Cancer最新文献

Background: Smoking may negatively affect health-related quality of life (HRQOL) in prostate cancer survivors, even though it is not a smoking-related malignancy. The longitudinal association of smoking with HRQOL was evaluated by focusing on intensity and duration.

Methods: Patients from the population-based North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, enrolled via the state cancer registry (2011-2013), were analyzed. HRQOL was measured with the Short Form 12 instrument at intervals of up to 5 years posttreatment. Smoking status was self-reported. Linear and mixed-effects models assessed associations with controlling for age, treatment, and time.

Results: Of 842 participants, 474 underwent prostatectomy, 258 had radiation therapy, and 110 had brachytherapy. Concurrent smoking was associated with worse general health, mental health, and physical functioning (all p < .05). Graded analysis revealed a significant dose response, with smoking ≥1 pack/day linked to the greatest declines in general health (β = -3.25; p < .001) and physical functioning (β = -2.35; p = .003) at 5 years.

Conclusions: Smoking demonstrates significant concurrent and longitudinal associations with poorer HRQOL in prostate cancer survivors, with a clear dose-response pattern. These results underscore the critical need to integrate structured smoking assessment and cessation support as a core component of comprehensive prostate cancer survivorship care.

Background: For most cytotoxic drugs, guidelines recommend body-surface-area-based dosing, yet some patients start with reduced doses, potentially reflecting tolerability concerns. The relationship between first-cycle dose reductions and subsequent delivery is unclear.

Methods: The authors analyzed data from women with stage I-IIIA breast cancer treated with adjuvant chemotherapy. Sankey diagrams illustrated trajectories from first-cycle dose proportion (FCDP) to average relative dose intensity (ARDI, ratio of received to expected dose intensity across the regimen), and cumulative dose proportion (CDP, ratio of total received to expected dose). Poisson regression estimated adjusted prevalence ratios for reduced FCDP (<95% vs. ≥95%) and three outcomes: ARDI reduction beyond initial FCDP, receiving fewer cycles, and CDP reduction beyond initial FCDP. Analyses assessed effect modification by age, body mass index (BMI), and comorbidities. Dosing was analyzed for cytotoxic and HER2-targeted therapy.

Results: A total of 8772 (90.8%) patients started with FCDP ≥95%; most maintained ARDI ≥95% (65.1%) and CDP ≥95% (79.9%). In multi-variable models, FCDP <95% was not significantly associated with further ARDI or CDP reductions or receipt of fewer cycles. BMI modified these associations (p-interaction = .004 for fewer cycles; p-interaction = .03 for CDP), with positive associations among overweight but not obese or normal-weight patients. FCDP <95% was linked to a lower likelihood of further ARDI reductions for both therapy types and lower likelihood of cumulative dose reduction in HER2-targeted therapy.

Conclusions: Early dosing decisions shaped subsequent chemotherapy delivery. Most patients who began at full dose maintained consistent dosing, whereas early reductions did not stave off subsequent changes, underscoring the need to balance safety with adequate dose intensity.

Introduction: Cancer diagnoses are associated with considerable psychological distress and increased incidence of new mental health disorders (MHDs). Our aim was to identify patterns and differences in the emergence of new MHDs within the first year following a cancer diagnosis, using data from a diverse, multi-institutional cancer cohort including more than half a million patients within a statewide academic health system.

Methods: The University of California Data Discovery Platform was used, which aggregates data of all patients at University of California-affiliated hospitals. We identified a cohort consisting of all adult patients with a cancer diagnosis and no documented MHDs before cancer diagnosis between 2013 and 2023. Multivariable adjusted time-partitioned hazard ratios for overall all-cause mortality were constructed using epochs of 12 through 35, 36 through 59, and 60 through 120 months.

Results: A total of 371,897 patients (mean age, 62.1 years) did not have a diagnosis. Following an incident cancer diagnosis, 39,687 patients (10.6%) developed a new MHD within a year. Of these, 13,904 (35.0%) were newly prescribed one or more oral psychotropic medications. After adjusting for covariates, early MHD was found to be linked to increased all-cause mortality in the initial 12 through 35 months (hazard ratio, 1.51; 95% CI, 1.47-1.56), which diminished over time, observed as 1.17 (95% CI, 1.11-1.24) for 36 through 59 months and 0.95 (95% CI, 0.89-1.01) for 60 through 120 months.

Conclusions: Patients with cancer who experience a mental health condition are at an increased risk of all-cause mortality. This reinforces and emphasizes existing recommendations for prompt screening and management of distress and mental health following a cancer diagnosis.

Gnathic osteosarcoma (OS), which includes mandibular and maxillary jaw OSs, account for 6%–9% of OS. Single-institutional and multi-institutional retrospective studies, as well as population-level databases, suggest that clinical differences exist among gnathic OS and OS of other sides, including other craniofacial OS. To date, no specific prospective studies of gnathic OS have been reported, and aspects of clinical management are controversial. Some elements of care are aligned with extragnathic OS, e.g., margin negative (R0) surgery, whereas others, such as chemotherapy and radiation, are not clearly defined. The authors reviewed the available literature for the diagnosis, treatment, and supportive/survivorship care patients with gnathic OS and offer consensus statements for the comprehensive management of this rare disease.