TOPLINE:

Regular exercise can significantly reduce a cancer survivor’s mortality from cancer or other causes, a large analysis finds.

METHODOLOGY:

• Following a cancer diagnosis, the impact of exercise on all cause and cause-specific mortality among survivors, and whether the benefit of exercise differs by cancer site, remains unclear.
• To investigate, researchers leveraged data from 11,480 cancer survivors in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial.
• Postdiagnosis exercise levels were quantified via a questionnaire. The primary outcome was all-cause mortality; secondary endpoints were deaths from cancer and other causes.
• Cox models estimated cause-specific hazard ratio for all-cause mortality as well as cancer and noncancer mortality based on whether survivors met or did not meet exercise guidelines.
• Meeting national exercise guidelines meant moderate-intensity exercise 4 or more days per week with sessions lasting, on average, 30 minutes or longer; and/or strenuous-intensity exercise 2 or more days per week with sessions lasting, on average, 20 minutes or longer.

TAKEAWAY:

• Overall, 62% of participants were deemed nonexercisers (no exercise or exercise below guidelines) and 38% were classified as exercisers (meeting or exceeding guidelines). After a median follow-up of 16 years from diagnosis, researchers documented 4,665 deaths – 1,940 from cancer and 2,725 from other causes.
• Exercise at recommended levels was associated with “near-universal” all-cause mortality benefit for most cancers represented, including prostate, breast, endometrial, renal, and head and neck cancers.
• In multivariate analysis, compared with nonexercisers, exercisers had a 25% reduced risk of all-cause mortality (HR, 0.75), with the benefit apparent within 5 years and persisting for at least 20 years after diagnosis.
• Exercise was associated with a 21% reduction in cancer mortality and a 28% reduction in mortality from other causes, with more exercise demonstrating a greater benefit on cancer-specific mortality risk.

IN PRACTICE:

Overall, “our findings show exercise is a holistic strategy that may complement contemporary management approaches to further reduce cancer mortality (in select sites) while simultaneously lowering risk of death from other competing causes, which combine to improve all-cause mortality,” the authors conclude. “This benefit was observed within a few years after diagnosis and sustained for at least 20 years.”

SOURCE:

The study, led by Jessica Lavery, MS, Memorial Sloan Kettering Cancer Center, New York, was published online in the Journal of Clinical Oncology.

LIMITATIONS:

Exercise habits were self-reported at one time point, not measured more objectively over time using wearable devices. The population studied was predominantly non-Hispanic White. The researchers could not determine whether exercise habits reflected lower disease and/or treatment-related toxicities as opposed to direct exercise-induced effects or better adherence to a healthy lifestyle.

DISCLOSURES:

Support for the study was provided by AKTIV Against Cancer and grants from Memorial Sloan Kettering Cancer Center and UCLA Jonsson Comprehensive Cancer Center. Disclosures for the study authors are available with the original article.

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

TOPLINE:

Regular exercise can significantly reduce a cancer survivor’s mortality from cancer or other causes, a large analysis finds.

METHODOLOGY:

• Following a cancer diagnosis, the impact of exercise on all cause and cause-specific mortality among survivors, and whether the benefit of exercise differs by cancer site, remains unclear.
• To investigate, researchers leveraged data from 11,480 cancer survivors in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial.
• Postdiagnosis exercise levels were quantified via a questionnaire. The primary outcome was all-cause mortality; secondary endpoints were deaths from cancer and other causes.
• Cox models estimated cause-specific hazard ratio for all-cause mortality as well as cancer and noncancer mortality based on whether survivors met or did not meet exercise guidelines.
• Meeting national exercise guidelines meant moderate-intensity exercise 4 or more days per week with sessions lasting, on average, 30 minutes or longer; and/or strenuous-intensity exercise 2 or more days per week with sessions lasting, on average, 20 minutes or longer.

TAKEAWAY:

• Overall, 62% of participants were deemed nonexercisers (no exercise or exercise below guidelines) and 38% were classified as exercisers (meeting or exceeding guidelines). After a median follow-up of 16 years from diagnosis, researchers documented 4,665 deaths – 1,940 from cancer and 2,725 from other causes.
• Exercise at recommended levels was associated with “near-universal” all-cause mortality benefit for most cancers represented, including prostate, breast, endometrial, renal, and head and neck cancers.
• In multivariate analysis, compared with nonexercisers, exercisers had a 25% reduced risk of all-cause mortality (HR, 0.75), with the benefit apparent within 5 years and persisting for at least 20 years after diagnosis.
• Exercise was associated with a 21% reduction in cancer mortality and a 28% reduction in mortality from other causes, with more exercise demonstrating a greater benefit on cancer-specific mortality risk.

IN PRACTICE:

Overall, “our findings show exercise is a holistic strategy that may complement contemporary management approaches to further reduce cancer mortality (in select sites) while simultaneously lowering risk of death from other competing causes, which combine to improve all-cause mortality,” the authors conclude. “This benefit was observed within a few years after diagnosis and sustained for at least 20 years.”

SOURCE:

The study, led by Jessica Lavery, MS, Memorial Sloan Kettering Cancer Center, New York, was published online in the Journal of Clinical Oncology.

LIMITATIONS:

Exercise habits were self-reported at one time point, not measured more objectively over time using wearable devices. The population studied was predominantly non-Hispanic White. The researchers could not determine whether exercise habits reflected lower disease and/or treatment-related toxicities as opposed to direct exercise-induced effects or better adherence to a healthy lifestyle.

DISCLOSURES:

Support for the study was provided by AKTIV Against Cancer and grants from Memorial Sloan Kettering Cancer Center and UCLA Jonsson Comprehensive Cancer Center. Disclosures for the study authors are available with the original article.

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

TOPLINE:

Regular exercise can significantly reduce a cancer survivor’s mortality from cancer or other causes, a large analysis finds.

METHODOLOGY:

• Following a cancer diagnosis, the impact of exercise on all cause and cause-specific mortality among survivors, and whether the benefit of exercise differs by cancer site, remains unclear.
• To investigate, researchers leveraged data from 11,480 cancer survivors in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial.
• Postdiagnosis exercise levels were quantified via a questionnaire. The primary outcome was all-cause mortality; secondary endpoints were deaths from cancer and other causes.
• Cox models estimated cause-specific hazard ratio for all-cause mortality as well as cancer and noncancer mortality based on whether survivors met or did not meet exercise guidelines.
• Meeting national exercise guidelines meant moderate-intensity exercise 4 or more days per week with sessions lasting, on average, 30 minutes or longer; and/or strenuous-intensity exercise 2 or more days per week with sessions lasting, on average, 20 minutes or longer.

TAKEAWAY:

• Overall, 62% of participants were deemed nonexercisers (no exercise or exercise below guidelines) and 38% were classified as exercisers (meeting or exceeding guidelines). After a median follow-up of 16 years from diagnosis, researchers documented 4,665 deaths – 1,940 from cancer and 2,725 from other causes.
• Exercise at recommended levels was associated with “near-universal” all-cause mortality benefit for most cancers represented, including prostate, breast, endometrial, renal, and head and neck cancers.
• In multivariate analysis, compared with nonexercisers, exercisers had a 25% reduced risk of all-cause mortality (HR, 0.75), with the benefit apparent within 5 years and persisting for at least 20 years after diagnosis.
• Exercise was associated with a 21% reduction in cancer mortality and a 28% reduction in mortality from other causes, with more exercise demonstrating a greater benefit on cancer-specific mortality risk.

IN PRACTICE:

Overall, “our findings show exercise is a holistic strategy that may complement contemporary management approaches to further reduce cancer mortality (in select sites) while simultaneously lowering risk of death from other competing causes, which combine to improve all-cause mortality,” the authors conclude. “This benefit was observed within a few years after diagnosis and sustained for at least 20 years.”

SOURCE:

The study, led by Jessica Lavery, MS, Memorial Sloan Kettering Cancer Center, New York, was published online in the Journal of Clinical Oncology.

LIMITATIONS:

Exercise habits were self-reported at one time point, not measured more objectively over time using wearable devices. The population studied was predominantly non-Hispanic White. The researchers could not determine whether exercise habits reflected lower disease and/or treatment-related toxicities as opposed to direct exercise-induced effects or better adherence to a healthy lifestyle.

DISCLOSURES:

Support for the study was provided by AKTIV Against Cancer and grants from Memorial Sloan Kettering Cancer Center and UCLA Jonsson Comprehensive Cancer Center. Disclosures for the study authors are available with the original article.

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

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

By the end of 2021, Anuj Peddada, MD, had hit a wall. He couldn’t sleep, couldn’t concentrate, erupted in anger, and felt isolated personally and professionally. To temper pandemic-driven pressures, the Colorado radiation oncologist took an 8-week stress management and resiliency course, but the feelings kept creeping back.

Still, Dr. Peddada, in his own private practice, pushed through, working 60-hour weeks and carrying the workload of two physicians. It wasn’t until he caught himself making uncharacteristic medical errors, including radiation planning for the wrong site, that he knew he needed help – and possibly a temporary break from medicine.

There was just one hitch: He was closing his private practice to start a new in-house job with Centura Health, the Colorado Springs hospital he’d contracted with for over 20 years.

Given the long-standing relationship – Dr. Peddada’s image graced some of the company’s marketing billboards – he expected Centura would understand when, on his doctor’s recommendation, he requested a short-term medical leave that would delay his start date by 1 month.

Instead, Centura abruptly rescinded the employment offer, leaving Dr. Peddada jobless and with no recourse but to sue.

“I was blindsided. The hospital had a physician resiliency program that claimed to encourage physicians to seek help, [so] I thought they would be completely supportive and understanding,” Dr. Peddada said.

He told this news organization that he was naive to have been so honest with the hospital he’d long served as a contractor, including the decade-plus he›d spent directing its radiation oncology department.

“It is exceedingly painful to see hospital leadership use me in their advertisement[s] ... trying to profit off my reputation and work after devastating my career.”

The lawsuit Dr. Peddada filed in July in Colorado federal district court may offer a rare glimpse of the potential career ramifications of seeking help for physician burnout. Despite employers’ oft-stated support for physician wellness, Dr. Peddada’s experience may serve as a cautionary tale for doctors who are open about their struggles.

Centura Health did not respond to requests for comment. In court documents, the health system’s attorneys asked for more time to respond to Dr. Peddada’s complaint.
 

