JMIR Cancer最新文献_第9页

Virtual Health Assistants in Preventive Cancer Care Communication: Systematic Review. 预防癌症护理沟通中的虚拟健康助理：系统回顾。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-15 DOI: 10.2196/73616

Aantaki Raisa, Xiaobei Chen, Emma G Bryan, Carma L Bylund, Jordan M Alpert, Benjamin Lok, Carla L Fisher, Lyndsey Thomas, Janice L Krieger

Background: Virtual health assistants (VHAs), interactive digital programs that emulate human communication, are being increasingly used in health care to improve patient education and care and to reduce the burden on health care providers. VHAs have the potential to promote cancer equity through facilitating patient engagement, providing round-the-clock access to information, and reducing language barriers. However, it is unclear to what extent audience-centeredness is being considered in the development of cancer-related applications.Objective: This systematic review identifies and synthesizes strategies used to make VHA-based cancer prevention and screening interventions audience-centered.Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched 4 databases (PubMed, Embase, Web of Science, and EBSCOhost) for peer-reviewed studies on VHA interventions promoting cancer screening (January 2022). Included studies focused on adult populations in primary care settings, with interventions emphasizing interactivity and immediacy (key VHA features). Excluded studies were on cancer treatment, noninteractive decision aids, or technical VHA development. Screening, data extraction, and quality assessment (Mixed Methods Appraisal Tool) were performed independently by multiple reviewers. Thematic synthesis was used to analyze audience-centered strategies.Results: Of 1055 records screened, 17 studies met inclusion criteria. Most (n=11) targeted colorectal cancer, with others addressing prostate, breast, cervical, or lung cancer. A total of 16 studies were US-based; 1 study focused on Uganda. Key strategies for audience-centered design included: (1) Demographic Concordance: Race or gender alignment between VHA and users (eg, African American participants interacting with Black-coded avatars); (2) User Feedback: Iterative testing via interviews, think-aloud protocols, or pilot studies to refine interventions; (3) Preintervention Needs Assessment: Identifying cultural, linguistic, or literacy barriers (eg, myths about screening in Ugandan communities); (4) Theoretical Frameworks: The Health Belief Model (most common), the Modality, Agency, Interactivity, and Navigability (MAIN) model, or tailored messaging theories guided design; (5) Information Customization: Culturally adapted content (eg, Spanish-language interfaces, narratives addressing racial disparities); and (6) Feature Customization: Adjusting VHA appearance (eg, animations and fonts) based on user preferences. Notably, 7/17 studies focused on racially minoritized groups (eg, African Americans, Hispanic farmworkers), addressing systemic barriers like mistrust in health care. However, gaps persisted in intersectional tailoring (eg, rurality and income) and non-English languages (only 2/17 studies). Recruitment methods influenced diversity; community

背景：虚拟健康助理（VHAs），一种模拟人类交流的交互式数字程序，正越来越多地用于卫生保健，以改善患者教育和护理，并减轻卫生保健提供者的负担。vha有潜力通过促进患者参与、提供全天候信息获取和减少语言障碍来促进癌症公平。然而，目前尚不清楚在癌症相关应用的开发中，以受众为中心的考虑程度如何。目的：本系统综述确定并综合了以vha为基础的癌症预防和筛查干预以受众为中心的策略。方法：根据PRISMA (Preferred Reporting Items for Systematic Reviews and meta - analysis) 2020指南，我们检索了4个数据库（PubMed、Embase、Web of Science和EBSCOhost），检索了关于VHA干预促进癌症筛查的同行评议研究（2022年1月）。纳入的研究集中在初级保健机构的成年人群，干预措施强调互动性和即时性（VHA的关键特征）。排除的研究包括癌症治疗、非互动性决策辅助或VHA技术开发。筛选、数据提取和质量评估（混合方法评估工具）由多位评论者独立完成。采用主题综合的方法分析以受众为中心的策略。结果：在筛选的1055项记录中，有17项研究符合纳入标准。大多数（n=11）针对结直肠癌，其他针对前列腺癌、乳腺癌、宫颈癌或肺癌。共有16项研究是在美国进行的；1项研究的重点是乌干达。以受众为中心设计的关键策略包括：(1)人口统计学一致性：VHA和用户之间的种族或性别一致性（例如，非裔美国人参与者与黑人编码的虚拟形象互动）；(2)用户反馈：通过访谈、有声思考协议或试点研究进行迭代测试，以完善干预措施；(3)干预前需求评估：识别文化、语言或读写障碍（例如，乌干达社区关于筛查的误解）；(4)理论框架：健康信念模型（最常见），模态、代理、交互性和可导航性（主要）模型，或定制信息理论指导设计；(5)信息定制：适应文化的内容（例如，西班牙语界面，解决种族差异的叙述）；(6)功能定制：根据用户偏好调整VHA外观（例如动画和字体）。值得注意的是，7/17的研究侧重于种族少数群体（如非洲裔美国人、西班牙裔农场工人），解决了医疗保健方面的不信任等系统性障碍。然而，在交叉裁剪（例如，农村和收入）和非英语语言（只有2/17的研究）方面，差距仍然存在。招聘方式影响多样性；基于社区的招聘策略比完全基于互联网的招聘方法产生了更具代表性的样本。结论：系统评价确定了目前以受众为中心的发展实践，用于基于vha的预防癌症护理干预。大多数研究包括使目标受众多样化和细分的过程，侧重于医学上代表性不足的人口群体，并执行对有关人口具有文化敏感性的战略。然而，仍有机会解决多方面的不平等问题（如农村准入和低识字率）。未来的干预措施应整合交叉框架，扩大语言多样性，并衡量社会存在以提高参与度。本综述为开发以公平为重点的癌症预防电子健康工具提供了路线图。

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引用次数: 0

Machine Learning for Preoperative Assessment and Postoperative Prediction in Cervical Cancer: Multicenter Retrospective Model Integrating MRI and Clinicopathological Data. 机器学习用于宫颈癌术前评估和术后预测：多中心回顾性模型整合MRI和临床病理数据。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-12 DOI: 10.2196/69057

Shuqi Li, Chenyan Guo, Yufei Fang, Junjun Qiu, He Zhang, Lei Ling, Jie Xu, Xinwei Peng, Chuchu Jiang, Jue Wang, Keqin Hua

Background: Machine learning (ML) has been increasingly applied to cervical cancer (CC) research. However, few studies have combined both clinical parameters and imaging data. At the same time, there remains an urgent need for more robust and accurate preoperative assessment of parametrial invasion and lymph node metastasis, as well as postoperative prognosis prediction.

