JNCI Cancer Spectrum最新文献

Screening for food insecurity and other social determinants of health is being integrated into oncology practice. We performed a pilot randomized trial to investigate whether an unconditional cash transfer (UCT) could be used to address food insecurity among female breast and gynecological cancer survivors. Food-insecure cancer survivors completed a baseline survey and were randomly assigned to receive $100/month for 3 months (UCT) or usual care (UC). Participants (n = 14) completed a follow-up survey after 3 months, and we compared changes in health-related quality of life, indicators of food insecurity, diet quality, and whether a participant had to forgo, delay, or make changes to medical care because of cost. The UCT was associated with higher physical health scores, fewer indicators of food insecurity, better diet quality, and a lower likelihood of forgoing medical care than those who received UC. Our results suggest that UCTs can improve outcomes for food-insecure cancer survivors.

Background: Few studies have investigated the relationship between neighborhood vulnerability and health-related quality of life (HRQOL) in the childhood cancer population. This study evaluated the impact of neighborhood vulnerability on HRQOL among adult survivors of childhood cancer.

Methods: This cross-sectional study included 4393 adult survivors of childhood cancer from the St Jude Lifetime Cohort Study. At the baseline (2007-2020), HRQOL was assessed using the SF36v2's physical and mental components summaries (PCS and MCS). Neighborhood vulnerability was assessed using the overall, domain, and indicator-specific scores of the Social Vulnerability Index (SVI) and Minority Health SVI (MHSVI). Multivariable logistic regression was used to evaluate associations of neighborhood vulnerability (quartiles: Q1-Q4) with impaired HRQOL (1SD below the norm), adjusting for diagnosis, demographics, personal socioeconomic status (SES), lifestyle, and chronic health condition burden. Interactions of SVI and MHSVI with personal SES on impaired HRQOL were analyzed.

Results: Among survivors, 51.9% were male, averaging 30.3 years of age at evaluation and 21.5 years since diagnosis. Comparing neighborhoods with higher vs lower vulnerability (Q4 vs Q1), overall (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.19 to 2.16) and domain-specific vulnerability (socioeconomic: OR = 1.59, 95% CI = 1.18 to 2.15; household composition: OR = 1.54, 95% CI = 1.16 to 2.06; housing and transportation: OR = 1.33, 95% CI = 1.00 to 1.76; medical vulnerability: OR = 1.60, 95% CI = 1.22 to 2.09) were significantly associated with impaired PCS, but not MCS. Residing in neighborhoods lacking urgent care clinics was significantly associated with impaired PCS (OR = 1.39, 95% CI = 1.08 to 1.78). Having lower vs higher personal education and living in higher vulnerability neighborhoods were associated with more impaired PCS (Pinteraction = .021).

Conclusions: Specific aspects of neighborhood vulnerability increase the risk for impaired physical HRQOL. Addressing these neighborhood factors is essential to enhance the HRQOL of survivors.

Background: Although therapeutic human papillomavirus vaccines could offer a noninvasive treatment for patients with cervical intraepithelial neoplasia, none has been clinically implemented. Oral administration of the therapeutic human papillomavirus vaccine IGMKK16E7 results in the histological regression of human papillomavirus 16-positive cervical intraepithelial neoplasia 2/3 to normal (complete response). We investigated biomarkers that could predict complete response after oral administration of IGMKK16E7.

Methods: Forty-two patients administered high-dose oral IGMKK16E7 in a phase I/II trial were included. Cervix-exfoliated cells were collected before vaccine administration. Gene expression of CD4, CD8, FOXP3, programmed cell death 1 protein, CTLA4, CD103, CD28, CD80, CD86, and programmed cell death 1 ligand 1 in the cells was measured by quantitative reverse transcriptase-polymerase chain reaction. Receiver operating characteristic curve analysis and Mann-Whitney tests were used to explore potential biomarkers. Pearson correlation coefficient analysis was used to correlate gene expression profiles with clinical outcome.

Results: The only predictive biomarker of vaccine response for which receiver operating characteristic curve analysis showed significant diagnostic performance with histological complete response was CD86 (area under the curve = 0.71, 95% confidence interval = 0.53 to 0.88, P = .020). Patients with complete response had significantly lower CD86 expression (CD86-low) than patients with no complete response (P = .035). The complete response rates for CD86-low and CD86-high patients were 50% and 19%, respectively, and CD86-low patients had a significantly higher complete response rate (P = .047). Compared with all patients, the CD86-low group had a 1.5-fold increase in the complete response rate. Gene expression of CD86 and CTLA4 showed the strongest positive correlation with clinical outcomes in the incomplete response group (P < .001).

Conclusion: Low expression of CD86 in exfoliated cervical cells can be used as a pretreatment biomarker to predict histological complete response after IGMKK16E7 administration.

Time toxicity is a considerable burden for oncology patients. This study evaluated the feasibility and acceptability of integrating mobile phlebotomy into standard of care procedures. From September 26, 2022, through December 31, 2023, a total of 345 patients had 1464 home laboratory test collection visits completed. These mobile phlebotomy laboratory collection visits occurred in New York (68.6% of visits), New Jersey (29.9%), Connecticut (1.1%), and Pennsylvania (0.5%). Specimen quality for home laboratory test collection surpassed the Memorial Sloan Kettering Department of Pathology and Laboratory Medicine benchmarks. Acceptability was high, 173 patients were approached, and 149 responded (86% response rate); most respondents (147 of 149, 99%) would use the service again or recommend it to others. This study assessed the integration of mobile phlebotomy into standard of care management for the collection of routine cancer laboratory tests. Mobile phlebotomy results in high patient satisfaction with superior specimen quality, offering a valuable solution to oncology patients for improved efficiency and convenience.

