The number of patients with overweight or obesity is increasing worldwide.¹ Obesity has been reported as a risk factor for solid tumors and lifestyle-related diseases, such as hypertension and diabetes.^2-7 Patients with cancer and obesity are generally recognized to have a less-favorable prognosis than their counterparts who have a normal weight. Therefore, both the American Cancer Society⁸ and the European Society for Medical Oncology⁹ advocate implementing weight management strategies among cancer survivors. However, several observational studies have reported that patients with cancer and a higher body mass index (BMI) experience improved survival compared with patients with normal weight and cancer receiving chemotherapy.^10-18 This discrepancy is known as the obesity paradox¹⁰ and exists not only in patients with cancer receiving conventional chemotherapy,^11-13 but also in those undergoing treatment with immune checkpoint inhibitors (ICIs).^14-18 For example, compared with patients with normal weight who had non–small cell lung cancer (NSCLC) and received ICI therapy, the overall survival hazard ratio (HR) was 0.64 (95% CI, 0.51-0.81) in patients with overweight and 0.81 (95% CI, 0.68-0.95) in those with obesity, with higher BMI associated with greater overall survival.¹⁶ The obesity paradox in patients with cancer can be explained by both clinical and methodologic factors.¹⁰ Clinically, less-aggressive tumor biologic factors in patients with obesity may play a role. For example, obesity is associated with less-aggressive molecular mutations in kidney carcinoma.¹⁹ Additionally, tumors in patients with obesity might respond better to therapy due to differences in pharmacokinetics and treatment allocation.²⁰ Methodologically, confounding factors, such as smoking and physical activity, influence both obesity and mortality but are not fully adjusted for, skewing results.²¹ Detection bias occurs when incidental cancers are diagnosed during screenings for other obesity-related conditions, such as diabetes, leading to overestimated cancer survival rates.²² These cancers are generally low-stage cancers with a good prognosis and may be the cause of the obesity paradox in patients with obesity.

The use of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). However, clinical trials often exclude those with a history of autoimmune diseases (ADs) because of concerns regarding immune-related adverse events. Therefore, the efficacy of ICIs in advanced NSCLC patients with ADs should be evaluated. This study used administrative claims data from advanced treatment centers in Japan and identified patients with advanced NSCLC who began chemotherapy between December 2016 and January 2023. The patients were divided into four groups based on the presence of ADs and types of chemotherapy received. The association between ICI therapy and overall survival in the subgroups with or without ADs, and the association between the presence of AD and overall survival in patients who received ICI therapy and conventional chemotherapy, were analyzed using Cox proportional hazard regression, including therapy and presence of ADs and their interaction as covariates. These results were obtained using the inverse probability of treatment weighting. ICI therapy had a hazard ratio (95% confidence interval) for death in the subgroup of AD and non-AD patients of 0.88 (0.84–0.92) and 0.83 (0.71–0.97), respectively (p = 0.459 for interaction). For some specific ADs, including type 1 diabetes mellitus, the association between ICI therapy and decreased mortality was not observed. In conclusion, our study showed comparable associations between ICI therapy and reduced mortality in AD and non-AD subgroups of patients with advanced NSCLC. However, therapy strategies tailored to each AD type and thorough discussions regarding the risk-benefit profile are crucial.

Background: Coronavirus disease 2019 (COVID‐19)‐associated pulmonary aspergillosis (CAPA) is one of the noticeable complications of COVID‐19 and its incidence varies widely. In Japan, research on the incidence, risk factors and mortality associated with CAPA is limited.Objectives: This study aimed to explore the incidence and potential risk factors for CAPA in patients with severe or critical COVID‐19 and evaluate the relationship between CAPA and mortality of patients with severe or critical COVID‐19.Methods: We investigated the incidence of CAPA in patients with severe and critical COVID‐19 using administrative claims data from acute care hospitals in Japan. We employed multivariable regression models to explore potential risk factors for CAPA and their contribution to mortality in patients with severe and critical COVID‐19.Results: The incidence of CAPA was 0.4%–2.7% in 33,136 patients with severe to critical COVID‐19. Age, male sex, chronic lung disease, steroids, immunosuppressants, intensive care unit admission, blood transfusion and dialysis were potential risk factors for CAPA in patients with severe to critical COVID‐19. CAPA was an independent factor associated with mortality.Conclusions: CAPA is a serious complication in patients with severe and critical COVID‐19 and may increase mortality.

Coronavirus disease 2019 (COVID-19) vaccination reduces the risk of progression to severe COVID-19 in the general population. To examine that preventive effect in dialysis patients, the association of vaccination status with severe COVID-19 progression was investigated in this retrospective observational study conducted from December 2020 to May 2022 of 100 such patients hospitalized for non-severe COVID-19 at Inoue Hospital (Suita, Japan). Fifty-seven were fully vaccinated, defined as receiving a COVID-19 vaccine second dose at least 14 days prior to the onset of COVID-19, while 43 were not. Among all patients, 13 (13.0%) progressed to severe COVID-19 with a median (interquartile range) time of 6 (2.5–9.5) days, while 87 (87.0%) were discharged after 11 (8–16) days. Kaplan–Meier analysis showed that fully vaccinated patients had a significantly lower rate of progression to severe COVID-19 (p = 0.001, log-rank test). Cox proportional hazard analysis also indicated that full COVID-19 vaccination was significantly associated with reduced instances of progression to severe COVID-19 (hazard ratio 0.104, 95% confidence interval 0.022 to 0.483; p = 0.004) after balancing patient background characteristics using an inverse probability of treatment weight method. These results suggest that full vaccination status contributes to reducing the risk of progression from non-severe to severe COVID-19 in dialysis patients.

Introduction: The prognosis of patients with epidermal growth factor receptor mutation-positive non-small cell lung cancer has improved with the introduction of oral EGFR-tyrosine kinase inhibitor (TKI). Lower adherence to oral anticancer medications is reportedly associated with a poor prognosis. It is important to understand the causes of lower adherence to oral anticancer medications. We aimed to assess the potential risk factors associated with low adherence to EGFR-TKIs in a real-world clinical setting using administrative claims data in Japan. Methods: We identified 10,809 outpatients routinely prescribed EGFR-TKIs between December 2015 and January 2023. Adherence to EGFR-TKIs was assessed based on the medication possession ratio (MPR) during the 12-month follow-up period from the date of first outpatient EGFR-TKI prescription. Multivariable linear regression analysis was performed to identify the potential risk factors associated with lower adherence. Results: The mean (standard deviation) MPR was 94.1% (14.0). Lower adherence was associated with increasing age (per 10-year increase), female sex, dysphagia, and a higher number of concomitant oral medications (per doubling of the count). Conclusion: Adherence to EGFR-TKIs was generally high, but the findings support tailored adherence strategies, especially for older patients and for those with a higher number of concomitant oral medications, including medication review to reduce pill burden and proactive support for swallowing difficulties.