More than half of Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans. These plans offer lower premiums and additional benefits compared with Traditional Medicare (TM) but commonly restrict organization and clinician networks, potentially limiting access to specialists, including oncologists. Little is known about the use of oncology networks in MA plans. To evaluate effective oncology network breadth under MA plans based on realized health care utilization. This cross-sectional study used linked 2016-2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to characterize effective oncology networks among beneficiaries diagnosed with 8 common cancers. Network trends were examined separately for regular MA plans and special needs plans (SNPs) within SEER counties, and network breadth was compared by metropolitan status and plan type (health maintenance organization [HMO], local or regional preferred provider organization [PPO], point-of-service [POS] plan, or other). Data were analyzed between March 1, 2025, and April 1, 2026. Effective oncology network breadth was defined at the plan-county-year level as the share of oncology organizations and oncologists accessed by MA beneficiaries relative to oncology organizations and oncologists accessed by TM beneficiaries in the same county-year, measured separately for oncology organizations, medical or surgical oncologists, and radiation oncologists and more than 1 MA-recorded visit to a National Cancer Institute (NCI)-designated comprehensive cancer center. A total of 807 580 MA beneficiaries (mean [SD] age, 70.4 [9.0] years; 420 662 males [52.1%]) were identified, representing 23 255 plan-year observations for regular MA plans and 17 716 for SNPs from 2016 through 2019. Across regular MA plans, beneficiaries accessed a mean (SD) of 12.0% (12.7%) of oncology organizations, 6.8% (9.6%) of medical or surgical oncologists, and 11.6% (13.8%) of radiation oncologists; across SNPs, beneficiaries accessed 12.4% (12.6%) of oncology organizations, 7.2% (8.6%) of medical or surgical oncologists, and 12.7% (15.5%) of radiation oncologists. MA-recorded visits to NCI-designated comprehensive cancer centers were observed in 25.7% (n = 5983 of 23255) of regular MA plans and 20.5% (n = 3624 of 17716) of SNPs. Effective oncology network breadth was narrower for HMOs; nonmetropolitan (vs metropolitan) counties and regional PPOs (vs other plan types) had lower likelihood of MA-recorded visits to NCI-designated comprehensive cancer centers. In this cross-sectional study of MA plans in SEER regions from 2016 to 2019, effective oncology organization and oncologist networks were constrained. Restricted access to NCI-designated comprehensive cancer centers might limit access to innovative treatments and cancer outcomes, which warrants future research.
The internet is often used as a source of information by patients with sarcoidosis, but its reliability has not yet been comprehensively analysed. The aim of this study was to analyse the content and quality of German-language information on sarcoidosis available on the internet. All German-language hits from the first 200 search results for "sarcoidosis" on Google, Yahoo, Bing, and YouTube were saved. Two independent investigators evaluated the content (content score with 25 items, 0-25 points) and quality (DISCERN score with 1-5 points, HONCode score with 0-8 points, JAMA score with 0-4 points). 128 websites and 12 videos were included. The median time since the last update was 36 and 9 months. The content score was 17 and 13 points, respectively. Quality was rated with a DISCERN score of 2.4 and 2.1 points, the JAMA score of the websites was 2 points, and the HONCode score of the videos was 4.2 points. Blogs achieved poorer results in terms of content (p=0.040) and DISCERN score (p=0.016), while the JAMA score was best for news/media (p=0.002). There were no differences for the videos. Although some German-language information on sarcoidosis found on the internet was adequate in terms of content, its quality was only moderate. It would be desirable to have a reliable and easily recognisable label for adequate information. Das Internet wird häufig als Informationsquelle von Patienten mit Sarkoidose genutzt, die Verlässlichkeit wurde bisher nicht umfassend analysiert. Ziel dieser Studie war es, Inhalt und Qualität von deutschsprachigen Informationen zu Sarkoidose im Internet zu analysieren.Von den jeweils ersten 200 Suchtreffern („Sarkoidose“) bei Google, Yahoo und Bing sowie YouTube wurden alle deutschsprachigen Treffer gespeichert. Zwei unabhängige Untersucher bewerteten Inhalt (Inhaltsscore mit 25 Merkmalen, 0–25 Punkte) und Qualität (DISCERN-Score mit 1–5 Punkten, HONCode-Score mit 0–8 Punkten, JAMA-Score mit 0–4 Punkten).128 Internetseiten und 12 Videos wurden eingeschlossen. Die mediane Zeit seit dem letzten Update betrug 36 und 9 Monate. Der Inhaltsscore lag bei 17 bzw. 13 Punkten. Die Qualität wurde mit einem DISCERN-Score von 2,4 und 2,1 Punkten bewertet, der JAMA-Score der Internetseiten lag bei 2 Punkten und der HONCode-Score der Videos bei 4,2 Punkten. Blogs erreichten in Bezug auf Inhalt (p=0,040) und DISCERN-Score (p=0,016) schlechtere Ergebnisse, der JAMA-Score war bei Nachrichten/Medien am besten (p=0,002). Für die Videos ergaben sich keine Unterschiede.Deutschsprachige Informationen zur Sarkoidose im Internet zeigten zwar einen teilweise ausreichenden Inhalt, schnitten qualitativ aber nur mäßig ab. Eine verlässliche und schnell zu erkennende Kennzeichnung adäquater Informationen ist wünschenswert.
