Pulmonology

TOPLINE: Veterans with chronic obstructive pulmonary disease (COPD) who had follow-up outcome data after completing a 12-week telehealth pulmonary rehabilitation program had improved functional capacity, with 6-minute walk distance increasing by 41.3 m (15.7%) and quality-of-life scores improving by 27.9% to 42.7%. The virtual program had an 86% completion rate, suggesting telehealth rehabilitation may be a feasible alternative to traditional in-person programs.

METHODOLOGY:

• A 12-week single-arm cohort intervention evaluated effectiveness, acceptability, and feasibility of in-home, supervised telehealth pulmonary rehabilitation delivered via US Department of Veterans Affairs (VA) Video Connect in Houston, Texas. 

• Participants included 51 veterans with COPD aged ≥ 18 years and referred to the program; exclusions included mobility-limiting surgery, neurologic disease impairing walking, likely nonadherence, or unwillingness to consent. 

• Intervention consisted of 1 session weekly for about 120 minutes led by a licensed physical therapist and respiratory therapist, with home monitoring of blood pressure, heart rate, SpO₂, respiratory rate, and exertion. 

• In-person outcome assessments occurred at baseline and 12 weeks; the primary outcome was the 6-minute walk test, and secondary outcomes included Timed Up & Go test, Five Times Sit-to-Stand test, and quality of life via the St. George’s Respiratory Questionnaire and COPD Assessment Test.

TAKEAWAY:

• Functional capacity improved significantly with a mean increase of 41.3 m in 6-minute walk distance, a 15.7% improvement (P < .001; d = 0.76), surpassing the minimal clinically important difference of 25 m for patients with COPD. 

• COPD-affected quality of life improved, with St. George’s Respiratory Questionnaire scores decreasing by 18.2 points, a 27.9% improvement (P < .001), and COPD Assessment Test scores decreasing by 12.1 points, a 42.7% improvement (P < .001). 

• Functional mobility and lower-body strength also improved, with Timed Up and Go test completion time decreasing by 1.2 seconds (9.9% faster; P = .02) and Five Times Sit-to-Stand test time improving by 1.2 seconds (9.0% faster; P = .02). 

• Program retention was high, with 44 of 51 participants (86.3%) completing the full intervention. When excluding COVID-19 pandemic–related dropouts, the retention rate increased to 90.2%

IN PRACTICE: “Our study not only highlights the effectiveness of pulmonary rehabilitation in improving the functional performance of COPD patients but also emphasizes the potential use of telehealth-rehabilitation as a viable alternative to traditional in-clinic programs,” the authors wrote.

SOURCE:The study’s first author was Abderrahman Ouattas, Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey VA Medical Center, Baylor College of Medicine in Houston. It was published online in Scientific Reports.

LIMITATIONS: According to the authors, the study lacked a control group and included predominantly male participants, which may limit generalizability. The modest sample size and insufficient exploration of potential confounding factors further constrain the generalizability of findings. Additionally, the study was limited to veterans living within 80 miles of Houston, creating an unusual proximity requirement for telehealth programs that could introduce selection bias. The researchers noted that actively recruiting during the COVID-19 pandemic presented unforeseen challenges, and the absence of remote biomechanical data collection may have limited the ability to monitor rehabilitation progress and make necessary adjustments.

DISCLOSURES: The authors report no commercial or financial relationships that could be construed as potential conflicts of interest. No specific funding sources or financial disclosures were mentioned.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Veterans with chronic obstructive pulmonary disease (COPD) who had follow-up outcome data after completing a 12-week telehealth pulmonary rehabilitation program had improved functional capacity, with 6-minute walk distance increasing by 41.3 m (15.7%) and quality-of-life scores improving by 27.9% to 42.7%. The virtual program had an 86% completion rate, suggesting telehealth rehabilitation may be a feasible alternative to traditional in-person programs.

METHODOLOGY:

• A 12-week single-arm cohort intervention evaluated effectiveness, acceptability, and feasibility of in-home, supervised telehealth pulmonary rehabilitation delivered via US Department of Veterans Affairs (VA) Video Connect in Houston, Texas. 

• Participants included 51 veterans with COPD aged ≥ 18 years and referred to the program; exclusions included mobility-limiting surgery, neurologic disease impairing walking, likely nonadherence, or unwillingness to consent. 

• Intervention consisted of 1 session weekly for about 120 minutes led by a licensed physical therapist and respiratory therapist, with home monitoring of blood pressure, heart rate, SpO₂, respiratory rate, and exertion. 

• In-person outcome assessments occurred at baseline and 12 weeks; the primary outcome was the 6-minute walk test, and secondary outcomes included Timed Up & Go test, Five Times Sit-to-Stand test, and quality of life via the St. George’s Respiratory Questionnaire and COPD Assessment Test.

TAKEAWAY:

• Functional capacity improved significantly with a mean increase of 41.3 m in 6-minute walk distance, a 15.7% improvement (P < .001; d = 0.76), surpassing the minimal clinically important difference of 25 m for patients with COPD. 

• COPD-affected quality of life improved, with St. George’s Respiratory Questionnaire scores decreasing by 18.2 points, a 27.9% improvement (P < .001), and COPD Assessment Test scores decreasing by 12.1 points, a 42.7% improvement (P < .001). 

• Functional mobility and lower-body strength also improved, with Timed Up and Go test completion time decreasing by 1.2 seconds (9.9% faster; P = .02) and Five Times Sit-to-Stand test time improving by 1.2 seconds (9.0% faster; P = .02). 

• Program retention was high, with 44 of 51 participants (86.3%) completing the full intervention. When excluding COVID-19 pandemic–related dropouts, the retention rate increased to 90.2%

IN PRACTICE: “Our study not only highlights the effectiveness of pulmonary rehabilitation in improving the functional performance of COPD patients but also emphasizes the potential use of telehealth-rehabilitation as a viable alternative to traditional in-clinic programs,” the authors wrote.

SOURCE:The study’s first author was Abderrahman Ouattas, Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey VA Medical Center, Baylor College of Medicine in Houston. It was published online in Scientific Reports.

LIMITATIONS: According to the authors, the study lacked a control group and included predominantly male participants, which may limit generalizability. The modest sample size and insufficient exploration of potential confounding factors further constrain the generalizability of findings. Additionally, the study was limited to veterans living within 80 miles of Houston, creating an unusual proximity requirement for telehealth programs that could introduce selection bias. The researchers noted that actively recruiting during the COVID-19 pandemic presented unforeseen challenges, and the absence of remote biomechanical data collection may have limited the ability to monitor rehabilitation progress and make necessary adjustments.

DISCLOSURES: The authors report no commercial or financial relationships that could be construed as potential conflicts of interest. No specific funding sources or financial disclosures were mentioned.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Veterans with chronic obstructive pulmonary disease (COPD) who had follow-up outcome data after completing a 12-week telehealth pulmonary rehabilitation program had improved functional capacity, with 6-minute walk distance increasing by 41.3 m (15.7%) and quality-of-life scores improving by 27.9% to 42.7%. The virtual program had an 86% completion rate, suggesting telehealth rehabilitation may be a feasible alternative to traditional in-person programs.

METHODOLOGY:

• A 12-week single-arm cohort intervention evaluated effectiveness, acceptability, and feasibility of in-home, supervised telehealth pulmonary rehabilitation delivered via US Department of Veterans Affairs (VA) Video Connect in Houston, Texas. 

• Participants included 51 veterans with COPD aged ≥ 18 years and referred to the program; exclusions included mobility-limiting surgery, neurologic disease impairing walking, likely nonadherence, or unwillingness to consent. 

• Intervention consisted of 1 session weekly for about 120 minutes led by a licensed physical therapist and respiratory therapist, with home monitoring of blood pressure, heart rate, SpO₂, respiratory rate, and exertion. 

• In-person outcome assessments occurred at baseline and 12 weeks; the primary outcome was the 6-minute walk test, and secondary outcomes included Timed Up & Go test, Five Times Sit-to-Stand test, and quality of life via the St. George’s Respiratory Questionnaire and COPD Assessment Test.

TAKEAWAY:

• Functional capacity improved significantly with a mean increase of 41.3 m in 6-minute walk distance, a 15.7% improvement (P < .001; d = 0.76), surpassing the minimal clinically important difference of 25 m for patients with COPD. 

• COPD-affected quality of life improved, with St. George’s Respiratory Questionnaire scores decreasing by 18.2 points, a 27.9% improvement (P < .001), and COPD Assessment Test scores decreasing by 12.1 points, a 42.7% improvement (P < .001). 

• Functional mobility and lower-body strength also improved, with Timed Up and Go test completion time decreasing by 1.2 seconds (9.9% faster; P = .02) and Five Times Sit-to-Stand test time improving by 1.2 seconds (9.0% faster; P = .02). 

• Program retention was high, with 44 of 51 participants (86.3%) completing the full intervention. When excluding COVID-19 pandemic–related dropouts, the retention rate increased to 90.2%

IN PRACTICE: “Our study not only highlights the effectiveness of pulmonary rehabilitation in improving the functional performance of COPD patients but also emphasizes the potential use of telehealth-rehabilitation as a viable alternative to traditional in-clinic programs,” the authors wrote.

SOURCE:The study’s first author was Abderrahman Ouattas, Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey VA Medical Center, Baylor College of Medicine in Houston. It was published online in Scientific Reports.

LIMITATIONS: According to the authors, the study lacked a control group and included predominantly male participants, which may limit generalizability. The modest sample size and insufficient exploration of potential confounding factors further constrain the generalizability of findings. Additionally, the study was limited to veterans living within 80 miles of Houston, creating an unusual proximity requirement for telehealth programs that could introduce selection bias. The researchers noted that actively recruiting during the COVID-19 pandemic presented unforeseen challenges, and the absence of remote biomechanical data collection may have limited the ability to monitor rehabilitation progress and make necessary adjustments.

DISCLOSURES: The authors report no commercial or financial relationships that could be construed as potential conflicts of interest. No specific funding sources or financial disclosures were mentioned.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Patients treated for chronic obstructive pulmonary disease (COPD) or pneumonia experienced worse outcomes when treated at hospitals acquired by private equity firms, based on data from a new study presented at the American Thoracic Society (ATS) 2026 International Conference.

“Previous studies have linked private equity acquisition of hospitals to worse patient experiences and higher rates of hospital-acquired adverse events, such as falls, although findings for specific medical conditions have been more variable,” according to lead author Stephen Mein, MD, a pulmonologist at Beth Israel Deaconess Medical Center in Boston.

“We wanted to understand whether private equity acquisitions impacted outcomes for patients hospitalized with COPD and pneumonia because these conditions are among the most common reasons for hospitalization and they are widely included in measures of hospital care quality,” he said.

Mein and colleagues reviewed data from Medicare fee-for-service claims data from 41 private equity hospitals and 192 matched control hospitals between 2010 and 2019, including 146,904 COPD visits and 194,993 pneumonia visits.

The study population was Medicare beneficiaries aged 65 years or older who had at least one hospital encounter (defined as observation stay or inpatient admission) for asthma, COPD, or pneumonia. The clinical outcomes were in-hospital mortality, 30-day mortality, and 30-day hospital revisit rates. The researchers compared changes in outcomes across 3 years before and after acquisition in a linear regression analysis. Models adjusted for patient age, sex, race and ethnicity, clinical risk score, and dual eligibility status.

Overall, no changes in patient age, sex, clinical risk scores or dual-eligibility status across all conditions at private equity hospitals were noted compared with control hospitals. However, 30-day hospital revisits among patients with asthma increased significantly at private equity hospitals compared to control hospitals (difference-in-differences, + 8.3 percentage points; 95% CI, 4.0-12.7). No significant changes were noted for in-hospital mortality or 30-day mortality.

Similarly, 30-day hospital revisits were significantly higher for patients with COPD at private equity hospitals than at control hospitals (+ 0.9 percentage points; 95% CI, 0.1-1.6). Patients with pneumonia had an increased in-hospital mortality at private equity hospitals compared with control hospitals (+ 0.7 percentage points; 95% CI, 0.2-1.2), with no differences in 30-day mortality or revisits.

The findings that patients treated for COPD at private equity-acquired hospitals more often returned to the hospital within 30 days after hospital discharge and that patients with pneumonia were more likely to die during their hospital stay were surprising, Mein noted. “The 1-percentage-point increase in deaths among patients with pneumonia is especially concerning as the baseline in-hospital mortality rate for this condition was only 3%-4%,” he said.

“Our findings add to growing concerns around the potential negative effects of private equity ownership in healthcare and highlight the need for stronger oversight of these acquisitions to help protect our patients, and the results have implications for many patients as private equity acquisitions of US hospitals are becoming more common,” Mein said.

The findings were limited by the focus on older adults with Medicare insurance, and may not be generalizable to other patient populations, said Mein. “In addition, we were unable to account for differences in private equity firm practices or identify potential heterogeneity in outcomes across hospitals acquired by different private equity firms,” he said. More research is needed to understand the factors contributing to worse outcomes at private equity-acquired hospitals in the current study and other published work, Mein added.

Vigilance is Needed to Optimize Outcomes

“Given the rapid increase in acquisitions of US hospitals by private equity firms, it is important to evaluate how these acquisitions affect patient health outcomes,” said Arianne K. Baldomero, MD, MS, a pulmonologist, critical care physician, and assistant professor of medicine at the University of Minnesota, Minneapolis.

