JNCI Cancer Spectrum最新文献

Cervical cancer elimination (<4 cases per 100 000) is a critical cancer prevention goal in the United States. Implementation of health policies and allocation of health resources occur at regional and state levels; therefore, understanding region- and state-specific cervical cancer incidence, mortality, and progress toward elimination-and remaining gaps-is essential. We estimated hysterectomy-corrected cervical cancer incidence, mortality, and progress toward elimination across all 50 states, the District of Columbia, and Puerto Rico. In 2021, Massachusetts was the only state nearing (4.3 per 100 000) the elimination threshold. Southeastern and Southwestern states were furthest, with the highest incidence rates in Mississippi (14.8), Louisiana (14.2), and Oklahoma (13.8). The mortality rate ranged from 6.8 (Alabama) to 1.4 (Wisconsin). In most states, cervical cancer incidence and mortality did not change from 2007-2011 to 2017-2021. Identifying and addressing regional- and state-level barriers impeding progress will be key to achieving cervical cancer elimination.

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: Supervised exercise may provide greater functional and quality of life benefits than unsupervised programs after cancer and is recommended for those with or at risk of breast cancer-related lymphedema. These exploratory analyses compared the effect of low- vs high-supervision exercise on the secondary survivorship outcomes of the SAFE breast cancer trial.

Methods: This randomized study (ANZCTR: ACTRN12616000547448) compared a 12-week exercise program (target 150 min.week-1, moderate intensity) supported by either 5 (low supervision [LOW]) or 20 (high supervision [HIGH)] supervised sessions. Inclusion criteria included: stage II+ breast cancer within 5 years, ≥1 comorbidity and/or treatment-related adverse effect, and insufficiently active. Outcomes included lymphedema (self-report and bioimpedance spectroscopy), arm symptoms, upper-extremity function (Patient Reported Outcomes Measurement Information System [PROMIS] Bank v1.2-Upper-Extremity), fatigue, pain, pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, and satisfaction with social roles (PROMIS-43 Profile v1.0). Chi-square tests evaluated between-group symptom changes. Generalized estimating equations assessed time, group, and time×group effects under an intention-to-treat, 2-sided framework.

Results: Sixty women (mean age, 50 years) were randomized to LOW (n = 30) vs HIGH (n = 30). At follow-up, both groups showed similar lymphedema prevalence, comparable rates of maintained or improved arm symptoms, and within-group improvements (P < .05) in fatigue, physical function, sleep, anxiety, depression, and satisfaction with social roles and activities. Potential for superior benefit in HIGH vs LOW was observed for self-reported range of movement, upper-extremity function, and pain interference and intensity (P < .05).

Conclusion: Findings indicate that breast cancer survivors with or at risk of lymphedema can benefit from exercise, even when supervision is limited.

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.

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.

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: The addition of immune checkpoint inhibitors (ICIs) to perioperative treatment for resectable gastric or gastroesophageal junction (GEJ) cancers has shown promising results. However, current pivotal trials (KEYNOTE-585 and MATTERHORN) have reported conflicting survival outcomes. To clarify their therapeutic value, we conducted a meta-analysis evaluating the efficacy and safety of adding ICIs to this population.

Methods: PubMed, Embase, and major oncology conference abstracts were systematically searched for randomized controlled trials (RCTs) comparing ICIs plus chemotherapy versus chemotherapy alone in patients with resectable gastric or GEJ adenocarcinoma. Outcomes included pathological complete response (pCR), event-free survival (EFS), overall survival (OS), and treatment-related adverse events (TRAEs). Risk differences (RDs) and hazard ratios (HRs) were pooled using a fixed-effect model meta-analysis.

Results: Seven RCTs involving 2510 patients were included. Compared with chemotherapy alone, chemoimmunotherapy significantly improved pCR (17.6% vs. 6.1%; RD = 0.11, 95% CI = 0.09 to 0.14, P < .001), EFS (HR = 0.76, 95% CI = 0.66 to 0.86, P < .001), and OS (HR = 0.82, 95% CI = 0.71 to 0.94, P = .005). Subgroup analyses showed statistically significant efficacy in PD-L1 positive tumors, whereas no significant benefit was observed in PD-L1 negative patients. Grade ≥3 TRAEs were not significantly increased with chemoimmunotherapy (66.1% vs. 62.7%; RD = 0.04, 95% CI = 0.00 to 0.08, P = .08).

Conclusions: The addition of ICIs to perioperative chemotherapy improves pathological and survival outcomes in resectable gastric or GEJ cancers, particularly in PD-L1 positive populations, without increasing grade ≥3 TRAEs. These findings support chemoimmunotherapy as a promising curative strategy.

Background: Texas has the largest uninsured population in the country. To cover medical costs of uninsured patients, multiple counties offer Financial Assistance Programs (FAPs). The association of these programs with access to cancer treatment and survival has not been studied.

Methods: Population-based Texas Cancer Registry was used to include uninsured patients aged 18 to 64 years and diagnosed with liver, lung, or pancreatic cancer from 2017 to 2021. County FAP status was ascertained from official county or county hospital websites. Multivariable binary logistic regression analyses were used to determine the adjusted odds of receipt of any cancer treatment (surgery, chemotherapy, or radiation). Subsample analyses were performed for patients with non-metastatic cancer and residents of metropolitan areas. Multivariable Cox Proportional Hazards analyses were used for survival analysis.

Results: Among 5,477 uninsured patients, 47.7% were reported to have received cancer treatment. On multivariable analysis, living in a county that offered (vs. did not offer) FAPs was associated with 1.49 higher odds of receiving cancer treatment (95%CI: 1.28-1.73). Survival analysis indicated that the Hazards of death were 44% to 55% lower for patients who received cancer treatment and lived in FAP counties (vs. did not receive cancer treatment and did not live in FAP Counties).

Relevance: For uninsured patients with cancer, residence in a county that offers financial assistance was associated with significantly increased odds of receiving treatment and significantly lower hazards of death. These findings provide evidence for policy interventions that may improve cancer care and outcomes for uninsured patients.