Cancer Control最新文献

IntroductionNanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (5-FU/LV) is an established second-line therapy for metastatic pancreatic ductal adenocarcinoma (PDAC). We previously developed a prognostic model (CGMH nomogram) to predict overall survival (OS) in patients receiving second-line chemotherapy before the nal-IRI + 5-FU/LV era. Herein, we aimed to validate the CGMH nomogram in a real-world cohort treated with nal-IRI plus 5-FU/LV, the current standard second-line treatment for metastatic PDAC.MethodsA retrospective cohort of 148 patients with metastatic PDAC treated with second-line nal-IRI + 5-FU/LV was analyzed. Prognostic scores were assigned using the CGMH nomogram, with patients stratified into tertiles as good, intermediate, and poor prognostic groups. Predictive performance was assessed using the concordance index (c-index) and calibration plots.ResultsOur cohort had a median OS of 6.1 months. Patients in the good, intermediate, and poor prognostic groups had median OS of 8.7 (95% confidence interval [CI], 6.7-10.7), 5.7 (95% CI, 5.3-6.3), and 4.0 (95% CI, 2.8-5.2) months, respectively. Compared with the good group, intermediate and poor groups had hazard ratios of 1.99 (95% CI, 1.29-3.07, P = .002) and 3.18 (95% CI, 1.87-5.40, P < .001), respectively. The nomogram demonstrated strong predictive ability, with c-indices of 0.73 and 0.70 for 6- and 12-month OS predictions, respectively. Calibration plots displayed excellent agreement between predicted and observed survival.ConclusionThe CGMH nomogram reliably predicted survival outcomes in nal-IRI + 5-FU/LV-treated patients with metastatic PDAC, and validation supported its use in clinical decision-making and personalized treatment planning.

IntroductionAmerican Indians and Alaska Natives (AIANs) experience significant cancer incidence and mortality disparities, with elevated cancer risk factor exposure, lower cancer screening rates, and poorer quality of cancer care relative to non-Hispanic Whites. To address these issues, the Southeastern American Indian Cancer health Equity Partnership (SAICEP) was formed to understand and address cancer disparities among southeastern American Indians (AIs).MethodsSAICEP formed in 2021 through the Community Outreach and Engagement offices of the NCI-designated Comprehensive Cancer Centers in North Carolina (NC). The catchment areas for these cancer centers include the tribal homelands for eight state and federally recognized Tribes, representing the largest AI populations in the eastern US. SAICEP seeks to: (1) increase awareness of cancer health needs of AI populations; (2) expand access to cancer health education and build community capacity to address cancer health needs; (3) develop collaborative research relationships to better understand and address the AI cancer burden.ResultsFor Aim 1, SAICEP created a virtual speakers' series, featuring prominent AI cancer researchers and clinicians, hosted by the UNC Lineberger Cancer Network three times a year. To date, 10 webinars have been convened, with a total of 538 participants. For Aim 2, SAICEP participates in tribal events throughout the year, reaching over 3500 AIs and disseminating printed cancer educational materials and giveaways. For Aim 3, SAICEP secured funding to conduct analyses to assess cancer incidence, mortality, and care quality for NC AIs, to collect information to understand community cancer needs and culturally adapt and disseminate information on cancer screening and risk reduction.ConclusionThrough its targeted research and engagement, SAICEP has successfully moved towards achieving its goal of understanding and addressing cancer disparities among AIs in NC. Future directions will involve the development of a community advisory board and collaborations with Tribes in other states.

