In the last decades, artificial intelligence has made tremendous steps in supporting decision-making in healthcare. Bayesian networks (BNs) have emerged as powerful tools for probabilistic modelling and offer important advantages compared with regression-based models. This systematic review identifies the available literature on BNs for prognostication in oncology, evaluates their performance and discusses how BNs can overcome limitations of traditional prediction models. The systematic review was performed according to the Cochrane guidance and reported according to the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The protocol was registered in PROSPERO. Studies identified in MEDLINE and EMBASE were included. Eligible studies investigated BNs as prognostication or predictive tools within oncology (solid or haematological malignancies). A total of 52 studies were included, with a median construction cohort size of 438 patients. More than half of studies harboured unclear or high concerns about bias. Most studies used score-based structure learning approaches to construct the BNs. External validation was applied in a minority of studies and showed excellent performance metrics when hybrid techniques (integration of machine-learning and expert knowledge) were applied. Studies comparing BN validation with Cox regression validation showed better performance for BNs in most studies. When constructed with hybrid techniques, BNs offer great potential to support decision-making in clinical oncology. Advantages include their ability to estimate treatment effects with non-randomised data, to model causal relationships, to apply counterfactual reasoning and to work with missing variables. To be implemented into clinical practice, hybrid construction techniques, high-quality external validation, prospective evaluation with a health technology assessment and adequate postmarketing surveillance and maintenance are essential. CRD420251140130.
To evaluate the associations between approval approaches and the Chinese Society of Clinical Oncology (CSCO) guidelines for haematological cancer drug indications. Haematological cancer drug indications approved via different approaches between 2015 and 2023 were retrieved from the National Medical Products Administration (NMPA) website, and their CSCO guideline recommendation levels were analysed. Basic characteristics were analysed descriptively. Fisher's test and t-tests were used to respectively explore the associations of the approval approaches and the recommendation level, and the time difference between the indications obtaining the recommendation level and being approved by the NMPA. Changes in recommendation levels were also analysed. The NMPA approved 52 haematological cancer drug indications (33 anticancer drugs) from 2015 to 2023. 5 indications were approved via routine approval (RA) and 47 were approved via accelerated approval (AA). 39 indications obtained CSCO guideline recommendation level I. Indications approved via the AA and RA were similarly likely to obtain level I. The average time for the indications approved via the RA to obtain the recommendation level is 7.6 months before the indications were approved by the NMPA. And the average time for the indications approved via AA to obtain the recommended level is -5.51 months. For indications approved via priority review and RA, there was a difference in the average time from obtaining recommendation level to obtaining NMPA approval. Compared with CSCO's initial recommendation levels, 15 indications obtained higher recommendation level in the updated CSCO guideline. Most haematological cancer drug indications obtained CSCO guideline recommendation level I, with no significant difference between AA and RA in the recommendation level. Indications approved via RA obtained recommendation level more quickly. Some indications obtained a higher recommendation level in the updated guideline. Strengthening communication between the NMPA and CSCO and ensuring timely integration of emerging evidence may improve the alignment between approval decisions and recommendation level.
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Peer review remains a cornerstone of scientific knowledge dissemination, yet comprehensive, practically relevant training is limited. This inspired us to develop Peerspectives, a peer review training course for doctoral students in the biomedical sciences in Berlin, Germany. We aimed to assess the effectiveness of the Peerspectives course on editor-judged quality of peer review reports. Doctoral students in health research fields who enrolled in the Peerspectives course between October 2020 and August 2022 were invited to participate in the study, and 80 consented. The ~18 week-long course provided training on the structure, purpose, and conduct of peer review and editorial processes in biomedical journals. It included 12 h of lectures, homework assignments, and 12 h of hands-on, small-group workshops, during which students reviewed original research manuscripts currently under consideration at The BMJ under the guidance of experienced mentors. The primary outcome was the overall quality of the peer review reports as judged by two independent BMJ editors using the global score of the Review Quality Instrument (RQI) pre- and post-intervention. Additionally, we compared participants' post-course scores with those of actual BMJ reviewers. We also compared participants' self-assessed knowledge and skills related to scholarly peer review (1-5 Likert scale) before and after the course. After course completion, the editor-assessed overall quality of the participants' peer review reports was higher than before the course (median increase of 0.5 points, p < 0.001; mean increase of 0.36 points, p < 0.001). The RQI scores of participants' post-course reports were not non-inferior to those of actual BMJ reviewers for the same manuscripts. Self-assessed peer review-related knowledge skills increased across all questionnaire items after course completion. Greatest improvements were seen in understanding reviewer expectations (increase in means from 2.9 to 4.5), confidence in reviewing (2.5 to 3.9), and knowing what to look for while reviewing (2.8 to 4.2). Providing doctoral students with comprehensive training resulted in an editorially significant increase in review report quality and improved understanding of the role and expectations of peer reviewers in the scholarly publishing processes and confidence in giving constructive feedback. PRE-REGISTRATION: https://osf.io/vndcx.
