala, Morocco, and Italy. Each tour incorporates tenets of lifestyle medicine, including healthy eating, movement, stress management, and community building.

Kiya Thompson, RN, a surgical trauma nurse for 20 years, was similarly inspired to share her passion for travel. She is now a certified family travel coach who helps parents plan meaningful trips through her company, LuckyBucky, LLC.



Dx: Self-Esteem Deficiency / Rx: Vivaldi in Venice

In June 2015, Thompson found herself at an all-time low. As a nurse, she felt confident that she was “built for the adrenaline rush and could take on anything.” But outside the trauma center, Thompson felt inadequate, her self-esteem eroded by years of abusive relationships. “The daily hardships of my personal life, combined with the mental fortitude it took to endure the demands of caring for the sickest of the sick, were incredibly weighty,” she recalled. 

To escape, Thompson booked her first solo trip: 3 weeks in Italy. But days after she arrived, she felt the need to “escape her escape.” On a bus in Naples, she was pick-pocketed. The man she had been dating before her trip stopped responding to her messages. In her hotel room in Venice, she felt “lost, alone, and helpless.”

One evening, Thompson attended a small orchestral performance of Vivaldi’s “The Four Seasons” in a centuries-old church. The music triggered memories of her Italian grandparents at whose home she’d listened to the same piece.

“A switch flipped, and I changed my whole outlook,” she remembers.

During the concert, she reflected on strangers who had shown her kindness and care. A Canadian man who gave her €50 after her wallet was stolen. A friend-of-a-friend who showed her around Rome. The clerk at her Venice hotel who had offered her a hug.

“In the wake of experiencing the worst of people, I’d experienced so much more of the best of people; strangers who were willing to go above and beyond to help me,” Thompson said.

When Thompson returned home, she brought her new mindset along. “ My ability to problem-solve my way through a solo trip that presented unexpected hardships empowered me,” she explained. “I learned I was much more capable than I’d thought.”



Dx: Wilderness Phobia / Rx: A Safari in Tanzania

On an evening in the mid-1990s, Funt was alone in a tent on a budget camping safari in Tanzania. Animals roared threateningly outside the thin walls. Earlier that day, a vulture had ripped a sandwich out of her hands. Funt was frightened to the core. Worrying that she’d be the next meal for the local wildlife, she started to sob. “This was as raw as I had ever gotten at that point in my life,” she said.

Suddenly, Funt said her brain shifted into problem-solving mode. She made one small decision: To switch to a different Jeep for the next day’s excursion. Having made a seemingly insignificant choice, she felt calmer and no longer like a victim. It brought control. Instead of worrying, she began looking forward to the wildlife she would see.

In the morning, in the new Jeep, she befriended a nurse from Canada. Together, they visited the Maasai Mara tribe and nearby pubs, meeting members of the community.

“It was the most exciting experience of my life,” Funt said. “And it had started with me crying.”



Dx: Parenting-itis / Rx: A Mountain Getaway 

As Thompson pointed out, sometimes the destination is secondary to the intension behind a trip. And the quality of the time away matters more than how long you can stay. After becoming parents 4 years ago, Thompson and her husband hadn’t traveled alone together. Like many parents of young children, they were short on time to relax and reconnect as a couple.

So Thompson planned a weekend trip to an isolated cabin in the Massanutten Mountain Range within the George Washington National Forest, about a 2-hour drive from their Washington, DC, area home.

“We put our devices away and focused on being completely present with one another,” said Thompson. The couple took a walk in the woods, where “all we could hear were drops of water from the snowmelt, the crunch of the snow beneath our feet, and the occasional bird looking for food,” she recalled. “There were no cars, no other people. It was quiet, calm, and incredibly peaceful.”

Whether sitting by the fire, soaking in the outdoor hot tub, or playing card games, “our conversation didn’t surround what we’d have for dinner or who would do baths and bedtime with whom,” Thompson said. “We didn’t talk about work, upcoming commitments, or items on our to-do lists.” The getaway was so refreshing, the couple intend to repeat the trip each year.



