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The incidence of gastroesophageal cancer diagnosed at ages younger than 50&#x2009;years is increasing. Assessment of the clinicopathologic and molecular characteristics of these cancers is limited currently. This analysis used Tempus' clinicogenomic database to compare patients diagnosed with gastroesophageal cancer at ages younger than 50 vs 50 years and older who completed tumor molecular profiling between December 2017 and July 2024. The spectrum of biomarkers, somatic alterations, and germline alterations were compared between those diagnosed with gastroesophageal cancer at ages younger than 50 years and those aged 50 years and older, and a multivariate analysis was conducted to identify factors associated with longer survival. Among 5863 gastroesophageal cancer patients, 785 had gastroesophageal cancer diagnosed at ages younger than&#x2009;50 years. There were more females (35% vs 25%, P&#x2009;<&#x2009;.001) and fewer White patients (69% vs 80%, P&#x2009;<&#x2009;.001) with gastroesophageal cancer at ages younger than 50 years. Fewer tumors of patients with gastroesophageal cancer at ages younger than 50 years had high tumor mutational burden (3.2% vs 10.2%, P&#x2009;<&#x2009;.001) or high microsatellite instability (1.7% vs 5.1%, P&#x2009;<&#x2009;.001), but there was no difference in PD-L1 positivity (49% vs 51%, P&#x2009;=&#x2009;.3). Higher incidence of somatic CDH1 mutations was seen in those with gastroesophageal cancer at ages younger than 50 years (16.1% vs 6.6%, q&#x2009;<&#x2009;0.001) with lower incidence of TP53 (65.6% vs 74.1%), CDKN2A (12.5% vs 19.8%), and KRAS (11.7% vs 18.3%, P&#x2009;<&#x2009;.001 for all) alterations. The most statistically significant germline difference was higher incidence of CDH1 (2.2% vs 0.3%, q&#x2009;=&#x2009;0.001) and TP53 (0.6% vs 0%, q&#x2009;=&#x2009;0.039) alterations among those with gastroesophageal cancer at ages younger than 50 years. Median survival for patients with metastatic disease was longer for gastroesophageal cancer at ages younger than 50 years (11 vs 8.5&#x2009;months, P&#x2009;=&#x2009;.002), and gastroesophageal cancer at ages younger than 50 years, ERBB2 amplification, and high microsatellite instability were associated with superior survival. Unique molecular and germline profiles were seen in patients with gastroesophageal cancer at ages younger than 50 years, which may suggest differences in causal factors yet undiscovered.

In aggregate, rare cancers are not so rare as they collectively represent about one-fourth of all cancer cases. As defined by the National Cancer Institute (NCI), rare cancers are those that affect fewer than 15 people per 100,000 individuals annually. Research on this wide spectrum of malignancies has been limited, often due to their rarity. Survival rates for many rare cancers are worse than for more common cancers. To address many of the issues that impact the advancement of prevention/interception research for rare cancers, the NCI and the Department of Defense (DoD) hosted a two-day virtual workshop in May 2024. Key stakeholders, including scientists, clinicians, and patient advocates from across the United States, Canada, and the United Kingdom, came together to identify critical research gaps in rare cancers, address approaches for prevention, and discuss the emerging opportunities in the field. Participants engaged in an open discussion, exploring and promoting the prospects to further research on rare cancer prevention and interception. This article addresses the major challenges associated with rare cancers research and outlines potential strategies to advance efforts in the prevention and interception of rare cancers.

