JNCI Cancer Spectrum最新文献

BRCA1 pathogenic variants are associated with a lower risk of developing prostate cancer than BRCA2, but aggressiveness remains unclear. Therefore, screening criteria are insufficiently established. Here, we reanalyzed the impact of BRCA1 pathogenic variants on aggressiveness using 11 300 prostate cancer patients, adjusting for age and area. The proportion of aggressive prostate cancer was higher in BRCA1 carriers (86.7%) than in noncarriers (61.1%) (odds ratio = 4.87; 95% confidence interval = 1.05 to 22.60). The proportion of high prostate-specific antigen levels was higher in BRCA1 carriers (66.7%) than in noncarriers (27.9%) (P = 7.61 × 10-3). BRCA1 carriers had a worse tendency than noncarriers for T classification (T3-4: BRCA1, 36.4%; noncarriers, 23.2%) and Gleason score (GS8-10: BRCA1, 53.3%; noncarriers, 31.0%). Moreover, we observed the first case of BRCA1-related aggressive prostate cancer showing long-term survival through early detection and multidisciplinary treatment. These results suggest that recommendations for early prostate cancer screening might need to be reconsidered for BRCA1 carriers.

Background: Hospice services play an important role in end-of-life (EoL) care. In Puerto Rico, Medicaid had no provisions for hospice care until July 2024, representing a significant public health challenge. This study examined the association between hospice coverage policy and EoL outcomes among patients with cancer enrolled in Medicaid.

Methods: This population-based retrospective cohort study analyzed data of cancer patients enrolled in Medicaid from the Puerto Rico Central Cancer Registry between 2011 and 2022 who died of cancer between 2016 and 2022. Hospice enrollment was categorized into timeframes before death: 1-7, 8-14, 15-30, 31-90, 91-120, and 121-180 days. We compared total costs, healthcare utilization, and death in acute settings by hospice enrollment status.

Results: Of 4481 patients in the study, 21.7% were enrolled in hospice. Non-hospice-enrolled patients had higher healthcare expenditures for the last 7 ($548; 95% confidence interval [CI ]= $166 to $931), 14 ($1619; 95% CI = $894 to $2344), 30 ($3410; 95% CI = $2263 to $4557), 90 ($4896; 95% CI = $1987 to $7804), 120 ($6171; 95% CI = $61 to $12 281), and 180 ($19 291; 95% CI = $10 851 to $27 731) days than hospice-enrolled patients. Emergency department visit rates and hospitalization rates were higher for all periods (P < .05) for non-hospice-enrolled patients than for hospice-enrolled patients. Similarly, non-hospice-enrolled patients had a higher likelihood of dying in acute settings (P < .05).

Conclusion: Hospice enrollment among Medicaid enrollees was associated with lower health expenditure, lower healthcare resource utilization, and a lower likelihood of mortality in an acute setting. The recent policy change to include hospice services coverage in Puerto Rico Medicaid is a positive step that must be sustained beyond 2027.

Background: Patients with metastatic cancer are living longer due to treatment advances. We explored oncologists' perceptions about curability in metastatic cancer.

Methods: We invited medical oncologists to complete a 21-item online survey. We conducted descriptive analyses and thematically analyzed free-text responses.

Results: A total of 126 respondents completed the survey. The median age was 39 years (range = 27-75). Most respondents worked in Australian (64%), metropolitan (88%), public practices (56%). The most frequently treated cancer types were breast (55%), lung (52%), and colorectal (50%). In total, 82% reported thinking that patients with metastatic cancer can be cured. Cancer types with the highest perceived chance of cure (median percentage) were testicular (81%), melanoma (32%), and colorectal (16%). At the time of diagnosis of metastatic cancer, 51% reported they would tell a patient that cure was possible. After treatment, 29% reported telling some patients they had been cured, whereas 74% reported telling some patients that they may have been cured. A higher proportion thought cure was a realistic possibility with immunotherapy (83%) rather than chemotherapy (40%), but only 44% and 27%, respectively, reported they would tell this to patients. In total, 46% reported discussing the possibility of cure more frequently with immunotherapy, 5% more frequently with chemotherapy, 7% as frequently with both, and 42% not discussing with either. Respondents identified oligometastatic disease, actionable mutations, and durable responses to immunotherapy as factors associated with cure.

Conclusions: Most respondents reported thinking that metastatic cancer is curable but were reluctant to tell individual patients with metastatic cancer they had been cured.

Background: Several ovarian cancer studies have suggested that a body mass index (BMI) of 30 or higher is associated with lower compliance with National Comprehensive Cancer Network-recommended chemotherapy but primarily involved treatment before 2012, when dose capping was recommended for patients with higher body surface areas. Updated analyses in the contemporary treatment era are warranted.

