Giancarlo Di Giuseppe,Arif Jetha,Petros Pechlivanoglou,Jason D Pole
BACKGROUNDCancer in adolescents and young adults (AYAs) emerges during critical transitional phases, resulting in lasting effects on financial well-being. It remains uncertain whether cancer in AYAs exhibits differences in financial impact on income based on gender and diagnosis age over time.METHODSWe linked Canada's national cancer registry to personal tax records to identify AYAs (15-39 years) diagnosed between 1994 and 2013. In the year before diagnosis, survivors were variable-ratio matched to 10 cancer-free individuals on several sociodemographic characteristics. Participants were followed longitudinally up to 10-years post-diagnosis or until 2015. Relative and absolute income changes were estimated using doubly-robust difference-in-differences. We categorized age into three groups: adolescents (15-17 years), emerging young adults (18-29 years), and young adults (30-39 years), reflecting the different AYA life stages. Analyses were stratified by gender and diagnosis age.RESULTSThere were 60,240 women and 33,085 men survivors matched to 490,645 and 274,595 cancer-free participants, respectively. Overall, men and women had 6.9% (95%CI: 5.1%-8.6%) and 4.5% (95%CI: 3.1%-5.8%) income reductions, respectively. Adolescent men had the largest reduction of 23.7% (95%CI: 1.9% to 40.6%), while a lack of significance was observed in women of the same age. Income was reduced for varying magnitudes and durations across the different intersections of gender and diagnosis age, with men experiencing longer periods of income reductions.CONCLUSIONSCancer impacts income generation differently for AYA men and women, and at various diagnosis ages over time. Men, particularly younger men, are most vulnerable to income reductions.
{"title":"Income After Cancer Across Gender and Age Among Canadian Adolescents and Young Adults.","authors":"Giancarlo Di Giuseppe,Arif Jetha,Petros Pechlivanoglou,Jason D Pole","doi":"10.1093/jnci/djaf333","DOIUrl":"https://doi.org/10.1093/jnci/djaf333","url":null,"abstract":"BACKGROUNDCancer in adolescents and young adults (AYAs) emerges during critical transitional phases, resulting in lasting effects on financial well-being. It remains uncertain whether cancer in AYAs exhibits differences in financial impact on income based on gender and diagnosis age over time.METHODSWe linked Canada's national cancer registry to personal tax records to identify AYAs (15-39 years) diagnosed between 1994 and 2013. In the year before diagnosis, survivors were variable-ratio matched to 10 cancer-free individuals on several sociodemographic characteristics. Participants were followed longitudinally up to 10-years post-diagnosis or until 2015. Relative and absolute income changes were estimated using doubly-robust difference-in-differences. We categorized age into three groups: adolescents (15-17 years), emerging young adults (18-29 years), and young adults (30-39 years), reflecting the different AYA life stages. Analyses were stratified by gender and diagnosis age.RESULTSThere were 60,240 women and 33,085 men survivors matched to 490,645 and 274,595 cancer-free participants, respectively. Overall, men and women had 6.9% (95%CI: 5.1%-8.6%) and 4.5% (95%CI: 3.1%-5.8%) income reductions, respectively. Adolescent men had the largest reduction of 23.7% (95%CI: 1.9% to 40.6%), while a lack of significance was observed in women of the same age. Income was reduced for varying magnitudes and durations across the different intersections of gender and diagnosis age, with men experiencing longer periods of income reductions.CONCLUSIONSCancer impacts income generation differently for AYA men and women, and at various diagnosis ages over time. Men, particularly younger men, are most vulnerable to income reductions.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grace Lee,Fridolin Haugg,Dennis Bontempi,John He,Osbert Zalay,Danielle S Bitterman,Paul Catalano,Vasco Prudente,Suraj Pai,Christian Guthier,Benjamin H Kann,Dirk De Ruysscher,Hugo J W L Aerts,Raymond H Mak
BACKGROUNDHumans age at different rates and facial characteristics may yield insight into biological age and physiologic health. FaceAge, a deep learning system estimating biological age from facial photographs, has shown potential as a biomarker for cancer prognosis. This study investigates the prognostic value of extreme discordance between FaceAge and chronological age (FaceAge-Age) in predicting survival and early mortality across a large clinical dataset of 28 cancer types.METHODSData from 24,556 cancer patients aged ≥60 treated with radiation therapy between 2008-2023 were analyzed. FaceAge estimates were compared with chronological age across different diagnoses/clinical contexts, and survival analyses were performed. All tests were two-sided.RESULTSFaceAge was older than chronological age in 65% (median FaceAge 74 versus age 70). Younger patients, female sex, diagnoses with worse prognosis, and treated for palliative intent had higher likelihood of FaceAge-Age ≥10 years. Patients with FaceAge-Age ≥10 years had significantly worse survival while those with FaceAge-Age ≤-5 years had better survival. On multivariate analysis, FaceAge-Age ≥10 years predicted higher mortality risk (HR 1.26, P<.001) and early mortality at 30 days (OR 1.38, P=.004) and 60 days (OR 1.33, P<.001), whereas FaceAge-Age ≤-5 years predicted lower mortality risk (HR 0.90, P<.001).CONCLUSIONSPatients with more advanced cancers tend to have significantly older FaceAge compared with age, and extreme discordance between FaceAge and chronological age is a novel, independent predictor of survival and early mortality. These findings support further development of facial health assessments for clinical prognostication models and personalized treatment decision-making.
