Cancer Control最新文献

Epithelial ovarian cancer (EOC), dominated by high-grade serous carcinoma, continues to impose a heavy global burden, particularly in low- and middle-income countries. Although advances in surgery and chemotherapy have extended survival, relapse within 2 years remains common, underscoring the need for novel strategies. Poly adenosine diphosphate ribose polymerase inhibitors (PARPi) have transformed maintenance therapy by prolonging progression-free survival, yet their influence on health-related quality of life (HRQoL) is less well characterized. Patient-reported outcomes (PROs) serve as key tools for evaluating the impact of treatment on physical, emotional, and social well-being. Trials including SOLO1, NOVA, and ARIEL3 demonstrate the increasing recognition of QoL endpoints, though heterogeneity in tools and endpoints limits cross-trial comparisons. Several gaps persist including limited data collection beyond disease progression. This review integrates evidence from published studies, highlights methodological challenges, and proposes directions for future work, emphasizing the centrality of patient-centered outcomes in advancing precision medicine for ovarian cancer. The evidence underscores the imperative of designing trials that incorporate QoL as a core endpoint, ensuring meaningful benefits for patients in both clinical and real-world settings.

IntroductionCulturally safe communication is essential for supporting First Nations Australians undergoing radiation therapy. First Nations Australian patients, however, often face barriers in accessing culturally safe communication and cancer care. This study evaluates changes in healthcare professionals' (HCPs) confidence, skills, and knowledge in culturally safe communication with First Nations cancer patients after completing an online learning program.MethodsThis single group pre-post intervention study recruited HCPs from three regional Australian cancer centres. Pre- and post-training surveys, administered via Qualtrics, assessed self-reported confidence, knowledge, and communication skills for engaging with First Nations radiation therapy patients. Participants completed an online learning program consisting of three self-directed modules focused on cultural competency, health literacy and communication, and application of an Indigenous radiation therapy talking book resource. The post-training survey also included module evaluation items. Pre- and post-training data were analysed using paired-sample t-tests (α = 0.05). Descriptive statistics and content analysis were applied to evaluate participant feedback.ResultsOf the 49 participants recruited, 38 participated in this study, most were non-Indigenous (94.7%), 52.6% were radiation therapists, and 65.8% reported seeing between 11-50 First Nations Australian patients annually. The participants' mean confidence in communicating with First Nations Australian patients increased from 3.50 to 4.03 (p = 0.006), and preparedness to support patient needs rose from 3.55 to 3.95 (p = 0.04). The online modules were highly rated as good or excellent by 95% of participants.ConclusionThe findings demonstrate that tailored online learning modules can significantly enhance HCP's self-reported confidence, skills, and knowledge in communicating with First Nations cancer patients receiving radiation therapy. Integrating training into routine practice may promote more culturally responsive cancer care, strengthening engagement and support for First Nations Australian radiation therapy patients.

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.

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.

IntroductionPublic parks are an integral part of the built environment, with a considerable role to promote public health by advancing physical health, mental wellness and overall quality of life. The potential exists for parks and greenspace to contribute to cancer control and prevention, and local park and recreation departments (PARDs) are natural partners for Comprehensive Cancer Centers as they pursue Community Outreach and Engagement activities. However there is a lack of research on best practices for structuring these relationships to ensure success.MethodsA collaboration framework for Comprehensive Cancer Centers and PARDs was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) model of implementation science. The model was applied by a large cancer center to 3 implementation sites in the greater Houston area. A set of shared measures were developed and tracked across all sites.ResultsThree PARDs implemented 5 unique active living and sun safety evidence-based interventions (EBIs) of 2 main types, educational focused interventions (to increase knowledge and change behavior) and infrastructure interventions (to modify the physical environment). Three-quarters (75%, 9/12) of all educational EBIs across communities were sustained by the PARDs one or more years after the funding ended; all (13/13) infrastructure projects were completed during the active implementation period and sustained by the PARDs. A range of 10-39 partners supported the work of the PARDs.ConclusionThe 3 collaboration sites each offer a case study on the impact and effectiveness of health promotion across sectors to impact modifiable risk factors for cancer, leveraging the replicable EPIS model. Partnership is critical to both sectors to advance community health and impact.