“The worse outcomes observed among patients hospitalized in privately acquired hospitals were not entirely unexpected,” said Baldomero, who was not involved in the study. “Although not explicitly stated in the abstract, these acquisitions may involve cost-containment strategies, such as potential reductions in staffing. particularly nursing and support staff, changes in supply chain management, or the scaling back of less profitable services, which likely contribute to worse patient outcomes,” she said.

More research is needed to identify the potential etiologies driving these differences in outcomes, which would help inform strategies for improvement, said Baldomero. However, the results of the new study suggest that clinicians managing patients discharged from acquired hospitals should be vigilant about discharge planning, transitions, and follow-up to mitigate poor health outcomes, she said.

The study received no outside funding. The researchers and Baldomero had no financial conflicts to disclose.

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

Patients treated for chronic obstructive pulmonary disease (COPD) or pneumonia experienced worse outcomes when treated at hospitals acquired by private equity firms, based on data from a new study presented at the American Thoracic Society (ATS) 2026 International Conference.

“Previous studies have linked private equity acquisition of hospitals to worse patient experiences and higher rates of hospital-acquired adverse events, such as falls, although findings for specific medical conditions have been more variable,” according to lead author Stephen Mein, MD, a pulmonologist at Beth Israel Deaconess Medical Center in Boston.

“We wanted to understand whether private equity acquisitions impacted outcomes for patients hospitalized with COPD and pneumonia because these conditions are among the most common reasons for hospitalization and they are widely included in measures of hospital care quality,” he said.

Mein and colleagues reviewed data from Medicare fee-for-service claims data from 41 private equity hospitals and 192 matched control hospitals between 2010 and 2019, including 146,904 COPD visits and 194,993 pneumonia visits.

The study population was Medicare beneficiaries aged 65 years or older who had at least one hospital encounter (defined as observation stay or inpatient admission) for asthma, COPD, or pneumonia. The clinical outcomes were in-hospital mortality, 30-day mortality, and 30-day hospital revisit rates. The researchers compared changes in outcomes across 3 years before and after acquisition in a linear regression analysis. Models adjusted for patient age, sex, race and ethnicity, clinical risk score, and dual eligibility status.

Overall, no changes in patient age, sex, clinical risk scores or dual-eligibility status across all conditions at private equity hospitals were noted compared with control hospitals. However, 30-day hospital revisits among patients with asthma increased significantly at private equity hospitals compared to control hospitals (difference-in-differences, + 8.3 percentage points; 95% CI, 4.0-12.7). No significant changes were noted for in-hospital mortality or 30-day mortality.

Similarly, 30-day hospital revisits were significantly higher for patients with COPD at private equity hospitals than at control hospitals (+ 0.9 percentage points; 95% CI, 0.1-1.6). Patients with pneumonia had an increased in-hospital mortality at private equity hospitals compared with control hospitals (+ 0.7 percentage points; 95% CI, 0.2-1.2), with no differences in 30-day mortality or revisits.

The findings that patients treated for COPD at private equity-acquired hospitals more often returned to the hospital within 30 days after hospital discharge and that patients with pneumonia were more likely to die during their hospital stay were surprising, Mein noted. “The 1-percentage-point increase in deaths among patients with pneumonia is especially concerning as the baseline in-hospital mortality rate for this condition was only 3%-4%,” he said.

“Our findings add to growing concerns around the potential negative effects of private equity ownership in healthcare and highlight the need for stronger oversight of these acquisitions to help protect our patients, and the results have implications for many patients as private equity acquisitions of US hospitals are becoming more common,” Mein said.

The findings were limited by the focus on older adults with Medicare insurance, and may not be generalizable to other patient populations, said Mein. “In addition, we were unable to account for differences in private equity firm practices or identify potential heterogeneity in outcomes across hospitals acquired by different private equity firms,” he said. More research is needed to understand the factors contributing to worse outcomes at private equity-acquired hospitals in the current study and other published work, Mein added.

Vigilance is Needed to Optimize Outcomes

“Given the rapid increase in acquisitions of US hospitals by private equity firms, it is important to evaluate how these acquisitions affect patient health outcomes,” said Arianne K. Baldomero, MD, MS, a pulmonologist, critical care physician, and assistant professor of medicine at the University of Minnesota, Minneapolis.

“The worse outcomes observed among patients hospitalized in privately acquired hospitals were not entirely unexpected,” said Baldomero, who was not involved in the study. “Although not explicitly stated in the abstract, these acquisitions may involve cost-containment strategies, such as potential reductions in staffing. particularly nursing and support staff, changes in supply chain management, or the scaling back of less profitable services, which likely contribute to worse patient outcomes,” she said.

More research is needed to identify the potential etiologies driving these differences in outcomes, which would help inform strategies for improvement, said Baldomero. However, the results of the new study suggest that clinicians managing patients discharged from acquired hospitals should be vigilant about discharge planning, transitions, and follow-up to mitigate poor health outcomes, she said.

The study received no outside funding. The researchers and Baldomero had no financial conflicts to disclose.

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

Patients treated for chronic obstructive pulmonary disease (COPD) or pneumonia experienced worse outcomes when treated at hospitals acquired by private equity firms, based on data from a new study presented at the American Thoracic Society (ATS) 2026 International Conference.

“Previous studies have linked private equity acquisition of hospitals to worse patient experiences and higher rates of hospital-acquired adverse events, such as falls, although findings for specific medical conditions have been more variable,” according to lead author Stephen Mein, MD, a pulmonologist at Beth Israel Deaconess Medical Center in Boston.

“We wanted to understand whether private equity acquisitions impacted outcomes for patients hospitalized with COPD and pneumonia because these conditions are among the most common reasons for hospitalization and they are widely included in measures of hospital care quality,” he said.

Mein and colleagues reviewed data from Medicare fee-for-service claims data from 41 private equity hospitals and 192 matched control hospitals between 2010 and 2019, including 146,904 COPD visits and 194,993 pneumonia visits.

The study population was Medicare beneficiaries aged 65 years or older who had at least one hospital encounter (defined as observation stay or inpatient admission) for asthma, COPD, or pneumonia. The clinical outcomes were in-hospital mortality, 30-day mortality, and 30-day hospital revisit rates. The researchers compared changes in outcomes across 3 years before and after acquisition in a linear regression analysis. Models adjusted for patient age, sex, race and ethnicity, clinical risk score, and dual eligibility status.

Overall, no changes in patient age, sex, clinical risk scores or dual-eligibility status across all conditions at private equity hospitals were noted compared with control hospitals. However, 30-day hospital revisits among patients with asthma increased significantly at private equity hospitals compared to control hospitals (difference-in-differences, + 8.3 percentage points; 95% CI, 4.0-12.7). No significant changes were noted for in-hospital mortality or 30-day mortality.

Similarly, 30-day hospital revisits were significantly higher for patients with COPD at private equity hospitals than at control hospitals (+ 0.9 percentage points; 95% CI, 0.1-1.6). Patients with pneumonia had an increased in-hospital mortality at private equity hospitals compared with control hospitals (+ 0.7 percentage points; 95% CI, 0.2-1.2), with no differences in 30-day mortality or revisits.

The findings that patients treated for COPD at private equity-acquired hospitals more often returned to the hospital within 30 days after hospital discharge and that patients with pneumonia were more likely to die during their hospital stay were surprising, Mein noted. “The 1-percentage-point increase in deaths among patients with pneumonia is especially concerning as the baseline in-hospital mortality rate for this condition was only 3%-4%,” he said.

“Our findings add to growing concerns around the potential negative effects of private equity ownership in healthcare and highlight the need for stronger oversight of these acquisitions to help protect our patients, and the results have implications for many patients as private equity acquisitions of US hospitals are becoming more common,” Mein said.

The findings were limited by the focus on older adults with Medicare insurance, and may not be generalizable to other patient populations, said Mein. “In addition, we were unable to account for differences in private equity firm practices or identify potential heterogeneity in outcomes across hospitals acquired by different private equity firms,” he said. More research is needed to understand the factors contributing to worse outcomes at private equity-acquired hospitals in the current study and other published work, Mein added.

Vigilance is Needed to Optimize Outcomes

“Given the rapid increase in acquisitions of US hospitals by private equity firms, it is important to evaluate how these acquisitions affect patient health outcomes,” said Arianne K. Baldomero, MD, MS, a pulmonologist, critical care physician, and assistant professor of medicine at the University of Minnesota, Minneapolis.

“The worse outcomes observed among patients hospitalized in privately acquired hospitals were not entirely unexpected,” said Baldomero, who was not involved in the study. “Although not explicitly stated in the abstract, these acquisitions may involve cost-containment strategies, such as potential reductions in staffing. particularly nursing and support staff, changes in supply chain management, or the scaling back of less profitable services, which likely contribute to worse patient outcomes,” she said.

More research is needed to identify the potential etiologies driving these differences in outcomes, which would help inform strategies for improvement, said Baldomero. However, the results of the new study suggest that clinicians managing patients discharged from acquired hospitals should be vigilant about discharge planning, transitions, and follow-up to mitigate poor health outcomes, she said.

The study received no outside funding. The researchers and Baldomero had no financial conflicts to disclose.

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

Approximately about 1 in 4 eligible Americans are up to date on their lung cancer screening, according to a recent study in JAMA Internal Medicine, prompting a need for clinicians to simplify referrals and scheduling of annual appointments.

Despite a 32% increase in lung cancer screening between 2022 and 2024, rates overall remain low at nearly 25%, and especially among patients between ages 50 and 54 years (11.32%; P < .05).

Determining eligibility entails calculating the total years a patient smoked cigarettes, whereas other screenings are based solely on age, such as breast cancer and colon cancer.

Some clinicians “will get into trying to do an actual pack year calculation, or where they smoked half a pack for this many years, and then they quit for this many years, and then, you know, they’re trying to do this massive calculation. And the reality is, we’re just trying to get a patient who’s at high risk for lung cancer” in for screening, said Timothy Mullett, MD, a thoracic surgeon and medical director of the Markey Cancer Center Network Development, University of Kentucky in Lexington, Kentucky, who helped the study authors.

As the second most common form of the disease, lung cancer is the leading cause of such mortality in the US. But low rates of screening mean opportunities for early detection are missed.

In an analysis of national survey data including 26,104 patients (45.6% women and 54.4% men) eligible for lung cancer screening between ages 50 and 79 years, rates increased from 18.49% to 24.49% (P < .05) over a 2-year period starting in 2022. 

Approximately one quarter of men and women were up to date on their screening (P < .05). Nearly one third of patients aged 65 years or older were up to date, whereas those between ages 50 and 54 years (11.32%), 55 and 59 years (19.45%), and 60 and 64 years (23.99%) showed lower rates.

Patients were most likely to be up to date on their screenings in the Northeast region of the country, with Massachusetts showing the highest prevalence rate (38.36%). The rate was lowest in South Dakota (13.43%).

No significant changes in rates were observed for Asian, Black, or Hispanic adults. Adults who were American Indian or Alaska native showed the largest improvement, from 18.74% in 2022 to 30.8% in 2024 (P < .05).

The US Preventive Services Task Force recommends annual screening starting at age 50 for individuals who are current smokers or previous smokers who have a history of consuming at least a pack a day for two decades. Previous smokers must have quit within the previous 15 years to qualify.

Making these calculations can be tricky, Mullett said. Patients’ tobacco use can change over time and a screening tool may not account for those changes. He encourages clinicians to take time to ask patients for more detail about their history. For instance, someone who smokes a half a pack a day now may not immediately qualify for screening, but deeper probing might reveal that they previously smoked two packs a day.

Tamatha Hughes, RN, a nurse navigator for the Missouri Baptist Lung Cancer Screening Program, Missouri Baptist Medical Center in St. Louis, said she often calms fears and corrects misinformation when scheduling patients for their first screening. Some patients think the screening involves an MRI or that radiation from the CT scan is dangerous.

“We go through explaining it as simple as possible,” she said.

If she has a referral for a patient who does not move forward with scheduling, she said she will try them again a few weeks later. Annual screenings are scheduled at a patient’s first appointment, and she said her clinic has an 80% rate for returning patients.

Getting the first scan is the biggest hurdle. Many patients feel stigma or associate lung cancer with a hopeless diagnosis, which can reduce rates, Mullet said.

“There’s a sense of fatalism, because all they’ve ever experienced with lung cancer has been someone who’s died from lung cancer, their grandmother, their grandfather, died of lung cancer. And historically, lung cancer has been found in late stages over 80% of the time,” he said. But screening has drastically improved rates of survival.

“We keep trying to tell patients that this is not your grandfather’s lung cancer,” Mullett said. “This is not what you saw in your family growing up, and we can find it early and we can treat it, and we even if we find it late, we have better treatments now.”

The study was funded by grants from the National Cancer Institute, the William Stamps Farish Endowed Chair in Cancer Research, and the CDC. Mullett and Hughes reported having no relevant financial disclosures.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.

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

Approximately about 1 in 4 eligible Americans are up to date on their lung cancer screening, according to a recent study in JAMA Internal Medicine, prompting a need for clinicians to simplify referrals and scheduling of annual appointments.

Despite a 32% increase in lung cancer screening between 2022 and 2024, rates overall remain low at nearly 25%, and especially among patients between ages 50 and 54 years (11.32%; P < .05).

Determining eligibility entails calculating the total years a patient smoked cigarettes, whereas other screenings are based solely on age, such as breast cancer and colon cancer.

