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.
Most squamous cell carcinomas of the anus, or anal cancers, are attributable to persistent infection with the human papillomavirus (HPV), analogous to cervical cancer. Although rare in the general population, rates of anal cancer are high among people with immune-compromising conditions or a history of HPV-related cancers. Recent evidence demonstrates that treatment of high-grade squamous intraepithelial lesions (HSIL), a precursor of anal cancer, prevents progression to anal cancer. This has motivated the international release of several guideline statements now recommending anal cancer screening. For a new practice of cancer screening to be integrated into routine care for at-risk populations, implementation strategies will need adaptation for local settings. Our aim is to illustrate the potential value of combining the methods of implementation science with the anal screening cascade framework to support evidence-informed adoption of the guidelines across the different clinical services points where patients might undergo anal cancer screening. We point out means by which research activity could be directed, with particular attention to identifying and addressing care gaps to inform the adoption and scale-up of anal cancer screening. These approaches may help to guide local decisions regarding first steps for anal cancer screening implementation, including determining which populations may need enhanced effort, and to identify where more preparation may be needed. It is time to understand how to best implement anal cancer screening. Although rare in the general population, rates of anal cancer are 20 to 100 times higher among people living with HIV, or with solid organ transplants, or among women who have had human papillomavirus-related cancers. Like cervical and colorectal cancer, early detection and treatment can prevent anal cancer. Unlike cervical or colorectal cancer, most jurisdictions do not routinely screen for anal cancer. In 2024, the first international guidelines for anal cancer screening were released. They recommend that clinicians offer screening to people at the highest risk—those who are at greater than 10 times the risk of the general population. In our paper, we describe strategies to evaluate early attempts at anal cancer screening implementation to support efforts to ensure that anal cancer screening becomes part of regular health care for people in whom it is recommended.
IntroductionIn Mexico, delays in pediatric cancer diagnosis remain a major barrier to timely care and are partly driven by inefficiencies in referral pathways. This study aimed to evaluate the impact of a direct pathway on referral intervals for patients with suspected childhood cancer treated at a high-specialty hospital in Mexico.MethodsWe conducted a retrospective observational cohort study based on a comprehensive review of medical records of patients referred to a high-specialty hospital in Mexico between 2017 and 2022. Patients' characteristics, along with dates from symptom recognition to diagnosis, were collected. The exposure was the referral pathway: standard versus direct (Golden Code strategy) pathway, which enables access to pediatric oncology through a zero-rejection policy. The primary outcome was the time attributable to oncological referral (TAOR), analyzed as a continuous variable and a dichotomous outcome. Secondary intervals were calculated using standardized definitions. Regression models were used to evaluate factors associated with untimely (>7 days) referral.ResultsA total of 399 patients were included. The direct pathway was associated with a shorter TAOR compared to the standard pathway (median 2.0 vs. 7.0 days; p<0.001). The proportion of timely referrals was substantially higher in the direct pathway (91.3%) than in the standard (50.6%) and reduced the likelihood of an untimely referral (OR = 0.098, 95% CI: 0.055-0.173; p<0.001). No differences were observed in other diagnostic intervals.ConclusionThe direct referral pathway improves the timeliness and consistency of access to pediatric oncology care by reducing referral delays and increasing the proportion of patients evaluated within recommended referral intervals. However, the absence of changes in the secondary intervals, such as time to oncological diagnosis, highlights the need for complementary actions targeting downstream diagnostic processes. Strengthening referral systems represents a feasible and impactful strategy to address delays in pediatric cancer care in middle-income settings. In Mexico, many children and adolescents with suspected cancer experience delays before seeing a cancer specialist. These delays can occur for various reasons, including the organization of the health system. When referrals move slowly through several levels of care, diagnosis and treatment may be postponed. This study examined a program called the Golden Code, which is designed to help children with possible cancer access a pediatric cancer specialist more quickly. The program allows doctors to refer patients directly to a specialized hospital, reducing administrative steps and speeding up appointments. Researchers reviewed the medical records of 399 children and adolescents treated between 2017 and 2022. They compared those referred through the Golden Code program with those referred through the usual system. The results showed that children referred through the Golden Code were seen by a cancer specialist much faster. On average, they had their specialist visit within two days, compared to seven days under the standard referral system. The program greatly reduced the chances of a delayed specialist visit. These findings show that improving how patients are referred within the health system can make an important difference in how quickly children with suspected cancer receive expert evaluation. Although Mexico performs better than some countries with fewer resources, further improvements in referral processes and access to care could help ensure children receive timely diagnosis and treatment.
