Early-onset gastrointestinal cancers (EOGIC) are increasingly recognised as an urgent global health concern. We aimed to describe the global incidence patterns of EOGIC in 2022 and evaluate country-level ecological associations with behavioural risk factors. The incident cases and age-standardised incidence rates (ASIRs) of overall EOGIC, early-onset colorectal cancer (EOCRC), early-onset oesophageal cancer, early-onset gallbladder and biliary tract cancer, early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset stomach cancer (EOSC) were extracted from the GLOBOCAN 2022 database. We used machine learning and generalised linear regression to screen and quantify the associations of behavioural risk factors and computed the model-based attributable fraction estimates. In 2022, an estimated 465 584 new EOGIC cases occurred globally (9.49% of all-age gastrointestinal cancers), with an ASIR = 11.50 per 100 000 persons. Early-onset colorectal cancer was the highest in both incident cases (n = 186 840), and ASIR = 4.60 per 100 000, followed by EOLC and EOSC. High Human Development Index countries (n = 205 168 incident cases, ASIR = 13.20 per 100 000) showed highest incidence of EOGIC. The highest number of EOGIC incident cases was in Eastern Asia (n = 147 677) and the highest ASIR occurred in Australia-New Zealand (ASIR = 18.70 per 100 000). In the ecological analyses, diet high in red meat and smoking showed the largest attributable fraction estimates for overall EOGIC incidence, at 12.78% and 8.17%, respectively. Smoking also showed comparatively larger estimates for EOCRC (11.29%) and EOPC (23.97%). High alcohol use was associated with nonzero attributable estimates for EOCRC (3.14%), early-onset oesophageal cancer (1.57%), EOLC (7.39%), EOPC (3.75%), and EOSC (6.88%), whereas diet high in sodium showed the largest estimate for EOSC (15.41%). Early-onset gastrointestinal cancer was a significant global health challenge, particularly for EOCRC and in high Human Development Index countries. These findings may help inform surveillance priorities and hypothesis generation for future etiologic research.
Anthropometry regarding muscle and fat is related to the mortality and quality of life in patients with cancer. We evaluated the role of muscle (hand grip strength, HGS) and fat (triceps skinfold thickness, TSF) in survival and quality of life among patients with cancer. The study included 15,788 (53.9% men) patients with cancer from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers Project of China. Outcomes included survival and health-related quality of life (QoL). Statistical analysis was performed using a maximally selected rank statistical method for sex-specific cutoff values. Cox analysis and Kaplan-Meier curves were used for survival analysis, and one-way ANOVA trend testing was used for quality of life. The patients' mean age was 57.25 ± 11.66 years. High TSF (adjusted HR = 0.77, 95% CI = 0.72-0.81, P < 0.001) and high HGS (adjusted HR = 0.72, 95% CI = 0.68-0.76, P < 0.001) were positively associated with survival. Patients with high TSF and low HGS (adjusted HR = 0.61, 95% CI = 0.54-0.68, P < 0.001) had better survival than patients with low TSF and high HGS (adjusted HR = 0.73, 95% CI = 0.67-0.78, P < 0.001). The quality of life of patients with high TSF and low HGS was also better than that of patients with low TSF and high HGS. The results were consistent in subgroup analyses of men and women and in sensitivity analyses that excluded patients who died within 6 months. TSF and HGS are positively associated with survival and quality of life. Considering the differences in TSF and HGS between men and women, fat mass is a better indicator of patients' survival and quality of life than muscle function.