Some clinicians “will get into trying to do an actual pack year calculation, or where they smoked half a pack for this many years, and then they quit for this many years, and then, you know, they’re trying to do this massive calculation. And the reality is, we’re just trying to get a patient who’s at high risk for lung cancer” in for screening, said Timothy Mullett, MD, a thoracic surgeon and medical director of the Markey Cancer Center Network Development, University of Kentucky in Lexington, Kentucky, who helped the study authors.

As the second most common form of the disease, lung cancer is the leading cause of such mortality in the US. But low rates of screening mean opportunities for early detection are missed.

In an analysis of national survey data including 26,104 patients (45.6% women and 54.4% men) eligible for lung cancer screening between ages 50 and 79 years, rates increased from 18.49% to 24.49% (P < .05) over a 2-year period starting in 2022. 

Approximately one quarter of men and women were up to date on their screening (P < .05). Nearly one third of patients aged 65 years or older were up to date, whereas those between ages 50 and 54 years (11.32%), 55 and 59 years (19.45%), and 60 and 64 years (23.99%) showed lower rates.

Patients were most likely to be up to date on their screenings in the Northeast region of the country, with Massachusetts showing the highest prevalence rate (38.36%). The rate was lowest in South Dakota (13.43%).

No significant changes in rates were observed for Asian, Black, or Hispanic adults. Adults who were American Indian or Alaska native showed the largest improvement, from 18.74% in 2022 to 30.8% in 2024 (P < .05).

The US Preventive Services Task Force recommends annual screening starting at age 50 for individuals who are current smokers or previous smokers who have a history of consuming at least a pack a day for two decades. Previous smokers must have quit within the previous 15 years to qualify.

Making these calculations can be tricky, Mullett said. Patients’ tobacco use can change over time and a screening tool may not account for those changes. He encourages clinicians to take time to ask patients for more detail about their history. For instance, someone who smokes a half a pack a day now may not immediately qualify for screening, but deeper probing might reveal that they previously smoked two packs a day.

Tamatha Hughes, RN, a nurse navigator for the Missouri Baptist Lung Cancer Screening Program, Missouri Baptist Medical Center in St. Louis, said she often calms fears and corrects misinformation when scheduling patients for their first screening. Some patients think the screening involves an MRI or that radiation from the CT scan is dangerous.

“We go through explaining it as simple as possible,” she said.

If she has a referral for a patient who does not move forward with scheduling, she said she will try them again a few weeks later. Annual screenings are scheduled at a patient’s first appointment, and she said her clinic has an 80% rate for returning patients.

Getting the first scan is the biggest hurdle. Many patients feel stigma or associate lung cancer with a hopeless diagnosis, which can reduce rates, Mullet said.

“There’s a sense of fatalism, because all they’ve ever experienced with lung cancer has been someone who’s died from lung cancer, their grandmother, their grandfather, died of lung cancer. And historically, lung cancer has been found in late stages over 80% of the time,” he said. But screening has drastically improved rates of survival.

“We keep trying to tell patients that this is not your grandfather’s lung cancer,” Mullett said. “This is not what you saw in your family growing up, and we can find it early and we can treat it, and we even if we find it late, we have better treatments now.”

The study was funded by grants from the National Cancer Institute, the William Stamps Farish Endowed Chair in Cancer Research, and the CDC. Mullett and Hughes reported having no relevant financial disclosures.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.

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

Approximately about 1 in 4 eligible Americans are up to date on their lung cancer screening, according to a recent study in JAMA Internal Medicine, prompting a need for clinicians to simplify referrals and scheduling of annual appointments.

Despite a 32% increase in lung cancer screening between 2022 and 2024, rates overall remain low at nearly 25%, and especially among patients between ages 50 and 54 years (11.32%; P < .05).

Determining eligibility entails calculating the total years a patient smoked cigarettes, whereas other screenings are based solely on age, such as breast cancer and colon cancer.

Some clinicians “will get into trying to do an actual pack year calculation, or where they smoked half a pack for this many years, and then they quit for this many years, and then, you know, they’re trying to do this massive calculation. And the reality is, we’re just trying to get a patient who’s at high risk for lung cancer” in for screening, said Timothy Mullett, MD, a thoracic surgeon and medical director of the Markey Cancer Center Network Development, University of Kentucky in Lexington, Kentucky, who helped the study authors.

As the second most common form of the disease, lung cancer is the leading cause of such mortality in the US. But low rates of screening mean opportunities for early detection are missed.

In an analysis of national survey data including 26,104 patients (45.6% women and 54.4% men) eligible for lung cancer screening between ages 50 and 79 years, rates increased from 18.49% to 24.49% (P < .05) over a 2-year period starting in 2022. 

Approximately one quarter of men and women were up to date on their screening (P < .05). Nearly one third of patients aged 65 years or older were up to date, whereas those between ages 50 and 54 years (11.32%), 55 and 59 years (19.45%), and 60 and 64 years (23.99%) showed lower rates.

Patients were most likely to be up to date on their screenings in the Northeast region of the country, with Massachusetts showing the highest prevalence rate (38.36%). The rate was lowest in South Dakota (13.43%).

No significant changes in rates were observed for Asian, Black, or Hispanic adults. Adults who were American Indian or Alaska native showed the largest improvement, from 18.74% in 2022 to 30.8% in 2024 (P < .05).

The US Preventive Services Task Force recommends annual screening starting at age 50 for individuals who are current smokers or previous smokers who have a history of consuming at least a pack a day for two decades. Previous smokers must have quit within the previous 15 years to qualify.

Making these calculations can be tricky, Mullett said. Patients’ tobacco use can change over time and a screening tool may not account for those changes. He encourages clinicians to take time to ask patients for more detail about their history. For instance, someone who smokes a half a pack a day now may not immediately qualify for screening, but deeper probing might reveal that they previously smoked two packs a day.

Tamatha Hughes, RN, a nurse navigator for the Missouri Baptist Lung Cancer Screening Program, Missouri Baptist Medical Center in St. Louis, said she often calms fears and corrects misinformation when scheduling patients for their first screening. Some patients think the screening involves an MRI or that radiation from the CT scan is dangerous.

“We go through explaining it as simple as possible,” she said.

If she has a referral for a patient who does not move forward with scheduling, she said she will try them again a few weeks later. Annual screenings are scheduled at a patient’s first appointment, and she said her clinic has an 80% rate for returning patients.

Getting the first scan is the biggest hurdle. Many patients feel stigma or associate lung cancer with a hopeless diagnosis, which can reduce rates, Mullet said.

“There’s a sense of fatalism, because all they’ve ever experienced with lung cancer has been someone who’s died from lung cancer, their grandmother, their grandfather, died of lung cancer. And historically, lung cancer has been found in late stages over 80% of the time,” he said. But screening has drastically improved rates of survival.

“We keep trying to tell patients that this is not your grandfather’s lung cancer,” Mullett said. “This is not what you saw in your family growing up, and we can find it early and we can treat it, and we even if we find it late, we have better treatments now.”

The study was funded by grants from the National Cancer Institute, the William Stamps Farish Endowed Chair in Cancer Research, and the CDC. Mullett and Hughes reported having no relevant financial disclosures.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.

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

Chest CT is being ordered too often for incidental pulmonary nodules found on neck imaging, according to a study at one US health system.

It’s not uncommon for neck CT or MRI to show nodules in the lung apices, but there’s been no data on how often those incidental findings turn out to be lung cancer.

For the new study, researchers analyzed data of 22,173 patients who underwent neck, brachial plexus, or parathyroid imaging at the Massachusetts General Brigham in Boston.

Of those patients, 273 (1.2%) had requests for supplemental chest CTs due to incidental lung findings. Ultimately, only one new lung cancer was detected — an indolent adenocarcinoma — yielding a 2-year incidence rate of 0.40%.

The results suggest that recommendations for chest CT “should likely be substantially decreased,” the researchers conclude in the Journal of the American College of Radiology — though they also acknowledge a need for studies of larger datasets.

As for what drives such CT requests, study co-author Mark Hammer, MD, a thoracic radiologist at Brigham and Women’s Hospital, Harvard Medical School in Boston, offered one possibility: Neuroradiologists, who typically interpret neck imaging, might be less familiar with lung nodule follow-up guidelines.

At his institution, Hammer told Medscape Medical News, thoracic radiologists generally follow the Fleischner Society guidelines on management of incidentally detected pulmonary nodules.

“The reality is that neuroradiologists are often unfamiliar with those guidelines and may recommend follow-up for nodules that do not require it,” he said.

The Fleischner guidelines don’t recommend imaging nodules smaller than 6 mm given the very low cancer risk. For nodules of 6-8 mm, they recommend follow-up chest CTs at 3-12 months to see if the nodule has grown or changed. For larger or otherwise suspicious lesions, they advise prompt evaluation.

But while guidelines exist, follow-up decisions after neck imaging are largely at the discretion of the provider, said Dave Yousem, MD, MBA, a neuroradiologist at Johns Hopkins University in Baltimore.

According to Yousem, some physicians might be comfortable with the possibility of missing a low-risk indolent cancer to spare many patients from unnecessary CTs. But there’s also concern that overlooking even one tumor could trigger litigation, he said.

Hammer’s team found that of all patients with chest CT recommendations, only 171 (62.6%) underwent scanning — a rate consistent with previous reports of incidentaloma follow-up.

Hammer said, thoracic radiologists might have been applying the Fleischner guidelines, but some patients might simply have been lost to follow-up, among other possibilities.

He and his colleagues said recommendations for additional imaging should be evidence-based and judicious to ensure “appropriate follow-up and early detection of lung cancer.”

Potential solutions, they added, include incidentaloma tracking systems, improved communication between providers, and AI-assisted image interpretation.

The study was funded by the Association of University Radiologists and the Agency for Healthcare Research and Quality. Hammer and Yousem had no relevant disclosures.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. He is also an MIT Knight Science Journalism fellow. Email: [email protected].

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

Chest CT is being ordered too often for incidental pulmonary nodules found on neck imaging, according to a study at one US health system.

It’s not uncommon for neck CT or MRI to show nodules in the lung apices, but there’s been no data on how often those incidental findings turn out to be lung cancer.

For the new study, researchers analyzed data of 22,173 patients who underwent neck, brachial plexus, or parathyroid imaging at the Massachusetts General Brigham in Boston.

Of those patients, 273 (1.2%) had requests for supplemental chest CTs due to incidental lung findings. Ultimately, only one new lung cancer was detected — an indolent adenocarcinoma — yielding a 2-year incidence rate of 0.40%.

The results suggest that recommendations for chest CT “should likely be substantially decreased,” the researchers conclude in the Journal of the American College of Radiology — though they also acknowledge a need for studies of larger datasets.

As for what drives such CT requests, study co-author Mark Hammer, MD, a thoracic radiologist at Brigham and Women’s Hospital, Harvard Medical School in Boston, offered one possibility: Neuroradiologists, who typically interpret neck imaging, might be less familiar with lung nodule follow-up guidelines.

At his institution, Hammer told Medscape Medical News, thoracic radiologists generally follow the Fleischner Society guidelines on management of incidentally detected pulmonary nodules.

“The reality is that neuroradiologists are often unfamiliar with those guidelines and may recommend follow-up for nodules that do not require it,” he said.

The Fleischner guidelines don’t recommend imaging nodules smaller than 6 mm given the very low cancer risk. For nodules of 6-8 mm, they recommend follow-up chest CTs at 3-12 months to see if the nodule has grown or changed. For larger or otherwise suspicious lesions, they advise prompt evaluation.

But while guidelines exist, follow-up decisions after neck imaging are largely at the discretion of the provider, said Dave Yousem, MD, MBA, a neuroradiologist at Johns Hopkins University in Baltimore.

According to Yousem, some physicians might be comfortable with the possibility of missing a low-risk indolent cancer to spare many patients from unnecessary CTs. But there’s also concern that overlooking even one tumor could trigger litigation, he said.

Hammer’s team found that of all patients with chest CT recommendations, only 171 (62.6%) underwent scanning — a rate consistent with previous reports of incidentaloma follow-up.

Hammer said, thoracic radiologists might have been applying the Fleischner guidelines, but some patients might simply have been lost to follow-up, among other possibilities.

He and his colleagues said recommendations for additional imaging should be evidence-based and judicious to ensure “appropriate follow-up and early detection of lung cancer.”

Potential solutions, they added, include incidentaloma tracking systems, improved communication between providers, and AI-assisted image interpretation.

The study was funded by the Association of University Radiologists and the Agency for Healthcare Research and Quality. Hammer and Yousem had no relevant disclosures.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. He is also an MIT Knight Science Journalism fellow. Email: [email protected].

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

Chest CT is being ordered too often for incidental pulmonary nodules found on neck imaging, according to a study at one US health system.

It’s not uncommon for neck CT or MRI to show nodules in the lung apices, but there’s been no data on how often those incidental findings turn out to be lung cancer.

For the new study, researchers analyzed data of 22,173 patients who underwent neck, brachial plexus, or parathyroid imaging at the Massachusetts General Brigham in Boston.

Of those patients, 273 (1.2%) had requests for supplemental chest CTs due to incidental lung findings. Ultimately, only one new lung cancer was detected — an indolent adenocarcinoma — yielding a 2-year incidence rate of 0.40%.

The results suggest that recommendations for chest CT “should likely be substantially decreased,” the researchers conclude in the Journal of the American College of Radiology — though they also acknowledge a need for studies of larger datasets.

