JCO Global Oncology最新文献

Purpose: Yoga therapy (YT) is a growing mind-body approach in oncology. However, its integration into hematopoietic stem cell transplantation (HSCT) remains limited, particularly in non-Western and resource-constrained settings. This formative qualitative study aimed to explore the lived experiences of HSCT patients in the United States, India, and Tanzania to inform the development of a culturally adapted YT protocol.

Methods: Fifteen post-HSCT adult participants were recruited from three international cancer centers using purposive sampling. Semistructured interviews were conducted in participants' preferred languages, transcribed, and thematically analyzed by an interdisciplinary team. Themes were mapped to domains of the Adaptome framework to guide adaptation decisions.

Results: Across sites, fatigue, sleep disruption, isolation, and emotional distress were common. Participants expressed interest in supportive, noninvasive interventions like yoga, but familiarity varied by region. Cultural adaptations included neutral, nonreligious language for meditation, flexible session timing, caregiver inclusion, same-language preference, and same-sex therapist. Contextual adaptations addressed environmental limitations (eg, space constraints, infection precautions), such as bed- and chair-based modules. Participants recommended short (20-30-minute), afternoon sessions with hybrid delivery options. Trust in the person introducing yoga (eg, physician v therapist) emerged as a culturally relevant factor.

Conclusion: This formative study offers critical insights into adapting (YT) for patients undergoing HSCT across diverse global contexts. Using the Adaptome framework, we applied a systematic, culturally, and contextually responsive approach that preserved core therapeutic elements while enhancing feasibility and relevance. These evidence-based adaptations directly informed the design and implementation of a single-arm, phase II trial of adjunct yoga in HSCT patients.

Purpose: The Global Oncology Enrichment Program (GOEP) is a collaborative initiative designed to address disparities in access to global oncology education for cancer health professionals and is hosted on the Princess Margaret (PM) Cancer Campus. This study evaluates GOEP's impact and sustainability across two delivery formats: a mixed synchronous/asynchronous model and an asynchronous-only model.

Materials and methods: This was a retrospective analysis of participants from 2020 to 2024. Participants completed pre- and post-course surveys assessing demographics, motivations and barriers in accessing global oncology education, and confidence in global oncology topics. Course engagement data were tracked and extracted from PM Cancer Campus' learning management system. Statistical tests compared demographics and evaluated changes in confidence and importance in course objectives.

Results: Among 256 participants who completed the precourse survey, 219 enrolled in a mixed format of the course (September 2020-November 2022) and 37 in an asynchronous-only format (December 2022-September 2024). The mixed-format cohort had significantly higher completion rates of at least seven of 10 course units (91.1% v 8.9%, P = .04). They were more likely to cite networking (77.6% v 0%) and mentorship (69.4% v 0%) as key motivators. Despite greater access to global oncology programs, the mixed-format cohort more often reported barriers, including limited faculty interest and lack of mentorship. Among those completing pre- and post-surveys (n = 99), confidence improved significantly across all topics, particularly among those already involved in global oncology.

Conclusion: GOEP was associated with improved confidence among participants who completed both surveys. Although asynchronous delivery improves scalability, the mixed format supports stronger engagement and completion. These findings suggest a need for hybrid learning models that balance scalability with engagement, ensuring global oncology education reaches more learners, while supporting mentorship, connection, and long-term capacity building.

Purpose: Radiation-associated sarcomas (RAS) are rare tumors developing in previously irradiated areas. Most data come from high-income countries, with limited reports from low- and middle-income countries (LMICs). To our knowledge, this is the largest RAS cohort from India, examining clinical features, genetic predisposition, systemic therapies, and outcomes, in a resource-limited setting.

Materials and methods: We conducted a retrospective analysis of a sarcoma database at AIIMS, New Delhi, from January 2015 to June 2025. Patients ≥18 year with biopsy-confirmed RAS, meeting modified Cahan criteria, were included.