Individuals with cancer often endure a substantial symptom burden. However, little is known about the symptom burden of patients with cancer participating in early phase cancer clinical trials (EPCT). We prospectively enrolled adults with cancer participating in EPCTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed surveys prior to EPCT initiation that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General), depression/anxiety symptoms (Patient Health Questionnaire-4), and financial well-being (COST). We used regression models to explore associations of symptom burden with patient-reported outcomes and clinical outcomes. Among 195 patients enrolled, 185 participants completed the surveys (94.9% response rate). Participants had a median age of 63.5 years (range: 31.8-88.6) and 57.3% were female. Most common cancer types were gastrointestinal and breast. Median survival was 7.82 (IQR: 3.88-18.71) months, and median follow-up time was 12.20 (IQR: 7.99-16.80) months. Participants reported moderate/severe fatigue (51.7%), poor well-being (49.7%), drowsiness (36.2%), pain (26.4%), and lack of appetite (25.8%). Higher ESAS-total scores and greater number of moderate/severe symptoms were associated with lower QOL, increased depression/anxiety symptoms, and worse financial well-being (p-values < 0.05 for all). Higher ESAS-total scores (HR:1.02, p < 0.001) were associated with worse overall survival. Among EPCT participants, higher symptom burden at time of clinical trial initiation correlated with decreased QOL, increased depression/anxiety symptoms, worse financial well-being, shorter time on trial, and worse overall survival. Interventions seeking to enhance care delivery and outcomes for EPCT participants should strive to address the symptom burden of this population.
Home-based chemotherapy via port catheters offers logistical and potential psychological benefits but may pose unique challenges for patients undergoing prolonged regimens such as mFOLFOX6. Evidence on the association between home-based infusion and anxiety, quality of life, and healthcare use in gastrointestinal (GI) cancer patients remains limited. In this prospective study, 190 GI cancer patients scheduled for adjuvant mFOLFOX6 were enrolled between July 2020 and December 2024. Patients chose either home-based port infusion (n = 94) or hospital-based peripheral infusion (n = 96). Anxiety was assessed using the State-Trait Anxiety Inventory (STAI-1 and STAI-2), and quality of life via EORTC QLQ-C30 at baseline, after six cycles (~3 months), and after 12 cycles (~6 months). Treatment-related toxicities and emergency visits were recorded. Logistic regression identified factors associated with high anxiety, low quality of life, and emergency visits. Baseline characteristics were similar between groups except for younger age in the home-based group, which lost significance after Bonferroni correction. After six cycles, home-based patients showed significantly higher state and trait anxiety than hospital-based patients (p < 0.001), though differences diminished by 12 cycles. Home-based patients also reported worse dyspnea, pain, fatigue, and nausea/vomiting after six cycles, with most symptoms improving later. Emergency visits without organic pathology were more frequent in the home-based group (32% vs. 13%, p = 0.002), although this difference did not remain statistically significant after Bonferroni correction. Multivariable analysis identified home-based infusion, living alone, social inactivity, shorter treatment duration, and low quality of life as independent factors associated with high state anxiety. Similar factors were associated with high trait anxiety, low quality of life, and emergency visits. Home-based port infusion for mFOLFOX6 is associated with transient increases in anxiety and impairments in quality of life early in treatment, which diminished by the end of treatment. Psychosocial support and close follow-up may help reduce anxiety and unnecessary emergency visits, particularly for socially isolated patients. Further randomized studies are warranted.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
The ongoing demographic transition toward an aging population is accompanied by a rising number of geriatric patients with cancer. Anemia is a common finding in older patients with malignancy. This study aimed to evaluate the prevalence of anemia and its association with functional status and depression among treatment-naïve geriatric patients with solid organ cancer (SOC). In this observational study, geriatric patients with SOC underwent screening for anemia and a comprehensive geriatric assessment (CGA). Those with anemia were further evaluated with iron studies, stool for occult blood, upper and lower gastrointestinal endoscopies, serum B12 and folate levels, Coombs test, serum lactate dehydrogenase levels, and a bone marrow examination, as appropriate. Descriptive statistics (mean, median, and standard deviation), Pearson's chi-square test, Fisher's exact test, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney U test were used to analyze the data. One hundred and seventy-six patients were included. The median age was 67 (range 60-94) years, with a male preponderance of 76.7% (n = 135) and a stage IV, 81.8% (N = 144) disease. Anemia was detected in 51.7% (n = 91) of patients, with 51.6% (n = 47) having grade 2 severity. Iron deficiency anemia (IDA), functional IDA, possible functional IDA, and no iron deficiency (NID) were found in 23.1% (n = 21), 44% (n = 40), 12.1% (n = 11), and 16.5% (n = 15) of the patients, respectively. We found a significant association of anemia with body-mass index (P = 0.017), performance status (P < 0.005), activities of daily living (P < 0.010), instrumental activities of daily living in males (P < 0.034), balance and mobility (P = 0.016), and depression (P < 0.001). More than half of the geriatric patients with SOC were anemic at presentation, with functional IDA being the most common subtype, followed by IDA. Anemia was significantly associated with poorer functional status, impaired mobility and balance, and higher rates of depression, underscoring its substantial impact on both the physical and psychological well-being of older patients with cancer. These findings highlight the importance of comprehensive geriatric assessment and detailed characterization of anemia subtypes, including IDA, functional IDA, possible functional IDA, and NID, as management strategies may vary according to iron status.
