The Lancet Regional Health: Western Pacific最新文献

{"title":"Preferences of patients with chronic obstructive pulmonary disease for online nursing consultation services: a discrete choice experiment","authors":"Juan He ,&nbsp;Xiaoqian Xia ,&nbsp;Jingbo Zhang ,&nbsp;Niuniu Sun ,&nbsp;Jiangfan Ma ,&nbsp;Ping Yang ,&nbsp;Chang Wu ,&nbsp;Yang Ni ,&nbsp;Yibo Wu","doi":"10.1016/j.lanwpc.2024.101382","DOIUrl":"10.1016/j.lanwpc.2024.101382","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) imposes a significant burden on patients and society, and the majority of COPD patients in China manage their condition at home long-term but often fail to achieve the desired outcomes. Online nursing consultation services (ONCS) are an effective intervention to help patients improve their disease prognosis. In recent years, artificial intelligence (AI) technology has garnered considerable attention. Medical institutions in China are exploring and planning ONCS combined with AI, and this study aims to understand the preferences and willingness to pay for ONCS among COPD patients.</div></div><div><h3>Methods</h3><div>We surveyed 224 COPD patients in Luoyang City, China, collecting their demographic information and responses to a discrete choice experiment (DCE) involving five attributes: service provider, response time, response accuracy, service content, and service cost.</div></div><div><h3>Findings</h3><div>The results revealed that COPD patients favoured ONCS provided by a combination of nurses and AI as service providers (β = 0.36), preferred faster response time (β = 3.38), higher response accuracy (β = 1.74), and chronic nursing as the service content (β = 0.92), all while expecting lower service costs. The relative importance (RI) of these attributes was distributed as 18.1%, 21.4%, 19.2%, 28.7%, and 12.6%, respectively. Specifically, participants were willing to pay an additional ¥22.3 for a shift from nurses to a combination of nurses and AI, ¥2.3 more for each minute reduction in response time, ¥1.5 more for every 1% increase in response accuracy, and ¥57.1 more for a shift from health education to chronic nursing.</div></div><div><h3>Interpretation</h3><div>This study thoroughly investigated COPD patients' preferences for ONCS. The findings offer valuable insights for optimizing these services. The findings suggest that healthcare organizations should actively integrate services that combine nurses and AI in order to reduce response time, enhance accuracy, effectively support chronic disease management, and minimise service costs.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101382"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and survival of colorectal cancer in china from 1990 to 2021: findings from the global burden of disease study","authors":"Boyuan Ma","doi":"10.1016/j.lanwpc.2024.101387","DOIUrl":"10.1016/j.lanwpc.2024.101387","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Colorectal cancer is a global health challenge due to its high incidence and mortality. In 2021, it was the second most diagnosed cancer and cause of cancer-related deaths worldwide. Risk factors include genetics, poor diet, obesity, and inflammatory conditions. Early detection significantly improves survival, with localized cancer showing over 90% of five-year survival. Screening programs like colonoscopy are vital for early diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study utilized data from the Global Burden of Diseases (GBD) 2021 to analyze colorectal cancer burden in China and globally. Using DisMod-MR 2.1, the study mapped colorectal cancer estimates to ICD-10 codes C18-C21. Incidence, prevalence, mortality, and DALYs were extracted and five-year relative survival rates were calculated using the formula (1–mortality/incidence) × 100 to assess cancer burden and survival in China. The study used age-standardized rates (ASR) to ensure comparability across regions and sexes. It calculated percentage changes and average annual percentage change (AAPC) to assess trends from 1990 to 2021. Decomposition analysis explored factors influencing changes, with significance tested via 95% confidence intervals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In 2021, colorectal cancer in China accounted for 3.61 million cases and 6.85 million DALYs, representing 30.9% and 28.1% of global totals, respectively. The age-standardized prevalence and DALY rates were 168.62 and 331.73 