Suboptimal practices in the evaluation and workup of nasal masses may lead to patient outcomes that could be improved. Recognizing common pitfalls and mishandled clinical scenarios underscores the need for clear, consensus-driven recommendations. To provide expert consensus recommendations regarding the appropriate workup and evaluation of nasal masses to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes. A systematic review from 1990 to 2025 was conducted in PubMed to identify gaps and discrepancies in practice guidelines and to assist in the development of consensus statements. Expert physicians from both academic and private practice environments from the US, UK, and Canada were identified and included specialties of comprehensive otolaryngology, head and neck surgery, rhinology, neurosurgery, and medical oncology. A modified Delphi approach was used to conduct an expert consensus survey. The statement generation and surveys were conducted from February 2025 to June 2025. The formulation and expert evaluation of 23 consensus statements. A total of 25 multidisciplinary experts, including 17 male and 8 female physicians spanning comprehensive otolaryngology (n = 3), head and neck surgery (n = 7), rhinology (n = 12), neurosurgery (n = 1), and medical oncology (n = 2), participated in the survey. Of the 23 statements, 20 reached consensus during the initial iteration among the initial evaluation, biopsy, imaging, pathologic evaluation, and additional workup subgroups. Two of these statements underwent revision and were ultimately accepted, while the last statement did not achieve expert consensus. This multidisciplinary expert consensus statement can guide physicians and medical practitioners in adopting the proper evaluation and workup of nasal masses, helping them to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes.
Patients with advanced cancer experience substantial symptom burden that impairs health-related quality of life (HRQOL) and contributes to emergency department (ED) visits and hospitalizations. Evidence for application (app)-facilitated palliative care interventions remains limited. To evaluate whether an app-facilitated palliative care intervention integrating digital symptom monitoring with nurse-led clinical follow-up can improve outcomes among patients with advanced cancer. This multicenter randomized clinical trial was conducted at 6 palliative care clinics in Hong Kong from January 25, 2023, to February 5, 2025. Community-dwelling adults with advanced solid cancer who were no longer receiving systemic anticancer treatment were randomized 1:1 to digital symptom monitoring plus usual care or usual care alone and followed up for 18 weeks. Digital symptom monitoring combined weekly symptom reporting using the Integrated Palliative Care Outcome Scale, automated self-management guidance, and nurse-led follow-up for severe symptom alerts. The primary outcome was change in HRQOL as measured by EuroQol 5-dimension 5-level (EQ-5D-5L) assessment. Secondary outcomes included self-efficacy (6-item Self-Efficacy for Managing Chronic Disease Scale), Eastern Cooperative Oncology Group performance status (ECOG PS), ED visits, and hospitalizations. Among 1214 randomized participants (590 to digital symptom monitoring and 624 to usual care; median age, 78 [range, 31-103] years; 617 [50.8%] male), including 821 caregivers (67.6%) as application users, HRQOL was better maintained with digital symptom monitoring at week 18. Mean changes from baseline favored the intervention compared with usual care for EQ-5D-5L utility (0.49 to 0.52 vs 0.50 to 0.38; mean