Objective: The objective of this study is to develop an integrated ML model combining clinicopathological variables and magnetic resonance image features for (1) preoperative parametrial invasion and lymph node metastasis detection and (2) postoperative recurrence and survival prediction.

Methods: Retrospective data from 250 patients with CC (2014-2022; 2 tertiary hospitals) were analyzed. Variables were assessed for their predictive value regarding parametrial invasion, lymph node metastasis, survival, and recurrence using 7 ML models: K-nearest neighbor (KNN), support vector machine, decision tree, random forest (RF), balanced RF, weighted DT, and weighted KNN. Performance was assessed via 5-fold cross-validation using accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve (AUC). The optimal models were deployed in an artificial intelligence-assisted contouring and prognosis prediction system.

Results: Among 250 women, there were 11 deaths and 24 recurrences. (1) For preoperative evaluation, the integrated model using balanced RF achieved optimal performance (sensitivity 0.81, specificity 0.85) for parametrial invasion, while weighted KNN achieved the best performance for lymph node metastasis (sensitivity 0.98, AUC 0.72). (2) For postoperative prognosis, weighted KNN also demonstrated high accuracy for recurrence (accuracy 0.94, AUC 0.86) and mortality (accuracy 0.97, AUC 0.77), with relatively balanced sensitivity of 0.80 and 0.33, respectively. (3) An artificial intelligence-assisted contouring and prognosis prediction system was developed to support preoperative evaluation and postoperative prognosis prediction.

Conclusions: The integration of clinical data and magnetic resonance images provides enhanced diagnostic capability to preoperatively detect parametrial invasion and lymph node metastasis detection and prognostic capability to predict recurrence and mortality for CC, facilitating personalized, precise treatment strategies.

背景：机器学习（ML）在宫颈癌（CC）研究中的应用越来越广泛。然而，很少有研究将临床参数和影像学资料结合起来。同时，对于参数性侵及淋巴结转移的术前评估，以及术后预后的预测，仍迫切需要更稳健、准确的评估。目的：本研究的目的是建立一个结合临床病理变量和磁共振图像特征的综合ML模型，用于(1)术前参数浸润和淋巴结转移检测，(2)术后复发和生存预测。方法：回顾性分析2014-2022年2所三级医院250例CC患者的资料。使用7 ML模型评估变量对参数入侵、淋巴结转移、生存和复发的预测价值：k -最近邻（KNN）、支持向量机、决策树、随机森林（RF）、平衡RF、加权DT和加权KNN。通过准确性、敏感性、特异性、精密度、f1评分和受试者工作特征曲线（AUC）下面积的5倍交叉验证来评估疗效。将最优模型应用于人工智能辅助轮廓和预测系统中。结果：250例患者中，死亡11例，复发24例。(1)在术前评估中，采用平衡RF的综合模型对参数浸润的评估效果最佳（敏感性0.81，特异性0.85），而加权KNN对淋巴结转移的评估效果最佳（敏感性0.98,AUC 0.72）。(2)对于术后预后，加权KNN对复发率（准确率0.94,AUC 0.86）和死亡率（准确率0.97,AUC 0.77）也具有较高的准确性，相对平衡的敏感性分别为0.80和0.33。(3)开发人工智能辅助轮廓与预后预测系统，支持术前评估和术后预后预测。结论：临床资料与磁共振影像的结合提高了术前参数浸润检测和淋巴结转移检测的诊断能力，提高了预测CC复发和死亡率的预后能力，有助于制定个性化、精准的治疗策略。

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引用次数: 0

Reducing Hallucinations and Trade-Offs in Responses in Generative AI Chatbots for Cancer Information: Development and Evaluation Study. 生成式AI聊天机器人在癌症信息响应中的减少幻觉和权衡：开发和评估研究。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-11 DOI: 10.2196/70176

Sota Nishisako, Takahiro Higashi, Fumihiko Wakao

Background: Generative artificial intelligence (AI) is increasingly used to find information. Providing accurate information is essential to support patients with cancer and their families; however, information returned by generative AIs is sometimes wrong. Returning wrong information is called hallucination. Retrieval-augmented generation (RAG), which supplements large language model (LLM) outputs with relevant external sources, has the potential to reduce hallucinations. Although RAG has been proposed as a promising technique, its real-world performance in public health communication remains underexplored.Objective: This study aimed to examine cancer information returned by generative AIs with RAG using cancer-specific information sources and general internet searches to determine whether using RAG with reliable information sources reduces the hallucination rates of generative AI chatbots.Methods: We developed 6 types of chatbots by combining 3 patterns of reference information with 2 versions of LLMs. Thus, GPT-4 and GPT-3.5 chatbots that use cancer information service (CIS) information, Google information, and no reference information (conventional chatbots) were developed. A total of 62 cancer-related questions in Japanese were compiled from public sources. All responses were generated automatically and independently reviewed by 2 experienced clinicians. The reviewers assessed the presence of hallucinations, defined as medically harmful or misinformation. We compared hallucination rates across chatbot types and calculated odds ratios (OR) using generalized linear mixed-effects models. Subgroup analyses were also performed based on whether questions were covered by CIS content.Results: For the chatbots that used information from CIS, the hallucination rates were 0% for GPT-4 and 6% for GPT-3.5, whereas those for chatbots that used information from Google were 6% and 10% for GPT-4 and GPT-3.5, respectively. For questions on information that is not issued by CIS, the hallucination rates for Google-based chatbots were 19% for GPT-4 and 35% for GPT-3.5. The hallucination rates for conventional chatbots were approximately 40%. Using reference data from Google searches generated more hallucinations than using CIS data, with an OR of 9.4 (95% CI 1.2-17.5, P<.01); the OR for the conventional chatbot was 16.1 (95% CI 3.7-50.0, P<.001). While conventional chatbots always generated a response, the RAG-based chatbots sometimes declined to answer when information was lacking. The conventional chatbots responded to all questions, but the response rate decreased (36% to 81%) for RAG-based chatbots. For questions on information not covered by CIS, the CIS chatbots did not respond, while the Google chatbots generated responses in 52% of the cases for GPT-4 and 71% for GPT-3.5.Conclusions: Using RAG with reliable information sources significantly