As for what drives such CT requests, study co-author Mark Hammer, MD, a thoracic radiologist at Brigham and Women’s Hospital, Harvard Medical School in Boston, offered one possibility: Neuroradiologists, who typically interpret neck imaging, might be less familiar with lung nodule follow-up guidelines.

At his institution, Hammer told Medscape Medical News, thoracic radiologists generally follow the Fleischner Society guidelines on management of incidentally detected pulmonary nodules.

“The reality is that neuroradiologists are often unfamiliar with those guidelines and may recommend follow-up for nodules that do not require it,” he said.

The Fleischner guidelines don’t recommend imaging nodules smaller than 6 mm given the very low cancer risk. For nodules of 6-8 mm, they recommend follow-up chest CTs at 3-12 months to see if the nodule has grown or changed. For larger or otherwise suspicious lesions, they advise prompt evaluation.

But while guidelines exist, follow-up decisions after neck imaging are largely at the discretion of the provider, said Dave Yousem, MD, MBA, a neuroradiologist at Johns Hopkins University in Baltimore.

According to Yousem, some physicians might be comfortable with the possibility of missing a low-risk indolent cancer to spare many patients from unnecessary CTs. But there’s also concern that overlooking even one tumor could trigger litigation, he said.

Hammer’s team found that of all patients with chest CT recommendations, only 171 (62.6%) underwent scanning — a rate consistent with previous reports of incidentaloma follow-up.

Hammer said, thoracic radiologists might have been applying the Fleischner guidelines, but some patients might simply have been lost to follow-up, among other possibilities.

He and his colleagues said recommendations for additional imaging should be evidence-based and judicious to ensure “appropriate follow-up and early detection of lung cancer.”

Potential solutions, they added, include incidentaloma tracking systems, improved communication between providers, and AI-assisted image interpretation.

The study was funded by the Association of University Radiologists and the Agency for Healthcare Research and Quality. Hammer and Yousem had no relevant disclosures.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. He is also an MIT Knight Science Journalism fellow. Email: [email protected].

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

Several newly identified biomarkers can help distinguish invasive aspergillosis from aspergillus colonization in lung transplant recipients, according to data from a new study presented at the annual meeting of the International Society for Heart and Lung Transplantation.

Aspergillus, a common environmental mold, can cause potentially serious infection or asymptomatic colonization in patients who have significant lung disease or are immunosuppressed, said Aaron Mishkin, MD, associate professor of medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia, who was not involved in the study.

“Determining if the aspergillus that is present is a colonizing organism vs disease is challenging clinically,” Mishkin said. Clinicians currently rely on criteria including a compatible patient, imaging findings, and a laboratory-based diagnostic such as tissue from a biopsy, cultures, polymerase chain reaction (PCR), or fungal antigen detection, said Mishkin. “Fungal antigen detection has variable specificity and sensitivity,” he noted. New biomarkers that look for an immune response could help differentiate between colonization and infection by assessing an immune-mediated inflammatory response, the hallmark of infection, he said.

To tease out potential biomarkers associated with invasive aspergillosis, Christine Ng, MS, a researcher at the University Health Network, Toronto, Ontario, Canada, and colleagues performed RNA sequencing on samples from 14 control lung transplant patients, 34 with aspergillus colonization, and seven with invasive aspergillosis. They identified potential candidate genes in 15 control samples, 17 aspergillus colonization samples, and 15 invasive aspergillosis samples.

Overall, signaling pathway analysis showed robust immune response, T-cell immunity, and leukocyte immunity in patients with invasive aspergillosis. By contrast, patients with aspergillus colonization showed enriched cellular responses (response to stimuli, epithelium development).

In a real-time quantitative PCR analysis, the researchers validated three biomarkers specific to invasive aspergillosis (IRF7, ZBP1, CYP27B1). Biomarkers AKR1C2, FGF10, and VGLL3 demonstrated specificity for aspergillus colonization. Additionally, biomarkers PTGER3, LPAR3, and COL14A1 were significant when aspergillus colonization was compared to controls but not in comparisons between invasive aspergillosis and aspergillus colonization. 

The study findings were limited by the small sample size, and larger studies are needed before they can be implemented in clinical practice, the researchers wrote. However, the results suggest that the new biomarkers reveal distinct host immune patterns and may improve differentiation of aspergillosis from colonization in lung transplant recipients, they concluded.

Clinical Implications and Next Steps

RNA testing can help differentiate colonization vs infection, Mishkin said. “Colonization is not typically treated, whereas infection would be treated with an anti-fungal and, in the case of a transplant recipient, a reduction in immunosuppression,” he said. “In lung transplantation, a delicate equilibrium must be maintained between achieving optimal immunosuppression and minimizing or treating infection. Any tools that can aid in this decision-making have the potential to enhance patient outcomes,” he added.

The current study was limited by the use of data only from a single center, and the broader applicability to additional populations, broader geographic areas, and a larger number of organisms remains unknown, Mishkin said. “This type of assay does have the possibility of applicability to a larger number of fungal and even bacterial species,” he noted.

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

Several newly identified biomarkers can help distinguish invasive aspergillosis from aspergillus colonization in lung transplant recipients, according to data from a new study presented at the annual meeting of the International Society for Heart and Lung Transplantation.

Aspergillus, a common environmental mold, can cause potentially serious infection or asymptomatic colonization in patients who have significant lung disease or are immunosuppressed, said Aaron Mishkin, MD, associate professor of medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia, who was not involved in the study.

“Determining if the aspergillus that is present is a colonizing organism vs disease is challenging clinically,” Mishkin said. Clinicians currently rely on criteria including a compatible patient, imaging findings, and a laboratory-based diagnostic such as tissue from a biopsy, cultures, polymerase chain reaction (PCR), or fungal antigen detection, said Mishkin. “Fungal antigen detection has variable specificity and sensitivity,” he noted. New biomarkers that look for an immune response could help differentiate between colonization and infection by assessing an immune-mediated inflammatory response, the hallmark of infection, he said.

To tease out potential biomarkers associated with invasive aspergillosis, Christine Ng, MS, a researcher at the University Health Network, Toronto, Ontario, Canada, and colleagues performed RNA sequencing on samples from 14 control lung transplant patients, 34 with aspergillus colonization, and seven with invasive aspergillosis. They identified potential candidate genes in 15 control samples, 17 aspergillus colonization samples, and 15 invasive aspergillosis samples.

Overall, signaling pathway analysis showed robust immune response, T-cell immunity, and leukocyte immunity in patients with invasive aspergillosis. By contrast, patients with aspergillus colonization showed enriched cellular responses (response to stimuli, epithelium development).

In a real-time quantitative PCR analysis, the researchers validated three biomarkers specific to invasive aspergillosis (IRF7, ZBP1, CYP27B1). Biomarkers AKR1C2, FGF10, and VGLL3 demonstrated specificity for aspergillus colonization. Additionally, biomarkers PTGER3, LPAR3, and COL14A1 were significant when aspergillus colonization was compared to controls but not in comparisons between invasive aspergillosis and aspergillus colonization. 

The study findings were limited by the small sample size, and larger studies are needed before they can be implemented in clinical practice, the researchers wrote. However, the results suggest that the new biomarkers reveal distinct host immune patterns and may improve differentiation of aspergillosis from colonization in lung transplant recipients, they concluded.

Clinical Implications and Next Steps

RNA testing can help differentiate colonization vs infection, Mishkin said. “Colonization is not typically treated, whereas infection would be treated with an anti-fungal and, in the case of a transplant recipient, a reduction in immunosuppression,” he said. “In lung transplantation, a delicate equilibrium must be maintained between achieving optimal immunosuppression and minimizing or treating infection. Any tools that can aid in this decision-making have the potential to enhance patient outcomes,” he added.

The current study was limited by the use of data only from a single center, and the broader applicability to additional populations, broader geographic areas, and a larger number of organisms remains unknown, Mishkin said. “This type of assay does have the possibility of applicability to a larger number of fungal and even bacterial species,” he noted.

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

Several newly identified biomarkers can help distinguish invasive aspergillosis from aspergillus colonization in lung transplant recipients, according to data from a new study presented at the annual meeting of the International Society for Heart and Lung Transplantation.

Aspergillus, a common environmental mold, can cause potentially serious infection or asymptomatic colonization in patients who have significant lung disease or are immunosuppressed, said Aaron Mishkin, MD, associate professor of medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia, who was not involved in the study.

“Determining if the aspergillus that is present is a colonizing organism vs disease is challenging clinically,” Mishkin said. Clinicians currently rely on criteria including a compatible patient, imaging findings, and a laboratory-based diagnostic such as tissue from a biopsy, cultures, polymerase chain reaction (PCR), or fungal antigen detection, said Mishkin. “Fungal antigen detection has variable specificity and sensitivity,” he noted. New biomarkers that look for an immune response could help differentiate between colonization and infection by assessing an immune-mediated inflammatory response, the hallmark of infection, he said.

To tease out potential biomarkers associated with invasive aspergillosis, Christine Ng, MS, a researcher at the University Health Network, Toronto, Ontario, Canada, and colleagues performed RNA sequencing on samples from 14 control lung transplant patients, 34 with aspergillus colonization, and seven with invasive aspergillosis. They identified potential candidate genes in 15 control samples, 17 aspergillus colonization samples, and 15 invasive aspergillosis samples.

Overall, signaling pathway analysis showed robust immune response, T-cell immunity, and leukocyte immunity in patients with invasive aspergillosis. By contrast, patients with aspergillus colonization showed enriched cellular responses (response to stimuli, epithelium development).

In a real-time quantitative PCR analysis, the researchers validated three biomarkers specific to invasive aspergillosis (IRF7, ZBP1, CYP27B1). Biomarkers AKR1C2, FGF10, and VGLL3 demonstrated specificity for aspergillus colonization. Additionally, biomarkers PTGER3, LPAR3, and COL14A1 were significant when aspergillus colonization was compared to controls but not in comparisons between invasive aspergillosis and aspergillus colonization. 

The study findings were limited by the small sample size, and larger studies are needed before they can be implemented in clinical practice, the researchers wrote. However, the results suggest that the new biomarkers reveal distinct host immune patterns and may improve differentiation of aspergillosis from colonization in lung transplant recipients, they concluded.

Clinical Implications and Next Steps

RNA testing can help differentiate colonization vs infection, Mishkin said. “Colonization is not typically treated, whereas infection would be treated with an anti-fungal and, in the case of a transplant recipient, a reduction in immunosuppression,” he said. “In lung transplantation, a delicate equilibrium must be maintained between achieving optimal immunosuppression and minimizing or treating infection. Any tools that can aid in this decision-making have the potential to enhance patient outcomes,” he added.

The current study was limited by the use of data only from a single center, and the broader applicability to additional populations, broader geographic areas, and a larger number of organisms remains unknown, Mishkin said. “This type of assay does have the possibility of applicability to a larger number of fungal and even bacterial species,” he noted.

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

TOPLINE:

Among women aged > 65 years who were at a high risk for cervical cancer and required screening, only 5.2% received appropriate screening. Women with a history of high-grade cervical dysplasia had a greater likelihood of appropriate screening.

METHODOLOGY:

• Researchers conducted a retrospective study to assess the rates of appropriate cervical cancer screening among 1787 women aged 66 years or older (median, 76 years; 96.3% White) who had a Medicare wellness visit or an annual gynecologic visit in a healthcare system in 2022.
• Data on age at the last cervical cancer screening, history of hysterectomy, human papillomavirus (HPV) status, and history of a diagnosis of cervical cancer or cervical dysplasia, high-grade dysplasia, and immune deficiency status were assessed.
• Participants were categorized into 2 groups: those at high risk for cervical cancer (prior high-grade cervical dysplasia or cancer, an immunocompromised status, or lack of two normal cytology results in the past 10 years; n = 250) and those at average risk (having no high-risk features and adequate prior screening or having a prior hysterectomy with no history of high-grade cervical dysplasia; n = 1537).
• The screening cessation criteria were based on adequate prior screening, defined as two prior negative cervical cancer screenings in the past 10 years, the absence of high-grade cervical dysplasia or cervical cancer, and no immune deficiency.

TAKEAWAY:

• Overall, 4.9% of patients had a history of inadequate prior screening; among women at high risk, 5.2% were appropriately screened.
• The odds of continued screening were greater for women with a history of a positive HPV test results (adjusted odds ratio [aOR], 3.4; P = .016), a history of high-grade cervical dysplasia (aOR, 3.8; P = .009), and those without prior hysterectomy (aOR, 2.2; P = .005).
• Among women at high risk for cervical cancer, those with a history of high-grade cervical dysplasia had increased odds of appropriate screening (aOR, 6.7; P = .002), whereas the odds decreased with every 5-year increase in age (aOR, 0.5; P = .031). Women with prior hysterectomy were less likely to be over-screened (aOR, 0.3; P < .001) than those without.
• Among the 79 women who underwent screening, 97.5% had normal cytology results; the remaining women had abnormal cytology results (atypical squamous cells of undetermined significance or atypical squamous cells); all patients with abnormal cytology results met high-risk criteria and were screened appropriately.

IN PRACTICE:

“[The study] findings suggest that most clinicians and patients are aware of recommendations to stop cervical cancer screening after age 65 years. However, there may be a lack of awareness regarding continued screening in high-risk patients or those with inadequate prior screening. The lack of prior screening history and results in the medical record suggests that providers may not understand the importance of these factors to inform cervical cancer screening in older patients,” the authors of the study wrote.

