Cancer Control最新文献

IntroductionTherapeutic intervention with chemopreventive agents (CPA) represents a promising avenue for cancer prevention; however, additional data on patient adherence are needed. We developed the Colorectal Cancer Chemoprevention Acceleration Platform (CRC-CHAMP) and examined the feasibility of real-world CPA intervention in persons with an increased risk for CRC. Herein, we describe the recruitment, uptake, and adherence within this pilot study.MethodsFor this single-arm prospective pilot study (NCT05402124), we recruited individuals from the Forzani and MacPhail Colon Cancer Screening Centre (CCSC) in Calgary, Alberta, Canada. Eligible individuals were between the ages of 50-59 and had a history of high-risk adenomatous polyps diagnosed at the CCSC in the preceding 12 months. After consenting, each participant was provided open-label acetylsalicylic acid (ASA) at 81 mg every day for 90 days. Participants were contacted by telephone every 30 days to collect current adherence (primary outcome) and occurrence of any adverse events (secondary outcome).ResultsThroughout recruitment, 823 potential participants were identified, with 69 (53.1%) being eligible and 67 (51.5%) finally enrolling in the study. The median age of the participants was 56 yr. At the follow-ups, 60 participants (89.6%) were adherent at 30 days, 54 participants (80.6%) were adherent at 60 days, and 55 (82.1%) participants were adherent at 90 days. A total of 9 (13.4%) participants experienced minor adverse events likely unrelated to the ASA.ConclusionParticipants recruited to this pilot study had a high level of adherence throughout the 90-day period with minimal side effects. Challenges to recruitment included low response rate by mail and a high number of those contacted already taking non-steroidal anti-inflammatory drugs. This study suggests that individuals post-polypectomy of large polyp may be interested in CRC chemoprevention. Additionally, this study provides a framework for future evaluation of additional therapeutic interventions.

IntroductionProstate cancer is frequently diagnosed at ages when men may also have comorbidity. Access to care may influence both comorbidity management and cancer treatment and recovery. We examined the association between comorbidity and postoperative outcomes among men with prostate cancer in the universal access Military Health System (MHS).MethodsWe identified a cohort of men diagnosed with non-metastatic prostate adenocarcinoma from 2001-2014 who received radical prostatectomy (RP) within 1 year of diagnosis in the MilCanEpi database, which links the Department of War Cancer Registry and MHS Data Repository. We used ICD-9 diagnosis codes to capture 90-day postoperative general and genitourinary (GU) complications and hospital readmissions; and 18-month postoperative GU complications. Poisson regression estimated the adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for the outcomes associated with comorbidity (0, 1-2, or ≥3) measured using the Elixhauser Index.ResultsThe study included 5645 men with non-metastatic prostate cancer (mean age 57.9 ± 7.7 years) who received RP; 39.9% of patients had no comorbidity, 43.9% had 1-2 conditions, and 16.2% had ≥3 conditions. Patients with ≥3 comorbidities had statistically significant higher risks of 90-day general (ARR = 1.88, 95% CI = 1.34, 2.64) and GU (ARR = 1.20, 95% CI = 1.06, 1.36) complications and hospital readmission (ARR = 1.59, 95% CI = 1.12, 2.26) relative to men with no comorbidity. At 18-month post-RP, men with 1-2 comorbidities (ARR = 1.19, 95% CI = 1.05, 1.35) and ≥3 comorbidities (ARR = 1.32, 95% CI = 1.13, 1.55) had statistically significant higher risk of measured GU complications relative to men with no comorbidity.ConclusionsIn the MHS, higher comorbidity was associated with an increased risk of 30-day and 18-month complications and 90-day readmissions following RP for prostate cancer. This study identifies a need for risk management strategies to reduce complication rates among men with higher comorbidity levels diagnosed with prostate cancer and treated by RP.

