Latest news with #oncologists
Medscape
a day ago
- Health
- Medscape
Turbulence in the Oncology Workforce: A Silver Lining
Physicians are in the midst of a tectonic shift in workforce patterns that could have ramifications lasting decades. In a few short months, the current administration has implemented policies that will drastically reduce federal funding for academic science. These massive cuts include hundreds of terminated grants and slashed funding for 'indirect costs' for National Institutes of Health (NIH) research grant recipients. Alongside the federal budget cuts, entire divisions of the NIH and National Science Foundation are also being reorganized. Clinicians at many academic institutions have been advised to prepare for uncertainty, while physicians and scientists have been instructed to restrict research hiring and spending, even terminate staff without existing grants or contracts. On top of that, entire global health programs have been decimated, and 'reduction in force' emails at the FDA, CDC, or Centers for Medicare and Medicaid Services have left many experts without a job. However, amid this turbulence and confusion, there's a potential silver lining. The assaults on research funding and government programs may inadvertently help address a major issue: the physician shortage. As many of my colleagues at academic institutions contemplate their next move, I suspect that oncologists may find themselves returning to full-time clinical practice and patient care. And that may not be a bad thing. Prior to the Trump administration's policies, the proportion of clinicians-hours spent seeing patients had declined nearly 8% over a decade. The number of doctors who spent most of their time seeing patients had dropped considerably as well. In fact, a 2024 survey from the American Medical Association found that over 35% of physicians expressed at least some interest in leaving clinical practice altogether. This, coupled with a massive influx of physicians entering retirement, is likely to exacerbate a growing physician shortage problem. But what if more of us now choose to increase our time in the clinic or start practicing full time? For many of my colleagues who cannot sustain a non-clinical career, I think that a return to full-time patient care will be a practical, even enticing move. And considering the shortages of physicians across almost all specialties, including oncology, doctors seeking refuge in clinical practice would be a welcome development. Would I be content with a career that is increasingly more clinical? I think I would be. For me, clinical practice represents the ultimate refuge, the source of stability in a career that could otherwise be ruled by frequent career transitions encountered in the business world. The patient exam room is the one place where I can focus on a one-on-one relationship instead of the hustle and bustle of grant applications and administrative tasks. Since patient care is often a health system's top revenue source, if more oncologists return to full-time practice, we may have more leverage to negotiate solutions that reduce burnout, advance practice providers, or provide greater vacation time. I also suspect that many clinicians who choose to spend more time with patients will do so as part of a medical group or private practice — potentially reversing a decades-long trend of doctors leaving private practice to work as employed physicians. There are several tools that can help physicians make this transition easier. For one, the emergence of ambient artificial intelligence (AI) scribing may curb the exodus from clinical practice by reducing excessive documentation burdens. Instead of hyperbolic claims of AI 'replacing' physicians, I suspect that the AI revolution will simply provide physicians the necessary tools to be more efficient. The growth of telemedicine and remote patient care platforms is another enabling factor. The rise of these virtual clinics means that physicians are no longer limited by geographically boundaries when practicing medicine. Continuing COVID-era policies that allow physicians to practice across state lines would also help. If more physicians contemplate a return to their clinical roots, we have an opportunity to reshape the patient care experience in ways that both serve our communities and that create more sustainable clinical careers. The physician workforce has always been adaptable. Now, if we can find our way back to the exam room, we will bring with us diverse experiences from research, policy, and business that can improve clinical practice. Perhaps the silver lining in today's uncertainty is the chance to rediscover what drew us to medicine in the first place — the profound privilege of caring for patients — while leveraging our broader perspectives to address the systemic issues that drove many away in the first place. The future of healthcare may depend on our ability to transform this moment of professional disruption into one of renewal and recommitment to our core mission.
Medscape
a day ago
- Health
- Medscape
Is It Worth Adding Chemo to ICI for NSCLC in Older Adults?
