搜索结果：Journal of the National Comprehensive Cancer Network : JNCCN

Combination amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy are the current standard first-line therapies for treatment-naïve patients with EGFR-mutated advanced lung cancer. We aim to compare the cost-effectiveness of all 3 regimens. This economic evaluation with a 20-year time horizon and annual 3% discount was conducted from the perspective of the health care sectors in Taiwan and the Unites States (US). Simulated patients were entered into partitioned survival models upon initiation of amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy. Model inputs were derived from trials and network meta-analyses (progression-free/overall survival, adverse events, and subsequent therapies), insurance payments or retail prices (costs of drug administration, physician visits, monitoring, and end-of-life care), and hospital cohorts (health utility). Subgroup, one-way deterministic, and probabilistic analyses were performed. The incremental cost-effectiveness ratios (ICERs) of osimertinib + chemotherapy versus osimertinib monotherapy (Taiwan: $231,234 per quality-adjusted life-year [QALY]; US: $442,506/QALY) and amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $412,332/QALY; US: $2,623,132/QALY) exceeded willingness-to-pay (WTP) thresholds (Taiwan: $70,000/QALY; US: $150,000/QALY). Cost of drugs and adverse event management accounted for the main cost differences among the 3 strategies. ICERs remained higher than WTP thresholds across patient subgroups. The lowest ICER for amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $232,192/QALY; US: $1,319,408/QALY) was noted among patients aged ≥65 years. Osimertinib + chemotherapy had a 2.0% (Taiwan) and 0.4% (US) probability of being cost-effective at the respective WTP thresholds, with amivantamab-lazertinib showing an even lower probability. Our analysis suggests that despite the superior efficacy of amivantamab-lazertinib and osimertinib + chemotherapy, neither is cost-effective compared with osimertinib as first-line treatment for EGFR-mutated advanced lung cancer.

Cancer-related fatigue (CRF) is a common, distressing symptom in patients undergoing hormone therapy for breast and prostate cancer. Although exercise is recommended, it is not suitable for all patients. Passive therapies such as massage and Reiki may offer accessible alternatives. This study evaluated the feasibility and preliminary efficacy of Reiki and massage therapy in reducing CRF, with Reiki also assessed for potential dose-response effects. Adults (age &#x2265;21 years) with breast cancer receiving aromatase inhibitors or with prostate cancer receiving androgen deprivation therapy (ADT) for at least 8 weeks, who reported moderate CRF (score &#x2265;4/10), were enrolled if they had completed other cancer treatments at least 2 months prior. Exclusion criteria included planned nonhormonal cancer treatments, use of erythropoietin or darbepoetin, recent professional massage or energy therapy, or contraindications to massage. CRF was assessed using the Brief Fatigue Inventory (BFI). ANCOVA, adjusted for baseline values, was used to evaluate between-group differences in BFI total score at week 6. Cohen d was used to estimate within-group effect sizes. Feasibility was assessed based on recruitment, retention, and adherence. A total of 87 participants (breast cancer, n=57; prostate cancer, n=30) were randomized to 2 sessions of massage therapy, 2 sessions of Reiki, or 4 sessions of Reiki. All interventions significantly reduced CRF from baseline (P<.001). Reiki produced greater within-group effect sizes (Cohen d=0.81-1.49 for 2 sessions; 0.99-1.49 for 4 sessions) than massage (d=0.50-0.60). The 4-session Reiki group had the largest reductions in total CRF (d=1.16), worst CRF (d=1.49), and CRF interference (d=0.99). Feasibility was high, with 51% recruitment, 94% retention, and 85% adherence. Reiki and massage are safe, feasible, and promising interventions for managing CRF in patients receiving hormone therapy. Reiki showed the largest improvements, supporting its clinical relevance. Larger trials are needed to confirm these findings and inform CRF management guidelines. gov Identifier: NCT02758756.