SOURCE:

The study was led by Daniel Rodriguez, BS, Kolschowsky Research and Education Institute, Sarasota Memorial Health Care System, Sarasota, Florida. It was published online on April 23, 2026, in the Journal of Lower Genital Tract Disease.

LIMITATIONS:

Screening history in electronic medical records may be incomplete.

DISCLOSURES:

The Sarasota Memorial Healthcare Foundation provided financial support for this research. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

TOPLINE:

Among women aged > 65 years who were at a high risk for cervical cancer and required screening, only 5.2% received appropriate screening. Women with a history of high-grade cervical dysplasia had a greater likelihood of appropriate screening.

METHODOLOGY:

• Researchers conducted a retrospective study to assess the rates of appropriate cervical cancer screening among 1787 women aged 66 years or older (median, 76 years; 96.3% White) who had a Medicare wellness visit or an annual gynecologic visit in a healthcare system in 2022.
• Data on age at the last cervical cancer screening, history of hysterectomy, human papillomavirus (HPV) status, and history of a diagnosis of cervical cancer or cervical dysplasia, high-grade dysplasia, and immune deficiency status were assessed.
• Participants were categorized into 2 groups: those at high risk for cervical cancer (prior high-grade cervical dysplasia or cancer, an immunocompromised status, or lack of two normal cytology results in the past 10 years; n = 250) and those at average risk (having no high-risk features and adequate prior screening or having a prior hysterectomy with no history of high-grade cervical dysplasia; n = 1537).
• The screening cessation criteria were based on adequate prior screening, defined as two prior negative cervical cancer screenings in the past 10 years, the absence of high-grade cervical dysplasia or cervical cancer, and no immune deficiency.

TAKEAWAY:

• Overall, 4.9% of patients had a history of inadequate prior screening; among women at high risk, 5.2% were appropriately screened.
• The odds of continued screening were greater for women with a history of a positive HPV test results (adjusted odds ratio [aOR], 3.4; P = .016), a history of high-grade cervical dysplasia (aOR, 3.8; P = .009), and those without prior hysterectomy (aOR, 2.2; P = .005).
• Among women at high risk for cervical cancer, those with a history of high-grade cervical dysplasia had increased odds of appropriate screening (aOR, 6.7; P = .002), whereas the odds decreased with every 5-year increase in age (aOR, 0.5; P = .031). Women with prior hysterectomy were less likely to be over-screened (aOR, 0.3; P < .001) than those without.
• Among the 79 women who underwent screening, 97.5% had normal cytology results; the remaining women had abnormal cytology results (atypical squamous cells of undetermined significance or atypical squamous cells); all patients with abnormal cytology results met high-risk criteria and were screened appropriately.

IN PRACTICE:

“[The study] findings suggest that most clinicians and patients are aware of recommendations to stop cervical cancer screening after age 65 years. However, there may be a lack of awareness regarding continued screening in high-risk patients or those with inadequate prior screening. The lack of prior screening history and results in the medical record suggests that providers may not understand the importance of these factors to inform cervical cancer screening in older patients,” the authors of the study wrote.

SOURCE:

The study was led by Daniel Rodriguez, BS, Kolschowsky Research and Education Institute, Sarasota Memorial Health Care System, Sarasota, Florida. It was published online on April 23, 2026, in the Journal of Lower Genital Tract Disease.

LIMITATIONS:

Screening history in electronic medical records may be incomplete.

DISCLOSURES:

The Sarasota Memorial Healthcare Foundation provided financial support for this research. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

TOPLINE:

Among women aged > 65 years who were at a high risk for cervical cancer and required screening, only 5.2% received appropriate screening. Women with a history of high-grade cervical dysplasia had a greater likelihood of appropriate screening.

METHODOLOGY:

• Researchers conducted a retrospective study to assess the rates of appropriate cervical cancer screening among 1787 women aged 66 years or older (median, 76 years; 96.3% White) who had a Medicare wellness visit or an annual gynecologic visit in a healthcare system in 2022.
• Data on age at the last cervical cancer screening, history of hysterectomy, human papillomavirus (HPV) status, and history of a diagnosis of cervical cancer or cervical dysplasia, high-grade dysplasia, and immune deficiency status were assessed.
• Participants were categorized into 2 groups: those at high risk for cervical cancer (prior high-grade cervical dysplasia or cancer, an immunocompromised status, or lack of two normal cytology results in the past 10 years; n = 250) and those at average risk (having no high-risk features and adequate prior screening or having a prior hysterectomy with no history of high-grade cervical dysplasia; n = 1537).
• The screening cessation criteria were based on adequate prior screening, defined as two prior negative cervical cancer screenings in the past 10 years, the absence of high-grade cervical dysplasia or cervical cancer, and no immune deficiency.

TAKEAWAY:

• Overall, 4.9% of patients had a history of inadequate prior screening; among women at high risk, 5.2% were appropriately screened.
• The odds of continued screening were greater for women with a history of a positive HPV test results (adjusted odds ratio [aOR], 3.4; P = .016), a history of high-grade cervical dysplasia (aOR, 3.8; P = .009), and those without prior hysterectomy (aOR, 2.2; P = .005).
• Among women at high risk for cervical cancer, those with a history of high-grade cervical dysplasia had increased odds of appropriate screening (aOR, 6.7; P = .002), whereas the odds decreased with every 5-year increase in age (aOR, 0.5; P = .031). Women with prior hysterectomy were less likely to be over-screened (aOR, 0.3; P < .001) than those without.
• Among the 79 women who underwent screening, 97.5% had normal cytology results; the remaining women had abnormal cytology results (atypical squamous cells of undetermined significance or atypical squamous cells); all patients with abnormal cytology results met high-risk criteria and were screened appropriately.

IN PRACTICE:

“[The study] findings suggest that most clinicians and patients are aware of recommendations to stop cervical cancer screening after age 65 years. However, there may be a lack of awareness regarding continued screening in high-risk patients or those with inadequate prior screening. The lack of prior screening history and results in the medical record suggests that providers may not understand the importance of these factors to inform cervical cancer screening in older patients,” the authors of the study wrote.

SOURCE:

The study was led by Daniel Rodriguez, BS, Kolschowsky Research and Education Institute, Sarasota Memorial Health Care System, Sarasota, Florida. It was published online on April 23, 2026, in the Journal of Lower Genital Tract Disease.

LIMITATIONS:

Screening history in electronic medical records may be incomplete.

DISCLOSURES:

The Sarasota Memorial Healthcare Foundation provided financial support for this research. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

Dual checkpoint blockade allowed 70.6% of patients with microsatellite instability-high (MSI-H) resectable gastric or gastroesophageal junction adenocarcinoma (G/GEJAC) to avoid surgery in a small cohort of the INFINITY study.

MSI-H tumors account for roughly 10% of early G/GEJACs. They respond well to immunotherapy, with high rates of pathologic complete responses. The Italian INFINITY trial set out to test whether some patients with these tumors might not need gastrectomy.

The trial treated MSI-H patients with durvalumab 1500 mg once a month for 3 months along with 1 300-mg dose of the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) blocker tremelimumab on day 1. The 18 patients in cohort 1 proceeded to surgery, with a 60% pathologic complete response rate. An additional 18 patients in cohort 2 were the subject of a presentation at the American Association for Cancer Research (AACR) Annual Meeting 2026. These patients were assessed for clinical complete response; if present, they went on to surveillance; if not, they had surgery.

To qualify for a clinical complete response and surveillance, patients were required to have negative findings on CT and PET scans; tumor-informed circulating tumor DNA (ctDNA); and upper endoscopy with ultrasound, including bite-on-bite biopsies and nodal sampling. Surveillance afterward included CT, endoscopy with biopsies, and ctDNA every 12 weeks for up to 2 years.

Among 17 evaluable patients, 1 withdrew consent during immunotherapy, 13 (76%) had a clinical complete response and started surveillance, and the other 4 went to surgery. One patient in the surveillance group had a local regrowth after 4 months, underwent salvage surgery, and remained disease-free. At a median follow-up of 27.1 months, there were no additional progression events.

Overall, 12 of the 17 patients (70.6%) were gastrectomy-free at 2 years without additional treatment. Progression-free survival was 94.1%, and all patients were alive.

“The results are very encouraging,” lead investigator Alberto Leone, MD, said while presenting the results at the AACR annual meeting.

“Nonoperative management could be a safe and effective strategy for patients achieving a clinical complete response after only 3 months of dual immunotherapy,” said Leone, who is a gastrointestinal medical oncologist at the Istituto Nazionale dei Tumori, Milan, Italy. “However, the optimal strategy needs to be established in larger randomized trials.”

Study discussant Yelena Janjagian, MD, gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, said the findings were important, particularly given that 70.6% of patients avoided a potentially life-altering gastrectomy.

In addition to surgery, the study also calls into question the need for chemotherapy, long the backbone of management alongside surgery, she said. To replace it, however, “it appears that dual checkpoint blockade will be required for a chemotherapy-free approach to achieve organ preservation.”

“Anti-PD-1 alone is not sufficient; we need CTLA-4 to expand and reactivate tumor-specific immunity,” Janjagian continued.

Ultimately, she expects immunotherapy to shift management of MSI-H cancers away from surgery, although some patients will still likely need an operation.

In addition to being MSI-H, patients in the study were mismatch repair deficient and Epstein-Barr virus-negative with T2/T3 tumors; T4 tumors were excluded.

Tumor-agnostic plasma ctDNA was positive at baseline in 13 patients and cleared in 11 after treatment. Higher baseline plasma ctDNA trended toward a lower likelihood of reaching a clinical complete response. Specificity was 100%, so when positive, the test was “very highly informative,” Leone said.

Three patients had grade 3 adverse events (hyperthyroidism, increased gamma-glutamyl transferase, and colitis) that resolved with steroids. There were no grade 4 events, treatment discontinuation, or deaths.

The work was funded by the GONO Foundation and AstraZeneca, the maker of durvalumab and tremelimumab. Leone reported having no disclosures. Janjagian reported having extensive industry ties, including travel funding, consulting fees, and research support from AstraZeneca.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected] 

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

Dual checkpoint blockade allowed 70.6% of patients with microsatellite instability-high (MSI-H) resectable gastric or gastroesophageal junction adenocarcinoma (G/GEJAC) to avoid surgery in a small cohort of the INFINITY study.

MSI-H tumors account for roughly 10% of early G/GEJACs. They respond well to immunotherapy, with high rates of pathologic complete responses. The Italian INFINITY trial set out to test whether some patients with these tumors might not need gastrectomy.

The trial treated MSI-H patients with durvalumab 1500 mg once a month for 3 months along with 1 300-mg dose of the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) blocker tremelimumab on day 1. The 18 patients in cohort 1 proceeded to surgery, with a 60% pathologic complete response rate. An additional 18 patients in cohort 2 were the subject of a presentation at the American Association for Cancer Research (AACR) Annual Meeting 2026. These patients were assessed for clinical complete response; if present, they went on to surveillance; if not, they had surgery.

To qualify for a clinical complete response and surveillance, patients were required to have negative findings on CT and PET scans; tumor-informed circulating tumor DNA (ctDNA); and upper endoscopy with ultrasound, including bite-on-bite biopsies and nodal sampling. Surveillance afterward included CT, endoscopy with biopsies, and ctDNA every 12 weeks for up to 2 years.

Among 17 evaluable patients, 1 withdrew consent during immunotherapy, 13 (76%) had a clinical complete response and started surveillance, and the other 4 went to surgery. One patient in the surveillance group had a local regrowth after 4 months, underwent salvage surgery, and remained disease-free. At a median follow-up of 27.1 months, there were no additional progression events.

Overall, 12 of the 17 patients (70.6%) were gastrectomy-free at 2 years without additional treatment. Progression-free survival was 94.1%, and all patients were alive.

“The results are very encouraging,” lead investigator Alberto Leone, MD, said while presenting the results at the AACR annual meeting.

“Nonoperative management could be a safe and effective strategy for patients achieving a clinical complete response after only 3 months of dual immunotherapy,” said Leone, who is a gastrointestinal medical oncologist at the Istituto Nazionale dei Tumori, Milan, Italy. “However, the optimal strategy needs to be established in larger randomized trials.”

Study discussant Yelena Janjagian, MD, gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, said the findings were important, particularly given that 70.6% of patients avoided a potentially life-altering gastrectomy.

In addition to surgery, the study also calls into question the need for chemotherapy, long the backbone of management alongside surgery, she said. To replace it, however, “it appears that dual checkpoint blockade will be required for a chemotherapy-free approach to achieve organ preservation.”

“Anti-PD-1 alone is not sufficient; we need CTLA-4 to expand and reactivate tumor-specific immunity,” Janjagian continued.

Ultimately, she expects immunotherapy to shift management of MSI-H cancers away from surgery, although some patients will still likely need an operation.

In addition to being MSI-H, patients in the study were mismatch repair deficient and Epstein-Barr virus-negative with T2/T3 tumors; T4 tumors were excluded.

Tumor-agnostic plasma ctDNA was positive at baseline in 13 patients and cleared in 11 after treatment. Higher baseline plasma ctDNA trended toward a lower likelihood of reaching a clinical complete response. Specificity was 100%, so when positive, the test was “very highly informative,” Leone said.