Introduction: Adolescent and young adult cancer survivors, especially racial/ethnic minorities and rural residents are particularly vulnerable to financial toxicity due to limited healthcare access, socioeconomic disparities, and cultural/language barriers. These social determinants of health compound financial hardship and contribute to poor healthcare transitions from pediatric to adult care, leading to worse outcomes and higher mortality rates.Methods: Our cross-sectional survey study examined racial (Black vs White) and geographic (rural vs urban) disparities in financial toxicity and healthcare transition outcomes among 260 adolescent and young adult cancer survivors through the Kentucky Cancer Registry. Survey data were collected on financial toxicity, healthcare transitions, and health-related quality of life. Financial toxicity was measured under three domains: psychological response, material conditions (e.g., loss of income, debt), and coping behaviors.Results: Results revealed moderate levels of financial toxicity and healthcare transition readiness across the sample, with strong associations between financial toxicity and anxiety, depression, and long-term effects of cancer treatment. Black participants showed higher levels of anxiety and coping behaviors compared to Whites, while urban participants experienced lower financial toxicity (as measured by material conditions) than their rural counterparts. Racial disparities were observed in global health and anxiety, even after adjusting for financial toxicity, but the relationship between financial toxicity and healthcare transitions outcomes did not vary by race or geography.Conclusion: This study highlights the importance of developing tailored strategies to mitigate the impact of cancer-related financial toxicity on the health outcomes and quality of life of underserved adolescent and young adult cancer survivors.

Background: Malignant pleural mesothelioma is the most common primary tumor of the pleura. The unique growth pattern of malignant pleural mesothelioma makes it difficult to apply the Response Evaluation Criteria for Solid Tumors (RECIST). Hence the need to use modified RECIST (mRECIST) criteria, as they better fit the unique growth pattern of malignant pleural mesothelioma. The thickness of the tumor perpendicular to the chest wall or mediastinum is measured at 2 points at 3 separate levels at least 1 cm apart on chest CT scans, and summed to obtain a one-dimensional pleural measurement. The same criterion has also been used to assess response to treatment. RECIST 1.1 represents a further update, taking into account new concepts such as revised minimum dimensions for lymph nodes and an approach to lesions that become non-measurable. Based on experience and published literature, the hypothesis of merging the 2 above-mentioned criteria in mRECIST 1.1 for mesothelioma and the use of iRECIST for the application to immune-based therapies (iRECIST) was considered. Purpose: Support the importance of studying pleural mesothelioma in a reliable and reproducible way, through a scrupulous methodology, applying the mRECIST1.1 and iRECIST criteria. Conclusions: Adoption of a standardized study metodology can make the study of PM reproducible and correct.

Despite significant advances in oncology, cancer care globally continues to face critical challenges, including stark disparities in access, insufficient preventive focus, fragmented primary health care (PHC) integration, unsustainable financing models, workforce shortages, and inadequate community involvement. This paper revisits the Alma Ata Declaration's principles-health equity, universal access, preventive care, and community participation-as a conceptual framework to address these persistent issues in cancer care. We highlight opportunities to strategically integrate oncology services within strengthened PHC systems, balancing centralized specialist resources with decentralized community-based care. Evidence from diverse settings illustrates how reinforcing PHC infrastructures enhances preventive measures, early detection, and survivorship care, thus mitigating geographic and socioeconomic disparities. Sustainable financing mechanisms and targeted workforce strategies, including task-shifting and multidisciplinary training, are proposed as essential components. Effective community engagement models demonstrate improved care relevance, acceptance, and outcomes. Additionally, we emphasize the critical role of health policy alignment with universal health coverage objectives, robust pharmacoeconomic evaluations, and evidence-based national cancer control plans. Integrating Alma Ata's principles into contemporary oncology provides a viable, scalable model to advance equitable, accessible, and sustainable cancer care globally, laying the theoretical groundwork for future research initiatives and informed policy development.

Background: Oral cancer remains 1 of the biggest health care challenges; it has a poor response to treatment, and treatment often results in severe side effects. Nano-targeted drug carrier-assisted drug delivery systems can improve the benefits of targeted drug delivery and treatment efficacy. A systematic review and meta-analysis was conducted to investigate the effect of targeted nano carrier drug delivery systems on the management of oral cancer.

Methods: A comprehensive literature search was performed using PubMed, ScienceDirect, the Cochrane Library, Google Scholar, and Scopus using PRISMA guidelines, to identify relevant in vitro and in vivo (human) studies. Studies evaluating the impact of nanocarrier-based delivery systems on oral cancer cells or human models were selected. Pooled effect sizes were calculated using random-effects models via RevMan 5.4, and heterogeneity among studies was assessed.