Immune checkpoint inhibitors (ICI) are a cornerstone of non-small cell lung cancer (NSCLC) treatment, but it's not clear whether adding chemotherapy to ICI — a common practice with younger patients with NSCLC — helps older ones. No randomized trial has directly compared stand-alone ICI with chemoimmunotherapy in geriatric patients with NSCLC. Without strong data supporting the combined approach, oncologists may stay away from offering chemoimmunotherapy to older patients, especially to those with multiple comorbidities, given concerns about increased toxicity. To address the evidence gap, investigators linked Medicare and Surveillance, Epidemiology, and End Results data to compare outcomes between 14,249 older patients with NSCLC who received ICI alone (pembrolizumab or nivolumab) and 3432 treated with ICI and platinum doublet chemotherapy. Patients were aged 74 years, on average, and at least 66 years. The median follow-up duration was 211 days. The team weighed the risks and benefits of chemoimmunotherapy vs stand-alone ICI to answer a key question: Is adding chemotherapy to ICI worth it for elderly patients with NSCLC? The findings were recently published in Jama Oncology . Benefits: Prolonged Survival in First Line In the upfront setting, chemotherapy add-on reduced patients' mortality risk by 34% compared with ICI alone. Benefits were slightly more notable in women (hazard ratio [HR], 0.62) than in men (HR, 0.72). Patients with autoimmune disease — who are often excluded from trials and who made up almost 20% of the study population — benefited the most, with a mortality risk reduction of 49%. A similar mortality benefit was observed in patients aged 66-75 years and those aged 76 years or older, 'which is notable given that immune senescence is hypothesized to lessen ICI treatment response in patients older than 75 years,' wrote the investigators, led by James Heyward, PhD, a pharmacoepidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore. However, in the second or later lines of treatment, patients did not experience a significant survival benefit with chemoimmunotherapy (HR, 0.94; 95% CI, 0.68-1.03). Risks: Increased Toxicity Adding chemotherapy in the first-line setting increased the risk for severe immune-related adverse events (AEs), which can include pneumonitis, colitis, hepatitis, and myocarditis, by 18%. Severe AEs were more common in men (HR, 1.29) than in women (HR, 1.08). Patients aged 76 years or older had the highest risk (30%) for severe immune-related AEs. However, older patients did not have an increased risk for severe immune-related AEs in second and later lines. The study did not consider chemotherapy toxicities. Is It Worth It? The team extrapolated from their data to calculate the harm-benefit trade-off of adding ICI to chemotherapy in older patients. The researchers found that for each extra year of life gained with first-line chemoimmunotherapy, the risk for severe immune-related AEs would be 0.31. Put differently, 31% of patients predicted to gain 1 extra year of life were likely to experience one severe immune-related AE. Past studies have found that patients are often willing to accept one severe AE for 1 year of added survival, which indicates that chemoimmunotherapy in the first line may be worth it for older patients with NSCLC. 'Given patient prioritization of survival benefits vs prevention of adverse effects, patients may prefer to initiate treatment with ICI + chemotherapy, albeit with careful follow-up for mitigation of severe immune-related AEs,' the investigators wrote. But, the authors noted, 'men experienced more harm and less benefit than women' in the first-line setting, which is consistent with previous research. And patients with an autoimmune disorder who received chemoimmunotherapy had a slightly higher risk for severe immune-related AEs (HR, 1.22) than those without a disorder (HR, 1.16). Still, the authors said, 'the reduction in mortality was also the highest for this group of patients, suggesting that the potential benefits of treatment may outweigh the potential harms.' In the second and later lines, the researchers found no increased risk for immune-related AEs with chemoimmunotherapy. Given the lack of statistically significant mortality benefit, the results suggest that stand-alone ICI are a better approach in this setting. Overall, this study provides 'a valuable contribution to an ongoing and complex discussion,' said medical oncologist Alessio Cortellini, MD, PhD, an immunotherapy and lung cancer specialist at Imperial College London, London, England, who was not involved in the research. However, it will be important to closely monitor patients for severe immune-related AEs. 'While adding chemotherapy to immunotherapy may be appropriate for selected older adults with NSCLC, I remain cautious about its widespread use in frail patients,' Cortellini added. 'Until we have dedicated trials in frail populations, the decision to use [chemotherapy-ICI]combinations in older adults should be highly individualized.'