per 100,000, respectively. China reported 658,321 new cases and 275,129 deaths, with age-standardized rates of 31.44 for incidence and 13.64 for mortality. Compared to 21 regions, China had lower age-standardized rates for prevalence, incidence, deaths, and DALYs. From 1990 to 2021, the number of colorectal cancer cases and deaths increased by 315.63% and 130.61%, respectively. The age-standardized incidence rate rose by 1.66% annually, while the mortality rate fell by 0.41%. Males had higher rates than females across all metrics. The increase in incidence and prevalence was largely due to epidemiological changes, while deaths and DALYs were driven by population aging. In 2021, the five-year relative survival rate was 58.21%, with slightly higher rates for males (58.38%) than females (57.91%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study analyzed colorectal cancer burden in China from 1990 to 2021, showing increasing incidence, prevalence, deaths, and DALYs, mainly due to epidemiological changes and population aging. The overall 5-year survival rate is 58.21%, with higher rates in males. Rapid economic development and industrialization have led to westernized lifestyle in developing countries, like China, characterized by unhealthy diets, sedentary behaviors, insufficient physical activity, and substance abuse. These factors may contribute to the prementioned significant rise in colorectal cancer burden in China. Despite this, the age-standardiz","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101387"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of factors influencing of supportive care needs in chemotherapy interval breast cancer patients based on a structural equation model: a cross-sectional study","authors":"Weichao Liu,&nbsp;Liping Wang,&nbsp;Chengang Hong,&nbsp;Qianyu Zhang,&nbsp;Jinghan Yang","doi":"10.1016/j.lanwpc.2024.101351","DOIUrl":"10.1016/j.lanwpc.2024.101351","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In recent years, although there have been studies on the supportive care needs (SCNs) of breast cancer patients, there have been no studies on the factors affecting the supportive care needs of breast cancer patients during the chemotherapy interval. Guided by the supportive care framework, this study aimed to analyze the factors influencing SCNs in chemotherapy interval breast cancer patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Study design: This is a cross-sectional study.&lt;/div&gt;&lt;div&gt;Participants: 286 female adult breast cancer patients who met the inclusion criteria in the department of Breast Surgery of a tumor hospital in Zhejiang, China, were selected by convenience sampling. Inclusion criteria: first diagnosis of breast cancer in pathology and clinical stage I-IIIA; postoperative adjuvant chemotherapy and have passed at least one chemotherapy interval; older than 18 years old; able to communicate normally; and willing to participate in this study. Exclusion criteria: tumor recurrence; unaware of the disease; mental illness; suicidal tendency.&lt;/div&gt;&lt;div&gt;Analysis: Primary outcomes: SCNs and symptom burden, social support and anxiety, depression. Sample size: This study included 286 cases. Statistical tests: Spearman correlation analysis was used to explore the correlation between SCNs and symptom burden, social support, anxiety and depression; constructing a structural equation model of SCNs' influencing factors, and to analyze the pathways and effects of different influencing factors on SCNs. Structural equation modeling (SEM) was performed using maximum likelihood estimation. Ethics approval: The study was approved by the Medical Ethics Committee of a tumor hospital in Zhejiang Province (No. IRB-2020-408).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Finding&lt;/h3&gt;&lt;div&gt;Participants' overall SCNs score was 76.16 (SD=21.06). Among the five dimensions of SCNs, the highest and lowest scoring dimensions were physical and daily living needs 2.77 (SD=0.72) and sexual needs 1.36 (SD=0.75). The constructed structural equation models fit well (χ&lt;sup&gt;2&lt;/sup&gt;/df =2.359&lt;3;RMSEA= 0.071&lt;0.08), symptom severity and symptom distress to life had direct and indirect effects on SCNs, with total effect values of 0.545 and 0.481 (P&lt;0.001), respectively; social support and anxiety had a direct effect on SCNs, with effect values of -0.338 and 0.667 (P&lt;0.001), respectively, and depression had an indirect effect on SCNs with an effect value of 0.380 (P&lt;0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study showed that SCNs in chemotherapy interval breast cancer patients were at a high level, confirming the direct or indirect effects of symptom burden, social support, depression and anxiety on SCNs in chemotherapy interval breast cancer patients, and providing a reference for future interventions by caregivers to intervene in SCNs in chemotherapy interval breast cancer patients.