Breast cancer treatment is complex, incorporating multimodality and preference-sensitive treatments dependent on oncologic characteristics, patient understanding, and shared decision-making. Health literacy (HL) is a key determinant of health in chronic disease, yet its impact in breast cancer remains undefined. This study evaluated the association of HL with receipt of breast cancer care and oncologic outcomes. We performed a retrospective cohort study of patients with breast cancer diagnosed from 2005 to 2022 at a tertiary care referral center. Surgical treatment was categorized as breast conservation therapy versus mastectomy, contralateral prophylactic mastectomy, and postmastectomy reconstruction. Multivariable logistic regression and Cox proportional hazard models were used to assess associations with treatment, overall survival, and recurrence-free survival. Among 3,579 patients with breast cancer, the mean [SD] Brief Health Literacy Screen (BHLS) score was 13.9 [2.1] (range, 3-15). Patients with low HL tended to be older (median age, 64 vs 58 years), non-White (21.3% vs 14.3%), and less likely to have private insurance (27.6% vs 55.6%). Adjusted for patient characteristics, higher BHLS score was protective against presenting with later-stage disease (adjusted odds ratio [aOR], 0.87; 95% CI, 0.85-0.91). Higher HL was also independently associated with an increased odds of undergoing prophylactic contralateral mastectomy (aOR, 1.07; 95% CI, 1.01-1.13) and reconstruction (aOR, 1.10; 95% CI, 1.03-1.16). There was no difference in receipt of breast conservation therapy versus mastectomy (aOR, 0.98; 95% CI, 0.94-1.02). Higher HL was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [aHR], 0.91; 95% CI, 0.89-0.94) and decreased risk of recurrence (aHR, 0.92; 95% CI, 0.87-0.97). HL is associated with stage at presentation, surgical treatment, and survival in breast cancer. These findings highlight the importance of HL in shared decision-making for breast cancer. Assessing and addressing HL in breast cancer care has the potential to contribute to early detection, treatment decisions, and survival outcomes.

Earlier and more frequent goals-of-care conversations (GOCCs) for patients with cancer have the potential to enhance person-centered care delivery. Structured electronic health record (EHR) functionality may support more consistent GOCCs and documentation; however, large-scale, multisite implementations remain limited. This study describes the implementation and evaluation of EHR-based goals-of-care documentation (GOCD) across 10 dedicated cancer centers participating in the Improving Goal Concordant Care (IGCC) initiative. The IGCC initiative was a multicomponent collaborative quality improvement project led by the Alliance of Dedicated Cancer Centers (ADCC) between 2020 and 2023. Participants developed a consensus definition of structured EHR GOCD to guide implementation at participating sites. Centers also used a range of enabling strategies to promote GOCD. Evaluation included process assessments and quarterly reporting on the percentage of deceased patients with at least one documented GOCC. All 10 sites implemented structured GOCD templates. Across the study period, aggregate GOCD rates improved significantly, increasing from 18% to 37% among all decedents and from 25% to 52% among inpatient decedents. However, the collaborative consensus goal of 70% was not achieved. Significant improvements in GOCD rates were observed among all decedents in 5 of 8 centers and among inpatient decedents in 6 of 9 centers. Sites that implemented clinician nudges or financial incentives achieved significantly higher final GOCD rates. This multicenter initiative demonstrated that structured EHR tools, paired with institutional engagement and behavioral strategies, can improve documentation of GOCCs in oncology. Variation in implementation across sites highlights the importance of local adaptation and sustained programmatic support in driving meaningful practice change.

