Cancer最新文献

{"title":"Impact of smoking status on engagement in remote symptom monitoring after oncologic surgery: Implications for symptom management and readmission rates","authors":"Jennifer R. Cracchiolo MD,&nbsp;Yuelin Li PhD,&nbsp;Michelle L. Lui MPH,&nbsp;Sigrid V. Carlsson MD, PhD, MPH,&nbsp;Richard S. Matulewicz MD,&nbsp;Jamie S. Ostroff PhD","doi":"10.1002/cncr.35708","DOIUrl":"10.1002/cncr.35708","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Remote symptom monitoring (RSM) is an evidence-based strategy shown to mitigate postoperative morbidity; however, platform engagement is required to benefit from RSM. Patients who report current smoking are at high risk for postoperative complications, but it is unknown whether smoking status influences engagement with RSM, symptom severity, or unanticipated acute care visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational case–control study was conducted in patients undergoing ambulatory oncologic surgery at a large cancer center. The authors examined the effect of current smoking status on adherence to an electronically delivered postoperative recovery-assessment tool. Symptom severity and readmissions by smoking status were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 19,481 patients who underwent surgery and were enrolled in RSM were included. The nonresponse rate (28%) in current smokers was significantly greater than the rate observed in never smokers (21%; odds ratio, 1.38; 95% confidence interval, 1.17–1.63; <i>p</i> &lt; .0001). Current smokers reported higher symptom scores for pain, wound swelling, constipation, and anxiety. The observed 30-day readmission rates were 3.6% for current smokers and 2.6% for never smokers, with overlapping confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current smokers report higher symptom burden after surgery yet are less likely to adopt proactive digital postoperative recovery strategies like RSM. Implementation strategies are needed to improve the engagement of current smokers in RSM if benefits are to be realized in this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival benefit of pembrolizumab plus chemoradiotherapy for patients with high-risk locally advanced cervical cancer","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35688","DOIUrl":"10.1002/cncr.35688","url":null,"abstract":"&lt;p&gt;The addition of pembrolizumab to chemoradiotherapy for patients with high-risk locally advanced cervical cancer significantly improved overall survival (OS), according to the second interim analysis of the phase 3 KEYNOTE-A18 trial published in &lt;i&gt;The Lancet&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;The finding provides further support for adding pembrolizumab to chemoradiotherapy in this setting, and it builds on previously reported results showing a significant improvement in progression-free survival.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These latter findings resulted in the US Food and Drug Administration’s approval of this regimen for patients with high-risk, International Federation of Gynecology and Obstetrics (FIGO) 2014 stage III–IVA cervical cancer.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Domenica Lorusso, MD, PhD, director of the Gynecological Oncology Unit at Humanitas Hospital San Pio X in Milan, Italy, and lead author of the study, first presented the results at the 2024 annual meeting of the European Society for Medical Oncology.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;At a median follow-up of 29.9 months, the 36-month OS rate was 82.6% for patients treated with pembrolizumab and chemoradiotherapy and 74.8% for patients treated with chemoradiotherapy alone, with a hazard ratio (HR) for death of 0.67 (95% CI, 0.50–0.90; &lt;i&gt;p&lt;/i&gt; = .004).&lt;/p&gt;&lt;p&gt;The trial included 1060 newly diagnosed patients with high-risk locally advanced cervical cancer randomized 1:1 to five cycles of pembrolizumab (200 mg) with concurrent chemoradiotherapy followed by 15 cycles of pembrolizumab (400 mg) (the investigational arm) or five cycles of a placebo with concurrent chemoradiotherapy followed by 15 cycles of a placebo (the control arm). Chemoradiotherapy included five cycles of cisplatin (40 mg/m&lt;sup&gt;2&lt;/sup&gt;) once weekly plus external-beam radiotherapy followed by brachytherapy.