Three patients had grade 3 adverse events (hyperthyroidism, increased gamma-glutamyl transferase, and colitis) that resolved with steroids. There were no grade 4 events, treatment discontinuation, or deaths.

The work was funded by the GONO Foundation and AstraZeneca, the maker of durvalumab and tremelimumab. Leone reported having no disclosures. Janjagian reported having extensive industry ties, including travel funding, consulting fees, and research support from AstraZeneca.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected] 

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

Dual checkpoint blockade allowed 70.6% of patients with microsatellite instability-high (MSI-H) resectable gastric or gastroesophageal junction adenocarcinoma (G/GEJAC) to avoid surgery in a small cohort of the INFINITY study.

MSI-H tumors account for roughly 10% of early G/GEJACs. They respond well to immunotherapy, with high rates of pathologic complete responses. The Italian INFINITY trial set out to test whether some patients with these tumors might not need gastrectomy.

The trial treated MSI-H patients with durvalumab 1500 mg once a month for 3 months along with 1 300-mg dose of the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) blocker tremelimumab on day 1. The 18 patients in cohort 1 proceeded to surgery, with a 60% pathologic complete response rate. An additional 18 patients in cohort 2 were the subject of a presentation at the American Association for Cancer Research (AACR) Annual Meeting 2026. These patients were assessed for clinical complete response; if present, they went on to surveillance; if not, they had surgery.

To qualify for a clinical complete response and surveillance, patients were required to have negative findings on CT and PET scans; tumor-informed circulating tumor DNA (ctDNA); and upper endoscopy with ultrasound, including bite-on-bite biopsies and nodal sampling. Surveillance afterward included CT, endoscopy with biopsies, and ctDNA every 12 weeks for up to 2 years.

Among 17 evaluable patients, 1 withdrew consent during immunotherapy, 13 (76%) had a clinical complete response and started surveillance, and the other 4 went to surgery. One patient in the surveillance group had a local regrowth after 4 months, underwent salvage surgery, and remained disease-free. At a median follow-up of 27.1 months, there were no additional progression events.

Overall, 12 of the 17 patients (70.6%) were gastrectomy-free at 2 years without additional treatment. Progression-free survival was 94.1%, and all patients were alive.

“The results are very encouraging,” lead investigator Alberto Leone, MD, said while presenting the results at the AACR annual meeting.

“Nonoperative management could be a safe and effective strategy for patients achieving a clinical complete response after only 3 months of dual immunotherapy,” said Leone, who is a gastrointestinal medical oncologist at the Istituto Nazionale dei Tumori, Milan, Italy. “However, the optimal strategy needs to be established in larger randomized trials.”

Study discussant Yelena Janjagian, MD, gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, said the findings were important, particularly given that 70.6% of patients avoided a potentially life-altering gastrectomy.

In addition to surgery, the study also calls into question the need for chemotherapy, long the backbone of management alongside surgery, she said. To replace it, however, “it appears that dual checkpoint blockade will be required for a chemotherapy-free approach to achieve organ preservation.”

“Anti-PD-1 alone is not sufficient; we need CTLA-4 to expand and reactivate tumor-specific immunity,” Janjagian continued.

Ultimately, she expects immunotherapy to shift management of MSI-H cancers away from surgery, although some patients will still likely need an operation.

In addition to being MSI-H, patients in the study were mismatch repair deficient and Epstein-Barr virus-negative with T2/T3 tumors; T4 tumors were excluded.

Tumor-agnostic plasma ctDNA was positive at baseline in 13 patients and cleared in 11 after treatment. Higher baseline plasma ctDNA trended toward a lower likelihood of reaching a clinical complete response. Specificity was 100%, so when positive, the test was “very highly informative,” Leone said.

Three patients had grade 3 adverse events (hyperthyroidism, increased gamma-glutamyl transferase, and colitis) that resolved with steroids. There were no grade 4 events, treatment discontinuation, or deaths.

The work was funded by the GONO Foundation and AstraZeneca, the maker of durvalumab and tremelimumab. Leone reported having no disclosures. Janjagian reported having extensive industry ties, including travel funding, consulting fees, and research support from AstraZeneca.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected] 

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

A personalized messenger RNA (mRNA) vaccine for pancreatic cancer continues to show promise for improving patient survival, according to 6-year follow-up results of a phase 1 clinical study.

Among the 8 out of 16 patients in the study who initially experienced an immune response to the vaccine, seven (87.5%) were still alive at follow-up, lead investigator Vinod P. Balachandran, MD, reported at the American Association for Cancer Research (AACR) Annual Meeting 2026.

Of the eight patients who did not respond, two (25%) were still alive, with a median survival time of 3.4 years. “This suggests that personalized vaccines can stimulate the immune system in some pancreatic cancer patients, and that these patients continue to do well for several years after vaccination,” said Balachandran, director of the Olayan Center for Cancer Vaccines at Memorial Sloan Kettering Cancer Center in New York City.

The findings suggest that this vaccine has the potential to improve outcomes in patients with pancreatic cancer, which is one of the deadliest cancers, he said.

The 5-year survival rate for pancreatic cancer is currently 13%, according to the American Cancer Society’s Cancer Statistics 2026 report.

Initial results of the trial evaluating the individualized neoantigen vaccine — autogene cevumeran, which is being developed by BioNTech and Genentech — were published in Nature in February 2025.

After pancreatic cancer surgery and chemo-immunotherapy, patients with pancreatic ductal adenocarcinoma (PDAC) received a vaccine personalized to each patient based on unique changes in their tumor DNA.

The eight patients with vaccine-induced T cells had prolonged recurrence-free survival (RFS; median not reached), whereas nonresponders had a median RFS of 13.4 months, the authors had reported in the Nature paper.

This correlation was not confounded by other factors, including those associated with the patient, tumor, treatment, and host immune fitness, Balachandran noted.

In the responders, the T-cell clones had “high magnitude and exceptional longevity,” with an average estimated lifespan of 7.7 years, he said.

A fundamental challenge in developing cancer vaccines has been generating durable functional T cells specific for tumor antigens, and these findings suggest that mRNA-lipoplex vaccines against somatic mutation-derived neoantigens like autogene cevumeran may help overcome this challenge in pancreatic cancer, he and his colleagues concluded in the Nature paper.

The latest findings presented at the AACR annual meeting further underscore the potential of this approach.

At the 6-year follow-up, median RFS was “still not reached” in the vaccine responders vs 1.1 year in the nonresponders, he noted.

“This translates to a difference in overall survival,” he said. “Seven of eight [responders to the vaccine] are still alive 4.5-6 years after surgery.”

And of the 2 of 8 nonresponders still alive, one appears to be mounting a subclinical vaccine-induced T-cell response, he added, noting that this “suggests that inducible vaccine immunity may also impact survival in PDAC.”

“The implication here, we believe, is that even if a cancer has very mutational by-products [like PDAC], these mutational by-products can empower potent and composite immunity,” he said. “This is important because it could potentially expand vaccine eligibility to many cancers.”

Currently, there are about 50 neoantigen vaccine trials in solid tumors ongoing worldwide, he noted.

Memorial Sloan Kettering reports that Genentech and BioNTech are now testing autogene cevumeran in a larger patient population at numerous sites worldwide.

Balachandran reported receiving research support from Genentech, Merck Sharp & Dohme, and AbbVie.

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on X: @SW_MedReporter.

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

A personalized messenger RNA (mRNA) vaccine for pancreatic cancer continues to show promise for improving patient survival, according to 6-year follow-up results of a phase 1 clinical study.

Among the 8 out of 16 patients in the study who initially experienced an immune response to the vaccine, seven (87.5%) were still alive at follow-up, lead investigator Vinod P. Balachandran, MD, reported at the American Association for Cancer Research (AACR) Annual Meeting 2026.

Of the eight patients who did not respond, two (25%) were still alive, with a median survival time of 3.4 years. “This suggests that personalized vaccines can stimulate the immune system in some pancreatic cancer patients, and that these patients continue to do well for several years after vaccination,” said Balachandran, director of the Olayan Center for Cancer Vaccines at Memorial Sloan Kettering Cancer Center in New York City.

The findings suggest that this vaccine has the potential to improve outcomes in patients with pancreatic cancer, which is one of the deadliest cancers, he said.

The 5-year survival rate for pancreatic cancer is currently 13%, according to the American Cancer Society’s Cancer Statistics 2026 report.

Initial results of the trial evaluating the individualized neoantigen vaccine — autogene cevumeran, which is being developed by BioNTech and Genentech — were published in Nature in February 2025.

After pancreatic cancer surgery and chemo-immunotherapy, patients with pancreatic ductal adenocarcinoma (PDAC) received a vaccine personalized to each patient based on unique changes in their tumor DNA.

The eight patients with vaccine-induced T cells had prolonged recurrence-free survival (RFS; median not reached), whereas nonresponders had a median RFS of 13.4 months, the authors had reported in the Nature paper.

This correlation was not confounded by other factors, including those associated with the patient, tumor, treatment, and host immune fitness, Balachandran noted.

In the responders, the T-cell clones had “high magnitude and exceptional longevity,” with an average estimated lifespan of 7.7 years, he said.

A fundamental challenge in developing cancer vaccines has been generating durable functional T cells specific for tumor antigens, and these findings suggest that mRNA-lipoplex vaccines against somatic mutation-derived neoantigens like autogene cevumeran may help overcome this challenge in pancreatic cancer, he and his colleagues concluded in the Nature paper.

The latest findings presented at the AACR annual meeting further underscore the potential of this approach.

At the 6-year follow-up, median RFS was “still not reached” in the vaccine responders vs 1.1 year in the nonresponders, he noted.

“This translates to a difference in overall survival,” he said. “Seven of eight [responders to the vaccine] are still alive 4.5-6 years after surgery.”

And of the 2 of 8 nonresponders still alive, one appears to be mounting a subclinical vaccine-induced T-cell response, he added, noting that this “suggests that inducible vaccine immunity may also impact survival in PDAC.”

“The implication here, we believe, is that even if a cancer has very mutational by-products [like PDAC], these mutational by-products can empower potent and composite immunity,” he said. “This is important because it could potentially expand vaccine eligibility to many cancers.”

Currently, there are about 50 neoantigen vaccine trials in solid tumors ongoing worldwide, he noted.

Memorial Sloan Kettering reports that Genentech and BioNTech are now testing autogene cevumeran in a larger patient population at numerous sites worldwide.

Balachandran reported receiving research support from Genentech, Merck Sharp & Dohme, and AbbVie.

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on X: @SW_MedReporter.

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

A personalized messenger RNA (mRNA) vaccine for pancreatic cancer continues to show promise for improving patient survival, according to 6-year follow-up results of a phase 1 clinical study.

Among the 8 out of 16 patients in the study who initially experienced an immune response to the vaccine, seven (87.5%) were still alive at follow-up, lead investigator Vinod P. Balachandran, MD, reported at the American Association for Cancer Research (AACR) Annual Meeting 2026.

Of the eight patients who did not respond, two (25%) were still alive, with a median survival time of 3.4 years. “This suggests that personalized vaccines can stimulate the immune system in some pancreatic cancer patients, and that these patients continue to do well for several years after vaccination,” said Balachandran, director of the Olayan Center for Cancer Vaccines at Memorial Sloan Kettering Cancer Center in New York City.

The findings suggest that this vaccine has the potential to improve outcomes in patients with pancreatic cancer, which is one of the deadliest cancers, he said.

The 5-year survival rate for pancreatic cancer is currently 13%, according to the American Cancer Society’s Cancer Statistics 2026 report.

Initial results of the trial evaluating the individualized neoantigen vaccine — autogene cevumeran, which is being developed by BioNTech and Genentech — were published in Nature in February 2025.

After pancreatic cancer surgery and chemo-immunotherapy, patients with pancreatic ductal adenocarcinoma (PDAC) received a vaccine personalized to each patient based on unique changes in their tumor DNA.

The eight patients with vaccine-induced T cells had prolonged recurrence-free survival (RFS; median not reached), whereas nonresponders had a median RFS of 13.4 months, the authors had reported in the Nature paper.

This correlation was not confounded by other factors, including those associated with the patient, tumor, treatment, and host immune fitness, Balachandran noted.

In the responders, the T-cell clones had “high magnitude and exceptional longevity,” with an average estimated lifespan of 7.7 years, he said.

A fundamental challenge in developing cancer vaccines has been generating durable functional T cells specific for tumor antigens, and these findings suggest that mRNA-lipoplex vaccines against somatic mutation-derived neoantigens like autogene cevumeran may help overcome this challenge in pancreatic cancer, he and his colleagues concluded in the Nature paper.

The latest findings presented at the AACR annual meeting further underscore the potential of this approach.

At the 6-year follow-up, median RFS was “still not reached” in the vaccine responders vs 1.1 year in the nonresponders, he noted.

“This translates to a difference in overall survival,” he said. “Seven of eight [responders to the vaccine] are still alive 4.5-6 years after surgery.”

And of the 2 of 8 nonresponders still alive, one appears to be mounting a subclinical vaccine-induced T-cell response, he added, noting that this “suggests that inducible vaccine immunity may also impact survival in PDAC.”

“The implication here, we believe, is that even if a cancer has very mutational by-products [like PDAC], these mutational by-products can empower potent and composite immunity,” he said. “This is important because it could potentially expand vaccine eligibility to many cancers.”