Dx: Persistent Grief / Rx: Hiking and Hinduism in Nepal

Nearly 3 years ago, Funt experienced a 2-month period where both of her kids left for college and both her father and father-in-law passed away. Besieged by grief, she found herself questioning whether her best years were behind her. She was also grappling with her mortality, because she was then approaching 59, the age at which her own mother had died. So Funt decided to go trekking in Nepal. “I am a traveler — it’s what I do,” she said.

Having the trip to prepare for changed Funt’s whole outlook, she remembers. Throwing herself into the planning helped her transcend her grief. But being in Nepal was even more impactful. She and her husband spent hours trekking through majestic mountain ranges, which “touched their souls.” At a crematorium, they learned about Hindu beliefs on death, which helped them with the grieving process.

The trip “lifted me so high up on so many levels and brought me back to my authentic self,” Funt said. On her flight home from Kathmandu, she decided to start her travel business.

“I needed something else [in addition to radiology] to put my passion, heart, and creativity into, and it would be another way of doing service,” she explained.



Dx: Couch Potato Syndrome / Rx: Planning an Adventure 

Like all of us, Funt knows exercise is important for health. But that knowledge alone doesn’t motivate her to move, she admitted. What does get her off the couch is scheduling an active trip — and then training for it. “When I have a goal tied to my values of adventure, connection, and community, fear will set in if I don’t start to move,” she said. It was after booking her Nepal trip (which included an 8-mile, 3000-foot trek) that Funt started getting in shape.

Travel has motivated Funt’s clients in similar ways. Last year, 8 months before one of her Morocco trips, Funt spoke over Zoom with a woman who’d just enrolled. This woman told her she’d signed up in order to commit to her health.

By the time Funt saw her again, on day 1 of the trip, the woman had lost 50 pounds. “It was the greatest transformation,” Funt recalled. “On the trip, she was the first one up the mountain and beamed the whole time. It was beautiful to watch her reclaim her power, body, and life.”

 

Getting Lost — Finding Inspiration

Since Thompson’s trip to Italy, she has traveled extensively, visiting nearly 25 countries. “Traveling inspired me to continue exploring the world and myself,” she said.

Since leading her first trip to Morocco in 2023, Funt said she’s received more letters of appreciation from her clients than her patients. The results from this type of travel therapy can be dramatic.

After a trip with Funt, one burned-out physician decided that she needed to find a job with a better work-life balance. An empty nester realized the “feeling of belonging and community” on the trip was what had been missing in her “regular” life. After returning home, she began rekindling relationships with old friends.

To many, a vacation is a treat. But, as Funt and Thompson have learned firsthand, it can also be a prescription — for ennui, sadness, loneliness, and all the physical issues that come with them. Sometimes, going far away helps you come home to yourself.

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

Even though older adults are more likely to be diagnosed with colorectal cancer (CRC), there is a concerning rise in diagnoses among younger adults, making it essential for healthcare providers to educate adult patients of all ages about the lifestyle-related risk factors associated with the disease.

Many are familiar with the modifiable risk factors of obesity, smoking, and alcohol consumption, but the impact of processed meat — a common element of the Western diet —often remains underappreciated.

But the data are clear: Processed meat, defined as meat that has been altered through methods such as salting, curing, fermentation, or smoking to enhance flavor or preservation, has been linked to an increased risk for CRC.

The International Agency for Research on Cancer, part of the World Health Organization, analyzed over 800 global studies and classified processed meats as carcinogenic to humans, whereas red meat was deemed “probably” carcinogenic. Their findings were later published in The Lancet Oncology, confirming that the strongest epidemiological evidence linked processed meat consumption to CRC.

“While I routinely counsel my patients about lifestyle and dietary risk factors for CRC, including processed meat, I’m not sure how often this is specifically mentioned by physicians in practice,” Peter S. Liang, MD, MPH, an assistant professor and researcher focused on CRC prevention at NYU Langone Health in New York City, and an AGA spokesperson, told GI & Hepatology News.

