搜索结果：Cancer control : journal of the Moffitt Cancer Center

IntroductionInformal carers provide essential support for people diagnosed with cancer, however, the demands of caregiving can negatively impact their psychological wellbeing. There is a need to examine psychological wellbeing among carers of First Nations cancer patients to understand the impacts of caregiving within cultural contexts. Therefore, this study aims to quantify carer psychological distress, burden, and quality of life (QoL) among carers of First Nations Australian cancer patients - key indicators of carer wellbeing that may have implications for both carers and patients.MethodsThis prospective cross-sectional study recruited adult (≥18 years) carers of First Nations Australians diagnosed with cancer across six Queensland hospitals (July 2021-December 2024). Of 221 eligible carers, 172 (78%) participated in the study. Logistic regression models assessed association between carer characteristics with high psychological distress (Distress Thermometer, score≥4) and significant carer burden (six-item Zarit Burden Interview, score≥6); linear models assessed associations with QoL (CarerQoL-7D).Results165 (96%) carers approached were included in the analysis, of which 67% (n=111) identified as First Nations. High distress was reported by 43% (95% CI:36%-51%), 44% reported significant carer burden (95%CI:37%-52%), and mean CarerQoL-7D score was 9.7 (95%CI:9.3-10.1). Only prevalence of high distress differed between First Nations and non-Indigenous carers. For all carers as well as First Nations carers, clinical diagnosis of anxiety and/or depression was associated with high distress, significant carer burden and lower QoL.ConclusionTo our knowledge, this study is the first to quantify the psychological wellbeing of carers of First Nations cancer patients in Australia. We observed no associations typically expected for wellbeing and distress among carers, except for with clinical anxiety/depression, suggesting that existing measures may not fully capture carer's experiences in this population. These findings highlight the need for culturally appropriate measures co-designed with Indigenous communities to better assess and support carer wellbeing. Why this research matters Informal carers often provide essential support for relatives or friends living with cancer, such as helping them attend their medical appointments, with housework, and supporting them through their cancer journey. This role can be rewarding but can affect their wellbeing. Currently, very little is known about the wellbeing of carers who support First Nations Australians with cancer. This study wants to understand how these carers are affected by their caring role, so that our findings can guide policy and support services to improve their wellbeing. What we did Carers of First Nations Australians diagnosed with cancer were identified through patients or hospital staff in six Queensland hospitals. Their contact details were given to the research team, 172 agreed to participate. Carers answered questions about themselves and their health, and their wellbeing: carer distress (Distress Thermometer), burden (six-item Zarit Burden Interview), and quality of life (CarerQoL-7D). We looked for associations between sociodemographic and clinical factors with the wellbeing measures. What we found 165 carers were included in the analysis (67% of which were First Nations). Almost half of the carers reported high distress (43%) and significant carer burden (44%). There was a higher prevalence of high distress among First Nations carers compared to non-Indigenous carers. For all carers, having a anxiety/depression diagnosis was associated with high distress, significant carer burden and lower quality of life. Why this is important To the best of our knowledge, this study is the first to measure the wellbeing of carers of First Nations Australian cancer patients. While these findings highlight challenges carers face, there were few associations with other personal or clinical factors, indicating that the measures used may not fully capture their wellbeing. Culturally informed, co-designed tools are needed to better understand and support carers’ experiences.

IntroductionExercise is a key part of cancer care, yet its integration into routine practice remains limited. This study explored the experiences of people living with and beyond cancer, with an updated, opt-out referral model embedded within a supportive oncology setting, focusing on initial engagement with exercise physiology appointments. Through this model, patients were automatically scheduled for a consultation with an in-house exercise professional during their cancer treatment.MethodsA qualitative descriptive design comprised of two focus groups with 13 participants was employed to explore views across pre-defined elements of the model: referral to exercise, appointments, counselling, and tailoring.ResultsParticipants valued the automatic appointment structure as it normalised exercise as being part of their treatment and reduced the burden from decision-making and arrangement of appointments. Trust in their treating doctors and nurses, together with consistent messaging, reinforced exercise as a medically endorsed intervention. Counselling on exercise addressed misinformation, highlighted the physiological rationale, and helped foster a sense of control and agency. The inclusive gym environment and tailored plans further supported engagement with exercise, from which the importance of collaborative but individualised care was noted. While the opt-out process facilitated initial uptake, sustained access to exercise services beyond the clinical setting remains a challenge.ConclusionsFindings support the feasibility and acceptability of integrated referral pathways and underscore the need for system-level changes and community partnerships to ensure long-term, equitable access to exercise in cancer care. Why we did this study: Exercise helps people with cancer, but most don't get referred to exercise services. We tested a new system where cancer patients automatically got an appointment with an exercise professional during their treatment, without having to ask for it. What we did: We talked to thirteen people with cancer in two group discussions to understand what they thought about this automatic referral system. What we found: People liked getting an automatic appointment because: It made exercise feel like a normal part of their cancer treatment. They did not have to make decisions or organise appointments themselves when they were already overwhelmed. When their doctors and nurses talked about exercise, it felt like proper medical advice they should follow. The exercise professional helped clear up wrong information and explained how exercise actually helps their body. Having personalised exercise plans that matched their individual needs made them feel more in control. The gym felt welcoming and inclusive. The main challenge was keeping up with exercise after their cancer treatment finished and they no longer had access to the hospital's exercise services. What this means: Automatically giving cancer patients exercise appointments works well and people like it. However, hospitals need to work with community gyms and exercise providers so people can continue exercising after their treatment ends.