Associated Press
2 days ago
- Health
- Associated Press
New York Cancer & Blood Specialists Opens State-of-the-Art Cancer Center on Manhattan's Upper East Side
New York, NY June 18, 2025 --( )-- New York Cancer & Blood Specialists (NYCBS), one of the nation's leading oncology practices, proudly announces the opening of its newest state-of-the-art cancer treatment center located at 210 East 86th Street, 6th Floor, New York, NY 10028. Located in Yorkville, this new Manhattan center reaffirms the practice's commitment to delivering high-quality, community-based cancer care across New York City. The new center offers a full spectrum of cancer care services under one roof. The facility was designed with patients in mind, featuring a warm, healing environment and a host of amenities that promote comfort, dignity, and wellness throughout the treatment journey. 'This new center is a true testament to our mission of delivering comprehensive cancer care that's not only accessible, but also compassionate,' said Dr. Jeff Vacirca, CEO of NYCBS. 'We're proud to expand our footprint in Manhattan and continue bringing world-class care closer to where our patients live and work.' The Upper East Side location is staffed by a distinguished team of board-certified oncologists and hematologists, including Dr. Steven Gruenstein, Dr. Amory Novoselac, Dr. Brenda Panzera, Dr. Niculae Ciobanu, Dr. Visaharan Sivasubramaniam, and Dr. Tong Dai. Together, they bring decades of experience, clinical excellence, and a compassionate approach to each patient they treat. In addition to cutting-edge medical oncology and hematology services, the center offers access to supportive care, clinical trials, infusion therapy, advanced diagnostics, and patient-centered programs, all within a modern, patient-first environment. To make an appointment, call 212-861-6660. For more information, visit Read More Contact Information: New York Cancer & Blood Specialists Mike Scanlon, Marketing Director 631-574-8366 Contact via Email Read the full story here: New York Cancer & Blood Specialists Opens State-of-the-Art Cancer Center on Manhattan's Upper East Side Press Release Distributed by
Yahoo
6 days ago
- Health
- Yahoo
Doctors stunned to see strict exercise regimen is as good as medicine for colon cancer
Exercise really is as good as a drug, a groundbreaking new study found. In a global trial, workouts did better than pricey chemotherapy to prevent colon cancer recurrence. Oncologists gathered at the biggest annual cancer meeting in June gave the news a standing ovation. Scientists and doctors love to joke that exercise is a pretty great drug. But can workouts really compete with chemotherapy to prevent a disease like recurrent colon cancer? That's been tough to prove — until now. Results of the first randomized controlled trial of exercise as a treatment for recurrent high-risk cancer were presented at the American Society of Clinical Oncology's (ASCO) annual meeting in Chicago on June 1, and they stunned the crowd of doctors gathered there from around the world. The 17-year trial included over 880 patients from around the globe, each recovering from high-risk stage 2 or stage 3 colon cancer after treatment. Half of the participants were given general advice about exercise and how it can improve cancer survival. The other half were given a structured, three-year exercise prescription to follow, with the goal of preventing recurrence or a new cancer diagnoses. In the trial, exercise outperformed what adjuvant (or, secondary) chemotherapy can do to boost a patient's long-term survival, after surgery and primary treatment is over. Adjuvant cancer treatment is the kind designed to kill any extra cancer cells left behind, and prevent cancer from coming back. "Exercise is no longer just an intervention that improves quality of life and fitness. It is a treatment," Chris Booth, the study's lead author and a medical oncologist at Queen's University in Ontario, told the crowd. In the study, patients who followed an exercise regimen reduced their risk of death by 37%, and reduced their risk of cancer recurrence and new cancer development by 28%. The benefits of this three-year exercise prescription — which included advice and support from a trainer or physical therapist — were also long-lasting. After eight years, 90% of patients in the exercise program were alive compared to 83% in the control group. This 7% survival bump is comparable to (and in some cases exceeds) the survival benefits of standard drugs that doctors use in this same context. The common adjuvant chemotherapy drug oxaliplatin gives patients an overall survival boost of 5% after 10 years. Many other adjuvant cancer drugs deliver similar survival benefits, of around 5 to 10%. The effect didn't seem to be due to other factors. Patients didn't lose weight or belly fat, and no meaningful difference was seen in fatal heart attacks. The exercisers also weren't turning into Olympic athletes; they were just doing the equivalent of about 1.5 to 2.25 extra hours of brisk walking each week. In addition to reducing colon cancer diagnoses and deaths, the exercise also seemed to reduce the risk of other cancers. In the exercise group, there were two new cases of breast cancer diagnosed, compared to 12 cases among the controls. Other cancer doctors at the conference were shocked at the magnitude of the effect even though they've always kind of known exercise is good for cancer. Exercise is generally recommended to patients in recovery to improve outcomes. But to beat standard chemotherapy drugs? That was impressive. Dr. Paul Oberstein, a medical oncologist at NYU Langone who was not involved in the study, said he'd like to bring this treatment to his patients, maybe with some help from wearables