A plea for help

In the complaint, Dr. Peddada and his attorneys claim that Centura violated the state’s Anti-Discrimination Act and the Americans with Disabilities Act (ADA) when it failed to offer reasonable accommodations after he began experiencing “physiological and psychological symptoms corresponding to burnout.”

Since 1999, Dr. Peddada had contracted exclusively with Centura to provide oncology services at its hospital, Penrose Cancer Center, and began covering a second Centura location in 2021. As medical director of Penrose’s radiation oncology department, he helped establish a community nurse navigator program and accounted for 75% of Centura’s radiation oncology referrals, according to the complaint.

But when his symptoms and fear for the safety of his patients became unbearable, Dr. Peddada requested an urgent evaluation from his primary care physician, who diagnosed him with “physician burnout” and recommended medical leave.

Shortly after presenting the leave request to Centura, rumors began circulating that he was having a “nervous breakdown,” the complaint noted. Dr. Peddada worried that perhaps his private health information was being shared with hospital employees.

After meeting with the hospital’s head of physician resiliency and agreeing to undergo a peer review evaluation by the Colorado Physician Health Program, which would decide the reinstatement timeline and if further therapy was necessary, Dr. Peddada was assured his leave would be approved.

Five days later, his job offer was revoked.

In an email from hospital leadership, the oncologist was informed that he had “declined employment” by failing to sign a revised employment contract sent to him 2 weeks prior when he was out of state on a preapproved vacation, according to the lawsuit.

The lawsuit alleges that Dr. Peddada was wrongfully discharged due to his disability after Centura “exploited [his] extensive patient base, referral network, and reputation to generate growth and profit.”

Colorado employment law attorney Deborah Yim, Esq., who is not involved in Peddada’s case, told this news organization that the ADA requires employers to provide reasonable accommodations for physical or mental impairments that substantially limit at least one major life activity, except when the request imposes an undue hardship on the employer.

“Depression and related mental health conditions would qualify, depending on the circumstances, and courts have certainly found them to be qualifying disabilities entitled to ADA protection in the past,” she said.

Not all employers are receptive to doctors’ needs, says the leadership team at Physicians Just Equity, an organization providing peer support to doctors experiencing workplace conflicts like discrimination and retaliation. They say that Dr. Peddada’s experience, where disclosing burnout results in being “ostracized, penalized, and ultimately ousted,” is the rule rather than the exception.

“Dr. Peddada’s case represents the unfortunate reality faced by many physicians in today’s clinical landscape,” the organization’s board of directors said in a written statement. “The imbalance of unreasonable professional demands, the lack of autonomy, moral injury, and disintegrating practice rewards is unsustainable for the medical professional.”

“Retaliation by employers after speaking up against this imbalance [and] requesting support and time to rejuvenate is a grave failure of health care systems that prioritize the business of delivering health care over the health, well-being, and satisfaction of their most valuable resource – the physician,” the board added in their statement.

Dr. Peddada has since closed his private practice and works as an independent contractor and consultant, his attorney, Iris Halpern, JD, said in an interview. She says Centura could have honored the accommodation request or suggested another option that met his needs, but “not only were they unsupportive, they terminated him.” 

Ms. Yim says the parties will have opportunities to reach a settlement and resolve the dispute as the case works through the court system. Otherwise, Dr. Peddada and Centura may eventually head to trial.
 

Current state of physician burnout

The state of physician burnout is certainly a concerning one. More than half (53%) of physicians responding to this year’s Medscape Physician Burnout & Depression Report said they are burned out. Nearly one-quarter reported feeling depressed. Some of the top reasons they cited were too many bureaucratic tasks (61%), too many work hours (37%), and lack of autonomy (31%).

A 2022 study by the Mayo Clinic found a substantial increase in physician burnout in the first 2 years of the pandemic, with doctors reporting rising emotional exhaustion and depersonalization.

Although burnout affects many physicians and is a priority focus of the National Academy of Medicine’s plan to restore workforce well-being, admitting it is often seen as taboo and can imperil a doctor’s career. In the Medscape report, for example, 39% of physicians said they would not even consider professional treatment for burnout, with many commenting that they would just deal with it themselves.

“Many physicians are frightened to take time out for self-care because [they] fear losing their job, being stigmatized, and potentially ending their careers,” said Dr. Peddada, adding that physicians are commonly asked questions about their mental health when applying for hospital privileges. He says this dynamic forces them to choose between getting help or ignoring their true feelings, leading to poor quality of care and patient safety risks.

Medical licensing boards probe physicians’ mental health, too. As part of its #FightingForDocs campaign, the American Medical Association hopes to remove the stigma around burnout and depression and advocates for licensing boards to revise questions that may discourage physicians from seeking assistance. The AMA recommends that physicians only disclose current physical or mental conditions affecting their ability to practice.

Pringl Miller, MD, founder and executive director of Physician Just Equity, told Medscape that improving physician wellness requires structural change.

“Physicians (who) experience burnout without the proper accommodations run the risk of personal harm, because most physicians will prioritize the health and well-being of their patients over themselves ... [resulting in] suboptimal and unsafe patient care,” she said.
 

Helping doctors regain a sense of purpose

One change involves reframing how the health care industry thinks about and approaches burnout, says Steven Siegel, MD, chief mental health and wellness officer with Keck Medicine of USC. He told this news organization that these discussions should enhance the physician’s sense of purpose. 

“Some people treat burnout as a concrete disorder like cancer, instead of saying, ‘I’m feeling exhausted, demoralized, and don’t enjoy my job anymore. What can we do to restore my enthusiasm for work?’ ”

Dr. Siegel recognizes that these issues existed before the pandemic and have only worsened as physicians feel less connected to and satisfied with their profession – a byproduct, he says, of the commercialization of medicine.

“We’ve moved from practices to systems, then from small to large systems, where it seems the path to survival is cutting costs and increasing margins, even among nonprofits.”
 

The road ahead

Making headway on these problems will take time. Last year, Keck Medicine received a $2 million grant to launch a 3-year randomized clinical trial to help reconnect physicians and other clinicians with their work. Dr. Siegel says the trial may serve as a national pilot program and will eventually grow to include 400 volunteers.

The trial will investigate the effectiveness of three possible interventions: (1) teaching people how to regulate their internal narratives and emotions through techniques like cognitive behavioral therapy and acceptance and commitment therapy; (2) providing customized EHR training to reduce the burden of navigating the system; and (3) allowing physicians to weigh in on workflow changes. 

“We put physicians on teams that make the decisions about workflows,” said Dr. Siegel. The arrangement can give people the agency they desire and help them understand why an idea might not be plausible, which enriches future suggestions and discussions, he says.

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

By the end of 2021, Anuj Peddada, MD, had hit a wall. He couldn’t sleep, couldn’t concentrate, erupted in anger, and felt isolated personally and professionally. To temper pandemic-driven pressures, the Colorado radiation oncologist took an 8-week stress management and resiliency course, but the feelings kept creeping back.

Still, Dr. Peddada, in his own private practice, pushed through, working 60-hour weeks and carrying the workload of two physicians. It wasn’t until he caught himself making uncharacteristic medical errors, including radiation planning for the wrong site, that he knew he needed help – and possibly a temporary break from medicine.

There was just one hitch: He was closing his private practice to start a new in-house job with Centura Health, the Colorado Springs hospital he’d contracted with for over 20 years.

Given the long-standing relationship – Dr. Peddada’s image graced some of the company’s marketing billboards – he expected Centura would understand when, on his doctor’s recommendation, he requested a short-term medical leave that would delay his start date by 1 month.

Instead, Centura abruptly rescinded the employment offer, leaving Dr. Peddada jobless and with no recourse but to sue.

“I was blindsided. The hospital had a physician resiliency program that claimed to encourage physicians to seek help, [so] I thought they would be completely supportive and understanding,” Dr. Peddada said.

He told this news organization that he was naive to have been so honest with the hospital he’d long served as a contractor, including the decade-plus he›d spent directing its radiation oncology department.

“It is exceedingly painful to see hospital leadership use me in their advertisement[s] ... trying to profit off my reputation and work after devastating my career.”

The lawsuit Dr. Peddada filed in July in Colorado federal district court may offer a rare glimpse of the potential career ramifications of seeking help for physician burnout. Despite employers’ oft-stated support for physician wellness, Dr. Peddada’s experience may serve as a cautionary tale for doctors who are open about their struggles.

Centura Health did not respond to requests for comment. In court documents, the health system’s attorneys asked for more time to respond to Dr. Peddada’s complaint.
 

A plea for help

In the complaint, Dr. Peddada and his attorneys claim that Centura violated the state’s Anti-Discrimination Act and the Americans with Disabilities Act (ADA) when it failed to offer reasonable accommodations after he began experiencing “physiological and psychological symptoms corresponding to burnout.”

Since 1999, Dr. Peddada had contracted exclusively with Centura to provide oncology services at its hospital, Penrose Cancer Center, and began covering a second Centura location in 2021. As medical director of Penrose’s radiation oncology department, he helped establish a community nurse navigator program and accounted for 75% of Centura’s radiation oncology referrals, according to the complaint.

But when his symptoms and fear for the safety of his patients became unbearable, Dr. Peddada requested an urgent evaluation from his primary care physician, who diagnosed him with “physician burnout” and recommended medical leave.

Shortly after presenting the leave request to Centura, rumors began circulating that he was having a “nervous breakdown,” the complaint noted. Dr. Peddada worried that perhaps his private health information was being shared with hospital employees.

After meeting with the hospital’s head of physician resiliency and agreeing to undergo a peer review evaluation by the Colorado Physician Health Program, which would decide the reinstatement timeline and if further therapy was necessary, Dr. Peddada was assured his leave would be approved.

Five days later, his job offer was revoked.

In an email from hospital leadership, the oncologist was informed that he had “declined employment” by failing to sign a revised employment contract sent to him 2 weeks prior when he was out of state on a preapproved vacation, according to the lawsuit.

The lawsuit alleges that Dr. Peddada was wrongfully discharged due to his disability after Centura “exploited [his] extensive patient base, referral network, and reputation to generate growth and profit.”

Colorado employment law attorney Deborah Yim, Esq., who is not involved in Peddada’s case, told this news organization that the ADA requires employers to provide reasonable accommodations for physical or mental impairments that substantially limit at least one major life activity, except when the request imposes an undue hardship on the employer.