Gastrectomy due to gastric cancer leads to metabolic alterations in body composition, significantly affecting nutritional status. This prospective study aimed to investigate the metabolic effects of gastrectomy and perioperative treatment on the nutritional status of gastric cancer patients. A total of 37 patients diagnosed with gastric cancer, treated with perioperative chemotherapy, without evidence of dissemination or metastasis, were included in the study. Demographic data, Body Mass Index, full blood count parameters, lipid profiles, vitamin B12, vitamin D, iron levels, albumin, prealbumin, total serum protein concentration, bioimpedance parameters, physical activity levels, quality of life, Prognostic Nutritional Index, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were assessed preoperatively and at two follow-ups (6 and 12 months post-surgery) for each patient. Significant changes were observed across the analyzed parameters, demonstrating the metabolic impact of gastrectomy and perioperative systemic treatment on the nutritional status of gastric cancer patients. The study provides a comprehensive evaluation of the long-term nutritional status of gastric cancer patients post-gastrectomy, offering valuable insights into postoperative metabolic and dietary adaptations. Obtained results underscore the dynamic physiological adaptations following gastric resection, emphasizing the importance of nutritional and metabolic monitoring for long-term recovery. Targeted rehabilitation strategies and micronutrient supplementation are crucial in reducing postoperative complications and improving patient outcomes.
Post-treatment weight gain and gut dysbiosis are important concerns in breast cancer patients. However, evidence on the gut microbiota in this population, particularly in relation to physical activity, is limited. Therefore, we compared gut microbiota in breast cancer patients with obesity with healthy controls and non-cancer controls with obesity and subsequently examined the effects of a combined dance and dietary intervention on gut microbiota, metabolic health, physical fitness, and quality of life. The observational part compared gut microbiota in breast cancer patients with obesity (BCO, BMI 32.43 ± 4.90 kg/m2) with non-cancer controls with obesity (OC, BMI 37.78 ± 6.68 kg/m2) and healthy controls (HC, BMI 21.26 ± 1.26 kg/m2). A controlled trial was conducted in breast cancer patients with obesity, with an intervention group (INT, n = 13) receiving a 12-week combined dance and dietary intervention and non-intervention controls (CTRL, n = 10). Gut microbiota was assessed using 16S rRNA sequencing, physical fitness was evaluated by an incremental bicycle ergometer test and motor tests, and quality of life was measured using the EORTC QLQ-C30 and BR23 questionnaires. In the observational study, breast cancer patients showed significant differences in beta diversity and a lower relative abundance of health-associated bacteria (e.g., Faecalibacterium prausnitzii) compared with both controls. In the controlled trial, the intervention led to a significant improvement in body composition, physical fitness (e.g., Vo2max, handgrip strength), and several validated quality-of-life domains (e.g., fatigue, body image). A statistically significant difference in beta diversity at the post-intervention phylum level was observed (p = 0.046, R2 = 0.11). Microbiota composition within INT shifted toward, increased health-associated taxa (Bifidobacterium spp.) and reduced opportunistic pathogens (Klebsiella oxytoca). However, a decrease in butyrate-producing taxa (Ruminococcus bromii, Ruminiclostridium hungatei) was also observed. Breast cancer patients showed more negative shifts in gut microbiota compared with both controls. In addition, a 12-week combined dance and dietary intervention improved body composition, physical fitness, quality of life, and was associated with mixed but potentially beneficial changes in select gut microbiota taxa among breast cancer patients with obesity. Clinical trial registration number: NCT07213271.