Methods: In a retrospective cohort of patients with newly diagnosed ovarian cancer receiving curative-intent carboplatin plus paclitaxel in the Yale-Smilow Cancer Network (2012-2022), we evaluated BMI at diagnosis in relation to relative dose intensity (RDI)-the ratio of completed chemotherapy dose intensity to the National Comprehensive Cancer Network-recommended dose intensity-which reflects dose modification both before and during treatment. We also assessed starting RDI (which reflects modifications before treatment) and received RDI (which reflects modifications during treatment). Data on hospitalizations and hematological chemotoxicities were collected. We examined the association between BMI (<25, 25-30, ≥30) and chemotherapy completion, hospitalizations, and toxicities using multivariable linear and logistic regressions.

Results: Among 327 patients, the average RDI was 79.7%, and 44.3% had an RDI below 85%. Mean (SD) starting and received RDI were 97.9% (9.1%) and 81.8% (25.7%), respectively. Higher BMI was associated with higher RDI (Paggregate = .03) and received RDI (Paggregate = .04). Body mass index was not associated with starting RDI, dose reductions, delays, hospitalizations, or hematological toxicities.

Conclusions: Among patients with ovarian cancer treated since 2012, the overall RDI was low. Relative dose intensity was higher among patients with a BMI of 25 or higher compared with a BMI below 25. Most dose modifications occurred during treatment and not before initiation. Studies with body composition data and interventions that maximize chemotherapy completion during treatment are warranted.

Background: Sarcomas are rare malignant tumors with heterogeneous histologies and limited population-based evidence. Although new treatments have been introduced in recent years, their effect on real-world survival outcomes remains unclear. This study aimed to evaluate recent trends in mortality for bone and soft tissue sarcomas in Japan.

Methods: We conducted a cohort study using data from the Bone and Soft Tissue Tumor Registry, a nationwide database maintained by the Japanese Orthopaedic Association. Patients diagnosed with primary sarcomas between 2006 and 2020 were included and grouped by diagnostic period (2006-2010, 2011-2015, 2016-2020). The primary outcome was cumulative mortality risk, estimated using Poisson regression. Subgroup analyses were conducted by age, sex, tumor origin, metastasis status, treatment modality, and histological subtype. Sensitivity analyses included multiple imputation, Kaplan-Meier estimates, and competing risk models.

Results: A total of 19 811 patients were analyzed. No statistically significant change in overall mortality risk was observed across diagnostic periods. Ewing sarcoma showed a consistent decline in mortality, whereas other subtypes did not. Mortality risk was lower in patients who received surgery and higher in those who received radiotherapy or chemotherapy. Results were robust across sensitivity analyses.

Conclusions: Survival outcomes for sarcoma patients in Japan have remained largely unchanged over the past 15 years, except for Ewing sarcoma. Novel therapeutic approaches are needed to achieve meaningful improvements in prognosis.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting motor, sensory, and autonomic function. Accurate assessment is important during treatment, when CIPN may necessitate dose reductions or discontinuation, and after treatment, as chronic CIPN can greatly impact quality of life and safety in cancer survivorship. Measurement tools can include subjective measures, including clinician-based grading scales or patient-reported outcome measures (PROMs), and objective measures. This review aimed to summarize current CIPN assessment tools, highlighting characteristics such as feasibility, minimum clinically important differences (MCIDs), validity and reliability to allow for comparison and selection of tools by clinicians and researchers.

Methods: Following the Scale for the Assessment of Narrative Review Articles methodology guidelines, 2 investigators performed a comprehensive literature search using predefined search terms relating to CIPN measurement. Additional papers were identified through a search of prior systematic reviews and tracing back references from key articles. Data were extracted from source papers and any available appendices.

Results: We identified 3 clinician-based grading scales, 20 PROMs, and 8 objective measurement tools. While the majority of tools have been validated for neuropathy, a minority of them have established MCIDs and validation in CIPN-specific populations.

Conclusions: Tool selection should align with the specific needs of clinicians and researchers. Instruments that are valid, reliable, and assess multiple CIPN domains are recommended. Further research is needed to validate many of these tools in CIPN-specific populations and to determine their MCIDs.

Background: Chemotherapy-induced side effects can diminish physical and psychological well-being for women with breast cancer. Although nutrition and exercise improve quality of life (QoL) posttreatment, their ability to attenuate treatment-related declines in QoL during chemotherapy remains underexplored.

Methods: Women diagnosed with stage I-III breast cancer initiating chemotherapy were randomized to a yearlong nutrition and exercise intervention (I; n = 87) or usual care (UC; n = 86). Patient-Reported Outcomes Measurement Information System (PROMIS)-29, PROMIS Cognitive Function, and PROMIS Global Health scales were assessed at diagnosis (baseline), postchemotherapy (PC), 1-year, and 2-years postrandomization.