IntroductionThe somatostatin receptor (SSTR) standardized uptake value (SUVmax_sstr) obtained by [⁶⁸Ga]Ga-edotreotide positron emission tomography-computed tomography ([⁶⁸Ga]Ga-SSTR PET/CT) helps recognize patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) who are at a high risk for adverse outcomes. This observational cohort study was conducted to verify whether the SSTR representative tumor volume (RTV_sstr) can provide incremental prognostic information over conventional PET/CT parameters in patients with metastatic disease.MethodsWe retrospectively evaluated patients (48% female) with metastatic GEP-NETs who underwent [⁶⁸Ga]Ga-SSTR PET/CT between January 2022 and November 2023. The mean SUVmax_sstr, mean RTV_sstr (cm³; 42% threshold), and total RTV_sstr were recorded. Thereafter, patients were followed up for 22.9 (range: 8-42) months. The PET/CT results were compared to the progression free survival (PFS).ResultsSixty patients (59 ± 5 years) were enrolled. Only the mean and total RTV_sstr values were predictive in the multivariate analysis. Kaplan-Meier survival analysis for both the mean and total RTV_sstr demonstrated a significantly better PFS in patients presenting with lower than greater values (P = 0.001 and P = 0.007, respectively; log-rank test). SUVmax_sstr was not appropriate for predicting PFS.ConclusionThe mean or total RTV_sstr represents a valuable volumetric parameter able to predict outcomes in patients with GEP-NETs that are metastatic at onset. The degree of the SSTR representative tumor burden, rather than the maximal SSTR representation at single voxel, has a predominant value for influencing the response to therapy in this cohort.

IntroductionSurgery is an essential component of breast cancer treatment. Surgical complications may impact receipt of adjuvant therapy and long-term outcomes. Differences in insurance coverage and access to care by patient age in the general U.S. population may affect breast cancer diagnosis and surgery and thus age comparisons in research. We compared postoperative outcomes following breast cancer surgery between age groups in the U.S. Military Health System, which provides beneficiaries access to comprehensive care across the lifespan.MethodsWe identified women aged ≥18 years with stage I-III breast cancer diagnosed from 2001 to 2014 undergoing surgery without reconstruction in the MilCanEpi database. Multivariable Poisson regression estimated the adjusted risk ratios (ARRs) with 95% confidence intervals (CIs) in association with age at diagnosis (18-39, 40-49, 50-64, and ≥65) for 30-day general and breast complications (surgical site infection, seroma, hematoma, or lymphedema), reoperation, and hospital readmission while controlling for potential confounders.ResultsThe study included 7835 women who were 18-39 (9.2%), 40-49 (23.6%), 50-64 (42.7%), and ≥65 (24.5%). The overall risk of general or breast complications did not differ significantly by age when controlled for demographic, tumor, and treatment variables. However, women aged 40-49 had a statistically increased adjusted risk of seroma (ARR = 1.50; 95% CI = 1.03-2.18) compared to women aged 50-64. No significant age-related differences were observed for reoperation or hospital readmission after adjustment.ConclusionIn the Military Health System, the overall risk of 30-day postoperative complications and hospital readmissions were not statistically different by age after adjustment for clinical and demographic factors. The findings support that surgical decision-making continue to prioritize tumor characteristics, comorbidity burden, and other clinical factors rather than age alone when assessing perioperative risk.

Background: While much of cancer research has historically centered on innovations within clinical or laboratory settings, most of the factors shaping equity in cancer outcomes reside outside hospital walls-in neighborhoods, workplaces, and community networks. This reality underscores the need for community-involved and community-living interventions: programs co-designed and delivered within communities to meet people where they live, work, and socialize. Such interventions hold the greatest promise for sustainability because they are embedded in the daily lives, cultures, and resources of the populations they serve. Methods: This special collection brings together research that illuminates the power of community-centered and community co-led strategies for prevention, early detection, treatment, and survivorship across diverse settings. Results: The articles in this series illustrate how innovation, cultural humility, and local engagement can bridge persistent gaps in cancer care. Conclusion: Together, they highlight how communities themselves are essential partners in dismantling disparities and achieving lasting cancer control.