difference in change, -0.15 [95% CI, -0.21 to -0.10]; P < .001) and EQ-5D visual analogue scale (63.16 to 65.72 vs 63.87 to 59.69; mean difference, -6.09 [95% CI, -8.67 to -3.51] points; P < .001). Self-efficacy was better maintained with the digital symptom monitoring intervention (5.29 to 5.34 vs 5.43 to 4.87; mean difference, -0.53 [95% CI, -0.78 to -0.27]; P < .001). Deterioration in ECOG PS (44 of 367 [12.0%] vs 66 of 379 [17.4%]; odds ratio [OR], 1.22 [95% CI, 0.83-1.79]; P = .31) and ED utilization (74 of 367 [20.2%] vs 97 of 379 [25.6%]; OR, 1.27 [95% CI, 0.97-1.67]; P = .09) were similar between groups. Hospitalization outcomes favored digital symptom monitoring, including fewer participants with worsening unplanned hospitalization episodes (63 of 367 [17.2%] vs 108 of 379 [28.5%]; OR, 1.59 [95% CI, 1.21-2.10]; P = .001) and fewer inpatient days during follow-up (mean [SD], 3.4 [8.9] vs 7.3 [15.5]). In this randomized clinical trial of patients with advanced cancer, an app-facilitated palliative care intervention helped maintain HRQOL and self-efficacy and reduced acute care use compared with usual care. ClinicalTrials.gov Identifier: NCT07475312.
This cross-sectional study uses clinical trial data, US and European oncology drug approval data, and health care professional survey data to examine the representation of South American patients in sarcoma clinical trials.
Phytotherapy is widely used by cancer patients as a complementary and alternative medicine approach. With the increasing reliance on the internet for health-related information, concerns regarding the quality, reliability, and readability of online phytotherapy content have become more prominent. This study aimed to evaluate the readability and quality of web-based information on phytotherapy for cancer patients using validated assessment tools and to identify specific deficiencies in content quality. A descriptive cross-sectional analysis was conducted using the Google search engine with four predefined search terms related to phytotherapy and oncology. The first 50 websites for each term were screened, yielding 200 websites, of which 99 met the inclusion criteria. Websites were categorized by source type and visibility. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, SMOG, and Coleman-Liau Index. Content quality was evaluated using the JAMA benchmark criteria and the DISCERN instrument, including item-level analysis. Non-parametric statistical tests were applied where appropriate. The median FKGL score was 9.3, indicating that most content required a high reading level. The median JAMA score was 4, while the median DISCERN score was 55, reflecting moderate but variable quality. Item-level analysis revealed that critical aspects such as treatment risks, benefits, uncertainties, and consequences of no treatment were frequently insufficiently addressed. Commercial websites demonstrated lower DISCERN scores compared with non-commercial sources. No significant differences were observed between first-page and subsequent search results. Online phytotherapy information for cancer patients is characterized by moderate quality, high readability demands, and important deficiencies in key domains necessary for informed decision-making. In the evolving landscape of AI-assisted health information retrieval, these limitations may have broader implications, highlighting the need for accurate, evidence-based, and accessible online resources.
This cohort study assesses the association between use of palliative radiotherapy and inpatient radiation oncology consultation among patients with limited life expectancy.
