JNCI Cancer Spectrum最新文献

Background: Longitudinal studies examining mental health outcomes among older (≥66 years) Asian, Native Hawaiian, and Pacific Islander (ANHPI) women diagnosed with breast cancer are limited. We evaluated incident depression after breast cancer among specific groups of older ANHPI compared with older non-Hispanic White (NHW) women. Predictors of depression and the risk of death following early onset of depression after breast cancer were also evaluated.

Methods: A cohort of 26 776 older ANHPI women in the United States diagnosed with breast cancer between 2000 and 2017 was identified from the SEER-Medicare linked claims. There were 6694 older ANHPI and 20 082 older NHW women diagnosed with breast cancer. Adjusted hazard ratios (HRs) were calculated with the Cox proportional hazards regression and 99% confidence intervals (CI) to evaluate incident depression and death among older ANHPI compared with age-matched NHW counterparts.

Results: Compared with older NHW women with breast cancer, older Japanese (HR = 0.43, 99% CI = 0.31 to 0.66), Chinese (HR = 0.46, 99% CI = 0.31 to 0.67), Filipino (HR = 0.43, 99% CI = 0.30 to 0.60), and Asian Indian/Pakistani women (HR = 0.49, 99% CI = 0.28 to 0.84) had a lower risk of depression overall and within 5 years of follow-up; lower risk persisted for Japanese and Chinese women >5 years. ANHPI breast cancer patients with early onset of depression had a higher risk of death (HR = 1.46, 99% CI = 1.30 to 1.65) compared to those without depression.

Conclusion: Compared with older NHW women, older ANHPI women had a lower incidence of depression, although disentangling the stigma surrounding depression by race and ethnicity remains challenging.

Background: The National Cancer Institute (NCI) requires that NCI-Designated Cancer Centers develop programs to reduce the burden of cancer within their catchment areas, or the geographic area they serve. Extending catchment area approaches to community cancer centers has the potential to meaningfully reduce the burden of cancer nationwide. Building on a prior report that identified 2 advanced breast cancer (BC) hotspots (geographic areas with significantly elevated rates of BC) in a community cancer center catchment area, the objective of this study was to identify screening-related and tumor biology factors that explain the advanced BC hotspots.

Methods: Logistic regressions were used to model the relationship between BC screening interval and odds of advanced BC in a catchment area-based cohort of 3492 breast cancer patients, adjusting for demographic and tumor characteristics. The observed to expected case ratios were used to evaluate how well the regression models explained the hotspots.

Results: In models adjusted for grade, molecular subtype, and histology, patients with inconsistent BC screening had more than twice the odds of advanced breast cancer as patients who screened regularly. The model largely explained one of the hotspots and approximately half of the excess cases observed for the second hotspot.

Conclusions: In a community cancer center catchment area, BC screening and tumor biology were associated with increased odds of advanced BC and helped to explain previously detected hotspots. Specific community outreach and engagement interventions are considered for these hotspots while broader implications for extending catchment area approaches to community cancer centers are discussed.

Background: Exposure to arsenic in drinking water may interact with common genetic variants in urinary bladder cancer risk.

Methods: We conducted a gene-environment interaction analysis among 1091 bladder cancer cases and 928 controls from the New England Bladder Cancer Study. Genetic variants tested as effect modifiers included those associated with bladder cancer and arsenic metabolism. Interactions with disease-specific polygenic scores and a genome-wide gene-environment interaction analysis were also conducted. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated with average arsenic concentration (µg/L), average daily arsenic (µg/day), and cumulative arsenic (mg) in water as exposures.

Results: Multiplicative interactions for bladder cancer risk were identified for cumulative arsenic and rs1046428 of GSTZ1 on 14q23 (TT and TC genotype: ORT3vsT1 = 1.44, 95% CI = 1.05 to 1.98; Pinteraction  = .01) and for average daily arsenic and rs1801133 (C677T) and rs1801131 (A1298C) of MTHFR on 1p36 (TT and TC genotypes: ORT3vsT1 = 1.53, 95% CI = 1.06 to 2.23; Pinteraction  = .02; CC and CA genotype: ORT3vsT1 = 1.63, 95% CI = 1.16 to 2.29; Pinteraction  =.01, respectively). A global interaction between arsenic exposure and polygenic scores was also observed (ORT3vsT1 = 1.80, 95% CI = 1.26 to 2.56; Pinteraction  =. 01). Genome-wide gene-environment interaction analyses suggested interactions with 5 loci with a Pinteraction of no more than 5e-6.