David A. Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University, both in Norfolk, Virginia, concurred.

Many healthcare providers may not fully recognize the risks posed by processed meat in relation to CRC to counsel their patients, Johnson said. “In my experience, there is not a widespread awareness.”

 

Understanding the Carcinogenic Risks 

The excess risk for CRC per gram of intake is higher for processed meat than for red meat. However, the threshold for harmful consumption varies among studies, and many group red and processed meat together in their analyses.

For example, a 2020 prospective analysis of UK Biobank data reported that a 70 g/d higher intake of red and processed meat was associated with a 32% and 40% greater risk for CRC and colon cancer, respectively.

More recently, a 2025 prospective study examined the associations between CRC and 97 dietary factors in 542,778 women. Investigators found that, aside from alcohol, red and processed meat were the only other dietary factors positively associated with CRC, with a 30 g/d intake increasing the risk for CRC by 8%.

Although the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) recommend limiting red meat consumption to no more than three portions a week, their guidance on processed meat is simpler and more restrictive: Consume very little, if any.

The risk for CRC associated with processed meats is likely due to a naturally occurring element in the meat and carcinogenic compounds that are added or created during its preparation, Johnson said.

Large bodies of evidence support the association between certain compounds in processed meat and cancer, added Ulrike Peters, PhD, MPH, professor and associate director of the Public Health Sciences Division at the Fred Hutchinson Cancer Center in Seattle.

These compounds include:

• Heterocyclic amines: Prevalent in charred and well-done meat, these chemicals are created from the reaction at high temperatures between creatine/creatinine, amino acids, and sugars.
• Nitrates/nitrites: Widely used in the curing of meat (eg, sausages, ham, bacon) to give products their pink coloring and savory flavor, these inorganic compounds bind with amines to produce N-nitrosamines, among the most potent genotoxic carcinogens.
• Polycyclic aromatic hydrocarbons: Generated during high-temperature cooking and smoking, these compounds can induce DNA damage in the colon.
• Heme iron: This type of iron, abundant in red and processed meats, promotes formation of carcinogenic N-nitroso compounds and oxidative damage to intestinal tissue.

Peters said that the compounds may work synergistically to increase the risk for CRC through various mechanisms, including DNA damage, inflammation, and altered gut microbiota.

While it would be useful to study whether the different meat-processing methods — for example, smoking vs salting — affect CRC risk differently, “practically, this is difficult because there’s so much overlap,” Liang noted.

 

Risk Mitigation

Lifestyle factors likely play a crucial role in the risk for CRC. For example, a study of European migrants to Australia found that those from countries with lower CRC incidences tended to develop a higher risk for CRC the longer they resided in Australia due to the dietary change.

Understanding how to mitigate these risk factors is becoming increasingly important with the rates of early-onset CRC projected to double by 2030 in the United States, a trend that is also being observed globally.

“With early-onset CRC, it’s becoming quite clear that there’s no single risk factor that’s driving this increase,” Liang said. “We need to look at the risk factors that we know cause CRC in older adults and see which have become more common over time.”

The consumption of processed meats is one such factor that’s been implicated, particularly for early-onset CRC. The average global consumption of all types of meat per capita has increased significantly over the last 50 years. A 2022 report estimated that global mean processed meat consumption was 17 g/d, with significantly higher rates in high-income regions. This number is expected to rise, with the global processed meat market projected to grow from $318 billion in 2023 to $429 billion by 2029. Given this, the importance of counseling patients to reduce their meat intake is further underscored.

Another strategy for mitigating the risks around processed meat is specifically identifying those patients who may be most vulnerable.

In 2024, Peters and colleagues published findings from their genome-wide gene-environment interaction analysis comparing a large population with CRC and healthy control individuals. The research identified two novel biomarkers that support the role of red and processed meat with an increased risk for CRC and may explain the higher risk in certain population subgroups. They are working on genetic risk prediction models that will incorporate these genetic markers but must first ensure robust validation through larger studies.

