Journal of Cancer Policy最新文献

{"title":"US pharmaceutical tariffs and European oncology: Policy risks, openings, and clinical implications","authors":"Javier-David Benitez-Fuentes","doi":"10.1016/j.jcpo.2025.100665","DOIUrl":"10.1016/j.jcpo.2025.100665","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100665"},"PeriodicalIF":2.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival as a safety guardrail in cancer drug trials","authors":"Rashidul Alam Mahumud","doi":"10.1016/j.jcpo.2025.100666","DOIUrl":"10.1016/j.jcpo.2025.100666","url":null,"abstract":"<div><div>Surrogate endpoints have accelerated access to oncology drugs but often leave uncertainty about net patient benefit. We propose a pragmatic framework that recentres overall survival (OS) as both the definitive patient-centred efficacy endpoint and a safety guardrail capable of detecting net harm that intermediate measures may miss. The framework comprises four pillars. First, designing for harm exclusion: protocols should prespecify a clinically meaningful OS harm margin, power event-driven follow-up to exclude or detect that margin with precision, and mandate independent data monitoring committee oversight. Analyses should match explicit estimands and pair hazard ratios with restricted mean survival time to accommodate non-proportional hazards. Second, handling crossover and post-progression therapy: when crossover is ethical or unavoidable, trials should adopt treatment-policy estimands for the primary question and prespecified causal sensitivity analyses. Protocols must map access to guideline-concordant post-progression care, record uptake and timing, and distinguish biological dilution from health-system scarcity. Third, using surrogates with discipline: when OS cannot feasibly be primary, sponsors should submit a disease-specific surrogate dossier summarising trial- and patient-level validation and quantifying expected translation to OS, while continuing to collect OS and assess it against the prespecified harm boundary. Fourth, preventing missingness-driven bias: continue outcome collection after treatment discontinuation, set triggers for asymmetric loss to follow-up, and perform structured tipping-point analyses. We recommend a regulatory traffic-light aligned to OS maturity, green (traditional approval), amber (time-limited with confirmatory obligations), red (standards unmet), and conditioning economic conclusions (QALYs, net monetary benefit) on OS harm exclusion. Operationalising OS as a safety guardrail protects patients and strengthens the credibility and value of cancer trials.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100666"},"PeriodicalIF":2.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor – Commentary on “Continued tobacco use beyond cancer diagnosis in India – A systematic review and meta-analysis”","authors":"Ruihang Luo ,&nbsp;Maosen Liu ,&nbsp;Wei Zhong,&nbsp;Hongyi Lai,&nbsp;Kun Ai,&nbsp;Mingshan Liu","doi":"10.1016/j.jcpo.2025.100661","DOIUrl":"10.1016/j.jcpo.2025.100661","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100661"},"PeriodicalIF":2.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic variation in experiences of cancer care in Scotland: Insights and policy implications from the Scottish Cancer Patient Experience Survey","authors":"Peter Murchie ,&nbsp;David McLernon ,&nbsp;Alexander Murchie ,&nbsp;David Nelson ,&nbsp;Natalia Calanzani","doi":"10.1016/j.jcpo.2025.100663","DOIUrl":"10.1016/j.jcpo.2025.100663","url":null,"abstract":"<div><h3>Background</h3><div>Rural residence is associated with reduced cancer survival but research linking geography to patient experience is limited. Evidence from Scotland suggests rural patients experience cancer care differently. The Scottish Cancer Patient Experience Survey (SCPES) provides nationally representative, patient-reported datasets capturing experiences across the cancer care pathway, offering a unique opportunity to examine geographic variation in care.</div></div><div><h3>Methods</h3><div>SCPES 2024 responses from 4540 adults were analysed. Data were weighted to account for non-response bias and structured for analysis by Scottish Government six-fold Urban-Rural classification. From 102 SCPES items, 32 were selected by two researchers independently (percentage agreement and Cohen’s kappa were calculated) based on relevance to cancer pathway stages, travel burden or rural-urban disparities. Analyses were conducted in three blocks: (1) pathway-relevant questions (n = 15), (2) distance to care components (n = 7), and (3) specific travel difficulties (n = 10). Cross-tabulations employed weighted counts, with χ² tests and linear-by-linear trend analyses for ordinal responses. Bonferroni correction was applied within each block.</div></div><div><h3>Results</h3><div>Rural-dwelling respondents reported significantly longer journeys to access aspects of their cancer care and were more likely to report specific travel difficulties. Rural-dwellers were significantly less-likely to be given the chance to participate in research. Despite this, rural-dwelling cancer patients were as likely as urban-dwellers to report that their cancer experience was positive overall.