“Depression and related mental health conditions would qualify, depending on the circumstances, and courts have certainly found them to be qualifying disabilities entitled to ADA protection in the past,” she said.

Not all employers are receptive to doctors’ needs, says the leadership team at Physicians Just Equity, an organization providing peer support to doctors experiencing workplace conflicts like discrimination and retaliation. They say that Dr. Peddada’s experience, where disclosing burnout results in being “ostracized, penalized, and ultimately ousted,” is the rule rather than the exception.

“Dr. Peddada’s case represents the unfortunate reality faced by many physicians in today’s clinical landscape,” the organization’s board of directors said in a written statement. “The imbalance of unreasonable professional demands, the lack of autonomy, moral injury, and disintegrating practice rewards is unsustainable for the medical professional.”

“Retaliation by employers after speaking up against this imbalance [and] requesting support and time to rejuvenate is a grave failure of health care systems that prioritize the business of delivering health care over the health, well-being, and satisfaction of their most valuable resource – the physician,” the board added in their statement.

Dr. Peddada has since closed his private practice and works as an independent contractor and consultant, his attorney, Iris Halpern, JD, said in an interview. She says Centura could have honored the accommodation request or suggested another option that met his needs, but “not only were they unsupportive, they terminated him.” 

Ms. Yim says the parties will have opportunities to reach a settlement and resolve the dispute as the case works through the court system. Otherwise, Dr. Peddada and Centura may eventually head to trial.
 

Current state of physician burnout

The state of physician burnout is certainly a concerning one. More than half (53%) of physicians responding to this year’s Medscape Physician Burnout & Depression Report said they are burned out. Nearly one-quarter reported feeling depressed. Some of the top reasons they cited were too many bureaucratic tasks (61%), too many work hours (37%), and lack of autonomy (31%).

A 2022 study by the Mayo Clinic found a substantial increase in physician burnout in the first 2 years of the pandemic, with doctors reporting rising emotional exhaustion and depersonalization.

Although burnout affects many physicians and is a priority focus of the National Academy of Medicine’s plan to restore workforce well-being, admitting it is often seen as taboo and can imperil a doctor’s career. In the Medscape report, for example, 39% of physicians said they would not even consider professional treatment for burnout, with many commenting that they would just deal with it themselves.

“Many physicians are frightened to take time out for self-care because [they] fear losing their job, being stigmatized, and potentially ending their careers,” said Dr. Peddada, adding that physicians are commonly asked questions about their mental health when applying for hospital privileges. He says this dynamic forces them to choose between getting help or ignoring their true feelings, leading to poor quality of care and patient safety risks.

Medical licensing boards probe physicians’ mental health, too. As part of its #FightingForDocs campaign, the American Medical Association hopes to remove the stigma around burnout and depression and advocates for licensing boards to revise questions that may discourage physicians from seeking assistance. The AMA recommends that physicians only disclose current physical or mental conditions affecting their ability to practice.

Pringl Miller, MD, founder and executive director of Physician Just Equity, told Medscape that improving physician wellness requires structural change.

“Physicians (who) experience burnout without the proper accommodations run the risk of personal harm, because most physicians will prioritize the health and well-being of their patients over themselves ... [resulting in] suboptimal and unsafe patient care,” she said.
 

Helping doctors regain a sense of purpose

One change involves reframing how the health care industry thinks about and approaches burnout, says Steven Siegel, MD, chief mental health and wellness officer with Keck Medicine of USC. He told this news organization that these discussions should enhance the physician’s sense of purpose. 

“Some people treat burnout as a concrete disorder like cancer, instead of saying, ‘I’m feeling exhausted, demoralized, and don’t enjoy my job anymore. What can we do to restore my enthusiasm for work?’ ”

Dr. Siegel recognizes that these issues existed before the pandemic and have only worsened as physicians feel less connected to and satisfied with their profession – a byproduct, he says, of the commercialization of medicine.

“We’ve moved from practices to systems, then from small to large systems, where it seems the path to survival is cutting costs and increasing margins, even among nonprofits.”
 

The road ahead

Making headway on these problems will take time. Last year, Keck Medicine received a $2 million grant to launch a 3-year randomized clinical trial to help reconnect physicians and other clinicians with their work. Dr. Siegel says the trial may serve as a national pilot program and will eventually grow to include 400 volunteers.

The trial will investigate the effectiveness of three possible interventions: (1) teaching people how to regulate their internal narratives and emotions through techniques like cognitive behavioral therapy and acceptance and commitment therapy; (2) providing customized EHR training to reduce the burden of navigating the system; and (3) allowing physicians to weigh in on workflow changes. 

“We put physicians on teams that make the decisions about workflows,” said Dr. Siegel. The arrangement can give people the agency they desire and help them understand why an idea might not be plausible, which enriches future suggestions and discussions, he says.

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

By the end of 2021, Anuj Peddada, MD, had hit a wall. He couldn’t sleep, couldn’t concentrate, erupted in anger, and felt isolated personally and professionally. To temper pandemic-driven pressures, the Colorado radiation oncologist took an 8-week stress management and resiliency course, but the feelings kept creeping back.

Still, Dr. Peddada, in his own private practice, pushed through, working 60-hour weeks and carrying the workload of two physicians. It wasn’t until he caught himself making uncharacteristic medical errors, including radiation planning for the wrong site, that he knew he needed help – and possibly a temporary break from medicine.

There was just one hitch: He was closing his private practice to start a new in-house job with Centura Health, the Colorado Springs hospital he’d contracted with for over 20 years.

Given the long-standing relationship – Dr. Peddada’s image graced some of the company’s marketing billboards – he expected Centura would understand when, on his doctor’s recommendation, he requested a short-term medical leave that would delay his start date by 1 month.

Instead, Centura abruptly rescinded the employment offer, leaving Dr. Peddada jobless and with no recourse but to sue.

“I was blindsided. The hospital had a physician resiliency program that claimed to encourage physicians to seek help, [so] I thought they would be completely supportive and understanding,” Dr. Peddada said.

He told this news organization that he was naive to have been so honest with the hospital he’d long served as a contractor, including the decade-plus he›d spent directing its radiation oncology department.

“It is exceedingly painful to see hospital leadership use me in their advertisement[s] ... trying to profit off my reputation and work after devastating my career.”

The lawsuit Dr. Peddada filed in July in Colorado federal district court may offer a rare glimpse of the potential career ramifications of seeking help for physician burnout. Despite employers’ oft-stated support for physician wellness, Dr. Peddada’s experience may serve as a cautionary tale for doctors who are open about their struggles.

Centura Health did not respond to requests for comment. In court documents, the health system’s attorneys asked for more time to respond to Dr. Peddada’s complaint.
 

A plea for help

In the complaint, Dr. Peddada and his attorneys claim that Centura violated the state’s Anti-Discrimination Act and the Americans with Disabilities Act (ADA) when it failed to offer reasonable accommodations after he began experiencing “physiological and psychological symptoms corresponding to burnout.”

Since 1999, Dr. Peddada had contracted exclusively with Centura to provide oncology services at its hospital, Penrose Cancer Center, and began covering a second Centura location in 2021. As medical director of Penrose’s radiation oncology department, he helped establish a community nurse navigator program and accounted for 75% of Centura’s radiation oncology referrals, according to the complaint.

But when his symptoms and fear for the safety of his patients became unbearable, Dr. Peddada requested an urgent evaluation from his primary care physician, who diagnosed him with “physician burnout” and recommended medical leave.

Shortly after presenting the leave request to Centura, rumors began circulating that he was having a “nervous breakdown,” the complaint noted. Dr. Peddada worried that perhaps his private health information was being shared with hospital employees.

After meeting with the hospital’s head of physician resiliency and agreeing to undergo a peer review evaluation by the Colorado Physician Health Program, which would decide the reinstatement timeline and if further therapy was necessary, Dr. Peddada was assured his leave would be approved.

Five days later, his job offer was revoked.

In an email from hospital leadership, the oncologist was informed that he had “declined employment” by failing to sign a revised employment contract sent to him 2 weeks prior when he was out of state on a preapproved vacation, according to the lawsuit.

The lawsuit alleges that Dr. Peddada was wrongfully discharged due to his disability after Centura “exploited [his] extensive patient base, referral network, and reputation to generate growth and profit.”

Colorado employment law attorney Deborah Yim, Esq., who is not involved in Peddada’s case, told this news organization that the ADA requires employers to provide reasonable accommodations for physical or mental impairments that substantially limit at least one major life activity, except when the request imposes an undue hardship on the employer.

“Depression and related mental health conditions would qualify, depending on the circumstances, and courts have certainly found them to be qualifying disabilities entitled to ADA protection in the past,” she said.

Not all employers are receptive to doctors’ needs, says the leadership team at Physicians Just Equity, an organization providing peer support to doctors experiencing workplace conflicts like discrimination and retaliation. They say that Dr. Peddada’s experience, where disclosing burnout results in being “ostracized, penalized, and ultimately ousted,” is the rule rather than the exception.

“Dr. Peddada’s case represents the unfortunate reality faced by many physicians in today’s clinical landscape,” the organization’s board of directors said in a written statement. “The imbalance of unreasonable professional demands, the lack of autonomy, moral injury, and disintegrating practice rewards is unsustainable for the medical professional.”

“Retaliation by employers after speaking up against this imbalance [and] requesting support and time to rejuvenate is a grave failure of health care systems that prioritize the business of delivering health care over the health, well-being, and satisfaction of their most valuable resource – the physician,” the board added in their statement.

Dr. Peddada has since closed his private practice and works as an independent contractor and consultant, his attorney, Iris Halpern, JD, said in an interview. She says Centura could have honored the accommodation request or suggested another option that met his needs, but “not only were they unsupportive, they terminated him.” 

Ms. Yim says the parties will have opportunities to reach a settlement and resolve the dispute as the case works through the court system. Otherwise, Dr. Peddada and Centura may eventually head to trial.
 

Current state of physician burnout

The state of physician burnout is certainly a concerning one. More than half (53%) of physicians responding to this year’s Medscape Physician Burnout & Depression Report said they are burned out. Nearly one-quarter reported feeling depressed. Some of the top reasons they cited were too many bureaucratic tasks (61%), too many work hours (37%), and lack of autonomy (31%).

A 2022 study by the Mayo Clinic found a substantial increase in physician burnout in the first 2 years of the pandemic, with doctors reporting rising emotional exhaustion and depersonalization.