Results: Twenty-three patients (0.32% of 7,138 sarcoma cases evaluated) were diagnosed with RAS. The median age at diagnosis was 51.1 years, with a median latency of 13.25 years following radiotherapy. Breast cancer was the most common antecedent malignancy (21.7%). Soft tissue sarcomas were predominant (14, 60.9%), with undifferentiated pleomorphic sarcoma (8, 34.8%) being the most frequent histologic subtype. At presentation, 12 patients (52.2%) had metastatic disease, while three (13.1%) had locally unresectable tumors. The majority of tumors were high-grade (20, 87.0%), with a median tumor size of 6.9 cm. Among eight patients with resectable disease, seven underwent surgery, achieving R0 resection in 62.5% of cases. Re-irradiation was performed in three patients (13.0%). Sixteen patients (69.6%) received systemic therapy: 12.5% had partial response, 25% had stable disease, and two patients on immunotherapy had progressive disease. At a median follow-up of 68.2 months, the median overall survival was 59.2 months and 13.4 months for patients with nonmetastatic and metastatic disease, respectively.

Conclusion: Despite large, high-grade, and advanced tumors, curative surgery was feasible in most nonmetastatic cases, and systemic therapies were widely used. The favorable survival outcomes underscore the importance of centralized, multidisciplinary sarcoma care in LMICs. Lack of immunotherapy responses calls for investigation into resistance mechanisms and histology-specific treatments.

Purpose: Sarcomas exhibit clinicopathologic heterogeneity, leading to diagnostic and therapeutic uncertainty. This study assesses the clinical value of integrating targeted RNA-based next-generation sequencing (NGS) into a multidisciplinary sarcoma workflow to improve diagnosis, enable comprehensive molecular characterization, and inform personalized treatment strategies.

Methods: In this prospective single-center study, 68 patients with suspected or confirmed soft tissue sarcoma underwent RNA-based NGS using a 138-gene fusion panel, integrated within a multidisciplinary sarcoma framework. Genomic findings integrated with histopathology and immunohistochemistry for diagnostic reclassification and treatment changes.

Results: Of 70 patients advised RNA-based NGS, 68 (97.1%) were evaluable (median age, 38.5 years). Soft tissue sarcomas predominated (77.1%), with 67.1% presenting with advanced disease. Initial histology included 17 round cell sarcomas (RC), 19 undifferentiated sarcomas (US), and 34 other subtypes. Among evaluable RC cases (n = 16), NGS identified diagnostic fusions in 87.5%, enabling reclassification in 68.7% and treatment change in 18.7%. In US, fusions were detected in 21.1%, all reclassified, with treatment altered in 75%. In other subtypes, fusions were found in 48.4%, enabling reclassification in 39.3% and treatment impact in 21.2%. Nondiagnostic mutations (eg, TP53, SLX4, NF1) were observed in 47.4% of US and 18.2% of other subtypes. Potentially actionable variants (KIT, PIK3CA) were seen in 5.8%. Overall, RNA-NGS was clinically informative in 50%, refined diagnosis in 41.1%, and influenced treatment in 26.4% of patients.

Conclusion: To our knowledge, this first-of-its-kind study highlights the clinical utility of integrating targeted RNA-based NGS into multidisciplinary sarcoma care, enabling diagnostic reclassification in 41.1% of cases most notably in round cell sarcomas with atypical morphology. Both canonical and rare fusions informed individualized therapy, reinforcing RNA-NGS as a pivotal tool for diagnostic refinement and precision oncology in sarcoma management.

Purpose: Carica papaya leaf extract (CPLE) is known to increase platelet counts (PCs) in certain infections.

Methods: Patients were randomly assigned in a 2:1 ratio to the CPLE or placebo arm and continued treatment until the PC improved to 75,000 × 10⁹/L or above, a platelet transfusion was required, or upto D+10. The primary outcome was to evaluate whether CPLE improves PC faster compared with placebo in a significant proportion of patients with a modified intention-to-treat protocol.

