This study aimed to determine perceptions of the oncology nursing role and workplace challenges among oncology nurses working in Australia and Türkiye. This cross-sectional comparative study used convenience sampling of from oncology nursing societies in Australia and Türkiye. Recruitment occurred via electronic invitations and social media. Participants (Australia: n = 846; Türkiye: n = 191) included registered nurses in clinical oncology; nonclinical roles were excluded. Data were collected using the translated and expert-validated Cancer Nursing Workforce Survey. Statistical analysis involved descriptive statistics and Pearson chi-square tests on dichotomized Likert-scale responses using SPSS. A total of 1,037 oncology nurses participated. Over 50% of Australian and Turkish nurses reported high workload and information overload as key workplace challenges. Most Turkish nurses (>50%) reported the following items as workforce challenges: difficulties integrating digital health technologies, restricted career progression, lack of training opportunities, unclear role expectations, ineffective interagency collaboration, and low staff motivation. Confidence in core clinical competencies was high in both countries. No significant differences were observed in confidence related to comprehensive cancer care, physical and psychological symptom management, autonomy, or peer and educational support. However, Turkish nurses reported higher confidence in managing spiritual distress, while Australian nurses reported clearer scopes of practice and greater access to professional development (P < .001). Oncology nurses in Türkiye and Australia reported high clinical confidence, with Turkish nurses expressing greater confidence in spiritual care and Australian nurses reporting clearer scopes of practice. High workload was a shared challenge, while Turkish nurses identified more structural barriers related to career progression, leadership support, and staff motivation, indicating that workforce experiences reflected system-level and career-related factors rather than individual competence. Tailored workforce strategies are required to strengthen leadership, professional development, role clarity, and resource allocation to support sustainable oncology nursing practice across diverse healthcare systems.
The ongoing demographic transition toward an aging population is accompanied by a rising number of geriatric patients with cancer. Anemia is a common finding in older patients with malignancy. This study aimed to evaluate the prevalence of anemia and its association with functional status and depression among treatment-naïve geriatric patients with solid organ cancer (SOC). In this observational study, geriatric patients with SOC underwent screening for anemia and a comprehensive geriatric assessment (CGA). Those with anemia were further evaluated with iron studies, stool for occult blood, upper and lower gastrointestinal endoscopies, serum B12 and folate levels, Coombs test, serum lactate dehydrogenase levels, and a bone marrow examination, as appropriate. Descriptive statistics (mean, median, and standard deviation), Pearson's chi-square test, Fisher's exact test, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney U test were used to analyze the data. One hundred and seventy-six patients were included. The median age was 67 (range 60-94) years, with a male preponderance of 76.7% (n = 135) and a stage IV, 81.8% (N = 144) disease. Anemia was detected in 51.7% (n = 91) of patients, with 51.6% (n = 47) having grade 2 severity. Iron deficiency anemia (IDA), functional IDA, possible functional IDA, and no iron deficiency (NID) were found in 23.1% (n = 21), 44% (n = 40), 12.1% (n = 11), and 16.5% (n = 15) of the patients, respectively. We found a significant association of anemia with body-mass index (P = 0.017), performance status (P < 0.005), activities of daily living (P < 0.010), instrumental activities of daily living in males (P < 0.034), balance and mobility (P = 0.016), and depression (P < 0.001). More than half of the geriatric patients with SOC were anemic at presentation, with functional IDA being the most common subtype, followed by IDA. Anemia was significantly associated with poorer functional status, impaired mobility and balance, and higher rates of depression, underscoring its substantial impact on both the physical and psychological well-being of older patients with cancer. These findings highlight the importance of comprehensive geriatric assessment and detailed characterization of anemia subtypes, including IDA, functional IDA, possible functional IDA, and NID, as management strategies may vary according to iron status.
One of the key challenges in cancer treatment and precision oncology is the use of multi-omics data and their integration into matched clinical information. Although several analytical portals have been developed, most platforms do not support user-uploaded data or the integrated analysis of clinical and multi-omics datasets. To address these limitations, we developed the Korea Cancer Omics Research (K-CORE) portal, a user-friendly analytical platform designed to integrate and analyze multi-omics and clinical data. K-CORE supports various omics levels and a wide range of analytical tools. To validate the utility and reproducibility of the K-CORE, we designed synthetic datasets that reflected real-world omics data distributions. The analytical results from K-CORE were compared side by side with those from widely used R packages such as maftools and edgeR. In conclusion, K-CORE offers a practical and intuitive platform for the multidomain integration of clinical and omics data, supporting the advancement of precision oncology. Nevertheless, as analytical technologies and precision oncology continue to evolve, continuous maintenance and user feedback will become essential for future platform improvements.