&lt;/div&gt;&lt;div&gt;Limitations: In this study, only breast cancer patie","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101351"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of an mHealth-based psychological resilience intervention on psychological resilience, negative emotions and self-efficacy in breast cancer patients during postoperative chemotherapy","authors":"Qianyu Zhang,&nbsp;Liping Wang,&nbsp;Jinghan Yang,&nbsp;Weichao Liu,&nbsp;Chengang Hong","doi":"10.1016/j.lanwpc.2024.101357","DOIUrl":"10.1016/j.lanwpc.2024.101357","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mental health problems are particularly acute in patients undergoing postoperative chemotherapy for breast cancer. Traditional offline psychological interventions not only cause patients to feel fatigued from travelling, but also increase the risk of group aggregation of infections. The application of mobile healthcare provides great convenience for patients. However, most of the existing online psychological intervention studies have not focused on the phenomenon of limitation of their limb movement due to postoperative incision and PICC problems. Therefore, this study will combine the consideration of these characteristics to investigate the effectiveness of a 3-month online psychological resilience intervention in improving negative emotions and increasing the level of psychological resilience in breast cancer patients during postoperative chemotherapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using an experimental research design, 70 breast cancer patients during postoperative chemotherapy were recruited from two breast surgery wards of a tertiary hospital in Zhejiang Province in June 2022. Inclusion criteria were: ① patients older than 18 years old; ② patients with a pathological diagnosis of breast cancer during postoperative chemotherapy; ③ patients with the ability to read and write in Chinese; ④ patients or their family members owning a smartphone; and ⑤ patients who voluntarily participated in this study. Exclusion criteria: (1) those who do not know the condition; (2) those with physical dysfunction; (3) those with previous history of psychological disorders and psychiatric illnesses; (4) those with understanding and communication disorders. Grouped by ward, patients in the control group received routine discharge care and follow-up, and patients in the intervention group used the psychological resilience applet on the basis of the control group. The sample size was calculated using Gpower 3.1 software, and the total sample size for both groups was finally determined to be 70 cases, taking into account the 10%-20% loss of follow-up rate. Data were analysed using SPSS 26.0.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Sixty-six patients completed the study, 34 in the intervention group and 32 in the control group. One case withdrew from the intervention group and three cases were lost in the control group at T1. Before the intervention (T0) there was no statistically significant difference between the total psychological resilience, anxiety and depression, self-efficacy scores and the scores of each dimension between the two groups of patients (P&gt;0.05). After the intervention (T1), the differences in psychological resilience, anxiety and depression, self-efficacy scores, and scores on all dimensions (except for the resilience and strength dimensions of psychological resilience) between the two groups were statistically significant (p&lt;0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study provides evidence ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101357"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-utility of comprehensive endoscopic screening strategies for upper gastrointestinal cancer in rural China","authors":"Ruyue Liu ,&nbsp;Yifan Li ,&nbsp;Yanxiu Liu ,&nbsp;Yuwang Shang ,&nbsp;Nan Zhang ,&nbsp;Qiang Sun","doi":"10.1016/j.lanwpc.2024.101331","DOIUrl":"10.1016/j.lanwpc.2024.101331","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic screening for upper gastrointestinal cancer (UGC) has been proven to be effective, but there is little evidence of its cost-utility regarding comprehensive screening strategies. We aimed to assess the cost-utility of various endoscopic screening strategies for UGC within the Chinese healthcare system.