&lt;/p&gt;&lt;p&gt;At the time of randomization, patients were stratified by the planned type of external-beam radiotherapy (intensity-modulated radiotherapy [IMRT] or volumetric modulated arc therapy [VMAT] vs. non-IMRT or non-VMAT), the stage of cervical cancer at screening, and the planned total radiotherapy dose (&lt;70 vs. ≥70 Gy).&lt;/p&gt;&lt;p&gt;The benefit of adding pembrolizumab to chemoradiotherapy generally was consistent among prespecified subgroups. For example, the HR for death was 0.89 (95% CI, 0.55–1.44) for patients at FIGO stages IB2–IIB and 0.57 (95% CI, 0.39–0.83) for patients at FIGO stages III–IVA.&lt;/p&gt;&lt;p&gt;Grade 3 or higher treatment-related adverse events were seen in 78% and 70% of the patients in the investigational and placebo arms, respectively. The most common event was anemia, with decreases in both white blood cell counts and neutrophil counts. Potential immune-mediated adverse events occurred in 39% and 17% of the patients, respectively.&lt;/p&gt;&lt;p&gt;“In the context of modern and high-quality radiotherapy that is curative in 75% of patients, the addition of pembrolizumab further increases ","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential new treatment approach for intermediate-stage hepatocellular carcinoma","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35687","DOIUrl":"10.1002/cncr.35687","url":null,"abstract":"&lt;p&gt;The addition of lenvatinib and pembrolizumab to transarterial chemoembolization (TACE) significantly improved progression-free survival (PFS) in comparison with TACE alone for patients with intermediate-stage hepatocellular carcinoma (HCC) according to interim results of the prospective, phase 3 LEAP-012 study.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;The lead author of the study, Josep M. Llovet, MD, PhD, director of the Liver Cancer Program and professor of medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai in New York, presented the results at the 2024 congress of the European Society for Medical Oncology in September.&lt;/p&gt;&lt;p&gt;At a median time of 25.6 months (from randomization to the data cutoff), the median PFS was 14.6 months for patients treated with the addition of lenvatinib and pembrolizumab to TACE and 10.0 months for patients treated with TACE alone, with a hazard ratio of 0.66 (95% CI, 0.51–0.84; &lt;i&gt;p&lt;/i&gt; = .0002).&lt;/p&gt;&lt;p&gt;The finding indicates that the prespecified significant improvement in the PFS endpoint of the study was met. No significant improvement in overall survival (OS) was found, but the data are considered immature at this interim analysis.&lt;/p&gt;&lt;p&gt;Grade 3–5 treatment-related adverse events occurred in 71.3% of patients treated with lenvatinib and pembrolizumab plus TACE and in 31.5% of patients treated with TACE alone, and they led to treatment discontinuation in 8.4% and 1.2% of patients, respectively.&lt;/p&gt;&lt;p&gt;Commenting on the study, Kenneth K. Tanabe, MD, professor of surgery at Harvard Medical School and chief of the Division of Oncologic and Gastrointestinal Surgery at Massachusetts General Hospital, says that the findings suggest that lenvatinib and pembrolizumab plus TACE could be a new treatment approach for HCC in the future, but it is “too early to say with any degree of certainty.”&lt;/p&gt;&lt;p&gt;He notes the significantly greater toxicity with the addition of lenvatinib and pembrolizumab to TACE and points to several unknowns that still need answers. First, he questions the benefit of adding pembrolizumab to this regimen considering prior data from the LEAP-002 study that showed no benefit from adding pembrolizumab to lenvatinib in comparison with lenvatinib alone for advanced HCC.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;Also left unanswered, he says, is whether giving TACE alone followed by lenvatinib (sequential administration) at the time of disease progression would yield equivalent OS to that achieved with TACE alone despite the inferior PFS.&lt;/p&gt;&lt;p&gt;“This is not practice changing at this time,” he says, but he urges oncologists to “stay tuned to this channel.”