Results: Between March 2020 and October 2024, 219 patients were randomly assigned, of whom 198 patients (CPLE arm: 129; placebo arm: 69) were analyzed for outcomes. The primary end point with modified intention-to-treat analysis showed a statistically significant increase in PC to ≥75,000 × 10⁹/L in a greater proportion of patients by D+4 compared with placebo (59% v 44%; P = .042). The primary outcome of increasing PC >75,000 × 10⁹/L at D+4 was significantly improved by CPLE (83/129, 64% v 33/69, 48%; P = .034) compared with placebo as per protocol analysis. There was no grade 3 or grade 4 treatment-related adverse events associated with CPLE. About 43% of patients in the placebo arm versus 25% of patients in the CPLE arm needed dose reductions or delays in their subsequent chemotherapy treatment for patients with grade 2 chemotherapy-induced thrombocytopenia (CIT) at the baseline (P 0.033) and not significant in grade 3 CIT.

Conclusion: CPLE is a potential therapeutic intervention to improve CIT faster and to a greater extent than placebo in this phase III randomized trial without any safety concerns. It could be potentially used as a secondary prophylaxis to maintain the chemotherapy intensity.

Purpose: Esophageal cancer (EC) remains a leading cause of cancer mortality worldwide, with East Africa forming a high-incidence EC belt. Despite Somalia's inclusion in this region, there are no cancer registries or outcome data. We conducted a multicenter observational study in Mogadishu to describe the burden, clinicopathologic characteristics, treatment patterns, referral pathways, and outcomes of EC.

Methods: We retrospectively reviewed records of patients (18 years and older) with histologically confirmed EC diagnosed between January 2022 and December 2024 in the two major diagnostic centers in Mogadishu. Demographic, clinical, pathologic, treatment, and referral data were extracted and analyzed descriptively.

Results: A total of 468 patients were included (mean age 55.9 years; 62% female). EC was the most common cancer diagnosed in both females and males. Dysphagia was the commonest symptom (56.8%). Squamous cell carcinoma accounted for 97.6%. Disease staging was poorly documented (>80% missing) although available data showed that most presented with advanced disease. Limited radiology capacity meant that diagnoses relied mainly on endoscopic biopsy. Hot tea consumption was the most recorded risk factor (48.9%). Treatment access was restricted: chemotherapy alone predominated (25.9%), whereas surgery (1.3%) and chemoradiotherapy (6.0%) were rare. Over one fifth (21.8%) received no treatment, and 44.2% was lost to follow-up. Of those cases with follow-up, 40.0% had died and 15.8% was alive. Referral analysis showed that 6.0% sought care in India, 0.6% in Ethiopia, 0.4% each in Kenya and Egypt, and 0.2% in Saudi Arabia, whereas 48.1% was managed locally and 43.8% had undocumented destinations.

Conclusion: To our knowledge, this first multicenter study from Somalia reveals late-stage presentation, severe staging and treatment gaps, and poor survival. Strengthening diagnostic infrastructure, multidisciplinary care, and cancer registry systems is urgently needed to improve EC outcomes in Somalia.

Purpose: Cervical cancer is the second commonest cancer among women in Nepal. The objective of the study was to evaluate the quality indicators (QIs) in radiotherapy management of cervical carcinoma and establishment of organizational priorities feasible in our setting.

Methods: The retrospective study included 83 patients with locally advanced cervical carcinoma who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected based on convenience sampling. All 19 QIs in cervical cancer management according to The European Society of Gynecological Oncology (ESGO)/European Society for Radiotherapy and Oncology (ESTRO) were chosen for assessment. These QIs were calculated for all patients and compared with the ESGO/ESTRO standard target. Frequencies and percentages were calculated. Binomial 95% of the rates for QI adherence was also calculated for each QI.