Patients with cancer experience significantly higher rates of suicidal self-directed violence (SSDV; defined as both fatal and nonfatal suicide attempts) than the general population. To assess longitudinal risks and methods for SSDV among veterans and identify associated risk factors to improve screening and prevention strategies. This national cohort study of veterans with cancer was conducted between January 2014 and December 2023. Data from established oncology and suicide registries and the Veterans Health Administration (VA) were used. Data were analyzed from January 2025 to February 2026. Diagnosis of invasive solid or hematologic cancer. The primary outcome was SSDV and rates per 100 000 person-years. Risk factors for SSDV were estimated as adjusted hazard ratios (aHRs) from multivariable Cox proportional hazards models. Among 292 271 veterans (mean [SD] age, 69.0 [9.4] years; 7108 female [2%]; 2664 American Indian or Alaska Native [1%]; 1365 Asian [1%]; 62 538 Black or African American [21%]; 13 965 Hispanic or Latino [5%]; 2306 Native Hawaiian or Other Pacific Islander [1%]; 219 205 White [75%]), there were 2400 SSDV events (1%; overall rate, 203 [95% CI, 195-211] per 100 000 person-years). The most common method used was poisoning (eg, opioids; 617 attempts [26%]). Estimated SSDV probabilities were highest for those with central nervous system (CNS), pancreas, head and neck, liver and biliary system, and thyroid cancer types. Veterans with severe frailty (544 [95% CI, 457-648] events per 100 000 person-years), advanced cancer (261 [95% CI, 233-293] events per 100 000 person-years), chronic mental illness (419 [95% CI, 399-439] events per 100 000 person-years), and high pain scores (236 [95% CI, 192-210] events per 100 000 person-years) had high SSDV rates compared with the overall cohort. Younger age (≤45 years; 643 [95% CI, 547-756] events per 100 000 person-years), female sex (369 [95% CI, 306-445] events per 100 000 person-years), American Indian or Alaska Native race (286 [95% CI, 201-407] events per 100 000 person-years), and CNS (394 [95% CI, 311-500] events per 100 000 person-years) and thyroid (359 [95% CI, 290-445] events per 100 000 person-years) cancers had high rates of nonfatal attempts. Increased SSDV hazards (6 months postdiagnosis) occurred among veterans of Asian compared with White race (aHR, 2.55; 95% CI, 1.12-5.76), unmarried veterans (aHR, 1.83; 95% CI, 1.47-2.27), veterans with CNS (aHR, 2.07; 95% CI, 1.13-3.80) or head and neck (aHR, 1.67; 95% CI, 1.13-2.48) compared with lung cancer, and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.00-1.68). Risk for most veterans decreased over time after diagnosis; however, risk remained elevated 5 years postdiagnosis for younger veterans (aged ≤45 vs 46-64 years; aHR, 1.58; 95% CI, 1.29-1.94), unmarried veterans (aHR, 1.48; 95% CI, 1.35-1.62), veterans with CNS vs lung cancer (aHR, 1.63; 95% CI, 1.22-1.27), and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.14-1.50). This study found that veterans with cancer were at risk for SSDV that persisted years into survivorship. Previously overlooked high risk, subgroups, such as younger veterans, Asian veterans, or veterans with thyroid cancer, stress the need to systematically track all suicidal behaviors, not just fatal attempts, to inform tailored screening and prevention strategies as a key component of cancer care.
Patient-reported outcomes (PROs) are critical in recurrent ovarian cancer, where symptom burden and quality of life (QOL) influence treatment decisions. Given limited psychometric validation of PROs in patients receiving modern targeted therapies, we conducted a comprehensive evaluation of the NCCN/FACT Ovarian Symptom Index-18 (NFOSI-18), including both Total and disease-related symptoms (DRS-P) subscale scores, and a single-item about side effect (GP5), to assess their reliability and validity in recurrent ovarian cancer. Data were drawn from NRG Oncology trial GY004 (n = 489). Participants completed the NFOSI-18, EQ-5D-3L and EQ-VAS at baseline and every 12 weeks. Baseline and last QOL time points were analyzed to evaluate psychometric properties of the NFOSI-18 DRS-P and Total scores, and the GP5 item. Analyses included internal consistency reliability, convergent and known-groups validity, responsiveness to change, and meaningful change thresholds. The DRS-P and Total scales demonstrated good internal consistency (Cronbach's α = 0.72-0.87) and moderate convergent validity with EQ-5D VAS and Utility Index (r = 0.56-0.63). Strong known-groups validity was observed, with moderate-to-large effect sizes (0.44-1.05) across performance status categories. Score declines were greater in patients with stable or progressive disease compared to those with complete or partial response, supporting responsiveness to clinically meaningful change. Recommended change thresholds were 4-12 points (Total) and 3-8 points (DRS-P). The NFOSI-18 DRS-P and Total scales are reliable, valid, and responsive measures in recurrent ovarian cancer. These findings support their use as PRO endpoints in future ovarian cancer clinical trials.
