Cancer Control最新文献

IntroductionWhile race/ethnicity are established factors of risk and outcomes for multiple cancers in women, nativity may more precisely estimate cancer risk and survival. The role of nativity in choriocarcinoma, a form of gestational trophoblastic neoplasia arising from the placenta, is unexplored. Our objective was to examine how race, ethnicity, and nativity influence disease presentation and survival in women with choriocarcinoma in Florida.MethodsUsing the Florida Cancer Data System (FCDS), we identified women diagnosed with choriocarcinoma from 1981-2020. Clinicodemographic data were extracted, including nativity (US-born/Non-US-born). Statistical analyses included chi-square, Cox proportional hazards models, and Kaplan-Meier method, with significance set at P < 0.05.Results262 eligible patients were included. Black women more frequently presented with distant disease vs White women (63.8% vs 46.2%, P = 0.05). Non-US-Born women were older at diagnosis than US-born (32.8 vs 26.7 years, P < 0.01) and received fewer surgical and radiation treatments (P < 0.05). Nativity, ethnicity, and race were not associated with overall survival (OS) (all P > 0.05). Multivariable analyses adjusted for race and birthplace showed increasing age (HR 1.05 [1.02-1.09], P = 0.023) and surgical treatment (HR 0.28 [0.09-0.79], P = 0.016) were associated with OS. Despite favorable OS, survival curves diverged after initial treatment, favoring White over Black patients, and Hispanic over Non-Hispanic patients, though neither were statistically significant (P > 0.05).ConclusionRace and nativity are associated with variations in choriocarcinoma presentation and treatment course but do not affect survival. Race and ethnicity may predict post-treatment, long-term survival, though whether this reflects choriocarcinoma biology or broader disparities remain unclear.

IntroductionInterval breast cancers are detected symptomatically after a non-suspicious mammogram, but before the patient's next scheduled screen. Interval breast cancers are often diagnosed at a later stage and larger size, and have poorer prognostic factors and survival than screen-detected breast cancer. Our qualitative study heard from women with interval breast cancer to describe their symptoms and their reactions to the diagnosis; and identify themes for educational messaging.MethodsWe conducted 20 in-depth interviews with participants who were between the ages 40-69, had all screening, diagnostic, and treatment services completed within the same hospital system, and had a negative mammogram screen followed by breast cancer diagnosis before the next screen.ResultsFifteen women noticed a lump cyst during a breast self-exam or when dressing. Most women reached out to their gynecologist or their primary care provider. Main themes from their reactions to the diagnosis included: unaware that interval breast cancers could occur; surprised that screening tools could not see all cancer; worried to being seen as ridiculous based on previous experience with non-cancerous breast issues, and disappointed that they waited to reach out for care. Ideas for messaging included: listen to your body, prioritize your health, and keep doing breast self-exams.ConclusionBreast cancer prevention programs should focus on the awareness of interval breast cancers and the importance of breast self-exams and self-awareness in conjunction with screening mammograms.

IntroductionDelirium is a common neuropsychiatric syndrome in hospitalized cancer patients that is associated with poor outcomes such as increased mortality and prolonged hospital stays. However, clinical predictors of delirium-related outcomes in acutely hospitalized, non-surgical cancer patients remain underexplored.MethodsThis was a retrospective cohort study of hospitalized cancer patients at a tertiary-care oncology center between May 2024 and August 2024 who developed delirium. Delirium was defined by a positive Confusion Assessment Method (CAM) screen. Patients who were admitted for surgical reasons or had an altered mental status (AMS) present on admission were excluded. Patient demographics and clinical factors associated with their hospital course were abstracted from electronic medical records. Primary outcomes analyzed were in-hospital mortality, delirium duration, and length of stay (LOS).ResultsA total of 126 patients met the inclusion criteria from a screening pool of 219 patients. The median age was 65.5 years (IQR: 58,73) and 65 patients (51.6%) were male. Nearly half (43.7%) had hematologic malignancies. Twenty patients (15.9%) died during hospitalization. Non-survivors had significantly lower albumin (3.0 vs 3.5 g/dL, P < 0.01), platelets (86 vs 190 × 10³/µL, P = 0.031), BMI (23.3 vs 27.1 kg/m², P = 0.046), and higher LDH (515 vs 273 U/L, P = 0.044). They also experienced delirium for longer (median 3 vs 1 days, P = 0.011), had a higher incidence of sepsis (27% vs 14%, P = 0.015), and received more benzodiazepines before delirium onset (0.152 vs 0.045 mg/day, P = 0.040). Prolonged delirium (>1 day) was associated with similar factors. LOS positively correlated with delirium duration and sedative exposure, and inversely with hemoglobin and platelet counts.ConclusionsDelirium in hospitalized cancer patients may reflect underlying physiological frailty that increases susceptibility to mortality from metabolic derangements, malnutrition, sepsis, and sedative exposure. Early identification of these high-risk clinical factors in cancer inpatients with delirium may help mitigate risks posed by these abnormalities.