</div></div><div><h3>Conclusion</h3><div>Satisfaction with cancer care in Scotland is positive irrespective of geography. Further research should focus on sustainably reducing travel-burden for rural-dwelling cancer patients and ensuring equal opportunities for them to participate in qualitative and quantitative research.</div></div><div><h3>Policy summary</h3><div>Efficient and meaningful analysis of publicly available cancer data should be encouraged. Future UK policy should support sustainable access to care for rural patients. Equal opportunities for research participation among rural patients should also be promoted. The SCPES should continue, and an additional question on overall support would be a useful addition.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100663"},"PeriodicalIF":2.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in the utilisation of curative-intent treatments for early-stage non-small cell lung cancer across urban and rural areas: A population-based study in England","authors":"Eva Kagenaar ,&nbsp;David G. Lugo-Palacios ,&nbsp;Ajay Aggarwal ,&nbsp;Andrew Hutchings ,&nbsp;Lu Han ,&nbsp;Stephen O’Neill ,&nbsp;Bernard Rachet ,&nbsp;John Edwards ,&nbsp;Corinne Faivre-Finn ,&nbsp;Richard Grieve","doi":"10.1016/j.jcpo.2025.100662","DOIUrl":"10.1016/j.jcpo.2025.100662","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess sociodemographic inequalities in anticancer treatments including curative-intent surgery and curative-intent radiotherapy for people with early-stage non-small cell lung cancer (NSCLC), across urban and rural areas.</div></div><div><h3>Methods</h3><div>A total of 38,229 eligible patients with early-stage NSCLC were identified from the English cancer registry and information on anti-cancer treatment (curative-intent surgery, curative-intent radiotherapy, palliative treatment, no anticancer treatment) was extracted from linked data. Multinomial logistic regression models estimated the association of sociodemographic measures with receipt of anticancer treatments, adjusting for case-mix and travel time.</div></div><div><h3>Results</h3><div>Those living in more deprived areas were less likely to receive curative-intent surgery with a mean change in the estimated probability of −11.1 %age points (95 % CI −12.5;-9.6), but more likely to receive curative radiotherapy with a mean change of + 4.3 %age points (95 % CI 3.0;5.6), than those living in the least deprived areas. Compared to those living in the five largest cities, the estimated probability of receiving curative-intent surgery was lower for those living in other urban areas with a mean change of −2.7 %age points (95 % CI −3.7;-0.2), and those living in rural areas, with a mean change of −2.2 %age points (95 % CI −3.7;-0.6). The probability of receiving curative-intent radiotherapy was lower by on average −2.3 %age points (95 % CI −3.2;-1.3) for those living in other urban areas versus the largest cities, but the corresponding reduction for those living in rural areas was small (-0.5 %age points, 95 % CI −1.9;0.1).</div></div><div><h3>Conclusion</h3><div>There are major inequalities in receipt of curative-intent surgery for early-stage NSCLC according to deprivation, and urban versus rural residence with smaller inequalities for receipt of curative-intent radiotherapy.</div></div><div><h3>Policy Implications</h3><div>The further expansion of radiotherapy services could reduce inequalities in uptake of curative-intent treatment for NSCLC, but the impact on patient outcomes must be assessed.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100662"},"PeriodicalIF":2.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National cancer plans and primary care a systematic analysis comparing Latin American and non-Latin American countries","authors":"Andrea Rioseco ,&nbsp;Klaus Puschel ,&nbsp;Gabriela Soto ,&nbsp;Zdenka Vescovi ,&nbsp;Isabella Fuentes ,&nbsp;Felipe Dibiase ,&nbsp;Gonzalo Ulloa ,&nbsp;Carolina Goic ,&nbsp;Jon Emery ,&nbsp;Beti Thompson ,&nbsp;Javiera Martinez-Gutierrez","doi":"10.1016/j.jcpo.2025.100659","DOIUrl":"10.1016/j.jcpo.2025.100659","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is a growing global health issue, particularly in middle- and high-income countries. National Cancer Control Plans (NCCPs) have emerged as a strategic response to reduce this burden. Primary care plays a crucial role across the cancer care continuum, yet its systematic inclusion in NCCPs remains unclear—especially in countries facing significant epidemiological challenges.</div></div><div><h3>Methods</h3><div>This study employed a systematic qualitative design based on document analysis. Using the READ (Ready material, Extract data, Analyze, Distil) model, we examined the integration of primary care policies and practices in eight NCCPs: four from non-Latin American high-income countries (NLAHIc—Australia, Canada, the United States, and the United Kingdom) and four from Latin American middle-income countries (LATAMc—Argentina, Colombia, Chile, and Mexico). Covidence software facilitated the systematic text review, and a set of evidence-based key performance indicators (KPIs) was developed to guide the analysis.</div></div><div><h3>Results</h3><div>Primary care integration varied across countries. LATAMc NCCPs showed greater inclusion of primary care than NLAHIc. Health promotion strategies were more consistently present in NLAHIc, while LATAMc better integrated primary prevention into primary care. However, only 50 % of KPIs for secondary prevention and 15 % for survivorship care were included in LATAMc. Palliative care was more consistently integrated in LATAMc (75 %) than in NLAHIc (33 %).