This study aimed to evaluate the quality of life of caregivers of cancer patients admitted to the Medical Oncology Department of Selçuk University Faculty of Medicine and to identify the factors influencing it. This descriptive, cross-sectional study included 300 cancer patients and 300 caregivers from the oncology outpatient clinic and ward. Data were collected through face-to-face interviews using a Sociodemographic Information Form, the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and the Caregiver Quality of Life Index-Cancer (CQOLC). Among the caregivers who participated in the study, 51.0% were female, 76.7% were married and the mean age was 43.57±14.53 years. Forty per cent of patients had an ECOG performance score of 3-4. The mean total CQOLC score for caregivers was 87.55±20.31. Caregivers with higher income had higher quality of life scores (p=0.004). Quality of life was significantly lower among caregivers providing care alone compared with those sharing the caregiving burden (p<0.001). It was determined that caregivers' quality of life scores decreased as patients' ECOG performance status worsened (p<0.001). The quality of life of individuals providing care to cancer patients alone was found to be lower. The quality of life is higher among individuals with a high income level who provide care to breast cancer patients. The deterioration of patients' performance status is associated with a decrease in the quality of life of caregivers.
[This corrects the article DOI: 10.1136/bmjonc-2025-000840.].
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A man in his early 70s with a prior history of high-grade urothelial carcinoma presented with a large left upper lobe lung mass detected on imaging. Endobronchial biopsy demonstrated non-small cell carcinoma with squamoid morphology and diffuse p40 positivity, supporting an initial diagnosis of primary pulmonary squamous cell carcinoma. The patient received neoadjuvant platinum-based chemotherapy and immunotherapy without a significant radiographic response. Subsequent lobectomy revealed a carcinoma with prominent papillary architecture and an immunophenotype characterised by cytokeratin 7, cytokeratin 20, GATA binding protein 3 (GATA3) and p40 positivity, supporting metastatic urothelial carcinoma. Review of the original biopsy confirmed limited tissue with overlapping squamoid features. This case highlights a potential diagnostic pitfall: metastatic urothelial carcinoma may demonstrate diffuse p40 expression and mimic primary pulmonary squamous cell carcinoma on limited lung biopsy, emphasising the importance of expanded immunohistochemical panels and clinicopathologic correlation.
Mucoid impaction of the bronchi is an uncommon benign condition that can closely mimic pulmonary malignancy on imaging. A woman in her 50s with a remote history of chest wall chondrosarcoma presented with chest pain and was found to have a new pulmonary mass with satellite nodules. Computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) findings raised concern for metastatic disease or primary lung cancer. Given the radiological suspicion and the patient's oncological history, surgical resection was undertaken. Intraoperative lymph node sampling was negative for malignancy. Histopathological examination of the lung specimen demonstrated dense mucoid impaction with eosinophils and Charcot-Leyden crystals, with no evidence of neoplasia. This case highlights the limitations of imaging alone in differentiating benign from malignant pulmonary lesions and reinforces the importance of histopathological confirmation before definitive oncological management.