背景：生成式人工智能（AI）越来越多地用于寻找信息。提供准确的信息对于支持癌症患者及其家属至关重要；然而，生成式人工智能返回的信息有时是错误的。返回错误的信息被称为幻觉。检索增强生成（RAG）用相关的外部来源补充大型语言模型（LLM）输出，具有减少幻觉的潜力。尽管RAG被认为是一种很有前途的技术，但其在公共卫生传播中的实际表现仍未得到充分探索。目的：本研究旨在通过癌症特异性信息源和一般互联网搜索来检查生成AI使用RAG返回的癌症信息，以确定使用具有可靠信息源的RAG是否会降低生成AI聊天机器人的幻觉率。方法：结合3种参考信息模式和2个版本的llm，开发出6种类型的聊天机器人。因此，开发了使用癌症信息服务（CIS）信息、谷歌信息和无参考信息（常规聊天机器人）的GPT-4和GPT-3.5聊天机器人。共有62个与癌症相关的日语问题从公共资源中汇编而成。所有应答均由2名经验丰富的临床医生自动生成并独立审查。审稿人评估了幻觉的存在，幻觉被定义为医学上有害的或错误的信息。我们比较了不同类型聊天机器人的幻觉率，并使用广义线性混合效应模型计算了比值比（OR）。还根据CIS内容是否涵盖问题进行了亚组分析。结果：对于使用CIS信息的聊天机器人，GPT-4和GPT-3.5的幻觉率分别为0%和6%，而使用GPT-4和GPT-3.5信息的聊天机器人的幻觉率分别为6%和10%。对于非CIS发布的信息的问题，基于google的聊天机器人的幻觉率在GPT-4和GPT-3.5中分别为19%和35%。传统聊天机器人的幻觉率约为40%。使用来自谷歌搜索的参考数据比使用CIS数据产生更多的幻觉，OR为9.4 （95% CI 1.2-17.5）。结论：使用具有可靠信息源的RAG显著降低了生成式AI聊天机器人的幻觉率，增加了承认信息缺失的能力，更适合于需要向用户提供准确信息的一般用途。

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引用次数: 0

Understanding and Addressing Challenges With Electronic Health Record Use in Gynecological Oncology: Cross-Sectional Survey of Multidisciplinary Professionals in the United Kingdom and Co-Design of an Integrated Informatics Platform to Support Clinical Decision-Making. 理解和解决妇科肿瘤电子健康记录使用的挑战：英国多学科专业人员的横断面调查和支持临床决策的综合信息平台的共同设计。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-10 DOI: 10.2196/58657

Laura Tookman, Rachael Lear, Yusuf S Abdullahi, Amit Samani, Phoebe Averill, Ashton Hunt, Dimitri Papadimitriou, Baleseng Elizabeth Nkolobe, Sadaf Ghaem-Maghami, Ben Glampson, Iain A McNeish, Erik K Mayer

Background: Electronic health records (EHRs) are a cornerstone of modern health care delivery, but their current configuration often fragments information across systems, impeding timely and effective clinical decision-making. In gynecological oncology, where care involves complex, multidisciplinary coordination, these limitations can significantly impact the quality and efficiency of patient management. Few studies have examined how EHR systems support clinical decision-making from the perspective of end users. This study aimed to explore multiprofessional experiences of EHR use in gynecological oncology and to develop a co-designed informatics platform to improve decision-making for ovarian cancer care.

Objective: This study aims to evaluate the perspectives of health care professionals on retrieving routine clinical data from EHRs in the management of ovarian cancer and to design an integrated informatics platform that supports clinical decision-making.

Methods: We conducted a national cross-sectional survey of 92 UK-based professionals working in gynecological oncology, including oncologists, nurses, radiologists, and other specialists in ovarian cancer. The web-based questionnaire, combining quantitative and free-text responses, assessed their experiences with EHR use, focusing on information retrieval, usability challenges, perceived risks, and benefits. In parallel, a human-centered design approach involving health care professionals, data engineers, and informatics experts codeveloped a digital informatics platform that integrates structured and unstructured data from multiple clinical systems into a unified patient summary view for clinical decision-making. Natural language processing was applied to extract genomic and surgical information from free-text records, with data pipelines validated by clinicians against original clinical system sources.

Results: Among 92 respondents, 84 out of 91 (92%) routinely accessed multiple EHR systems, with 26 out of 91 (29%) using 5 or more. Notably, 16 out of 92 respondents (17%) reported spending more than 50% of their clinical time searching for patient information. Key challenges included lack of interoperability (35/141 reported challenges, 24.8%), difficulty locating critical data such as genetic results (57/85 respondents, 67%), and poor organization of information. Only 10 out of 92 professionals (11%) strongly agreed that their systems provided well-organized data for clinical use. While ease of access to patient data was a key benefit, 54 out of 90 respondents (60%) reported lacking access to comprehensive patient summaries. To address these issues, our co-designed informatics platform consolidates disparate patients' data from different EHR systems into a single visual display to support clinical decision-making and audit.