Although burnout affects many physicians and is a priority focus of the National Academy of Medicine’s plan to restore workforce well-being, admitting it is often seen as taboo and can imperil a doctor’s career. In the Medscape report, for example, 39% of physicians said they would not even consider professional treatment for burnout, with many commenting that they would just deal with it themselves.

“Many physicians are frightened to take time out for self-care because [they] fear losing their job, being stigmatized, and potentially ending their careers,” said Dr. Peddada, adding that physicians are commonly asked questions about their mental health when applying for hospital privileges. He says this dynamic forces them to choose between getting help or ignoring their true feelings, leading to poor quality of care and patient safety risks.

Medical licensing boards probe physicians’ mental health, too. As part of its #FightingForDocs campaign, the American Medical Association hopes to remove the stigma around burnout and depression and advocates for licensing boards to revise questions that may discourage physicians from seeking assistance. The AMA recommends that physicians only disclose current physical or mental conditions affecting their ability to practice.

Pringl Miller, MD, founder and executive director of Physician Just Equity, told Medscape that improving physician wellness requires structural change.

“Physicians (who) experience burnout without the proper accommodations run the risk of personal harm, because most physicians will prioritize the health and well-being of their patients over themselves ... [resulting in] suboptimal and unsafe patient care,” she said.
 

Helping doctors regain a sense of purpose

One change involves reframing how the health care industry thinks about and approaches burnout, says Steven Siegel, MD, chief mental health and wellness officer with Keck Medicine of USC. He told this news organization that these discussions should enhance the physician’s sense of purpose. 

“Some people treat burnout as a concrete disorder like cancer, instead of saying, ‘I’m feeling exhausted, demoralized, and don’t enjoy my job anymore. What can we do to restore my enthusiasm for work?’ ”

Dr. Siegel recognizes that these issues existed before the pandemic and have only worsened as physicians feel less connected to and satisfied with their profession – a byproduct, he says, of the commercialization of medicine.

“We’ve moved from practices to systems, then from small to large systems, where it seems the path to survival is cutting costs and increasing margins, even among nonprofits.”
 

The road ahead

Making headway on these problems will take time. Last year, Keck Medicine received a $2 million grant to launch a 3-year randomized clinical trial to help reconnect physicians and other clinicians with their work. Dr. Siegel says the trial may serve as a national pilot program and will eventually grow to include 400 volunteers.

The trial will investigate the effectiveness of three possible interventions: (1) teaching people how to regulate their internal narratives and emotions through techniques like cognitive behavioral therapy and acceptance and commitment therapy; (2) providing customized EHR training to reduce the burden of navigating the system; and (3) allowing physicians to weigh in on workflow changes. 

“We put physicians on teams that make the decisions about workflows,” said Dr. Siegel. The arrangement can give people the agency they desire and help them understand why an idea might not be plausible, which enriches future suggestions and discussions, he says.

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

Despite a growing list of Janus kinase (JAK) inhibitors, ruxolitinib remains the go-to for patients with symptomatic, higher risk myelofibrosis, according to Anthony M. Hunter, MD, a myeloid malignancies specialist at Emory University, Atlanta.

“We are thankfully starting to be blessed with more options than we’ve ever had,” he said, but “in the front-line proliferative setting, ruxolitinib has remained the standard of care.” It’s “well established in higher-risk patients and very much an option for very symptomatic lower-risk patients.”

Dr. Hunter helped his colleagues navigate the evolving field of JAK inhibition for myelofibrosis in a presentation titled “Choosing and Properly Using a JAK Inhibitor in Myelofibrosis,”at the Society of Hematologic Oncology annual meeting.

Ruxolitinib was the first JAK inhibitor for myelofibrosis on the U.S. market, approved in 2011. Two more have followed, fedratinib in 2019 and pacritinib in 2022.

A fourth JAK inhibitor for myelofibrosis, momelotinib, is under Food and Drug Administration review with a decision expected shortly.

JAK inhibitors disrupt a key pathogenic pathway in myelofibrosis and are a mainstay of treatment, but Dr. Hunter noted that they should not replace allogeneic transplants in patients who are candidates because transplants remain “the best way to achieve long term survival, especially in higher risk patients.”

He noted that not every patient needs a JAK inhibitor, especially “lower-risk, more asymptomatic patients who are predominantly manifesting with cytopenias. [They] are less likely to benefit.”

Dr. Hunter said that although ruxolitinib remains a treatment of choice, fedratinib “is certainly an option” with comparable rates of symptom control and splenomegaly reduction. Also, while ruxolitinib is dosed according to platelet levels, fedratinib allows for full dosing down to a platelet count of 50 x 10⁹/L.

“But there’s more GI toxicity than with ruxolitinib, especially in the first couple of months,” he said, as well as a black box warning of Wernicke’s encephalopathy. “I generally put all my [fedratinib] patients on thiamine repletion as a precaution.”

One of the most challenging aspects of using JAK inhibitors for myelofibrosis is their tendency to cause cytopenia, particularly anemia and thrombocytopenia, which, ironically, are also hallmarks of myelofibrosis itself.

Although there’s an alternative low-dose ruxolitinib regimen that can be effective in anemic settings, the approval of pacritinib and most likely momelotinib is particularly helpful for cytopenic patients, “a population which historically has been very hard to treat with our prior agents,” Dr. Hunter said.

Pacritinib is approved specifically for patients with platelet counts below 50 x 10⁹/L; momelotinib also included lower platelet counts in several studies. Both agents indirectly boost erythropoiesis with subsequent amelioration of anemia.

“Momelotinib is an important emerging agent for these more anemic patients,” with a spleen response comparable to ruxolitinib and significantly higher rates of transfusion independence, but with lower rates of symptom control, Dr. Hunter said.

Pacritinib “really helps extend the benefit of JAK inhibitors to a group of thrombocytopenic patients who have been hard to treat with ruxolitinib,” with the added potential of improving anemia, although, like fedratinib, it has more GI toxicity, he said.

There are multiple add-on options for JAK inhibitor patients with anemia, including luspatercept, an erythropoiesis-stimulating agent approved for anemia in patients with myelodysplastic syndromes; promising results were reported recently for myelofibrosis.

Fedratinib, pacritinib, and momelotinib all have activity in the second line after ruxolitinib failure, Dr. Hunter noted, but he cautioned that ruxolitinib must be tapered over a few weeks, not stopped abruptly, to avoid withdrawal symptoms. Some clinicians overlap JAK inhibitors a day or two to avoid issues.

“Clinical trials should still be considered in many of these settings,” he said, adding that emerging agents are under development, including multiple combination therapies, often with JAK inhibitors as the background.

No disclosure information was reported.

Despite a growing list of Janus kinase (JAK) inhibitors, ruxolitinib remains the go-to for patients with symptomatic, higher risk myelofibrosis, according to Anthony M. Hunter, MD, a myeloid malignancies specialist at Emory University, Atlanta.

“We are thankfully starting to be blessed with more options than we’ve ever had,” he said, but “in the front-line proliferative setting, ruxolitinib has remained the standard of care.” It’s “well established in higher-risk patients and very much an option for very symptomatic lower-risk patients.”

Dr. Hunter helped his colleagues navigate the evolving field of JAK inhibition for myelofibrosis in a presentation titled “Choosing and Properly Using a JAK Inhibitor in Myelofibrosis,”at the Society of Hematologic Oncology annual meeting.

Ruxolitinib was the first JAK inhibitor for myelofibrosis on the U.S. market, approved in 2011. Two more have followed, fedratinib in 2019 and pacritinib in 2022.

A fourth JAK inhibitor for myelofibrosis, momelotinib, is under Food and Drug Administration review with a decision expected shortly.

JAK inhibitors disrupt a key pathogenic pathway in myelofibrosis and are a mainstay of treatment, but Dr. Hunter noted that they should not replace allogeneic transplants in patients who are candidates because transplants remain “the best way to achieve long term survival, especially in higher risk patients.”

He noted that not every patient needs a JAK inhibitor, especially “lower-risk, more asymptomatic patients who are predominantly manifesting with cytopenias. [They] are less likely to benefit.”

Dr. Hunter said that although ruxolitinib remains a treatment of choice, fedratinib “is certainly an option” with comparable rates of symptom control and splenomegaly reduction. Also, while ruxolitinib is dosed according to platelet levels, fedratinib allows for full dosing down to a platelet count of 50 x 10⁹/L.

“But there’s more GI toxicity than with ruxolitinib, especially in the first couple of months,” he said, as well as a black box warning of Wernicke’s encephalopathy. “I generally put all my [fedratinib] patients on thiamine repletion as a precaution.”

One of the most challenging aspects of using JAK inhibitors for myelofibrosis is their tendency to cause cytopenia, particularly anemia and thrombocytopenia, which, ironically, are also hallmarks of myelofibrosis itself.

Although there’s an alternative low-dose ruxolitinib regimen that can be effective in anemic settings, the approval of pacritinib and most likely momelotinib is particularly helpful for cytopenic patients, “a population which historically has been very hard to treat with our prior agents,” Dr. Hunter said.

Pacritinib is approved specifically for patients with platelet counts below 50 x 10⁹/L; momelotinib also included lower platelet counts in several studies. Both agents indirectly boost erythropoiesis with subsequent amelioration of anemia.

“Momelotinib is an important emerging agent for these more anemic patients,” with a spleen response comparable to ruxolitinib and significantly higher rates of transfusion independence, but with lower rates of symptom control, Dr. Hunter said.

Pacritinib “really helps extend the benefit of JAK inhibitors to a group of thrombocytopenic patients who have been hard to treat with ruxolitinib,” with the added potential of improving anemia, although, like fedratinib, it has more GI toxicity, he said.

There are multiple add-on options for JAK inhibitor patients with anemia, including luspatercept, an erythropoiesis-stimulating agent approved for anemia in patients with myelodysplastic syndromes; promising results were reported recently for myelofibrosis.

Fedratinib, pacritinib, and momelotinib all have activity in the second line after ruxolitinib failure, Dr. Hunter noted, but he cautioned that ruxolitinib must be tapered over a few weeks, not stopped abruptly, to avoid withdrawal symptoms. Some clinicians overlap JAK inhibitors a day or two to avoid issues.

“Clinical trials should still be considered in many of these settings,” he said, adding that emerging agents are under development, including multiple combination therapies, often with JAK inhibitors as the background.

No disclosure information was reported.