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 ≥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’s overall health, treatment goals, ability to tolerate surgery, and personal preferences.
IntroductionSurveillance of at-risk populations for pancreatic ductal adenocarcinoma (PDAC) is a potential strategy to reduce its incidence and improve its prognosis. However, there is considerable debate about who should participate and relatively little information about how people perceive different testing options.MethodsUsing the Health Belief Model as a framework, this qualitative, observational study including eleven focus groups and seven interviews, summarizes the knowledge, motivations, barriers and preferences for PDAC surveillance in underserved populations with low cancer screening rates and for high-risk individuals (HRI).ResultsHRIs have a high motivation to participate in PDAC screening and perceive few barriers to engage. Participants from underserved populations had little knowledge of PDAC and surveillance, but they were interested in surveillance for PDAC based on their perception of the benefits of cancer screenings. The main barriers for participation in PDAC surveillance programs were cost, distrust of the larger medical system, discomfort associated with the testing, lack of a provider's recommendation, and fear of a positive result. These barriers varied based on a person's race/ethnicity and geographic location (urban vs. rural). Preferences expressed by underserved populations suggest that tests for early PDAC detection will need to be accurate, no or low cost, minimally invasive, and convenient to access. There was a correlation between a person's self-perceived susceptibility for PDAC and their willingness to tolerate more invasive and less convenient methods. In addition, participants were motivated to participate in early detection programs with clear guidelines accompanied by their doctor's recommendations.ConclusionThere appears to be an association between actual and perceived risk of PDAC and patient willingness to participate in an early detection program. For populations lower along the risk spectrum, there is limited knowledge about pancreatic cancer or its risk factors, and potentially significant barriers to participate in an early detection program if deemed eligible. Surveillance of at-risk populations for pancreatic cancer (PDAC) is a potential strategy to reduce its incidence and improve its prognosis. However, there is considerable debate about who should participate and relatively little information about how people perceive different testing options. Using the Health Belief Model as a framework, this qualitative study, including eleven focus groups and seven interviews, summarizes the knowledge, motivations, barriers and preferences for PDAC surveillance in underserved populations with low cancer screening rates and for high-risk individuals (HRI). We found that HRIs have a high motivation to participate in PDAC screening and perceive few barriers to engage. Participants from underserved populations had little knowledge of PDAC and surveillance, but they were interested in surveillance for PDAC based on their perception of the benefits of cancer screenings. People who lost a family member due to cancer also felt susceptible to PDAC and were more motivated to participate. The main barriers for participation in PDAC surveillance programs were cost, distrust of the larger medical system, discomfort associated with the testing, lack of a provider’s recommendation, and fear of a positive result. These barriers varied based on a person’s race/ethnicity and geographic location (urban vs. rural). Preferences expressed by underserved populations suggest that tests for the early detection of PDAC will need to be accurate, no or low cost, minimally invasive, and convenient to access. There was a correlation between a person’s self-perceived susceptibility for PDAC and their willingness to tolerate more invasive and less convenient methods. In addition, people were motivated to participate in early detection programs that had clear guidelines accompanied by their doctor’s recommendations. This study should inform the development and dissemination of novel PDAC detection tests that might be applied to at-risk patient populations.
IntroductionCancer pain is one of the most debilitating sequelae of cancer, and reducing this symptom burden benefits patients, nurses, and the nursing profession, especially in the care of breakthrough cancer pain (BTCP). This study aimed to assess the clinical application effectiveness of advanced nursing practices in a nurse-led cancer pain management model.MethodsThis was a non-randomized before-after quasi-experimental study. Using the convenience sampling method, 116 patients experiencing cancer pain who were admitted to tertiary comprehensive hospitals in the southern Hubei region from 2020 to 2021 were selected as the control group, and 104 patients experiencing cancer pain who were admitted from 2022 to 2025 were selected as the intervention group. A full process management model for cancer pain was implemented in the intervention group, whereas the control group did not receive the intervention. Both groups were followed-up for 6 months to compare the average pain score, incidence of BTCP, and satisfaction with pain control.ResultsThe incidence of BTCP in patients with cancer decreased from 42% to 23% (19% reduction), the accuracy of the pain score evaluation increased from 84% to 95% (11% increase), and satisfaction with pain control increased from 80% to 94% (14% increase). The average pain and BTCP scores of patients with cancer pain significantly improved (P<0.05).ConclusionsThe nurse-led cancer pain management model may play a positive role, suggesting potential benefits in reducing the incidence of BTCP, effectively controlling the average pain score, and enhancing patient satisfaction with pain management.