Conclusions: Genetic variants that function in arsenic metabolism involving folate and oxidative stress pathways and a global summary of genetic susceptibility to bladder cancer may modify the association between elevated arsenic exposure from drinking water and bladder cancer.

Background: Lynch syndrome (LS) is a hereditary cancer predisposition that increases risk for colorectal, endometrial, and other cancers. Although population-based genomic screening programs identify individuals with LS, clinical presentation in such genomically ascertained populations is unknown.

Methods: MyCode is a healthcare system-based biobank that returns clinically actionable genomic screening results to participants, including pathogenic/likely pathogenic (P/LP) variants in LS genes (MLH1, MSH2, MSH6, PMS2). Adult cases (participants with an LS result) and controls (participants without a cancer predisposition variant matched to cases) reported their personal and family cancer histories. Rates of meeting National Comprehensive Cancer Network (NCCN) genetic testing guidelines and rates of colorectal and endometrial cancers in cases, controls, and their family members were calculated and compared.

Results: A total of 175 cases (10 MLH1, 7 MSH2, 83 MSH6, and 75 PMS2) and 169 controls were included. Of case pedigrees, 62/175 (35.4%) met NCCN criteria for LS evaluation. Case pedigrees were more likely (P < .001) to meet criteria than control pedigrees (4/169, 8.35%). Case probands had significantly higher rates of colorectal and endometrial cancer than controls (7.7% vs 2.4%, P = .03 colorectal; 11.5% vs 0%, P < .001 endometrial), as did their relatives (3.1% vs 0.9%, P < .001 colorectal; 2.2% vs 0.5%, P < .001 endometrial).

Conclusions: NCCN guidelines missed 65% of cases with P/LP LS variants despite families having higher colorectal and endometrial cancer rates compared with controls. Genomic screening can assist in identifying individuals at risk for LS-related cancers, providing an opportunity to tailor risk management for cancer prevention and early detection.

Assessing Medicare payment trends for cervical cancer care is important to mitigate the financial impact on Medicare. This multiyear cross-sectional study included 65 years and older cervical cancer patients in SEER registries diagnosed between 2010 and 2019 who had continuous Part A and B Medicare coverage at least 6 months before diagnosis and at least within the first year of diagnosis and were not enrolled in any Health Maintenance Organization (HMO) in this duration. The main outcomes were trends in total and service-specific mean monthly Medicare payments within the first year of a cervical cancer diagnosis. This study included 2147 cervical cancer patients. The mean Medicare payments increased from $8300 in 2010 to $8520 in 2019, largely driven by a statistically significant increase in outpatient services costs, from $1361 to $2056 (AAPC = 5.45, 95% CI = 1.38 to 9.67, P = .008). These findings highlight the need for policy actions to mitigate cervical-cancer-related financial impact on Medicare.

Advanced melanoma was historically considered incurable; however, a 52% 10-year melanoma-specific survival rate from seminal immunotherapy trials challenges that conclusion.1 There is no literature exploring clinicians' discussion of treatment intent with patients, or whether this represents cure. We performed a multicenter retrospective cohort analysis to examine treatment intent, using electronic medical records to identify 278 patients with unresectable or stage IV melanoma consented for immunotherapy from 2019 to 2023. Thirty-two (12%) were consented for curative-intent treatment (CIT). CIT frequency was not significantly influenced by patient or disease characteristics. Patients consented for CIT received significantly higher rates of combination immunotherapy than patients consented for non-curative-intent treatment (NCIT), 76% (16/21) vs 47% (116/246), P = .022. Among 267 unresectable patients, CIT rates differed significantly between Victoria and South Australia, 14% (20/142) vs 0.8% (1/125), P < .001. Our data confirms variability of documented treatment-intent in advanced melanoma. Further research is needed to understand how this affects patients.