Despite a growing list of Janus kinase (JAK) inhibitors, ruxolitinib remains the go-to for patients with symptomatic, higher risk myelofibrosis, according to Anthony M. Hunter, MD, a myeloid malignancies specialist at Emory University, Atlanta.

“We are thankfully starting to be blessed with more options than we’ve ever had,” he said, but “in the front-line proliferative setting, ruxolitinib has remained the standard of care.” It’s “well established in higher-risk patients and very much an option for very symptomatic lower-risk patients.”

Dr. Hunter helped his colleagues navigate the evolving field of JAK inhibition for myelofibrosis in a presentation titled “Choosing and Properly Using a JAK Inhibitor in Myelofibrosis,”at the Society of Hematologic Oncology annual meeting.

Ruxolitinib was the first JAK inhibitor for myelofibrosis on the U.S. market, approved in 2011. Two more have followed, fedratinib in 2019 and pacritinib in 2022.

A fourth JAK inhibitor for myelofibrosis, momelotinib, is under Food and Drug Administration review with a decision expected shortly.

JAK inhibitors disrupt a key pathogenic pathway in myelofibrosis and are a mainstay of treatment, but Dr. Hunter noted that they should not replace allogeneic transplants in patients who are candidates because transplants remain “the best way to achieve long term survival, especially in higher risk patients.”

He noted that not every patient needs a JAK inhibitor, especially “lower-risk, more asymptomatic patients who are predominantly manifesting with cytopenias. [They] are less likely to benefit.”

Dr. Hunter said that although ruxolitinib remains a treatment of choice, fedratinib “is certainly an option” with comparable rates of symptom control and splenomegaly reduction. Also, while ruxolitinib is dosed according to platelet levels, fedratinib allows for full dosing down to a platelet count of 50 x 10⁹/L.

“But there’s more GI toxicity than with ruxolitinib, especially in the first couple of months,” he said, as well as a black box warning of Wernicke’s encephalopathy. “I generally put all my [fedratinib] patients on thiamine repletion as a precaution.”

One of the most challenging aspects of using JAK inhibitors for myelofibrosis is their tendency to cause cytopenia, particularly anemia and thrombocytopenia, which, ironically, are also hallmarks of myelofibrosis itself.

Although there’s an alternative low-dose ruxolitinib regimen that can be effective in anemic settings, the approval of pacritinib and most likely momelotinib is particularly helpful for cytopenic patients, “a population which historically has been very hard to treat with our prior agents,” Dr. Hunter said.

Pacritinib is approved specifically for patients with platelet counts below 50 x 10⁹/L; momelotinib also included lower platelet counts in several studies. Both agents indirectly boost erythropoiesis with subsequent amelioration of anemia.

“Momelotinib is an important emerging agent for these more anemic patients,” with a spleen response comparable to ruxolitinib and significantly higher rates of transfusion independence, but with lower rates of symptom control, Dr. Hunter said.

Pacritinib “really helps extend the benefit of JAK inhibitors to a group of thrombocytopenic patients who have been hard to treat with ruxolitinib,” with the added potential of improving anemia, although, like fedratinib, it has more GI toxicity, he said.

There are multiple add-on options for JAK inhibitor patients with anemia, including luspatercept, an erythropoiesis-stimulating agent approved for anemia in patients with myelodysplastic syndromes; promising results were reported recently for myelofibrosis.

Fedratinib, pacritinib, and momelotinib all have activity in the second line after ruxolitinib failure, Dr. Hunter noted, but he cautioned that ruxolitinib must be tapered over a few weeks, not stopped abruptly, to avoid withdrawal symptoms. Some clinicians overlap JAK inhibitors a day or two to avoid issues.

“Clinical trials should still be considered in many of these settings,” he said, adding that emerging agents are under development, including multiple combination therapies, often with JAK inhibitors as the background.

No disclosure information was reported.

Thoracic Oncology And Chest Imaging Network

Lung Cancer Section

Lung cancer is the third most prevalent cancer in United States, with the highest mortality (Oliver, 2022)(Siegel et al, 2023). The factors contributing to its occurrence have become more complex due to increased industrialization and worsening environmental pollution. Air pollution is a well-established environmental risk factor for lung cancer (Lu et al. 2019). On average, a full-time worker spends around 90,000 hours at work over their lifetime. It is crucial to control environmental and occupational exposures to decrease the risk of developing lung cancer. Occupations like asbestos-related work, mining, and transportation are well-known to be at risk for lung cancer (Li et al. 2021). With worsening air pollution, occupations such as firefighters, outdoor delivery workers, and forest rangers are facing an increased risk as well. Many of these carcinogens independently increase lung cancer risk (Li et al. 2021). Smoking combined with these exposures, causes a synergistic effect on lung cancer incidence. They also have a cell subtype differential risk favoring squamous and small cell lung cancer (Christiani, 2020). It is essential for workers in these high-risk occupations to use proper PPE, have regular check-ups and screenings and follow occupational safety regulations and guidelines. As air pollution continues to worsen, individuals living in these areas should reduce outdoor activities during AQI alerts, and use air purifiers and masks. Public health efforts to decrease air pollution with cleaner transportation and energy production, and better local and national air quality regulations will decrease risk in the general population (Rice et al. 2021).

CHEST

Amaraja Kanitkar, MD, MBBSGuest Author

References

Christiani DC. Occupational exposures and lung cancer. Am J Respir Crit Care Med. 2020;202(3):317-19.

Li N, et al. Association of 13 occupational carcinogens in patients with cancer, individually and collectively, 1990-2017. JAMA Netw Open. 2021;4(2):e2037530.

Lu T, et al. Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res. 2019;11:943-53.

Oliver AL. Lung cancer: Epidemiology and screening. Surg Clin North Am. 2022;102(3):335-44.

Rice MB, et al. Respiratory impacts of wildland fire smoke: Future challenges and policy opportunities an official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(6):921-30.
 

Siegel RL, et al. Cancer statistics: 2023. CA Cancer J Clin. 2023;73(1):17-48.

Thoracic Oncology And Chest Imaging Network

Lung Cancer Section

Lung cancer is the third most prevalent cancer in United States, with the highest mortality (Oliver, 2022)(Siegel et al, 2023). The factors contributing to its occurrence have become more complex due to increased industrialization and worsening environmental pollution. Air pollution is a well-established environmental risk factor for lung cancer (Lu et al. 2019). On average, a full-time worker spends around 90,000 hours at work over their lifetime. It is crucial to control environmental and occupational exposures to decrease the risk of developing lung cancer. Occupations like asbestos-related work, mining, and transportation are well-known to be at risk for lung cancer (Li et al. 2021). With worsening air pollution, occupations such as firefighters, outdoor delivery workers, and forest rangers are facing an increased risk as well. Many of these carcinogens independently increase lung cancer risk (Li et al. 2021). Smoking combined with these exposures, causes a synergistic effect on lung cancer incidence. They also have a cell subtype differential risk favoring squamous and small cell lung cancer (Christiani, 2020). It is essential for workers in these high-risk occupations to use proper PPE, have regular check-ups and screenings and follow occupational safety regulations and guidelines. As air pollution continues to worsen, individuals living in these areas should reduce outdoor activities during AQI alerts, and use air purifiers and masks. Public health efforts to decrease air pollution with cleaner transportation and energy production, and better local and national air quality regulations will decrease risk in the general population (Rice et al. 2021).

CHEST

Amaraja Kanitkar, MD, MBBSGuest Author

References

Christiani DC. Occupational exposures and lung cancer. Am J Respir Crit Care Med. 2020;202(3):317-19.

Li N, et al. Association of 13 occupational carcinogens in patients with cancer, individually and collectively, 1990-2017. JAMA Netw Open. 2021;4(2):e2037530.

Lu T, et al. Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res. 2019;11:943-53.

Oliver AL. Lung cancer: Epidemiology and screening. Surg Clin North Am. 2022;102(3):335-44.

Rice MB, et al. Respiratory impacts of wildland fire smoke: Future challenges and policy opportunities an official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(6):921-30.
 

Siegel RL, et al. Cancer statistics: 2023. CA Cancer J Clin. 2023;73(1):17-48.

Thoracic Oncology And Chest Imaging Network

Lung Cancer Section

Lung cancer is the third most prevalent cancer in United States, with the highest mortality (Oliver, 2022)(Siegel et al, 2023). The factors contributing to its occurrence have become more complex due to increased industrialization and worsening environmental pollution. Air pollution is a well-established environmental risk factor for lung cancer (Lu et al. 2019). On average, a full-time worker spends around 90,000 hours at work over their lifetime. It is crucial to control environmental and occupational exposures to decrease the risk of developing lung cancer. Occupations like asbestos-related work, mining, and transportation are well-known to be at risk for lung cancer (Li et al. 2021). With worsening air pollution, occupations such as firefighters, outdoor delivery workers, and forest rangers are facing an increased risk as well. Many of these carcinogens independently increase lung cancer risk (Li et al. 2021). Smoking combined with these exposures, causes a synergistic effect on lung cancer incidence. They also have a cell subtype differential risk favoring squamous and small cell lung cancer (Christiani, 2020). It is essential for workers in these high-risk occupations to use proper PPE, have regular check-ups and screenings and follow occupational safety regulations and guidelines. As air pollution continues to worsen, individuals living in these areas should reduce outdoor activities during AQI alerts, and use air purifiers and masks. Public health efforts to decrease air pollution with cleaner transportation and energy production, and better local and national air quality regulations will decrease risk in the general population (Rice et al. 2021).

CHEST

Amaraja Kanitkar, MD, MBBSGuest Author

References

Christiani DC. Occupational exposures and lung cancer. Am J Respir Crit Care Med. 2020;202(3):317-19.

Li N, et al. Association of 13 occupational carcinogens in patients with cancer, individually and collectively, 1990-2017. JAMA Netw Open. 2021;4(2):e2037530.

Lu T, et al. Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res. 2019;11:943-53.

Oliver AL. Lung cancer: Epidemiology and screening. Surg Clin North Am. 2022;102(3):335-44.

Rice MB, et al. Respiratory impacts of wildland fire smoke: Future challenges and policy opportunities an official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(6):921-30.
 

Siegel RL, et al. Cancer statistics: 2023. CA Cancer J Clin. 2023;73(1):17-48.