IntroductionWhile gender is a known prognostic factor for many cancers, its specific role in pancreatic neuroendocrine tumors (PanNETs) survival remains poorly characterized. This study aimed to investigate gender-based differences in PanNETs prognosis using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThis retrospective cohort study included patients diagnosed with PanNETs between the years 2000 and 2020, extracted from the SEER database. Propensity score matching (PSM) was applied to mitigate potential selection bias. Overall survival (OS) was evaluated using Kaplan-Meier analysis and multivariable Cox regression.ResultsAmong the 5155 patients included (2814 males, 2341 females), males showed significantly worse OS than females both before (hazard ratio [HR] 1.29, 95% CI 1.14-1.47, P < 0.001) and after (HR 1.19, 95% CI 1.02-1.38, P = 0.026) PSM. Subgroup analyses confirmed a consistent OS advantage for females across most categories. Multivariable analysis identified marital status, age, tumor grade, gender, year of diagnosis, N stage, M stage, and surgical intervention as independent predictors of OS. Similar predictors were found in males, whereas in females, marital status, age, grade, N stage, M stage, and surgery were specifically significant.ConclusionsFemale patients with PanNETs exhibit superior OS rates. Further research is needed to clarify the biological and clinical mechanisms underlying these gender-related disparities.

IntroductionThe Lessening the Impact of Financial Toxicity (LIFT) intervention-a financial navigation intervention-demonstrated preliminary effectiveness. Scaling LIFT to an eight-site single-arm trial, however, posed implementation challenges that were not present in the single-site pilot study. Here, we analyze factors influencing LIFT implementation.MethodsWe used a deductive-inductive hybrid qualitative approach to analyze transcribed meeting recordings from 55 technical assistance (TA) and 23 peer support (PS) calls with financial navigators (FN). First, we deductively coded all implementation-relevant content into the five domains of the Consolidated Framework for Implementation Research (CFIR). We then inductively generated themes and sub-themes within each of the CFIR domains. Coder reliability was assessed at multiple points during coding via coder consensus.ResultsThe qualitative analysis of nearly 78 h of TA and PS calls with FNs resulted in 18 themes and 91 sub-themes across the six CFIR domains. Outer setting themes (7 themes, 37 sub-themes) included institutional workforce problems, limited organizational resources for specific needs, and the unpredictability of external resource application success. Determinants in the inner setting (3 themes, 18 sub-themes) included existing clinical infrastructure and navigators' competing responsibilities in the clinic. Determinants in the individual domain (2 themes, 11 sub-themes) were the navigator workload and the patient motivation to engage in LIFT. Determinants in the innovation domain (2 themes, 5 sub-themes) were the intervention structure (ie, sequence and timing of LIFT activities). The most common implementation strategies (ie, process; 4 themes, 23 sub-themes) were pacing intervention content to meet patient needs, reframing the study to appeal to patients, and changing intervention delivery (eg, allowing phone visits).ConclusionsThis analysis highlights the challenges of implementing FN across multiple oncology sites, with workforce and administrative barriers being key challenges. Operational process data such as TA and PS calls can provide valuable information to guide implementation.

IntroductionBreast cancer (BC) is a leading cause of death and has become an emerging issue for global public health. We aimed to explore and identify the modifiable factors associated with delayed diagnosis among patients with BC in Pakistan.MethodsAn epidemiological analytical cross-sectional study was conducted on patients with BC undergoing chemotherapy at a specialized cancer hospital in Punjab, Pakistan. Data on demographic characteristics and factors associated with delayed diagnosis were collected directly from patients using a self-structured questionnaire. Simultaneously, tumor-related information was obtained from their medical records. Chi-square test and forward stepwise binary logistic regression were applied to find out association and statistical significance.ResultsOf the 490 BC patients analyzed, 68.6% experienced diagnostic delays. Multivariable logistic regression identified several significant predictors of delay: high diagnostic costs (AOR = 0.627; 95% CI: 0.403-0.976; P = 0.039), consultation with traditional healers (AOR = 0.317; 95% CI: 0.196-0.512; P < 0.001), and negligence toward the disease (AOR = 2.35; 95% CI: 1.30-4.28; P = 0.005). Financial problems showed a borderline association (AOR = 0.634; 95% CI: 0.398-1.009; P = 0.055).ConclusionDelayed BC diagnosis was significantly associated with high diagnostic costs, consultation with traditional healers before diagnosis, and patient negligence.