Circulating tumor DNA (ctDNA) has emerged as a clinically actionable biomarker for the management of colorectal cancer (CRC). Improvements in analytical accuracy and sequencing depth have expanded the role of ctDNA from early cancer detection to include molecular profiling of advanced disease, postoperative risk stratification, and real-time evaluation of therapeutic response and resistance. In screening and early detection settings, ctDNA-based assays integrating mutation analysis, methylation profiling, and fragmentomic features have demonstrated high specificity for CRC and multi-cancer early detection (MCED). Prospective studies suggest that ctDNA can identify CRC before clinical diagnosis; however, its sensitivity for advanced premalignant lesions remains limited, supporting its use as a complementary approach for individuals who do not participate in established screening rather than as a replacement for stool-based tests or colonoscopy. Postoperatively, ctDNA-based detection of minimal residual disease (MRD) is a strong independent predictor of recurrence and survival, often preceding radiographic evidence of relapse. Randomized trials have demonstrated that ctDNA-guided adjuvant strategies have the potential to reduce overtreatment and identify candidates for treatment escalation, although the impact on long-term outcomes remains under prospective validation. In metastatic disease, serial ctDNA monitoring enables early treatment-response assessment, detection of resistance mechanisms, and optimization of targeted therapy, including rechallenge strategies. The emerging concept of NeoRAS further illustrates the dynamic nature of tumor genomics and its therapeutic implications. Collectively, these advances have positioned ctDNA as a central tool in precision medicine. This narrative review summarizes recent clinical evidence supporting ctDNA-guided strategies for CRC and discusses their implications for the broader field of precision oncology. What is this review about? Colorectal cancer is a common cancer, and many people still die from it despite advances in treatment. Doctors need better ways to detect cancer early, decide who needs treatment after surgery, and monitor how well treatments are working. This review explains how a blood test called circulating tumor DNA (ctDNA) may help improve these decisions. What is circulating tumor DNA (ctDNA)? ctDNA consists of very small pieces of DNA released into the bloodstream by cancer cells. It can be detected using a simple blood sample. Because blood tests are less invasive than tissue biopsies, ctDNA can be measured repeatedly over time. How can ctDNA be used in colorectal cancer care? This review summarizes evidence showing that ctDNA can be useful at several stages of care. Before diagnosis, ctDNA blood tests can detect colorectal cancer with high accuracy, but they are not very good at finding precancerous polyps. Therefore, they should not replace standard screening methods such as stool tests or colonoscopy, but may help people who do not participate in existing screening programs. After surgery, ctDNA can detect tiny amounts of remaining cancer cells earlier than scans or standard blood markers. This can help doctors decide who truly needs additional chemotherapy and who may safely avoid it. In advanced cancer, repeated ctDNA testing can show whether treatments are working, identify early drug resistance, and help guide personalized treatment choices. Why is this important? Using ctDNA may reduce unnecessary treatments, detect cancer recurrence earlier, and support more personalized care. However, challenges remain, including cost, access, and the need for clear guidelines on when and how to use these tests. What comes next? More clinical studies are needed before ctDNA testing becomes routine in everyday colorectal cancer care.

IntroductionRight-sided colon cancer (RCC) is common among older adults and represents a major clinical burden in this population. However, substantial competing mortality and the lack of competing-risk analyses in prior studies have obscured the cancer-specific benefit of surgery.MethodsWe conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), including patients aged &#x2265;75 years with RCC. To minimize baseline imbalances, a 1:1 propensity-score-matched (PSM) cohort was constructed. Survival was assessed using Kaplan-Meier methods for overall and cancer-specific survival and competing-risk analyses for cancer-specific death (CSD) and other-cause death (OCD). Independent predictors of CSD were identified using multivariable Fine-Gray regression, and a competing-risk nomogram was developed and internally validated for individualized risk prediction.ResultsAmong 46,932 eligible patients, 1:1 propensity-score matching with exact T and M stage matching yielded a balanced cohort of 2,892 patients (1,446 per group). In the matched cohort, surgery was associated with significantly improved overall and cancer-specific survival. Competing-risk analyses showed that the 5-year cumulative incidence of CSD was 20.4% in the surgery group versus 63.9% in the non-surgery group (Gray's test P < 0.001), while OCD was 31.7% versus 29.6% (Gray's test P < 0.001). In multivariable Fine-Gray regression, surgery remained the strongest independent protective factor for CSD (sHR 0.18, 95% CI 0.16-0.19; P < 0.001). Sensitivity analysis excluding T1 tumours showed that the association between surgery and improved survival remained consistent. The resulting competing-risk nomogram showed acceptable discrimination and overall calibration, and decision curve analysis suggested potential net clinical benefit across a range of thresholds.ConclusionIn elderly patients with RCC, our findings are consistent with a cancer-specific survival benefit of surgery. What is this study about? Right-sided colon cancer is common in older adults. For patients aged 75 years or older, deciding whether to have surgery can be difficult. Some older patients may benefit from removing the cancer, but others may have frailty, other serious illnesses, or a higher risk of dying from causes unrelated to cancer. This makes treatment decisions challenging for patients, families, and doctors. What did the researchers do? We used a large United States cancer database to study older adults with right-sided colon cancer. We compared patients who had surgery with those who did not. Because older patients may die from causes other than cancer, we used statistical methods that considered both cancer-related death and death from other causes. What did the study find? After balancing important differences between the surgery and no-surgery groups, surgery was associated with a lower risk of dying from colon cancer. This association was also seen in additional analyses that excluded very early-stage cancers. What do the findings mean? These findings suggest that surgery may be beneficial for selected older patients with right-sided colon cancer. However, this study cannot prove that surgery directly caused better outcomes, because important information such as frailty, physical function, other illnesses, and the reason for not having surgery was not available in the database. Treatment decisions should therefore not be based on age alone. Instead, doctors should consider each patient&#x2019;s overall health, treatment goals, ability to tolerate surgery, and personal preferences.