The Health Equity Report Card (HERC) was developed to establish best practice recommendations and promote accountability among health systems in addressing care inequities. Recognizing the growing importance of health equity, particularly in cancer care, this study aims to evaluate the feasibility of implementing the HERC within academic cancer centers and to gather insights on its benefits and challenges during implementation to improve its usability. This quality improvement study used a mixed-methods approach, collecting both quantitative and qualitative data over an 18-month period from April 2022 to October 2024 from 5 NCCN Member Institutions. Participants completed self- and third-party scores, as well as survey evaluations providing feedback on the process of using the HERC. Feedback from stakeholders was systematically collected to assess usability and identify areas for improvement. All participating sites successfully achieved the feasibility objectives by completing the self- and third-party scoring processes using the HERC, with unanimous agreement among the sites regarding the feasibility of the HERC for implementation. Site feedback indicated areas for enhancement, particularly in improving question clarity and simplifying the scoring process. Continuous feedback loops facilitated iterative improvements to the HERC, ultimately enhancing user experience and the scoring process. The HERC demonstrates strong potential as a viable framework for prioritizing and assessing equity in care delivery within academic cancer centers. The successful implementation across multiple sites, along with positive stakeholder feedback, underscores its utility in enhancing accountability and promoting best practices in addressing health inequities. Future studies should explore the long-term impacts of HERC implementation on patient outcomes and equity in care delivery. A study testing the HERC for applicability in community oncology settings is ongoing.

The recent approval of encorafenib, cetuximab, and FOLFOX based on the phase III BREAKWATER trial has introduced a new standard of care for the first-line treatment of BRAF V600E-mutated metastatic colorectal cancer (mCRC). However, its safety and efficacy in patients with significant liver dysfunction remains unclear and, as such, patients are often excluded from pivotal clinical trials. This report presents a case of BRAF V600E-mutated mCRC presenting with extensive hepatic involvement and liver dysfunction. Despite the absence of guidelines, the patient was initiated on full-dose encorafenib, cetuximab, and FOLFOX. He experienced a rapid clinical and biochemical response, with near-normalization of liver enzymes after cycle 1, and complete functional recovery by cycle 3. Treatment was well tolerated, with no significant adverse events throughout 9 cycles. He subsequently transitioned to maintenance 5-FU, cetuximab, and encorafenib. Posttreatment blood-based next-generation sequencing revealed no residual actionable mutations. The patient then successfully underwent complete surgical resection of his primary tumor and metastatic disease with negative margins. This case highlights the importance of considering encorafenib-based therapy in select patients with BRAF V600E-mutated mCRC in the setting of compromised liver function.

HER2-positive breast cancer accounts for approximately 15%-20% of breast cancers and was historically associated with poor outcomes. The introduction of HER2-targeted therapies has significantly improved prognosis, particularly in the treatment of early-stage disease. Neoadjuvant HER2-directed therapy combined with chemotherapy is the standard of care for patients with stage II and III HER2-positive breast cancer, enabling pathologic complete response-guided treatment personalization. This review summarizes current evidence guiding the neoadjuvant management of early-stage HER2-positive breast cancer. We discuss pivotal trials establishing dual HER2 blockade with trastuzumab and pertuzumab, strategies to optimize and de-escalate chemotherapy backbones, and emerging data supporting chemotherapy-sparing approaches in selected patients. Recent studies evaluating taxane-only regimens, carboplatin omission, antibody-drug conjugates, and immunotherapy-based combinations are reviewed with attention to efficacy, toxicity, and clinical applicability. We further examine validated and emerging biomarkers of response, including molecular subtyping, genomic assays, tumor immune features, circulating tumor DNA, and functional imaging, all of which may enable risk-adapted treatment strategies. Finally, we review mechanisms of resistance to HER2-targeted therapies, as well as novel therapeutic approaches under investigation to overcome treatment resistance. This review provides a contemporary, evidence-based framework for individualized neoadjuvant treatment of early-stage HER2-positive breast cancer.