</div><div>Policy Summary</div><div>This is the first study to benchmark NCCPs from Latin American and high-income countries using evidence-based KPIs to assess primary care involvement in cancer control. Findings highlight an urgent need to strengthen primary care integration. LATAMc should improve secondary prevention and survivorship care, while NLAHIc need to better incorporate primary prevention and palliative care into their NCCPs.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100659"},"PeriodicalIF":2.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrepancies in the therapeutic indications granted by the European Medicines Agency and the US Food and Drug Administration for new cancer drugs: An analysis of potential explanations","authors":"Allan Cramer ,&nbsp;Freja Karuna Hemmingsen Sørup ,&nbsp;Hanne Rolighed Christensen ,&nbsp;Kristian Karstoft ,&nbsp;Tonny Studsgaard Petersen","doi":"10.1016/j.jcpo.2025.100660","DOIUrl":"10.1016/j.jcpo.2025.100660","url":null,"abstract":"<div><h3>Background</h3><div>Studies have found notable differences between the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) in indications granted to new cancer drugs (e.g., different treatment lines). It is unknown why they occur; therefore, we aimed to analyse if maturity of data or characteristics of the pivotal trials might be explanations.</div></div><div><h3>Methods</h3><div>New cancer drugs approved by both EMA and the FDA in the study period between January 1, 2020, to December 31, 2022, and new cancer drugs that were approved by one agency in the study period and at the other agency outside the study period were included in the analysis. The drugs were identified by searching the FDA and EMA websites.</div></div><div><h3>Results</h3><div>A total of 36 new cancer drugs were included. Notable differences between EMA and the FDA in the granted indication were found in 15 (42 %) of the drugs. The proportion of cancer drugs with differences in maturity of data at time of assessment between EMA and the FDA was similar for drugs with and without notable differences in the indication. Furthermore, the results did not indicate that low level of evidence (e.g., early phase trial as the pivotal, single-arm design, or use of surrogate endpoints) was more common in the cancer drugs with notable differences in the indication.</div></div><div><h3>Conclusion</h3><div>The frequent discrepancies in the granted indications between EMA and the FDA for new cancer drugs during a three year period could not be explained by maturity of data at time of assessment or characteristics of the pivotal trials. Therefore, divergence in regulatory policies between the two agencies is considered a more likely explanation.</div></div><div><h3>Policy summary</h3><div>Discrepancies between regulatory agencies in the indications granted to new cancer drugs suggest a problematic extrapolation and thus uncertainty regarding the clinical benefit for the patients. The present study seeks to identify potential explanations for the discrepancies to reduce the misalignment in the future.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100660"},"PeriodicalIF":2.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing multidisciplinary oncology care: Feasibility of structured tools for Belgian multidisciplinary oncological consultation meetings","authors":"Nadine Boesten ,&nbsp;Melissa De Regge ,&nbsp;Hannes Vanpoecke ,&nbsp;Mark Leys ,&nbsp;Kristof Eeckloo ,&nbsp;Paul Gemmel","doi":"10.1016/j.jcpo.2025.100656","DOIUrl":"10.1016/j.jcpo.2025.100656","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary team meetings (MDTMs) are considered a cornerstone of oncology care, yet questions remain about their efficiency and patient-centeredness. While tools exist to guide and structure MDTMs, their integration into hospital settings is often inconsistent.</div></div><div><h3>Methods</h3><div>This feasibility study examined the use of two validated tools—the MDT-QuIC checklist and the MDT-MeDiC complexity tool—across ten Multidisciplinary Oncological Consultations (MOCs) in five Belgian hospitals. Baseline assessments were conducted using the validated MDT-MODe observational instrument. Implementation feasibility was evaluated through repeated observations at the MOCs and interviews with MOC chairs.</div></div><div><h3>Results</h3><div>Baseline data showed limited discussion of psychosocial information and patient preferences, and minimal nurse contribution. The MDT-QuIC was generally accepted as helpful for structure and role clarity, though not consistently applied due to time pressures. The MDT-MeDiC tool was considered too resource-intensive for routine use. Implementation success varied by existing structure, leadership style, and administrative support.</div></div><div><h3>Conclusion</h3><div>Structured tools can improve the organization of MOCs, but feasibility is dependent on local context. Broader uptake across health systems requires attention to team composition, preparatory workflows, and integration into supportive policy and digital frameworks.