Conclusions: Current EHR systems are suboptimal for support

背景：电子健康记录（EHRs）是现代医疗保健服务的基石，但其目前的配置往往是跨系统的信息碎片，阻碍了及时有效的临床决策。在妇科肿瘤学中，护理涉及复杂的多学科协调，这些限制会显著影响患者管理的质量和效率。很少有研究调查了电子病历系统如何从最终用户的角度支持临床决策。本研究旨在探讨多专业在妇科肿瘤中使用电子病历的经验，并开发一个共同设计的信息学平台，以改善卵巢癌护理的决策。目的：本研究旨在评估卫生保健专业人员在卵巢癌管理中从电子病历中检索常规临床数据的观点，并设计一个支持临床决策的综合信息平台。方法：我们对92名在英国工作的妇科肿瘤学专业人员进行了全国性的横断面调查，包括肿瘤学家、护士、放射科医生和其他卵巢癌专家。基于网络的问卷，结合定量和自由文本的回答，评估了他们使用电子病历的经验，重点关注信息检索、可用性挑战、感知风险和收益。同时，以人为中心的设计方法涉及医疗保健专业人员、数据工程师和信息学专家共同开发了一个数字信息学平台，该平台将来自多个临床系统的结构化和非结构化数据集成到一个统一的患者摘要视图中，用于临床决策。应用自然语言处理从自由文本记录中提取基因组和手术信息，临床医生根据原始临床系统来源验证数据管道。结果：在92名受访者中，91名中有84名（92%）经常访问多个电子病历系统，91名中有26名（29%）使用5个或更多。值得注意的是，92名受访者中有16名（17%）表示，他们将超过50%的临床时间用于搜索患者信息。主要挑战包括缺乏互操作性（35/141报告的挑战，24.8%），难以定位关键数据，如遗传结果（57/85受访者，67%），以及信息组织不良。在92名专业人员中，只有10人（11%）强烈同意他们的系统为临床使用提供了组织良好的数据。虽然易于获取患者数据是一个关键的好处，但90名受访者中有54人（60%）表示无法获得全面的患者摘要。为了解决这些问题，我们共同设计的信息平台将来自不同EHR系统的不同患者数据整合到一个单一的视觉显示中，以支持临床决策和审计。结论：目前的电子病历系统在支持复杂的妇科肿瘤治疗方面还不够理想。我们的发现强调了迫切需要集成的、以用户为中心的临床决策工具。碎片化和缺乏互操作性阻碍了信息检索，并可能危及患者护理。我们共同设计的卵巢癌信息学平台是一个潜在的现实世界解决方案，可以提高数据可见性、临床效率，并最终提高卵巢癌护理的质量。

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引用次数: 0

Exploring Women's Perceptions of Traditional Mammography and the Concept of AI-Driven Thermography to Improve the Breast Cancer Screening Journey: Mixed Methods Study. 探索女性对传统乳房x线摄影的认知和人工智能驱动的热成像概念，以改善乳腺癌筛查过程：混合方法研究。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-10 DOI: 10.2196/64954

Kristýna Sirka Kacafírková, Anneleen Poll, An Jacobs, Antonella Cardone, Juan-Jose Ventura

Background: Breast cancer is the most common cancer among women and a leading cause of mortality in Europe. Early detection through screening reduces mortality, yet participation in mammography-based programs remains suboptimal due to discomfort, radiation exposure, and accessibility issues. Thermography, particularly when driven by artificial intelligence (AI), is being explored as a noninvasive, radiation-free alternative. However, its acceptance, reliability, and impact on the screening experience remain underexplored.

Objective: This study aimed to explore women's perceptions of AI-enhanced thermography (ThermoBreast) as an alternative to mammography. It aims to identify barriers and motivators related to breast cancer screening and assess how ThermoBreast might improve the screening experience.

Methods: A mixed methods approach was adopted, combining an online survey with follow-up focus groups. The survey captured women's knowledge, attitudes, and experiences related to breast cancer screening and was used to recruit participants for qualitative exploration. After the focus groups, the survey was relaunched to include additional respondents. Quantitative data were analyzed using SPSS (IBM Corp), and qualitative data were analyzed in MAXQDA (VERBI software). Findings from both strands were synthesized to redesign the breast cancer screening journey.

Results: A total of 228 valid survey responses were analyzed. Of 228, 154 women (68%) had previously undergone mammography, while 74 (32%) had not. The most reported motivators were belief in prevention (69/154, 45%), invitations from screening programs (68/154, 44%), and doctor recommendations (45/154, 29%). Among nonscreeners, key barriers included no recommendation from a doctor (39/74, 53%), absence of symptoms (27/74, 36%), and perceived age ineligibility (17/74, 23%). Pain, long appointment waits, and fear of radiation were also mentioned. In total, 18 women (mean age 45.3 years, SD 13.6) participated in 6 focus groups. Participants emphasized the importance of respectful and empathetic interactions with medical staff, clear communication, and emotional comfort-factors they perceived as more influential than the screening technology itself. ThermoBreast was positively received for being contactless, radiation-free, and potentially more comfortable. Participants described it as "less traumatic," "easier," and "a game changer." However, concerns were raised regarding its novelty, lack of clinical validation, and data privacy. Some participants expressed the need for human oversight in AI-supported procedures and requested more information on how AI is used. Based on these insights, an updated screening journey was developed, highlighting improvements in preparation, appointment booking, privacy, and communication of results.