Although intermediate clinical endpoints (ICEs) may expedite completion of randomized controlled trials (RCTs) evaluating perioperative systemic treatments for localized muscle-invasive bladder cancer (MIBC), no validated surrogate for overall survival (OS) has been established. We aimed to assess the surrogacy of pathologic complete response (pCR), pathologic objective response (pOR), and disease-free survival (DFS) for OS. We analyzed 4,828 patients with MIBC (cT2-T4N0M0) who underwent radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) across 29 European centers (2001-2024). The inverse probability of treatment weighting (IPTW) approach was used to adjust for confounding between NAC and RC-only groups. Surrogacy was evaluated using: (1) adapted Prentice criteria to test whether each ICE remained a significant predictor of OS while the treatment effect disappeared in IPTW-adjusted multivariable Cox models; (2) the proportion of treatment effect explained (PTE); and (3) an emulated 2-stage meta-analytic framework to estimate the pseudo-trial-level R2 between treatment effects on each ICE and OS across 1,000 replicates of 5 random clusters. The surrogate threshold effect (STE) was calculated for ICEs demonstrating strong surrogacy (R2&#x2265;0.7). Overall, 1,288 (26.7%) patients received NAC followed by RC and 3,540 (73.3%) underwent RC alone. In IPTW-adjusted Cox regression analyses including NAC and each ICE separately, pCR (hazard ratio [HR], 0.32; 95% CI, 0.24-0.41; P<.001), pOR (HR, 0.26; 95% CI, 0.21-0.31; P<.001), and DFS (HR, 5.17; 95% CI, 4.56-5.86; P<.001) were independent predictors of OS. The PTE was 0.42 (95% CI, 0.22-0.54), 0.48 (95% CI, 0.24-0.58), and 0.84 (95% CI, 0.66-0.96) for pCR, pOR, and DFS, respectively. At the pseudo-trial level, the R2 was 0.22 (95% CI, 0.20-0.25), 0.33 (95% CI, 0.31-0.36), and 0.83 (95% CI, 0.81-0.84) for the correlation between treatment effects on pCR, pOR, and DFS and OS, respectively. The STE was 0.82 (95% CI, 0.81-0.84) for DFS. We observed uncertainty regarding the surrogacy of pCR and pOR in patients undergoing RC with or without NAC for localized MIBC. Only DFS consistently mediated the treatment effect on OS, supporting its use as a surrogate for RCT dimensioning when a recurrence or death risk reduction of &#x2265;18% is expected.

Radical cystectomy has long been the standard of care for muscle-invasive bladder cancer (MIBC), an aggressive cancer with a high risk of progression to recurrent or metastatic disease. Systemic therapy has improved survival outcomes for these patients, with administration in neoadjuvant, adjuvant, and, more recently, "sandwich" perioperative settings. Cisplatin-based therapies have been the mainstay of neoadjuvant treatment for patients without comorbidities who are considered eligible for this chemotherapy. Immune checkpoint inhibition has more recently shown promise not only in prospective single-arm neoadjuvant clinical trials, but also in demonstrating significant improvement in disease-free survival when administered adjuvantly in patients at high risk of recurrence based on residual disease at the time of cystectomy. Furthermore, a biomarker-adapted approach in which patients with detectable postoperative circulating tumor DNA (ctDNA) are selected appears to enhance identification of those most likely to benefit from adjuvant immune checkpoint inhibition. Alternatively, a novel paradigm adopting a combination of preoperative and postoperative therapy sandwiched around cystectomy has been adopted in contemporary clinical trials. Two of these perioperative regimens-cisplatin/gemcitabine/durvalumab and enfortumab vedotin/pembrolizumab-have yielded significant improvements in survival for patients with MIBC and appear poised to become the dominant systemic therapy paradigm for those with MIBC undergoing radical cystectomy. With these advances, opportunities remain to further improve patient outcomes and potentially synthesize these response-adaptive and perioperative approaches. Future studies will address the contribution of postoperative therapy and may ultimately identify patients for whom cystectomy can be deferred altogether.

