Cancer Control最新文献

BackgroundColorectal cancer (CRC) predominantly affects older adults, whose treatment outcomes may be influenced by baseline health-related quality of life (HRQoL). This study aimed to identify predictors of poor preoperative HRQoL in older patients undergoing CRC surgery and to stratify them into risk groups.MethodsWe retrospectively analyzed data on patients aged ≥65 years who underwent radical CRC surgery at a single medical center in Taiwan (2016-2018). Preoperative HRQoL was assessed using the EORTC QLQ-ELD14 questionnaire and a comprehensive geriatric assessment. Patients were stratified into high or low HRQoL groups based on the median QLQ-ELD14 sum score. Logistic regression identified independent predictors of poor HRQoL, and recursive partitioning analysis (RPA) was applied for risk stratification.ResultsAmong the 179 patients, the most distressing HRQoL domains were Burden of Disease, Maintaining Purpose, and Worries about Others. Independent predictors of poor HRQoL included female sex (adjusted odds ratio [OR] = 2.41, P = 0.029), frailty (adjusted OR = 1.53, P = 0.042), poor Eastern Cooperative Oncology Group (ECOG) performance status (adjusted OR = 2.19, P = 0.008), and lower educational attainment (adjusted OR = 0.23, P = 0.019). RPA identified five patient subgroups with distinct risk levels; frail female had the highest risk (71.4%), while fit patients with college education or higher had the lowest (9.5%).ConclusionFrailty, functional status, sex, and education level are key determinants of preoperative HRQoL in older patients with CRC. The RPA provides a simple tool to identify high-risk patients, allowing targeted preoperative interventions to optimize care and enhance surgical outcomes.

ObjectivesThis study aims to evaluate the perceived impact of extreme weather events from 2017 - 2024 on delivery of radiotherapy in Puerto Rico (PR), including effects on radiation oncologists, medical physicists, clinical staff, and patients. A secondary objective is to identify resources and strategies that may strengthen resiliency and support continuity of care in radiation oncology clinics located in weather-vulnerable regions.MethodsWe developed a comprehensive online cross-sectional survey to evaluate clinic emergency preparedness and the impact of extreme weather events on radiation oncology clinic stakeholders in PR. Potential participants were identified through the American Society for Radiation Oncology (ASTRO) membership directory and were invited to participate via email and direct outreach.ResultsFourteen radiation oncologists and four medical physicists were invited to participate, with a response rate of 56% (n = 10), representing 71.4% of radiation oncology clinics in PR. Among respondents, 90% reported clinical disruptions due to extreme weather events from 2017 to 2024. The most commonly reported impacts were property damage (90%), communication failures between providers, patients and staff (90%), power outages (80%), and school and/or childcare closures (80%). A majority (90%) supported developing comprehensive supportive resources, including professional society resources, to enhance disaster preparedness and operational resiliency.ConclusionRadiation oncology providers in PR reported significant disruptions in care delivery from extreme weather events and identified a need for strong resiliency measures. Institutional policy, coupled with targeted support from professional societies, may reduce lapses in treatment, safeguard vulnerable patients - particularly those with complex treatment plans - and improve continuity of care and outcomes in weather-prone regions.

IntroductionFinancial hardship during cancer treatment is common in privatised healthcare systems and has been extensively studied in cancer survivorship groups. The experience of financial concerns by people living with advanced, incurable cancer has been less frequently explored. This paper sought to describe the proportion of patients experiencing financial worry longitudinally, in a cohort with advanced colorectal cancer, in a publicly funded healthcare system.MethodsThis secondary analysis of a prospective, observational cohort study 'Palliative Care Early and Systematic (PaCES)' project, analysed data from 131 patients with advanced colorectal cancer, from Alberta's two tertiary cancer centres, treated between January 2018 - December 2020. Rates of self-reported financial concerns were obtained from the Canadian Problem Checklist, completed monthly for 10 months and 3 monthly thereafter.ResultsFifty-seven patients (43%) affirmed at least once that they had worried about their finances in the preceding month. Of those who reported they had "noˮ financial concerns at enrolment, 41 (35%) subsequently answered "yesˮ. The proportion of patients experiencing financial worry at any given time point fluctuated but the mean proportion was 18%. Multivariable analysis confirmed younger age (<65) was associated with more financial worry (P-value <0.01).ConclusionFinancial worry is a common and often recurrent concern for patients with advanced colorectal cancer, particularly for younger patients. Serial screening is important to detect persisting or de novo worry.

