News in Brief: Never too late to quit smoking, even with cancer; VEGFI and ICI combination therapy and cardiovascular risk; Stigmatising language in medical records

It’s not too late to quit smoking, even if you already have cancer

The significant benefits of quitting smoking, even after being diagnosed with lung cancer, has been shown after a large observational study found that overcoming the addiction slows disease progression and decreases mortality among patients with early non-small cell lung cancer.

In a survey of 517 patients who were smoking when diagnosed with lung cancer, less than half quit (44.5%), and very few relapsed. The patients who quit smoking were more likely to live longer overall (6.6 years vs. 4.8. years), live longer without lung cancer (5.7 vs. 3.9 years) and have a longer time to death from lung cancer (7.9 vs. 6 years).

Investigators from the specialised cancer agency of the World Health Organization and the N.N. Blokhin National Medical Research Centre of Oncology in Russia, who collaborated on the study say more than 80% of patients with non-small cell lung cancer have a history of smoking, and about half are current smokers at the time of diagnosis. But with limited evidence that smoking cessation may improve survival many patients report believing that it is too late to quit once they’ve been diagnosed with lung cancer.

But, according to the authors, these results show that even after being diagnosed with lung cancer, there is still significant benefit to quitting smoking. Physicians should make their lung cancer patients aware that quitting smoking can extend life overall and extend life without cancer recurrence.

The study is published in the Annals of Internal Medicine.

VEGFI and ICI combination therapy will be accompanied by a substantial increase in cardiovascular risk

The anticipated rise in VEGFI and ICI combination therapy has prompted oncologists to warn of the cardiovascular toxicities associated with the anti-cancer therapies.

Writing in Clinical Science oncologists and pharmacologists from Erasmus University Medical Center in the Netherlands
said while currently the combination therapy is recommended for the treatment of advanced renal cell carcinoma, it has shown ‘promising’ treatment efficacy in other tumour types well – signalling its role as an important therapeutic strategy for various malignancies.

But, despite their ‘unprecedented’ anti-tumour effects, the combinatory approach is expected to be accompanied by a substantial increase in cardiovascular risk, as both types of agents could act synergistically to induce cardiovascular sequelae, including hypertension, congestive heart failure, myocarditis and acceleration of atherosclerosis, the oncologists add.

As part of a detailed review of the currently registered VEGFIs and ICIs the group has argued that a comprehensive baseline assessment and monitoring by specialised cardio-oncology teams is essential in case these agents are used in combination, particularly in high-risk patients.

The review which also discusses the main vascular and cardiac toxicity profiles of approved agents and future directions for various clinical situations can be accessed here.

Physicians urged to avoid stigmatising language in medical records

When writing in a patient’s medical record, physicians should be conscious of the use of language that reinforces negative and stigmatising attitudes toward patients that may influence the decisions of other clinicians subsequently caring for that patient, according to the authors of a US study.

An analysis of 600 medical records written by 138 physicians at a major hospital identified five types of negative and judgmental language used to describe patient encounters that encompassed racial and class stereotyping, personal disapproval of their actions, questioning a patient’s credibility and portraying them as a difficult or non-compliant. The stigmatising attitudes found in medical notes also included the use of authoritative and paternalistic language by physicians in which they recorded themselves as ‘instructing’ patients, according to researchers from Johns Hopkins University.

In their article, published in JAMA Network Open, they offered six examples of how physicians could use positive and collaborative language in medical records including compliments, approval of positive behaviours and noting of humanising personal details, in addition to acknowledgement of the physician’s own negative attitude and explaining non-adherence in a non-judgmental way.

“Just as we have developed a greater understanding about microaggressions and micro-inequities, this study’s findings suggest that we must raise consciousness about how we write and read medical records,” they said.

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