Conclusions: While AI-driven thermography shows promise as

背景：乳腺癌是欧洲妇女中最常见的癌症，也是导致死亡的主要原因。通过筛查的早期检测降低了死亡率，但由于不适、辐射暴露和可及性问题，参与基于乳房x光检查的项目仍然不是最佳选择。热成像技术，特别是在人工智能（AI）驱动下，正在被探索作为一种无创、无辐射的替代方法。然而，它的可接受性、可靠性和对筛查体验的影响仍未得到充分探讨。目的：本研究旨在探讨女性对人工智能增强热成像（ThermoBreast）作为乳房x光检查替代品的看法。它旨在确定与乳腺癌筛查相关的障碍和激励因素，并评估ThermoBreast如何改善筛查体验。方法：采用在线调查与随访焦点小组相结合的混合方法。该调查收集了女性对乳腺癌筛查的知识、态度和经验，并用于招募参与者进行定性探索。在焦点小组之后，调查重新开始，包括更多的受访者。定量资料采用SPSS （IBM Corp .）分析，定性资料采用MAXQDA （VERBI软件）分析。研究人员综合了两种方法的结果，重新设计了乳腺癌筛查过程。结果：共分析有效问卷228份。在228名妇女中，有154名（68%）以前接受过乳房x光检查，而74名（32%）没有。报告最多的动机是对预防的信念（69/154,45%），来自筛查项目的邀请（68/154,44%）和医生建议（45/154,29%）。在非筛查者中，主要障碍包括没有医生建议（39/74,53%）、没有症状（27/74,36%）和认为年龄不适合（17/74,23%）。疼痛、漫长的预约等待以及对辐射的恐惧也被提及。共有18名女性（平均年龄45.3岁，SD 13.6）参加了6个焦点小组。参与者强调了与医务人员相互尊重和感同身受的互动、清晰的沟通和情感安慰的重要性——他们认为这些因素比筛查技术本身更有影响力。热胸因无接触、无辐射、可能更舒适而受到好评。参与者将其描述为“创伤较小”、“更容易”和“改变游戏规则”。然而，人们对其新颖性、缺乏临床验证和数据隐私提出了担忧。一些与会者表示，人工智能支持的程序需要人工监督，并要求提供更多关于如何使用人工智能的信息。基于这些见解，开发了更新的筛选流程，突出了准备、预约、隐私和结果沟通方面的改进。结论：虽然人工智能驱动的热像仪有望成为一种无创、用户友好的乳房x光检查替代品，但其采用取决于信任、临床验证和卫生保健专业人员的有效沟通。它可能会扩大乳房x光检查服务不足的人群的筛查机会，例如年轻和行动不便的妇女，但并不能消除所有参与障碍。需要对乳房x线照相术和热像照相术进行长期研究和直接比较，以评估诊断准确性、患者经验及其对筛查参与和结果的影响。

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引用次数: 0

The Burden of Cancer and Precancerous Conditions Among Transgender Individuals in a Large Health Care Network: Retrospective Cohort Study. 大型医疗保健网络中跨性别者的癌症和癌前病变负担：回顾性队列研究

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-08 DOI: 10.2196/73843

Shuang Yang, Yongqiu Li, Christopher W Wheldon, Jessica Y Islam, Mattia Prosperi, Thomas J George, Elizabeth A Shenkman, Fei Wang, Jiang Bian, Yi Guo

Background: Disparities in cancer burden between transgender and cisgender individuals remain an underexplored area of research.Objective: This study aimed to examine the cumulative incidence and associated risk factors for cancer and precancerous conditions among transgender individuals compared with matched cisgender individuals.Methods: We conducted a retrospective cohort study using patient-level electronic health record (EHR) data from the University of Florida Health Integrated Data Repository between 2012 and 2023. Transgender individuals were identified using a validated, computable phenotype algorithm that used structured data and clinical notes. They matched 1:10:10 by age and calendar year of index date with cisgender women and cisgender men. The index date was the first transgender-related record for transgender individuals and a matched diagnosis date for cisgender controls. Primary outcomes included new-onset cancers associated with human papillomavirus, human immunodeficiency virus, tobacco, alcohol, lung, breast, and colorectal sites. Secondary outcomes were precancerous conditions related to the same cancer types. We calculated cumulative incidence rates and conducted time-to-event analyses using the Fine-Gray method, treating all-cause death as a competing risk, to assess associations between gender identity and the presence of cancer or precancer, adjusting for demographic and clinical covariates. Interaction analyses evaluated if associations between cancer risk factors and precancer differed by gender identity.Results: We identified 2745 transgender individuals (mean age at index date 25.1, SD 14.0 years) and matched them with 27,450 cisgender women and 27,450 cisgender men from the same health care system. The cumulative incidence of cancer did not differ significantly between transgender and cisgender cohorts (transgender n=28, 1.0% vs cisgender women, n=358, 1.3%; P=.13 and cisgender men, n=314, 1.1%; P=.64). However, transgender individuals exhibited significantly higher risks for precancerous conditions compared to cisgender women (subdistribution hazard ratios [sHRs] 1.1, 95% CI 1.0-1.3) and cisgender men (sHR 1.3; 95% CI 1.2-1.5). Specifically, transgender individuals were more likely to develop colorectal precancer (sHR 1.2; 95% CI 1.1-1.4) compared to cisgender women, as well as human papillomavirus-related precancer (sHR 1.8; 95% CI 1.4-2.3) and colorectal precancer (sHR 1.4; 95% CI 1.2-1.6) compared to cisgender men. Subgroup analyses showed similar patterns in both female-to-male and male-to-female individuals compared with their matched cisgender counterparts. Interaction analyses revealed stronger protective effects of private insurance or Medicare against precancers in transgender individuals than in cisgender peers, while being non-Hispanic Black or having substantial comorbidities were stronger risk factors among trans