Nonpharmacologic interventions are the mainstay of management for cancer-related fatigue (CRF), with few pharmacologic options available-notably methylphenidate (MPH) and dexmethylphenidate (d-MPH). Given mixed evidence from randomized controlled trials (RCTs) and newly published phase III data, we conducted an updated systematic review and meta-analysis to clarify the efficacy and safety of these psychostimulants in managing CRF. PubMed, Embase, and CENTRAL were searched through January 2025 for placebo-controlled, double-blind RCTs evaluating MPH/d-MPH in adults with advanced cancer or receiving active cancer-directed therapy. Outcomes included between-group differences in fatigue score changes measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), self-rated 0-10 scales, or any validated scales, as well as treatment-emergent adverse events (TEAEs). Exploratory subanalyses examined FACIT-F score changes at 2 &#xb1; 1, 5 &#xb1; 1, and &#x2265;8 weeks after treatment initiation. Pooled estimates were calculated using random-effects models. A total of 9 RCTs met inclusion criteria (n=823; with evaluable sample sizes varying per analysis). Compared with placebo, MPH/d-MPH monotherapy (MPH-equivalent dose range: 5-100 mg/d) produced statistically significant improvements in fatigue scores, as measured by FACIT-F (mean difference [MD], 2.43; 95% CI, 0.90 to 3.96), self-rated 0-10 scales (MD, -1.52; 95% CI, -2.90 to -0.14), and any validated scale (standardized MD, 0.38; 95% CI, 0.17 to 0.60). FACIT-F improvements followed a temporal gradient, exceeding the 3-point threshold for clinical meaningfulness by 5 &#xb1; 1 weeks (MD, 3.56; 95% CI, 1.57 to 5.55) and rising further by &#x2265;8 weeks (MD, 3.89; 95% CI, 1.76 to 6.01). No statistically significant differences in the odds of key TEAEs were observed. MPH-type psychostimulants produce a modest but consistent reduction in CRF, with therapeutic benefits becoming clinically meaningful after 5 weeks and a favorable safety profile in the studied population, thereby meriting consideration for carefully selected individuals living with cancer when nonpharmacologic strategies are insufficient or still taking effect.

Among older adults with cancer, poverty is associated with end-of-life (EoL) care quality; however, its impact on care among adolescents and young adults (AYAs) is poorly understood. We examined the relationship between neighborhood poverty and EoL care among AYAs. We identified AYAs with cancer who died between the ages of 12 and 39 years from 2003 to 2019 at Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California. Outcomes abstracted from medical records included care/treatment information, symptom evaluation, and psychosocial/spiritual care. Neighborhood poverty was derived by linking patient ZIP Code Tabulation Areas to the 2009 to 2013 American Community Survey. Multivariable logistic regression models assessed the relationship between neighborhood poverty and outcomes, adjusting for age at death, sex, race, ethnicity, cancer site, and care site. Included AYAs (n=1,905) had median age of 30 years at diagnosis and 32 years at death; 55% were female, 61% were White, 27% were Hispanic/Latino, and 19% were from a high-poverty neighborhood. In bivariate analyses, compared with AYAs from low-poverty neighborhoods, AYAs from high-poverty neighborhoods were more likely to be hospitalized &#x2265;2 times in their last 30 days (29% vs 22%; P=.004) and had lower hospice use (57% vs 64%; P=.008). Pain was assessed among 98% and was assessed less often among AYAs from high-poverty neighborhoods (96% vs 99%; P=.008). In multivariable analyses, AYAs from high-poverty neighborhoods had higher odds of >1 emergency department visit (odds ratio [OR], 1.33; 95% CI, 1.00-1.76) and >1 hospitalization in the last 30 days of life (OR, 1.33; 95% CI, 1.02-1.75), and lower odds of hospice use (OR, 0.76; 95% CI, 0.58-0.98). Sustainable care delivery methods for patients who lack resources to address their EoL needs outside of the health care system are needed.