Lung cancer is commonly associated with smoking. However, if considered separately, lung cancer in never-smokers (LCINS) is the seventh most common cause of cancer-related death worldwide. Expanding the limited understanding of LCINS, especially in the UK, is crucial to improving diagnosis. We will establish a retrospective and prospective UK multicentre observational cohort comprising never-smoking (lifetime use of <100 tobacco cigarettes) adults with lung cancer using routinely available primary and secondary care electronic health records (EHRs). Demographic data including occupation and ethnicity, exposures and lung cancer outcomes will be extracted. Deep learning-based natural language processing will be used to analyse free-text data. Quantitative or qualitative data collection for information not available in EHR may be initiated in the future. Follow-up will be until death, withdrawal or end of study (5 years from study activation date). Primary outcomes will be sociodemographic characteristics, comorbidities, environmental exposures, pathways to presentation and symptoms. A feasibility pilot of 225 patients (25 participants per year both retrospectively and prospectively) will be undertaken at one hospital before extending the study to multiple sites. Patient representatives have been involved in adapting the research protocol including the recruitment process and patient-facing materials. National ethical approval has been obtained from Health Research Authority (HRA) (24/YH/0147). Access to patient records without explicit consent, including deceased patient records, is legally supported by the Confidentiality Advisory Group and HRA. The study is sponsored by University College London Hospital.Data will be anonymised and analysed 2 years after the study start date and on study completion. Together with our patient representatives, we will disseminate data to the scientific and academic community and public through peer-reviewed publications, presentations at conferences, patient-facing charities and social media.
The BioCaPPE (Biomarkers of Prostate Cancer/Prevention and Environment) study is a multicentre prospective observational cohort designed to identify biomarkers associated with prostate cancer (PCa) risk that may be modifiable through lifestyle factors. This paper describes the cohort, along with the data and bio-samples available for future studies in PCa risk assessment. Canadian men at risk of PCa were enrolled based on one of two criteria (1) negative first prostate biopsy within 6 months from enrolment (Group 1); or (2) a prostate-specific antigen (PSA) blood level between 2.5 and 10 ng/mL without prior prostate biopsy (Group 2). At baseline, blood samples and comprehensive data were collected. PCa incidence and lifestyle factors were updated for all participants over 2 years, with extended follow-up for those who provided additional consent. Recruitment was conducted across four health centres in Quebec, Canada. A total of 2053 men were enrolled-1499 in Group 1 and 554 in Group 2. All participants completed the initial visit, which included collection of medical and family history, anthropometric measurements, demographic information, dietary and alcohol intake, physical activity, tobacco use, medication use, and quality of life assessments, and candidate biomarker measurements. At the 2-year mark, 7.2% of participants had developed PCa; this figure has since increased to 15.3% (median follow-up: 6.1 years). Additionally, 84% (n=1718) consented to ongoing annual follow-up. This large, prospective cohort of men at risk of PCa offers valuable resources for risk stratification and primary prevention. The BioCaPPE biosamples and data are available to support the identification of lifestyle-related biomarkers associated with PCa risk in this population. ClinicalTrials.gov Identifier: NCT03383016.
Empowering nurses to discuss clinical trials with patients can increase recruitment rates. Clinical trials are essential for improving lung cancer patient outcomes; in the short term, they provide individuals access to new treatments and care regimens which, longer term, have the potential to advance clinical care. However, recruitment into lung cancer clinical trials is as low as 5%, and lung cancer nurses feel ill-equipped to signpost clinical trial opportunities to patients. This study aimed to pilot and assess the acceptability and utility of the 'Lung I-ACT tool': a newly developed resource comprising a patient-facing leaflet and a nurse-facing poster, designed to help lung cancer nurses initiate clinical trial discussions with patients. A 6-month, mixed methods, pilot study was conducted at seven NHS hospital sites in the UK; four were intervention sites, three were control sites. Data on self-efficacy, knowledge, confidence, awareness and current practice were collected using online surveys for nurses at baseline, 3 and 6 months, and online interviews with lung cancer nurses and patients from intervention sites. Survey data were analysed using descriptive and inferential statistics, and interview data were thematically analysed via Framework Method. Thirty-four nurse respondents were recruited to the survey. Survey findings indicated increased frequency of clinical trial discussions at the intervention sites, and increased nurse awareness, confidence and knowledge to navigate these discussions. Eleven nurses and four patients were interviewed; these data comprised five themes regarding lung cancer nurses' and patients' views of the Lung I-ACT tool: (1) content and format of the tool, (2) application and utility of the tool in practice, (3) perceived changes to practice, (4) knowledge, awareness and confidence to discuss clinical trials, (5) contextual and situational factors impacting the presentation of clinical trials. The Lung I-ACT tool improves nurses' confidence in discussing trials with patients through increasing their awareness of clinical trial opportunities and helping them to structure conversations.
