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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Obesity-related cancer rising among both younger and older adults worldwide
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02718
Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03883
URL goes live when the embargo lifts
A surveillance study compared international cancer incidence trends of 13 cancer types in younger and older adults. The study found that cancer incidence rates increased for several cancer types in the countries studied; however, besides colorectal cancer, increases occurred in both younger and older adults. The cancer types where incidence rates rose for both younger and older adults were all related to obesity. These results can help guide future research priorities and public health guidelines. The study is published in Annals of Internal Medicine.
Researchers from The Institute of Cancer Research and Imperial College London studied annual cancer incidence data from 2003 to 2017 from 42 countries in Asia, Europe, Africa, North and South America, and Australasia in the International Agency for Research on Cancer’s GLOBOCAN database. They evaluated 13 cancer types previously reported to be increasing in many countries in younger adults: leukemia and colorectal, stomach, breast, prostate, endometrial, gallbladder, kidney, liver, esophageal, oral, pancreatic, and thyroid cancer. Cancer in younger adults was defined as diagnoses at ages 20 to 49 years and in older adults as diagnoses at age 50 years or older. Cancer incidence rates increased in younger adults in over 75% of countries examined for thyroid, breast, colorectal, kidney, endometrial cancer and leukemia. For all these cancer types except colorectal cancer, incidence rates also increased in older adults. For colorectal cancer, the increasing trends in younger adults were greater than the trends in older adults for 69% of countries. For liver, oral, esophageal, and stomach cancer, incidence rates decreased in younger adults in more than 50% of the countries studied. The results indicate that changes in exposures resulting in increases in cancer incidence rates are likely to be common across age groups rather than specific to younger adults. The cancer types that increased in both younger and older adults in most countries were all related to obesity, with endometrial and kidney cancer being the most strongly associated with obesity. Additionally, the patterns observed among colorectal cancer incidence could be due to exposure to novel carcinogens or effective screening in older adults. Overall, this analysis suggests that in many countries, cancer types previously seen rising in younger adults are increasing in both younger and older adults, and the implications of focusing new research studies for these cancer types only on younger adults should be carefully considered.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Amy Berrington de Gonzalez, DPhil please email Laura Milne at Laura.Milne@icr.ac.uk.
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2. PCPs spend over 60 hours a week caring for patients, partly caused by high volumes of patient messages
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01412
URL goes live when the embargo lifts
A cross-sectional, observational study aimed to estimate the yearly work effort for primary care physicians (PCPs) per patient on a primary care panel, how work effort varies by a PCP’s clinical workload, and measurable patient factors associated with yearly work effort per patient. A higher volume of patient requests for medical advice was associated with higher time expenditure from PCPs, so the results can inform efforts to support PCP workload and facilitate the sustainability of primary care careers. The results are published in Annals of Internal Medicine.
Researchers from Brigham and Women’s Hospital, University of California at San Francisco, Massachusetts General Hospital, and colleagues studied electronic health record (EHR) and administrative data from 406 PCPs across 33 clinics in the Mass General Brigham health system who delivered care for at least 9 months in 2021. The researchers estimated the annual average work effort per patient for each PCP by combining estimations of total appointment time and time spent on the EHR outside scheduled patient visit hours. The researchers found that PCPs spent a median of 1.7 hours per year per patient on their panel, representing 61.8 hours per week per 1.0 clinical full-time equivalent (cFTE). Work effort varied by cFTE category, with part-time physicians spending more time per patient on average than clinicians with a higher cFTE. Patient characteristics associated with higher yearly PCP time expenditure included average age, medical complexity, high average of medical advice request messages, and Medicaid coverage. The results can inform efforts to facilitate the sustainability of primary care careers including adjusting patient panel sizes, prioritizing team-based workflow for managing patient messages, and using novel technologies, like artificial intelligence, to help physicians reply to patient messages.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Lisa S. Rotenstein, MD, MBA, MSc please email Chad Burns at Chad.Burns@ucsf.edu.
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3. ACP calls for better performance measures relevant to internal medicine for colorectal cancer screening
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01163
URL goes live when the embargo lifts
Colorectal cancer is the second leading cause of cancer-related deaths for males and females. Screening for colorectal cancer is an effective strategy to reduce morbidity and mortality. An evidence-based guidance statement from the American College of Physicians (ACP) supports colorectal cancer screening in asymptomatic average risk adults aged 50-75. ACP reviewed current performance measures for colorectal cancer screening and surveillance to identify those that are methodologically sound and evidence-based to inform physician, payers, and policymakers in their selection and use of these measures for assessing quality of care. ACP supports the use of one – Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy out of the five measures relevant to internal medicine reviewed by ACP’s Performance Measures Committee (PMC). ACP's report is published in Annals of Internal Medicine.
Colorectal cancer screening and surveillance measures are widely used in pay-for-performance, public reporting, and accountability programs. ACP stresses that using appropriate measures is essential to avoid unnecessary harms to patients and to limit physician burden, protect reputation and reimbursement.
The PMC supported one measure as it promotes patient safety by tracking unplanned hospital admissions resulting from colonoscopies. The other four performance measures reviewed were either not aligned with current scientific evidence, promoted unnecessary screening in patients beyond the appropriate age groups, or measures were not tested, valid, or reliable at the level where they were being applied and hence no proof they would improve quality of clinical outcomes -- perhaps leading to unintended consequences such as increased harms.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please contact Angela Collom at acollom@acponline.org.
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Also new this issue:
Complications Associated with Transvenous Cardiac Implantable Electronic Devices: Recognition and Management
Peter J. Zimetbaum, MD; Enrico G. Ferro, MD; Eric A. Secemsky, MD, MSc; Adolf W. Karchmer, MD;
and Daniel B. Kramer, MD, MPH
Review
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02383
END
Obesity-related cancer rising among both younger and older adults worldwide
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