PPIs may impair efficacy of checkpoint inhibitors
Proton pump inhibitors (PPIs) may reduce the effectiveness of some immune checkpoint inhibitor (ICI) cancer treatments by causing gut dysbiosis, Australian researchers say.
A retrospective review of outcomes for 1202 lung cancer participants in the IMPower150 trial of immunotherapies found that PPI use was independently associated with worse Overall Survival (Hazard 1.53 [1.21–1.95], P < 0.001) and Progression Free Survival (1.34 [1.12–1.61], P = 0.002) in patients treated with atezolizumab.
PPI use also had a negative effect in patients treated with atezolizumab and bevacizumab plus carboplatin plus paclitaxel (BCP), but not BCP alone.
Lead author Dr Ash Hopkins from the Flinders Health and Medical Research Institute, Adelaide, said it was important to understand the impacts of PPIs since about 30% of cancer patients use them, and usually for extended periods of time.
“Of concern is that the medication is often overused, or used inappropriately, as it is seen to cause little harm, however our research could indicate a need to change this approach,” said Dr Hopkins, a NHMRC Investigator Fellow and leader of the Clinical Cancer Epidemiology Lab at Flinders University.
He suggested the effect may be mediated via the gut microbiota as it plays an important role in regulating immune function.
Hep B app in Indigenous languages
An app designed to improve health literacy about the hepatitis B virus (HBV) has been translated into several Indigenous languages to provide access to more than 70% of the Northern Territory (NT) Aboriginal population.
The Hep B Story App project recognises the high burden of the virus in Aboriginal communities and the importance of in-language, community-led health promotion initiatives.
Associate Professor Jane Davies, Principal Research Fellow at the Menzies School of Health Research said hepatitis B health literacy had been found to be poor among patients, Aboriginal health practitioners and community workers.
“Having an educational tool in an Aboriginal client’s first language is crucial in developing treatment partnerships for patients with chronic hepatitis B.”
“Our project team has worked with communities all over the NT, from Gunbalanya, Groote Eylandt, the Tiwi Islands, Alice Springs and beyond, with translators and advisors adapting the app in their languages,” Associate Professor Davies said.
The app is available in English, Yolŋu Matha, Arrernte, Tiwi, Warlpiri, Kunwinjku and Pitjantjatjara. In 2022, the app will also be launched in Anindilyakwa, Gurindji, Murrinh-patha, Kriol and Burarra.
The Hep B Story app is free to download from the Apple and Google Play stores and the Menzies website
Specialty training colleges have ‘dirty secret’
Training colleges, consultants, and hospital executives have been blamed for enabling ongoing abuse and overwork of registrars, in an article about speciality training written by an anonymous junior doctor deploring what they describe as medicine’s ‘dirty secret’.
Published in mainstream newspapers this week, the article entitled ‘Distressed doctors don’t bend, so they break’ describes a training regime that encourages mental distress and suicide among registrars who are given a heavy workload and responsibilities but no support from senior doctors or management.
“They are the first to arrive at the hospital and the last to leave. You are told not to make waves, to keep your head down, to get through it. You are often working unsupervised with vast responsibilities and unsupportive distant supervisors. The less you complain, the more you’re willing to endure, the more attractive and hireable you become. Troublemakers do not get hired,” it says.
The article says the current approach by training colleges is flawed because “the focus has been on coping with abuse rather than ending abuse.”
“The medical fraternity needs to host a meaningful discussion about how to fix our training system to provide more support for doctors and improve their wellbeing. Workload is an issue but the crux of the problem is the lack of support from those in authority,” it concludes.