{"title":"FaceAge as a biomarker for prognosis and treatment stratification in large-scale oncology cohort.","authors":"Grace Lee,Fridolin Haugg,Dennis Bontempi,John He,Osbert Zalay,Danielle S Bitterman,Paul Catalano,Vasco Prudente,Suraj Pai,Christian Guthier,Benjamin H Kann,Dirk De Ruysscher,Hugo J W L Aerts,Raymond H Mak","doi":"10.1093/jnci/djaf323","DOIUrl":"https://doi.org/10.1093/jnci/djaf323","url":null,"abstract":"BACKGROUNDHumans age at different rates and facial characteristics may yield insight into biological age and physiologic health. FaceAge, a deep learning system estimating biological age from facial photographs, has shown potential as a biomarker for cancer prognosis. This study investigates the prognostic value of extreme discordance between FaceAge and chronological age (FaceAge-Age) in predicting survival and early mortality across a large clinical dataset of 28 cancer types.METHODSData from 24,556 cancer patients aged ≥60 treated with radiation therapy between 2008-2023 were analyzed. FaceAge estimates were compared with chronological age across different diagnoses/clinical contexts, and survival analyses were performed. All tests were two-sided.RESULTSFaceAge was older than chronological age in 65% (median FaceAge 74 versus age 70). Younger patients, female sex, diagnoses with worse prognosis, and treated for palliative intent had higher likelihood of FaceAge-Age ≥10 years. Patients with FaceAge-Age ≥10 years had significantly worse survival while those with FaceAge-Age ≤-5 years had better survival. On multivariate analysis, FaceAge-Age ≥10 years predicted higher mortality risk (HR 1.26, P<.001) and early mortality at 30 days (OR 1.38, P=.004) and 60 days (OR 1.33, P<.001), whereas FaceAge-Age ≤-5 years predicted lower mortality risk (HR 0.90, P<.001).CONCLUSIONSPatients with more advanced cancers tend to have significantly older FaceAge compared with age, and extreme discordance between FaceAge and chronological age is a novel, independent predictor of survival and early mortality. These findings support further development of facial health assessments for clinical prognostication models and personalized treatment decision-making.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin K H Ho,Shanzeh Chaudhry,Jennifer Chai,Carlo Deangelis,Kelvin K W Chan,Mina Tadrous
BACKGROUNDBiologics have greatly improved cancer management but are costly. Biosimilars cost less and have no clinically meaningful differences compared to reference products. However, they are not identical, leading to hesitation among clinicians and patients to use them.OBJECTIVETo measure the uptake of oncology-related biosimilars versus reference products in the USA and countries with similar regulatory frameworks.METHODSWe conducted a cross-sectional sales analysis from 13 countries between October 2022 and September 2023 for five oncology-related biologics with biosimilars: bevacizumab, filgrastim, pegfilgrastim, rituximab, and trastuzumab. We used IQVIA MIDAS® data on country-level quarterly sales volume and value.RESULTSAmong the 13 countries, the USA ranked tenth in the proportion of oncology-related biosimilar uptake by units sold (75% versus median 86%) and spending (58% versus 76%). Biosimilar uptake in the USA was 84% for filgrastim (versus 95%), 83% for bevacizumab (versus 86%), 75% for rituximab (versus 93%), 70% for trastuzumab (versus 70%), and 44% for pegfilgrastim (versus 83%). The USA spent USD $8.4 billion on these biologics during the study period. European countries including Norway, Italy, and Sweden had the highest uptake, while New Zealand, Japan, and Belgium had the lowest. Across countries, biosimilar filgrastim had the highest uptake (95% of units) and trastuzumab the lowest (70%).CONCLUSIONSOncology-related biosimilar uptake in the USA was below-average among included countries. Increasing biosimilar uptake may reduce spending, and savings can be reinvested into cancer care. Future research on time trends can help assess barriers and enablers of biosimilar uptake across countries.
