JCO Global Oncology最新文献

Purpose: Management of locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision. Recently, total neoadjuvant treatment (TNT) has gained attention. In developing countries, patients with rectal cancer often present at advanced stages. This study assesses treatment patterns and outcomes in LARC at a largest referral center in Ethiopia.

Materials and methods: A cross-sectional study was conducted on 100 patients with LARC treated at Tikur Anbessa Specialized Hospital from January 2020 to September 2022.

Results: The median age at diagnosis was 45.5 years (range, 20-86), with 51% male. Of the patients, 81% had no previous oncologic treatment and 75.3% was discussed in a multidisciplinary tumor board. Up-front surgery was planned for 44.4% of patients, whereas 22.2% and 8.6% were assigned to TNT and NACRT, respectively. Among 81 treatment-naïve patients, 79 were triaged for surgery, but only 47 (59.5%) underwent surgery, achieving an 89.9% R0 resection rate. Of 36 up-front planned surgeries, 35 proceeded as planned, whereas only 12 of 43 (28%) planned after neoadjuvant treatment underwent surgery. Neoadjuvant chemotherapy (NACT) was given to 37% of patients, with 16.7% (5 of 30) undergoing subsequent surgery. Radiotherapy was given to 24.2% of participants, with 56.25% undergoing surgery. Short-course radiotherapy (SCRT) was given to two patients. Only 14.8% completed all planned treatments, with radiation waiting time (median, 10 months) being the main impediment.

Conclusion: Timely administration of neoadjuvant treatment is not possible in most resource-limited settings. Because of better treatment completion, up-front surgery looks a more viable option than NACT in these situations. Extended waiting time for radiotherapy can be mitigated by opting for alternatives like SCRT in selected patients.

Purpose: The optimal lymphadenectomy approach for solid-dominant stage I non-small cell lung cancer (NSCLC) is controversial. We compared postlobectomy survival outcomes to elucidate.

Materials and methods: Patients diagnosed with solid-dominant stage I NSCLC between 2008 and 2015 were included and grouped according to the mode of lymphadenectomy. Disease-free survival (DFS) and overall survival (OS) were compared, and survival analysis was performed among the groups. Cox analysis was used to identify independent prognostic factors. Nomograms for survival prediction on the basis of the lymphadenectomy mode were constructed and internally calibrated. Propensity score matching (PSM) was used to account for potential confounders. Subgroup comparisons between bilateral mediastinal lymphadenectomy (BML), systematic nodal dissection (SND), lobe-specific nodal dissection (L-SND), and selected nodal sampling (SNS) were conducted.

Results: In total, 983 patients were included. The 5-year OS rates were 98.2%, 86.9%, 86.4%, and 82.8% (P = .006), and the 5-year DFS rates were 87.1%, 76.4%, 69.5%, and 70.9% (P = .008) in the BML, SND, L-SND, and SNS groups, respectively. Given PSM, patients who underwent BML had longer OS (hazard ratio [HR], 0.358 [95% CI, 0.127 to 1.008]; P = .052) and DFS (HR, 0.563 [95% CI, 0.295 to 1.074]; P = .081) than patients who underwent SND with marginal significance. Compared with L-SND and SNS, BML was associated with significantly improved OS (HR, 0.343 [95% CI, 0.123 to 0.958]; P = .041 and HR, 0.250 [95% CI, 0.088 to 0.709]; P = .009, respectively) and DFS (HR, 0.474 [95% CI, 0.258 to 0.868]; P = .016 and HR, 0.467 [95% CI, 0.232 to 0.938]; P = .032, respectively). Subgroup analyses demonstrated that in male patients and those whose tumors were larger or more advanced, BML was associated with significantly better OS and DFS than other types of lymphadenectomies.

Conclusion: BML may be associated with improved survival in patients with solid-dominant stage I NSCLC, and BML is recommended for such patients, especially those with large tumors or more advanced disease.

Purpose: There is limited cancer clinical research in sub-Saharan African countries despite the significant burden of cancers. The primary objective of this strengths, weaknesses, opportunities, and threats (SWOT) analysis was to understand and document factors affecting the successful implementation of prostate cancer (CaP) clinical research in Nigeria.

Methods: The research team used a qualitative design involving International Registry of Men with Advanced Prostate Cancer (IRONMAN) study team members as participants from four regional sites in Nigeria. One-hour listening sessions were conducted via Zoom at each site, focusing on SWOT related to the IRONMAN study. All sessions were recorded, transcribed, and analyzed. Themes were inductively coded and then synthesized across all four sites.