IntroductionThis study aimed to evaluate the independent associations of myopenia, myosteatosis, and frailty with survival outcomes in older patients with prostate cancer undergoing definitive radiotherapy.MethodsA total of 124 patients aged &#x2265;65 years who received definitive radiotherapy for localized or locally advanced prostate cancer between 2014 and 2023 were retrospectively analyzed. Myopenia and myosteatosis were quantified using the psoas muscle index (PMI) and Hounsfield unit average calculation (HUAC), respectively. Comorbidity-based frailty was assessed using the modified frailty index-11 (mFI-11). The cut-off points for the PMI and HUAC were determined using receiver operating characteristic (ROC) curve analysis. Univariate and parsimonious multivariable Cox regression analyses were used to examine the prognostic value of these markers for progression-free survival (PFS) and overall survival (OS).ResultsThe median age of the patients was 72 years (range: 65-87). According to the mFI-11, 47.6% of the patients were classified as frail. The cut-off values for PMI and HUAC were 2.0 cm2/m2 and 37.7 HU, respectively. In univariate analysis, only PMI was significantly associated with both PFS (HR: 2.23, p = 0.02) and OS (HR: 2.45, p = 0.03). When entered separately into parsimonious multivariable Cox models adjusted for age and NCCN risk group, PMI remained an independent prognostic factor for both PFS (HR: 2.36, p = 0.01) and OS (HR: 2.40, p = 0.04), whereas mFI-11 and HUAC were not significantly associated with either endpoint.ConclusionAmong the evaluated body composition and frailty-related markers, only PMI-defined myopenia remained independently associated with both PFS and OS in older patients receiving definitive radiotherapy for localized or locally advanced prostate cancer. As PMI can be obtained opportunistically from routine planning CT, it may have value for prognostic stratification, although confirmation in external prospective datasets is required. Prostate cancer is common in older men, who often have other health problems and may be physically weaker. Doctors need simple tools to estimate how long these patients are likely to live and how well they might do after radiotherapy. In this study, we examined 124 men aged 65 years or older who received radiotherapy for prostate cancer that had not spread to distant organs. Before treatment, all patients had routine planning CT scans. From these scans, we measured the size of a large muscle in the lower back (the psoas muscle) and calculated a value called the psoas muscle index, which reflects overall muscle mass. We also assessed muscle quality and a standard frailty score based on other illnesses and general condition. We found that men with lower muscle mass had a higher risk of cancer worsening and a higher risk of death. This link remained even after accounting for age and cancer risk group. Our results suggest that a simple muscle measurement from existing scans may help doctors better estimate prognosis and guide treatment decisions in older men receiving radiotherapy for prostate cancer.

IntroductionFinancial toxicity (FT) is more prevalent among rural-dwelling cancer survivors who also face greater cancer care-related travel burdens. We sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies.MethodsRapid qualitative analysis of semi-structured interviews with rural-dwelling cancer survivors who screened positive for FT per the COmprehensive Score for financial Toxicity (COST) measure. Our analysis was structured around three inductive themes: rural-dwelling patients' experiences of cancer treatment while navigating FT, patient perceptions of travel burdens undertaken in the course of accessing cancer care, and perceived implications of both FT and travel burdens for care on HRQoL.ResultsThe (n = 12) participants in our study were mostly women, with a median age of 60.1. The median COST score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as "stacking" appointments to reduce travel costs and taking advantage of non-medical assistance offered by health systems' financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs.ConclusionsEstimates of travel distances to cancer care likely understate travel burdens, because they do not capture the frequency of appointments and their associated indirect and opportunity costs for cancer survivors experiencing FT. Financial assistance for cancer survivors should be responsive to the dual and cumulative financial and travel burdens of cancer care. Rural-dwelling cancer survivors are more likely to experience Financial Toxicity (FT) in tandem with greater cancer care-related travel burdens. This qualitative study sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies. We conducted semi-structured interviews with (n = 12) participants sampled from the Lessening the Impact of Financial Toxicity (LIFT) study, an intervention that screened for FT and provided site-based financial navigation services and supports. Interview participants were mostly women, with a median age of 60.1. The median COmprehensive Score for financial Toxicity (COST) score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as &#x201c;stacking&#x201d; appointments to reduce travel costs and taking advantage of non-medical assistance offered health systems&#x2019; financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs. Concomitant caregivers- or cancer survivors who were also caregivers- were especially in need to supports to mitigate the dual burdens of cancer care-related FT and travel burdens.