This study aims to examine the physical activity levels and exercise beliefs of patients with cancer receiving outpatient chemotherapy and to investigate their associations with social participation and quality of life. A cross-sectional study included 101 outpatient cancer cases undergoing chemotherapy. Physical activity level was assessed by using the International Physical Activity Questionnaire (IPAQ), exercise beliefs with the Exercise Belief Questionnaire. Quality of life with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and social participation with the Reintegration to Normal Living Index (RNLI). Participants were mostly female (57.4%) and diagnosed with gastrointestinal system (38.6%) or breast cancer (28.7%). According to the IPAQ total score, 44.5% were inactive and 55.4% were minimally active. In terms of exercise beliefs, many participants agreed that exercise makes them feel better (5.4 ± 1.1), positively affects their mood (5.3 ± 1.3), and reduces stress (5.3 ± 1.2). The most common exercise barriers were fatigue (4.5 ± 1.7), bad weather conditions (4.0 ± 2.1), and lack of motivation (3.9 ± 1.9). Patients with higher physical activity levels reported significantly lower exercise barrier (33.4 ± 8.2 vs. 30.0 ± 9.2, p = 0.021). Physical activity level was positively correlated with EORTC QLQ-C30 function score (r = 0.331, p = 0.001), general health score (r = 0.247, p < 0.05), and RNLI score (r = 0.453, p < 0.001). Furthermore, positive exercise beliefs were positively correlated with IPAQ total score (r = 0.308, p < 0.05) and higher perceived exercise barriers were negatively correlated with all EORTC QLQ-C30 quality of life domains (p < 0.05), RNLI total score (r = -0.388, p < 0.001), and IPAQ total score (r = -0.273, p < 0.05). Our results suggest that higher physical activity and lower negative exercise beliefs were associated with better social participation and improved quality of life in patients with cancer. To promote better rehabilitation outcomes, future targeted interventions should focus on enhancing patients' exercise self-efficacy and directly reducing modifiable barriers, such as fatigue and low motivation, alongside reinforcing positive exercise beliefs.
Gastrointestinal (GI) cancers are a significant health concern in South Korea. Recently, machine learning (ML) models have emerged as powerful tools to support early screening efforts and identify people at risk before disease onset. However, the low incidence of GI malignancies in prospective cohorts leads to severe class imbalance, often causing ML models to favor the majority "healthy" class at the expense of clinical sensitivity. This study aimed to evaluate class imbalance mitigation strategies and develop ML-based GI cancer risk prediction models using noninvasive and minimally invasive predictors linked to modifiable behavioral and metabolic risk factors. We analyzed a prospective cohort (n=7652) with 156 incident GI cancer cases (2%) identified over a 14-year follow-up period. The data were randomly split into training (5356/7652, 70%) and testing (2296/7652, 30%) sets. To address class imbalance while preserving observed population structure, we developed a patient-centered undersampling technique (PCUSTe) based on the logic of frequency-matched case-control studies. PCUSTe was compared with commonly used resampling approaches, including synthetic minority oversampling (SMOTE), adaptive synthetic sampling (ADASYN), and SMOTE with edited nearest neighbors (ENN). Six classifiers were implemented, including both batch and incremental training variants. To account for the prior shift introduced by resampling, probability correction was applied. Model performance was evaluated on the independent test set using a classification threshold equal to the observed event proportion (cumulative incidence) in the training data and then across thresholds reflecting incidence values between 1% and 5%. Primary performance metrics included sensitivity, specificity, Matthews correlation coefficient, and area under the receiver operating characteristic curve (AUC). Models trained using PCUSTe demonstrated improved sensitivity compared with standard resampling techniques, particularly for more complex classifiers. The incrementally trained stochastic gradient descent model achieved the highest overall performance trained on PCUSTe data with a sensitivity of 0.77 (95% CI 0.64-0.89), specificity of 0.65 (95% CI 0.63-0.67), AUC of 0.77 (95% CI 0.70-0.84), and Matthews correlation coefficient of 0.12 (95% CI 0.08-0.16). In contrast, logistic regression achieved balanced performance without resampling (sensitivity 0.70, 95% CI 0.57-0.83; specificity 0.71, 95% CI 0.69-0.72; AUC 0.75, 95% CI 0.68-0.82). Our results showed that PCUSTe primarily enhanced sensitivity in more complex models at the expense of specificity. Integrating epidemiological principles, including covariate frequency matching and threshold selection based on the observed cumulative incidence in the training data, improved minority class detection in GI cancer risk prediction. However, model performance varied by algorithm, and in some cases, decision threshold adjustment alone achieved comparable or superior results to data resampling. These findings highlight the importance of carefully selecting imbalance mitigation strategies based on modeling objectives. The resulting models achieved sensitivity levels that may be suitable for early risk identification in cohort settings and could contribute to personalized risk stratification and targeted prevention or screening strategies.
