Weight loss interventions associated with improvements in several symptoms of PCOS

Embargoed for release until 5:00 p.m. ET on Monday 4 November 2024    

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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. Weight loss interventions associated with improvements in several symptoms of PCOS

Abstract:  https://www.acpjournals.org/doi/10.7326/M23-3179 

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A systematic review of randomized controlled trials (RCTs) found that weight-loss interventions were associated with improvements in some polycystic ovary syndrome (PCOS) symptoms, including improvement in menstrual frequency, and could be considered a routine treatment option for patients with PCOS. According to the researchers, this is the first review to also show that weight loss interventions were associated with a clinically significant improvement in menstrual frequency, an important outcome identified by those living with PCOS and an indicator for subsequent fertility. This study is published in Annals of Internal Medicine.

Researchers at the University of Oxford comprehensively searched several scientific research databases for RCTs from database inception until June 2024 comparing interventions aiming to reduce weight against usual care or low-intensity weight-loss interventions in people with PCOS. The researchers conducted this review to address the gap in evidence quantifying the impact of weight loss on the management of PCOS, which makes it particularly challenging for clinicians to advise the potential impacts of weight loss interventions. Pairs of independent reviewers screened the studies and analyzed the impact of weight-intervention on metabolic markers, hormonal markers, gynecological markers and quality of life compared to offering no additional care, usual care (metformin, oral contraceptives, standard advice) or a lower-intensity weight loss intervention (advice for weight loss without support). Interventions included behavioral interventions (diet or physical activity), current or previously licensed weight loss pharmacotherapy (or those which share a class-effect), bariatric surgery, or combinations of such interventions. The researchers also spoke with 36 women who have PCOS to better inform their selection of primary outcomes and presentation of findings. The researchers found that weight loss interventions were associated with greater reductions in glycemic control and hormonal markers including the free androgen index (FAI). These findings indicate that weight loss interventions may be an effective tool for PCOS management in applied clinical settings, and clinicians could use these results to counsel patients with PCOS on the improvements in PCOS markers after weight loss and direct them towards appropriate interventions. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Jadine Scragg, BSc, MSci, PhD, please email jadine.scragg@phc.ox.ac.uk.

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2. Policies assuring safe practice by late-career physicians vary widely among health care organizations

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00829

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A mixed-methods study found that variations in policies developed to assure safe practice by late-career physicians (LCPs) makes it difficult for these programs to reach their full potential. Interviews conducted with health care organization leaders responsible for implementing such programs revealed varying levels of successes and frustrations. This study is important because it highlights the need for better physician acceptance and improved program rigor to meet policy objectives. The findings are published in Annals of Internal Medicine.

LCPs, or physicians working beyond age 65 to 75 years, may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. However, little is known about the content or implementation of these policies.

Researchers from the University of Washington School of Medicine studied LCP policies at 29 health care organizations and interviewed 21 physicians in charge of those policies to characterize key program features and physician perspectives. LCP policies were assessed for rationale and process for adoption, whom the policy covers, assessment methods, actions taken on assessment results, confidentiality and procedural fairness protections, and who executes policy components. The researchers found that the LCP policies at all health care organizations applied to 100 percent of physicians seeking new or renewed clinical privileges and required an age-based screening assessment, with a median starting age of 70 years. Of those, 79.3% required reassessment every two years, and almost all required a physical examination (89.7%) and/or a neuropsychological examination (82.8%). Potential follow-up actions varied widely after a concerning LCP assessment, and 7 policies did not include potential actions after a concerning finding. Many organization leaders cited patient safety as the primary reason for LCP policy implementation and said the top challenges when implementing LCP programs included pushback from physicians, logistical difficulties with program rollout and doubts about predictive accuracy of the assessments. Outcomes data across LCP programs was limited, but the respondents noted the primary effect of the programs was voluntary retirements, with one organization reporting that over a quarter of physicians eligible for the assessment resigned before getting screened.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Andrew A. White, MD, please email andwhite@uw.edu.

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3. Researchers report first published case of a patient with treatment-emergent neuroendocrine prostate cancer who showed a remarkable response to an anti-HER2 antibody-drug conjugate

Abstract:  https://www.acpjournals.org/doi/10.7326/ANNALS-24-01409 

URL goes live when the embargo lifts   

A new case report published in Annals of Internal Medicine describes the success of human epidermal growth factor receptor 2 (HER2) antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in a patient with HER2-expressing treatment-emergent neuroendocrine prostate cancer (t-NEPC). t-NEPC is an aggressive subtype of metastatic castration-resistant prostate cancer (mCRPC), and prior clinical trials with HER2-targeted therapies for mCRPC have failed to show meaningful results.

Researchers from Washington DC VA Medical Center and The George Washington University detail the case of a 60-year-old Air Force Veteran diagnosed with high-volume metastatic prostate cancer in March of 2019. He was first treated with androgen-deprivation therapy and docetaxel, but tumor progression occurred. He received six additional therapies, including participation in three clinical trials, over the course of four years. His response to all treatments was short-lived and followed by rapid disease progression, and he subsequently developed brain metastases. Tissue biopsy confirmed the patient now had t-NEPC, and testing for HER2 by immunohistochemistry showed a strong expression in both his prostate tumor and brain metastasis. In February 2024, he started off-label treatment with T-DXd. After 4 cycles, a 57% overall reduction in tumor volume was seen across sites, including the brain. His clinical status improved significantly despite being told several months before starting T-DXd that he should transition to hospice care due to a lack of treatment options. The case suggests that T-DXd has anti-tumor activity in HER2-expressing mCRPC, including aggressive subtypes like t-NEPC. The researchers also note that this case highlights the need for testing HER2 expression using immunohistochemistry, which is not routinely done for patients with advanced prostate cancer to better identify patients who might benefit from T-DXd treatment. As of October 2024, patient is clinically doing well.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Maneesh Jain, MD, MS, please email Katelyn Deckelbaum at katelyn.deckelbaum@gwu.edu. 

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4. Patients outside metropolitan areas often travel significantly more than 20 minutes for primary care visit

New data on patient travel patterns could lead to more accurate geographic market definitions

Abstract:  https://www.acpjournals.org/doi/10.7326/ANNALS-24-00857 

URL goes live when the embargo lifts       

A cross-sectional study of U.S. healthcare utilization survey data provided a nationally representative measure of patient travel patterns across provider types. The data can inform more accurate choices of geographic market definitions to monitor provider competition, access to care, outcomes and costs. The study is published in Annals of Internal Medicine. 

Researchers from the Agency for Healthcare Research and Quality and the University of Maryland School of Public Health studied data from 2018 to 2021 from the Medical Expenditure Panel Survey (MEPS) to better understand patient travel patterns and assess to what degree commonly used geographic definitions of health care markets capture travel patterns. The researchers used geocoding software to calculate travel time between patient homes and healthcare provider addresses, including office visits, emergency department (ED) visits, and inpatient stays. They found that the median travel time for physician office visits was about 14 minutes inside and 28 minutes outside metropolitan statistical aeras.  The median travel time for physician office visits to specialists was nearly 42 minutes outside of metropolitan statistical areas.   The median travel time for ED visits was 13.6 minutes and for inpatients stays was 18.1 minutes. Only half of primary care visits fell within a primary care service area (PCSA), while nearly 40% of inpatient stays fell outside of defined hospital service areas.  Based on the data collected, the researchers found that some geographic market definitions exclude much of the care utilized by residents. This data can inform choices of market definitions and provide national benchmarks for patient travel time. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Sandra L. Decker, PhD, please email Caryn McManus at Caryn.McManus@ahrq.hhs.gov.

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