Breast cancer screening is crucial for early detection and improved survival in Alzheimer disease and related dementias (ADRD) patients, but real-world evidence of its effects on survival and prognosis remains insufficient. We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare data (1999-2019) to analyze the impact of breast cancer screening on prognosis (ie, cancer stage) and survival in ADRD women with breast cancer diagnosed at ages 67&#x2009;years and older. Logistic and Cox regression models were employed to assess the relationship between screening and risk of advanced stage at diagnosis and length of survival, adjusted for relevant covariates (eg, marital status, comorbidities, age at screening). The cohort included 8739 ADRD patients with breast cancer, with 4483 completed at least 1 screening between their ADRD and first breast cancer diagnosis. The cohort completed screening had statistically significant lower rates of advanced-stage diagnosis (22.2% vs 42.6%) and longer survival (65.9 vs 45.7&#x2009;months) compared with the cohort without any screening history. Unscreened patients had 2.7 times higher odds of advanced-stage diagnosis and 2 times higher hazard of death than patients with at least 1 screening completed before breast cancer diagnosis. Effects of comorbidities, age, and race were statistically significant on diagnosis stage and survival in breast cancer patients. Our study demonstrated the benefit of screening in early diagnosis and longer survival in ADRD patients with breast cancer, which advocates for an expansion of current breast cancer screening recommendations to more effectively guide cancer care for ADRD patients.

Cancer survivors are at-risk for transportation insecurity given the frequency of medical visits and cost of care. Little is known about how transportation insecurity relates to important social relationship measures adversely impacting cancer survivors (eg, loneliness, lack of emotional support). Thus, we evaluated the association between transportation insecurity and social relationship measures among patients with and without a history of cancer. Using data from the 2023 Behavioral Risk Factor Surveillance System, we characterized relationships between transportation insecurity and 2&#xa0;social relationship measures: (1) loneliness and (2) emotional support among individuals with and without a history of cancer. We used multivariable logistic regression models to estimate associations between transportation insecurity and adverse social relationships, with sensitivity analyses for at-risk groups. Models were adjusted for sociodemographic and health-related covariates. We identified 237 180 respondents with 29 579 reporting a history of cancer (12.5%). Transportation insecurity was more common among individuals who were younger, non-White, uninsured or publicly insured, unemployed, unable to work, and not partnered. Transportation insecurity was associated with both social relationship measures (loneliness: aOR&#x2009;=&#x2009;1.24-3.00, 95% CI = 1.11 to 3.54; lack of emotional support aOR = 1.31-2.47, 95% CI = 1.19 to 2.84). Although these associations were consistent across cancer and non-cancer populations, in univariate analyses individuals with a history of cancer reported transportation insecurity more often if they were younger (18-49&#x2009;years), non-White, had Medicaid, or no insurance compared to those without a history of cancer. These findings highlight intersections between transportation insecurity and unmet social relationship needs among individuals with and without a history of cancer.

Although cancer prevention, care, and survivorship in the United States have dramatically improved over the last decade, inequities in morbidity and mortality among under-resourced populations have grown, mostly attributed to structural, societal, and institutional factors. To address inequities in cancer-related outcomes, community-engaged research (CEnR) and practice remains essential. Community-engaged research is generally supported by Community Outreach and Engagement (COE) units in National Cancer Institute-designated cancer centers. For more than a decade, COE remains a requirement for comprehensive designation and is a significant factor in the overall cancer center scoring. Community engagement occurs on a continuum from community-engaged to community-based participatory research. Engaging communities experiencing inequities in cancer incidence, morbidity, and mortality to ameliorate factors contributing to poorer cancer-related outcomes remains a goal, albeit a challenging one. This commentary details both novel and successful approaches that researchers throughout the country have used to engage communities to address cancer-related inequities in their catchment areas by leveraging COE infrastructure to facilitate CEnR across research programs. We also highlight and forward recommendations from a recent scientific pre-conference workshop. Cancer center-led CEnR is critical to engaging with key communities, and yet there are tremendous opportunities to better articulate and implement approaches to effective engagement. Internal inequities and barriers in COE infrastructures and how researchers, directors, and stakeholders can collaborate to optimize cancer health outcome/CEnR are discussed, in addition to potential solutions involving collaboration with upstream policy stakeholders. In this commentary, we emphasize why this work remains an ongoing but critical priority.