“This approach aligns with precision medicine principles, allowing for more personalized prevention strategies, though we’re not quite there yet in terms of clinical application,” Peters said.

Another knowledge gap that future research efforts could address is how dietary factors influence survival outcomes after a diagnosis of CRC.

“The existing guidelines primarily focus on cancer prevention, with strong evidence linking processed meat consumption to increased CRC risk. However, the impact of dietary choices on survival after CRC diagnosis remains poorly understood,” Peters said. “This distinction between prevention and survival is crucial, as biological mechanisms and optimal dietary interventions may differ significantly between these two contexts.”

Well-designed studies investigating the relationship between dietary patterns and CRC survival outcomes would enable the development of evidence-based nutritional recommendations specifically tailored for CRC survivors, Peters said. In addition, she called for well-designed studies that compare levels of processed meat consumption between cohorts of patients with early-onset CRC and healthy counterparts.

“This would help establish whether there’s a true causal relationship rather than just correlation,” Peters said.

 

Simple Strategies to Dietary Changes

With a 2024 study finding that greater adherence to WCRF/AICR Cancer Prevention Recommendations, including reducing processed meat consumption, was linked to a 14% reduction in CRC risk, physicians should emphasize the benefits of adopting dietary and lifestyle recommendations to patients.

Johnson advised simple strategies to encourage any needed dietary changes.

“Pay attention to what you eat, proportions, and variation of meal menus. Those are good starter points,” he told GI & Hepatology News. “None of these recommendations related to meats should be absolute, but reduction can be the target.”

Liang stressed the importance of repeated, nonjudgmental discussions.

“Research shows that physician recommendation is one of the strongest motivators in preventive health, so even if it doesn’t work the first few times, we have to continue delivering the message that can improve our patients’ health.”

A version of this article appeared on Medscape.com.

Even though older adults are more likely to be diagnosed with colorectal cancer (CRC), there is a concerning rise in diagnoses among younger adults, making it essential for healthcare providers to educate adult patients of all ages about the lifestyle-related risk factors associated with the disease.

Many are familiar with the modifiable risk factors of obesity, smoking, and alcohol consumption, but the impact of processed meat — a common element of the Western diet —often remains underappreciated.

But the data are clear: Processed meat, defined as meat that has been altered through methods such as salting, curing, fermentation, or smoking to enhance flavor or preservation, has been linked to an increased risk for CRC.

The International Agency for Research on Cancer, part of the World Health Organization, analyzed over 800 global studies and classified processed meats as carcinogenic to humans, whereas red meat was deemed “probably” carcinogenic. Their findings were later published in The Lancet Oncology, confirming that the strongest epidemiological evidence linked processed meat consumption to CRC.

“While I routinely counsel my patients about lifestyle and dietary risk factors for CRC, including processed meat, I’m not sure how often this is specifically mentioned by physicians in practice,” Peter S. Liang, MD, MPH, an assistant professor and researcher focused on CRC prevention at NYU Langone Health in New York City, and an AGA spokesperson, told GI & Hepatology News.

David A. Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University, both in Norfolk, Virginia, concurred.

Many healthcare providers may not fully recognize the risks posed by processed meat in relation to CRC to counsel their patients, Johnson said. “In my experience, there is not a widespread awareness.”

 

Understanding the Carcinogenic Risks 

The excess risk for CRC per gram of intake is higher for processed meat than for red meat. However, the threshold for harmful consumption varies among studies, and many group red and processed meat together in their analyses.

For example, a 2020 prospective analysis of UK Biobank data reported that a 70 g/d higher intake of red and processed meat was associated with a 32% and 40% greater risk for CRC and colon cancer, respectively.

More recently, a 2025 prospective study examined the associations between CRC and 97 dietary factors in 542,778 women. Investigators found that, aside from alcohol, red and processed meat were the only other dietary factors positively associated with CRC, with a 30 g/d intake increasing the risk for CRC by 8%.