Prostate cancer often requires frequent in-person clinical visits, imposing substantial travel, financial, and time burdens for patients. Combining telehealth with in-home monitoring (enhanced telehealth) has the potential to make care more patient centered and efficient. To assess the feasibility and implementation context of enhanced telehealth for patients with prostate cancer. Adult patients with prostate cancer receiving androgen deprivation therapy (ADT) were enrolled in this multiphase quality improvement study of enhanced telehealth from June 1, 2023, to June 30, 2024, and followed up for 8 months. The study was conducted at 7 ambulatory oncology practice sites at Memorial Sloan Kettering, an academic comprehensive cancer center. Phase 1 included semistructured interviews with key stakeholders to assess implementation considerations of enhanced telehealth. Phase 2 piloted an enhanced telehealth program offering remote blood pressure (BP) monitoring, mobile phlebotomy, and injections at home; patients could choose to participate in any available component. Enhanced telehealth, a care delivery model that augments routine telehealth encounters with (1) home phlebotomy, (2) remote BP monitoring, and/or (3) at-home administration of ADT or other injectable therapies. The primary outcome was feasibility, assessed by completion rates for each enhanced telehealth component at the patient and visit levels. Patient and clinician satisfaction was assessed using the Net Promotor Score. Acceptability, appropriateness, and feasibility were measured using validated measures on a 5-point Likert scale. Thirty-eight patients participated; the median age was 70.0 years (IQR, 61.5-76.7 years) and 24 (63.2%) had metastatic castration-sensitive prostate cancer. Patient-level completion rates for at least 1 service were telehealth, 68.4% (26 of 38); remote BP monitoring, 91.9% (34 of 37); home phlebotomy, 96.3% (26 of 27); and at-home injections, 90.0% (9 of 10). Visit-level completion rates were high for telehealth (92.3% [60 of 65]), phlebotomy (95.4% [145 of 152]), and injections (84.6% [11 of 13]) but lower for BP monitoring (65.0% [343 of 528]). Patients rated all components as acceptable (mean [SD] score, 4.8 [0.4]; range, 3.25-5), appropriate (mean [SD] score, 4.8 [0.4]; range, 3.75-5), and feasible (mean [SD] score, 4.7 [0.5]; range, 3.25-5). Enhanced telehealth had high patient and clinician satisfaction (Net Promotor Score: patients, 82.4%; clinicians, 80.0% for telehealth, 80.6% for remote BP monitoring, 84.6% for home phlebotomy, and 75.0% for home injections). In this quality improvement study, enhanced telehealth was feasible, with greater than 60% completion for all scheduled visits, with strong endorsement of benefits from patients with prostate cancer as well as clinicians. These findings support further development of enhanced telehealth.
For patients with advanced non-small cell lung cancer (NSCLC) and programmed cell death 1 ligand 1 (PD-L1) expression of 50% or higher, programmed cell death 1 protein or PD-L1 (PD-[L]1) inhibitor monotherapy is commonly used as first-line therapy; however, whether adding chemotherapy improves outcomes in this population remains unknown. To compare overall survival (OS) and progression-free survival (PFS) associated with PD-(L)1 inhibitor monotherapy vs chemoimmunotherapy in treatment-naive patients with advanced NSCLC and high PD-L1 expression. PubMed, Embase, and major oncology conference proceedings were searched for phase 3 randomized clinical trials (RCTs) published before August 3, 2025. Eligible studies were phase 3 RCTs that enrolled patients with untreated advanced NSCLC, evaluated PD-(L)1 inhibitor monotherapy or chemoimmunotherapy vs chemotherapy alone, and reported outcomes in patients with high PD-L1 expression. Hazard ratios (HRs) for OS and PFS were extracted from published studies and synthesized using inverse variance methods. Additional analyses included meta-regression, network meta-analysis, and reconstructed individual patient data from published Kaplan-Meier curves. Primary outcome was OS; secondary outcome was PFS. Among 24 trials including 5546 patients with PD-L1-high NSCLC, 16 evaluated chemoimmunotherapy and 8 PD-(L)1 