Social work (SW) notes provide a multifaceted narrative of a patient's cancer journey. Topic modeling is a computational technique that can be used to cluster notes into thematic clusters and study topics in oncological SW at scale. In this study, we used BERTopic to perform topic modeling of cancer SW notes and identify roles and themes frequently documented in oncological SW. We collected 106,676 SW notes from 25,341 patients diagnosed with cancer at UCSF. Notes were split at the sentence level, and BERTopic model parameters were optimized experimentally. For each BERTopic cluster, two annotators independently assigned labels to 250 randomly selected sentences and keyword sets, with disagreements adjudicated by a third reviewer. Given the same sentences and keywords, three large language models (LLMs) independently labelled each cluster. Finally, human- and LLM-generated labels were harmonized. Topic modeling of SW notes revealed 15 topics, classified into three distinct subthemes: social worker assessments of patient psychosocial needs and service provision, patient-centric factors, experiences, and the impact of cancer diagnosis on lifestyle; and family and caregiver experiences when caring for someone with cancer. Topic modeling supplemented by large-language model interpretation reveals complex psychosocial themes experienced by patients receiving social work services during cancer care. We envision these methods supporting research that clusters oncological social work notes into thematic cohorts for qualitative studies on how social work care differs across patient strata and how topics are differentially distributed across cancer subtypes.

Cognitive effects of breast cancer antiestrogen endocrine therapy are a salient concern for survivors, given the growing evidence that estrogen plays a role in late-life dementia risk. The APOE4 genotype has been linked with risk for cognitive difficulties, studied mainly in younger cancer survivors. We found that women aged 60+ with nonmetastatic breast cancer enrolled in the prospective Thinking and Living with Cancer study who underwent endocrine therapy had lower subjective (P&#x2009;=&#x2009;.06) and objective (P&#x2009;=&#x2009;.08) cognitive function than frequency-matched controls across time. At 5 years, however, women with breast cancer exposed to endocrine therapy and APOE4 carriers in particular exhibited lower learning and memory scores than other groups (P&#x2009;<&#x2009;.05). Our results suggest endocrine therapy may have long-term effects on cognitive function in women with breast cancer, particularly APOE4 carriers. Further characterization of genetic risk for long-term cognitive decline will be useful to inform survivorship care of older women.

The purpose of this systematic review and meta-analysis was to (i) evaluate effects of exercise on cancer-related lymphedema (CRL) incidence, and (ii) explore whether effect differed according to patient and exercise intervention characteristics. A search of 6 electronic databases was undertaken to identify intervention studies published up to May 2025. Studies included individuals at risk of and with CRL, comparing exercise to no exercise, and reporting lymphedema outcomes. Meta-analyses using random effects models estimated the relative risk (RR) of exercise on CRL. Exploratory subgroup analyses were conducted for upper- vs lower-limb lymphedema, <5 or 5+ lymph nodes dissected, and exercise intervention characteristics including exercise mode and degree of supervision. Overall quality of evidence was assessed using the GRADE approach. Seventeen studies (published 2002-2024) involving 2739 individuals were included. Most (88%, n&#x2009;=&#x2009;15) studies focused on upper-limb lymphedema post-breast cancer, and 2 studies investigated risk of lower-limb lymphedema. With low overall certainty, the RR of developing CRL for those in the exercise group compared with the non-exercise group was 0.71 (95% confidence interval [CI] = 0.53 to 0.96). The majority of evidence is derived from studying those at high risk of breast cancer-related lymphedema, but subgroup analyses suggest that the benefit may extend outside the breast cancer setting. Subgroup analyses support participation in any/all exercise modes, even when unsupervised. These findings underscore the promise of exercise for CRL risk reduction and the urgent need for rigorously designed trials to clarify effects across patient risk profiles, cancer types, and exercise approaches. CRD42020196623.