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 2×2 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 (α > .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.
IntroductionWomen with metastatic breast cancer (mBC) often face complex treatment decisions that require careful consideration of values and priorities, which may be unique to each individual and evolve over the course of treatment. The patient-reported Values Assessment Tool (VAsT) was developed to help prioritize and communicate values to clinicians and care partners, thereby improving treatment decision-making. This study aimed to further refine the VAsT, assess perspectives on utility and usability of the VAsT, and evaluate the potential impact on communication between women with mBC, care partners, and clinicians who utilize the VAsT.MethodsA qualitative study using cognitive interview methodology was conducted. Qualitative cognitive interviews were conducted with seven women with mBC, three care partners, and four breast oncology clinicians. Participant feedback informed the refinement of the tool, and thematic analysis guided by Normalization Process Theory was conducted to understand the utility and usability of the VAsT among women with their clinicians and care partners.ResultsThe VAsT domains were confirmed (e.g., financial concerns of affording cancer care; minimize and manage side effects of treatment), and instructions and purpose were refined. Three themes related to the usability and communication with VAsT were identified: 1) Comprehension of values and meaningful use of the tool, 2) Usability and format of the VAsT, and 3) Communication and clinical utility of the VAsT.ConclusionFindings indicate there is variation in perspectives of how often the VAsT should be utilized over the course of treatment, which future research on the feasibility and efficacy of the VAsT will better elucidate. Women with mBC may use the VAsT to facilitate communication and build trust with clinicians, which is perceived to allow for higher-quality care and value-congruent treatment decisions.
IntroductionIn 2013, the United States (U.S.) Preventive Services Task Force recommended low-dose computed tomography (LDCT) for lung-cancer screening. We assessed temporal, population-level changes in incidence, stage at diagnosis, and mortality before and after this recommendation among adults aged 55-79 years.MethodsUsing the US Centers for Disease Control and Prevention Wide-ranging Online Data WONDER (CDC WONDER), Global Burden of Disease (GBD), and SEER data, we examined age-adjusted incidence (AAIR) and mortality (AAMR) trends. Joinpoint regression and interrupted time-series (ITS) models evaluated pre- and post-2014 changes in population-level trends; counterfactual analyses estimated differences between observed outcomes and projections based on pre-2014 trends. SEER was used to characterize stage distributions (localized, regional, distant).ResultsPost-2014 declines accelerated across data systems. Annual AAMR decreased by 3.03% in CDC WONDER and 2.58% in GBD; AAIR declined by 1.85% and 2.37%, respectively. SEER showed a higher proportion of localized disease and fewer distant-stage diagnoses after 2014; joinpoint analyses identified a 2013 inflection with steeper declines in distant-stage incidence thereafter. In models extrapolating pre-2014 trends to subsequent years, observed deaths were lower than counterfactual projections by 28,168 in CDC WONDER and 6,906 in GBD. As an exploratory indicator, mortality-to-incidence ratios declined nationally and in both sexes.ConclusionsDuring the USPSTF LDCT guideline era, independent national datasets showed accelerated mortality declines and a shift toward localized-stage diagnoses. These convergent findings are temporally consistent with real-world benefits of LDCT screening, but they should be interpreted within a broader context that includes continued reductions in smoking, gradual screening uptake, and major therapeutic advances. The findings are hypothesis-generating and do not estimate the isolated causal effect of LDCT screening. Why was this study done? Lung cancer is the leading cause of cancer death worldwide. To reduce these deaths, United States health officials issued a major recommendation in 2013: adults aged 55–79 with a history of heavy smoking should undergo annual screening using Low-Dose Computed Tomography (LDCT). The goal of this policy was to catch tumors early when they are curable. We wanted to see if this national recommendation actually led to better outcomes for patients across the country. What did we do? We analyzed data from three massive national databases (CDC WONDER, Global Burden of Disease, and SEER) covering millions of Americans. We compared trends in lung cancer cases and deaths from before the recommendation (1999–2013) to the trends after it was implemented (2014–2021). We used statistical models to determine if the “speed” of improvement changed after the policy began. What did we find? We found that after 2014, lung cancer death rates declined more rapidly than in earlier years. We also observed a population-level shift toward more localized-stage diagnoses and fewer distant-stage diagnoses. Compared with projections based on pre-2014 trends, observed deaths were approximately 28,000 lower in CDC WONDER data during the post-2014 period. What does this mean? These findings are consistent with improved population-level lung cancer outcomes during the guideline era. However, they cannot determine how much of the observed change was attributable to LDCT screening, as smoking reductions, diagnostic changes, and therapeutic advances also occurred during this period.