Critical Care Network

Palliative and End-of-Life Section

Symptoms at the end of life in patients with COPD are just as severe as in patients with advanced cancer (Solano JP, et al. J Pain Symptom Manage. 2006;31[1]:58-69). However, despite the high symptom burden, palliative care is less common in patients with COPD (Gore J, et al. Thorax. 2000;55[12]:1000-6).

CHEST

Palliative care is associated with a number of benefits, including improved symptom burden, quality of life, and patient satisfaction (Vermylen JH, et al. Int J Chron Obstruct Pulmon Dis. 2015;10:1543-51). The majority of pulmonologists report that palliative care for patients with COPD is desirable, but about half of pulmonologists indicate that they do not use the palliative care guidelines and many were not even aware they existed (Duenk RG, et al. Int J Chron Obstruct Pulmon Dis. 2017;12:299-311). Patients with COPD often have unmet needs, and the majority of patients with COPD do not have access to palliative care at their end of life (Gore JM, et al). Unfortunately, the supply of palliative care specialists is too low to meet demand, especially in outpatient settings (Kamal AH, et al. Am J Med. 2017;130:113-4).

The ATS released a multisociety policy statement in 2022 that established a framework for early palliative care in the care in patients with respiratory illnesses (Sullivan DR, et al. Am J Respir Crit Care Med. 2022;206[6]:e44-e69). However, given the paucity of specialists and the aging population, the needs of patients and their loved ones cannot be met exclusively by palliative care specialists. Pulmonologists must expand their practice to include guideline-based palliative care in order to truly serve our patients to the best of our abilities. It is incumbent on training programs to train future pulmonologists with these palliative skills, and upon medical organizations to supply time and resources to ensure the pulmonologist is able to use these skills.

Gretchen Winter, MD

Section Member-at-Large

Critical Care Network

Palliative and End-of-Life Section

Symptoms at the end of life in patients with COPD are just as severe as in patients with advanced cancer (Solano JP, et al. J Pain Symptom Manage. 2006;31[1]:58-69). However, despite the high symptom burden, palliative care is less common in patients with COPD (Gore J, et al. Thorax. 2000;55[12]:1000-6).

CHEST

Palliative care is associated with a number of benefits, including improved symptom burden, quality of life, and patient satisfaction (Vermylen JH, et al. Int J Chron Obstruct Pulmon Dis. 2015;10:1543-51). The majority of pulmonologists report that palliative care for patients with COPD is desirable, but about half of pulmonologists indicate that they do not use the palliative care guidelines and many were not even aware they existed (Duenk RG, et al. Int J Chron Obstruct Pulmon Dis. 2017;12:299-311). Patients with COPD often have unmet needs, and the majority of patients with COPD do not have access to palliative care at their end of life (Gore JM, et al). Unfortunately, the supply of palliative care specialists is too low to meet demand, especially in outpatient settings (Kamal AH, et al. Am J Med. 2017;130:113-4).

The ATS released a multisociety policy statement in 2022 that established a framework for early palliative care in the care in patients with respiratory illnesses (Sullivan DR, et al. Am J Respir Crit Care Med. 2022;206[6]:e44-e69). However, given the paucity of specialists and the aging population, the needs of patients and their loved ones cannot be met exclusively by palliative care specialists. Pulmonologists must expand their practice to include guideline-based palliative care in order to truly serve our patients to the best of our abilities. It is incumbent on training programs to train future pulmonologists with these palliative skills, and upon medical organizations to supply time and resources to ensure the pulmonologist is able to use these skills.

Gretchen Winter, MD

Section Member-at-Large

Critical Care Network

Palliative and End-of-Life Section

Symptoms at the end of life in patients with COPD are just as severe as in patients with advanced cancer (Solano JP, et al. J Pain Symptom Manage. 2006;31[1]:58-69). However, despite the high symptom burden, palliative care is less common in patients with COPD (Gore J, et al. Thorax. 2000;55[12]:1000-6).

CHEST

Palliative care is associated with a number of benefits, including improved symptom burden, quality of life, and patient satisfaction (Vermylen JH, et al. Int J Chron Obstruct Pulmon Dis. 2015;10:1543-51). The majority of pulmonologists report that palliative care for patients with COPD is desirable, but about half of pulmonologists indicate that they do not use the palliative care guidelines and many were not even aware they existed (Duenk RG, et al. Int J Chron Obstruct Pulmon Dis. 2017;12:299-311). Patients with COPD often have unmet needs, and the majority of patients with COPD do not have access to palliative care at their end of life (Gore JM, et al). Unfortunately, the supply of palliative care specialists is too low to meet demand, especially in outpatient settings (Kamal AH, et al. Am J Med. 2017;130:113-4).

The ATS released a multisociety policy statement in 2022 that established a framework for early palliative care in the care in patients with respiratory illnesses (Sullivan DR, et al. Am J Respir Crit Care Med. 2022;206[6]:e44-e69). However, given the paucity of specialists and the aging population, the needs of patients and their loved ones cannot be met exclusively by palliative care specialists. Pulmonologists must expand their practice to include guideline-based palliative care in order to truly serve our patients to the best of our abilities. It is incumbent on training programs to train future pulmonologists with these palliative skills, and upon medical organizations to supply time and resources to ensure the pulmonologist is able to use these skills.

Gretchen Winter, MD

Section Member-at-Large

Airways Disorders Network

Asthma & COPD Section

Many of us may have experienced the extreme weather and climate patterns in the past year, depending on the region in which we live. These extreme weather changes are not unusual, but their recent occurrences may have been especially impactful on our patients.

Earlier works investigating effects of temperature and humidity changes on the airway in patients with asthma are insightful (Strauss, et al. 1978). Heat can irritate asthmatic airways that are already hyperreactive. Cold air can remove airway moisture. Similar mechanisms with warm/hot air can affect airway inflammation in COPD. In addition, poor air quality often occurs during extreme heat events and can affect patients with COPD.

Seasonal variation in COPD exacerbations was demonstrated by the TORCH study, where a two-fold increase in COPD exacerbations and hospitalizations was noted during the winter months in both northern and southern regions of the world. This trend was not observed in tropical countries with average annual temperatures of >18 °C (64 °F). Factors accounting for this variation may include greater risk of viral infections, increased host susceptibility, and more time spent indoors, along with impact of temperature variation on lung function (Jenkins, et al. 2012). This effect was accompanied by variation in the treatment choices with antibiotics alone or in combination with steroids. A trend towards combined antibiotics and steroids was noted during winters.

Ideal conditions for patients with COPD to minimize risk for exacerbation would be home humidity between 30% and 50% with indoor temperature of 21°C at least 9 hours per day in living areas (Osman, et al. 2008).

Outdoor activities during extreme temperatures should be avoided. Air conditioning and/or humidifiers can be helpful in modifying influences.


Maria Azhar, MD

Section Fellow-in-Training

Richard George Barbers, MD, FCCP

Section Chair

References

Jenkins CR, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39(1):38-45.

Osman LM, et al. Home warmth and health status of COPD patients. Eur J Public Health. 2008;18(4):399-405.

Strauss RH, et al. Influence of heat and humidity on the airway obstruction induced by exercise in asthma. J Clin Invest. 1978;61(2):433-40.
 

Airways Disorders Network

Asthma & COPD Section

Many of us may have experienced the extreme weather and climate patterns in the past year, depending on the region in which we live. These extreme weather changes are not unusual, but their recent occurrences may have been especially impactful on our patients.

Earlier works investigating effects of temperature and humidity changes on the airway in patients with asthma are insightful (Strauss, et al. 1978). Heat can irritate asthmatic airways that are already hyperreactive. Cold air can remove airway moisture. Similar mechanisms with warm/hot air can affect airway inflammation in COPD. In addition, poor air quality often occurs during extreme heat events and can affect patients with COPD.

Seasonal variation in COPD exacerbations was demonstrated by the TORCH study, where a two-fold increase in COPD exacerbations and hospitalizations was noted during the winter months in both northern and southern regions of the world. This trend was not observed in tropical countries with average annual temperatures of >18 °C (64 °F). Factors accounting for this variation may include greater risk of viral infections, increased host susceptibility, and more time spent indoors, along with impact of temperature variation on lung function (Jenkins, et al. 2012). This effect was accompanied by variation in the treatment choices with antibiotics alone or in combination with steroids. A trend towards combined antibiotics and steroids was noted during winters.

Ideal conditions for patients with COPD to minimize risk for exacerbation would be home humidity between 30% and 50% with indoor temperature of 21°C at least 9 hours per day in living areas (Osman, et al. 2008).

Outdoor activities during extreme temperatures should be avoided. Air conditioning and/or humidifiers can be helpful in modifying influences.


Maria Azhar, MD

Section Fellow-in-Training

Richard George Barbers, MD, FCCP

Section Chair

References

Jenkins CR, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39(1):38-45.

Osman LM, et al. Home warmth and health status of COPD patients. Eur J Public Health. 2008;18(4):399-405.

Strauss RH, et al. Influence of heat and humidity on the airway obstruction induced by exercise in asthma. J Clin Invest. 1978;61(2):433-40.
 

Airways Disorders Network

Asthma & COPD Section

Many of us may have experienced the extreme weather and climate patterns in the past year, depending on the region in which we live. These extreme weather changes are not unusual, but their recent occurrences may have been especially impactful on our patients.

Earlier works investigating effects of temperature and humidity changes on the airway in patients with asthma are insightful (Strauss, et al. 1978). Heat can irritate asthmatic airways that are already hyperreactive. Cold air can remove airway moisture. Similar mechanisms with warm/hot air can affect airway inflammation in COPD. In addition, poor air quality often occurs during extreme heat events and can affect patients with COPD.

Seasonal variation in COPD exacerbations was demonstrated by the TORCH study, where a two-fold increase in COPD exacerbations and hospitalizations was noted during the winter months in both northern and southern regions of the world. This trend was not observed in tropical countries with average annual temperatures of >18 °C (64 °F). Factors accounting for this variation may include greater risk of viral infections, increased host susceptibility, and more time spent indoors, along with impact of temperature variation on lung function (Jenkins, et al. 2012). This effect was accompanied by variation in the treatment choices with antibiotics alone or in combination with steroids. A trend towards combined antibiotics and steroids was noted during winters.

Ideal conditions for patients with COPD to minimize risk for exacerbation would be home humidity between 30% and 50% with indoor temperature of 21°C at least 9 hours per day in living areas (Osman, et al. 2008).