People with advanced cancer often invest substantial amounts of time to receive palliative treatments. This has been labeled the "time toxicity" of cancer treatment. However, stakeholder views on time toxicity are still being established. This study used mixed methods to explore Australian oncologists' perspectives on the time burdens of palliative systemic cancer treatments. Semistructured qualitative interviews were conducted with a convenience sample of gastrointestinal oncologists recruited from 1 metropolitan and 1 regional center, supplemented by online advertising through the Australian Gastro-Intestinal Trials Group. Themes emerging from initial interviews (n&#x2009;=&#x2009;8) informed the development of an online survey disseminated to Australian oncologists via professional groups. Qualitative data were analyzed using an inductive approach. Survey data were summarized descriptively. Fifteen oncologists were interviewed, 60% of whom were primarily based in major metropolitan areas. One overarching theme-the value of time-unified 4 subthemes: (1) contributors to time toxicity, (2) benefits and uncertainties, (3) time as a decision-modifier, and (4) proposed solutions. Surveyed oncologists (n&#x2009;=&#x2009;108) expressed broad agreement with the thematic framework in interviews, affirming the importance of time for patients with advanced cancer and supporting strategies to reduce time burdens. However, responses acknowledged the subjectivity of time toxicity to individual patients. This mixed-methods study establishes Australian oncologists' perspectives on the time toxicity of palliative systemic cancer treatments, identifying potential barriers and opportunities for including discussions of health-care time into shared decision making, and system-level strategies for addressing unwanted health-care contact time.

COVID-19 pandemic-related disruptions may have altered pediatric cancer detection in the US. Using the National Childhood Cancer Registry, we compared observed incidence rates among individuals aged 0-17 years during 2020-2022 to expected rates with 95% credible intervals (CrI) derived from pre-pandemic trends. Rates were evaluated overall and by race/ethnicity, cancer site, and stage-at-diagnosis. Among 27,996 cancers diagnosed in 2020-2022, total incidence was 17.44 per 100,000, similar to the expected rate of 17.39 (95% CrI, 16.80-17.98). Annual patterns showed an incidence reduction in 2020, followed by modestly higher-than-expected rates in 2021-2022. Pandemic-era late-stage incidence was significantly higher than expected, however (10.58 vs 10.19 per 100,000). Overall, pediatric cancer incidence during the COVID-19 pandemic matched expectations, but late-stage diagnoses increased, underscoring the need to restore timely evaluation and maintain diagnostic access during health-system disruptions.

Cancer surveillance in Mainland China is based on household-registered residents (HRR) and therefore fails to cover migrant populations. This introduces selection bias and leads to a misestimation of the true cancer burden. Estimating lung cancer (LC) incidence and mortality among resident populations (RPs) provides a more accurate epidemiological and public health assessment. Using 2016 data from 487 cancer registries and multidimensional covariates, we developed a Bayesian-integrated nested Laplace approximation with stochastic partial differential equation (INLA-SPDE) model to estimate LC incidence and mortality among the RP, with adjustments for interprovincial migration. In 2016, the interprovincial migrant population in Mainland China reached 140.96 million, representing 10.1% of the HRR. The results indicate that the INLA-SPDE model outperformed the Bayesian hierarchical linear model in estimation accuracy, effectively captured spatial heterogeneity and achieved a Bayesian credible interval coverage exceeding 94%. Significant disparities in LC incident cases and deaths between RPs and HRR were observed in Henan (9159 cases and 7539 deaths), Guangdong (8851 cases and 7235 deaths), and Shanghai (5406 cases and 4332 deaths). The largest rate differences occurred in Shanghai (incidence, 20.4/100&#xa0;000, 23.7%; mortality, 8.7/100&#xa0;000, 15.1%). Disparities in incidence and mortality vary with the direction and magnitude of interprovincial migration, indicating that household-registered residency-based registration overestimates LC burden in high-immigration regions and underestimates it in high-emigration regions. We recommend transitioning to RP-based registration to improve the accuracy of LC burden estimates of cancer surveillance, particularly in regions with substantial migrant populations.