Results: The study teams identified several strengths and weaknesses in conducting the IRONMAN study at their respective sites. Key strengths included access to robust patient population for recruitment and the availability of essential resources, such as lab space, clinical knowledge, and adequate staffing. Weaknesses centered on the social determinants of health that hinder patient participation, such as transportation challenges, distance to clinics, limited access to care, and insufficient biorepository space for sample storage. A prominent opportunity identified was the potential for Nigerian institutions to engage in more clinical research, particularly multisite global trials. Threats included difficulties in retaining research staff and political instability.

Conclusion: This study highlights the promising research opportunities in Nigeria. The lessons learned from the IRONMAN study provide valuable insights into the feasibility of conducting CaP clinical research and trials tailored to the needs of Black men in sub-Saharan Africa. These findings offer a roadmap for future research efforts, with the potential to expand clinical trials and improve health outcomes across the region.

Despite the acknowledged merits of precision oncology (PO) and its increasing global implementation, its full potential for advancing care and prevention remains unrealized. The benefits are currently accessible to only limited patient segments because of multifaceted barriers. Successful implementation hinges on various factors-scientific complexities not limited to technical, clinical, regulatory, economic, administrative, and health care policy-related challenges. From building infrastructure to the associated costs, including research and development, testing, processing, and trained personnel, a lack of alignment persists. Administrative alignment with regulatory and payor acceptance is crucial. Health care policy must adapt to the ongoing shift from a one-size-fits-all treatment to a personalized approach. Without official endorsement of long-term gains over short-term costs and the health establishment's readiness for innovation, PO prospects, even in prosperous economies, may stagnate. Lower-income countries face exacerbated challenges, intensifying barriers to adoption. Nevertheless, growing awareness and utilization, driven by recognized potential for patients and public health, along with successful examples and advocacy, are progressively influencing policy for a more inclusive and beneficial approach to PO adoption.

Purpose: In Aotearoa New Zealand, there are inequitable outcomes for Pacific peoples who experience higher rates of preventable cancers and poorer survival compared with other ethnicities. The aim of this study was to explore Pacific peoples lived experience of cancer and its treatment in the Auckland setting.

Methods: Data were collected through semistructured interviews (talanoa) with Pacific patients under the Auckland Regional Cancer and Blood Service. A general inductive approach was used to analyze the data. Ethical approval was granted by the Auckland Health Research Ethics Committee (reference number AH24086).

Results: Thirteen participants of Samoan and Tongan ethnicity were interviewed. Participants had a range of tumor diagnoses and were receiving curative and noncurative treatments. Five key themes were identified, giving insight into beliefs around cancer, struggles faced by patients, and potential areas of priority. These include (1) cancer means death, (2) holistic and collective approach to support, (3) communication and trust, (4) cost in accessing cancer care and treatment, and (5) Pacific representation.

Conclusion: This study sheds light on both positive and negative experiences of Pacific peoples living with cancer in Aotearoa New Zealand. It highlights gaps in the current model of oncology care for this population, which are multilevel and therefore require a multifaceted approach. It calls for priority toward reducing barriers to access of care and creating a more culturally safe pathway.

Purpose: The use of social media is transforming physician-patient communication, mainly in the field of medical oncology. The pattern of social media use by medical oncologists is poorly studied. Therefore, we developed a survey to understand the preferences, experiences, opinions, and expectations of Italian medical oncologists and oncology fellows regarding the use of social media in cancer medicine to identify the different profiles of social media users.

Materials and methods: This multicentric, cross-sectional, observational study included oncologists or oncology fellows from Italy, who were surveyed from July to December 2023 on their use of social media. Data were analyzed through K-means clustering, and the Hartigan-Wong algorithm was applied to identify different profiles of social media users among the participants.

Results: Of the 245 participants who accepted the invitation, 116 completed the entire survey and were included in the cluster analysis. Three profiles of social media users were identified through clustering: the highly social, the social skeptic, and the moderately social, accounting for 31%, 31%, and 38% of the participants, respectively. In general, older age (P = .0001), being a specialized oncologist (P = .003), and a higher mean time spent on social media (P = .0001) were associated with a greater consideration of the professional use of social media.

Conclusion: The use of social media among medical oncologists and oncology fellows represents a spectrum ranging from the social skeptic user to the highly social. Age, professional status (specialist or fellow), and frequency on social media use were associated with different patterns, opinions, and behaviors related to social media use.

Purpose: Kerala in India leads the nation in both Human Development Index and Sustainable Development Index. The state is a harbinger for the rest of the country in matters of health. Documentation of cancer trends and quantifying the cancer burden is crucial for planning oncology services in the country. In this study, we aim to perform a time series analysis using data from the National Cancer Registry.