Serious illness conversations (SICs) aim to elicit patient preferences and are associated with improved quality of life and reduced care utilization, but they occur infrequently. Sustainable interventions that encourage SICs are needed. This pragmatic 4-arm randomized controlled trial enrolled adult patients at 5 disease-based oncology clinics at 2 sites of an academic cancer center between December 4, 2022, and July 31, 2024. All patients had pathways data indicating they were starting a treatment associated with a poor prognosis without documentation of an SIC in the Advance Care Planning module of the electronic health record (ACP-SICs) in the prior 6 months. Patients were randomized to 1 of 4 groups: (1) a nudge consisting of a mailed letter and questionnaire encouraging SICs; (2) a clinician nudge comprising an email reminder sent the day prior to the clinic visit to prompt an SIC; (3) both nudges; or (4) no nudges. The primary outcome was the proportion of patients with ACP-SICs within 60 days of randomization comparing the control (no-nudge) and combined-nudge arms; a prespecified alternate primary outcome included SICs identified in the free text of clinician notes using natural language processing (ACP + NLP-SIC). A total of 1,051 patients (median age, 65 years; 60% female; 79% White) were randomized to the control (n=261), clinician-nudge (n=240), patient-nudge (n=273), and combined-nudge arms (n=277). The ACP-SIC rates were 10.7%, 16.7%, 10.6%, and 17.3% for the control, clinician-nudge, patient-nudge, and combined-nudge arms, respectively, and the ACP + NLP-SIC rates were 22.6%, 28.8%, 22.3%, and 32.5%, respectively. Patients in the combined-nudge group had significantly higher ACP-SIC and ACP + NLP-SIC rates than the control group (P=.045 and P=.01, respectively), whereas the clinician-nudge and patient-nudge groups did not. Combined clinician- and patient-directed nudges resulted in higher SIC rates in 60 days, driven largely by the clinician nudge. NLP increased detection of SICs, demonstrating the importance of evaluating SICs in free-text notes.

Immunotherapies have recently changed the treatment landscape of multiple myeloma (MM). CAR T cells and T-cell-redirecting bispecific antibodies (BsAbs) yield impressive responses and extend survival in patients with relapsed/refractory MM. There are now 2 BCMA-directed CAR T-cell products and 4 BsAbs (3 targeting BCMA, 1 targeting GPRC5D) currently approved by the FDA for relapsed/refractory MM, in which they demonstrated considerable efficacy. These drugs are now being evaluated in early treatment settings, including as part of frontline regimens for newly diagnosed MM. Importantly, administration of CAR T-cell therapy and BsAbs necessitate careful attention to unique toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenias, and heightened infection risk. This review summarizes the current landscape of immunotherapy in MM, including perspectives on sequencing CAR T-cell therapy and BsAbs. It also discusses ongoing clinical trials evaluating immunotherapy in new combinations and treatment contexts. Immunotherapies have become a key component of the MM therapeutic armamentarium and are poised to assume an even larger role in the coming years.

Pathogenic germline variant (PGV) rates in cancer risk genes and their association with clinicopathologic features inform genetic testing practices for patients with prostate cancer (PCa). In this study, we determined the rate of PGVs in PCa risk genes in a real-world, diverse cohort of patients with PCa and identified clinical predictors of carrier status. Genetic testing results for 12 PCa risk genes, along with clinical, pathologic, and family history variables, were abstracted from 1,032 patients with PCa who met NCCN genetic testing criteria in oncology clinics, and 3,602 patients with PCa who underwent testing through the VA National Precision Oncology Program. Individual gene PGV rates in patients with PCa were compared with those in individuals assigned male at birth who were cancer-free. Statistical analyses were performed using unpaired t tests and Fisher exact tests. Among 4,634 patients with PCa, 5.4% had PGVs, with BRCA2 (1.7%), ATM (1.3%), and CHEK2 being the most common. The total PGV rate was significantly higher in 2,825 self-identified White and 1,527 self-identified Black patients (6.3% vs 3.7%; Padjusted=.0024), although rates of BRCA2 and BRCA1 PGVs were similar (1.9% vs 1.3%; Padjusted=.0885 and 0.6% vs 0.5%; Padjusted=.8005, respectively). PGV rates did not differ significantly between 311 self-identified Hispanic and 4,188 self-identified non-Hispanic patients (3.9% vs 5.5%; Padjusted=1.000). In self-identified White and Black patients, PGV rates in BRCA2 and Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2) were significantly higher compared with a cancer-free cohort of individuals assigned male at birth. In a multivariable logistic regression, age at initial PCa diagnosis and self-identified race were significantly associated with the presence of any PGV. In this racially diverse, real-world cohort of individuals with advanced PCa meeting NCCN testing criteria, the overall PGV rate was approximately 5%. Outside of ATM and CHEK2, PGV rates were similar across self-identified race, self-identified ethnicity, and clinical stage. These data support NCCN Guideline-recommended universal genetic testing for patients with aggressive PCa.