Childhood cancer radiation therapy (RT) increases subsequent neoplasm risk. Radiation dose may modulate DNA damage responses, but the small sample sizes of prior human studies of homologous recombination repair hampered dose-specific investigations. We pooled data for 12&#x2009;180 survivors (8339 from the Childhood Cancer Survivor Study and 3841 from the St Jude Lifetime Cohort) to estimate associations between deleterious homologous recombination repair variants and RT-related subsequent neoplasms (most commonly breast cancer, meningioma, thyroid cancer, and sarcoma) using conditional logistic regression with matched controls. In all, 1253 (10.3%) survivors were homologous recombination repair variant carriers, and 1301 (10.7%) developed at least 1 RT-related subsequent neoplasms. Variants increased the risk of out-of-field RT-related subsequent neoplasms (cases, 40/190 [21.1%]; control individuals, 9.7%; odds ratio&#x2009;[OR] =&#x2009;2.5, 95% confidence interval [CI]&#x2009;=&#x2009;1.7 to 3.6; P&#x2009;=&#x2009;4.80&#x2009;&#xd7;10-6), with consistent results across cohorts (Childhood Cancer Survivor Study, OR&#x2009;=&#x2009;2.5, 95% CI&#x2009;=&#x2009;1.6 to 3.7, P&#x2009;=&#x2009;3.77&#x2009;&#xd7;10-5; St Jude Lifetime Cohort, OR&#x2009;=&#x2009;2.5, 95% CI&#x2009;=&#x2009;1.0 to 6.4, P&#x2009;=&#x2009;3.07&#x2009;&#xd7;10-2). No association was observed for in-field or near-field subsequent neoplasms or individuals not undergoing RT. Findings emphasize homologous recombination repair variant-conferred susceptibility to RT-related subsequent neoplasms and dose-dependent DNA damage repair.

Breast cancer survivors face many health challenges, including tinnitus, hearing loss, and vertigo which will grow with an aging population and improved treatment outcomes. However, the prevalence of hearing/vestibular problems, racial differences, and relationships to physical function are poorly characterized in breast cancer survivors. Between July and September 2023, we surveyed the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Tinnitus, hearing loss, and vertigo were self-reported and verified through electronic health records. Physical function impairment was measured using the SF-36 10-item instrument. We fit logistic regression models for hearing/vestibular problems and linear regression models for physical function score, controlling for sociodemographic and clinical factors. Of 1466 breast cancer survivors (mean [SD] age, 63.5 [11.8] years), 16.6%, 17.3%, and 8.6% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Black survivors had lower odds of hearing loss (adjusted odds ratio [AOR] = 0.51; 95% confidence interval [CI] = 0.31 to 0.86) but greater odds of vertigo (AOR = 2.29; 95% CI = 1.34 to 3.89) than White survivors. Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without. In the adjusted regression models, survivors who reported experiencing tinnitus (&#x3b2; = 0.76; 95% CI = 0.10 to 1.43), hearing loss (&#x3b2; = 0.73; 95% CI = 0.06 to 1.40), or vertigo (&#x3b2; = 1.70; 95% CI = 0.81 to 2.58) had a higher level of physical function impairment. This study demonstrates racial differences in hearing/vestibular problems and associations between these problems and physical function impairment. Survivorship programs should consider routine screening and interventions to improve hearing health and physical function among breast cancer survivors.

Financial toxicity (FT), the economic stress from medical care, is common among people with cancer and is associated with worse health outcomes. While risk factors for FT are known, personalized FT risk prediction tools to help mitigate FT are lacking. This study developed and evaluated machine learning models to predict FT risk using data from the Medical Expenditures Panel Survey-Experiences with Cancer Survivorship Supplement for patients undergoing or within 1&#x2009;year of cancer treatment. FT was defined as the presence of >1 of the following: bankruptcy, unpaid medical bills, payment concerns, or debt. Several models were trained using demographic, clinical, economic, and social variables. Fine-tuning was performed to enhance sensitivity in predicting FT. The Shapley additive explanations (SHAP) were used for interpretability of the model. Among 793 people with cancer, 283 (36%) experienced FT. A fine-tuned random forest algorithm achieved an AUROC of 0.84 (95% CI&#x2009;=&#x2009;0.78 to 0.91) and an accuracy of 0.78 (95% CI&#x2009;=&#x2009;0.71 to 0.85), with a sensitivity of 0.84 (95% CI&#x2009;=&#x2009;0.72 to 0.92) and specificity of 0.75 (95% CI&#x2009;=&#x2009;0.66 to 0.83), demonstrating balanced classification performance. SHAP values identified key predictors of FT risk, including younger age, lower income, higher medical expenditures, and poorer health status. To support clinical implementation, we developed a web-based FT risk calculator (https://hd-research.shinyapps.io/ftriskcalc/). The fine-tuned random forest algorithm resulted in promising results for predicting personalized FT risk. Integrated into a web-based calculator, the model has strong potential to help mitigate FT by identifying high-risk patients early in the cancer care continuum.