Although the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) recommend limiting red meat consumption to no more than three portions a week, their guidance on processed meat is simpler and more restrictive: Consume very little, if any.

The risk for CRC associated with processed meats is likely due to a naturally occurring element in the meat and carcinogenic compounds that are added or created during its preparation, Johnson said.

Large bodies of evidence support the association between certain compounds in processed meat and cancer, added Ulrike Peters, PhD, MPH, professor and associate director of the Public Health Sciences Division at the Fred Hutchinson Cancer Center in Seattle.

These compounds include:

• Heterocyclic amines: Prevalent in charred and well-done meat, these chemicals are created from the reaction at high temperatures between creatine/creatinine, amino acids, and sugars.
• Nitrates/nitrites: Widely used in the curing of meat (eg, sausages, ham, bacon) to give products their pink coloring and savory flavor, these inorganic compounds bind with amines to produce N-nitrosamines, among the most potent genotoxic carcinogens.
• Polycyclic aromatic hydrocarbons: Generated during high-temperature cooking and smoking, these compounds can induce DNA damage in the colon.
• Heme iron: This type of iron, abundant in red and processed meats, promotes formation of carcinogenic N-nitroso compounds and oxidative damage to intestinal tissue.

Peters said that the compounds may work synergistically to increase the risk for CRC through various mechanisms, including DNA damage, inflammation, and altered gut microbiota.

While it would be useful to study whether the different meat-processing methods — for example, smoking vs salting — affect CRC risk differently, “practically, this is difficult because there’s so much overlap,” Liang noted.

 

Risk Mitigation

Lifestyle factors likely play a crucial role in the risk for CRC. For example, a study of European migrants to Australia found that those from countries with lower CRC incidences tended to develop a higher risk for CRC the longer they resided in Australia due to the dietary change.

Understanding how to mitigate these risk factors is becoming increasingly important with the rates of early-onset CRC projected to double by 2030 in the United States, a trend that is also being observed globally.

“With early-onset CRC, it’s becoming quite clear that there’s no single risk factor that’s driving this increase,” Liang said. “We need to look at the risk factors that we know cause CRC in older adults and see which have become more common over time.”

The consumption of processed meats is one such factor that’s been implicated, particularly for early-onset CRC. The average global consumption of all types of meat per capita has increased significantly over the last 50 years. A 2022 report estimated that global mean processed meat consumption was 17 g/d, with significantly higher rates in high-income regions. This number is expected to rise, with the global processed meat market projected to grow from $318 billion in 2023 to $429 billion by 2029. Given this, the importance of counseling patients to reduce their meat intake is further underscored.

Another strategy for mitigating the risks around processed meat is specifically identifying those patients who may be most vulnerable.

In 2024, Peters and colleagues published findings from their genome-wide gene-environment interaction analysis comparing a large population with CRC and healthy control individuals. The research identified two novel biomarkers that support the role of red and processed meat with an increased risk for CRC and may explain the higher risk in certain population subgroups. They are working on genetic risk prediction models that will incorporate these genetic markers but must first ensure robust validation through larger studies.

“This approach aligns with precision medicine principles, allowing for more personalized prevention strategies, though we’re not quite there yet in terms of clinical application,” Peters said.

Another knowledge gap that future research efforts could address is how dietary factors influence survival outcomes after a diagnosis of CRC.

“The existing guidelines primarily focus on cancer prevention, with strong evidence linking processed meat consumption to increased CRC risk. However, the impact of dietary choices on survival after CRC diagnosis remains poorly understood,” Peters said. “This distinction between prevention and survival is crucial, as biological mechanisms and optimal dietary interventions may differ significantly between these two contexts.”

Well-designed studies investigating the relationship between dietary patterns and CRC survival outcomes would enable the development of evidence-based nutritional recommendations specifically tailored for CRC survivors, Peters said. In addition, she called for well-designed studies that compare levels of processed meat consumption between cohorts of patients with early-onset CRC and healthy counterparts.