The use of patient-reported outcome measures (PROM) can be beneficial in several ways. However, presentations of PROM data from individuals living with, through, or beyond cancer are scarce in the existing scientific literature, and challenges in presenting and interpreting PROM data may be an explanation. Our overall aim was to describe aspects of wellbeing in individuals living with current or previous cancer, 1-2 and 5-6 years after diagnosis. We also aimed to identify vulnerable subgroups of individuals and to facilitate the interpretation of PROM data by combining different presentation forms. Adults in the Southern healthcare region in Sweden with invasive breast, prostate, lung, or colorectal cancer diagnosed 1-2 or 5-6 years ago were invited to a survey using the European Organisation for Research and Treatment of Cancer (EORTC) instrument QLQ-C30 (C30). We analyzed subgroups of respondents using scale scores, clinically anchored problem ranges, and Quality-Adjusted Life Years weights. Moreover, we compared our C30 scores to Swedish general population reference values, EORTC diagnose-specific reference values, and other similar cancer studies. A total of 2,131 individuals responded (26% response rate). The results demonstrate consistent differences in C30 scale scores, where respondents with several comorbidities, younger age, and lung and colorectal cancer diagnoses had poorer scores. Respondents within problem ranges were consistent with the results on scale scores. Quality-Adjusted Life Years weights displayed a generally similar pattern. Our respondents showed no differences on C30 scales compared to the Swedish general population and recent similar studies. There were some differences compared to diagnose-specific reference values and some older similar studies. Aspects of wellbeing varied between subgroups, suggesting potential to develop care for certain patient groups with poorer scores, i.e. the younger age groups and in those with several comorbidities, and individuals diagnosed with lung cancer and colorectal cancer. However, individuals who lived 1-2 or 5-6 years after cancer diagnosis experienced no difference in wellbeing than published results from the Swedish general population. Our different ways of presenting PROM show similar results overall but serve to elucidate different aspects which may contribute to the practice of presenting and interpreting PROM data.
Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that, regarding the cell morphology experiments shown in Fig. 4C and 9B on p. 1066 and p. 1069 respectively, the 'NC' data panel in Fig. 4C appeared to match with the data shown to represent the 'Control' data panel in Fig. 9B, albeit the images appeared in these figures at different sizes. The authors have been contacted by the Editorial Office to offer an explanation for the apparent re‑use of the same data in this paper, and we are awaiting their response. Owing to the fact that the Editorial Office has been made aware of potential issues surrounding the scientific integrity of this paper, we are issuing an Expression of Concern to notify readers of this potential problem while the Editorial Office continues to investigate this matter further. [Oncology Reports 39: 1063‑1071, 2018; DOI: 10.3892/or.2017.6176].
To explore how nurses comfort pediatric hematology-oncology (PHO) patients, examine nurses' confidence and educational preparation in providing comfort, and inform recommendations for enhancing new nurses' readiness. Seventeen PHO nurses in the southeastern United States were recruited through professional networks and PHO-focused organizations to complete an anonymous online survey. PHO nurses completed a survey with 12 closed and 4 open-ended questions. Open-coding content analysis was used to derive themes about how nurses comfort PHO patients. Demographic data were analyzed using descriptive statistics. A conceptual model described how nurses comfort PHO patients through dynamic individualized care using the approaches of preparation, comforting presence, listening, and distraction. More experienced nurses appeared to be more likely to identify listening as a comforting approach. Nurses who were more confident using comfort approaches appeared to be more likely to use them. Comfort care is a particular priority when caring for a PHO patient. Understanding nurses' readiness to provide comfort and how they approach this key aspect of PHO care strengthens patient care and nursing practice transitions. There are opportunities to increase education and readiness for this nursing role.