&lt;/p&gt;&lt;p&gt;The LEAP-012 trial included 480 patients with HCC randomized 1:1 to lenvatinib (12 mg for a body weight ≥60 kg and 8 mg for a body weight &lt;60 kg) and pembrolizumab (400 mg) or a placebo for up to 2 years. All patients in both groups received TACE, with the first administration occurring 2–4 weeks after the ","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First person profile: Julie Brahmer, MD","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35686","DOIUrl":"10.1002/cncr.35686","url":null,"abstract":"&lt;p&gt;A strong work ethic modeled after her father, who was a farmer, greased the tracks for Julie Brahmer, MD, and led her toward a career in oncology. She credits hard work for her many accomplishments as a clinician researcher of immunotherapy agents for thoracic cancers.&lt;/p&gt;&lt;p&gt;As a young investigator in her first faculty position at the Johns Hopkins University School of Medicine in the early 2000s, she performed research that paved the way for the first immunotherapy agent to receive approval from the US Food and Drug Administration for the treatment of lung cancer. The drug was nivolumab. Dr Brahmer led the first-in-human trial (phase 1) that showed the potential efficacy of nivolumab in lung cancer and co-led the phase 2 and 3 trials that eventually led to its approval as a second-line treatment for advanced non–small cell lung cancer (NSCLC).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;Dr Brahmer called it a dream to be a part of developing a new drug for lung cancer. “My dream when starting out in drug development was to take a drug from its first-in-human trials and help it through its development and approval to help our lung cancer patients,” she says. “That dream was realized.”&lt;/p&gt;&lt;p&gt;Her vision was further realized with the subsequent approval of pembrolizumab for the treatment of lung cancer. She was the lead investigator on the KEYNOTE-024 trial, which was the first to show the superiority of pembrolizumab over chemotherapy for patients with previously untreated advanced NSCLC with programmed death ligand 1 expression. This led to the approval of pembrolizumab as a first-line treatment in this setting.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;\u0000 &lt;/p&gt;&lt;p&gt;Thereafter, she mentored younger investigators whose research led to the approval of nivolumab in combination with chemotherapy for even early stages of lung cancer, such as the Checkmate 816 trial for neoadjuvant therapy of resectable NSCLC.&lt;/p&gt;&lt;p&gt;“It is amazing to see the changes in lung cancer treatment over the past 15 years,” she says. “We’re now talking about curing patients with immunotherapy and using it in multiple cancers, all the way from head and neck cancer to esophageal cancer and mesothelioma.”&lt;/p&gt;&lt;p&gt;Dr Brahmer’s leadership roles include serving as the director of the Thoracic Oncology Program and a professor of oncology at the Sidney Kimmel Comprehensive Cancer Center. She is also a coprincipal investigator of the Johns Hopkins National Clinical Trials Network. She oversees clinical trials of immunotherapies for lung cancer and drug development for thoracic malignancies and focuses on developing treatments for mesothelioma. She also serves as the chair of the Thoracic Cancer Committee of the ECOG–ACRIN National Cooperative Group.&lt;/p&gt;&lt;p&gt;Although hard work drove her younger years, Dr Brahmer now describes her work ethic as working efficiently—a necessary refinement when managing many tasks and juggling multiple leadership roles.&lt;/p&gt;&lt;p&gt;Among these roles, she receives the mos","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to “Advancing trial recruitment science through enhanced study design”","authors":"Krupa K. Nathan MD,&nbsp;Angela B. Smith MD, MS","doi":"10.1002/cncr.35705","DOIUrl":"10.1002/cncr.35705","url":null,"abstract":"&lt;p&gt;We deeply appreciate the interest that Drs Lewicki and Stensland have taken to reflect on the operational tactics introduced in our recent &lt;i&gt;Cancer&lt;/i&gt; article&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and the demonstrable association between our centralized email, &lt;i&gt;CISTOquestion&lt;/i&gt;, and patient accrual in the CISTO study (ClinicalTrials.gov identifier NCT03933826). Patient accrual remains the primary reason for failure or premature termination of clinical trials within urology and oncology at large, and reliable predictors of trial success have yet to be discretely identified.