Currently, there are about 50 neoantigen vaccine trials in solid tumors ongoing worldwide, he noted.

Memorial Sloan Kettering reports that Genentech and BioNTech are now testing autogene cevumeran in a larger patient population at numerous sites worldwide.

Balachandran reported receiving research support from Genentech, Merck Sharp & Dohme, and AbbVie.

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on X: @SW_MedReporter.

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

TOPLINE:

A large cohort study found that the use of GLP-1 receptor agonists (GLP-1 RAs) over 3 years was associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION) compared with the use of SGLT2 inhibitors in veterans with type 2 diabetes (T2D).

METHODOLOGY:

• Pharmacovigilance reports and emerging, but inconsistent, population-based studies suggest that the use of GLP-1 RAs may be linked to ocular adverse events, including a possible increased risk for NAION; however, it remains unclear whether the association is specific to NAION as compared with other optic disorders.
• Researchers conducted a target trial emulation study using nationwide electronic health records from the US Department of Veterans Affairs to compare the 3-year risk for NAION among veterans with T2D who initiated GLP-1 RAs vs SGLT2 inhibitors.
• The study included 588,168 veterans with T2D, of whom 139,546 initiated GLP-1 RA therapy (mean age, 65.33 years; 90.2% male) and 448,622 initiated SGLT2 inhibitor therapy (mean age, 67.94 years; 95.3% male) between 2017 and 2024; groups were subsequently matched using propensity score-based inverse probability weighting.
• Cases of NAION were identified from medical records using standard diagnostic codes; cases diagnosed by an eye care specialist and repeat diagnoses were also evaluated.
• The 3-year cumulative incidence, cumulative incidence difference (CID), and cumulative incidence ratio of NAION were estimated.

TAKEAWAY:

• Over 3 years, individuals who started GLP-1 RAs had a small but statistically significant increase in the risk for NAION compared with those who started SGLT2 inhibitors — 39.07 vs 29.33 cases per 10,000 people (CID, 9.98 per 10,000 people; 95% CI, 3.48-14.03) — and a relative increase of about 35% (cumulative incidence ratio, 1.35; 95% CI, 1.11-1.51).
• The increased risk for NAION with the use of GLP-1 RAs was consistent across definitions: diagnosis by an eye care specialist (CID, 8.73; 95% CI, 2.46-12.89), repeat diagnoses (CID, 6.35; 95% CI, 2.40-9.65), and repeat diagnoses with a specialist (CID, 5.91; 95% CI, 2.00-8.88).
• Compared with the use of SGLT2 inhibitors, the use of GLP-1 RAs was not associated with an increased risk for other optic disorders such as diabetic retinopathy, macular degeneration, retinal vascular occlusion, or optic neuritis.
• The frequency of ophthalmology or optometry clinic visits during follow-up was found to be similar between the two groups, suggesting that the association with NAION was not due to differential surveillance.

IN PRACTICE

“GLP-1 RA use was associated with a modestly increased risk of NAION compared with [SGLT2 inhibitor] use. While the absolute risk remains low, the specificity of this finding may warrant heightened vigilance,” the authors of the study wrote.

SOURCE:

The study was led by Taeyoung Choi, MS, Clinical Epidemiology Center, Research and Development Service, VA St Louis Health Care System, St. Louis. It was published online on April 30, 2026, in JAMA Network Open.

LIMITATIONS:

The study cohort was older and predominantly male, limiting generalizability to other populations. Residual confounding, selection bias, and outcome misclassification could not be fully excluded.

DISCLOSURES:

The study was funded by the US Department of Veterans Affairs. Two authors reported being uncompensated consultants for Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

TOPLINE:

A large cohort study found that the use of GLP-1 receptor agonists (GLP-1 RAs) over 3 years was associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION) compared with the use of SGLT2 inhibitors in veterans with type 2 diabetes (T2D).

METHODOLOGY:

• Pharmacovigilance reports and emerging, but inconsistent, population-based studies suggest that the use of GLP-1 RAs may be linked to ocular adverse events, including a possible increased risk for NAION; however, it remains unclear whether the association is specific to NAION as compared with other optic disorders.
• Researchers conducted a target trial emulation study using nationwide electronic health records from the US Department of Veterans Affairs to compare the 3-year risk for NAION among veterans with T2D who initiated GLP-1 RAs vs SGLT2 inhibitors.
• The study included 588,168 veterans with T2D, of whom 139,546 initiated GLP-1 RA therapy (mean age, 65.33 years; 90.2% male) and 448,622 initiated SGLT2 inhibitor therapy (mean age, 67.94 years; 95.3% male) between 2017 and 2024; groups were subsequently matched using propensity score-based inverse probability weighting.
• Cases of NAION were identified from medical records using standard diagnostic codes; cases diagnosed by an eye care specialist and repeat diagnoses were also evaluated.
• The 3-year cumulative incidence, cumulative incidence difference (CID), and cumulative incidence ratio of NAION were estimated.

TAKEAWAY:

• Over 3 years, individuals who started GLP-1 RAs had a small but statistically significant increase in the risk for NAION compared with those who started SGLT2 inhibitors — 39.07 vs 29.33 cases per 10,000 people (CID, 9.98 per 10,000 people; 95% CI, 3.48-14.03) — and a relative increase of about 35% (cumulative incidence ratio, 1.35; 95% CI, 1.11-1.51).
• The increased risk for NAION with the use of GLP-1 RAs was consistent across definitions: diagnosis by an eye care specialist (CID, 8.73; 95% CI, 2.46-12.89), repeat diagnoses (CID, 6.35; 95% CI, 2.40-9.65), and repeat diagnoses with a specialist (CID, 5.91; 95% CI, 2.00-8.88).
• Compared with the use of SGLT2 inhibitors, the use of GLP-1 RAs was not associated with an increased risk for other optic disorders such as diabetic retinopathy, macular degeneration, retinal vascular occlusion, or optic neuritis.
• The frequency of ophthalmology or optometry clinic visits during follow-up was found to be similar between the two groups, suggesting that the association with NAION was not due to differential surveillance.

IN PRACTICE

“GLP-1 RA use was associated with a modestly increased risk of NAION compared with [SGLT2 inhibitor] use. While the absolute risk remains low, the specificity of this finding may warrant heightened vigilance,” the authors of the study wrote.

SOURCE:

The study was led by Taeyoung Choi, MS, Clinical Epidemiology Center, Research and Development Service, VA St Louis Health Care System, St. Louis. It was published online on April 30, 2026, in JAMA Network Open.

LIMITATIONS:

The study cohort was older and predominantly male, limiting generalizability to other populations. Residual confounding, selection bias, and outcome misclassification could not be fully excluded.

DISCLOSURES:

The study was funded by the US Department of Veterans Affairs. Two authors reported being uncompensated consultants for Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

TOPLINE:

A large cohort study found that the use of GLP-1 receptor agonists (GLP-1 RAs) over 3 years was associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION) compared with the use of SGLT2 inhibitors in veterans with type 2 diabetes (T2D).

METHODOLOGY:

• Pharmacovigilance reports and emerging, but inconsistent, population-based studies suggest that the use of GLP-1 RAs may be linked to ocular adverse events, including a possible increased risk for NAION; however, it remains unclear whether the association is specific to NAION as compared with other optic disorders.
• Researchers conducted a target trial emulation study using nationwide electronic health records from the US Department of Veterans Affairs to compare the 3-year risk for NAION among veterans with T2D who initiated GLP-1 RAs vs SGLT2 inhibitors.
• The study included 588,168 veterans with T2D, of whom 139,546 initiated GLP-1 RA therapy (mean age, 65.33 years; 90.2% male) and 448,622 initiated SGLT2 inhibitor therapy (mean age, 67.94 years; 95.3% male) between 2017 and 2024; groups were subsequently matched using propensity score-based inverse probability weighting.
• Cases of NAION were identified from medical records using standard diagnostic codes; cases diagnosed by an eye care specialist and repeat diagnoses were also evaluated.
• The 3-year cumulative incidence, cumulative incidence difference (CID), and cumulative incidence ratio of NAION were estimated.

TAKEAWAY:

• Over 3 years, individuals who started GLP-1 RAs had a small but statistically significant increase in the risk for NAION compared with those who started SGLT2 inhibitors — 39.07 vs 29.33 cases per 10,000 people (CID, 9.98 per 10,000 people; 95% CI, 3.48-14.03) — and a relative increase of about 35% (cumulative incidence ratio, 1.35; 95% CI, 1.11-1.51).
• The increased risk for NAION with the use of GLP-1 RAs was consistent across definitions: diagnosis by an eye care specialist (CID, 8.73; 95% CI, 2.46-12.89), repeat diagnoses (CID, 6.35; 95% CI, 2.40-9.65), and repeat diagnoses with a specialist (CID, 5.91; 95% CI, 2.00-8.88).
• Compared with the use of SGLT2 inhibitors, the use of GLP-1 RAs was not associated with an increased risk for other optic disorders such as diabetic retinopathy, macular degeneration, retinal vascular occlusion, or optic neuritis.
• The frequency of ophthalmology or optometry clinic visits during follow-up was found to be similar between the two groups, suggesting that the association with NAION was not due to differential surveillance.

IN PRACTICE

“GLP-1 RA use was associated with a modestly increased risk of NAION compared with [SGLT2 inhibitor] use. While the absolute risk remains low, the specificity of this finding may warrant heightened vigilance,” the authors of the study wrote.

SOURCE:

The study was led by Taeyoung Choi, MS, Clinical Epidemiology Center, Research and Development Service, VA St Louis Health Care System, St. Louis. It was published online on April 30, 2026, in JAMA Network Open.

LIMITATIONS:

The study cohort was older and predominantly male, limiting generalizability to other populations. Residual confounding, selection bias, and outcome misclassification could not be fully excluded.

DISCLOSURES:

The study was funded by the US Department of Veterans Affairs. Two authors reported being uncompensated consultants for Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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

Though end-of-life care for veterans with chronic obstructive pulmonary disease (COPD) in the US Department of Veterans Affairs (VA) has become more prevalent in recent years, a recent retrospective cohort study found that most patients do not receive palliative care or inpatient VA hospice over the past year of life, with rates lower than for other terminal illnesses. 

Among 332,770 decedents traced from 2010 through 2020, only 16.8% received either palliative or inpatient hospice care in the year before their death. The median time between their first palliative care appointment and death was 46 days, reported pulmonologist Natalia Smirnova, MD, assistant professor of medicine, Emory School of Medicine, Atlanta, et al in CHEST Pulmonary. 

A total of 15.9% of the decedents received inpatient hospice care from the VA. 

“These findings point to an opportunity to improve access to palliative care and hospice services for veterans with COPD, including earlier identification of need and stronger access pathways across care settings,” Smirnova told Federal Practitioner.

COPD Common Among Vets

An estimated 8%-19% of US veterans have COPD, higher than the estimated rate of 6% in adults from the general population. The condition is believed to be underdiagnosed in veterans. 

“Palliative care should be integrated early into routine care, when symptoms start,” Kathleen Lindell, PhD, RN, associate professor and chair, Palliative Care Health, School of Nursing, Medical University of South Carolina, Charleston, explained in a Federal Practitioner interview. “COPD is a serious respiratory illness, and patients experience progressively debilitating dyspnea or shortness of breath, frequent hospitalizations. And they frequently experience high rates of anxiety and depression,” 

Lindell is familiar with the study findings but didn’t take part in the research. 

“Early palliative care,” she said, “addresses symptom management and advance care planning to reduce suffering and ensure what matters most to the patient as the disease progresses.”

Smirnova noted that “hospice is a related but distinct service for veterans with a terminal condition, generally when life expectancy is < 6 months and the veteran is no longer seeking treatment other than palliative care.”

The study analyzed electronic health records and patterns of palliative and hospice care in the year before death. The 332,770 patients were mostly male (98.1%) and White (81.0%). Many had comorbidities such as congestive heart failure (30.0%), depression (26.0%), coronary artery disease (25.5%), anxiety (13.4%), and lung cancer (12.1%).

Researchers found that palliative care was mostly (61.6% of encounters) delivered in the inpatient setting, where it occurred a median 30 days before death. In the outpatient setting, it began a median of 71 days before death. 

From 2010 through 2020, the prevalence of palliative care increased from 10.4% to 16.0%, and the prevalence of VA inpatient hospice care increased from 15.0% to 18.0%. Some veterans may have received hospice services in other settings; in-home hospice is common.

Who is More Likely to Receive Palliative Care?

Black patients (adjusted odds ratio [AOR], 1.21), Latino/Hispanic ethnicity (AOR, 1.22), patients with housing instability (AOR, 1.38) and who were underweight (AOR, 1.75) were linked to more palliative care use. Black patients were especially likely to get inpatient palliative care, a fact that “may, in part, be driven by increased care intensity at the end of life, as has been demonstrated in prior studies,” the authors noted.

Marriage (AOR, 0.88) was linked to less palliative care use, while patients with lung cancer were especially likely to receive it (AOR, 2.48). There were similar differences in use of hospice care apart from higher use for Black patients. 

Smirnova said the study was not designed to determine the causes of patterns in palliative care use. However, important factors appear to include hospitalization, comorbidities, and access to care at health care sites. (Usage rates were lower at rural centers and higher at more complex centers.)