Outdoor activities during extreme temperatures should be avoided. Air conditioning and/or humidifiers can be helpful in modifying influences.


Maria Azhar, MD

Section Fellow-in-Training

Richard George Barbers, MD, FCCP

Section Chair

References

Jenkins CR, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39(1):38-45.

Osman LM, et al. Home warmth and health status of COPD patients. Eur J Public Health. 2008;18(4):399-405.

Strauss RH, et al. Influence of heat and humidity on the airway obstruction induced by exercise in asthma. J Clin Invest. 1978;61(2):433-40.
 

It is estimated that almost one billion people globally are affected by obstructive sleep apnea (OSA) (Benjafield A, et al. Lancet Respir Med. 2019;7[8]:687-98). Despite such high prevalence, the treatment options for OSA are somewhat limited. Continuous positive airway pressure (CPAP), the gold standard therapy, is not viable for many due to difficulties tolerating the device or mask, and thus may not be a realistic long-term solution. As per certain estimates, nearly 50% of CPAP users discontinue treatment by the fifth year (Schoch O, et al. Respiration. 2014;87[2]:121-8). Furthermore, alternative options such as mandibular advancement devices, positional therapy, weight loss, and maxillofacial or palate surgery, also have unique challenges and limitations.

CHEST

First described in 2001, hypoglossal nerve stimulation (HGNS) is a relatively new and emerging technology for the treatment of OSA (Schwartz A, et al. Arch Otolaryngol Head Neck Surg. 2001 Oct;127[10]:1216-23). HGNS therapy was approved by the Food and Drug Administration in 2014 for the treatment of moderate to severe OSA. The therapy involves surgical implantation of the HGNS device, optimization of device settings, and evaluation for treatment response. A physician-led multidisciplinary Hypoglossal Nerve Stimulation Clinic involves collaboration from essential stakeholders, most importantly sleep medicine providers, clinic staff, sleep technologists, and ENT sleep surgeons. Goals of the multidisciplinary program are to ensure timely follow-up, optimization of device settings, and maximizing treatment efficacy. This review describes steps involved in developing a successful multidisciplinary HGNS program within a sleep medicine practice.
 

Patient selection and evaluation

There is growing interest in HGNS relative to conventional CPAP therapy, with many patients presenting to clinic to inquire about this therapy. However, not all patients are candidates for HGNS therapy. Prioritizing appropriate patient selection and education are key first steps. The initial assessments usually occur with a sleep medicine specialist. It begins with confirmation of the diagnosis of OSA in all patients and a concerted effort to troubleshoot and address any barriers to CPAP use before consideration of surgery. Patients who are unwilling to use or unable to tolerate CPAP therapy undergo further evaluation for HGNS therapy. It is important to ensure that patients are also screened for other sleep disorders, such as insomnia or restless leg syndrome, to rule out its contribution to daytime (or nighttime) symptoms.

Other salient inclusion criteria include an apnea-hypopnea index (AHI) between 15-100 events per hour (previously 65), at least 18 years of age, and a body mass index (BMI) less than 40 kg/m² (previously 32). Qualifying patients undergo an updated polysomnography if a recent study is not available. If the polysomnography reveals central and mixed apneas comprising less than 25 percent of the total AHI, patients are referred to ENT Sleep Surgery, and drug-induced sleep endoscopy is offered to examine upper airway anatomy. When a complete concentric collapse of the soft palate is seen on drug-induced sleep endoscopy, surgery is contraindicated. Prior palate surgery or maxillomandibular advancement (MMA) are not contraindications to HGNS therapy.

The patients receive comprehensive information on the nature of the surgery, expected recovery course, and device activation timeline. Perhaps most importantly, the patients receive structured education on HGNS therapy and potential outcomes to set realistic expectations. In the STAR trial, patients experienced a reduction in the AHI of approximately 70% (Strollo P, et al. N Engl J Med. 2014;370[2]:139-49). It is important to note that a response to therapy was defined as a reduction in the AHI by at least 50% and a value less than 20 events/hour (Strollo P, et al. Sleep. 2015;38[10]:1593-8). Therefore, patients who are expecting complete resolution of snoring and/or OSA may not be ideal candidates for surgery. Furthermore, patients who continue to experience fatigue and sleepiness on CPAP despite control of OSA may not experience amelioration of these symptoms with HGNS therapy.
 

Surgery and device management

The surgery, performed under general anesthesia, lasts approximately 3 hours, and may be followed by an overnight hospital stay depending on patient’s comorbidities. The device implantation involves placement of an implantable pulse generator (IPG) in the chest wall and leads to the hypoglossal nerve. The IPG is similar to a pacemaker and functions to stimulate the ipsilateral hypoglossal nerve innervating the tongue during sleep. The most common postoperative complications noted in the STAR trial data include incision site pain and swelling as well as temporary tongue weakness or paresthesia. Postoperative restrictions are minimal and include no heavy lifting for one month after surgery.

One week postsurgery, patients return to the ENT Sleep Surgery Clinic for follow-up, at which time the incisions as well as tongue strength and sensation are evaluated. In a subsequent visit between 4 and 6 weeks postsurgery, patients are evaluated in a joint Sleep Medicine and ENT clinic. They undergo device education and activation of the IPG using a dedicated programmer obtained from the device manufacturer. Device comfort features such as start delay and pause time are also programmed. Furthermore, appropriate tongue movement, lead placement, and voltage range settings are assessed during the visit. The ENT surgery team reevaluates the incision sites and assesses for tongue function and sensation. Patients are instructed to increase the voltage incrementally every week as tolerated with the goal of using the device nightly for the entirety of sleep. If patients tolerate the therapy well during the 2- to 3-month follow-up, a sleep study is scheduled to evaluate treatment effectiveness at the peak tolerable voltage. For those struggling with the therapy, adjustments to electrode configurations should be considered for pulse width, and rate. Occasionally, patients may require awake endoscopy and/or an advanced HGNS titration while asleep to determine the most appropriate settings to optimally control sleep apnea.

Until recently, patients implanted with an early version of the HGNS were limited to magnetic resonance imaging (MRI) scans of the head, neck, and extremities only. However, patients with the latest model IPGs can now undergo full-body MRI scans. It is important to note that the MRI’s Tesla cannot exceed 1.5T, necessitating specific imaging centers. Other constraints include the inability to adjust device settings remotely, which could mean long travel for minor setting adjustments such as altering start delay or pause times. Furthermore, provider education on operating and managing the device can be time consuming and may also be a barrier to implementation in a clinic. Also challenging may be the availability of an ENT surgery, which plays a critical role in the implantation of the devices and follow-up.

Currently, Inspire Medical Systems is the only FDA-approved hypoglossal nerve stimulation device available in the United States, and globally, more than 45,000 patients have been implanted. However, the field of neurostimulation is rapidly growing. Companies like LivaNova have secured Investigational Device Exemption for their HGNS device. The Genio system by Nyxoah is evaluating the use of bilateral hypoglossal nerve stimulation in patients with OSA and complete concentric collapse of the palate. A multidisciplinary Hypoglossal Nerve Stimulation Clinic is an important component of a comprehensive sleep medicine clinic for patient care and medical education. In the appropriate patient, this emerging technology may provide improvement in OSA severity and symptoms.
 

Dr. Gill is Clinical Associate Professor, Division of Sleep Medicine, Stanford (Calif.) University.

It is estimated that almost one billion people globally are affected by obstructive sleep apnea (OSA) (Benjafield A, et al. Lancet Respir Med. 2019;7[8]:687-98). Despite such high prevalence, the treatment options for OSA are somewhat limited. Continuous positive airway pressure (CPAP), the gold standard therapy, is not viable for many due to difficulties tolerating the device or mask, and thus may not be a realistic long-term solution. As per certain estimates, nearly 50% of CPAP users discontinue treatment by the fifth year (Schoch O, et al. Respiration. 2014;87[2]:121-8). Furthermore, alternative options such as mandibular advancement devices, positional therapy, weight loss, and maxillofacial or palate surgery, also have unique challenges and limitations.

CHEST

First described in 2001, hypoglossal nerve stimulation (HGNS) is a relatively new and emerging technology for the treatment of OSA (Schwartz A, et al. Arch Otolaryngol Head Neck Surg. 2001 Oct;127[10]:1216-23). HGNS therapy was approved by the Food and Drug Administration in 2014 for the treatment of moderate to severe OSA. The therapy involves surgical implantation of the HGNS device, optimization of device settings, and evaluation for treatment response. A physician-led multidisciplinary Hypoglossal Nerve Stimulation Clinic involves collaboration from essential stakeholders, most importantly sleep medicine providers, clinic staff, sleep technologists, and ENT sleep surgeons. Goals of the multidisciplinary program are to ensure timely follow-up, optimization of device settings, and maximizing treatment efficacy. This review describes steps involved in developing a successful multidisciplinary HGNS program within a sleep medicine practice.
 

Patient selection and evaluation

There is growing interest in HGNS relative to conventional CPAP therapy, with many patients presenting to clinic to inquire about this therapy. However, not all patients are candidates for HGNS therapy. Prioritizing appropriate patient selection and education are key first steps. The initial assessments usually occur with a sleep medicine specialist. It begins with confirmation of the diagnosis of OSA in all patients and a concerted effort to troubleshoot and address any barriers to CPAP use before consideration of surgery. Patients who are unwilling to use or unable to tolerate CPAP therapy undergo further evaluation for HGNS therapy. It is important to ensure that patients are also screened for other sleep disorders, such as insomnia or restless leg syndrome, to rule out its contribution to daytime (or nighttime) symptoms.

Other salient inclusion criteria include an apnea-hypopnea index (AHI) between 15-100 events per hour (previously 65), at least 18 years of age, and a body mass index (BMI) less than 40 kg/m² (previously 32). Qualifying patients undergo an updated polysomnography if a recent study is not available. If the polysomnography reveals central and mixed apneas comprising less than 25 percent of the total AHI, patients are referred to ENT Sleep Surgery, and drug-induced sleep endoscopy is offered to examine upper airway anatomy. When a complete concentric collapse of the soft palate is seen on drug-induced sleep endoscopy, surgery is contraindicated. Prior palate surgery or maxillomandibular advancement (MMA) are not contraindications to HGNS therapy.