A highly sensitive but accessible molecular diagnostic method is urgently needed for the early diagnosis and minimal residual disease (MRD) monitoring of cancers, such as acute promyelocytic leukemia. Herein, based on the finding of RNA and DNA cotargeting LbuCas13a, we proposed an efficient amplification system that integrated cell-free nucleic acid sequence-based amplification with the bimodal activation of LbuCas13a (NASBi-Cas13a) and accordingly developed a simple electrochemical biosensor platform using magnetic beads for an ultrasensitive detection of the PML/RARα fusion transcript. The developed NASBi-Cas13a E-sensor achieved a detection limit as low as 10 aM for transcript target and demonstrated a linear dynamic range from 500 aM to 100 fM. The biosensor demonstrated exceptional specificity, capable of detecting positive cells amidst a 1000-fold excess of negative cells. A clinical validation study demonstrated that this method achieved a sensitivity and specificity of 100% across 22 blood samples, showing strong concordance with reverse transcription-quantitative polymerase chain reaction results. Furthermore, in five cases, this method accurately monitored changes in transcript levels. This method, due to its simplified process without reverse transcription and thermal cycling as well as the free of clumsy instrument, holds promise as a point-of-care tool for MRD detection and could potentially prove invaluable in the regular follow-up and efficacy evaluation of cancer treatment.
To examine the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in Mexican cancer patients, and to evaluate their utility as brief screening measures for depressive and anxiety symptoms in oncology care. In this cross-sectional study, 357 adult patients receiving oncological treatment at a cancer hospital in Mexico completed the culturally adapted Spanish versions of the PHQ-9 and GAD-7. Exploratory and confirmatory factor analyses were conducted to assess the factorial structure of both instruments, and internal consistency was evaluated using Cronbach's alpha. Concurrent validity was examined through correlations with related measures. The PHQ-9 yielded a 2-factor structure with acceptable internal consistency (Cronbach's α = 0.837), while the GAD-7 showed a 1-factor structure with good internal consistency (Cronbach's α = 0.881). The PHQ-9 explained 55.3% of the variance and the GAD-7 explained 58.5%. Confirmatory factor analyses indicated adequate model fit for both instruments. Findings suggest that the PHQ-9 and GAD-7 are brief, valid, and reliable tools for detecting depressive and anxiety symptoms in Mexican cancer patients. Their use may facilitate the early identification of symptoms of anxiety and depression in oncology settings and support both clinical care and psycho-oncology research.
Background: Head and neck cancer (HNC) and its multimodal treatment substantially impair speech, swallowing, breathing, appearance, and psychosocial well-being. Patient-reported outcome measures (PROMs) improve symptom monitoring and quality of life in oncology, yet their integration into routine HNC care remains inconsistent. This study assessed patterns of PROM use, perceived value, and barriers to implementation among healthcare professionals (HCPs) involved in HNC care. Methods: A 30-item cross-sectional survey was distributed to HCPs treating HNC patients between June 2024 and April 2025. The questionnaire explored PROM use in clinical practice and trials, perceived relevance across care phases, and implementation barriers. Respondents were classified as non-users, occasional users, or regular users. Data were analyzed descriptively with comparisons between groups. Results: Among 133 respondents, 33.8% were non-users, 29.3% occasional users, and 36.8% regular users of PROMs. Users reported inviting half of patients to complete PROMs, predominantly via paper-based questionnaires (67.8%). PROMs were mainly applied during active treatment and early follow-up to monitor symptoms, overall health, and emotional well-being, and were less frequently used to guide treatment decisions. The EORTC QLQ-C30 and HNC-specific tools were most commonly reported. Compared with users, non-users more often cited lack of time, limited training in interpreting PROM data, insufficient institutional support, resource constraints, and lack of appropriate instruments (all p < 0.05). PROM use in clinical trials was associated with routine use (p < 0.001). Conclusions: Although PROMs are widely valued in HNC care, their integration into clinical decision-making remains limited. Addressing organizational, educational, and digital barriers is essential to support sustainable implementation.