IntroductionThe integration of artificial intelligence (AI) into health information seeking is transforming health promotion. Understanding how users accept and trust these communication technologies is critical for health communication and cancer control. This study examined how the Technology Acceptance Model II (TAM II) applies to colorectal cancer information seeking, comparing link-based search (e.g., Google search) versus generative response paradigms (e.g., ChatGPT/AI) while examining trust, perceived threat, and contextual factors in technology use decisions.MethodsA prospective, randomized 2&#xd7;2 factorial experiment was conducted with 764 Texas adults randomly assigned to conditions to view either Google search results or ChatGPT responses for colorectal cancer symptoms, presented in either high-concern or low-concern scenarios. Participants completed validated measures including TAM II constructs adapted from Davis (1989) and Kamal et al (2020), multidimensional trust scales, Extended Parallel Process Model threat measures (Witte, 1992), and technology-related stress items, all demonstrating acceptable reliability (&#x3b1; > .77). Data analysis included two-way ANOVAs, correlation analysis, and stepwise regression modeling.ResultsGoogle search received significantly higher ratings than AI across all Technology Acceptance Model II constructs. Technology preferences appeared to reflect multiple factors including interface familiarity, trust in information sources, and usability expectations, with traditional search benefiting from established user mental models and transparent source attribution. Trust emerged as the strongest predictor of behavioral intention. No significant main effects were found for concern level, and no interaction effects emerged between technology type and concern level, indicating that technology preferences remained consistent regardless of symptom severity.ConclusionsFor cancer control and prevention, these findings suggest that patients seeking colorectal cancer symptom information may be more likely to trust and act upon traditional search results than AI-generated responses, focusing on technology use intentions for health information seeking that directly inform cancer screening and care-seeking behaviors, potentially affecting screening behaviors and care-seeking timing. Current AI implementations may not optimally serve health information needs with lower acceptance potentially related to limited source transparency and increased cognitive demands compared to familiar search interfaces, as suggested by preference patterns. Cancer control professionals should anticipate that the growing integration of AI into health information seeking may influence the public's cancer symptom evaluation and screening behaviors. When people have worrying symptoms like stomach pain or changes in bowel habits, they often search online for information before deciding whether to see a doctor. Today, people can get health information from traditional search engines like Google or from newer artificial intelligence (AI) chatbots like ChatGPT. But we don't know which type of search people trust more, especially when they're worried about serious health problems like colorectal cancer. We studied 762 adults in Texas to find out how people feel about using AI versus Google for health information. We showed participants realistic examples of both Google search results and AI responses about colorectal cancer symptoms. Some people saw information about serious symptoms (like blood in stool), while others saw less worrying symptoms (like occasional gas). We then asked them how useful, easy to use, and trustworthy they found each type of search, and whether they would actually use it for health questions.Our results showed that people strongly preferred Google over AI for health information across every measure we tested. They found Google more trustworthy, easier to use, and more helpful. Surprisingly, it didn't matter whether the symptoms were serious or minor - people consistently chose Google over AI regardless. The biggest factor in whether people would use a search method was how much they trusted it.These findings matter because AI is becoming more common in health information, but people may not be ready to trust it yet. For cancer prevention, this means patients might be more likely to act on information from familiar sources like Google rather than AI. Healthcare providers should be aware that patients may have different levels of trust in AI-generated health advice, which could affect how they interpret symptoms and decide when to seek medical care.

ObjectivesAdolescents and young adults (AYAs) with cancer often experience educational and vocational challenges that hinder long-term developmental goals and milestones. While more attention has been paid to addressing employment-related needs, little research has focused on identifying and addressing educational needs during or after treatment for AYAs with cancer, particularly younger AYAs, who rely on caregivers for educational support and guidance. We report our process for developing and refining an educational guidance session for caregivers of AYAs with cancer.MethodsGuided by an extended Social Determinants of Health framework, we developed a standardized process to identify and address educational needs reported by caregivers of AYAs with cancer. Key stakeholders were consulted at multiple stages of development, and the process included a prescreening tool, guidance session, and curated resource list. During beta testing, formative guidance sessions were conducted with caregivers, followed by one- and three-month follow-up check-ins to collect feedback and refine the intervention.ResultsDuring beta testing, we pre-screened caregivers of 16 AYAs (ages 12-20 years; M = 16.31; SD = 2.18). Thirteen caregivers screened positive and were eligible for the guided session; 11 reported their AYA had unmet educational needs. Reported concerns were clustered into three domains: school enrollment, learning support, and school-related financial barriers. Most participants reported sessions were helpful and appreciated personalized resources. Preferences varied by depth and frequency of support, underscoring the need for flexibility in delivery and resulted in a standard, yet tailorable slide for future guidance sessions.ConclusionThis caregiver- and patient-informed intervention addresses a critical gap in AYA cancer care by identifying and responding to educational needs. The structured guidance model is more inclusive of educational needs specific to younger AYAs and caregiver support and thus integrated as a component of an AYA needs navigation program (AYA-NAV). Adolescents and young adults with cancer often experience major disruptions to their education and work during and after treatment. These challenges can affect their emotional well-being, independence, and quality of life, yet support for navigating school and job-related needs is often limited. This study describes the development of educational guidance sessions designed to help young people with cancer and their caregivers identify and address education- and work-related challenges. The program includes a brief screening to identify needs, structured guidance sessions with a trained navigator, and tailored resources to support school and employment goals. Feedback from young people with cancer, caregivers, and other stakeholders was used to refine the program so that it is practical, relevant, and responsive to their needs. Although a pilot study is currently underway to examine how feasible and acceptable the program is in a clinical setting, this paper focuses on how the program was developed and refined. This work aims to improve access to educational and vocational support for young people with cancer and their families.