Fasting combined with anti-cancer therapies improves tumor regression and survival in animals. Fasting sensitizes cancer cells to cytotoxic therapies while promoting stress resistance in healthy cells, a phenomenon known as differential stress resistance. Since prolonged water-only fasting is challenging, intermittent fasting has emerged as an attractive alternative. Here, we describe the protocol of a single-blind, randomized controlled trial testing whether time-restricted eating (TRE) can improve clinical, molecular, and behavioral outcomes in cancer patients. We will enroll 175 adults with newly diagnosed stage I-III human epidermal growth factor receptor 2-positive or triple-negative breast cancer or stage II-IV rectal cancer who are receiving neoadjuvant therapy. Patients will be randomized to early TRE (eTRE; ≤8-hour eating window early in the day) or to eat over a ≥12-hour window (control group) from around the start of treatment until surgery (typically 4-8 months). The primary outcomes are the pathologic complete response, the organ preservation rate, and patient-reported adverse events. Secondary outcomes include clinical response, tumor response, quality of life, and provider-reported adverse events. To test the differential stress resistance theory, we will measure the expression of proteins involved in cell growth, cell death, and stress resistance in tumor and adjacent normal tissue. Finally, we will determine the effects of eTRE on emotional, psychosocial, and lifestyle factors and how these factors influence adherence and clinical responsiveness. This trial will provide critical insight into whether intermittent fasting can potentially improve cancer outcomes, reduce toxicities from anti-cancer therapies, and enhance quality of life in cancer patients. The study is registered on ClinicalTrials.gov (NCT04722341).
GI cancers contribute substantially to global cancer morbidity and mortality. China experiences a high burden of GI cancers, yet the burden, epidemiologic trends, and attributable risk factors of early-onset GI cancers in China have not been systematically investigated. We conducted a population-based ecologic study with data from the Global Burden of Disease 2023. Early-onset GI cancers were defined with the diagnosis during age 20-49 years. Temporal trends were evaluated using Joinpoint regression and age-period-cohort models. Risk-attributable mortality was assessed using the comparative risk assessment framework. Exponential smoothing models were applied to project incidence rates through 2035. In 2023, early-onset colorectal cancer had the highest incidence rate (7.31 [95% CI, 5.73 to 9.58] per 100,000), whereas stomach cancer had the highest mortality rate (3.30 [95% CI, 2.45 to 4.47] per 100,000). From 2000 to 2023, both incidence and mortality rates generally declined across early-onset GI cancers (average annual percent change range: -0.85 to -4.21 for incidence; -0.97 to -4.86 for mortality). However, all GI cancer sites showed increasing trends during 2020-2022. Risk-attributable patterns varied by sex, age group, and cancer type, with tobacco and alcohol contributing more prominently to mortality among males. Forecasts suggested largely stable trends for most sites through 2035, with persistent sex disparities. Early-onset GI cancers in China showed overall declines over the past two decades but a concerning rebound since 2020, alongside substantial heterogeneity in attributable risks by sex and age. These findings support longitudinal monitoring, alongside strengthened risk-stratified screening and targeted, integrated prevention strategies in alignment with the Healthy China 2030 agenda.