IntroductionAdolescents and Young Adults (AYAs) affected by cancer are at risk of experiencing late and long-term effects following cancer diagnosis and treatment. While structured interventions have demonstrated potential benefits for well-being during the intervention itself, little is known about how AYAs affected by cancer engage with and experience nature in their everyday lives beyond the formal program context. The aim of this study was to explore how a selected group of AYAs affected by cancer-who had participated in a nature-based intervention (the WAYA program)-experience nature and its role in supporting and managing late and long-term effects of cancer and its treatment, beyond the context of the program itself.MethodThis qualitative study explored the experiences of nature following the WAYA intervention among AYAs affected by cancer. Data were collected by focus group interviews at a three-month follow-up, using participant-selected photographs as visual prompts to elicit reflection on how nature supports management of late and long-term effects of cancer. A photovoice-inspired approach guided discussion questions and facilitated individual and collective meaning-making. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis.ResultsThe analysis of this study showed one theme: Reconnecting with self and meaning through nature's unconditional presence-beyond human connection. The theme comprises the two categories Nature as a resource for inner balance and Nature as a meaningful companion, and five sub-categories: Managing by being mindful, Managing by experiencing rest and being calm, Experiencing metaphoric recognition, Sparking comfort, hope and positive emotions, and Nature as a space without obligations.ConclusionThis study explored how AYAs affected by cancer engage with nature beyond formal programs, revealing its potential in better management of late and long-term effects. These findings can inform low-threshold, personal meaningful, and sustainable approaches to clinical practice, well-being, and rehabilitation for this vulnerable group.

IntroductionCervical cancer screening literacy among rural women living with HIV (WLHIV), the ability to access, understand, appraise, and apply cervical cancer screening information to use cervical cancer screening services, is affected by individual factors including low educational attainment, low socioeconomic status, poor cervical cancer risk perception, fear, misconceptions, and beliefs, as well as interpersonal, community, and health facility barriers. However, rural public health facilities have limited resources that limit their ability mitigate these challenges. This research identified barriers and facilitators of healthcare providers' responsiveness to cervical cancer screening literacy needs of rural WLHIV in Eastern Uganda.MethodsThis was a descriptive qualitative study that involved conducting 15 Key Informant Interviews with all individuals involved in planning, communicating, and providing cervical cancer screening services at 4 purposively selected rural public health facilities in Eastern Uganda. Data were collected using a guide developed based on the organizational Health Literacy responsiveness framework. This framework was used to derive deductive categories (domains and sub-domains) during thematic analysis, and barriers and facilitators were inductively identified from the interviews.ResultsBarriers included non-involvement of health workers and affected women in planning, limited funding, few trained health workers, long waiting times, limited space, limited communication modalities, inadequate Information Education and Communication (IEC) materials, IEC materials not translated to the local language, challenges with addressing misconceptions, and language barriers. Facilitators included support from implementing partners, free cervical cancer screening services, integration of cervical cancer screening into HIV care, consumer-centered care, clear pathways and navigation support, using peers during health education, availability of IEC materials, using simple, local language during education sessions, and health worker facilitation.ConclusionStrategies targeted at the identified factors can improve health care providers' responsiveness to the cervical cancer screening literacy needs of rural WLHIV in Eastern Uganda.

IntroductionInetetamab has demonstrated favorable efficacy and safety in treating HER2-positive metastatic breast cancer (MBC).MethodsThe multicenter retrospective study enrolled 140 patients with HER2-positive MBC who received inetetamab-based regimens between November 2020 and April 2023. Primary endpoint was progression-free survival (PFS); secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety.ResultsThe median patient age was 53 (range: 27-90) years, with inetetamab-based regimens administered as first-, second-, or third-line (or later) therapy in 13 (9.3%), 29 (20.7%), and 98 (70.0%) patients, respectively. Median PFS was 6.1 months in the overall population, with an ORR of 35.0% and a DCR of 77.1%. Patients receiving inetetamab as first- or second-line therapy had significantly longer median PFS (14.5 months; 95% CI, 9.5-19.5) than those receiving it as third-line or later therapy (4.8 months; 95% CI, 4.2-5.3; P < 0.0001). First-line treatment resulted in a median PFS of 22.2 months. Patients previously treated with trastuzumab without HER2-TKIs had longer median PFS than those with prior TKI exposure (12.8 vs 5.7 months; P = 0.001). Multivariate analysis confirmed that treatment line (1-2 vs ≥3) was independently associated with PFS (hazard ratio = 0.330; 95% CI: 0.211-0.517). The most common grade 3 or 4 adverse events included leukopenia (16.4%) and neutropenia (12.9%). No treatment-related deaths were reported.ConclusionInetetamab-based regimens have shown promising efficacy and are well-tolerated for patients with HER2-positive MBC. These anti-HER2 regimens could be considered an alternative treatment option for this disease.

