JNCI Cancer Spectrum最新文献

Background: Breast cancer screening is crucial for early detection and improved survival in Alzheimer's Disease and Related Dementias (ADRD) patients, but real-world evidence of its effects on survival and prognosis remains insufficient.

Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare data (1999 to 2019) to analyze the impact of breast cancer screening on prognosis (ie cancer stage) and survival in ADRD women with breast cancer diagnosed ≥ 67 years. Logistic and Cox regression models were employed to assess the relationship between screening and risk of advanced stage at diagnosis, and length of survival, adjusted for relevant covariates (e.x. marital status, comorbidities, age at screening).

Results: The cohort included 8,739 ADRD patients with breast cancer, with 4,483 completed at least one screening between their ADRD and first breast cancer diagnosis. The cohort completed screening had significant lower rates of advanced-stage diagnosis (22.2% vs 42.6%) and longer survival (65.9 vs 45.7 months) compared to the cohort without any screening history. Unscreened patients had 2.7 times higher odds of advanced-stage diagnosis, and 2 times higher hazard of death than patients with at least one screening completed before breast cancer diagnosis. Effects of comorbidities, age, and race were significant on both diagnosis stage and survival in breast cancer patients.

Conclusion: Our study demonstrated the benefit of screening in early diagnosis and longer survival in ADRD patients with breast cancer, which advocates for an expansion of current breast cancer screening recommendations to more effectively guide cancer care for ADRD patients.

Background: Prior studies suggest positive associations of type 2 diabetes (T2D) with risk of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM), but few studies had sufficient statistical power to evaluate associations for specific histologic subtypes.

Methods: We pooled data from the Cancer Prevention Study-II Nutrition Cohort, California Teachers' Study, Health Professionals Follow-up Study, Nurses' Health Study (NHS), and NHSII cohorts and a sample of Kaiser Permanente Southern California members (585,114 total study participants). We confirmed incident diagnoses of NHL and MM using medical records or cancer registries. T2D history was assessed by self-report or clinical diagnosis. We estimated the associations of T2D history (yes/no) and T2D duration with risk of overall NHL, NHL subtypes, or MM using multivariable Cox regression models adjusted for age, sex, cohort, follow-up year, race, education, smoking, and body mass index.

Results: We confirmed 11,478 NHL and 2,783 MM diagnoses over a median follow-up of 20 years. T2D history was not associated with overall NHL risk but was positively associated with risk of diffuse large B-cell lymphoma (DLBCL; hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.04-1.28) and MM (1.20, 1.07-1.35) and inversely associated with risk of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (0.45, 0.27-0.75), T-cell NHL (0.78, 0.62-0.97), and mycosis fungoides/Sezary syndrome (0.67, 0.46-0.98). T2D duration was positively associated with risk of DLBCL and MM.

Conclusions: Our findings suggest a role for T2D in DLBCL and MM; thus, T2D prevention may be important in reducing their incidence. Some unexpected inverse associations require further investigation.

Background: Radiotherapy (RT) plays a crucial role in managing cancer-related symptoms. This study characterized symptom documentation, especially pain, preceding bone metastasis (BM) diagnosis and initiation of RT for BM, using natural language processing (NLP) approaches.

Methods: A de-identified cohort of patients who received RT for BM at a single tertiary-care institution (2013-2023) was created. Clinical data, notes, and metadata were computationally extracted. A previously validated NLP pipeline based on the clinical Text Analysis and Knowledge Extraction System was used to extract CTCAE-encoded symptoms from all notes in the 30 days preceding BM diagnosis and each course of RT for BM. Logistic regression analyses examined the association between clinical and demographic variables and pain documentation.

Results: 1,061 patients (median [IQR] age, 64 [54-72] years; 582 [54.9%] men) received 1,718 courses of RT for BM. The most common documented symptoms before BM diagnosis and first RT for BM, respectively, were BM-related pain (52.5% vs 91.6%, p < .001), nausea (20.8% vs 48.9%, p < .001), and constipation (12.8% vs 34.2%, p < .001). Prior to BM diagnosis, multiracial/other race (OR = 0.61 [95% CI 0.38-0.99], p = .045) was associated with decreased pain documentation compared to white race. Prior to RT for BM, women (OR = 1.48 [95% CI 1.02-2.15], p = .039) had increased pain documentation compared to men.

Conclusions: Women and multiracial/other race patients experienced a relative increase in pain documentation from BM diagnosis to RT for BM. This may reflect differential decision-making for which patients are offered RT for BM sooner in the symptom trajectory. Interventions are needed to increase equitable distribution of RT.