Gastrointestinal schwannomas are rare mesenchymal tumors that arise from the Schwann cells of the enteric nervous system, representing a unique clinicopathological entity among subepithelial lesions of the gastrointestinal tract. The aim of this state-of-the-art review is therefore to analyze the specific clinicopathological characteristics of these rare tumors as well as to better understand the appropriate diagnostic tools and therapeutic approaches where these are required. This review combines findings from large series studies to provide a complete analysis of gastrointestinal schwannomas, even those with unusual locations. Despite the typical occurrence of these tumors within the stomach, they can occur throughout the gastrointestinal tract, from the esophagus, small intestine, colon, rectum, through to the mesentery, presenting a diagnostic dilemma. Due to the non-specific presentation, radiological, and endoscopic similarities between schwannomas and gastrointestinal stromal tumors (GISTs), a preoperative misdiagnosis is common. Recent improvements in immunohistochemistry have helped to define their biological identity based on widespread staining for S100/SOX10 with absence of KIT/DOG1 mutations. While techniques such as contrast-enhanced CT scans as well as endoscopic ultrasonography have certain diagnostic advantages, they are not sufficient to make a diagnosis without histopathological validation. Surgical resection is considered the mainstay of therapy, addressing both purposes. Endoscopic methods have been adopted for smaller lesions in more favorable locations, while surgical resection is considered standard for larger or more complex lesions. Despite their rarity, early and accurate diagnosis is important to avoid unnecessary interventions when conservative management may be appropriate. When treatment is required, resection strategies should be tailored to tumor characteristics.
The impact of preoperative weight loss and body composition changes on surgical and patient-reported outcomes remains unclear in gastrointestinal cancer patients. Prehabilitation programmes integrating exercise, nutrition and psychological support can improve surgical readiness and recovery but the role of body mass and composition changes within such services is not well understood. This study aims to investigate the associations between preoperative changes in body mass and composition and surgical, physical fitness, nutritional and quality of life outcomes among people with obesity undergoing surgery for upper gastrointestinal or colorectal cancer within the context of a cancer prehabilitation service (Active Together). This prospective observational study will recruit 100 adults (≥18 years; body mass index ≥30 kg/m²) scheduled for curative upper gastrointestinal or colorectal cancer surgery and enrolled in the Active Together prehabilitation service. Participants will attend two study visits: one as soon as possible after diagnosis and one within 2 weeks before surgery. Participants will undergo body mass, composition and size measurements and complete questionnaires on their nutritional status and quality of life. Routinely collected surgical outcomes (complications, operative approach and duration, length of hospital stay, readmissions, 1-year survival) and Active Together assessment data (physical fitness, psychological well-being, nutritional status) will also be collected. Correlation analyses and regression models will be used to explore the associations between preoperative changes in body mass and composition and surgical, physical fitness, nutritional status and quality of life outcomes. Ethical approval has been obtained from the Health Research Authority (Integrated Research Application System project ID 361634; Research Ethics Comittee reference 26/YH/0019). Written informed consent will be obtained from all participants. Data will be processed in accordance with General Data Protection Regulations and the Data Protection Act 2018. Findings will be disseminated via peer-reviewed publications, conference presentations and patient and public involvement activities.
Early-onset appendiceal cancer (EOAC), diagnosed before age 50, accounts for approximately 30% of all appendiceal malignancies. Its clinical profile, treatment strategies, and outcomes remain underexplored compared to late-onset disease. This study aimed to assess demographics, disease profile, management, and outcomes of EOAC. A retrospective cohort study using NCDB data (2005-2019), including patients with stage-known appendiceal adenocarcinomas or neuroendocrine tumors (NETs), was condcuted. Patients were categorized as EOAC (< 50 years) or late-onset appendiceal cancer (LOAC). Demographics, tumor features, treatments, and outcomes were compared. Kaplan-Meier and Cox proportional hazard analyses were used to assess overall survival (OS) and predictors of mortality. The primary outcome was 5-year OS. Among 27,276 patients (55.9% females, median age: 58 years), 30.6% had EOAC. EOAC patients were more often female, Hispanic, and privately insured. Most EOACs were NETs, low-grade, and early-stage (stage I: 39.4% vs. 21.2%; p < 0.001). EOAC was treated more often with appendectomy and minimally invasive surgery, less often with hemicolectomy or chemotherapy. EOAC had better 5-year OS than LOAC (79.9% vs. 59.3%, p < 0.001), consistent across all histologic types and stages. EOAC patients had shorter hospital stays and significantly lower rates of positive surgical margins, 30- and 90-day mortality, and unplanned readmission. EOAC was associated with significantly higher OS than LOAC, across all disease stages and tumor histologies. This finding should be interpreted in light of disparities in patient and disease characteristics and treatments between the two groups, as EOACs were generally smaller, early stage and low grade, and consisted mainly of NETs compared to LOAC.