Background: High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts.

Methods: A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument).

Results: Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended.

Conclusions: Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.

The role of immune checkpoint inhibitors for patients with gastroesophageal cancer with liver metastasis remains unclear. Our objective was to investigate whether immune checkpoint inhibitors are beneficial in patients with gastroesophageal cancer with liver metastasis. We searched PubMed, Embase, European Society for Medical Oncology, and American Society of Clinical Oncology meeting abstracts for phase 3 randomized clinical trials testing immune checkpoint inhibitors in metastatic/advanced gastroesophageal cancer from 2017 to 2023. Seven studies were included. Overall survival was similar among all patients (hazard ratio [HR] = 0.72 [95% confidence interval (CI) = 0.67 to 0.77], P < .001), in patients without liver metastases (HR = 0.73 [95% CI = 0.67 to 0.81], P < .001, I2 = 0.0%), and in patients with liver metastases (HR = 0.74 [95% CI = 0.67 to 0.81], P < .001, I2 = 0.0%). Progression-free survival was also similar among all patients (HR = 0.63 [95% CI = 0.57 to 0.70], P < .001), in patients without liver metastases (HR = 0.62 [95% CI = 0.51 to 0.76], P < .001), and in patients with liver metastases (HR = 0.66 [95% CI = 0.57 to 0.76], P < .001). Immune checkpoint inhibitors showed no difference in benefit in patients with gastroesophageal cancer, regardless of liver metastasis. Future studies could focus on deciphering the tumor microenvironment of liver metastasis as an area of translational research.

Background: Chronic exposure to ambient stressors, including neighborhood crime, may have a detrimental impact on the body's stress response system with implications for colorectal carcinogenesis.

Methods: We examined associations between the mean neighborhood homicide rates from 2000 and 2018 and diagnosis of colorectal adenoma among patients at the University of Illinois Health and Hospital System in Chicago, Illinois, between 2015 and 2018.

Results: Of the 5,225 patients who underwent colonoscopy and were included in the analytic dataset, 60% had colorectal adenoma. Older age, male sex, and higher body mass index (BMI) were associated with greater odds of colorectal adenoma. The neighborhood homicide rate was associated with identifying as Black and Hispanic and higher BMI. A mediation analysis showed that the neighborhood homicide rate effects on colorectal adenoma were mediated through BMI.

Conclusion: The study concluded that older age, male sex, and higher BMI significantly increase the odds of colorectal adenoma, with neighborhood homicide rate indirectly influencing this risk through its association with BMI, particularly among Black and Hispanic individuals.

Background: Monitoring toxicities among patients receiving immune checkpoint inhibitors (ICIs) using patient-reported outcome (PRO) measures (PROMs) is relatively recent. This scoping review aims to guide decision-making in the development of PROMs ICI programs.

Methods: Four electronic databases were searched from inception to January 2024. Data on PROMs ICI programs (eg, PROMs used, frequency) were extracted. Two authors with established inter-rater reliability screened titles, abstracts, and full texts. A narrative synthesis identified patterns in the data.

Results: 22 articles described 16 unique multicomponent, electronic PRO programs, mainly developed for remote monitoring of toxicities between appointments. Patients typically completed 18-26 items from the PRO-CTCAE or CTCAE weekly, with high adherence/satisfaction. Commonly monitored symptoms were diarrhea, fatigue, shortness of breath, cough, nausea, decreased appetite, rash, joint pain, pain, and mood. Other features of PROM programs included clinician alerts, with some program only flagging symptoms that had an impact on treatment. Some program also or only sent alerts to patients to contact their clinicians and gave access to symptom management information. In terms of efficacy, the only consistent finding was an increase in QOL.

Discussion: The findings of this scoping review provide some indication as to which components of a PROM program are promising. However, as the evidence-based for PROMs among patients receiving ICIs is growing, many questions remain, including which symptoms to monitor, using which PROM, and at what frequency. More trials are needed to answer these questions and to determine how best to implement PROM ICI programs in clinical practice.

Background: One in eight females will be diagnosed with breast cancer in their lifetime. While medical advances have increased the likelihood of survival, up to 90% of females will gain weight during and after treatment increasing the risk of breast cancer recurrence and obesity related co-morbidities in survivorship. Behavioral lifestyle interventions focused on diet with or without physical activity can provide breast cancer survivors non-pharmacological options to decrease weight gain and cardiometabolic risk.

Method: A PubMed search was conducted to identify all behavioral lifestyle interventions focused on diet or diet combined with physical activity longer than 4 weeks of duration in breast cancer survivors that included body weight as an outcome. This review aims to summarize the effects on body weight, body composition and cardiometabolic risk markers are summarized.

Results: Based on the review, there is high heterogeneity in type and duration of the intervention to affect weight and cardiometabolic risk in survivorship. Calorie restriction with and without physical activity appears to promote weight loss among breast cancer survivors. However, the effects on cardiometabolic factors are less clear.

Conclusion: Future studies should be powered for both body weight and cardiometabolic effects. Researchers should also consider interventions that are: 1) less complex, 2) recruit a more racially and ethnically diverse sample, 3) integrate resistance training, 4) implement the intervention in closer proximity to diagnosis, 5) target weight management in this population before it occurs and 6) analyze body composition in addition to body weight measurements.