COPD vs Other Terminal Diseases

“The modest increases in utilization of palliative care and VA inpatient hospice from 2010 to 2020 align with previous work [research] in inpatients with COPD and heart failure,” the researchers wrote, “possibly reflecting the effect of international professional society guidelines, increased acceptance of palliative care, improvements related to VA end-of-life care and life-sustaining treatment decisions initiatives, and increases in the specialist palliative care workforce.”

Still, there appears to be a major discrepancy regarding the use of palliative care for COPD within the VA compared with other diseases. A study of data from 2014 through 2017 found that for patients with several comorbidities—including COPD, heart failure, cancer, and dementia—inpatient palliative care was introduced a median of 58 days before death and outpatient care 160 days before death. 

“This suggests that veterans with COPD receive palliative care later than those with other serious illnesses,” the authors argued. 

Don’t Wait for the ‘Right Time’

Sarah Miller, PhD, RN, associate professor, and assistant dean, PhD Nursing Science Program, School of Nursing, Medical University of South Carolina, Charleston, praised the study in an interview and noted that uncertainty about the “right time” to refer patients to palliative care could play a role in the findings. Miller is familiar with the study but did not participate in the research.

Lindell, the chair of Palliative Care Health, agreed.

“With COPD—a chronic, progressive disease—decline can be gradual, which makes it difficult to identify a clear transition point,” Lindell told Federal Practitioner. “This has contributed to many palliative referrals happening only when patients are clearly deteriorating or nearing the end of life. But palliative care should not be introduced reactively; it should be integrated early, alongside disease-directed treatment.”

For her part, Miller noted that “many veterans with COPD are navigating complex comorbidities and fragmented care across settings. Diseases like COPD don’t follow a predictable path, so referrals don’t always happen like they should.”

Moving forward, “if symptoms are present, early palliative care is appropriate,” Lindell said. These conversations should happen early and over time.

“The VA should prioritize early referral and access to palliative care for patients with COPD to provide the best care for these individuals.”

No study funding was reported. Smirnova discloses relationships with the CHEST Foundation and National Heart, Lung, and Blood Institute. Other authors disclose relationships with various grantors. 

Miller discloses a relationship with AstraZeneca. Lindell discloses relationships with Boehringer Ingelheim and Heart & Lung: The Journal of Acute and Critical Care. 

Though end-of-life care for veterans with chronic obstructive pulmonary disease (COPD) in the US Department of Veterans Affairs (VA) has become more prevalent in recent years, a recent retrospective cohort study found that most patients do not receive palliative care or inpatient VA hospice over the past year of life, with rates lower than for other terminal illnesses. 

Among 332,770 decedents traced from 2010 through 2020, only 16.8% received either palliative or inpatient hospice care in the year before their death. The median time between their first palliative care appointment and death was 46 days, reported pulmonologist Natalia Smirnova, MD, assistant professor of medicine, Emory School of Medicine, Atlanta, et al in CHEST Pulmonary. 

A total of 15.9% of the decedents received inpatient hospice care from the VA. 

“These findings point to an opportunity to improve access to palliative care and hospice services for veterans with COPD, including earlier identification of need and stronger access pathways across care settings,” Smirnova told Federal Practitioner.

COPD Common Among Vets

An estimated 8%-19% of US veterans have COPD, higher than the estimated rate of 6% in adults from the general population. The condition is believed to be underdiagnosed in veterans. 

“Palliative care should be integrated early into routine care, when symptoms start,” Kathleen Lindell, PhD, RN, associate professor and chair, Palliative Care Health, School of Nursing, Medical University of South Carolina, Charleston, explained in a Federal Practitioner interview. “COPD is a serious respiratory illness, and patients experience progressively debilitating dyspnea or shortness of breath, frequent hospitalizations. And they frequently experience high rates of anxiety and depression,” 

Lindell is familiar with the study findings but didn’t take part in the research. 

“Early palliative care,” she said, “addresses symptom management and advance care planning to reduce suffering and ensure what matters most to the patient as the disease progresses.”

Smirnova noted that “hospice is a related but distinct service for veterans with a terminal condition, generally when life expectancy is < 6 months and the veteran is no longer seeking treatment other than palliative care.”

The study analyzed electronic health records and patterns of palliative and hospice care in the year before death. The 332,770 patients were mostly male (98.1%) and White (81.0%). Many had comorbidities such as congestive heart failure (30.0%), depression (26.0%), coronary artery disease (25.5%), anxiety (13.4%), and lung cancer (12.1%).

Researchers found that palliative care was mostly (61.6% of encounters) delivered in the inpatient setting, where it occurred a median 30 days before death. In the outpatient setting, it began a median of 71 days before death. 

From 2010 through 2020, the prevalence of palliative care increased from 10.4% to 16.0%, and the prevalence of VA inpatient hospice care increased from 15.0% to 18.0%. Some veterans may have received hospice services in other settings; in-home hospice is common.

Who is More Likely to Receive Palliative Care?

Black patients (adjusted odds ratio [AOR], 1.21), Latino/Hispanic ethnicity (AOR, 1.22), patients with housing instability (AOR, 1.38) and who were underweight (AOR, 1.75) were linked to more palliative care use. Black patients were especially likely to get inpatient palliative care, a fact that “may, in part, be driven by increased care intensity at the end of life, as has been demonstrated in prior studies,” the authors noted.

Marriage (AOR, 0.88) was linked to less palliative care use, while patients with lung cancer were especially likely to receive it (AOR, 2.48). There were similar differences in use of hospice care apart from higher use for Black patients. 

Smirnova said the study was not designed to determine the causes of patterns in palliative care use. However, important factors appear to include hospitalization, comorbidities, and access to care at health care sites. (Usage rates were lower at rural centers and higher at more complex centers.)

COPD vs Other Terminal Diseases

“The modest increases in utilization of palliative care and VA inpatient hospice from 2010 to 2020 align with previous work [research] in inpatients with COPD and heart failure,” the researchers wrote, “possibly reflecting the effect of international professional society guidelines, increased acceptance of palliative care, improvements related to VA end-of-life care and life-sustaining treatment decisions initiatives, and increases in the specialist palliative care workforce.”

Still, there appears to be a major discrepancy regarding the use of palliative care for COPD within the VA compared with other diseases. A study of data from 2014 through 2017 found that for patients with several comorbidities—including COPD, heart failure, cancer, and dementia—inpatient palliative care was introduced a median of 58 days before death and outpatient care 160 days before death. 

“This suggests that veterans with COPD receive palliative care later than those with other serious illnesses,” the authors argued. 

Don’t Wait for the ‘Right Time’

Sarah Miller, PhD, RN, associate professor, and assistant dean, PhD Nursing Science Program, School of Nursing, Medical University of South Carolina, Charleston, praised the study in an interview and noted that uncertainty about the “right time” to refer patients to palliative care could play a role in the findings. Miller is familiar with the study but did not participate in the research.

Lindell, the chair of Palliative Care Health, agreed.

“With COPD—a chronic, progressive disease—decline can be gradual, which makes it difficult to identify a clear transition point,” Lindell told Federal Practitioner. “This has contributed to many palliative referrals happening only when patients are clearly deteriorating or nearing the end of life. But palliative care should not be introduced reactively; it should be integrated early, alongside disease-directed treatment.”

For her part, Miller noted that “many veterans with COPD are navigating complex comorbidities and fragmented care across settings. Diseases like COPD don’t follow a predictable path, so referrals don’t always happen like they should.”

Moving forward, “if symptoms are present, early palliative care is appropriate,” Lindell said. These conversations should happen early and over time.

“The VA should prioritize early referral and access to palliative care for patients with COPD to provide the best care for these individuals.”

No study funding was reported. Smirnova discloses relationships with the CHEST Foundation and National Heart, Lung, and Blood Institute. Other authors disclose relationships with various grantors. 

Miller discloses a relationship with AstraZeneca. Lindell discloses relationships with Boehringer Ingelheim and Heart & Lung: The Journal of Acute and Critical Care. 

Though end-of-life care for veterans with chronic obstructive pulmonary disease (COPD) in the US Department of Veterans Affairs (VA) has become more prevalent in recent years, a recent retrospective cohort study found that most patients do not receive palliative care or inpatient VA hospice over the past year of life, with rates lower than for other terminal illnesses. 

Among 332,770 decedents traced from 2010 through 2020, only 16.8% received either palliative or inpatient hospice care in the year before their death. The median time between their first palliative care appointment and death was 46 days, reported pulmonologist Natalia Smirnova, MD, assistant professor of medicine, Emory School of Medicine, Atlanta, et al in CHEST Pulmonary. 

A total of 15.9% of the decedents received inpatient hospice care from the VA. 

“These findings point to an opportunity to improve access to palliative care and hospice services for veterans with COPD, including earlier identification of need and stronger access pathways across care settings,” Smirnova told Federal Practitioner.

COPD Common Among Vets

An estimated 8%-19% of US veterans have COPD, higher than the estimated rate of 6% in adults from the general population. The condition is believed to be underdiagnosed in veterans. 

“Palliative care should be integrated early into routine care, when symptoms start,” Kathleen Lindell, PhD, RN, associate professor and chair, Palliative Care Health, School of Nursing, Medical University of South Carolina, Charleston, explained in a Federal Practitioner interview. “COPD is a serious respiratory illness, and patients experience progressively debilitating dyspnea or shortness of breath, frequent hospitalizations. And they frequently experience high rates of anxiety and depression,” 

Lindell is familiar with the study findings but didn’t take part in the research. 

“Early palliative care,” she said, “addresses symptom management and advance care planning to reduce suffering and ensure what matters most to the patient as the disease progresses.”

Smirnova noted that “hospice is a related but distinct service for veterans with a terminal condition, generally when life expectancy is < 6 months and the veteran is no longer seeking treatment other than palliative care.”

The study analyzed electronic health records and patterns of palliative and hospice care in the year before death. The 332,770 patients were mostly male (98.1%) and White (81.0%). Many had comorbidities such as congestive heart failure (30.0%), depression (26.0%), coronary artery disease (25.5%), anxiety (13.4%), and lung cancer (12.1%).

Researchers found that palliative care was mostly (61.6% of encounters) delivered in the inpatient setting, where it occurred a median 30 days before death. In the outpatient setting, it began a median of 71 days before death. 

From 2010 through 2020, the prevalence of palliative care increased from 10.4% to 16.0%, and the prevalence of VA inpatient hospice care increased from 15.0% to 18.0%. Some veterans may have received hospice services in other settings; in-home hospice is common.

Who is More Likely to Receive Palliative Care?

Black patients (adjusted odds ratio [AOR], 1.21), Latino/Hispanic ethnicity (AOR, 1.22), patients with housing instability (AOR, 1.38) and who were underweight (AOR, 1.75) were linked to more palliative care use. Black patients were especially likely to get inpatient palliative care, a fact that “may, in part, be driven by increased care intensity at the end of life, as has been demonstrated in prior studies,” the authors noted.

Marriage (AOR, 0.88) was linked to less palliative care use, while patients with lung cancer were especially likely to receive it (AOR, 2.48). There were similar differences in use of hospice care apart from higher use for Black patients. 

Smirnova said the study was not designed to determine the causes of patterns in palliative care use. However, important factors appear to include hospitalization, comorbidities, and access to care at health care sites. (Usage rates were lower at rural centers and higher at more complex centers.)

COPD vs Other Terminal Diseases

“The modest increases in utilization of palliative care and VA inpatient hospice from 2010 to 2020 align with previous work [research] in inpatients with COPD and heart failure,” the researchers wrote, “possibly reflecting the effect of international professional society guidelines, increased acceptance of palliative care, improvements related to VA end-of-life care and life-sustaining treatment decisions initiatives, and increases in the specialist palliative care workforce.”

Still, there appears to be a major discrepancy regarding the use of palliative care for COPD within the VA compared with other diseases. A study of data from 2014 through 2017 found that for patients with several comorbidities—including COPD, heart failure, cancer, and dementia—inpatient palliative care was introduced a median of 58 days before death and outpatient care 160 days before death. 

“This suggests that veterans with COPD receive palliative care later than those with other serious illnesses,” the authors argued. 

Don’t Wait for the ‘Right Time’

Sarah Miller, PhD, RN, associate professor, and assistant dean, PhD Nursing Science Program, School of Nursing, Medical University of South Carolina, Charleston, praised the study in an interview and noted that uncertainty about the “right time” to refer patients to palliative care could play a role in the findings. Miller is familiar with the study but did not participate in the research.

Lindell, the chair of Palliative Care Health, agreed.

“With COPD—a chronic, progressive disease—decline can be gradual, which makes it difficult to identify a clear transition point,” Lindell told Federal Practitioner. “This has contributed to many palliative referrals happening only when patients are clearly deteriorating or nearing the end of life. But palliative care should not be introduced reactively; it should be integrated early, alongside disease-directed treatment.”

For her part, Miller noted that “many veterans with COPD are navigating complex comorbidities and fragmented care across settings. Diseases like COPD don’t follow a predictable path, so referrals don’t always happen like they should.”

Moving forward, “if symptoms are present, early palliative care is appropriate,” Lindell said. These conversations should happen early and over time.

“The VA should prioritize early referral and access to palliative care for patients with COPD to provide the best care for these individuals.”

No study funding was reported. Smirnova discloses relationships with the CHEST Foundation and National Heart, Lung, and Blood Institute. Other authors disclose relationships with various grantors. 

Miller discloses a relationship with AstraZeneca. Lindell discloses relationships with Boehringer Ingelheim and Heart & Lung: The Journal of Acute and Critical Care.