IntroductionThe global status of core labor force (CLF) health is underestimated, particularly the burden of patients with early-onset gastrointestinal cancers (EOGICs), aged 15-49 years old. We aim to investigate the pattern and trend of EOGICs among CLF from 1990 to 2021.MethodsEOGIC burden and its attributable risk factors were estimated using data from the GBD 2021. The ASR and EAPC by age, sex and SDI were utilized for measuring incidence rate trends. Joinpoint regression analysis was utilized to explore the variation in disease burden. The Bayesian Age-Period-Cohort (BAPC) model was performed to forecast the disease burden up to 2050.ResultsFrom 1990 to 2021, the global ASIR for EOGICs among core labor force remained broadly stable, moving from 10.9 to 9.62 per 100,000(EAPC=-0.42, -1.70 to 0.87), while incident cases increased from 295,514 to 379,709. The overall incidence pattern was driven largely by declines in early-onset GC. The age-standardized DALY rate declined from 375.16 to 238.40 per 100,000(EAPC=-1.46, -2.76 to -0.15). Only early-onset CRC showed increasing DALYs. Joinpoint analysis showed a continuous downward trend in the ASIR for overall EOGICs(AAPC=-0.97%; -0.81 to -1.08). Risk-factor decomposition indicated substantial contributions from modifiable exposures, mainly led by smoking, alcohol use, and dietary risks, with marked sex- and age-specific variation.ConclusionThe results of the present study are significant for global health policy and practice in core labor force. Differentiated intervention and outreach strategies based on age and gender would be necessary to reduce the impact of EOGICs.
Esophagectomy is one of the highest risk surgical procedures and complications are common. While patient safety remains the primary focus, the impact on healthcare staff-the so-called 'second victims'-is often overlooked. Evidence suggests that a large proportion of surgeons experience emotional, professional, and social consequences following adverse outcomes. Our aims were to explore the effect of complications on personal and professional wellbeing and to identify systems and support required to help surgeons. An online survey, containing questions on surgeon demographics, the impact of surgical complications on personal and professional wellbeing, and current support systems available, was distributed globally to practicing esophageal cancer surgeons. A total of 100 responses were analysed from 30 countries. The median number of esophagectomies performed was 18 (IQR 0-90; n = 100)/annually. The complications with the most significant impact included patient mortality, gastric conduit necrosis and tracheobronchial injury. About 73% of surgeons reported changes in personal relationships and 66% experienced workplace pressures. Support was mainly obtained from colleagues (67%) or family (30%), however, 29% sought no support. 55% felt they received adequate support. About 58% felt under-supported by their particular institution. Complications after esophagectomy significantly affect surgeons' emotional wellbeing and clinical practice. While peer support was valued, many felt under-supported institutionally. These findings highlight the need for structured support systems to protect surgeon wellbeing and maintain safe surgical standards.