Colorectal cancer (CRC) survival is improving, yet long-term survivors remain at risk for cancer- and treatment-related late effects, which may emerge many years after diagnosis and treatment. We aimed to summarize evidence on late effects and their risk factors reported &#x2265;5&#x2009;years after CRC diagnosis, compared to cancer-free controls. The literature search for this scoping review was conducted in PubMed, EMBASE, and Web of Science from inception to November 18, 2025. Primary research studies investigating late effects and providing relative risk estimates specifically &#x2265;5&#x2009;years after diagnosis were included. Risk of bias was assessed with the Newcastle-Ottawa-Scale. The study was registered with Open Science Framework, 10.17605/OSF.IO/JY6DX. We identified 9 observational studies that reported relative risk estimates for late effects. Seven studies had a low risk of bias and 2 were at moderate risk. The most frequently investigated late effect was incidence of diabetes (5 studies). The highest relative risks were reported for immunity disorders (5-10&#x2009;years hazard ratio [HR] = 4.56, 99% CI = 1.36 to 15.31), depression (>5&#x2009;years HR = 2.65, 95% CI =1.61 to 4.36), and nutritional deficiency (5-10&#x2009;years HR = 1.69, 99% CI = 1.38 to 2.08). Comorbidities at diagnosis, age at diagnosis, and treatment were the most common risk factors associated with late effects. This scoping review found that even &#x2265;5&#x2009;years after diagnosis late effects requiring treatment are considerably more common among CRC survivors than cancer-free controls. The small number of studies and the broad spectrum of identified late effects highlight the need for extensive research to characterize late effects to improve long-term survivorship care.

The ArteraAI Prostate Test (ArteraAI Inc.) is the first predictive biomarker for the benefit of adding short-term androgen deprivation therapy (ADT) to radiotherapy for intermediate-risk prostate cancer. We evaluated the cost-effectiveness of ArteraAI to guide short-term ADT using a Markov model simulating 15-year outcomes for 71-year-old patients with intermediate-risk prostate cancer receiving radiotherapy using NRG/RTOG 9408 data on which ArteraAI was validated. Three strategies were compared: (1) all patients receive ADT (ADT-for-all), (2) only patients with unfavorable intermediate-risk prostate cancer receive ADT (National Comprehensive Cancer Network [NCCN]), and (3) only ArteraAI-positive patients receive ADT (ArteraAI). Costs and utilities obtained from Medicare claims and published literature were used to calculate incremental cost-effectiveness ratios. A willingness-to-pay threshold of $100&#x2009;000/quality-adjusted life year (QALY) was chosen. The ADT-for-all strategy was dominated by the NCCN strategy. Compared with the NCCN strategy, the ArteraAI strategy lowered costs by $12&#x2009;296 and improved effectiveness by 0.01 QALYs making it dominant.

