Journal of the National Comprehensive Cancer Network最新文献

Background: Breast cancer survivors face a risk of significant psychological distress, which can persist for years after their initial diagnosis. Although numerous guidelines and tools exist to help screen for and measure distress in patients with cancer, additional longitudinal studies are needed to better characterize the trajectory of distress over time.

Patients and methods: We conducted a longitudinal study to evaluate distress and health-related quality of life in patients with breast cancer. Annual assessments included global mental and physical health scores using the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10), posttraumatic stress symptoms using the Impact of Event Scale-Revised (IES-R), and depressive symptoms using the Patient Health Questionnaire-2 (PHQ-2). Eligible participants had stage 0-III breast cancer, with baseline surveys administered within 1 year of diagnosis. Annual follow-up surveys were conducted through year 4 after the baseline survey. Only patients who completed the baseline survey and at least one follow-up survey were included in this analysis. Individuals with stage IV or recurrent breast cancer were excluded.

Results: A total of 2,140 individuals were included. Over time, global mental health scores declined slightly, with differences in T-scores from baseline ranging from 0.4 to 0.9. In contrast, global physical health scores improved, with differences in T-scores ranging from 0.3 to 0.6. Mean scores remained in the normative range. Depressive symptoms remained stable throughout the study period, while posttraumatic stress symptoms showed improvement over time.

Conclusions: This study provides important longitudinal data on distress subtypes in breast cancer survivors with nonmetastatic disease. Although global mental health declined slightly, depression symptoms remained stable, and posttraumatic stress symptoms improved. Investigation of distress subtypes over time merits further study to advance detection of significant distress across the cancer continuum.

Ewing sarcoma and osteosarcoma constitute 36% of all primary bone cancers. However, these 2 subtypes represent the most commonly diagnosed bone cancer types in the pediatric and adolescent population. Although still largely unknown, certain genetic mutations, rearrangements, and/or predisposition syndromes likely play a role in the pathogenesis of bone cancer. Osteosarcoma may also develop as a direct result of the long-term side effects of radiation therapy. With the implementation of a multimodality approach to treatment, including multiagent neoadjuvant and adjuvant chemotherapy regimens, targeted therapy options, surgery, and radiation, individuals with Ewing sarcoma and osteosarcoma are showing higher cure rates and improved overall survival. The NCCN Guidelines for Bone Cancer provide a consensus and evidence-based framework for the workup, management, and surveillance of local and recurrent/metastatic disease.

Background: Evaluation of the quality of care delivered to patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) has been limited. We sought to examine trends and racial/ethnic disparities in quality of care among patients with mPDAC as well as the impact on outcomes using a novel and easily applied quality metric.

Methods: Medicare beneficiaries diagnosed with mPDAC between 2005 and 2019 were identified using SEER-Medicare data. Achievement of a quality score based on 3 criteria was assessed: (1) cancer-specific survival (CSS) >12 months, (2) receipt of systemic therapy, and (3) utilization of hospice/palliative care services. We examined factors associated with achieving the quality score, including race/ethnicity, social vulnerability index (SVI), and year of treatment. The impact of the quality score on CSS was also analyzed.

Results: Among 14,147 patients with mPDAC, 62.2% (n=8,794) received systemic therapy, 83.3% (n=11,791) utilized palliative care/hospice services, and 13.7% (n=1,933) had CSS >12 months after diagnosis. Achievement of at least one quality criterion increased over time (from 84.5% in 2005 to 97.0% in 2019; P<.001). Multivariable analysis showed that a high overall SVI (odds ratio [OR], 0.70; 95% CI, 0.54-0.91) was independently associated with lower odds of meeting at least one quality criterion. This effect was mainly driven by the SVI subthemes of high socioeconomic status (OR, 0.66; 95% CI, 0.48-0.90) and high racial/ethnic minority status (OR, 0.75; 95% CI, 0.60-0.93). Achievement of quality score ≥1 (excluding CSS criterion) was associated with improved overall survival (1-year CSS, 14.5% vs 3.2%; P<.001).

Conclusions: Approximately 9 in 10 patients with mPDAC achieved at least one of the quality score criteria, though racial/ethnic minority patients and socially vulnerable populations had lower achievement. Lower quality score achievement was associated with poorer long-term survival. These findings highlight the need for targeted interventions to meet quality metrics for all patients with mPDAC to mitigate disparities in end-of-life care.

The NCCN Guidelines for Testicular Cancer provide recommendations for the multidisciplinary approach to the diagnostic workup, treatment, and follow-up for testicular germ cell tumors, including both seminoma and nonseminoma. These NCCN Guidelines Insights discuss the current treatment recommendations and supporting clinical data for seminomas as presented in Version 2.2025 of the NCCN Guidelines for Testicular Cancer.

Gastric cancer is a significant global health concern, with CDH1-associated gastric cancer representing a small but important subset of cases. Historically, individuals with CDH1 pathogenic germline variants were advised to undergo prophylactic total gastrectomy due to the high reported risk of gastric cancer and the limited sensitivity of upper endoscopy in detecting signet ring cell carcinoma (SRCC). However, emerging data suggest that the cumulative lifetime risk of advanced gastric cancer among CDH1 germline pathogenic variant carriers is lower than previously thought, and early-stage SRCC detected on endoscopy does not necessarily indicate imminent-or even eventual-progression to advanced cancer. The near-universal presence of T1a SRCC in gastrectomy specimens from asymptomatic CDH1 pathogenic variant carriers calls into question the reflexive recommendation for gastrectomy, including upon detection of SRCC during surveillance. Furthermore, the morbidity and quality-of-life impact associated with total gastrectomy require careful consideration. Active endoscopic surveillance has shown promise as an alternative management strategy for gastrectomy in patients lacking indicators of >T1a SRCC, though current data are limited by short follow-up periods and selection bias. This review synthesizes recent findings on the natural history of CDH1-associated gastric cancer and evaluates the risks and benefits of gastrectomy versus active endoscopic surveillance, with the goal of helping clinicians provide personalized and evidence-based recommendations for patients with CDH1 pathogenic variants.