背景：变性人和顺性人之间癌症负担的差异仍然是一个未被充分探索的研究领域。目的：本研究旨在研究跨性别个体与匹配的顺性别个体相比，癌症和癌前病变的累积发病率及相关危险因素。方法：我们利用2012年至2023年佛罗里达大学健康综合数据库的患者级电子健康记录（EHR）数据进行了一项回顾性队列研究。变性人是通过使用结构化数据和临床记录的有效的、可计算的表现型算法来识别的。他们将顺性女性和顺性男性按年龄和日历年进行1:10:10的匹配。索引日期是跨性别个体的第一个与跨性别相关的记录，也是与顺性别对照相匹配的诊断日期。主要结局包括与人类乳头瘤病毒、人类免疫缺陷病毒、烟草、酒精、肺、乳腺和结直肠部位相关的新发癌症。次要结果是与相同癌症类型相关的癌前状况。我们计算了累积发病率，并使用Fine-Gray方法进行了时间-事件分析，将全因死亡视为竞争风险，评估性别认同与癌症或癌前病变存在之间的关系，调整了人口统计学和临床协变量。相互作用分析评估癌症风险因素和癌前病变之间的关联是否因性别认同而异。结果：我们确定了2745名变性人（索引日期平均年龄25.1岁，标准差14.0岁），并将他们与来自同一医疗保健系统的27,450名顺性女性和27,450名顺性男性相匹配。变性人和顺性人群的累积癌症发病率无显著差异（变性人n=28, 1.0% vs顺性女性n=358, 1.3%； P= 0.13；顺性男性n=314, 1.1%； P= 0.64）。然而，与顺性女性（亚分布风险比[sHR] 1.1, 95% CI 1.0-1.3）和顺性男性（sHR 1.3, 95% CI 1.2-1.5）相比，变性人患癌前病变的风险明显更高。具体而言，与顺性女性相比，跨性别者更容易发生结直肠癌前病变（sHR 1.2; 95% CI 1.1-1.4），与顺性男性相比，人乳头瘤病毒相关的癌前病变（sHR 1.8; 95% CI 1.4-2.3）和结直肠癌前病变（sHR 1.4; 95% CI 1.2-1.6）。亚组分析显示，女性对男性和男性对女性个体的模式与匹配的顺性别个体相似。相互作用分析显示，与顺性同龄人相比，私人保险或医疗保险对变性人的癌前病变的保护作用更强，而非西班牙裔黑人或有大量合并症是变性人更强的危险因素。结论：与顺性人群相比，跨性别人群的癌症发病率相似，但癌前病变发生率明显高于顺性人群，这可能提示诊断不足或发现延迟。这些发现突出表明，需要制定量身定制的预防保健策略，包括有针对性的筛查和降低风险的干预措施，以解决跨性别人群中的癌症差异。

{"title":"The Burden of Cancer and Precancerous Conditions Among Transgender Individuals in a Large Health Care Network: Retrospective Cohort Study.","authors":"Shuang Yang, Yongqiu Li, Christopher W Wheldon, Jessica Y Islam, Mattia Prosperi, Thomas J George, Elizabeth A Shenkman, Fei Wang, Jiang Bian, Yi Guo","doi":"10.2196/73843","DOIUrl":"10.2196/73843","url":null,"abstract":"Background: Disparities in cancer burden between transgender and cisgender individuals remain an underexplored area of research.Objective: This study aimed to examine the cumulative incidence and associated risk factors for cancer and precancerous conditions among transgender individuals compared with matched cisgender individuals.Methods: We conducted a retrospective cohort study using patient-level electronic health record (EHR) data from the University of Florida Health Integrated Data Repository between 2012 and 2023. Transgender individuals were identified using a validated, computable phenotype algorithm that used structured data and clinical notes. They matched 1:10:10 by age and calendar year of index date with cisgender women and cisgender men. The index date was the first transgender-related record for transgender individuals and a matched diagnosis date for cisgender controls. Primary outcomes included new-onset cancers associated with human papillomavirus, human immunodeficiency virus, tobacco, alcohol, lung, breast, and colorectal sites. Secondary outcomes were precancerous conditions related to the same cancer types. We calculated cumulative incidence rates and conducted time-to-event analyses using the Fine-Gray method, treating all-cause death as a competing risk, to assess associations between gender identity and the presence of cancer or precancer, adjusting for demographic and clinical covariates. Interaction analyses evaluated if associations between cancer risk factors and precancer differed by gender identity.Results: We identified 2745 transgender individuals (mean age at index date 25.1, SD 14.0 years) and matched them with 27,450 cisgender women and 27,450 cisgender men from the same health care system. The cumulative incidence of cancer did not differ significantly between transgender and cisgender cohorts (transgender n=28, 1.0% vs cisgender women, n=358, 1.3%; P=.13 and cisgender men, n=314, 1.1%; P=.64). However, transgender individuals exhibited significantly higher risks for precancerous conditions compared to cisgender women (subdistribution hazard ratios [sHRs] 1.1, 95% CI 1.0-1.3) and cisgender men (sHR 1.3; 95% CI 1.2-1.5). Specifically, transgender individuals were more likely to develop colorectal precancer (sHR 1.2; 95% CI 1.1-1.4) compared to cisgender women, as well as human papillomavirus-related precancer (sHR 1.8; 95% CI 1.4-2.3) and colorectal precancer (sHR 1.4; 95% CI 1.2-1.6) compared to cisgender men. Subgroup analyses showed similar patterns in both female-to-male and male-to-female individuals compared with their matched cisgender counterparts. Interaction analyses revealed stronger protective effects of private insurance or Medicare against precancers in transgender individuals than in cisgender peers, while being non-Hispanic Black or having substantial comorbidities were stronger risk factors among trans","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e73843"},"PeriodicalIF":2.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Retraction: "Designing Positive Psychology Interventions for Social Media: Cross-Sectional Web-Based Experiment With Young Adults With Cancer". 撤回：“为社交媒体设计积极心理学干预：针对年轻癌症患者的横断面网络实验”。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-05 DOI: 10.2196/82724

引用次数: 0

Burden and Future Trends of Gastric Cancer in 5 East Asian Countries From 1990 to 2036: Epidemiological Study Analysis Using the Global Burden of Diseases Study 2021. 1990年至2036年东亚5国胃癌负担和未来趋势：使用2021年全球疾病负担研究的流行病学研究分析

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-09-03 DOI: 10.2196/74389

Tianhao Guo, Tingting Zhou, Wenjie Zhu, Yumo Yuan, Yifan Hui, Wenjian Zhu, Weixing Shen, Liu Li, Wei Wei, Haibo Cheng, Xiaoyu Wu

Background: Effective prevention and treatment are urgently needed, since gastric cancer (GC) poses a grave threat to the health and well-being of patients. The 5 East Asian countries (China, Japan, North Korea, South Korea, and Mongolia) represent one of the most significant regions globally in terms of GC burden.

Objective: The goal of this study is to examine the patterns and trends of GC across 5 East Asian countries between 1990 and 2021.