Informal caregivers of patients with advanced cancer face increasing psychosocial and financial burdens; however, their health-related needs remain underrecognized. Although prior studies have examined social capital and financial toxicity separately, their combined impact on caregiver well-being is less understood. This study examined how social capital and financial toxicity are associated with caregivers' health-related quality of life (HRQoL), psychological distress, and overall health. We conducted a cross-sectional survey of 200 caregivers of patients with advanced cancer at a tertiary hospital. Social capital was measured by social connectedness, group participation, and trust, whereas financial toxicity was evaluated as material burden and psychological distress related to financial concerns. Stepwise multivariate logistic regression identified factors associated with caregiver HRQoL, anxiety, depression, and self-rated health status. The median age of caregivers was 50 years (IQR, 41-60); most were women (70.5%) and either a spouse or child of the patient. Approximately 50% of caregivers experienced high financial toxicity, 43% had low participation in social groups, and 42% reported low social trust. Low social connectedness (adjusted odds ratio [aOR], 2.36; 95% CI, 1.21-4.63) and high psychological distress related to financial concerns (aOR, 8.35; 95% CI, 4.27-16.31) were each significantly associated with poor HRQoL. Depression was more likely to occur among caregivers with limited social participation (aOR, 3.77; 95% CI, 1.79-7.95) and with both higher psychological distress related to financial concerns (aOR, 7.44; 95% CI, 3.79-14.60) and material burden (aOR, 2.67; 95% CI, 1.30-5.46). Our findings indicate that social connectedness with friends and participation in social groups were associated with better HRQoL and mental health, whereas psychological distress related to financial burden was strongly associated with poorer outcomes across all domains. Interventions designed to strengthen social support networks and alleviate financial stress may therefore be essential components of comprehensive cancer care.

Survivors of hematopoietic cell transplantation (HCT) have an increased risk of skin cancer, yet adherence to recommended skin self-examination (SSE) and annual physician skin examinations is low. Scalable strategies to improve screening in this high-risk population are needed. We conducted a randomized controlled trial of 720 adult survivors of HCT enrolled between October 30, 2020, and December 13, 2023. Participants received remotely delivered print materials and 12 educational text messages over 9 months (patient activation and education [PAE]). In the PAE plus physician activation group (PAE + Phys), providers also received educational materials and guidance on performing skin examinations. Primary outcomes were participant-reported SSE within the prior 2 months and physician skin examination within the prior 12 months, assessed at baseline and 12 months. Secondary outcomes included the number of body regions examined and skin cancer knowledge. Median age at enrollment was 61 years (range, 18-81), and the median time from HCT until enrollment was 3.1 years (range, 1.7-5.3). The proportion of participants reporting both physician skin examination and SSE increased in both groups, from 15.8% to 47.5% in the PAE group (odds ratio [OR], 4.98; 95% CI, 3.54-7.02) and from 18.0% to 52.1% in the PAE + Phys group (OR, 5.49; 95% CI, 4.03-7.50), with no significant between-group difference. SSE increased significantly in both groups, from 34.7% to 81.5% in the PAE group and from 31.5% to 79.0% in the PAE + Phys group, without no significant between-group difference. Physician skin examinations increased from 32.1% to 55.3% in the PAE group and from 33.2% to 64.8% in the PAE + Phys group, with a significantly greater increase in the PAE + Phys group (P=.01). The mean number of body regions examined more than doubled in both groups, and skin cancer knowledge and self-efficacy improved significantly. Remotely delivered interventions improved skin cancer screening among HCT survivors. Patient activation substantially increased SSE, whereas physician activation provided additional benefit for physician-performed skin examinations. These findings suggest that physician activation enhances clinician-performed screening and supports scalable survivorship care models for high-risk populations. gov identifier: NCT04358276.