Our study aimed to investigate the experiences of adolescents and young adults (AYAs) with cancer from racially/ethnically diverse and/or 2SLGBTQIA + communities within the Canadian healthcare system to identify areas for improvement in their cancer care experience. The study included participants who self-identified as racially/ethnically diverse and/or 2SLGBTQIA + , diagnosed with cancer between ages 15 and 39 years, currently aged 18 years or older, and received or were receiving cancer care in Canada. Patient partners with lived experience of cancer were recruited as collaborators. Semi-structured virtual interviews were conducted using an interview guide, and transcripts were analyzed using framework analysis. Twenty-three participants (17 racially/ethnically diverse; 1 sexual/gender diverse; 5 both racially and sexually diverse) were interviewed. Positive experiences reported by participants included being able to identify with healthcare providers (HCPs), effective communication, comprehensive information sharing, and access to support services tailored for younger patients. Negative experiences were characterized by perceptions of judgmental attitudes and racialization from HCPs, the necessity of self-advocacy to obtain resources, systemic barriers to care, and psychosocial difficulties. Participants' recommendations for improving cancer care included increasing the diversity of HCPs, implementing equity, diversity, and inclusion training, and enhancing both communication and information dissemination practices. The experiences of diverse AYAs revealed both facilitators and barriers to equitable cancer care. Findings emphasize the need for workforce diversity and equity-informed practices to advance culturally responsive oncology care. Précis: This study examined the cancer care experiences of racially/ethnically diverse and/or 2SLGBTQIA + adolescents and young adults in Canada, revealing both supportive interactions and significant barriers such as discrimination and systemic inequities. Participants recommended increasing provider diversity, equity-focused training, and improved communication to create more inclusive and responsive cancer care.
Dyspnea is a common and distressing symptom in patients with cancer, particularly in advanced stages and lung cancer. It is associated with poor quality of life and is often challenging to manage. The Respiratory Distress Observation Scale (RDOS) is a validated tool for assessing dyspnea in noncommunicative patients. To assess the validity of the RDOS by comparing it with patient-reported dyspnea using the revised Edmonton Symptom Assessment System (ESAS-r) in patients with cancer receiving palliative care (PC), and to explore associations with functional status. Observational, cross-sectional study. The study was conducted at the National Cancer Institute (INCan) in Mexico City from October 2022 to February 2023. A total of 194 adult cancer patients with dyspnea receiving PC were included. RDOS, ESAS-r, and Karnofsky Performance Status (KPS) scores were assessed. Analyses included Spearman's correlation and comparisons across KPS groups. Median RDOS score was 5 (interquartile range 3-9), with 36.1% experiencing severe dyspnea. Higher RDOS scores were observed in patients with KPS ≤40. RDOS scores correlated significantly with ESAS-r dyspnea, insomnia, and drowsiness. Agreement between RDOS and ESAS-r was higher in moderate/severe cases (79.08%) than in none/mild (63.41%). Notably, 36.59% of patients rated as mild by ESAS-r were classified as moderate/severe by RDOS. RDOS is a valuable tool for detecting respiratory distress in cancer patients unable to self-report. Early identification and comprehensive management of dyspnea are crucial, particularly in patients with compromised functional status, or advanced disease, and those vulnerable to undetection because of inability to self-report distress.
Multiple myeloma (MM) develops through asymptomatic precursor stages characterized by progressive remodeling of the bone marrow (BM) immune microenvironment and disruption of bone homeostasis. To delineate changes in natural killer (NK) cell states during disease evolution, we investigated coordinated immune-tumor remodeling by integrating NK cell functional states with plasma cell-intrinsic susceptibility programs derived from CRISPR-based screens across healthy donors (HD), monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM), and newly diagnosed MM patients. The integration of NK cell state-associated gene signatures with plasma cell transcriptional programs revealed stage-specific co-variation between immune and tumor compartments. Public single-cell RNA sequencing datasets were interrogated to resolve NK cell heterogeneity, identifying cytotoxic CD56dim and regulatory CD56bright subsets. NK cell dynamics displayed stage-dependent changes, with early expansion followed by the contraction of CD56dim cells in BM, whereas CD56bright cells showed predominantly compositional remodeling. Within the CD56bright subset, transcriptional changes included an increased expression of KLRC1 (encoding NKG2A), subsequently validated by multiparametric flow cytometry. In parallel, plasma cell programs associated with NK sensitivity progressively decreased along disease stages, supporting tumor adaptation to immune pressure. The NKG2A ligand HLA-E displayed selective expression within CD16+ monocytes and followed a distinct variable pattern across disease stages, highlighting a microenvironmental contribution to NK cell regulation. Collectively, these findings indicate a coordinated process of immune-tumor co-evolution, characterized by dynamic remodeling of NK cell states and plasma cell susceptibility, with the NKG2A-HLA-E axis emerging as a central interface during MM progression.