The establishment of an effective strategy for recurrence prevention following curative treatment for hepatocellular carcinoma (HCC), including radiotherapy, remains a critical unmet clinical need. Despite favourable local control and safety profiles, recurrence after particle therapy remains a major challenge, highlighting the need for effective adjuvant strategies to improve long-term outcomes. The present phase Ib/II trial is designed to evaluate the safety and efficacy of atezolizumab plus bevacizumab (Atezo+Bev) administered after carbon-ion radiotherapy (C-ion RT) in patients with unresectable non-metastatic large HCC. This study aims to explore the potential of this multimodal approach as a novel adjuvant strategy to improve outcomes in patients at high risk of recurrence. This is a phase Ib/II, single-arm clinical trial designed to evaluate the safety and efficacy of adjuvant Atezo+Bev following C-ion RT in patients with HCC. Eligible patients will be enrolled in the first registration phase. C-ion RT (60 Gy) will be administered over four consecutive treatment days ideally within one calendar week. Patients will receive a combination of atezolizumab (1200 mg) and bevacizumab (15 mg/kg) administered intravenously every 21 days for one treatment cycle. The primary endpoint of the phase Ib part is the proportion of patients with dose-limiting toxicity (DLT). DLT is defined as prespecified toxicities associated with the investigational drug among the adverse events that occurred from the start date of the investigational drug (Day 1) to Day 21. If there is one or fewer cases of DLT out of six cases, the trial will proceed to the phase II part. The primary endpoint of the phase II part is the 1-year recurrence-free survival rate. This study was approved by the ethics committee of two participating institutions (Chiba University Hospital (approval No. 2024021) and National Institute for Quantum and Radiological Science and Technology, QST Hospital (approval No. C24-001)). Trial results will be reported in a peer-reviewed journal publication. jRCT2031240284.
Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context. The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication. CTRI/2025/08/092672.
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We aimed to disentangle whether elevated body mass index (BMI) is directly associated with adverse survival in primary colorectal cancer (CRC), or indirectly through treatment-related mechanisms, e.g., dose-capping adjuvant chemotherapy (ACT) and toxicity, using individual participant data meta-analysis (IPD-MA) and causal inference approaches. Using BMI from four CRC-ACT randomised trials [OCTOPUS], and two ACT adherence measures (average cumulative relative dose [ACRD]; average relative dose intensity [ARDI]), we performed two-stage random effects IPD-MA, assessing total (TE) and direct effects (DE) (excluding and including mediators, respectively) of pre-defined causal paths, with overall survival (OS) as primary outcome. In 7264 patients, the TE of 5 kg/m2 BMI increments was a significant ACRD reduction (-1.15% [95% CI -1.92, -0.38]), and ACRD 5% increments were associated with improved OS (HR 0.94 [0.91, 0.96]), implying possible adverse indirect effects; though not large enough to induce an adverse TE of BMI on OS (HR 0.98 [0.90, 1.07]). BMI-ARDI relationships were similar (TE -1.08% [-1.44, -0.72]), but ARDI-OS relationships were inverted (HR 1.05 [1.01, 1.09]). BMI showed no association with grade 3+ toxicity (OR 1.01 (0.91, 1.14)). However, toxicity was associated with worse OS (TE HR 1.37 [1.17, 1.61]), which attenuated on adjusting for ACRD (DE HR 1.20 [1.02, 1.41]), suggesting partial mediation via a significant toxicity-ACRD relationship (-10.37% [-11.77, -8.97]). Our study establishes possible adverse indirect effects of obesity on CRC survival, through treatment-selection, supporting full BSA-based ACT dosing.
Invasive ductal carcinoma of the breast is known to typically metastasise to the lungs, liver, bone and brain, with subcutaneous soft tissue involvement being rare, with only eight cases reported internationally. We report the case of a woman with a history of left-sided invasive ductal carcinoma treated with a mastectomy and adjuvant therapy, who presented 7 years later with a 2.8 cm subcutaneous lesion over the contralateral shoulder. Histopathological examination and immunohistochemistry confirmed metastatic invasive ductal carcinoma, displaying a morphological and receptor profile congruent with her primary tumour. This case highlights the potential for late and atypical metastatic presentations of breast cancer and underlines the importance of maintaining diagnostic vigilance in long-term survivors.