GI cancers contribute substantially to cancer-related morbidity and mortality in Kenya, where patients often present with advanced disease and experience delayed treatment, interruptions, and loss to follow-up. To address barriers to care, Kenyatta National Hospital (KNH) implemented a Patient Navigation Program (PNP) in 2017, although its impact on clinical outcomes and equity had not been fully evaluated. To assess the effect of the KNH PNP on treatment timeliness, continuity of care, 1-year survival, and equity among adults with GI cancers. We conducted a retrospective cohort study of 360 adults with GI cancers treated at KNH between 2010 and 2025, comparing a prenavigation cohort (2010-2016; n = 180) with a navigation-era cohort (2017-2025; n = 180). Primary outcomes were time from diagnosis to treatment initiation and disease status at follow-up. Secondary outcomes included treatment initiation within 30 days, treatment completion, loss to follow-up by 1 year, and 1-year overall survival. Survival was analyzed using Kaplan-Meier methods and log-rank tests. Multivariable logistic regression assessed predictors of loss to follow-up and disease status, including equity by residence and insurance status. Median time to treatment initiation did not differ between cohorts (55 v 62 days; P = .14), and treatment completion remained low (41.1% v 46.1%; P = .96). Loss to follow-up declined from 20.0% to 6.7% (P < .001), and 1-year survival improved from approximately 70% to approximately 80% (log-rank P = .027). Benefits were consistent across residence and insurance subgroups. Patient navigation significantly improved continuity of care and 1-year survival without increasing disparities, supporting its role as an equity-promoting intervention in resource-limited settings.
Early detection is critical in pancreatic ductal adenocarcinoma (PDAC)-one of the most lethal malignancies due to its typically late diagnosis. In this study, we aimed to validate an epidemiological risk score (ERS) designed to identify individuals at increased risk of developing PDAC prior to the use of imaging or other diagnostic procedures. The ERS was constructed through a meta-analysis of 24 well-established epidemiological risk factors. We applied this score to a prospective cohort of 178 high-risk individuals with a family history of PDAC within the IMAGene project (ClinicalTrials.gov registration code: NCT06334458). To evaluate the predictive value of the ERS, all participants underwent whole-body or abdominal magnetic resonance imaging (MRI) and the findings were classified according to the Oncologically Relevant Findings Reporting and Data System criteria to identify and categorize lesions based on their malignant potential. External validation was conducted by using a subset of the UK Biobank (UKB) cohort (≈300 000 individuals), among whom 1648 were diagnosed with PDAC. Higher ERS values were associated with the presence of potentially malignant lesions on MRI. Both pancreatic and extra-pancreatic malignant lesions were more frequent among individuals with higher ERS scores (P = .01 and P = .02 respectively) compared with controls. External validation in PDAC cases within the UKB cohort confirmed these associations. Our findings support the integration of the ERS as a feasible, low-cost tool for PDAC risk stratification, with the potential to facilitate earlier detection and improve clinical outcomes.
This cross-sectional study examines the effects of multidimensional social support on anxiety and depression symptoms in colorectal cancer patients, with particular focus on the mediating role of psychological resilience in this association. We recruited patients from the Shantou Central Hospital between October 2023 and December 2024 using consecutive recruitment. Participants completed validated instruments: the Perceived Social Support Scale (PSSS), Connor- Davidson Resilience Scale (CD-RISC), and Hospital Anxiety and Depression Scale (HADS). Structural equation modeling (SEM)-based path analysis with maximum likelihood estimation was performed to analyze the mediation pathways after establishing bivariate correlations through Pearson's analysis, using composite scores of the scales (rather than latent variables). We recruited 268 Chinese colorectal cancer patients (51.49% male, mean age predominantly 45-65 years, 34.33% at Stage Ⅲ and 31.72% at Stage Ⅳ) who received surgery alone or combined with chemotherapy/radiotherapy. The cohort demonstrated moderate resilience levels (58.62 ± 12.14), with mean perceived social support scores of 42.38 ± 10.72 and HADS scores of 22.40 ± 7.62. Significant correlations emerged: social support positively correlated with resilience (r = 0.62, P < 0.01) and negatively with anxiety/depression (r=-0.54, P < 0.01), while resilience showed inverse associations with anxiety/depression (r=-0.67, P < 0.01). The SEM revealed excellent model fit (CFI = 0.97, RMSEA = 0.04). Social support was associated with lower anxiety/depression both directly (β=-0.41, P < 0.001) and indirectly via an association with greater resilience enhancement (β=-0.29, P < 0.01), with resilience accounting for 29.17% of the variance in the social support-anxiety/depression relationship. Our findings suggest psychological resilience acts as a partial mediator in the pathway between perceived social support and mental health among colon cancer patients. The results highlight the importance of integrating psychosocial interventions that simultaneously strengthen external support systems and cultivate internal resilience capacities.