Weight loss surgery lowers cancer risk

Researchers at the Cleveland Clinic published an article in the Journal of the American Medical Association (JAMA) this week showing that those who had bariatric surgery were 32% less likely to get obesity-related cancers (including stomach, esophageal, colon, breast, endometrial and ovarian cancers) and 48% less likely to die of these cancers compared to a matched group of obese subjects who did not get bariatric surgery.

This was a large study (over 5,000 who got the surgery, and over 25,000 matched controls who did not get surgery) over a long time period. (The study lasted 14 years, and patients were observed for an average of six years.) The study design is especially strong because researchers used data from electronic medical records to match patients. A previous smaller study from Sweden showed a 37% decrease in incidence of cancer in diabetics who had bariatric surgery over 13 years of follow-up.

This adds to previous research that shows that bariatric surgery is associated with decreased total mortality, and bariatric surgery is more effective than intensive medical management in obese diabetics on insulin.

Implications for employers

• Obesity clearly leads to a higher incidence of bad health outcomes, including cancer, diabetes and death.
• Bariatric surgery is effective at achieving weight loss of over 10% and decreasing risk of cancer, diabetes and death.
• Diet alone is not enough to get to substantially lower weight for most people with severe obesity, although weight loss from ultra-low carbohydrate or ketogenic diet is more sustainable than other diets for those who can maintain such diets.
• Growing evidence supports coverage of bariatric surgery in employer-sponsored health plans, although this is not required.
• Employers can encourage exercise and good nutrition while promoting an inclusive workplace and avoiding “fat shaming.” Here is a recent article from Nature showing the adverse impact of “sizeism” on academic scientists.

New immunotherapy exceptionally effective against rectal cancer

The New England Journal of Medicine published a report of a small trial (12 participants) given a new immunotherapy drug (dostarlimab) for rectal cancer that had already spread locally. This type of cancer would generally require chemotherapy, radiation therapy and surgery, and long-term cure rates have been disappointing; however, the dozen people who were treated for six months with this immunotherapy have now been observed from six to 25 months after treatment, and none of them has needed additional therapy. None had any severe side effects from the treatment. This follows reports that an mRNA vaccine led to no recurrence for 18 months in half of a small trial in those who had surgery and chemotherapy for pancreatic cancer.

Implications for employers

• These therapies are likely still a few years away, as the studies need to be repeated and the follow-up required is long.
• These treatments are likely to be expensive, although conventional treatment for locally advanced cancer is expensive, too.

New study shows huge increases in launch prices of new drugs

New research published this week in JAMA shows that the price at launch of new drugs increased from $2,115 in 2008 to $180,007 in 2021. Only 9% of newly approved drugs cost over $150,000 a year in 2008, while 47% cost more than $150,000 in 2021. Oncology drug and rare disease drugs were the most expensive. Researchers also looked at “net prices” (after rebates) for 72% of these drugs where this data was available and found that drug costs at launch increased from $1,376 in 2008 to $159,042 in 2021.

Implications for employers

• The U.S. is the only high-income country that does not regulate or negotiate the cost of new drugs when they are approved.
• The U.S. is one of only two countries (New Zealand is the other) in the world that allows direct-to-consumer marketing of medications.
• Proposed legislation to improve drug affordability addresses only costs of a subset of existing drugs and is currently silent on the price or cost of drugs when they are first approved.

COVID-19 updates

• Omicron strains BA.4 and BA.5 are rapidly increasing in the U.S. They are more contagious than previous variants, although there is no evidence that they cause more severe disease. BA.4 and BA.5 were less than 1% of total sequenced cases just a month ago and are now up to 13% of cases. The continued wave of new mutations has meant that many with previous infections and vaccinations have been reinfected. It also helps explain the continued high rate of community transmission.
• NBA players and staff who were recently boosted (median of 20 days prior) were 57% less likely to have COVID-19 infections in December 2021 and January 2022, when Omicron was the predominant strain.
• Moderna says its vaccine coded for Omicron-specific spike protein builds higher levels of immunity than previous vaccines and will apply to the FDA for authorization of a “bivalent” booster to be administered this fall. This could be the first step toward an annual COVID-19 shot that would vary based on variants circulating that year.
• The Food and Drug Administration’s (FDA’s) advisory panel unanimously recommended emergency use authorization for the Novavax COVID-19 vaccine. The FDA will decide in the near future whether to authorize its use, and distribution could take a number of weeks because the manufacturing is done in India and is subject to FDA review. The Novavax vaccine does not require refrigeration, and perhaps some who have been skeptical of the new technology of mRNA vaccines will be more likely to accept this vaccine. It is likely to be authorized as a two-dose vaccine but will probably need boosters, like the other COVID-19 vaccines.
• Patients with COVID-19 may be at higher risk of diabetes according to a meta-analysis of seven observational studies that followed over 325,000 patients. Employers can highlight appropriate diabetes screening and awareness, especially during this time period with increased coronavirus transmission and especially for their employees who may be at higher risk.

Author

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Jeff Levin-Scherz, MD

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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