IntroductionWe aimed to investigate the predictive value of body fat composition parameters obtained using computed tomography (CT) for preoperative occult peritoneal metastasis (OPM) in gastric cancer.MethodsWe adopted a single-center case-control design and retrospectively analyzed data from 115 patients with gastric cancer who underwent laparoscopic exploration or radical gastrectomy at our hospital between October 2020 and March 2024. Patients were divided into OPM-positive (n = 35) and OPM-negative (n = 80) groups. The visceral adipose tissue (VAT) area, subcutaneous adipose tissue (SAT) area, and mean attenuation of CT images at the central level of the L3 lumbar spine were measured using the sliceOmatic software, and the clinical and imaging characteristics of the patients were analyzed.ResultsSignificant differences were present in the VAT area, VAT/SAT area, mean attenuation of SAT, mean attenuation of VAT, VAT area of different N stages, and lesion sites between the OPM-positive and OPM-negative groups (P < 0.05). Results of a multifactor logistic regression analysis showed that the VAT/SAT area ratio and VAT mean attenuation were independent risk factors for OPM in gastric cancer (P < 0.05). The AUC of the clinical-imaging model in predicting gastric cancer OPM was 0.92 (95% confidence interval, 0.86-0.97). A VAT/SAT area of 1.04 (specificity: 54%, sensitivity: 86%) and a VAT mean attenuation of -83.60 Hounsfield unit (HU) (specificity: 99%, sensitivity:34%) were used as optimal cutoff values for identifying the occurrence of OPM in gastric cancer.ConclusionVAT/SAT area ratio and mean VAT attenuation in body fat composition are potential auxiliary parameters for predicting OPM in gastric cancer.

IntroductionPatients with cancer may overestimate their ability to adhere to oral anticancer treatments (OAT) which may significantly reduce adherence rates. However, only few studies have investigated the specific role of personality traits and cognitive distortions in the definition of the adherence trajectory in the cancer field.MethodsThis study is nested in the Pfizer project (65080791), and it is a secondary, observational analysis of prospectively collected data from a randomized controlled trial (RCT). To avoid potential bias from comparing measurements across different time points, we limited the evaluation of associations among variables to the baseline data. 94 metastatic breast cancer (MBC) patients (mean age 56.8) receiving OAT for MBC have been enrolled. Each participant filled a set of measures assessing personality (Big Five), adherence (AAI-28 and MMAS-8) (© 2006 Donald E Morisky), and optimistic bias (VAS), and Quality of Life (EORTC QLQ-C30 and EORTC QLQ-BR23).ResultsA discrepancy between self-oriented and other-oriented evaluation of the capacity to take the therapy in the doses, frequencies, and times prescribed was observed (P < 0.001). A negative association between adherence rate and the self-perception of treatment adherence was identified (P < 0.001). Further, conscientiousness correlated positively with the perception of risk to their own health (P = 0.034), and negative association between extraversion and self-perception of treatment adherence (P = 0.05) and between agreeableness and self-perception of treatment adherence have been observed (P = 0.029).ConclusionsOur findings suggest that optimistic bias and personality may contribute to shaping adherence in MBC patients. Personality traits influence adherence both directly, by increasing the perception of health risks, and indirectly, by influencing coping strategies and emotion regulation. MBC patients having an OB may underestimate the important side effects and physical comorbidities, as well as difficulties in the daily management and adjustment of therapy due to disease progression.

Introduction: The use of antibiotic (Abx) is common in gastric cancer (GC) patients undergoing radical resection; however, the prognostic value of the use of these agents in stage I-III patients remains largely unknown.Methods: Data concerning the use of Abx in GC patients during surgery including the cumulative defined daily dose (cDDD) and types of Abx, were collected retrospectively. Differences in clinical features between cDDD subgroups and type subgroups were compared. Overall survival (OS) differences were tested via the Kaplan-Meier method, and risk factors for survival were validated by a Cox proportional hazards model.Results: Of 162 patients enrolled, 81 were assigned to the low-cDDD and 81 to the high-cDDD group. Among them, 19 patients were assigned to ≤2 types and 143 to ≥3 types. The low- and high-cDDD subgroups of patients presented no significant difference in OS (log rank = 2.21, P = 0.137). Patients receiving ≥3 types presented significantly better OS (log rank = 4.58, P = 0.032) than those receiving ≤2 types. The low- and high-cDDD subgroups (log rank = 3.83, P = 0.050), but not the ≤2 and ≥3 type subgroups (log rank<0.01, P = 0.982), presented a significant difference in OS in patients undergoing total gastrectomy. These differences were maintained in patients without total gastrectomy (cDDD: log rank = 7.92, P = 0.005; types: log rank = 6.52, P = 0.011). The use of multiple Abx types was validated as an independent factor for OS (HR = 0.46, 95% CI: 0.24-0.90; P = 0.024).Conclusions: Abx use during surgery in patients with stage I-III GC may potentially correlate with the prognosis. Patients with ≥3 types of Abx were more likely to have good outcomes, particularly in those without total gastrectomy.