Methods: We retrieved data from the Global Burden of Disease Study (GBD) 2021 regarding the prevalence, incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) associated with GC in 5 East Asian countries from 1990 to 2021. We further assessed the burden of GC according to age and sex. We used decomposition analysis to examine the changes in the number of new cases, patients, and deaths related to GC. We also used Joinpoint (Joinpoint Regression Program, Version 5.1.0) and age-period-cohort analysis methods to interpret the epidemiological characteristics of GC. Autoregressive integrated moving average model (ARIMA) and Bayesian age-period-cohort (BAPC) prediction models were used to forecast the GC burden by 2036.

Results: Among the 5 East Asian countries, China recorded the highest incidence, prevalence, death, YLLs, YLDs, and DALYs in both 1990 and 2021. From 1990 to 2021, the age-standardized rates for prevalence, mortality, incidence, YLDs, YLLs, and DALYs across the 5 East Asian countries showed an overall decline, though they remained higher than the global average. In all 5 East Asian countries, individuals aged 65 years and older consistently exhibited the highest rates for prevalence, incidence, mortality, YLDs, YLLs, and DALYs. The prevalence rate in South Korea, the incidence rate in North Korea and Mongolia, and the mortality rate in China are influenced by aging, surpassing the global aging average.

Conclusions: The disease burden of GC in the 5 East Asian countries has consistently ranked high over the past 3 decades, particularly among the older individuals. The burden of GC in the 5 East Asian countries is expected to present a major public health challenge, primarily driven by the large population size and the aging demographic.

背景：胃癌对患者的健康和福祉构成严重威胁，迫切需要有效的预防和治疗。东亚5个国家（中国、日本、朝鲜、韩国和蒙古）是全球GC负担最重的地区之一。目的：本研究的目的是研究1990年至2021年间东亚5个国家的GC模式和趋势。方法：我们从全球疾病负担研究（GBD） 2021中检索数据，包括1990年至2021年5个东亚国家与GC相关的患病率、发病率、死亡率、残疾生存年数（YLDs）、生命损失年数（YLLs）和残疾调整生命年（DALYs）。我们进一步根据年龄和性别评估GC负担。我们使用分解分析来检查与GC相关的新病例、患者和死亡人数的变化。我们还使用Joinpoint （Joinpoint Regression Program, Version 5.1.0）和年龄-时期-队列分析方法来解释GC的流行病学特征。采用自回归综合移动平均模型（ARIMA）和贝叶斯年龄-时期-队列（BAPC）预测模型预测到2036年的GC负担。结果：在东亚5个国家中，中国在1990年和2021年的发病率、患病率、死亡率、YLLs、YLDs和DALYs均为最高。从1990年到2021年，东亚五国的流行率、死亡率、发病率、生命周期、生命周期和生命周期的年龄标准化率总体下降，但仍高于全球平均水平。在所有5个东亚国家中，65岁及以上的个体在患病率、发病率、死亡率、生命周期、生命周期和生命周期方面始终表现出最高的比率。韩国的患病率、朝鲜和蒙古的发病率、中国的死亡率均受到老龄化的影响，超过全球老龄化平均水平。结论：在过去的30年里，东亚5国的胃癌疾病负担一直很高，特别是在老年人中。预计东亚5国的胃癌负担将构成一项重大的公共卫生挑战，主要原因是人口规模庞大和人口老龄化。

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引用次数: 0

Serum Alpha-Fetoprotein-Tumor Size Ratio as a Prognostic Marker After Hepatic Resection for Primary Hepatocellular Carcinoma: Propensity Score Matched Retrospective Cohort Study. 血清甲胎蛋白-肿瘤大小比作为原发性肝癌肝切除术后的预后指标：倾向评分匹配的回顾性队列研究。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-08-26 DOI: 10.2196/64929

Shutian Mo, Yongfei He, Tianyi Liang, Guangzhi Zhu, Hao Su, Chuangye Han, Tao Peng

Background: Patients with hepatocellular carcinoma (HCC) exhibit a high rate of recurrence and poor prognosis after surgery, and effective prognostic indicators and stratification strategies are currently lacking. Hence, this study proposes new prognostic markers to provide a theoretical basis for patients with HCC.

Objective: We aim to build and evaluate a model estimating the effect of alpha-fetoprotein-tumor size ratio (ATR) on the prognosis of patients undergoing hepatectomy for HCC.

Methods: We retrospectively reviewed hospital records to identify patients who underwent hepatectomy for HCC at the First Affiliated Hospital of Guangxi Medical University from January 2013 to December 2018. Outcomes (recurrence events and mortality) not available in the outpatient medical records were determined through telephone interviews until February 2022. The optimal cutoff value was determined using X-tile (Yale School of Medicine). Independent risk factors for prognosis were investigated by Cox regression modeling, and between-group differences were reduced through propensity score matching. A predictive model for HCC prognosis was constructed using a nomogram, and the predictive performance of the model was evaluated using the C-index.

Results: Of the 1628 eligible patients, 1204 patients were included in the analysis. Patients were stratified into low, medium, and high ATR groups with X-tile. Before propensity score matching, ATR was identified as an independent risk factor for overall survival (low vs medium: HR 1.41, 95% CI 1.03-1.94; P=.03; medium versus high: HR 1.59, 95% CI 1.02-2.47; P=.04) and relapse-free survival (low vs medium: HR 1.33, 95% CI 1.03-1.70; P=.03; medium versus high: HR 2.10, 95% CI 1.40-3.15; P<.001) of patients with HCC following hepatectomy. A nomogram incorporating ATR, China Clinic Liver Cancer staging, bleeding, and postoperative transcatheter arterial chemoembolization was developed to predict moderate predictive efficacy for overall survival (C-index: 0.73) and relapse-free survival (C-index: 0.73). ATR was found to be associated with microvascular, macroinvasion, and poor tumor differentiation.

Conclusions: ATR is an independent prognostic risk factor in patients with HCC after hepatectomy and is associated with microvascular, macroinvasion, and poor tumor differentiation.