Brain tumors remain among the most lethal cancers, in part due to the limited ability of therapeutic agents to reach malignant cells protected by the blood-brain barrier (BBB). This specialized vascular interface preserves neural homeostasis through several mechanisms and different elements. In brain malignancies, the barrier may be disrupted, remodeled, or remain largely intact depending on tumor type, leading to highly variable effects on different therapeutic approaches. These challenges have driven the development of innovative delivery strategies, including molecular engineering, nanocarriers, receptor-mediated transport systems, focused ultrasound, and direct regional administration. Understanding BBB biology and its tumor-specific alterations is essential for designing effective therapeutic approaches capable of improving outcomes in brain cancer. Recent studies showed promising results with different approaches, including pharmacological approaches, nanotechnology-based approaches, physical disruption techniques, biological and cellular approaches, and convection-enhanced delivery. This review summarizes the current understanding of the role of BBB in brain cancer, and reviews emerging strategies to overcome this barrier and enable effective brain cancer therapy. Brain tumors are among the deadliest cancers because many treatments cannot reach the tumor cells. This is largely due to the blood&#x2013;brain barrier, a natural protective system that controls what substances can enter the brain to keep it healthy. In brain cancers, this barrier can behave differently: in some tumors it is damaged, in others it changes shape, and in some it stays mostly intact. Because of this, treatments that work for one brain tumor may not work for another. To overcome this problem, researchers are developing new ways to deliver drugs to the brain. These include designing drugs that can cross the barrier more easily, using nanoparticles, taking advantage of natural transport systems in blood vessels, applying focused ultrasound to temporarily open the barrier, and delivering treatments directly to the brain or tumor area. A better understanding of how the blood&#x2013;brain barrier works&#x2014;and how it changes in different brain tumors&#x2014;is critical for creating more effective treatments. This review explains what is currently known about the blood&#x2013;brain barrier in brain cancer and highlights new strategies aimed at improving drug delivery and patient outcomes.

BackgroundLiver cancer (LivCa) is one of the most prevalent malignancies globally, and can result from viral hepatitis, non-alcoholic steatohepatitis (NASH), and alcohol use. LivCa is of increasing concern in Asia, but the burden of etiology-specific LivCa and future projections remain to be elucidated.MethodsWe extracted the incidence, mortality, and disability-adjusted life years (DALYs) of LivCa across Asia and in 34 Asian countries in 1990-2021 from the Global Burden of Disease Study 2021 (GBD 2021). We then calculated their estimated annual percentage change (EAPC) and percentage variation to quantify the changes in the burden of LivCa. The association of the level of social development with LivCa burden was explored using the sociodemographic index (SDI). Moreover, the trend of the epidemiology of LivCa burden in Asia from 2022 to 2040 was predicted using the Bayesian age-period-cohort (BAPC) model.ResultsOverall, the age-standardized incidence, mortality, and DALYs rates of LivCa in Asia showed a general declining trend, with EAPCs of -0.47, -0.73, and -1.14, respectively. Notably, hepatitis B virus remained the predominant cause. However, the burdens attributed to non-alcoholic steatohepatitis and alcohol use increased significantly, while that of hepatoblastoma decreased. Regarding demographic distribution, the highest disease burden was observed among males and the elderly population aged 85-94 years. Geographically, Nepal, Taiwan (Province of China), India, and Malaysia contributed most substantially to the increasing burden. In terms of risk factors, high BMI and alcohol use were prominent in Central Asia, whereas smoking was a key factor in East and Southeast Asia. Additionally, a positive correlation was observed between the SDI and the burden of LivCa. Finally, projections from the BAPC model indicated a persistent decline in the burden of LivCa from 2022 to 2040.ConclusionsDespite the overall decreasing trend, targeted strategies addressing etiology-specific risks and regional disparities are urgently needed to further reduce the future burden of LivCa in Asia.

BackgroundThe approved induction chemotherapy regimen with docetaxel, cisplatin, and 5-fluorouracil is associated with a high risk of severe toxicity, which may compromise the feasibility of subsequent chemoradiation. Safer and more effective induction strategies are needed for patients with unresectable locally advanced head and neck squamous cell carcinoma (HNSCC).MethodsWe aimed to evaluate the feasibility, efficacy, and safety of induction immunochemotherapy followed by (chemo)radiation in patients with unresectable locally advanced HNSCC. In this prospective, multicenter, non-randomized phase II trial, patients with PD-L1-positive (Combined Positive Score &#x2265;1) locally advanced squamous cell carcinoma of the oropharynx, larynx, or hypopharynx and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 received three 21-day cycles of pembrolizumab, cisplatin, and 5-fluorouracil, followed by chemoradiotherapy or radiotherapy in the absence of disease progression.ResultsAmong 120 enrolled patients, 116 were evaluable for response. The objective response rate after induction therapy was 62.9%, including 16.4% complete responses. After a median follow-up of 26 months, the 2-year PFS and OS rates were 53.0% and 65.1%, respectively. Grade 3-4 adverse events occurred in 30.8% of patients, with neutropenia reported in 23.3% and febrile neutropenia in 1.7%. Immune-related events were infrequent and mild (skin rash: 1.7%; hypothyroidism: 0.8%). No treatment-related deaths occurred.ConclusionsInduction immunochemotherapy with pembrolizumab, cisplatin, and fluorouracil demonstrated encouraging efficacy, manageable toxicity, and high transition and completion rates of chemoradiation. These findings should be considered hypothesis-generating rather than practice-changing and require confirmation in a randomized trial. This study tested whether giving immunotherapy together with chemotherapy before radiation therapy can help patients with advanced head and neck cancer. One hundred twenty patients received three treatment cycles with pembrolizumab plus cisplatin and fluorouracil. Most patients responded well and almost all were able to continue to curative radiation treatment. Serious side effects were manageable, and no treatment-related deaths occurred. These results suggest that starting treatment with immunotherapy plus chemotherapy may improve outcomes and prepare patients better for radiation therapy.