Background: Nine National Cancer Institute-Designated Cancer Centers received supplemental funding to expand community outreach and engagement activities through a partnership with Centers for Disease Control and Prevention-funded comprehensive cancer control coalitions. This article reports on an evaluation of these awards focused on organizational relationships and partnership outcomes.

Methods: The National Cancer Institute, community outreach and engagement, and coalition representatives co-designed the evaluation, which involved document review and 18 semistructured interviews with 16 community outreach and engagement and 19 coalition representatives. Artificial intelligence-generated interview transcripts were dual-coded in NVivo, version 20/R1, software.

Results: The funding generated a diverse collection of projects and partnerships. Community outreach and engagement-coalition synergies and lessons learned were evident in the following domains: infrastructure; community and partner engagement; data monitoring; and intervention implementation, evaluation, and dissemination. Outcomes of this funding initiative were evident in the following domains: strengthened partnerships, expanded knowledge, improved health or health-care programs and policies, and thriving communities.

Conclusions: Fostering community outreach and engagement-coalition partnerships created opportunities to use synergies and build capacity for engagement across multiple domains, contributing to enhanced trust and implementation of interventions across the cancer continuum. The findings provide examples and lessons on which cancer centers and coalitions can capitalize. Successful collaborative relationships were based on identifying shared goals and complementary expertise and roles, sharing financial and other resources, and a commitment to authentic and open dialogue. Although modest and short term, supplemental funding can strengthen organizational relationships and promote effective collaboration on community-facing activities; it can also lead to improved research engagement and translation of evidence to practice.

Background: Patients' self-report of their symptoms can provide important data for the evaluation of treatment benefit and tolerability of oncology drugs. Contemporary treatment approaches, including immunotherapy and molecular targeted therapies, have unique toxicities based on their novel mechanisms of action. This scoping review aimed to summarize evidence from existing reviews and clinical practice guidelines to examine the type and prevalence of toxicities including symptomatic adverse events (sympAEs) for adult cancer patients to inform clinical care and therapeutic trials.

Methods: A systematic search of PubMed, Web of Science, and Embase was performed using predefined eligibility criteria. Thirty-one literature reviews and 3 clinical practice guidelines met inclusion criteria and were selected for review and data abstraction.

Results: Findings from this scoping review demonstrated several leading sympAEs that were reported across immunotherapy and targeted therapy drugs, including fatigue, diarrhea, and rash. In addition to these more prevalent sympAEs, there were some less frequently reported class-specific sympAEs, which had potential for significant harm or disability to the patient if not properly identified and treated. Many studies reported toxicities as AEs or syndromes solely using data reported by clinicians without additional self-report from patients.

Conclusion: We identified several core sympAEs experienced by patients participating in oncology trials using immunotherapy and targeted therapy agents, which has implications for future trial design and drug labeling. Future cancer trials should assess patient-reported sympAEs based on the identified drug mechanism to inform the tolerability of these newer agents and enhance patient safety during trial participation and clinical care.

Nearly all cervical cancers are caused by human papillomavirus (HPV). In 2006, adolescent females were recommended to receive the HPV vaccine. Our study aimed to quantify the impact of introducing the HPV vaccine in 2006 on cervical cancer incidence in 2022. We analyzed the latest Surveillance, Epidemiology, and End Results data. Our design compared the change in cervical cancer incidence from 2019 to 2022 between females recommended for HPV vaccination in 2006 (age 25-29) and females who were not (age 35-54). Beyond simple pre/post comparisons, our linear regression model adjusted for age-specific incidence trends. We found that, unlike the stagnate trends in older females between 2019 and 2022, in 25-29-year-old females, cervical cancer incidence declined 2.1 cases/100 000 (95% CI = -2.7 to -1.6): a 48% reduction from baseline trends. Although tempered by uneven adherence, after 15 years we finally appear to be realizing quantifiable benefits from this cancer prevention vaccine.