Single nucleotide variation (SNV), as a key biomarker for disease diagnosis and personalized treatment, faces challenges in rapid and accurate detection. This study developed a single-tube accelerated recognition of SNVs strategy named STAR-CRISPR, which could accomplish SNV detection within only 20 min. This method integrated isothermal amplification and CRISPR/Cas12b cleavage system in one pot, and results could be directly identified by the naked eye. This method could accurately distinguish single-base differences, and could detect as low as 1% mutations against high background interference. We verified the proposed method by testing 70 clinical samples of idiopathic chronic pancreatitis, pancreatic cancer and acute myeloid leukemia. Results showed 100% consistency with next-generation sequencing results, demonstrating good accuracy and reliability of the proposed method. To further facilitate point-of-care diagnosis, we developed integrated miniature microfluidic chips, which greatly simplified sample identification and enabled logical interpretation of results. The combined STAR-CRISPR and microfluidic platform not only identifies SNVs but also supports simultaneous visual genotyping of wild-type, homozygous, and heterozygous mutations. Consequently, the proposed strategy is accurate, rapid, and versatile, holding significant potential for next-generation molecular diagnostics.
Large extracellular vesicles (large EV) released from tumor and benign cells are detectable in blood and hold potential as non-invasive biomarkers. While their diagnostic relevance has been shown in several malignancies, their role in head and neck squamous cell carcinoma (HNSCC) remains insufficiently characterized. Large EV were isolated from peripheral blood of patients with HNSCC (n = 66), non-small cell lung cancer (NSCLC; n = 52; adenocarcinoma n = 39, squamous cell carcinoma (SQCCL) n = 11), and healthy controls (n = 11) by differential centrifugation. Flow cytometry quantified surface expression of EGFR, EPCAM, MUC1, and PD-L1. Associations with clinical parameters were analyzed using t-tests, Spearman correlations, logistic regression, and random forest modeling. HNSCC-derived large EV showed significantly higher EGFR and MUC1, but lower EPCAM expression compared to controls. PD-L1 expression increased with advancing tumor stage and was positively associated with metastatic status, whereas EGFR levels declined in metastatic disease. Combined ROC analysis of EGFR, EPCAM, and PD-L1 yielded an AUC of 0.785 (p = 0.003), distinguishing HNSCC from controls. Comparative profiling revealed higher EGFR and EPCAM expression in HNSCC versus NSCLC, while MUC1 predominated in NSCLC, particularly in SQCCL; notably, the NSCLC cohort was predominantly adenocarcinoma. A marker panel comprising EGFR, EPCAM, and MUC1 differentiated HNSCC from SQCCL in this limited subgroup (n = 11) with 96.97% sensitivity, 45.45% specificity, 92.75% positive predictive value and 75.00% negative predictive value. Flow-cytometric profiling of circulating large EV provides a feasible liquid biopsy approach for tumor characterization in HNSCC. PD-L1 expression reflects tumor burden, and combined large EV marker analysis enables differentiation between HNSCC and primary squamous lung carcinoma, supporting its diagnostic utility in clinical oncology.
Intervention for patients with symptomatic varicose veins is largely driven by a combination of symptoms, the magnitude of venous reflux, clinical severity scoring algorithms, and unresponsiveness to conservative medical therapy. Our goal was to evaluate biological features of superficial veins from patients with symptomatic varicose veins, comparing these to healthy veins for biological insight into the progression of superficial vein disease. RNA was extracted from incompetent great saphenous veins at the time of phlebectomy and compared with residual healthy superficial veins from patients following coronary artery bypass graft surgery. The venous wall transcriptome was interrogated by NanoString. PANTHER and Gene Ontology identified biological pathways of interest. Based on these data, plasma biomarkers from patients with varicose veins or matched controls were evaluated. Multiple genes were upregulated and downregulated for pathways involving angiogenesis, collagen biosynthesis, and inflammation. COL1A1 was upregulated in varicose veins by fourfold, and interleukin-6 (IL-6) was downregulated by 21-fold. The blood IL-6 concentration was higher in the validation cohort of patients with varicose veins compared with relatively healthy patients (4.8 vs 1.3 pg/mL, p = 0.0085). Blood collagen 1A1 (COL1A1) was lower in patients with varicose veins compared with healthy patients (66,355 vs 82,661 pg/mL, p = 0.0497). A positive association was observed between circulating COL1A1 concentration and the Venous Clinical Severity Score, suggesting its potential utility as a prognostic biomarker for pathological great saphenous vein remodeling in patients with varicose veins. This hypothesis-generating study revealed that blood COL1A1 and IL-6 concentrations may be blood biomarkers used as additional objective data that may indicate adverse vein remodeling in patients with varicose veins.