Methods: Data for crude incidence, age-adjusted incidence, and disease-specific incidence were extracted from published reports of the Population-Based Cancer registries at Kollam and Thiruvananthapuram. Data collected between 2006 and 2008 were analyzed and published in 2010. Data collected between 2012 and 2016 were published in 2020. Descriptive statistics was used for analysis.

Results: Age-adjusted incidence rates increased from 121.7 per 100,000 men to 137.8 in Thiruvananthapuram from 2006-2008 to 2012-2016 period. Among women, in Thiruvananthapuram, the age-adjusted rates increased from 108.3 to 127.3. In Kollam, the age-adjusted incidence rate increased from 113.3 to 127.1 among men and 89.7 to 107.1 among women. Lung and breast cancers remain the most common cancers among men and women.

Conclusion: There has been an increase in both crude and age-adjusted incidence rates in Kerala. However, these changes are in line with global trends in cancer incidence. Lifestyle changes and reduced tobacco and alcohol use will help decrease the incidence of cancer in Kerala.

Purpose: To compare overall survival (OS), toxicity, and quality of life (QOL) in patients with metastatic gallbladder cancer receiving oral capecitabine (X) with best supportive care (BSC) and BSC alone.

Materials and methods: Patients with metastatic gallbladder cancer and Karnofsky Performance Status (KPS) ≥70 were accrued and assigned to either arm A or B. Assignment to these two arms was based on physician/patient discretion. Arm A received oral capecitabine 825 mg/m² twice a day d1-14, repeated every 3 weeks for six cycles with BSC, and arm B received BSC alone. The Kaplan-Meier method computed OS and comparison was using a log-rank test. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 administered at baseline, 3 months, and 6 months. The linear mixed-effects model was used for the longitudinal analysis of QOL.

Results: Between December 2020 and April 2022, 64 patients diagnosed with metastatic gallbladder carcinoma and KPS ≥70 were accrued in the study, and 32 patients were assigned to each arm. In arm A versus B, the median age was 52 versus 55 (P = .21); the median KPS was 80 versus 70 (P = .008). The median OS in arm A versus B was 3.4 versus 2 months (P = .001). Grade 1-2 vomiting and diarrhea were seen in 50% versus 78% (P = .041) and 59% versus 9.3% (P = .01) patients in arm A versus B, respectively. Grade 1-2 hand-foot syndrome was seen in 12 (37.5%) patients in arm A. Dynamic changes showed an improvement in pain in the linear mixed model with a significant difference between the arms (P = .011); arm A experienced a significant improvement in pain over time (arm × time P = .020). Global QOL improved over time (P = .038) with parallel improvement between arms (arm × time P = .490).

Conclusion: Compared with BSC alone, patients who receive X + BSC experience an OS improvement of 1.4 months and better pain control without grade 3 toxicities or negative impact on QOL.

Purpose: Moderate hypofractionation (MHF) offers logistical and financial advantages, and has become standard in Western countries but not yet in Africa. This study assessed GI and genitourinary (GU) acute toxicity in Rwandan men undergoing MHF (20 × 3 Gy) treatment.

Materials and methods: Since 2021, patients with prostate cancer at the Rwanda Cancer Centre have been informed about the study on MHF treatment and could participate by signing an informed consent. The study included patients with confirmed prostate adenocarcinoma (any T, any prostate-specific antigen any Gleason score, N0M0), excluding those with inflammatory bowel disease, previous pelvic irradiation, or previous prostatectomy. Participants received 20 fractions of 3 Gy over 4 weeks using the volumetric modulated arc radiotherapy (RT) technique with a 6 megavoltage linear accelerator. GI and GU acute toxicity was evaluated at week 2, at the end of RT, and 3 months after treatment using the Radiation Therapy Oncology Group (RTOG) acute toxicity grading system.

Results: Fifty consecutive patients with localized prostate cancer were included. The median patient age was 70 years. Most patients (86%) had high-risk disease and 94% received androgen-deprivation therapy. The cost and treatment time were reduced by 50%. The distribution of maximum acute RTOG toxicity scores were for GI 10% grade 0, 70% grade 1, 20% grade 2, 0% grade 3, and for GU scores were 0%, 40%, 54%, and 6%, respectively. By 3 months, RT symptoms had returned to baseline levels for most patients.

Conclusion: MHF (20 × 3 Gy) was well tolerated in men treated for prostate cancer in Rwanda, showing that MHF is feasible in an African setting. However, further research on acute and late toxicity for more patients is warranted.