Results: Participants (N = 173) were on average 52.8 ± 11.1 years of age and 51% had stage I breast cancer. At diagnosis, PROMIS scores were comparable to the general US population, except for heightened anxiety. PROMIS scores worsened from diagnosis to PC for physical function (I = -5.5 (1.0); UC = -5.4 (1.0)), fatigue (I = 5.4 (1.1); UC = 6.2 (1.1)), social roles (I = -5.4 (1.0); UC = -7.1 (1.0)), cognitive function (I = -4.8 (1.0); UC = -4.3 (1.1)), global physical health (I = -10.9 (0.8); UC = -10.1 (0.8)), and global mental health (I = -11.2 (1.1); UC = -9.7 (1.2)), with anxiety improving (I = -5.1 (0.9); UC = -3.7 (0.9)). No between-arm differences were observed. By 1 year, most scores returned to baseline levels and remained stable through 2 years, except anxiety, which remained improved.

Conclusion: Despite improving nutrition and exercise, the intervention did not attenuate declines in QoL compared with UC. This study fills a gap on interventions with nutrition and exercise components during chemotherapy and highlights needing more research to identify those most likely to have benefits in QoL from lifestyle interventions delivered during active treatment.

Clinical trial registration: NCT03314688.

Transgender and gender-diverse patients experience significant disparities throughout the cancer continuum, including receiving less frequent preventive cancer screenings for all cancer types, being diagnosed with cancer at later stages, and being less likely to receive treatment for some types of cancer. This brief correspondence describes steps that providers and institutions can take to improve research, provider training, and clinical care for this vulnerable population.

Background: Physical activity (PA) is associated with improved overall survival (OS) among colorectal cancer (CRC) patients, but research on PA changes after diagnosis remains limited. This study examines associations between OS and changes in PA from CRC diagnosis onward, across stage- and treatment-related subgroups.

Methods: Data were analyzed from patients in two large CRC cohorts (PLCRC and COLON) enrolled between August 2010 and December 2022 (follow-up until February 1st, 2024). This included 3395 stage I-IIA patients who underwent surgery only, 2406 stage IIB/C-III patients who received (neo-)adjuvant therapy, and 669 metastatic CRC (mCRC) patients. PA was assessed via the validated SQUASH questionnaire at diagnosis (T0), and at 6, 12, and 24 months post-diagnosis (T6 to T24). Moderate-to-vigorous-intensity recreational activity was quantified by calculating Metabolic Equivalent of Task (MET) hours per week. Associations with OS were examined for change (active [tertile 2 and 3] vs inactive [tertile 1]) between timepoints using multivariable Cox proportional hazards models.

Results: Among surgery-only patients, change from inactivity to activity between T0 and T6 was significantly associated with OS (HR = 0.58, 95% CI = 0.35 to 0.96). For (neo-)adjuvantly treated patients, significant associations were observed between T6 and T12 (HR = 0.53, 95% CI = 0.31 to 0.90). Among mCRC patients, a significant association was observed between T6 and T12 (HR = 0.53, 95% CI = 0.29 to 0.99).

Conclusion: Changing from inactivity to activity is significantly associated with prolonged survival during the early months post-diagnosis for surgery-only CRC patients, and later for those undergoing (neo-)adjuvant therapy or with metastatic disease. Validation is warranted in interventional studies.

Background: Cardiometabolic risk factors and cardiovascular disease (CVD) incidence in racially and ethnically underrepresented women with breast cancer are not well characterized.

Methods: The Pathways Heart Study is a prospective cohort of 14 942 women diagnosed with invasive breast cancer between 2005 and 2013 at Kaiser Permanente Northern California. Incidence of cardiometabolic risk factors and CVD outcomes was determined from electronic health records and calculated with a competing risk framework for non-CVD death. Fine-Gray proportional hazards regression estimated subdistribution hazard ratios by race and ethnicity compared with non-Hispanic White women, with additional Asian subgroup analysis.

Results: Participants were, on average, 61 years old at diagnosis; 65% were non-Hispanic White, 7.5% were Black, 14.4% were Asian, 11.9% were Hispanic, 0.4% were Pacific Islander, and 0.8% were American Indian or Alaska Native. Black and Asian women had 1.2 to 1.3 times higher incident hypertension risk; Black, Asian, Hispanic, and Pacific Islander women had 1.5 to 3.0 times higher incident diabetes risk; and Asian women had 1.2 times higher incident dyslipidemia risk. Black women had 1.3 to 1.4 times higher risk of incident ischemic heart disease, heart failure, and overall CVD. Filipino women had 1.6 times higher risk of stroke. South Asian women had 2.5 to 2.6 times higher ischemic heart disease and heart failure risk.

Conclusions: Compared with non-Hispanic White women, racially and ethnically diverse women with breast cancer experienced a higher risk of incident diabetes, hypertension, and dyslipidemia. Black and Asian women, particularly Filipino and South Asian women, had a higher risk of incident CVD. Better characterization of health disparities in cardio-oncology is critical to inform future CVD prevention and treatment.