Triplets incorporating proteasome inhibitors, immunomodulatory drugs, and dexamethasone are active regimens for patients with relapsed/refractory multiple myeloma (RRMM). All-oral regimens may offer greater real-world feasibility and convenience than other options. This phase I/II dose-escalation and expansion study evaluated the oral proteasome inhibitor ixazomib at a dose of 3 or 4 mg on a twice-weekly schedule (days 1, 4, 8, and 11) in 21-day cycles, plus pomalidomide at a dose of 2, 3, or 4 mg (days 1-14) and dexamethasone 12 or 8 mg (days of/after ixazomib), in 50 patients with RRMM. Patients had received a median of 2 prior lines, with 98.0% and 88.0% having received prior lenalidomide and bortezomib, respectively. The highest dose level investigated (ixazomib 4 mg, pomalidomide 4 mg) was the recommended phase II dose (RP2D). Patients received a median of 11 cycles. Common toxicities were neutropenia (76.0%; grade 3/4 22.0%/4.0%), thrombocytopenia (70.0%; 8.0%/8.0%), leukopenia (68.0%; 22.0%/0%), fatigue (52.0%; 4.0%/0%), and anemia (46.0%; 2.0%/0%). During dose escalation, two dose-limiting toxicities (grade 3 upper respiratory tract infection; grade 3 neutropenia) were reported. The overall response rate was 60.0% (24.0% ≥very good partial response [VGPR]) in all 50 patients and 65.8% (28.9% ≥VGPR) in the 38 patients who received the RP2D; the median duration of response was 18.0 and 19.3 months, median progression-free survival was 13.9 and 17.8 months, and 3-year overall survival rates were 85.2% and 80.3%, respectively. Twice-weekly ixazomib plus pomalidomide-dexamethasone is a well-tolerated, efficacious all-oral regimen with real-world utility in RRMM.
Primary plasma cell leukemia (pPCL) is a rare but highly aggressive plasma cell malignancy with a dismal prognosis. We retrospectively analyzed the KMMWP-2204 cohort of 127 patients with newly diagnosed pPCL from 20 Korean centers to identify prognostic factors and assess treatment outcomes, and integrated these findings with exploratory single-cell RNA sequencing (scRNA-seq) data from bone marrow samples obtained from 4 patients with pPCL, 2 with multiple myeloma, and 3 healthy donors. Our findings support the revised 2021 International Myeloma Working Group 5% circulating plasma cell (CPC) diagnostic threshold, as patients with 5-19% and ≥20% CPCs had comparable survival despite differences in disease burden. Poor performance status (odds ratio [OR], 3.28; P=0.031), elevated lactate dehydrogenase (OR, 3.45; P=0.019) and del(17p) (OR, 3.58; P=0.025) independently predicted 6-month early mortality. Achievement of complete remission was the strongest predictor of improved survival (hazard ratio for overall survival, 0.30; P=0.005), whereas autologous stem cell transplantation (ASCT) appeared to have a consolidative rather than independent effect in timedependent analyses. Although the use of intensive triplet or quadruplet induction regimens and ASCT increased in the post-2016 era, survival outcomes remained broadly similar across eras, likely reflecting differences in baseline risk and the retrospective nature of the cohort rather than regimen-specific efficacy. Exploratory scRNA-seq analysis identified transcriptional features suggestive of altered immune differentiation and myeloid-associated immunoregulatory signaling in pPCL, providing preliminary biological context for the observed clinical aggressiveness. These findings should be interpreted as hypothesis-generating and require validation in larger cohorts with orthogonal functional studies.