IntroductionDeep learning has rapidly reshaped breast cancer imaging, but the evolution of segmentation, detection, and diagnostic research remains insufficiently characterized. This bibliometric review mapped global trends, collaboration patterns, thematic evolution, and emerging frontiers from 2006 to 2025.MethodsThis bibliometric study retrieved publications on deep learning in breast cancer imaging from the Web of Science Core Collection and Scopus. English-language articles and reviews published between 2006 and 2025 were included. After deduplication, Bibliometrix, VOSviewer, and CiteSpace analyzed publication trends, country contributions, collaboration patterns, keyword co-occurrence, temporal topic evolution, and citation bursts.ResultsA total of 3,568 publications were included. Annual output remained limited before 2016 but increased markedly thereafter, with especially rapid growth after 2020, indicating the transition of this field from an exploratory stage to accelerated development. China ranked first in corresponding-author publications, whereas the USA and the United Kingdom showed stronger citation impact, reflecting differences between publication scale and academic influence. Keyword analysis showed that the field was primarily structured around deep learning, breast cancer, mammography, segmentation, detection, and computer-aided diagnosis. Temporal analyses further indicated a shift from early computer-aided diagnosis frameworks and conventional neural-network approaches toward more advanced and clinically relevant themes, including explainable artificial intelligence, nomogram, self-attention, transformers, neoadjuvant therapy, and axillary lymph node metastasis.ConclusionDeep learning in breast cancer imaging has evolved into a rapidly expanding and increasingly sophisticated field centered on segmentation, detection, and clinically relevant diagnostic research. Future progress will depend on improved interpretability, robust validation, and stronger clinical integration. Breast cancer is one of the most common cancers worldwide, and early and accurate detection is critical for improving patient outcomes. In recent years, a type of artificial intelligence called deep learning has been increasingly used to help analyze medical images, such as mammograms, to find and diagnose breast cancer. In this study, we reviewed and analyzed thousands of scientific papers published between 2006 and 2025 to understand how research in this field has developed over time. We found that before 2016, there were relatively few studies, but research activity increased rapidly after that, especially in the past five years. This shows that deep learning has become an important and fast-growing area in breast cancer imaging. We also found that early studies mainly focused on basic computer programs to assist doctors, while more recent research is exploring advanced methods that can not only detect cancer but also help explain how decisions are made and support treatment planning. New topics such as improving model transparency, using more advanced algorithms, and linking imaging results with clinical outcomes are becoming increasingly important. Overall, our findings show that deep learning is playing a growing role in breast cancer imaging and has the potential to improve diagnosis and patient care. However, further work is needed to ensure that these technologies are reliable, understandable, and widely applicable in real clinical settings.
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 ≥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.
IntroductionRacial disparities in ovarian cancer outcomes persist even after accounting for clinical and treatment factors. Psychosocial stressors, including discrimination and perceived stress, may contribute through behavioral and biological pathways, but their associations with advanced disease at diagnosis remain understudied.MethodsWe conducted a cross-sectional analysis of 451 women (69 Black, 382 White) with ovarian cancer enrolled in the Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD) study, a population-based study recruiting from state cancer registries across seven US states between March 2021 and August 2024. Participants completed surveys assessing everyday discrimination (EOD) and perceived stress (PSS-4); disease characteristics were obtained from cancer registry records. Logistic regression models assessed associations between psychosocial stressors and late-stage disease (FIGO stage IV) or Type II epithelial histology.ResultsOverall, 12.4% reported EOD in ≥3 domains while 11.5% reported high PSS-4 scores. Black women reported significantly higher discrimination levels; 49% reported discrimination in 3+ domains versus 6% of White women. PSS-4 scores did not differ by race. In adjusted models, higher EOD score was associated with 42% increased odds of late-stage disease (OR 1.42, 95% CI: 0.64, 2.98) and higher PSS-4 score with 32% increased odds (OR 1.32, 95% CI: 0.56, 2.94), though these associations were not statistically significant. Discrimination while receiving service in stores or restaurants showed a nominally significant association with late-stage diagnosis (adjusted OR = 2.11, 95% CI: 1.05-4.25), though this did not survive correction for multiple testing.ConclusionsBlack women with ovarian cancer experience substantially higher levels of racial discrimination, but these exposures were not consistently associated