inhibitor monotherapy. Compared with chemotherapy, survival was improved by both chemoimmunotherapy (OS: HR, 0.63 [95% CI, 0.56-0.72]; P < .001; PFS: HR, 0.44 [95% CI, 0.39-0.49]; P < .001) and PD-(L)1 inhibitor monotherapy (OS: HR, 0.74 [95% CI, 0.69-0.80]; P < .001; PFS: HR, 0.70 [95% CI, 0.65-0.76]; P < .001). Tests for subgroup differences suggested improved benefit with chemoimmunotherapy compared to PD-(L)1 inhibitor monotherapy (OS: χ21 = 4.1; P = .04; I2 = 75.8%; PFS: χ21 = 48.1; P < .001; I2 = 97.9%), consistent with meta-regression analyses (OS: HR, 0.85 [95% CI, 0.72-1.00]; P = .048; PFS: HR, 0.61 [95% CI, 0.50-0.75]; P < .001) and network meta-analyses (OS: HR, 0.85 [95% CI, 0.73-0.99]; PFS: HR, 0.61 [95% CI, 0.50-0.75]). In the reconstructed individual patient data analysis, median OS was longer with chemoimmunotherapy (n = 704 patients) compared to PD-(L)1 inhibitor monotherapy (n = 1706 patients) (29.2 months [95% CI, 25.2-35.4] vs 19.8 months [95% CI, 18.3-21.7]; HR, 0.74 [95% CI, 0.66-0.82]; P < .001). Similarly, median PFS was significantly longer with chemoimmunotherapy (n = 701 patients) compared to PD-(L)1 inhibitor monotherapy (n = 1706 patients) (11.3 months [95% CI, 10.3-13.5] vs 6.8 months [95% CI, 6.2-7.1]; HR, 0.67 [95% CI, 0.60-0.75]; P < .001). In this meta-analysis of phase 3 RCTs, chemoimmunotherapy was associated with significantly improved OS and PFS compared with PD-(L)1 inhibitor monotherapy in patients with advanced NSCLC and high PD-L1 expression. Prospective trials are needed to confirm these findings.
This essay explores how cancer is depicted in the work of Georgia O’Keeffe and Hannah Wilke.
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A 25-year-old female patient reported noticing a lesion in the left maxillary region 8 years prior and presented with an enlarged left-sided facial mass. What is your diagnosis?
Lower socioeconomic status is a risk factor for poorer quality of life (QOL) among patients with head and neck cancer (HNC) after treatment; however, there is a paucity of literature describing baseline QOL in these patients, with much of the existing literature focused on financial characteristics rather than comprehensive, geographically based factors. Shifting focus to these factors could better capture the entire patient experience and allow clinicians to provide improved care. To examine the associations between area-level deprivation, a marker of socioeconomic disadvantage, and QOL among patients with HNC before treatment initiation. This cross-sectional single-institution study included patients diagnosed with HNC between 2015 and 2022 receiving care at a tertiary care center in a metropolitan setting who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) questionnaire before starting treatment. Data were analyzed between December 2024 and May 2025. Area-level deprivation (measured using the area deprivation index [ADI]), as designated by the patient's respective ADI quintile, with the first quintile being the least deprived or socioeconomically disadvantaged and the fifth quintile being the most deprived or disadvantaged. FACT-HN domains of social, emotional, functional, physical, HNC-specific, and overall well-being or QOL. Multivariable linear regression models (1 for each domain) were used to estimate associations between ADI quintiles and FACT-HN domains, adjusting for patient and clinical characteristics. A total of 600 patients (mean [SD] age, 62.5 [11.4] years; 72.3% males [n = 434]) were included in the analysis. The ADI quintiles were equally distributed, with approximately 20% of patients in each quintile. Patients residing in the most disadvantaged areas reported lower HNC-specific well-being scores (β = -3.62; 95% CI, -6.23 to -1.01) compared with those residing in the least disadvantaged areas. Associations between ADI quintile and other well-being scores were weak and not clinically meaningful. In this cross-sectional study, greater socioeconomic disadvantage is associated with poorer baseline QOL among patients diagnosed with HNC. These findings could be used to identify patients at higher risk of lower QOL and support the equitable allocation of resources from multidisciplinary cancer care teams.
