By 2030, prostate and lung cancers expected to be most common cancers among HIV population
1. By 2030, prostate and lung cancers expected to be the most common cancers among aging HIV population
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Despite declines in cancer incidence rates among HIV-infected people, cancer will remain a significant concern as this patient population ages. By 2030, prostate and lung cancers are projected to be the most common cancers among individuals aging with HIV. The findings are published in Annals of Internal Medicine.
Due to their weakened immune systems, people living with HIV have a higher risk of some cancers than the general population. The development of modern antiretroviral therapy (ART) has allowed people with HIV to live to older ages and has reduced the risk of certain cancers, such as non-Hodgkin lymphoma and cervical cancer, which were previously prevalent in this population. This trend, along with the aging population, has resulted in a shift in the types of cancers diagnosed in patients with HIV. As such, projecting cancer rates and the expected number of cancers in this high-risk population is necessary to inform public health efforts like cancer screening and prevention.
Researchers from the National Cancer Institute used data from linked HIV and cancer registries to project cancer incidence rates in HIV-infected adults in the U.S. through 2030. They applied those rates to projections of the number of HIV-infected people from the Centers for Disease Control and Prevention (CDC) to estimate the future cancer burden. By 2030, they expect substantial aging of the U.S. HIV population, with the proportion of HIV-infected people who are 65+ years old projected to be 21.4 percent (up from 8.5 percent in 2010). While the number of cancer cases diagnosed among adults with HIV is projected to decline, incidence of non-AIDS-defining cancers will remain a concern. Prostate cancer cases are expected to increase over this timeframe, and prostate and lung cancers will each be more common in 2030 than AIDS-defining cancers combined.
According to the researchers, these findings underscore the continuing importance of cancer as a co-morbidity as people with HIV live longer and age. The findings should help to inform the priorities of targeted screening, treatment, and prevention programs.
2. No definitive answer on whether prescription drug monitoring programs help to reduce opioid overdoses
Authors caution that programs aimed at reducing prescription opioid supply should also address the supply and demand of illicit opioids
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Evidence is insufficient to determine whether implementing prescription drug monitoring programs (PDMPs) increases or decreases overdoses. Vast variations in programs and their administrative features make them especially challenging to study. Findings from a systematic evidence review are published in Annals of Internal Medicine.
Opioid prescribing increased 350 percent between 1999 and 2015. During the same timeframe, the rate of overdose deaths from both prescription opioids and heroin also increased substantially. PDMPs have been identified as a critical tool for reducing prescription opioid-related morbidity and mortality, and are a key component of the President's Prescription Drug Abuse Prevention Plan. PDMPs utilize centralized statewide data systems to transmit prescription data, which can flag patients who are potentially abusing opioids or physicians who are overprescribing. Currently, all 50 states and the District of Columbia have either implemented a PDMP or have passed legislation to begin doing so. As such, it is crucial to determine if these programs are helping to reduce opioid overdose.
Researchers from Columbia University Mailman School of Public Health reviewed studies addressing the relationship between PDMPs and nonfatal and fatal overdoses, and attempted to clarify the program features that might be most effective. Of the 17 studies included in the analysis, 10 linked PDMP implementation to reductions in fatal opioid overdoses. Mandatory review of PDMP data by providers before writing prescriptions was the most studied program feature associated with this outcome. Other features correlating with a decrease in fatal overdoses were frequent (at least weekly) updates of PDMP data, provider authorization to access PDMP data, and monitoring of nonscheduled drugs.
The authors also identified an unintended consequence of PDMPs. Three studies included in their analysis showed an increase in heroin overdose deaths after PDMP implementation. These findings suggest that heroin substitution may have increased after PDMP inspired restrictions on opioid prescribing. They caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.
Because programs and their administration varied so widely by state, the authors conclude that evidence is insufficient to draw definitive conclusions about their effect on overdoses or to determine which administrative features lead to success.
3. Firearm injury prevention experts suggest setting a "firearm retirement date" for patients with dementia
Position Paper Abstract: http://annals.org/aim/article/doi/10.7326/M18-0140
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Firearm injury prevention experts suggest setting a "firearm retirement date" for patients with dementia. According to the authors of an opinion piece published in Annals of Internal Medicine, discussions about firearm access strongly parallel discussions about driving. They offer recommendations for addressing the issue of when it's time to "give up the keys" with regard to gun access.
Firearms pose an important risk to patients with dementia. For example, persons with dementia are at risk for suicide, and firearms are the most common method for suicide among this population. In addition, persons with dementia who have firearm access may inadvertently harm others. Delusions about home intruders or confusion about the identity of persons in their lives may lead them to confront family members, health aides, or other visitors. Access to a firearm may increase the potential for injury or death in such situations.
The Veterans Health Administration system recommends that clinicians counsel veterans with dementia and caregivers on firearm safety and encourage restricted access to firearms and ammunition. While a diagnosis of cognitive impairment or dementia does not mean that a person has to give up access to a firearm, it is important to consider the level of impairment. To help patients maintain dignity and a sense of control over their lives, the experts recommend working with a trusted family member to create an advance directive that specifies when the patient should retire his or her gun privileges.
According to the authors, physicians have the right and duty to inquire about guns and to provide counsel to their patients. They believe that a concerted, cooperative effort can help to prevent injuries or death while protecting the dignity and rights of older adults with dementia.
Also new in this issue:
Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?
N. Lance Downing, MD; David W. Bates, MD, MSc; and Christopher A. Longhurst, MD, MS
Ideas and Opinions
Transfusion-Transmitted Plasmodium falciparum in a Patient With Sickle Cell Hemoglobinopathy
Salimah Valliani, MD; Pradyumna Agasthi, MD; Gloria Westney, MD, MSCR; Marilyn Foreman, MD, MS
Observation: Case Report