IntroductionPediatric acute leukemia is the most common childhood malignancy and one of the leading causes of cancer-related mortality worldwide, particularly, in low- and middle-income countries (LMICs), where treatment abandonment remains a major barrier to survival. Geographic accessibility and socioeconomic conditions are recognized determinants, but their combined influence in Mexico remains understudied. This study evaluated the association between geographic accessibility, socioeconomic factors, and treatment abandonment among children with acute leukemia in south-central Mexico.MethodsA prospective cohort study was conducted in Oaxaca, Puebla, and Tlaxcala from 2021 to 2023, including 574 children under 18 years diagnosed with acute lymphoblastic or myeloid leukemia. Geographic accessibility was estimated using travel distance and time from patients' residences to referral hospitals, calculated with ORS Tools in QGIS. Socioeconomic variables included public health insurance affiliation, parental education and occupation, and number of siblings. Treatment abandonment was defined per SIOP criteria as failure to initiate or discontinuation of treatment for ≥4 consecutive weeks. Multivariable logistic regression, adjusted for child's sex, age, year of diagnosis, and leukemia subtype, was used to assess associations.ResultsTreatment abandonment occurred in 16.6% of patients. In multivariable analysis, lack of public health insurance (aOR = 2.83; 95% CI: 1.39-5.76; P < 0.01) and living ≥141 km from the hospital (aOR = 1.68; 95% CI: 1.02-2.74; P = 0.03) were significantly associated with abandonment. Other factors, including number of siblings, maternal education, and fathers' occupation, were not statistically significant.ConclusionLack of public health insurance and greater distance to the hospital are key determinants of treatment abandonment in children with acute leukemia in south-central Mexico. Expanding insurance coverage, reducing indirect costs, and addressing geographic barriers are critical to improve treatment adherence and survival outcomes in this population.

Purpose: The predictive sensitivity of carbohydrate antigen 19-9 (CA19-9) in assessing the prognosis of intrahepatic cholangiocarcinoma (ICC) remains inadequate. Integrating CA19-9 with tumor volume offers a potentially viable strategy for improving prognostic accuracy. This study aimed to develop a prognostic model utilizing volume-adjusted CA19-9 (VACA) for ICC patients.

Patients and methods: A retrospective analysis was conducted on data from 436 ICC patients. These patients from two centers were divided into the training (n = 291, Center 1) and validation (n = 145, Center 2) cohorts. Using the training cohort, univariate and multivariable Cox regression analyses were employed to identify clinicopathological characteristics significantly associated with overall survival (OS) and recurrence-free survival (RFS), which enabled the construction of prognostic nomograms both with and without VACA. The nomograms' discriminatory and calibration abilities were assessed using receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves, applying both training and validation cohorts.

Results: VACA emerged as an independent variable that significantly correlated with prognosis. The nomogram incorporating VACA demonstrated superior accuracy in predicting OS and RFS rates compared to the model without VACA. In the validation cohort, the nomogram with VACA yielded area under the ROC curve (AUC) values of 0.695 (95% CI = 0.597∼0.793) and 0.666 (95% CI = 0.559∼0.773) (1- year), 0.662 (95% CI = 0.518∼0.806) and 0.651 (95% CI = 0.446∼0.857) (3- years), and 0.701 (95% CI = 0.486∼0.916) and 0.703 (95% CI = 0.428∼0.978) (5- years) for OS and RFS, respectively, along with improved calibration and DCA curves.

Conclusions: VACA, formed by integrating tumor volume with CA19-9, exhibits promising prognostic capabilities. The nomogram incorporating data from two centers and utilizing VACA demonstrates robust prognostic performance and holds clinical utility.

Condensed abstract: Combining CA19-9 with tumor volume presents a potentially viable strategy for improving prognostic accuracy. The nomogram incorporating VACA demonstrates robust prognostic performance and holds clinical utility.

BackgroundLocal advanced rectal cancer (LARC) patients who achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) generally have a favorable prognosis. This retrospective study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) parameters and neutrophil-to-lymphocyte ratio (NLR) in LARC patients with pCR.MethodsBetween 2015 and 2019, 180 LARC patients who achieved pCR after NCRT and surgery were included. MRI parameters and NLR were evaluated as potential predictors for 5-year overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier and COX regression analysis.ResultsWith a median follow-up time of 68.3 months, the 5-year OS and DFS rates were 94.2% and 91.4%, respectively. Thirteen patients (7.2%) died, 2 (1.1%) experienced local recurrence, and 15 (8.3%) experienced distant metastases. Pretreatment MRI parameters and NLR were correlated with 5-year OS and DFS in pCR patients in the univariate analysis. The multivariate analysis identified baseline EMVI and NLR as independent predictors for 5-year OS and DFS (all P < .05). Patients in the low-risk group (EMVI-negative and/or NLR ≤ 2.8, n = 159, 88.3%) had a more favorable 5-year DFS compared to those in the high-risk group (EMVI-positive and NLR > 2.8, n = 21, 11.7%) (95.6% vs 59.4%, P < .001), with similar findings for 5-year OS (97.4% vs 70.6%, P < .001).ConclusionsThis study showed that MRI parameters and NLR were associated with long-term prognosis in patients with pCR. These findings could aid in stratifying pCR patients and guide subsequent treatment and follow-up strategies.