Results: Of the 19 QIs, very high adherence rates were observed in QIs associated with brachytherapy like Treatment with brachytherapy boost (97.59%), Imaging for Image guided Adaptive Brachytherapy (100%), and Brachytherapy after the patient has received a total EBRT dose ≥36 Gy (100%). Compliance was good for patients receiving primary chemo-radiotherapy (86.74%) and center treating adequate cases (100%). Very low adherence rates were observed for pretreatment work-up (0%), use of intensity modulated radiotherapy (2.4%), on-board image guided radiotherapy (0%), clinical trial participation (0%), and follow-up program and sexual rehabilitation (0%). Multidisciplinary team meeting discussion of cases (48.19%), use of interstitial brachytherapy when required (12.34%), and EBRT dose of 45 Gy/25 fractions (27.71%) also had a low adherence rate.

Conclusion: The study highlighted rates of compliance to cervical radiotherapy QIs in our hospital. Low adherence to various QIs was identified. On the basis of these findings, mitigating strategies could be planned at our center.

Purpose: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have redefined the standard of care for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (BC). However, patterns of use and access across Latin America remain poorly characterized.

Methods: We conducted a cross-sectional survey of Latin American medical oncologists with experience in treating advanced BC using CDK4/6i. The survey assessed drug availability and clinical decision making across various scenarios. Descriptive statistics were used to summarize responses.

Results: A total of 116 oncologists from 15 countries participated. Ribociclib was the preferred agent (56.8%), driven largely by its overall survival benefit across pivotal trials. Abemaciclib was favored in endocrine resistance, central nervous system metastases, and patients with cardiac or hepatic comorbidities. Palbociclib was preferred in geriatric and male patients. Despite high reported national availability of CDK4/6i, access at the institutional level was uneven. Among oncologists working primarily in private practice, 54.3% reported that their prescribing patterns would differ if treating publicly insured patients, compared with only 22.6% of public sector oncologists who reported the opposite.

Conclusion: Although CDK4/6i are accepted as essential therapies for advanced BC, substantial institutional access barriers persist in Latin America. Clinical preferences reflect both emerging evidence and local constraints. Broader integration of CDK4/6i into public formularies and continuous generation of real-world data are critical for improving equity and outcomes in the region.

Purpose: Breast cancer is the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Income-related disparities in breast cancer survival are well documented in both high- and low- and middle-income countries. In Colombia, although formally employed women benefit from universal health care coverage, significant income disparities persist, potentially affecting timely diagnosis, treatment access, and survival outcomes. This study aimed to evaluate the association between income, measured in monthly minimum wages (MMW), and 5-year overall survival among formally employed women diagnosed with breast cancer in Colombia.

Patients and methods: We conducted a retrospective cohort study using national administrative databases to evaluate the association between income and 5-year survival in women diagnosed with breast cancer between January 1, 2013, and June 30, 2018. Breast cancer diagnosis was confirmed through an algorithm requiring at least three International Classification of Diseases, 10th Revision codes across different months and one oncologic procedure. Income at diagnosis was expressed in legal MMW units and categorized into quartiles. Covariates included age, cancer stage, Charlson Comorbidity Index, region, insurer, and year of diagnosis. Follow-up lasted up to 5 years or until death. Survival analyses used Cox regression models to estimate hazard ratios (HRs) with 95% CIs. Relative Index of Inequality (RII) and Slope Index of Inequality (SII) were also estimated using Poisson regression.

Results: A total of 3,352 formally employed women with breast cancer were included, with a mean age at diagnosis of 46.59 years. Income levels for the 25th, 50th, and 75th percentiles were 1.00, 1.43, and 2.76 MMW, respectively. Over the 5 years, 511 deaths were recorded (15.24% mortality). After adjustment for confounders, women in the highest income quartile had a 26% lower risk of death compared with those in the lowest quartile (adjusted HR, 0.74 [95% CI, 0.57 to 0.95]). RII and SII further confirmed significant income-related disparities in survival outcomes.

Conclusion: Among formally employed women in Colombia, income disparities are significantly associated with breast cancer survival. These findings suggest that structural, economic, and regional barriers persist in delivering optimal cancer care.