with advanced disease at diagnosis. A nominally significant domain-specific association with service-setting discrimination warrants investigation in larger, prospective studies. These findings suggest that specific discrimination experiences may represent a pathway through which psychosocial stress contributes to ovarian cancer disparities. What We StudiedWe examined whether stress and experiences of discrimination are connected to how advanced ovarian cancer is when women are first diagnosed. We surveyed 451 women with ovarian cancer (69 Black, 382 White) about discrimination in everyday life and their stress levels. To our knowledge, this is one of the first studies to examine these connections in a diverse group of ovarian cancer patients.What We FoundBlack women reported dramatically higher levels of discrimination than White women. Nearly half (49%) reported discrimination in three or more areas of daily life, compared to only 6% of White women, with the largest gaps in getting service in stores or restaurants, at work, and in housing. This represents a substantial, largely invisible burden that Black women carry alongside their cancer diagnosis. We did not find consistent, statistically significant links between discrimination or stress and later-stage diagnosis overall. Women who experienced discrimination while getting service in stores or restaurants appeared more likely to be diagnosed at a later stage, but this connection was no longer statistically reliable once we accounted for the many comparisons we made. Other measures of discrimination and stress showed similar trends that were not strong enough to confirm.Why This MattersThis study documents that Black women with ovarian cancer face dramatically higher discrimination in their daily lives. While discrimination in public settings may be linked to later-stage diagnosis, larger studies are needed to confirm these patterns and clarify how chronic stress might shape cancer outcomes.
In low- and middle-income countries (LMICs), leadership in cancer prevention and control is often concentrated among a small number of key individuals across the cancer continuum. While these leaders are crucial to system development, insufficient succession planning and mentorship mean that over-reliance on individuals places cancer prevention and control at risk of disruption during leadership transitions. Grounded in a critical synthesis of the field, this Perspective examines succession planning and mentorship in cancer prevention and control, highlighting how fragile leadership pipelines, the "missing middle" of mid-career professionals, and informal mentorship cultures and structural inequities, weaken system continuity and resilience. The article further examines barriers to effective mentorship in LMICs and proposes strategies centered on institutionalized mentorship, inclusive approaches, and distributed leadership to strengthen continuity and sustainable development of cancer prevention and control systems. A stable leadership structure requires collaboration across career stages, with senior leaders contributing institutional memory and strategic judgement, mid-career professionals anchoring operational delivery and governance, and early-career professionals contributing innovation and fresh perspectives. Importantly, we advocate for succession planning and mentorship to be institutionalized as core functions of cancer systems, rather than left to individual goodwill, to enable this collaborative structure to sustain leadership continuity and resilience.
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 20–24 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.
IntroductionFrailty is a known predictor of poor outcomes in older patients with cancer; however, its recognition in non-older populations remains limited. In this prospective multicenter observational study, we compared the Taiwan Cancer Frailty Tool (TCFT) with the Flemish version of the Triage Risk Screening Tool (fTRST) and comprehensive geriatric assessment (CGA) in screening for frailty among non-older Taiwanese patients with cancer.MethodsWe prospectively enrolled 1,162 patients with cancer aged <65 years from multiple Taiwanese centers (2022-2024). Frailty was assessed using CGA (reference standard), TCFT, and fTRST, with frailty defined as ≥2 abnormal CGA domains. Both TCFT and fTRST were tested at two thresholds (>0 and >1). Diagnostic performance metrics and Kaplan-Meier survival analyses were performed.ResultsThe median patient age was 54 years (range, 20-64 years), and 74.6% were male. The predominant cancer types were head and neck, esophageal, and gastric/small bowel cancers. The prevalence of frailty was 44.0% (CGA), 65.0% (TCFT >0), and 73.4% (fTRST >0). TCFT >0 demonstrated a higher sensitivity (88.8%) and negative predictive value (86.0%) than fTRST >0 (88.5% and 80.9%, respectively). TCFT >1 provided superior specificity (93.1%) and positive predictive value (83.5%). The area under the curve for TCFT was significantly higher than that for fTRST (0.788 vs. 0.748; p = 0.012). All tools predicted poor survival, with TCFT exhibiting a more consistent prognostic performance across thresholds than fTRST.ConclusionFrailty is prevalent and prognostically significant in non-older patients with cancer. TCFT demonstrated superior diagnostic and prognostic utility compared with fTRST, supporting its integration into routine frailty screening for this population.