Introduction: Precision radiotherapy relies on accurate segmentation of tumor targets and organs at risk (OARs). Clinicians manually review automatically delineated structures on a case-by-case basis, a time-consuming process dependent on reviewer experience and alertness. This study proposes a general process for automated threshold generation for structural evaluation indicators and patient-specific quality assurance (QA) for automated segmentation of nasopharyngeal carcinoma (NPC).

Methods: The patient-specific QA process for automated segmentation involves determining the confidence limit and error structure highlight stage. Three expert physicians segmented 17 OARs using computed tomography images of NPC and compared them using the Dice similarity coefficient, the maximum Hausdorff distance, and the mean distance to agreement. For each OAR, the 95% confidence interval was calculated as the confidence limit for each indicator. If two or more evaluation indicators (N2) or one or more evaluation indicators (N1) exceeded the confidence limits, the structure segmentation result was considered abnormal. The quantitative performances of these two methods were compared with those obtained by artificially introducing small/medium and serious errors.

Results: The sensitivity, specificity, balanced accuracy, and F-score values for N2 were 0.944 ± 0.052, 0.827 ± 0.149, 0.886 ± 0.076, and 0.936 ± 0.045, respectively, whereas those for N1 were 0.955 ± 0.045, 0.788 ± 0.189, 0.878 ± 0.096, and 0.948 ± 0.035, respectively. N2 and N1 had small/medium error detection rates of 97.67 ± 0.04% and 98.67 ± 0.04%, respectively, with a serious error detection rate of 100%.

Conclusion: The proposed automated patient-specific QA process effectively detected segmentation abnormalities, particularly serious errors. These are crucial for enhancing review efficiency and automated segmentation, and for improving physician confidence in automated segmentation.

Background: Serum high-density lipoprotein cholesterol (HDL-c) may influence cancer development. However, its relationship with the histological grade of pancreatic ductal adenocarcinoma (PDAC) is not well understood. This study aims to explore the potential associations between serum HDL-c levels and different histological grades of PDAC.

Methods: This retrospective study included 181 patients with pathologically confirmed PDAC who underwent radical surgery. Clinical data, blood biochemical results, imaging features, and pathological details of the patients were collected, such as age, gender, diabetes, hypertension, tumor grade, tumor size and location, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA).

Results: Patients with high-grade PDAC had significantly lower HDL-c levels compared to those with low-grade PDAC across both training and validation cohorts (P < 0.05). Significant associations were found between HDL-c levels and high-grade PDAC in the training (P < 0.001) and validation (P = 0.044) groups. Moreover, HDL-c levels were inversely related to lymph node metastasis in the training (P = 0.001) and validation (P = 0.012) sets.

Conclusions: Lower HDL-c levels are associated with high-grade PDAC and lymph node metastasis, suggesting that HDL-c may play a protective role in the progression of PDAC.

IntroductionVulvar squamous cell carcinoma (VSCC) is a rare but increasingly prevalent gynecological malignancy. This study aimed to identify risk factors for stage I VSCC, which accounts for approximately 70% of VSCC patients, and to develop a nomogram to predict cancer-specific survival (CSS) for this large subgroup.MethodsThis study analyzed the datasets consisting of public training and independent external validation sets of patients diagnosed with stage I VSCC between 2010 and 2019. Prognostic factors were discerned through Cox regression analyses and the least absolute shrinkage and selection operator (LASSO) method. A nomogram for CSS was developed and evaluated using the C-index, Kaplan-Meier curves, and decision curve analysis (DCA) plots.ResultsOur analysis revealed variations in predictors of CSS and overall survival (OS) in stage I VSCC cases from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate Cox model suggested associations between CSS and age, grade, and number of tumors (NMT), while the LASSO model indicated potential roles for age, stage, invasion depth, NMT, and surgical method. The nomogram showed reasonable discriminative ability in the training (C-index: 0.785) and validation cohorts (C-index: 0.729), with supporting Kaplan-Meier and DCA analyses.ConclusionThis study proposes a prognostic model for CSS in stage I VSCC, identifying exploratory associations with multifocal tumors and surgical extent. Further prospective studies are needed to validate these findings and clarify their clinical implications.