Pancreatic adenocarcinoma remains highly lethal. How modern chemotherapy reshapes the full mortality profile, including competing non‑cancer deaths, is incompletely defined. Using Surveillance, Epidemiology, and End Results (2010-2021), we identified 9624 adults (20-89 years) with primary pancreatic adenocarcinoma who received systemic chemotherapy. Cause of death (International Classification of Diseases, Tenth Revision) was classified as pancreatic cancer, other cancers, or non‑cancer causes. Stage-stratified analyses characterized mortality heterogeneity. Standardized mortality ratios (SMRs) versus the general US population were calculated in SEER*Stat; multivariable Poisson regression assessed risk factors. Temporal patterns were examined across ≤1 year, 1 to 5 years, and >5 years from diagnosis. Over a median follow-up of 14.2 months, 8218 deaths occurred. Pancreatic cancer accounted for 90.6% (n = 7448); non‑cancer causes accounted for 6.1% (n = 498), and other cancers accounted for 3.3% (n = 272). Non-cancer mortality comprised 7.8% of stage I/II deaths versus 5.1% in stage III/IV, reflecting longer survival enabling competing risks. Overall, non‑cancer mortality was markedly elevated (SMR 15.38, 95% confidence interval: 14.06-16.79), peaking in year 1 (SMR 96.10) and declining thereafter (1-5 years, SMR 13.63; >5 years, SMR 3.19). Cardiovascular deaths carried the greatest non‑cancer burden (heart disease SMR 9.96; cerebrovascular disease SMR 12.7). Infectious causes showed the highest relative risks (septicemia SMR 20.3; pneumonia/influenza SMR 88.69), concentrated in the first year. Chronic obstructive pulmonary disease (SMR 17.57) and diabetes (SMR 19.3) were additional contributors. Older patients (70-89 years) experienced the steepest early mortality. Suicide risk was strikingly increased (SMR 113.68), underscoring substantial psychological distress. In chemotherapy‑treated pancreatic cancer, non‑cancer mortality is substantial, time‑dependent, and dominated by cardiovascular and infectious causes in the first year after diagnosis. These data support integrated cardio‑oncology pathways, aggressive infection prevention, metabolic and pulmonary co‑management, and early psychosocial interventions to reduce preventable deaths and improve outcomes.
Adolescents and young adults (AYAs) with cancer experience substantial psychological distress and unmet supportive care needs. Routine screening with age-specific tools may improve the identification and addressing of concerns. The Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST) is a validated instrument, yet little is known about how AYAs and healthcare professionals (HCPs) experience its use in clinical practice. To explore how the AYA-POST supports AYAs in identifying, prioritizing, and communicating the health concerns most important to them and to examine HCP perspectives on patient engagement, communication, and decision-making. We conducted a qualitative study combining semi-structured individual interviews with AYAs (18-39 years) in a treatment trajectory for acute leukemia or malignant lymphoma and focus group interviews with physicians and nurses. Patients completed the AYA-POST prior to two consultations; interviews followed the second visit. Data were analyzed using reflexive thematic analysis. Patients experienced that the AYA-POST facilitated self-reflection, preparation, and prioritization of concerns, enhancing communication with HCPs. The tool uncovered often-overlooked physical, psychological, and sensitive issues, including sexual health and emotional well-being, and promoted patient empowerment. HCPs reported that it expanded consultations beyond biomedical symptoms and encouraged patient-centered dialogue. Challenges included time constraints, variability in patient readiness, staff training needs, and practical issues with paper-based forms. Both groups highlighted the importance of flexible timing, multidisciplinary collaboration, and integration into routine workflows. The AYA-POST can strengthen patient-centered communication and empowerment in hematological AYA care. Successful implementation requires integration into clinical workflows, staff training, flexible timing, and systematic follow-up.
Childhood cancer survivors are at high risk for treatment-related chronic health conditions. How much of this risk can be attributed to lifestyle is not known. In this study, we assess associations between lifestyle and a range of chronic health conditions and estimate lifestyle-specific population attributable fractions for chronic health conditions in survivors and compare them to those of radiotherapy and chemotherapy. Here we show that unhealthy lifestyle is associated with higher risk for subsequent hypertension, dyslipidemia, diabetes, heart attack, heart failure, valvular disease, joint replacement, anxiety, depression, and impaired physical and mental quality of life. Disease proportions attributed to unhealthy lifestyle exceed those of chemotherapy and radiotherapy for hypertension, diabetes, joint replacement, anxiety, depression, and impaired physical and mental quality of life. Unlike previous cancer treatment exposures, lifestyle can be modified. We need to further develop and implement effective lifestyle interventions in childhood cancer survivors, promoting healthy weight and physical activity.