</div></div><div><h3>Methods</h3><div>A Markov model was constructed to assess the cost-utility of 40 screening strategies consisting of different screening starting ages (40, 45, 50, or 55 years old), screening frequencies (once per lifetime and every year, 2 years, 5 years, 10 years and 15 years), and follow-up or not. Model parameters were estimated based on our survey data, public surveillance data, and published literature. The primary outcome was the incremental cost-utility ratios (ICUR, incremental health care costs per quality-adjusted life-year [QALY] gained). Deterministic and probabilistic sensitivity analyses were performed to examine key parameter uncertainty.</div></div><div><h3>Findings</h3><div>The cost-utility analysis identified 7 strategies as the dominant strategies given 1 times per capita GDP (¥70653/$9821.69) of Shandong province in China in 2019. Compared with no screening, all dominant strategies were associated with improved ICUR by CNY 12 095.60 to ¥31 456.29 per QALY. Compared with neighboring strategy, all dominant strategies were associated with improved ICUR by CNY 12 095.62 to ¥66 764.06 per QALY. The y40-nf-il would be the most cost-utility strategy, with probabilities of 42% to 95% at 1-3 times the per capita GDP. At a WTP lower than 1 times per capita GDP, the probability of the y40-nf-i2 strategy being more cost-utility is highest. Findings were robust in all sensitivity analyses.</div></div><div><h3>Interpretation</h3><div>Combined endoscopic screening for UGC appears cost-utility in the Chinese healthcare system. Screening at the age of 40, conducting it annually and without follow-up, would be the optimal strategy. However, in areas with economic constraints and limited resources, modifying this optimal strategy to be implemented every 2 years could enhance cost-utility. Those findings would be useful for the development of policies targeting the prevention and control of UGC in China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101331"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice preferences for AI-based medication counselling in patients with chronic obstructive pulmonary disease: a discrete choice experiment","authors":"Jialiang Feng ,&nbsp;Yisong Yao ,&nbsp;Xiaoqian Xia ,&nbsp;Huirong Liu ,&nbsp;Yibo Wu","doi":"10.1016/j.lanwpc.2024.101403","DOIUrl":"10.1016/j.lanwpc.2024.101403","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patients with chronic obstructive pulmonary disease (COPD) require long-term and accuracy medication guidance, making it a promising tool for the management of COPD. Nevertheless, patient preferences for AI-based medication counselling in COPD management remain unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data from 325 patients were analyzed. We identified 6 attributes of AI-based medication counselling and utilized an orthogonal design to generate a selection set for a discrete choice experiment (DCE). Questionnaires were collected from patients with COPD in Henan Province, comprising a general information questionnaire, DCE questionnaire, five-level EuroQol five-dimensional questionnaire (EQ-5D-5L), medication literacy scale, and e-health scale. We employed a conditional logit regression model to estimate patient-reported preferences for each attribute and calculated their willingness to pay. Additionally, we determined that the 3-class model has the best data fit superiority by calculating the Akaike information criterion (AIC), and performed latent class analysis (LCA) to analyze the heterogeneity of people's preferences for AI-based medication counselling. Based on the results of LCA, we further used multinomial logistic regression analysis to explore the factors influencing patients' preferences for AI-based medication counselling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The conditional logit regression model reveals that patients prioritize the attributes of AI-based medication counseling in the following order of importance: accuracy, comprehensibility, consultation channels, presentation format, manual review, and cost. The calculation of WTP revealed that participants are willing to pay an additional 20.81 RMB for a boost in result accuracy from 60% to 100% and 14.33 RMB for an increase from 80% to 100%. Likewise, enhancing comprehensibility to fully understandable from incomprehensible or partially comprehensible garners an extra 13.85 RMB or 4.39 RMB, respectively. Latent class analysis categorized patients into three groups: Class1 (21.2%) favors human-reviewed consultations via websites and audio/dialogue; Class2 (59.7%) prefers app-based consultations without human review and presented with images; and Class3 (19.1%) is less concerned with consultation details but prioritizes unreviewed audio or dialogue formats. Multinomial logistic regression analysis showed that, among Class1 and Class2, gender (p=0.034) age (p=0.017) and e-health literacy scores (p=0.001) significantly influence classification, with females and older, more digitally literate individuals leaning towards Class1. Comparatively, Class1 versus Class3 analysis indicated that higher income (p=0.027) and the presence of other chronic diseases (p=0.005) significantly predict Class1 membership, suggesting that wealthier individuals or those with multiple health conditions are more likely to prefer Class1.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101403"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social inequalities in lung cancer screening in China: a cross-sectional study","authors":"Zhicheng Wang ,&nbsp;Pengyun Meng ,&nbsp;Qianyi Xia ,&nbsp;Zixuan Yang ,&nbsp;Chang Lu ,&nbsp;Haomin Yang ,&nbsp;Jiantuo Yu","doi":"10.1016/j.lanwpc.2024.101317","DOIUrl":"10.1016/j.lanwpc.2024.101317","url":null,"abstract":"<div><h3>Background</h3><div>Lung cancer is the leading cause of cancer-related deaths in China, while screening for lung cancers offers an opportunity for early detection and reduced mortality. Limited data exist on nationwide lung cancer screening uptake in China, particularly concerning social inequalities. This study aims to assess lung cancer screening uptake situation in China, examine sociodemographic factors associated with screening participation, and identify barriers to screening, particularly in relation to social inequalities.</div></div><div><h3>Methods</h3><div>Between September 2022 and January 2023, we conducted the Chinese Residents Cancer Screening Services Survey, assessing uptake and willingness to participate in screening for various cancers, including lung cancer. The survey included a nationally representative sample of 10,000 adults aged 35-69 from 100 counties and districts across 26 provinces. Lung cancer screening uptake was defined as prior participation in chest or lung CT scans for cancer screening or detection. Key variables examined include age, gender, smoking habits, and individual-level and area-level socioeconomic status.</div></div><div><h3>Findings</h3><div>Lifetime lung cancer screening rates were 37.21% (95% CI 35.83-38.61) for men and 39.58% (95% CI 38.26-40.92) for women, while screening within the past five years was 34.42% (95% CI 33.07-35.80) for men and 37.47% (95% CI 36.16-38.80) for women. Smokers had the lowest uptake (33.97%, 95% CI 32.12-35.86) compared to ever-smokers (46.77%, 95% CI 43.05-50.51) and never-smokers (39.25%, 95% CI 38.08-40.42). Rural residents had lower uptake (26.59%, 95%CI 25.03-28.20) compared to urban residents (43.67%, 95%CI 42.50-44.84). Education and income levels were strongly associated with screening participation, with higher rates in richer and educated individuals. Area-level social inequalities were also notable, with screening uptake ranging from 56.87% (95% CI 54.32-59.39) in the least deprived 10% counties to 26.00% (95% CI 22.21-30.08) in the most deprived 10%. Across all socioeconomic groups, the primary reason for not participating in cancer screening was the belief that their risk of cancer was too low, while socially vulnerable groups were more likely to be deterred by screening costs or fear of a cancer diagnosis.</div></div><div><h3>Interpretation</h3><div>Lung cancer screening uptake in China remains low, particularly among smokers. Notable social inequalities in screening participation were identified, with lower uptake among rural residents and individuals with socioeconomic disadvantages at both the individual and area levels. Targeted public health interventions are crucial to raise awareness and improve access to lung cancer screening, especially in underserved communities.