IntroductionThis study investigates the cumulative association between adverse childhood experiences and lung cancer risk and analyzes whether a healthy lifestyle could modify this association.MethodsUsing the UK Biobank, we analyzed 156,798 participants who completed a baseline Mental Health Questionnaire. Lung cancer risk from age 30 was recorded, classifying childhood adversity severity using cumulative categories (none, mild [1-2 types], and severe [&#x2265;3 types]). We used multi-variable Cox regression and competing risk models to estimate hazard ratios (HR) between childhood adversity and lung cancer risk. Mediation analyses assessed the role of smoking.ResultsDuring a median follow-up of 41 years from age 30, 677 participants were diagnosed with lung cancer, and 401 died. Lung cancer risk increased progressively with increasing childhood adversity severity. Compared with individuals without childhood adversity, those who experienced any adversity had a 37% higher risk of lung cancer (HR 1.37, 95% CI 1.15-1.63), while those with severe adversity had an 82% higher risk (HR 1.82, 95% CI 1.27-2.62), demonstrating a clear summative effect. Participants who experienced any form of adversity had a 18% increased risk of dying from lung cancer (HR 1.18 [1.05-1.32]). Smoking severity was higher among participants with childhood adversity and accounted for approximately 40% of the observed association. Timely smoking cessation was associated with a substantially lower risk of lung cancer (approximately 75%). However, in the severe adversity group, smoking cessation did not provide a protective effect (HR 0.47 [0.20-1.09]). Smoking cessation significantly reduced lung cancer mortality regardless of adversity level.ConclusionChildhood adversity was associated with a higher risk of lung cancer in a cumulative manner, even after accounting for non-cancer death. Smoking accounted for a substantial proportion of the association between childhood adversity and lung cancer risk, and smoking cessation was associated with lower lung cancer risk across adversity levels. The association between childhood adversity and lung cancer remained robust, warranting further research to explore additional mediating pathways.

IntroductionAchieving the global goal of cervical cancer elimination faces major challenges, particularly in ensuring the large-scale and sustained implementation of proven technologies. In Argentina, HPV testing as primary screening was introduced through the Jujuy Demonstration Project (JDP) in 2012. The aim of this study is to analyze barriers and facilitators of the implementation of HPV testing in two provinces-Jujuy, and Catamarca-a decade after the JDP's completion.MethodsWe carried out a descriptive in-depth case study using a mixed-method approach, using qualitative and quantitative methods. Data were collected through participant observations in health services, semi-structured interviews with key informants, analysis of secondary sources, and program indicators. Barriers and facilitators were analyzed using an adapted Health System Framework focusing on four key dimensions: stewardship, organizational capacity, financing, and technology.ResultsRegarding stewardship, reduced technical support and monitoring from the National Program emerged as significant barrier. About financing, the most critical obstacle was the national interruption in the provision of HPV tests. Although both provinces have initiated procedures to purchase tests using provincial funds, this process was constrained by limited financial resources and competing priorities. Finally, regarding organizational capacity, challenges persisted in maintaining laboratory centralization, sustaining the offer of self-collection, and fully utilizing information systems for program monitoring. Facilitators related to stewardship included the stability of human resource in both provinces and the long-standing institutional recognition and leadership of provincial program staff. Sustained adherence to national guidelines and the existence of provincial resolutions were key enablers of continuity. In addition, acceptability of the technology remained high, with HPV testing continuing to be widely accepted in both provinces.ConclusionsOur findings reveal barriers and facilitators in the implementation ten years after JDP finalization, providing valuable lessons for scaling up HPV-based screening in national cancer control programs. Cervical cancer can be prevented through effective screening. Testing for human papillomavirus (HPV) is one of the most effective methods available. In Argentina, HPV testing was first introduced in 2012 through the Jujuy Demonstration Project, which helped expand this strategy nationwide. However, maintaining screening programs over time can be challenging, particularly when resources and support change. This study describes barriers and facilitators of HPV testing implementation in two Argentine provinces, Jujuy and Catamarca, 10 years after the original project ended. We used different sources of information, including interviews with health professionals and authorities, observations in health services, program documents, and screening indicators. The study found that stable health teams, strong leadership from provincial program staff, and adherence to national screening guidelines helped sustain HPV testing. However, reduced technical support and monitoring at the national level were challenges. A major difficulty arose when the national supply of HPV tests was disrupted in 2023, forcing provinces to purchase tests with their limited resources. Despite these challenges, HPV testing remains widely accepted by health care providers and is the preferred screening method in both provinces.

IntroductionPoor diet and excess weight have been linked to increased risk for at least 13 types of cancer. Culinary medicine utilizes experiential cooking skill development to improve individuals' capacity for healthy eating. Digital communication strategies offer pathways for scalable culinary medicine interventions, but little research has explored how online cooking tools could be leveraged for cancer prevention messaging. We conducted a cross-sectional survey study exploring online cooking information-seeking habits and content preferences among participants in four cancer prevention and control cohorts to inform future digital culinary medicine interventions.MethodsA cross-sectional survey study was conducted with a convenience sample of participants from four existing cohort studies being undertaken at the University of Texas MD Anderson Cancer Center. Survey items examined current cooking practices, online cooking information-seeking behavior, digital intervention content preferences, and evaluation of three online cooking videos. Descriptive statistics were used to summarize findings, and open text comments were examined using rapid thematic analysis to add further context.ResultsMost of the 102 respondents were women (99%), with a mean age of 58 years old. Many (78.4%) reported preparing meals at home &#x2265;4 days per week. Search engines were the most common way recipes were identified online and the majority of respondents reported cooking from online videos some or all of the time. Participants gave the highest overall ratings to the 2-4 minute cooking video and highlighted the host personality and video production as important aspects of online cooking video content.ConclusionsThe findings of this study offer insight to inform the development of digital culinary medicine tools for MD Anderson's cancer prevention and control cohorts.