“This would help establish whether there’s a true causal relationship rather than just correlation,” Peters said.

 

Simple Strategies to Dietary Changes

With a 2024 study finding that greater adherence to WCRF/AICR Cancer Prevention Recommendations, including reducing processed meat consumption, was linked to a 14% reduction in CRC risk, physicians should emphasize the benefits of adopting dietary and lifestyle recommendations to patients.

Johnson advised simple strategies to encourage any needed dietary changes.

“Pay attention to what you eat, proportions, and variation of meal menus. Those are good starter points,” he told GI & Hepatology News. “None of these recommendations related to meats should be absolute, but reduction can be the target.”

Liang stressed the importance of repeated, nonjudgmental discussions.

“Research shows that physician recommendation is one of the strongest motivators in preventive health, so even if it doesn’t work the first few times, we have to continue delivering the message that can improve our patients’ health.”

A version of this article appeared on Medscape.com.

Even though older adults are more likely to be diagnosed with colorectal cancer (CRC), there is a concerning rise in diagnoses among younger adults, making it essential for healthcare providers to educate adult patients of all ages about the lifestyle-related risk factors associated with the disease.

Many are familiar with the modifiable risk factors of obesity, smoking, and alcohol consumption, but the impact of processed meat — a common element of the Western diet —often remains underappreciated.

But the data are clear: Processed meat, defined as meat that has been altered through methods such as salting, curing, fermentation, or smoking to enhance flavor or preservation, has been linked to an increased risk for CRC.

The International Agency for Research on Cancer, part of the World Health Organization, analyzed over 800 global studies and classified processed meats as carcinogenic to humans, whereas red meat was deemed “probably” carcinogenic. Their findings were later published in The Lancet Oncology, confirming that the strongest epidemiological evidence linked processed meat consumption to CRC.

“While I routinely counsel my patients about lifestyle and dietary risk factors for CRC, including processed meat, I’m not sure how often this is specifically mentioned by physicians in practice,” Peter S. Liang, MD, MPH, an assistant professor and researcher focused on CRC prevention at NYU Langone Health in New York City, and an AGA spokesperson, told GI & Hepatology News.

David A. Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University, both in Norfolk, Virginia, concurred.

Many healthcare providers may not fully recognize the risks posed by processed meat in relation to CRC to counsel their patients, Johnson said. “In my experience, there is not a widespread awareness.”

 

Understanding the Carcinogenic Risks 

The excess risk for CRC per gram of intake is higher for processed meat than for red meat. However, the threshold for harmful consumption varies among studies, and many group red and processed meat together in their analyses.

For example, a 2020 prospective analysis of UK Biobank data reported that a 70 g/d higher intake of red and processed meat was associated with a 32% and 40% greater risk for CRC and colon cancer, respectively.

More recently, a 2025 prospective study examined the associations between CRC and 97 dietary factors in 542,778 women. Investigators found that, aside from alcohol, red and processed meat were the only other dietary factors positively associated with CRC, with a 30 g/d intake increasing the risk for CRC by 8%.

Although the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) recommend limiting red meat consumption to no more than three portions a week, their guidance on processed meat is simpler and more restrictive: Consume very little, if any.

The risk for CRC associated with processed meats is likely due to a naturally occurring element in the meat and carcinogenic compounds that are added or created during its preparation, Johnson said.

Large bodies of evidence support the association between certain compounds in processed meat and cancer, added Ulrike Peters, PhD, MPH, professor and associate director of the Public Health Sciences Division at the Fred Hutchinson Cancer Center in Seattle.

These compounds include:

• Heterocyclic amines: Prevalent in charred and well-done meat, these chemicals are created from the reaction at high temperatures between creatine/creatinine, amino acids, and sugars.
• Nitrates/nitrites: Widely used in the curing of meat (eg, sausages, ham, bacon) to give products their pink coloring and savory flavor, these inorganic compounds bind with amines to produce N-nitrosamines, among the most potent genotoxic carcinogens.
• Polycyclic aromatic hydrocarbons: Generated during high-temperature cooking and smoking, these compounds can induce DNA damage in the colon.
• Heme iron: This type of iron, abundant in red and processed meats, promotes formation of carcinogenic N-nitroso compounds and oxidative damage to intestinal tissue.