The patients receive comprehensive information on the nature of the surgery, expected recovery course, and device activation timeline. Perhaps most importantly, the patients receive structured education on HGNS therapy and potential outcomes to set realistic expectations. In the STAR trial, patients experienced a reduction in the AHI of approximately 70% (Strollo P, et al. N Engl J Med. 2014;370[2]:139-49). It is important to note that a response to therapy was defined as a reduction in the AHI by at least 50% and a value less than 20 events/hour (Strollo P, et al. Sleep. 2015;38[10]:1593-8). Therefore, patients who are expecting complete resolution of snoring and/or OSA may not be ideal candidates for surgery. Furthermore, patients who continue to experience fatigue and sleepiness on CPAP despite control of OSA may not experience amelioration of these symptoms with HGNS therapy.
 

Surgery and device management

The surgery, performed under general anesthesia, lasts approximately 3 hours, and may be followed by an overnight hospital stay depending on patient’s comorbidities. The device implantation involves placement of an implantable pulse generator (IPG) in the chest wall and leads to the hypoglossal nerve. The IPG is similar to a pacemaker and functions to stimulate the ipsilateral hypoglossal nerve innervating the tongue during sleep. The most common postoperative complications noted in the STAR trial data include incision site pain and swelling as well as temporary tongue weakness or paresthesia. Postoperative restrictions are minimal and include no heavy lifting for one month after surgery.

One week postsurgery, patients return to the ENT Sleep Surgery Clinic for follow-up, at which time the incisions as well as tongue strength and sensation are evaluated. In a subsequent visit between 4 and 6 weeks postsurgery, patients are evaluated in a joint Sleep Medicine and ENT clinic. They undergo device education and activation of the IPG using a dedicated programmer obtained from the device manufacturer. Device comfort features such as start delay and pause time are also programmed. Furthermore, appropriate tongue movement, lead placement, and voltage range settings are assessed during the visit. The ENT surgery team reevaluates the incision sites and assesses for tongue function and sensation. Patients are instructed to increase the voltage incrementally every week as tolerated with the goal of using the device nightly for the entirety of sleep. If patients tolerate the therapy well during the 2- to 3-month follow-up, a sleep study is scheduled to evaluate treatment effectiveness at the peak tolerable voltage. For those struggling with the therapy, adjustments to electrode configurations should be considered for pulse width, and rate. Occasionally, patients may require awake endoscopy and/or an advanced HGNS titration while asleep to determine the most appropriate settings to optimally control sleep apnea.

Until recently, patients implanted with an early version of the HGNS were limited to magnetic resonance imaging (MRI) scans of the head, neck, and extremities only. However, patients with the latest model IPGs can now undergo full-body MRI scans. It is important to note that the MRI’s Tesla cannot exceed 1.5T, necessitating specific imaging centers. Other constraints include the inability to adjust device settings remotely, which could mean long travel for minor setting adjustments such as altering start delay or pause times. Furthermore, provider education on operating and managing the device can be time consuming and may also be a barrier to implementation in a clinic. Also challenging may be the availability of an ENT surgery, which plays a critical role in the implantation of the devices and follow-up.

Currently, Inspire Medical Systems is the only FDA-approved hypoglossal nerve stimulation device available in the United States, and globally, more than 45,000 patients have been implanted. However, the field of neurostimulation is rapidly growing. Companies like LivaNova have secured Investigational Device Exemption for their HGNS device. The Genio system by Nyxoah is evaluating the use of bilateral hypoglossal nerve stimulation in patients with OSA and complete concentric collapse of the palate. A multidisciplinary Hypoglossal Nerve Stimulation Clinic is an important component of a comprehensive sleep medicine clinic for patient care and medical education. In the appropriate patient, this emerging technology may provide improvement in OSA severity and symptoms.
 

Dr. Gill is Clinical Associate Professor, Division of Sleep Medicine, Stanford (Calif.) University.

It is estimated that almost one billion people globally are affected by obstructive sleep apnea (OSA) (Benjafield A, et al. Lancet Respir Med. 2019;7[8]:687-98). Despite such high prevalence, the treatment options for OSA are somewhat limited. Continuous positive airway pressure (CPAP), the gold standard therapy, is not viable for many due to difficulties tolerating the device or mask, and thus may not be a realistic long-term solution. As per certain estimates, nearly 50% of CPAP users discontinue treatment by the fifth year (Schoch O, et al. Respiration. 2014;87[2]:121-8). Furthermore, alternative options such as mandibular advancement devices, positional therapy, weight loss, and maxillofacial or palate surgery, also have unique challenges and limitations.

CHEST

First described in 2001, hypoglossal nerve stimulation (HGNS) is a relatively new and emerging technology for the treatment of OSA (Schwartz A, et al. Arch Otolaryngol Head Neck Surg. 2001 Oct;127[10]:1216-23). HGNS therapy was approved by the Food and Drug Administration in 2014 for the treatment of moderate to severe OSA. The therapy involves surgical implantation of the HGNS device, optimization of device settings, and evaluation for treatment response. A physician-led multidisciplinary Hypoglossal Nerve Stimulation Clinic involves collaboration from essential stakeholders, most importantly sleep medicine providers, clinic staff, sleep technologists, and ENT sleep surgeons. Goals of the multidisciplinary program are to ensure timely follow-up, optimization of device settings, and maximizing treatment efficacy. This review describes steps involved in developing a successful multidisciplinary HGNS program within a sleep medicine practice.
 

Patient selection and evaluation

There is growing interest in HGNS relative to conventional CPAP therapy, with many patients presenting to clinic to inquire about this therapy. However, not all patients are candidates for HGNS therapy. Prioritizing appropriate patient selection and education are key first steps. The initial assessments usually occur with a sleep medicine specialist. It begins with confirmation of the diagnosis of OSA in all patients and a concerted effort to troubleshoot and address any barriers to CPAP use before consideration of surgery. Patients who are unwilling to use or unable to tolerate CPAP therapy undergo further evaluation for HGNS therapy. It is important to ensure that patients are also screened for other sleep disorders, such as insomnia or restless leg syndrome, to rule out its contribution to daytime (or nighttime) symptoms.

Other salient inclusion criteria include an apnea-hypopnea index (AHI) between 15-100 events per hour (previously 65), at least 18 years of age, and a body mass index (BMI) less than 40 kg/m² (previously 32). Qualifying patients undergo an updated polysomnography if a recent study is not available. If the polysomnography reveals central and mixed apneas comprising less than 25 percent of the total AHI, patients are referred to ENT Sleep Surgery, and drug-induced sleep endoscopy is offered to examine upper airway anatomy. When a complete concentric collapse of the soft palate is seen on drug-induced sleep endoscopy, surgery is contraindicated. Prior palate surgery or maxillomandibular advancement (MMA) are not contraindications to HGNS therapy.

The patients receive comprehensive information on the nature of the surgery, expected recovery course, and device activation timeline. Perhaps most importantly, the patients receive structured education on HGNS therapy and potential outcomes to set realistic expectations. In the STAR trial, patients experienced a reduction in the AHI of approximately 70% (Strollo P, et al. N Engl J Med. 2014;370[2]:139-49). It is important to note that a response to therapy was defined as a reduction in the AHI by at least 50% and a value less than 20 events/hour (Strollo P, et al. Sleep. 2015;38[10]:1593-8). Therefore, patients who are expecting complete resolution of snoring and/or OSA may not be ideal candidates for surgery. Furthermore, patients who continue to experience fatigue and sleepiness on CPAP despite control of OSA may not experience amelioration of these symptoms with HGNS therapy.
 

Surgery and device management

The surgery, performed under general anesthesia, lasts approximately 3 hours, and may be followed by an overnight hospital stay depending on patient’s comorbidities. The device implantation involves placement of an implantable pulse generator (IPG) in the chest wall and leads to the hypoglossal nerve. The IPG is similar to a pacemaker and functions to stimulate the ipsilateral hypoglossal nerve innervating the tongue during sleep. The most common postoperative complications noted in the STAR trial data include incision site pain and swelling as well as temporary tongue weakness or paresthesia. Postoperative restrictions are minimal and include no heavy lifting for one month after surgery.

One week postsurgery, patients return to the ENT Sleep Surgery Clinic for follow-up, at which time the incisions as well as tongue strength and sensation are evaluated. In a subsequent visit between 4 and 6 weeks postsurgery, patients are evaluated in a joint Sleep Medicine and ENT clinic. They undergo device education and activation of the IPG using a dedicated programmer obtained from the device manufacturer. Device comfort features such as start delay and pause time are also programmed. Furthermore, appropriate tongue movement, lead placement, and voltage range settings are assessed during the visit. The ENT surgery team reevaluates the incision sites and assesses for tongue function and sensation. Patients are instructed to increase the voltage incrementally every week as tolerated with the goal of using the device nightly for the entirety of sleep. If patients tolerate the therapy well during the 2- to 3-month follow-up, a sleep study is scheduled to evaluate treatment effectiveness at the peak tolerable voltage. For those struggling with the therapy, adjustments to electrode configurations should be considered for pulse width, and rate. Occasionally, patients may require awake endoscopy and/or an advanced HGNS titration while asleep to determine the most appropriate settings to optimally control sleep apnea.

Until recently, patients implanted with an early version of the HGNS were limited to magnetic resonance imaging (MRI) scans of the head, neck, and extremities only. However, patients with the latest model IPGs can now undergo full-body MRI scans. It is important to note that the MRI’s Tesla cannot exceed 1.5T, necessitating specific imaging centers. Other constraints include the inability to adjust device settings remotely, which could mean long travel for minor setting adjustments such as altering start delay or pause times. Furthermore, provider education on operating and managing the device can be time consuming and may also be a barrier to implementation in a clinic. Also challenging may be the availability of an ENT surgery, which plays a critical role in the implantation of the devices and follow-up.

Currently, Inspire Medical Systems is the only FDA-approved hypoglossal nerve stimulation device available in the United States, and globally, more than 45,000 patients have been implanted. However, the field of neurostimulation is rapidly growing. Companies like LivaNova have secured Investigational Device Exemption for their HGNS device. The Genio system by Nyxoah is evaluating the use of bilateral hypoglossal nerve stimulation in patients with OSA and complete concentric collapse of the palate. A multidisciplinary Hypoglossal Nerve Stimulation Clinic is an important component of a comprehensive sleep medicine clinic for patient care and medical education. In the appropriate patient, this emerging technology may provide improvement in OSA severity and symptoms.
 

Dr. Gill is Clinical Associate Professor, Division of Sleep Medicine, Stanford (Calif.) University.