IntroductionOnly two-thirds of patients with ovarian cancer ever see a gynecologic oncologist. Our objective was to examine the feasibility of an electronic health record-based nudge to clinicians for referral to gynecologic oncology at suspected ovarian cancer by imaging.MethodsWe developed a nudge, a short behavioral economics informed best practice advisory with a pended referral order for gynecologic oncology, for primary care, emergency medicine, and obstetrician/gynecology clinicians for when a patient had a O-RADS 4 or 5 lesion on imaging and had not already seen gynecologic oncology. In 2024, clinicians were sent the nudge within 2 business days of a patient's abnormal imaging through the electronic health record. Our primary outcome was referral rate to gynecologic oncology compared to a historic cohort of patients with O-RADS 4 or 5 lesions from 2020-2023.ResultsIn this prospective cohort study, we sent 20 clinician nudges for gynecologic oncology referral; six clinicians (30%) responded that the nudge changed their referral behavior. The 90-day referral rate was 75% compared to historic baseline of 61%. In the pilot, 92% patients undergoing surgery for complex adnexal mases had surgery with gynecologic oncology compared to historic baseline of 82%. One in four patients in the pilot were diagnosed with cancer, all early-stage disease.ConclusionsA clinician nudge for gynecologic oncology referral at suspected ovarian cancer diagnosis was acceptable and associated with 75% referral rate. A clinician nudge standardizes gynecologic oncology referral and may improve early detection of ovarian cancer. A randomized controlled trial of the clinician nudge is warranted.

Gallbladder cancer (GBC) is a rare yet highly aggressive malignancy of the biliary tract, characterized by a five-year survival rate of less than 5%. Its asymptomatic onset and the lack of reliable early diagnostic tools contribute to delayed detection and poor clinical outcomes. Although epidemiological and genetic studies have identified numerous risk factors, the molecular mechanisms linking these factors to tumor initiation and progression remain incompletely understood. This review integrates current evidence on the multifactorial etiology of GBC-including geographic variation, genetic predisposition, environmental exposures, chronic inflammation, and infections-with emerging insights into metabolic and molecular dysregulation. Particular focus is placed on metabolic reprogramming as a central driver of carcinogenesis. Altered lipid metabolism, bile acid signaling, and redox imbalance interact with inflammatory and oncogenic pathways, fostering a permissive microenvironment for malignant transformation. Key molecular cascades include inflammation-driven NF-κB activation, bile acid-induced oxidative stress, PI3K/AKT-mediated metabolic remodeling, and DNA damage and repair defects. By consolidating diverse epidemiological and mechanistic data into a unified molecular-metabolic framework, this narrative review identifies new opportunities for biomarker discovery, metabolic imaging, early detection, and targeted therapeutic development, advancing translational research to improve outcomes in this devastating disease.

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 World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2⁺).MethodsWomen who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2⁺ across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05.ResultsAmong 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2⁺ occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2⁺ was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods (P = .941).ConclusionsVIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.

Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related mortality worldwide. Currently, surgical resection remains the cornerstone of curative treatment for CRC; however, patients with advanced disease continue to face significant risks of postoperative recurrence and metastasis. Although immune checkpoint inhibitors (ICIs), represented by PD-1/PD-L1 monoclonal antibodies, have reshaped the therapeutic landscape of various solid tumors, their clinical benefit in CRC is strictly limited by mismatch repair (MMR) status, leaving the vast majority of proficient mismatch repair/microsatellite stable (pMMR/MSS) patients with minimal therapeutic gain. Importantly, tumor-associated macrophages (TAMs)-a key regulatory component of the tumor immune microenvironment-not only exert immunosuppressive functions through PD-1 and multiple other pathways, but also promote PD-1 expression on tumor cells via distinct mechanisms. Consequently, accumulating evidence suggests that TAMs play a critical role in mediating resistance to PD-1/PD-L1 inhibitors in CRC. Nevertheless, research on the underlying mechanisms remains at an early stage. This narrative review aims to summarize the latest advances regarding the involvement of TAMs in resistance to PD-1/PD-L1 blockade, with a particular focus on strategies to enhance immunotherapy responsiveness through TAM modulation. We further discuss limitations in current clinical studies and propose potential directions for future research. By juxtaposing successful mechanistic studies with underwhelming clinical trial data, we aim to redefine the therapeutic rationale for combining TAM-targeted agents with immune checkpoint blockade.