Peters said that the compounds may work synergistically to increase the risk for CRC through various mechanisms, including DNA damage, inflammation, and altered gut microbiota.

While it would be useful to study whether the different meat-processing methods — for example, smoking vs salting — affect CRC risk differently, “practically, this is difficult because there’s so much overlap,” Liang noted.

 

Risk Mitigation

Lifestyle factors likely play a crucial role in the risk for CRC. For example, a study of European migrants to Australia found that those from countries with lower CRC incidences tended to develop a higher risk for CRC the longer they resided in Australia due to the dietary change.

Understanding how to mitigate these risk factors is becoming increasingly important with the rates of early-onset CRC projected to double by 2030 in the United States, a trend that is also being observed globally.

“With early-onset CRC, it’s becoming quite clear that there’s no single risk factor that’s driving this increase,” Liang said. “We need to look at the risk factors that we know cause CRC in older adults and see which have become more common over time.”

The consumption of processed meats is one such factor that’s been implicated, particularly for early-onset CRC. The average global consumption of all types of meat per capita has increased significantly over the last 50 years. A 2022 report estimated that global mean processed meat consumption was 17 g/d, with significantly higher rates in high-income regions. This number is expected to rise, with the global processed meat market projected to grow from $318 billion in 2023 to $429 billion by 2029. Given this, the importance of counseling patients to reduce their meat intake is further underscored.

Another strategy for mitigating the risks around processed meat is specifically identifying those patients who may be most vulnerable.

In 2024, Peters and colleagues published findings from their genome-wide gene-environment interaction analysis comparing a large population with CRC and healthy control individuals. The research identified two novel biomarkers that support the role of red and processed meat with an increased risk for CRC and may explain the higher risk in certain population subgroups. They are working on genetic risk prediction models that will incorporate these genetic markers but must first ensure robust validation through larger studies.

“This approach aligns with precision medicine principles, allowing for more personalized prevention strategies, though we’re not quite there yet in terms of clinical application,” Peters said.

Another knowledge gap that future research efforts could address is how dietary factors influence survival outcomes after a diagnosis of CRC.

“The existing guidelines primarily focus on cancer prevention, with strong evidence linking processed meat consumption to increased CRC risk. However, the impact of dietary choices on survival after CRC diagnosis remains poorly understood,” Peters said. “This distinction between prevention and survival is crucial, as biological mechanisms and optimal dietary interventions may differ significantly between these two contexts.”

Well-designed studies investigating the relationship between dietary patterns and CRC survival outcomes would enable the development of evidence-based nutritional recommendations specifically tailored for CRC survivors, Peters said. In addition, she called for well-designed studies that compare levels of processed meat consumption between cohorts of patients with early-onset CRC and healthy counterparts.

“This would help establish whether there’s a true causal relationship rather than just correlation,” Peters said.

 

Simple Strategies to Dietary Changes

With a 2024 study finding that greater adherence to WCRF/AICR Cancer Prevention Recommendations, including reducing processed meat consumption, was linked to a 14% reduction in CRC risk, physicians should emphasize the benefits of adopting dietary and lifestyle recommendations to patients.

Johnson advised simple strategies to encourage any needed dietary changes.

“Pay attention to what you eat, proportions, and variation of meal menus. Those are good starter points,” he told GI & Hepatology News. “None of these recommendations related to meats should be absolute, but reduction can be the target.”

Liang stressed the importance of repeated, nonjudgmental discussions.

“Research shows that physician recommendation is one of the strongest motivators in preventive health, so even if it doesn’t work the first few times, we have to continue delivering the message that can improve our patients’ health.”

A version of this article appeared on Medscape.com.