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; Our goal is to share the strategies that we have found to maximize enrollment in the CISTO study so that these methods can be strategically used to optimize the success of future multi-institutional trials that strengthen evidence-based practices derived from these studies.&lt;/p&gt;&lt;p&gt;Among the engagement approaches used by the CISTO study team, our data suggest that CISTOquestion effectively contributed to increased and sustained enrollment and was unequivocally favored by CISTO site research coordinators, allowing for continual engagement. We agree that, from our analysis, causality between CISTOquestion and enrollment remains uncertain because of the nonrandomized rollout of CISTO study site participation and CISTOquestion. As Lewick and Stensland suggested, randomized, controlled methods for grouped site involvement and time-regulated CISTOquestion access would allow for determining a definitive effect of CISTOquestion on patient enrollment among different sites. Alternatively, it is important to consider that controlled access to CISTOquestion itself may limit site engagement, thereby counteracting enrollment for sites that rely on CISTOquestion for patient screening. This would be a tradeoff between site engagement/enrollment and determination of a true association between CISTOquestion and accrual. Such a compromise may be mitigated by allocating one half of the sites access to CISTOquestion for a brief period of time, as thoughtfully proposed.&lt;/p&gt;&lt;p&gt;Upon review of the feedback survey data administered to CISTO site research coordinators, CISTOquestion was regarded as a more beneficial resource versus all sites meetings, which aimed to facilitate structured engagement with CISTO study sites. Staffing and logistical coordination were substantial investments in the execution of all sites meetings, yet CISTOquestion was rated as more beneficial to CISTO site research coordinators given that principal investigators and CISTO study staff who responded to inquiries provided personalized, patient-specific responses. This was a testament to how CISTOquestion provided the most value given the resources used to initiate and maintain it. Considering the advancements in technology being integrated into trial design and clinical practice, the impact of CISTOquestion can be enhanced through the use of artificial intelligence with its capability of &lt;i&gt;learning&lt;/i&gt; on a","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olaparib as treatment for platinum-sensitive relapsed ovarian cancer by BRCA mutation and homologous recombination deficiency: Phase 2 LIGHT study final overall survival analysis","authors":"Ying L. Liu MD, MPH,&nbsp;Cara A. Mathews MD,&nbsp;Fiona Simpkins MD,&nbsp;Karen A. Cadoo MD,&nbsp;Diane Provencher MD,&nbsp;Colleen C. McCormick MD,&nbsp;Adam C. ElNaggar MD,&nbsp;Alon D. Altman MD,&nbsp;Lucy Gilbert MD,&nbsp;Destin Black MD,&nbsp;Nashwa Kabil MD, PhD,&nbsp;Rosie N. Taylor MSc,&nbsp;Alan Barnicle PhD,&nbsp;Jiefen Y. Munley MD,&nbsp;Carol Aghajanian MD","doi":"10.1002/cncr.35707","DOIUrl":"10.1002/cncr.35707","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>LIGHT (oLaparib In HRD-Grouped Tumor types; NCT02983799) prospectively evaluated olaparib treatment in patients with platinum-sensitive relapsed ovarian cancer (PSROC) assigned to cohorts by known BRCA mutation (BRCAm) and homologous recombination deficiency (HRD) status: germline BRCAm (gBRCAm), somatic BRCAm (sBRCAm), HRD-positive non-BRCAm, and HRD-negative. At the primary analysis, olaparib treatment demonstrated activity across all cohorts, with greatest efficacy in terms of objective response rate and progression-free survival observed in the g/sBRCAm cohorts. The authors report final overall survival (OS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this phase 2, open-label, noncomparative study, patients with PSROC and one or more prior line of platinum-based chemotherapy were assigned to cohorts by BRCAm and HRD status. OS was a secondary end point. Tumors were analyzed using Myriad BRACAnalysis CDx and MyChoice CDx assays; HRD-positive tumors were defined using a genomic instability score of ≥42.