IntroductionIn 2026, an estimated 321,910 new cases of invasive breast cancer will be diagnosed.However, there is a lack of comprehensive data on breast cancer incidence trends and how they vary across different age groups and racial and ethnic populations. Existing studies have evaluated breast cancer incidence trends over short periods, resulting in a lack of clear information on specific population variations over extended periods to ascertain disease-specific trends.MethodsWe used the 2000-2023 Surveillance, Epidemiology, and End Results program dataset to analyze routine data and published cancer cases to identify incidence trends and disease burden by age and race/ethnicity using Joinpoint regression. We included new cases of breast cancer identified using International Classification of Diseases (ICD) codes. Patient's demographic information was obtained from the medical records.ResultsThe overall breast cancer incidence among women was 190.8 per 100,000, showing an increasing trend from 2000 to 2023. There was also a significant increase in age-adjusted incidence rates in breast cancer trends from 2000 to 2023 (AAPC = 0.76%), with the highest incidence being reported in women aged 75-⁠79 years (456.3 per 100,000). Non-Hispanic white women recorded the highest incidence over the period (228.9 per 100,000). Non-Hispanic White women experienced increasing incidence trends between 2000 and 2023 (AAPC = 0.76%).ConclusionFrom 2000 to 2023, there was a significant increase in breast cancer incidence trends in all groups, with notable rates among women in their 40s and above. These trends underscore the need for adaptive screening strategies and policy recommendations to initiate mammography at age 40. Progress could also be accelerated by understanding the associations among ethnic, racial, and other existing social disparities to ensure early diagnosis and treatment.
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.
IntroductionLymphomas are a heterogeneous group of haematological malignancies commonly treated with chemotherapy. Hodgkin lymphoma predominantly affects younger adults, while Non-Hodgkin lymphoma is more prevalent among older adults. Although survival outcomes have improved, treatment-related cardiovascular, musculoskeletal, and functional adverse effects contributing to fatigue, reduced cardiorespiratory fitness (CRF), diminished quality of life (QoL), and increased frailty risk, remain, particularly among older adults. Reduced CRF, measured by peak oxygen uptake (VO2peak), is an independent predictor of all-cause and cancer-specific mortality, and chemotherapy tolerance, making its preservation a clinically meaningful target. Evidence supporting exercise during active chemotherapy remains limited. This study aims to evaluate the effect of a 20-week combined exercise (EX) intervention on CRF in people with lymphoma receiving chemotherapy, compared with a treatment-as-usual (TAU) group.MethodsEDONOLA is a randomised (1:1), multicentre, parallel-group, open-label controlled clinical trial involving adults aged >18 years (n=180, EX, n=90; TAU, n=90). The exercise intervention comprises supervised sessions (two days/week) of low-to high-intensity resistance and aerobic interval training, plus two days/week of unsupervised exercise. The TAU group will receive standard clinical care and physical activity advice. Assessments will be conducted at baseline, 10 weeks, and 20 weeks. The primary outcome will be CRF, measured as VO2peak. Secondary outcomes will include muscular strength, frailty, body composition, physical activity, sedentary behaviour, QoL, fatigue, sleep, and biochemical profile, including immune biomarkers. Older participants (≥70 years) will additionally undergo a comprehensive geriatric assessment, and EX participants will be invited to a voluntary semi-structured qualitative interview.DiscussionThis multidisciplinary project integrates structured exercise into standard oncology care, aligned with Sustainable Development Goal 3. The intervention aims to mitigate treatment-related side effects, preserve CRF and muscular strength, improve QoL, and reduce frailty risk in people with lymphoma undergoing chemotherapy, while potentially decreasing long-term healthcare burden. People with lymphoma often receive chemotherapy, which can cause tiredness, loss of strength and fitness, and make everyday activities more difficult. These effects can be especially challenging for older adults. Exercise may help reduce these problems, but there is still limited research on how helpful it is for people receiving treatment for lymphoma. The EDONOLA study will test whether a 20-week exercise programme can help people with lymphoma stay stronger and fitter during chemotherapy. The study will include 180 adults with Hodgkin and non-Hodgkin lymphoma. Half of the participants will take part in supervised exercise sessions that combine strength and aerobic activities, along with additional exercise at home. The other half will receive their usual medical care and general advice about physical activity. Researchers will measure changes in physical fitness, strength, tiredness, sleep, daily activity, and quality of life during the study. Older participants will also receive additional health assessments. The goal is to find out whether exercise can help people cope better with treatment, maintain independence, and improve wellbeing during and after chemotherapy.