</div></div><div><h3>Policy summary</h3><div>Embedding structured MDTM tools into oncology policy, through digital integration, case complexity triaging, and incentives for psychosocial and nursing input enables efficient use of expert time while safeguarding patient-centredness.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100656"},"PeriodicalIF":2.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global emerging trends and correlation of financial toxicity in cancer care: A bibliographic review (2013–2024)","authors":"Xiaojun Zhang ,&nbsp;Shixiang Chen ,&nbsp;Yuting Feng ,&nbsp;Hailing Ren ,&nbsp;Yanwen Zhang ,&nbsp;Ying Chen ,&nbsp;Bingxin Ma ,&nbsp;Jin Yang ,&nbsp;Yaogang Wang ,&nbsp;Qi Lu ,&nbsp;Yue Zhao","doi":"10.1016/j.jcpo.2025.100658","DOIUrl":"10.1016/j.jcpo.2025.100658","url":null,"abstract":"<div><h3>Purpose</h3><div>Financial toxicity has garnered increasing attention due to the financial “toxic effect” of cancer therapy. This study was conducted to provide an overall research landscape on financial toxicity from chronological, geographical, socioeconomic and epidemiological perspectives.</div></div><div><h3>Designs</h3><div>Publications on financial toxicity were retrieved from the Web of Science Core Collection. IBM SPSS 26.0 was used to analyze the correlation between the number of publications and socioeconomic and epidemiological factors. VOSviewer, CiteSpace, Scimago Graphica and Pajek were used for country/region collaboration, reference cocitation, keyword cooccurrence, and keyword burst analysis.</div></div><div><h3>Results</h3><div>Between 2013 and 2024, 501 publications were identified, with the number of publications increasing annually. The annual number of publications was highly positively correlated with the annual cancer incidence rate, prevalence rate, death rate, and disability-adjusted life years (R² = 0.907, 0.820, 0.836, 0.808, respectively). The number of publications in different countries was highly positively correlated with total health spending, government health spending, and out-of-pocket health spending (R² = 0.955, 0.906, 0.746, respectively). The top journal was Supportive Care in Cancer (79 publications). Research hotspots focus on the impact of financial toxicity on quality of life and psychological distress, the measurement and cost burden of financial toxicity, its impact on health outcomes, and the employment and health impact of financial toxicity. Research frontiers focused on the financial stress and young adult.</div></div><div><h3>Conclusions</h3><div>The increasing number of publications on financial toxicity highlights its growing recognition as an important issue in healthcare. Health professionals and governments should address the high costs of cancer care and explore interventions to reduce its impact on patients and healthcare spending.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100658"},"PeriodicalIF":2.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Areca nut-related oral cancer awareness in adults: A meta-analysis","authors":"Nathaniel Wu ,&nbsp;Thomas J. Roberts ,&nbsp;Nikki Apana ,&nbsp;Sanjena Venkatesh ,&nbsp;Nicole Deville ,&nbsp;Eric Pineda ,&nbsp;Song Zhang ,&nbsp;Mona Pathak ,&nbsp;Kekoa Taparra ,&nbsp;William J. Moss","doi":"10.1016/j.jcpo.2025.100649","DOIUrl":"10.1016/j.jcpo.2025.100649","url":null,"abstract":"<div><h3>Background</h3><div>Areca nut is classified as a Group I carcinogen for oral cavity malignancies by the International Agency for Research on Cancer. Cultivation of the substance and oral cancer incidences have risen considerably in recent years. The assessment of areca nut-related health risk awareness is an increasingly imperative global health topic.</div></div><div><h3>Methods</h3><div>A systematic review of the Medline, Web of Science, Embase and Cochrane databases was undertaken in search of prospective survey studies evaluating areca nut-related health literacy in adults. The primary outcome of interest was the percentage of respondents that were unaware that areca nut products cause oral cancer. A random effects meta-analysis was used to calculate pooled weighted averages. Subgroup analyses stratifying by healthcare education level, geography and publication year were performed using a Chi-square test.</div></div><div><h3>Results</h3><div>Twenty-eight articles with a total of 13,440 respondents were included in the analysis. Collectively, 50 % (95 % CI: 40 %-60 %, I² 99·5 %) of respondents did not identify areca nut products in general as a risk factor for oral cancer. Only five studies specifically inquired about the carcinogenicity of areca nut without additives. Collectively, 80 % (95 % CI: 63 %-96 %, I² 99·3 %) of these respondents did not know that pure areca nut is a carcinogen. There were no significant discrepancies on subgroup analyses by healthcare education level, geography or date of publication.</div></div><div><h3>Conclusion</h3><div>An international collection of evidence substantiates drastic areca nut-related health literacy deficiencies internationally.</div></div><div><h3>Policy Summary</h3><div>There is an urgent need for healthcare professionals in areca nut regions to launch formalized educational campaigns. Medically-accurate, culturally-sensitive warning labels are strongly indicated.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100649"},"PeriodicalIF":2.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}