</div></div><div><h3>Funding</h3><div>China Development Research Foundation.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101317"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Price trends and affordability of metastatic non–small cell lung cancer drugs in China from 2019 to 2024","authors":"Xin Du ,&nbsp;Xingxian Luo ,&nbsp;Xufeng Lv ,&nbsp;Lizong Li ,&nbsp;Lin Huang ,&nbsp;Yi Zhang","doi":"10.1016/j.lanwpc.2024.101318","DOIUrl":"10.1016/j.lanwpc.2024.101318","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The affordability of novel cancer drugs is a determinant of health disparities in China and worldwide. Encouragingly, China has initiated drug regulatory reform and national price negotiation policies since 2015. As a growing number of novel lung-cancer targeted drugs are approved in China, it is expected to improve the affordability of lung cancer targeted drugs. This study aims to assess the monthly treatment cost of approved targeted drugs for metastatic Non–Small Cell Lung Cancer (NSCLC) and the possible impact of within-class drugs in China from 2019 to 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The domestic and imported new therapeutic agents for metastatic NSCLC approved in China between January 1, 2010, and October 1, 2024, were included, using data from the National Medical Products Administration database. We searched the launch and the latest price data between 2019 and 2024 from the procurement platforms of the provincial medical insurance bureau. The main outcome was trends over time in monthly treatment cost and the correlation in cost among the multiple NSCLC agents within each therapeutic class, measured using the Pearson correlation coefficient. We further compared the cost of different medication with the per capita disposable monthly income in China in 2024. The compounded annual growth rates of different medication costs were also assessed. The exchange rate of the U.S. dollar to the Chinese yuan was 7.1 and we adjusted the price based on the annual consumption index published by the National Bureau of Statistics of China given the effect of inflation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In our cohort study, 30 targeted drugs for metastatic NSCLC were analyzed, including 10 PD1/PDL1 inhibitors, 8 EGFR inhibitors, 6 ALK/ROS inhibitors and 6 MEK/RET inhibitors, respectively. The median monthly treatment of NSCLC drugs on the market at launch (median: $3956; IQR, $2152-$5691) and the latest (median: $1811, IQR, $631-$5450) were significantly higher than the per capita disposable monthly income ($484) in China in 2024. Higher latest monthly treatment costs for PD1/PDL1 (median: $4265, IQR, $518-$6551) and MEK/RET inhibitors (median: $5668, IQR, $5290-8136) were observed. &lt;strong&gt;The median Pearson correlation coefficient values were 0.99 (IQR, 0.91-0.99) for PD1/PDL1 inhibitors, 0.92 (IQR, 0.74-0.99) for EGFR inhibitors, 0.73 (IQR, 0.63-0.99) for ALK inhibitors, and 0.97 for MEK and RET inhibitors.&lt;/strong&gt; The median compounded annual growth rates were -0.98% (IQR, -1.51%, -0.97%) for PD1/PDL1 inhibitors, -26.35% (IQR, -38.17%, -11.50%) for EGFR inhibitors, -30.72% (IQR, -37.45%, -21.67%) for ALK/ROS and -0.49% (IQR, -12.05%, 0%) for MEK/RET inhibitors. The lung-cancer drugs included in national health insurance through negotiation had more significant price reductions (-20.53% vs -1.1%, &lt;em&gt;P&lt;/em&gt;&lt;0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The approval of within-class drugs and adjustm","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101318"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the impact of biopsy techniques and surgical waiting time on early breast cancer prognosis: a real-world comparative study","authors":"Qichen Dai ,&nbsp;Gang Liu ,&nbsp;Zhihui Zhang ,&nbsp;Yu Tang ,&nbsp;Han Cheng ,&nbsp;Xiangyu Tong ,&nbsp;Fengshan Wang ,&nbsp;Lin Feng ,&nbsp;Yipeng Wang","doi":"10.1016/j.lanwpc.2024.101392","DOIUrl":"10.1016/j.lanwpc.2024.101392","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative biopsy techniques, including fine needle aspiration (FNA), core needle biopsy (CNB), and surgical excision, are commonly employed in early-stage breast cancer. Our study aimed to assess the impact of these three biopsy techniques on prognosis and, importantly, for the first time, to explore the effect of surgical waiting time following biopsy on survival outcomes.