Over the past decade, various large observational studies have suggested an association between silicone breast implants (SBIs) and autoimmune and rheumatic diseases (ARDs), rekindling long-standing breast implant-safety concerns among breast cancer survivors with breast reconstructions and newly diagnosed breast cancer patients. We investigated the association between SBIs and ARDs in a large multicenter cohort of women treated for breast cancer, part of whom received SBIs for reconstructive purposes. Clinical data and events of interest were identified through linkages with prospectively maintained nationwide- and institutional registries. Hazard Ratios (HRs) for ARDs were calculated using Cox proportional hazards regression models adjusted for potential confounders. Of 12,262 women in the cohort, 3,082 (25%) had received SBI-based breast reconstructions. Median follow-up time was 12.0 (IQR, 7.0) years. The event rate of ARD-diagnoses was 62.5 per 10,000 person-years. Compared with women without SBI-exposure, women with an implant-based breast reconstruction did not have an increased risk of ARDs (multivariably adjusted HR, 1.06, 95% CI [0.89 to 1.27]). In addition, no statistically significant association was found between SBI-exposure and inflammatory arthritis, systematic rheumatic disease, inflammatory dermatosis, inflammatory bowel disease or any specific condition. Sensitivity analyses in which SBI-exposure was analyzed as a time-dependent variable confirmed the results of the main analysis. The findings of this study indicate that SBI-exposure is not associated with an increased risk of ARDs in women with breast cancer and challenge the results of earlier studies in women with cosmetic implants. This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality in the US, yet survival outcomes are shifting with evolving therapies and screening. Recent findings suggest that survival improvements vary across healthcare systems, with favorable trends observed in the Veterans Health Administration (VHA). We sought to compare NSCLC survival trends across US health systems. We conducted a retrospective cohort study of patients with NSCLC (2007 to 2019) using data from the VHA and the National Cancer Database (NCDB), representing the non-VHA US general population. The primary exposure was health system (VHA vs non-VHA), and the primary outcome was 3-year all-cause mortality. Multivariable Cox models estimated annual adjusted overall survival (OS), with interaction terms for health system and stage. Among 1,463,996 patients (VHA n&#x2009;=&#x2009;79,027; NCDB n&#x2009;=&#x2009;1,384,96), adjusted 3-year OS increased from 24% to 51% (VHA) and from 24% to 41% (non-VHA) between 2007 and 2019. The VHA survival advantage persisted in analyses stratified by stage (all p-values <0.0001), and when analyses were limited to NCDB patients with Medicare or private insurance (51% vs 42% in 2019; p&#x2009;<&#x2009;0.0001). In this nationally representative study, 3-year OS among patients with NSCLC improved between 2007 and 2019, with larger and more rapid gains observed within the VHA compared to non-VHA settings. These findings suggest that lung cancer care delivered within an integrated, publicly funded system is associated with greater and more rapidly improving survival than care delivered across a heterogeneous mix of U.S. healthcare delivery settings represented in the NCDB.

Given excellent prostate cancer outcomes, comorbidity management is critical to survivorship. While hormone therapy or androgen deprivation therapy (ADT) is a mainstay of treatment, they can negatively impact quality of life and survivorship through cardiovascular, sexual, and metabolic effects. ADT-induced metabolic syndrome causes impaired glucose tolerance, muscle mass loss, and weight gain. This systematic review examined recent randomized clinical trials (RCTs) investigating the impact of diet and weight management strategies on mitigating ADT-related adverse effects. A systematic review of RCTs (2015-2025) was performed using PubMed/Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To identify how diet and weight management impacts ADT symptoms, search terms included: "prostate cancer," "diet," "nutrition," "glucagon-like peptide-1 receptor agonists" (GLP-1RA), and "ADT." Risk of Bias 2 (ROB2) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools evaluated RCT quality. Of 2799 publications, 16 met inclusion/exclusion criteria (range, 23-96 patients/RCT). No RCTs had a high risk of bias or evaluated GLP-1RA. Outcomes included metabolic labs, body composition, and quality of life. Mediterranean and low-carbohydrate diets with exercise reduced cardiovascular and metabolic risk factors, with variable durability. Creatine trended toward increasing lean muscle mass. Multidisciplinary care and community involvement improved accountability and outcome durability. This comprehensive review of diet and ADT in prostate cancer identified nutritional interventions that were safe, feasible, and may be recommended as part of prostate cancer treatment and survivorship. Future RCTs should evaluate optimal diet duration, longer follow-up, multidisciplinary patient support, and novel anti-metabolic therapies like GLP-1RA.