Low-risk gestational trophoblastic tumors (GTT; International Federation of Gynecology and Obstetrics [FIGO] score ≤6) are typically treated with single-agent chemotherapy, achieving cure rates of approximately 70%. Avelumab (anti-programmed cell death 1 ligand 1 monoclonal antibody) has demonstrated activity in chemotherapy-resistant GTT, supporting investigation in earlier treatment settings. To evaluate the safety and efficacy of avelumab combined with methotrexate as first-line therapy in patients with low-risk GTT. TROPHAMET (Avelumab and Methotrexate in Low-Risk Gestational Trophoblastic Neoplasias as First-Line Treatment) was a multicenter, phase 1/2 nonrandomized clinical trial of patients with low-risk GTT (FIGO score ≤6) treated at academic referral centers. The study period was from April 14, 2020, to December 5, 2023, with a follow-up of 41 months. Data were analyzed from December 20, 2024, to July 3, 2025. Avelumab, 800 mg, intravenously on day 1 plus methotrexate, 1 mg/kg, intramuscularly on days 1, 3, 5, and 7 alternating with oral folinic acid in 2-week cycles until normalization of human chorionic gonadotropin (hCG) level; and followed by 3 consolidation cycles. Phase 1 primary end point was dose-limiting toxic effects (DLTs); phase 2 primary end point was the rate of serum hCG normalization permitting treatment discontinuation. Of 27 female patients treated (median [range] age, 35 [20-50] years), 26 were assessable for efficacy. Eight patients (31%) had FIGO scores of 1 to 2; 8 patients (31%) had scores of 3 to 4; and 10 patients (38%) had scores of 5 to 6. The treatment regimen demonstrated acceptable safety: 1 DLT occurred (grade 3 sepsis on central venous catheter); immune- and treatment-related adverse events of grade 2 or higher occurred in 6 patients (22%), all of which fully resolved except for 1 case of grade 2 dysthyroidism; and there were no grade 4 or higher events. The rate of successful hCG normalization was 96.2% (90% CI, 85.9%-97.9%). After a median (IQR) follow-up of 41 (37-45) months, no relapses were observed. Among patients with childbearing potential and pregnancy intention, 13 of 14 achieved pregnancy (93%). In this nonrandomized clinical trial, avelumab combined with methotrexate demonstrated a manageable safety profile and high efficacy in low-risk GTT in more than 95% of patients, with durable responses and preserved fertility. This combination may represent a promising first-line strategy warranting evaluation in comparative studies, particularly for patients at higher risk of chemoresistance. ClinicalTrials.gov Identifier: NCT04396223.
This Viewpoint discusses the potential benefits and risks, such as privacy violations, discrimination, and exacerbation of health disparities, that may accompany the unfiltered upload of electronic health records to large language models.
Magnetic resonance imaging (MRI) is routinely used in prostate cancer diagnosis, but there is uncertainty about its optimal use in population-level screening. To provide consensus recommendations on the acquisition, interpretation, and reporting of prostate MRI for cancer screening. A systematic review and meta-analysis of randomized clinical trials and prospective cohort studies evaluating MRI for prostate cancer screening was conducted for these international consensus recommendations. A search of PubMed, CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov, citation searching, and consultation with experts was performed in September 2024. Studies performing upfront MRI for the purpose of prostate cancer screening were included. A total of 6 studies were identified and included 1919 participants, of whom 1426 underwent upfront screening MRI. Most studies used 3.0-T non-contrast-enhanced MRI. The pooled biopsy recommendation rate was 19.2% (95% CI, 11.7-26.7), with grade group (GG) 2 or higher prostate cancer detection of 6.0% (95% CI, 3.1-9.0) and GG1 cancer detection of 1.4% (95% CI, 0.7-2.2). The positive predictive value for GG2 or higher cancer was 36.3% (95% CI, 21.1-51.4). Findings informed a RAND/UCLA Appropriateness Method consensus exercise used to produce the Prostate Imaging Standards for Screening Magnetic Resonance Imaging (PRISM) recommendations. A total of 21 experts (8 urologists, 11 radiologists, and 2 pathologists from 6 countries) were included on the panel. Among 323 consensus statements, 235 (72.8%) reached agreement. If MRI is used in screening, it is recommended for men with an estimated life expectancy greater than 10 years and aged 50 to 70 years or from age 45 years in Black men. Screening MRI should be performed in men after a prostate-specific antigen (PSA) test, but there was no consensus on the optimal PSA threshold. Non-contrast-enhanced MRI with only T2-weighted and diffusion-weighted imaging was considered appropriate, with a maximum acceptable acquisition time of 15 minutes. The stage-gated (2-step) approach to reporting, where all MRI sequences are only revealed (second step) if a concordant focal lesion is identified on axial T2-weighted and high b-value diffusion imaging (first step), was recommended. Repeat screening should be risk stratified according to patient characteristics. Screening MRI should only be performed in accredited centers with radiologists meeting minimum reporting requirements and quality standards. The PRISM consensus recommendations provide standardized expert guidance on the use of MRI in prostate cancer screening trials and future screening programs, including abbreviated non-contrast-enhanced MRI protocols, recommended screening intervals, stage-gated reporting, and quality assurance standards.