Background: Patients with incurable gastroesophageal adenocarcinoma (GAC) have an impaired health-related quality of life (HRQoL). Exercise combined with nutritional support may improve this outcome. Careful evaluation of this supportive care strategy is needed to avoid burdening patients at this vulnerable stage with interventions that may offer no (meaningful) benefit. Therefore, this study aims to investigate the effects of a combined exercise and nutritional intervention on HRQoL in.

Patient: s with incurable GAC.

Methods: RADICES is a multicenter randomized controlled trial aiming to include 196 patients with incurable GAC. Participants are randomly assigned (1:1) to a patient tailored intervention or a control group. The intervention group is provided with two training sessions per week and biweekly nutritional consultations, delivered by trained physiotherapists and dietitians, during 12 weeks. The control group receives usual care supplemented with general physical activity advice.The primary outcome is the difference in HRQoL between the intervention group and the control group at 12 weeks, accounting for baseline HRQoL, measured by the EORTC QLQ-C30 summary score. HRQoL is assessed at baseline, 6, 12 weeks, and every 3 months thereafter up to 1 year. Key secondary outcomes include patient-reported outcomes, cardiorespiratory fitness, dietary intake, disease progression, overall survival and cost-effectiveness. Adherence and safety are monitored throughout the intervention period.

Discussion: This study will generate evidence on the effectiveness of a patient tailored combined exercise and nutritional intervention in patients with incurable GAC. If effective for HRQoL, this intervention could be integrated into standard care for patients with incurable GAC.

Background: People with advanced cancer often invest substantial amounts of time to receive palliative treatments. This has been labeled the "time toxicity" of cancer treatment. However, stakeholder views on time toxicity are still being established. This study used mixed methods to explore Australian oncologists' perspectives on the time burdens of palliative systemic cancer treatments.

Methods: Semistructured qualitative interviews were conducted with a convenience sample of gastrointestinal oncologists recruited from 1 metropolitan and 1 regional center, supplemented by online advertising through the Australian Gastro-Intestinal Trials Group. Themes emerging from initial interviews (n = 8) informed the development of an online survey disseminated to Australian oncologists via professional groups. Qualitative data were analyzed using an inductive approach. Survey data were summarized descriptively.

Results: Fifteen oncologists were interviewed, 60% of whom were primarily based in major metropolitan areas. One overarching theme-the value of time-unified 4 subthemes: (1) contributors to time toxicity, (2) benefits and uncertainties, (3) time as a decision-modifier, and (4) proposed solutions. Surveyed oncologists (n = 108) expressed broad agreement with the thematic framework in interviews, affirming the importance of time for patients with advanced cancer and supporting strategies to reduce time burdens. However, responses acknowledged the subjectivity of time toxicity to individual patients.

Conclusions: This mixed-methods study establishes Australian oncologists' perspectives on the time toxicity of palliative systemic cancer treatments, identifying potential barriers and opportunities for including discussions of health-care time into shared decision making, and system-level strategies for addressing unwanted health-care contact time.

Background: Weight gain and physical inactivity during chemotherapy for patients with early-stage breast cancer are common. We sought to investigate the feasibility of a virtual lifestyle (exercise and diet) intervention for breast cancer survivors during chemotherapy.

Methods: This single-arm phase 2 trial delivered 12 weekly 1-hour telehealth sessions of supervised exercise and diet education to breast cancer survivors (patients with stage I-III disease) starting neoadjuvant chemotherapy. Screening, recruitment, intervention, and study assessments completed at baseline (T0), immediately after the intervention (T1), and 3 months after the intervention (T2) were conducted by telehealth in 2022-2023. The primary outcome was that at least 60% of participants achieved 50% of the predetermined exercise and dietary goals. Secondary outcomes were acceptability (participation, attendance, completion), physical health, and lifestyle outcomes.

Results: Of 73 referrals, 60 individuals were eligible, 58 (97%) provided consent, 51 (85%) commenced the intervention, and 34 (57%) completed at least 1 postintervention assessment (completion rate = 67%). The mean (SD) age of participants was 51 (8.8) years, and 50% of participants were receiving neoadjuvant chemotherapy. Attendance was lower for exercise than for diet sessions (44% vs 62% attended ≥75% sessions). At T1, 36% of participants adhered to at at least 50% of the preset goals, improving at T2 (62.5%). Weight was not statistically significantly different between T0 and T1 (P = .199) but increased substantially at T2 (P = .018). Average waist circumference was reduced at T1 (‒1.9 cm, P = .014) and at T2 (‒3.3 cm, P < .001). Weekly exercise time increased by 38.5 minutes from T0 to T1 (P = .038), and the proportion of participants who met exercise guidelines improved from 6% (T0) to 41% (T2).

Conclusion: Our primary outcome was not achieved immediately after the intervention but was observed 3 months later. Individuals completing the intervention attended at least half the diet and exercise sessions during chemotherapy. Results of this study will inform design of a phase 3 study.

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: 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: 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.