IntroductionAdolescents and young adults (AYAs) with cancer experience substantial psychosocial distress, yet participation in supportive oncology services remains low. Community-based and nonprofit programs outside hospital systems provide essential developmentally appropriate supportive care, particularly during transitions to surveillance and longer-term follow-up, yet determinants of uptake in these settings are understudied. We examined program leaders' perspectives on participation gaps and strategies to strengthen equitable engagement beyond the hospital.MethodsWe conducted a qualitative interview study using semi-structured interviews with leaders of community-based and nonprofit AYA psychosocial support programs in the United States and Canada (N = 21). A structured environmental scan and expert verification yielded a 132-program sampling frame; 33 organizations expressed interest. Interviews were analyzed using the Framework Method, organized deductively with the Social Ecological Model and the Theoretical Domains Framework and refined inductively. Transcripts were double-coded, and themes were developed through team consensus.ResultsLeaders described multilevel determinants of uptake, including fragmented referral pathways, limited organizational capacity and program visibility, stigma and safety concerns, and misalignment between program structures and early adulthood realities. Timing was a cross-cutting determinant: engagement was described as least feasible during intensive treatment and especially vulnerable at transitions such as treatment completion and early survivorship, when routines shift and clinical contact decreases. A central finding was wide variability in sociodemographic data collection. Many programs did not routinely collect participant sociodemographic information, limiting their ability to identify representation gaps and tailor outreach. Leaders prioritized strategies including ethical sociodemographic data collection, trust-based community partnerships, clinician-facing referral workflow supports, and shared infrastructure for repeated needs assessment and resource matching.ConclusionLow participation was shaped by implementation conditions, not individual disinterest. Improving equitable uptake may require investments in referral and re-referral workflows across care transitions, equity-monitoring infrastructure, and community-embedded approaches that build trust and improve discoverability beyond the hospital. Young people with cancer often face serious emotional, social, and practical challenges. Many supportive programs exist to help them cope, but these services are often underused. This study explored why that gap exists by listening directly to the leaders of community-based cancer support programs. What We Did: We interviewed leaders from nonprofit and community-based programs in the United States and Canada that provide psychosocial support to adolescents and young adults with cancer. We asked about who their programs reach, who they struggle to reach, and what makes it difficult for young people to enroll or stay involved. What We Found: Program leaders described many barriers that limit participation. Young adults may feel overwhelmed by treatment, lack time or energy, or feel uncomfortable seeking support. Programs also face system-level challenges, such as unclear referral processes, limited visibility, staffing shortages, and heavy reliance on philanthropic funding. Most programs do not routinely collect demographic information, making it difficult to know which groups are being left out. Leaders consistently reported that young people from racially and ethnically minoritized communities, rural areas, lower-income backgrounds, or who speak languages other than English were least likely to participate. Why It Matters: Low participation in cancer support programs is not because young people do not want help. Instead, it reflects gaps in how support is organized, funded, promoted, and connected to health care systems. Improving referral pathways, collecting better demographic data, and building stronger community partnerships could help ensure that supportive care reaches young people who need it most.

IntroductionThe diagnosis of adult hematologic malignancies primarily originating in the bone marrow (BM) requires comprehensive evaluation. In many cases, a definitive diagnosis necessitates referring patients from peripheral healthcare centers to tertiary hospitals. This study aimed to analyze incidence patterns and age-specific trends of such malignancies over a decade at one national tertiary hospital in Indonesia.MethodsA retrospective cross-sectional study was conducted using bone marrow aspiration (BMA) results from patients suspected of having primary BM hematologic malignancies. Procedures were performed in the Division of Hematology and Medical Oncology, Department of Internal Medicine, and analyses were conducted in the Department of Clinical Pathology at Sardjito Hospital between 2012 and 2022. Sex and age data were collected to calculate crude incidence rates (CIR), age-specific incidence rates (ASR), and age-standardized incidence rates (ASIR).ResultA total of 3,144 cases were analyzed and the results showed that the incidence of myeloid lineage malignancies was higher than lymphoid, predominantly in males. ASR showed that Myeloproliferative Neoplasms (MPN) and Myelodysplastic Syndromes (MDS) increased with age. Acute Myeloid Leukemia (AML) remained stable in younger age groups but increased significantly in older adults. Acute Lymphoblastic Leukemia (ALL) was more common in younger individuals, particularly in the 20-24 age group. Meanwhile, the incidences of Chronic Lymphocytic Leukemia (CLL) and Multiple Myeloma (MM) increased with age. A linear regression analysis of incidence trends over the years showed no statistically significant trend.ConclusionThis study provides essential epidemiological evidence on hematological malignancies of primary BM origin in Indonesia, showing the predominance of myeloid lineage malignancies and distinct age-related patterns. These findings may support age-targeted awareness, early detection strategies, and coordinated national efforts to address the growing burden of hematologic malignancies in adults. The diagnosis of adult hematologic malignancies primarily originating in the bone marrow (BM) requires comprehensive evaluation. In many cases, a definitive diagnosis necessitates referring patients from peripheral healthcare centers to tertiary hospitals. This study aimed to analyze incidence patterns and age-specific trends of the malignancies over a decade at one national tertiary hospital in Indonesia. A retrospective cross-sectional study was conducted using bone marrow aspiration (BMA) results from patients suspected of having primary BM hematologic malignancies. Procedures were performed in the Division of Hematology and Medical Oncology, Department of Internal Medicine, and analyses were conducted in the Department of Clinical Pathology at Sardjito Hospital between 2012 and 2022. Sex and age data were collected to calculate crude incidence rates (CIR), age-specific incidence rates (ASR), and age-standardized incidence rates (ASIR). As a result, a total of 3,144 cases were analyzed and the results showed that the incidence of myeloid lineage malignancies was higher than lymphoid, predominantly in males. ASR showed that Myeloproliferative Neoplasms (MPN) and Myelodysplastic Syndromes (MDS) increased with age. Acute Myeloid Leukemia (AML) remained stable in younger age groups but increased significantly in older adults. Acute Lymphoblastic Leukemia (ALL) was more common in younger individuals, particularly in the 20&#x2013;24 age group. Meanwhile, the incidences of Chronic Lymphocytic Leukemia (CLL) and Multiple Myeloma (MM) increased with age. In conclusion, this study filled a major gap in the literature on primary bone marrow hematologic malignancies by providing essential epidemiological data on disease burden. Myeloid malignancies predominated and demonstrated distinct age-related incidence patterns.