IntroductionBrain metastases (BM) represent a common and fatal progression in small cell lung cancer (SCLC), yet prognostic tools for this population remain underdeveloped. This study aimed to establish and externally validate a machine learning-based model to predict overall survival (OS) in SCLC patients with BM.MethodsWe extracted clinical data from 2392 SCLC patients with BM from the SEER database to construct prognostic models using Cox regression, AJCC staging, and four machine learning algorithms: Random Survival Forest (RSF), Extreme Gradient Boosting (XGB), Elastic Net (Enet), and Artificial Neural Network (ANN). Key features were selected via Lasso-Cox regression. Model performance was evaluated using time-dependent AUC, calibration curves, Brier scores, precision-recall (PR) curves, and decision curve analysis (DCA). SHAP and partial dependence plots were applied for model interpretability. External validation was conducted using an independent hospital-based cohort of 85 patients, with comparability to the SEER cohort addressed through inverse probability of treatment weighting (IPTW).ResultsAmong all models, the RSF algorithm demonstrated the best overall performance. In the training cohort, it achieved AUCs of 0.738 and 0.809 for 1-year and 2-year OS, respectively. In the internal validation cohort, AUCs were 0.718 and 0.748, and in the external validation cohort, 0.686 and 0.802, respectively. The RSF model also showed favorable calibration and the lowest Brier scores across datasets. SHAP analysis ranked chemotherapy, liver metastasis, N stage, and age as the most influential prognostic features. A web-based calculator was developed to enable real-time individualized risk prediction.ConclusionsThis study presents a robust, interpretable, and externally validated RSF-based model for predicting OS in SCLC patients with BM. The model offers clinically relevant insights and is accessible via an online tool, supporting its potential integration into personalized treatment planning.

IntroductionThe influence of iodine on papillary thyroid carcinoma (PTC) remains a subject of debate. This meta-analysis was conducted to evaluate the risk association between varying levels of iodine intake and the occurrence of PTC and different subtypes of thyroid carcinoma (TC), particularly papillary thyroid microcarcinoma (PTMC).MethodsFour databases-the Cochrane Library, Embase, PubMed, and Web of Science-were systematically searched for relevant studies published up until May 30, 2024. An updated search was conducted on November 20, 2025. Literature screening and information collection were performed according to predefined eligibility criteria. The Newcastle-Ottawa Scale (NOS) was used to appraise the quality of the eligible literature. Statistical analysis was performed using Stata 17.ResultsThis meta-analysis encompassed 17 studies involving 273 651 individuals. The findings revealed a correlation between high urinary iodine concentrations and an increased risk of TC (odds ratio [OR]: 6.43, 95% confidence interval [CI]: 2.72-15.22, P < .05). The elevated risk was observed for both PTC (OR: 7.56, 95% CI: 1.6-35.78, P < .001) and PTMC (OR: 8.96, 95% CI: 5.89-13.64, P < .001). These results suggested that greater urinary iodine concentrations were associated with a higher risk of TC. However, there was no significant association between dietary iodine intake and TC risk (OR: 0.75, 95% CI: 0.37-1.52, P > .05).ConclusionThis meta-analysis demonstrated a definitive link between high urinary iodine excretion and an increased risk of TC. The relationship between dietary iodine intake and TC requires further investigation. Considering the current limitations, future large-scale, multicenter, prospective investigations are anticipated to provide further validation.