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People with cancer who have been vaccinated against Covid-19 remain at increased risk for infection compared with people who don’t have cancer, a very large new study reveals. Johns Hopkins Kimmel Cancer Center director William Nelson describes the findings.

Nelson: In the end they had 45,000 or more cancer patients who had been vaccinated. And what they tried to see was who got infected, when did they get infected, was there any difference between one cancer and another? Overall there were 13.6% of the cancer patients had a breakthrough infection. Twenty-four to 25% of the pancreatic cancer patients had a breakthrough infection, 22 to 23% of liver cancer, 20-21% of lung cancer, a little bit less breast cancer patients. Only about 4.9 to 5% of the people who didn’t have cancer got a breakthrough infection.  :33

Nelson emphasizes that getting vaccinated and being careful remain the best strategies against Covid-19 infection. At Johns Hopkins, I’m Elizabeth Tracey.

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An immunotherapy agent called nivolumab given before surgery in people with lung cancer dramatically lengthened the interval before cancer returned, a new study shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, is thrilled.

Nelson: Will we slowly but surely get to point where the treatments are good enough that maybe you don’t need the surgery at all. This is potentially transforming it’s already going to pay off, this is going to be the way people will get treated. Very exciting. :12

Nelson says this strategy has been on deck for some time.

Nelson: People have thought of this before. It’s always you need to get that surgery done as quickly as possible to remove as much of the cancer as you could. And then for those people in whom there was no evidence of cancer but you knew they were likely to have the cancer come back that you’d chase after that with hormonal therapy or chemotherapy or some combination. After a while they figured out that it was just as effective to give before the surgery as after the surgery.  :21

At Johns Hopkins, I’m Elizabeth Tracey.

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Nivolumab is the name of an immunotherapy used to treat cancer, and a recent study of people with lung cancer using it before surgery shows it really helps. Johns Hopkins Kimmel Cancer Center director William Nelson explains.

Nelson: Three hundred fifty-eight people randomized to receive the immunotherapy or not, along with chemotherapy before surgery. It’s a significant clinical advance. The time when cancer is going to recur was significantly prolonged, and the most stunning finding is when they did the surgery, in the people who had chemotherapy about 2.2 percent of the time it looked like the cancer had completely disappeared. If you got the addition of the nivolumab 24 percent of those people had no sign of any cancer whatsoever in their surgery.  :34

Nelson says side effects were largely acceptable and manageable, and predicts this will be the new standard of care for people with this type of lung cancer. At Johns Hopkins, I’m Elizabeth Tracey.

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Do you use e-cigarettes? If you’re a younger person you may have started out using them occasionally but are now a more regular user, or you may have attempted to quit be haven’t been able to do so. That’s what’s been shown in recent studies, and Michael Blaha, an anti-smoking advocate and cardiologist at Johns Hopkins, says there are harms associated with use.

Blaha: There is some literature that suggests that e-cigarettes are less harmful than cigarettes, but they probably cause just as much addiction. So I think we’re seeing a major crisis still in addiction, and we need to improve our strategies for decreasing the addiction because it can lead to behavioral problems and problems with school, and there is a lot of evidence e-cigarette use keeps company with a lot of other risky behaviors, for example alcohol use, drinking and driving, the company it keeps is what’s the most scary.  :29 

Blaha says better regulation of these devices, especially with regard to marketing to young people, is needed. At Johns Hopkins, I’m Elizabeth Tracey.

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If you’ve been using electronic cigarettes and attempt to quit but can’t, are you addicted? That’s one interpretation of a recent study among US youth, showing that since the introduction of e-cigarettes more unsuccessful quit attempts have been seen. Michael Blaha, an anti-smoking advocate and cardiologist at Johns Hopkins, says he’s persuaded.

Blaha: I do think that unsuccessful quit attempts are a metric of increasing addiction to nicotine. But of course we do want people to try to quit using their nicotine products so in that sense, more people trying to quit is a good thing. But we’re obviously failing in supporting our patients and individuals in the community in succeeding to quit, and this is in part because there are very few strategies out there for informing people who use e-cigarettes or vape, on the most successful strategies for quitting.  :29

Blaha says it’s unclear whether quitting strategies for traditional cigarettes will work for e-cigarettes. At Johns Hopkins, I’m Elizabeth Tracey.

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Youth who take up vaping may have difficulty quitting, a recent analysis from the Monitoring the Future study looking at nicotine use among US 8th, 10th and 12th graders finds. Michael Blaha, an anti-smoking advocate and cardiologist at Johns Hopkins, says he’s seen another disturbing trend.

Blaha: During the pandemic we’re seeing a decrease in occasional use of e-cigarettes, particularly amongst youths and young adults. But of those users we’re seeing a greater percentage of which are daily users that seem to be addicted to nicotine. I think we’re shifting in the research about e-cigarettes and vaping toward more like a product that people are using more like they used to use cigarettes. More daily use, more addiction, and less of the occasional use that we used to see with experimentation with electronic cigarettes early in their development.  :29

Blaha notes that while vaping may be somewhat less harmful than combustible cigarettes harms do exist, some of which won’t be fully known until much more data accumulates. At Johns Hopkins, I’m Elizabeth Tracey.

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While fewer young people seem to be taking up vaping, those who have are having a hard time quitting, recent research shows. Michael Blaha, an anti-smoking advocate and cardiologist at Johns Hopkins, says the very nature of the devices lend themselves to nicotine addiction.

Blaha: With the recent products on the market as far as vaping or e-cigarettes go, we’re seeing equivalent if not higher doses of nicotine being delivered, compared to traditional cigarettes, and that nicotine can be delivered sometimes even faster with modern e-cigarettes, and also the user can be in control of how much nicotine they get with many vaping delivery devices. So this is a whole new world of nicotine delivery. I think it does have a potential for greater nicotine addiction.  :26

The data come from the Monitoring the Future study, surveying 8th, 10th and 12th grade students from a national sample, and point to the need for more stringent policies regarding use of these devices by young people. At Johns Hopkins, I’m Elizabeth Tracey.