背景：肝细胞癌（HCC）患者术后复发率高、预后差，目前缺乏有效的预后指标和分层策略。因此，本研究提出新的预后标志物，为HCC患者提供理论依据。目的：建立并评价甲胎蛋白-肿瘤大小比（ATR）对肝癌切除术患者预后影响的模型。方法：回顾性分析2013年1月至2018年12月在广西医科大学第一附属医院因肝癌行肝切除术的患者。门诊医疗记录中没有的结果（复发事件和死亡率）通过电话访谈确定，直到2022年2月。采用X-tile（耶鲁大学医学院）确定最佳截止值。采用Cox回归模型研究影响预后的独立危险因素，通过倾向评分匹配缩小组间差异。采用nomogram构建HCC预后预测模型，并采用C-index评价模型的预测性能。结果：在1628例符合条件的患者中，有1204例患者被纳入分析。患者按x位分为低、中、高ATR组。在倾向评分匹配之前，ATR被确定为总生存率（低对中：HR 1.41, 95% CI 1.03-1.94， P= 0.03；中对高：HR 1.59, 95% CI 1.02-2.47， P= 0.04）和无复发生存率(低对中：HR 1.33, 95% CI 1.03-1.70， P= 0.03；中对高：HR 2.10, 95% CI 1.40-3.15；结论：ATR是肝切除术后HCC患者的独立预后危险因素，与微血管、大浸润和肿瘤分化不良有关。

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引用次数: 0

Care Coordination and Patient Satisfaction With Ambulatory Cancer Care During the COVID-19 Pandemic in Manitoba, Canada: Report of An Online Survey Study of Patient-Reported Experience Measures With Interpretation Guided by Fit Theory. 加拿大马尼托巴省COVID-19大流行期间的护理协调和患者对门诊癌症护理的满意度：一项基于契合理论解释的患者报告体验措施的在线调查研究报告。

IF 2.7 Q2 ONCOLOGY

JMIR Cancer

Pub Date : 2025-08-25 DOI: 10.2196/58999

Maclean Thiessen, Andrea Soriano, Jason Park, Kathleen Decker

Background: In Manitoba, Canada, the impact of the COVID-19 pandemic on cancer care delivery included, but was not limited to, disruption of many routine health care services, and the rapid introduction of both social distancing and virtual care. Little was known about how COVID-19-related changes to cancer care delivery would impact patient satisfaction with care and care coordination.

Objective: This report aims to present and interpret findings of an online survey of people with oncology-related conditions in Manitoba, Canada, during the COVID-19 pandemic, exploring patient satisfaction and care coordination.

Methods: A link to an online survey was made available to patients receiving cancer treatment in Manitoba, Canada, between July 31, 2020, and February 28, 2022. The survey included validated patient-reported experience measures (PREMs) for patient satisfaction and care coordination. Analysis included the generation of descriptive statistics and logistic regression, including univariate and multivariate analysis using stepwise model building. The survey results were interpreted using fit theory as a theoretical lens.

Results: A total of 203 responses were collected, of which 154 had completed responses for all PREM measures and were included in the analysis. Response rate is estimated at 3.3%-2.0%. The average age was 65 (SD 11.7) years. Most respondents were male (n=79, 52.7%). Most respondents were being treated with curative intent (n=81, 53.6%). The most common type of cancer was breast (n=41, 26.6%). Univariate analysis demonstrated that ages 60-69 years were associated with above average patient satisfaction (OR 2.205, 95% CI 1.045-4.624; P=.04). Age <60 years (OR 0.437, 95% CI 0.204-0.934; P=.03) and European Cooperative Group functional status (ECOG) ≥2 (OR 0.327, 95% CI 0.137-0.782; P=.01) were associated with below average patient satisfaction. Age <60 years, ECOG ≥2, and hematological cancer were selected through stepwise multivariate model building, resulting in an explanatory model (R2=0.129) of patient satisfaction. ECOG ≥2 was associated with below-average care coordination (OR 0.357, 95% CI 0.145-0.880; P=.03), and was the only identified predictor of care coordination, with no explanatory multivariate model generated. Fit theory supports that the level of patient satisfaction and care coordination in each population subset inversely reflects a relative level of unmet supportive care need.

Conclusions: Survey respondents with poor functional status, those outside the 60-69 years age range, and those with nonhematological malignancies likely experience increased unmet supportive care needs compared with their counterparts. Further research is needed to determine whether these findings reflect transient phenomena related to the COVID-19 pandemic, selection biases associated with the survey method used, or underlying

背景：在加拿大马尼托巴省，2019冠状病毒病大流行对癌症医疗服务的影响包括但不限于许多常规医疗服务中断，以及迅速引入社交距离和虚拟医疗。关于与covid -19相关的癌症护理服务变化将如何影响患者对护理和护理协调的满意度，人们知之甚少。目的：本报告旨在介绍和解释2019冠状病毒病大流行期间加拿大马尼托巴省肿瘤相关疾病患者在线调查的结果，探讨患者满意度和护理协调。方法：在2020年7月31日至2022年2月28日期间，向加拿大马尼托巴省接受癌症治疗的患者提供了在线调查的链接。该调查包括经过验证的患者报告体验措施（PREMs），用于患者满意度和护理协调。分析包括生成描述性统计和逻辑回归，包括单变量和多变量分析，使用逐步模型构建。调查结果用拟合理论作为理论透镜来解释。结果：共收集到203份问卷，其中154份完成了所有PREM措施的回答，并被纳入分析。应答率估计为3.3%-2.0%。平均年龄65岁（SD 11.7）。调查对象以男性居多（n=79, 52.7%）。大多数应答者以治愈为目的接受治疗（n=81, 53.6%）。最常见的癌症类型是乳腺癌（n=41, 26.6%）。单因素分析显示，60-69岁的患者满意度高于平均水平（OR 2.205, 95% CI 1.045-4.624； P= 0.04）。年龄结论：功能状态差的调查对象，年龄在60-69岁之外的人，以及那些患有非血液系统恶性肿瘤的人，与他们的同行相比，可能经历更多未满足的支持性护理需求。需要进一步的研究来确定这些发现是否反映了与COVID-19大流行相关的短暂现象，与所使用的调查方法相关的选择偏差，或潜在的卫生保健提供不公平。

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