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 272 enrolled patients, 271 received olaparib and 270 met the inclusion criteria for the efficacy analysis. At data cutoff, 18-month OS rates in the gBRCAm, sBRCAm, HRD-positive non-BRCAm, and HRD-negative cohorts were 86.4%, 88.0%, 78.6%, and 59.6%, respectively. No new safety signals were observed. In a post hoc analysis, patients on treatment for &gt;18 months were most frequently present in g/sBRCAm cohorts (31.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Olaparib treatment continued to demonstrate benefit across all cohorts. Consistent with the primary analysis, the highest OS rates were observed in the BRCAm cohorts, regardless of g/sBRCAm. In patients without a BRCAm, a higher OS rate was observed in the HRD-positive non-BRCAm than the HRD-negative cohorts. These results highlight the importance of biomarker testing in this treatment setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National survey of financial burden and experience among patients with cancer and autoimmune disease receiving charitable copay assistance","authors":"Jeffrey Peppercorn MD, MPH,&nbsp;Jill S. Hasler PhD,&nbsp;Bonnie Hu BA,&nbsp;Erin K. Tagai PhD,&nbsp;Greg J. Zahner MD,&nbsp;Anh Lam MD,&nbsp;Sarina Robbins BA,&nbsp;Stephanie B. Wheeler PhD,&nbsp;Ryan D. Nipp MD, MPH,&nbsp;Suzanne M. Miller PhD","doi":"10.1002/cncr.35721","DOIUrl":"10.1002/cncr.35721","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Little is known about the role that charitable copay assistance (CPA) plays in addressing access to care and financial distress. The study sought to evaluate financial distress and experience with CPA among patients with cancer and autoimmune disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a national cross-sectional self-administered anonymous electronic survey conducted among recipients of CPA to cover the costs of a drug for cancer or autoimmune disease. Self-reported financial distress as measured by Comprehensive Score for Financial Toxicity as well as health care spending and experience with financial barriers to care were evaluated, as were perspectives on policy questions related to CPA and costs of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1566 respondents (1108 with cancer and 458 with autoimmune disease, median age 71, 51% female, 89% White, 69% household income &lt;$60,000), 53% reported mild and 31% moderate/severe financial distress, despite CPA. Eighteen percent reported missing recommended care because of costs. Most respondents (96%) had Medicare, 55% reported supplemental insurance, and 66% believed that insurance would prevent them from facing high costs of health care. A total of 52% reported paying more than $100 monthly in drug costs and 41% spending more than 10% of monthly income on health care. Financial distress was similar among patients with cancer and autoimmune diseases. In multivariable regression analysis, younger age, less education, unemployment, higher comorbidity, and lower income were independently associated with higher financial distress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study informs policy debate over the role of CPA foundations in the U.S. health insurance safety net and highlights the inadequacy of Medicare to guarantee access to care for older patients with chronic illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing trial recruitment science through enhanced study design","authors":"Patrick Lewicki MD, MS,&nbsp;Kristian Stensland MD, MPH, MS","doi":"10.1002/cncr.35703","DOIUrl":"10.1002/cncr.35703","url":null,"abstract":"","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of obesity on outcome in children diagnosed with cancer in Canada: A report from Cancer in Young People in Canada","authors":"Samuel Sassine MD, MSc,&nbsp;André P. Ilinca MD,&nbsp;Hallie Coltin MD, MSc,&nbsp;Henrique Bittencourt MD, PhD,&nbsp;Uma Athale MD,&nbsp;Lynette Bowes MD,&nbsp;Josée Brossard MD,&nbsp;Sara Israels MD,&nbsp;Donna L. Johnston MD,&nbsp;Ketan Kulkarni MD,&nbsp;Sarah McKillop MD,&nbsp;Meera Rayar MD,&nbsp;Roona Sinha MD,&nbsp;Tony Truong MD, MPH,&nbsp;Catherine Vézina MD,&nbsp;Laura Wheaton MD,&nbsp;Alexandra P. Zorzi MD,&nbsp;Lillian Sung MD, PhD,&nbsp;Marie-Claude Pelland-Marcotte MD, PhD,&nbsp;Thai Hoa Tran MD","doi":"10.1002/cncr.35673","DOIUrl":"10.1002/cncr.35673","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Childhood obesity can result in adverse health outcomes. The objectives of this study were to describe the prevalence of obesity and determine the association between obesity at cancer diagnosis and event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors conducted a retrospective cohort study using the Cancer in Young People in Canada database, including all children with newly diagnosed cancer aged 2–18 years across Canada from 2001 to 2020. Obesity was defined as age-adjusted and sex-adjusted body mass index greater than or equal to the 95th percentile. Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 11,291 patients were included, of whom 10.5% were obese at diagnosis. In multivariable models controlling for age, sex, ethnicity, neighborhood income quintile, treatment era, and cancer categories, obesity at diagnosis was independently associated with inferior EFS (adjusted hazard ratio [aHR], 1.16; 95% confidence interval [CI], 1.02–1.32; <i>p</i> = .02) and OS (aHR, 1.29; 95% CI, 1.11–1.49; <i>p</i> = .001). The adverse prognostic impact of obesity was particularly notable for acute lymphoblastic leukemia (ALL) and central nervous system (CNS) tumors. In children with ALL (<i>n</i> = 3458), obesity remained associated with inferior EFS (aHR, 1.55; <i>p</i> = .002) and OS (aHR, 1.75; <i>p</i> = .002) in multivariable analysis. In patients with CNS tumors (<i>n</i> = 2458), obesity was also associated with inferior EFS (aHR, 1.38; <i>p</i> = .008) and OS (aHR, 1.47; <i>p</i> = .004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this population-based study, obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, and prominently in children with ALL and CNS tumors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of focal anaplastic Wilms tumor: A report from the Children's Oncology Group AREN0321 and AREN03B2 studies","authors":"Amy E. Armstrong MD,&nbsp;Najat C. Daw MD,&nbsp;Lindsay A. Renfro PhD,&nbsp;James I. Geller MD,&nbsp;John A. Kalapurakal MD,&nbsp;Geetika Khanna MD,&nbsp;Arnold C. Paulino MD,&nbsp;Elizabeth J. Perlman MD,&nbsp;Peter F. Ehrlich MD,&nbsp;Kenneth W. Gow MD,&nbsp;Anne B. Warwick MS, MD, MPH, MSS, Colonel,&nbsp;Paul E. Grundy MD,&nbsp;Conrad V. Fernandez MD,&nbsp;Elizabeth A. Mullen MD,&nbsp;Jeffrey S. Dome MD, PhD,&nbsp;the Children's Oncology Group AREN0321 and AREN03B2 Study Committees","doi":"10.1002/cncr.35713","DOIUrl":"10.1002/cncr.35713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the fifth National Wilms Tumor Study, patients received vincristine and dactinomycin (VA) without radiation for stage I focal anaplastic Wilms tumor (FAWT) and VA plus doxorubicin (DD4A) and radiation for stage II–IV FAWT. Four-year event-free survival (EFS) and overall survival (OS) for stage I FAWT were 67.5% and 88.9% and for stage IV FAWT were 61.4% and 71.6%, respectively. Therapy intensification for stage I and IV FAWT was evaluated as secondary objectives in AREN0321.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Central review in the AREN03B2 Renal Tumors Classification, Biology, and Banking Study confirmed patient stage and tumor histology. Patients were then enrolled in AREN0321 and received DD4A with radiation for stage I–III FAWT and vincristine, doxorubicin, cyclophosphamide, carboplatin, and etoposide (UH-1/revised UH-1) with radiation for stage IV FAWT. Outcomes of patients with FAWT who were treated in AREN0321 (<i>n</i> = 25) and in AREN03B2 (<i>n</i> = 20) treated as per AREN0321 were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the pooled data analysis from AREN0321 and AREN03B2, 4-year EFS and OS were both 100% for stage I–II FAWT (<i>n</i> = 21), 82.4% (95% CI, 66.1%–100%) and 87.8% (95% CI, 73.4%–100%) for stage III FAWT (<i>n</i> = 17), respectively, and both 85.7% (95% CI, 63.3%–100%) for stage IV FAWT (<i>n</i> = 7). Four patients enrolled in AREN0321 had events: treatment failure occurred in three patients with stage III FAWT, and one treatment-related death was observed in a patient with stage IV FAWT following revised UH-1. No EFS or OS events occurred in patients with FAWT enrolled in AREN03B2 only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with stage I and II FAWT have outstanding survival when treated with DD4A and radiation. Intensification of therapy may have improved survival for stage IV FAWT, albeit with an increased toxicity risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 2","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}