Although studies have reported on the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening, data on long-term changes remain limited, particularly during the later phases of the pandemic (post 2021) and among racial and ethnic subgroups. We analyzed data from the 2019, 2021, and 2023 National Health Interview Survey to assess clinician recommendations for CRC screening, past 2-year screening rates, and screening modalities used. Trends were compared across racial/ethnic groups and social determinants of health, including insurance status and income. Our sample represented 95 million individuals in 2019, 97 million in 2021, and 98 million in 2023. Compared with 2019, CRC screening recommendations dropped by 20% in 2021 (P<.0001), with larger decreases among Hispanics (28%) and uninsured individuals (41%). Recommendations remained 11% lower in 2023 (P=.03). In 2021, past 2-year colonoscopy use declined by 8% (P=.001), whereas multitarget stool DNA testing (mt-sDNA) increased by 18% (P=.03) and fecal immunochemical test/fecal occult blood test (FIT/FOBT) use increased by 55% (P<.001). Colonoscopy declines were greatest among Asian individuals (32%), whereas increases in FIT/FOBT use were highest among Hispanic (78%) and Black (92%) individuals. By 2023, colonoscopy use had returned to prepandemic levels (28%), and mt-sDNA use increased by an additional 40%, resulting in an overall 8% increase in past 2-year screening compared with 2019 (P<.001). Early in the pandemic, increased stool-based testing offset reduced colonoscopy uptake. Colonoscopy rates have since recovered, whereas stool-based testing continues to increase, with notable differences across ethnic groups. This sustained shift toward stool-based testing offers an opportunity to improve screening, especially where colonoscopy access is limited.

Lung cancer screening (LCS) uptake remains inequitable across the United States, especially among individuals who identify as Black or African American. Synthesized and integrated analyses of quantitative and qualitative studies provide a more thorough understanding of complex facilitators and barriers to LCS uptake among Black veterans. An explanatory sequential mixed-methods design was used to conduct 1 quantitative and 2 qualitative studies at the Durham Veterans Affairs Healthcare System. Quantitative data from a cross-sectional study of Black and White veterans referred for LCS between July 2013 and August 2021 were integrated with thematic analyses of semistructured interviews with Black veteran patients, primary care providers, and LCS program staff. A content analysis of barriers and facilitators to LCS was guided by Fetters' assessment of coherence to determine the fit of data integration. We integrated data from 4,562 veteran patient electronic health record charts, 32 veteran patient interviews, and 20 health care provider interviews. Areas of confirmation included motivation for screening, patient characteristics and social networks, shared decision-making, and multistep processes for LCS. Areas of discordance included perceived risk, patient-provider trust, rurality, and transportation. Finally, areas of expansion included competing priorities and race, racism, and structural inequities. This study highlights critical areas influencing LCS uptake among Black veterans, as well as where veteran and provider perceptions align-and diverge-from quantitative screening data. The findings underscore the need for implementation strategies that address both individual-level and structural changes to ensure equity in LCS uptake.

Systemic Epstein-Barr virus-positive T-cell lymphoma of childhood (STCLC) is a rare and highly aggressive malignancy with a dismal prognosis and no standard curative treatment. This report describes the first reported case of STCLC in a White child who, after experiencing failure with intensive chemotherapy regimens, achieved a complete response following targeted immunotherapy. Initially, the patient had a rapidly progressive illness with multisystem involvement, presenting as a diagnostic and treatment dilemma due to its rarity. Histomolecular workup was most consistent with a diagnosis of STCLC. Chemotherapy-induced temporary partial response was followed by brisk clinical and radiologic progression. Subsequent immunotherapy resulted in a complete response, which was consolidated with an allogeneic hematopoietic stem cell transplant. The patient currently remains disease-free 3 years later. This case underscores the role of precision medicine in guiding the diagnosis and treatment of rare malignancies. It also highlights the role of immunotherapy as a novel targeted treatment option in STCLC, warranting further investigation.