</div></div><div><h3>Methods</h3><div>In this study (ChiCTR2300075857), we retrospectively analyzed medical records from breast cancer patients who underwent FNA, CNB, or excision from 2009 to 2017 and were subsequently treated with standard surgical procedures. Overall survival (OS) and disease-free survival (DFS) were examined using Kaplan‒Meier analysis and Cox proportional hazards models.</div></div><div><h3>Findings</h3><div>The study cohort consisted of 4465, 1305, and 950 patients who underwent FNA, CNB, and excision biopsies, respectively. The median waiting period between biopsy and surgery was 5 days (IQR 3-8) in the FNA group and 8 days (IQR 4-15) in the CNB group. The majority of excision biopsies took place on the same day as the standard surgical procedure. Univariate analysis showed that the excision group had better OS (HR=0.57, p&lt;0.01) and DFS (HR=0.69, p&lt;0.01) compared to the FNA and CNB groups. However, after adjustment using multivariate and propensity-score matching analyses, no significant differences in OS (p=0.16) or DFS (p=0.44) were observed between the groups. Furthermore, patients with a waiting period for surgery exceeding 14 days demonstrated worse DFS both in the FNA group (p=0.022) and the excision group (p=0.047). In the CNB group, a surgical waiting time exceeding 30 days led to worse DFS (p=0.015) and OS (p=0.034).</div></div><div><h3>Interpretation</h3><div>Despite the different biopsy techniques, the prognoses of patients were similar. Notably, this is the first study to explore the impact of surgical waiting time, and our findings suggest that reducing the interval across all groups may improve survival outcomes. However, due to the retrospective design, there is an inevitable risk of information bias, which limits the robustness of the results to some extent. Thereby, well-designed prospective studies and randomized trials are required in the future to validate the conclusion.</div></div><div><h3>Fundings</h3><div>This research was funded by the <span>CAMS Innovation</span> Fund for Medical Sciences (2021-I2M-1-014) and the Beijing Hope Run Special Fund of <span>Cancer Foundation of China</span> (LC2022A02).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101392"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted axillary lymph node dissection in patients with node-positive breast cancer: techniques, learning curve, and preliminary results","authors":"Zhjie Wu,&nbsp;Zuxiao Chen,&nbsp;Zongyan Li,&nbsp;Xiaoyan Fu,&nbsp;Yunxiang Luo,&nbsp;Qiongyu Hu,&nbsp;Haiyan Li","doi":"10.1016/j.lanwpc.2024.101339","DOIUrl":"10.1016/j.lanwpc.2024.101339","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted axillary lymph node dissection (RALND) has little application experience. In patients with breast cancer that have positive lymph nodes, we present the initial outcomes of RALND.</div></div><div><h3>Methods</h3><div>We examined the medical records of individuals with breast cancer from a single institution that underwent RALND treatment between March 2024 and August 2024. The clinicopathological characteristics, learning curve, and consequences of RALND were investigated to determine the efficacy and safety of RALND.</div></div><div><h3>Findings</h3><div>A total of 21 patients with RALND were included in the analysis. we reported that the Docking time took 8–10 minutes, and the average operation duration was 56.1 ± 14.6 min. After the accumulation of experience in 6 patients, the time required to complete RALND stabilized at about 60 minutes. The mean blood loss was 4.1 ± 2.1 mL, and the number of lymph nodes was 17.1 ± 5.6, of which 2.2 ± 3.5 were positive. All 21 patients had good shoulder joint movement (DASH score 10.82 ± 2.46), and no wound infection and lymphatic leakage were observed.</div></div><div><h3>Interpretation</h3><div>According to our initial experience, RALND is a safe surgical procedure that can decrease intraoperative bleeding and the effect on upper limb function, lower the incidence of complications, and potentially be an alternative technique for treating patients with positive axillary lymph nodes in breast cancer.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101339"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}