IntroductionWhile largely preventable, cervical cancer remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), where gaps in screening uptake persist despite expanding prevention efforts. In many patriarchal settings, men play influential roles in household decision-making and access to healthcare, positioning them as critical but under-engaged stakeholders. There remains limited understanding of how educational strategies to improve health literacy can be designed to effectively engage men in supporting women's screening participation.MethodsWe conducted a qualitative study in northern Ghana to explore men's understanding, priorities, and values related to cervical cancer prevention to inform male-focused educational strategies. Guided by the Consolidated Framework for Implementation Research and the Health Belief Model, 9 in-depth semi-structured interviews were conducted with married adult men recruited from community settings, examining household roles, perceptions of cervical cancer and screening, and preferences for education and engagement approaches. Interviews were conducted in English or Dagbani, audio-recorded, transcribed, and analyzed thematically using a hybrid inductive and deductive approach.ResultsThree cross-cutting themes emerged. Men viewed healthcare professionals as trusted sources of cervical cancer information and described their roles as primary financial decision-makers, with cost and competing household priorities influencing support for screening. Masculine responsibility, particularly related to fertility and family wellbeing, strongly motivated engagement, and messages framed around these themes were more compelling than disease-focused messaging alone. Participants recommended integrating education into routine health services, leveraging healthcare workers, offsetting screening-related costs, and using mass media to initiate awareness and information seeking.ConclusionMen represent pivotal yet underutilized partners in cervical cancer prevention. Educational strategies that align with men's roles, economic realities, and trusted sources of information and address household decision-making barriers may enhance screening uptake while supporting women-centered care. These findings provide implementation-relevant insights to inform male-engaged cervical cancer prevention strategies across diverse LMIC settings.

IntroductionAdolescents and young adults (AYA) with cancer have limited opportunities to share their experiences and insights with healthcare providers and supporters. However, they have tangible insights to share with a goal of improving AYA cancer care and support. We worked with 11 AYAs to design an immersive theatre experience that invited audience members-AYAs, healthcare providers (including community organizations), health leaders, researchers, funders, and family members and supporters-to get a felt sense of what it means to navigate cancer as an AYA.Methods91 audience members participated in the immersive theatre experience. Each member provided informed consent and completed a qualitative questionnaire. Responses were analyzed thematically.ResultsIn their responses audience members reflected on three overarching clusters: struggles with providing care and support, impacts of the immersive theatre experience on audience members, and tangible actions to improve cancer care and support for AYAs.ConclusionThis novel approach to research and knowledge translation helped to: identify the need for more tools to better support AYAs; provide an embodied, experiential approach to learning; catalyze responsibility; identify tangible changes to improve cancer care and support; and to invite audience members to move from agency to action. Further follow-up remains necessary to further understand the ongoing impacts; however, immersive theatre experience can offer an innovative approach to inspire changes in AYA cancer care and support in practice.

IntroductionBone metastasis in breast cancer patients can lead to poor quality of life and cause significant morbidity. First-line treatments for bone metastases include bone modifying agents that inhibit osteoclast activity to reduce bone resorption. The most commonly used bone modifying agents include zoledronic acid and denosumab. It is currently unknown whether a therapy change from zoledronic acid to denosumab would result in greater symptom control or improved disease outcomes in breast cancer patients. In this single institution retrospective cohort study, we aimed to identify the reasons why patients transitioned from zoledronic acid to denosumab and to determine whether denosumab, as a second-line therapy, led to reduced narcotic use for metastatic bone pain.Materials and MethodsBreast cancer patients with bone metastases treated at The Ohio State University Comprehensive Cancer center from 2011-2018 with a bone modifying agent were examined. Nineteen patients who received second-line denosumab following previous exposure to zoledronic acid were identified and included in this study.ResultsThe two most common reasons patients switched from zoledronic acid to denosumab were related to side effect burden (28%) and bone metastasis progression (28%). No reduction in narcotic use due to bone pain was observed six months after starting denosumab. None of the patients developed new skeletal related events after switching to Denosumab.ConclusionOverall, denosumab as a second-line therapy appeared to be well-tolerated in our cohort, as we did not observe any treatment-related toxicity. Patients who switched to denosumab did not experience improved pain control. When breast cancer spreads to the bone, it can cause pain and poor quality of life. The first-line treatments used are bone-strengthening agents, which work by slowing down bone breakdown. The two most commonly used drugs are zoledronic acid and denosumab. However, it is not known whether switching from zoledronic acid to denosumab provides better symptom control or outcomes. In this study, we looked at why patients switched to denosumab and whether this change helped with bone pain and reduced pain medication use. We reviewed breast cancer patients with bone metastasis who were treated at The Ohio State University Comprehensive Cancer Center between 2011 and 2018. Nineteen patients who received denosumab after first being treated with zoledronic were included. The most common reasons for switching to denosumab were side effects from zoledronic acid and worsening bone disease. Overall, denosumab was well tolerated as a second-line treatment. However, switching to denosumab did not appear to improve pain control in our group of patients.