Results: After full-text assessment, 15 research articles were included [14 in vitro studies and 1 randomized controlled trial (RCT)]. In the meta-analysis, the pooled data (IC₅₀) for the impact of the nanocarrier delivery system vs control on oral cancer was -7.67 (95% CI: -41.77, 26.43), with a high heterogeneity (I² = 92%, P < 0.00001). Moreover, in vitro studies had a medium risk of bias, while the RCT had some concerns in the randomization domain.

Conclusion: Nanocarrier-based drug delivery has been found to be a superior approach compared to drug delivery in free form, increasing the efficacy and safety of oral cancer treatment.

IntroductionThis cross-sectional study examined the relationship between paid sick leave and colorectal cancer (CRC) endoscopy screening among employed adults, including the examination of potential pathways.MethodsWe analyzed data from 15,352 employed adults aged 45-75 from the 2021 and 2023 National Health Interview Survey. A generalized structural equation model (GSEM) assessed the direct and indirect pathways between employment status (full-time vs part-time), paid sick leave, health insurance, usual source of care, and CRC endoscopy screening. Survey weights were applied to ensure nationally representative estimates.ResultsFull-time employment was positively associated with paid sick leave (OR = 6.57, 95% CI: 5.85, 7.38) and health insurance (OR = 1.30, 95% CI: 1.07, 1.59). Paid sick leave increased the likelihood of having a usual source of care (OR = 1.57, 95% CI: 1.31, 1.87) and was directly associated with CRC screening (OR = 1.15, 95% CI: 1.03, 1.28). Health insurance increased the likelihood of having a usual source of care (OR = 5.32, 95% CI: 4.30, 6.58) and CRC screening (OR = 3.22, 95% CI: 2.58, 4.02). Usual source of care was also associated with CRC screening (OR = 3.53, 95% CI: 2.89, 4.32).ConclusionsPaid sick leave was associated with CRC endoscopy utilization both directly and indirectly through improved healthcare access. Workplace policies that expand paid sick leave, alongside efforts to strengthen insurance coverage and primary care access, may reduce barriers to CRC endoscopy screening and improve population health.

Adaptive combination therapy is deemed the most intuitive strategy to thwart therapeutic resistance through dynamic treatment tuning that accounts for cancer evolutionary dynamics. However, higher accuracy and reliability of treatment response predictions would be needed, in addition to the need for clinically feasible models of adaptive combination therapy that consider newly approved therapeutics and the growing multimodal data being available about cancer. Grounded in nonlinear system control theory, this review offers a perspective on exploiting GenAI learning and inferencing capabilities to predict treatment response and recommend treatments in the context of adaptive cancer therapy. Results from nonlinear system identification, control theory and deep learning are integrated within an adaptive cancer control framework to leverage the continuously expanding data about cancer and its treatment towards GenAI-enhanced adaptive therapy. The resulting models and their analysis contribute to a much-needed conceptual clarity about the research and translational pathways that would be needed to realize GenAI-assisted cancer treatments. In particular, they underscore that access to clinical data, deep learning opacity, and clinical validation present critical challenges that require adequate attention to pave the way towards acceptance and integration of GenAI in real-world oncology workflows.

The leucine-rich pentatricopeptide repeat-containing (LRPPRC) protein, a member of the pentatricopeptide repeat (PPR) family, is a mitochondria-associated protein that regulates various biological processes, including cell cycle progression and mitochondrial gene translation. LRPPRC has also been identified as an important causative gene in several mitochondrial diseases. N6-methyladenosine (m6A) is the most prevalent and extensive modification of mRNA in eukaryotes, playing a significant role in cellular proliferation, differentiation, and oncogenesis. As an m6A regulator, LRPPRC has been shown to play an important role in the development of various human metabolic diseases and malignant tumors. This review mainly focuses on summarizing the biological roles of LRPPRC in a variety of human malignant tumors, emphasizing the molecular mechanisms LRPPRC is involved in and its potential impact on tumor prognosis.