like watches, and on-demand fitness classes people can access at home. "If you could somehow package this and bill it as a drug, it would be very valuable because the benefit was really remarkable," he said. Researchers are still studying the blood samples of patients who were in this study, drilling down into what might be driving the anti-cancer effects from exercise. Oberstein suspects that exercise is probably doing something that's powerfully anti-inflammatory in the body, reducing tumor growth, and preventing cancer's spread. At least, that's what he observes when he studies mice on treadmills in his lab. "Of course, mice on treadmills are not really people," he said, chuckling. "But what we see, and what we think might be applying, is that they have less inflammation." Other researchers think that perhaps exercise is revving up the immune system, engaging in what's called "immune surveillance" against cancer. "These are very hard things to measure over a long period of time," Oberstein said. Booth, who's been an avid long-distance runner ever since he was a kid, said this treatment should now be offered to any recovering colon cancer patient who wants it. "This intervention is empowering for patients, it is achievable for patients, and with a cost that is far lower than our standard," he said near the end of his talk. Slowly, but surely, the whole crowd stood up and burst into a sustained and hearty standing ovation. Read the original article on Business Insider
The Guardian
04-06-2025
- Health
- The Guardian
People with cancer face ‘ticking timebomb' due to NHS staff shortages
People with cancer face a 'ticking timebomb' of delays in getting diagnosed and treated because the NHS is too short-staffed to provide prompt care, senior doctors have warned. An NHS-wide shortage of radiologists and oncologists means patients are enduring long waits to have surgery, chemotherapy or radiotherapy and have a consultant review their care. Hold-ups lead to some people's cancer spreading, which can reduce the chances of their treatment working and increase the risk of death, the Royal College of Radiologists (RCR) said. NHS cancer services are struggling to keep up with rising demand for tests, such as scans and X-rays, and treatment, created by the growing number of people getting the disease. Evidence the RCR collected from the heads of NHS cancer centres across the UK and the clinical directors of radiology departments shows that delays to potentially 'life-saving' care occur because of 'chronic' workforce gaps. All radiology bosses surveyed said during 2024 their units could not scan all patients within the NHS's maximum waiting times because they did not have enough staff. 'Delays in cancer diagnosis and treatment will inevitably mean that for some patients their cancer will progress while they wait, making successful treatment more difficult and risking their survival,' said Dr Katharine Halliday, the RCR's president. The findings are particularly worrying because research has found that a patient's risk of death can increase by about 10% for each month they have to wait for treatment. Nine out of 10 cancer centre chiefs said patients were delayed starting their treatment last year while seven in 10 said they feared workforce gaps were putting patients' safety at risk. 'The government must train up more radiologists and oncologists to defuse this ticking timebomb for cancer diagnosis and treatment,' added Halliday. One head of a cancer service said patients with suspected bladder or prostate cancer had faced long waits to be tested, that more than 1,500 patients had to wait longer than they should for a follow-up appointment to review their treatment, and that staff were feeling 'burnt out'. Other doctors also said: 'Our waiting times for breast radiotherapy are now the worst I have ever known in 20 years.' 'Current wait for head and neck cancers [is] six weeks, meaning possible progression before radiotherapy.' 'A multiple week wait for palliative treatment has sometimes led to deterioration to the point is no longer possible.' Some cancer centres are so short-staffed that they are sending patients to be treated quicker at nearby hospitals under 'mutual aid' agreements, the RCR says in two reports published on Thursday. Radiologists and clinical oncologists face 'unsustainable' workloads, it adds. Sign up to Headlines UK Get the day's headlines and highlights emailed direct to you every morning after newsletter promotion The strain of working in overstretched cancer services is so great that doctors are quitting at younger ages, with some even doing so while still in their 30s, the RCR found. Genevieve Edwards, the chief executive of Bowel Cancer UK, said: 'The disease is treatable and curable if diagnosed early, but too many patients are facing long delays to start their treatment after going to their GP with symptoms. These delays may lead to the cancer spreading, making it harder to treat successfully.' The Department of Health and Social Care acknowledged that too many patients face delays. 'This government inherited a broken NHS where too many cancer patients are waiting too long for treatment but through our plan for change, we are determined to tackle delays, diagnose cancer earlier and treat it faster,' a spokesperson said. 'We are delivering 40,000 more appointments every week, investing £1.5bn in both new surgical hubs and AI scanners, rolling out cutting-edge radiotherapy machines to every region in the country, and backing our radiologists and oncologists with above inflation pay rises for the second year in a row. 'Later this year we will also publish a refreshed workforce plan to ensure the NHS has the right people in the right places to deliver the care patients need.'