The association between medical financial hardship and nonadherence to healthy lifestyle and late-effects surveillance recommendations in long-term survivors of childhood cancer is unknown. To study the associations between medical financial hardship and nonadherence to healthy lifestyle and late-effects surveillance recommendations. This retrospective cohort study was performed among participants in the multiinstitutional Childhood Cancer Survivor Study. Participants were 5-year cancer survivors diagnosed at age 21 years or younger between January 1, 1970, and December 31, 1999, and who completed both a medical financial hardship survey between 2017 and 2019 and a follow-up survey assessing lifestyle behaviors and adherence to risk-based surveillance between 2020 and 2022. Data were analyzed between September 29, 2023, and September 2, 2025. Self-reported medical financial hardship determined by an affirmative response to at least 1 item in the material, behavioral, or psychological domains. Associations of non-guideline-concordant physical activity, problematic drinking, smoking, and abnormal body mass index with domains of medical hardship were examined using separate multivariable logistic regression models. Associations between a composite lifestyle score (unhealthy, moderately healthy, and healthy) and nonadherence to surveillance for cardiomyopathy or breast, colorectal, cervical, and/or skin cancer were examined using polytomous logistic regression models. Among 3322 survivors who completed both surveys (median [range] age, 41 [20-69] years; 1751 female [52.7%]), the presence of material, behavioral, and psychological hardship was reported by 1401 (42.2%), 1003 (30.2%), and 1243 (37.4%), respectively. Material hardship was associated with a greater odds of non-guideline-concordant physical activity (odds ratio [OR], 1.67 [95% CI, 1.29-2.18]) and abnormal body mass index (OR, 1.47 [95% CI, 1.15-1.88]). Behavioral and psychological hardships were associated with a higher odds of smoking (OR, 2.29 [95% CI, 1.13-4.62] and 3.95 [95% CI, 2.42-6.44], respectively). Material and psychological hardship were associated with a composite unhealthy lifestyle score (OR, 1.52 [95% CI, 1.11-2.07] and 1.96 [95% CI, 1.31-2.93], respectively), and a higher risk was noted among survivors reporting hardship in at least 2 domains. Psychological hardship was associated with greater nonadherence to skin cancer surveillance (OR, 1.78 [95% CI, 1.05-3.02]) among survivors at high risk due to treatment exposures. Material hardship was associated with greater nonadherence to breast cancer screening (OR, 2.85 [95% CI, 1.27-6.38]) among survivors at average risk. Associations between multiple medical hardship domains and nonadherence to cervical cancer screening were also observed (material and behavioral hardship: OR, 3.20 [95% CI, 1.44-7.14]; material and psychological hardship: OR, 2.18 [95% CI, 1.10-4.35]; behavioral and psychological hardship: OR, 3.25 [95% CI, 1.50-7.04]). This cohort study of adult survivors of childhood cancer found that medical financial hardship was associated with nonadherence to healthy lifestyle behaviors and certain recommended surveillance tests for subsequent malignant neoplasms. These findings underscore the need to identify and address medical financial hardship as a potential risk factor of nonadherence to healthy lifestyle and guideline-concordant survivorship care.