{"title":"Uptake of oncology-related biosimilars: a global analysis of usage data.","authors":"Martin K H Ho,Shanzeh Chaudhry,Jennifer Chai,Carlo Deangelis,Kelvin K W Chan,Mina Tadrous","doi":"10.1093/jnci/djaf335","DOIUrl":"https://doi.org/10.1093/jnci/djaf335","url":null,"abstract":"BACKGROUNDBiologics have greatly improved cancer management but are costly. Biosimilars cost less and have no clinically meaningful differences compared to reference products. However, they are not identical, leading to hesitation among clinicians and patients to use them.OBJECTIVETo measure the uptake of oncology-related biosimilars versus reference products in the USA and countries with similar regulatory frameworks.METHODSWe conducted a cross-sectional sales analysis from 13 countries between October 2022 and September 2023 for five oncology-related biologics with biosimilars: bevacizumab, filgrastim, pegfilgrastim, rituximab, and trastuzumab. We used IQVIA MIDAS® data on country-level quarterly sales volume and value.RESULTSAmong the 13 countries, the USA ranked tenth in the proportion of oncology-related biosimilar uptake by units sold (75% versus median 86%) and spending (58% versus 76%). Biosimilar uptake in the USA was 84% for filgrastim (versus 95%), 83% for bevacizumab (versus 86%), 75% for rituximab (versus 93%), 70% for trastuzumab (versus 70%), and 44% for pegfilgrastim (versus 83%). The USA spent USD $8.4 billion on these biologics during the study period. European countries including Norway, Italy, and Sweden had the highest uptake, while New Zealand, Japan, and Belgium had the lowest. Across countries, biosimilar filgrastim had the highest uptake (95% of units) and trastuzumab the lowest (70%).CONCLUSIONSOncology-related biosimilar uptake in the USA was below-average among included countries. Increasing biosimilar uptake may reduce spending, and savings can be reinvested into cancer care. Future research on time trends can help assess barriers and enablers of biosimilar uptake across countries.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine L Hathaway,Elizabeth R Brown,Stephen Cherne,Alyssa L Sepulveda,Zvavahera M Chirenje,Nitesha Jeenarain,Logashvari Naidoo,Samantha Siva,Nishanta Singh,Kubashni Woeber,Zakir Gaffoor,Brenda Gati Mirembe,Flavia Matovu Kiweewa,Leila E Mansoor,Lameck Chinula,Sufia Dadabhai,Nelly R Mugo,Thesla Palanee-Phillips,Ruanne V Barnabas
BACKGROUNDObservational data on the synergy between HPV infection and risk for HIV acquisition are needed. HPV clearance, associated with an influx of cells targeted by HIV, may increase HIV risk. This study examined the association between HPV and HIV acquisition using endocervical swabs collected in MTN-020/ASPIRE.METHODSHealthy, sexually active women without HIV participating in the ASPIRE dapivirine ring study in Malawi, South Africa, Uganda, and Zimbabwe, provided endocervical swabs monthly, which were tested for HPV-DNA. HPV status was classified into: prevalent, persistent (HPV+ for at least 4 months), HPV clearance (HPV+ followed by HPV-), HPV acquisition (HPV- followed by HPV+), and remaining HPV positive (two subsequent HPV+). Cox time-varying regression models were used to assess associations between HPV states and HIV acquisition.RESULTSAmong 91 HIV acquisition endpoints, HPV clearance increased HIV risk for high-risk types (16/18/31/33/35/45/52/58) (HR: 2.40, 95% CI: 1.59-3.62). Remaining HPV+ also showed a moderately increased risk (HR: 1.59, 95% CI: 1.07-2.35), while prevalent, persistent, and HPV acquisition events showed non-significant associations. Elevated HIV risk was also observed for clearance of HPV16/18, other high-risk types, low-risk types, and HPV6/11. There was also a dose-response relationship, with HIV risk increasing by 1.75-fold (95% CI: 1.55-1.96) for each additional HPV type cleared.CONCLUSIONSHPV clearance-related immune activation is strongly linked to HIV acquisition, likely due to increased CD4+ T cells and inflammation. These findings support HPV vaccination as a potential HIV prevention strategy and highlight the need to integrate HIV prevention into cervical cancer programs.
{"title":"Association of HPV on risk of HIV acquisition in african women: Analyses from MTN-020/ASPIRE.","authors":"Christine L Hathaway,Elizabeth R Brown,Stephen Cherne,Alyssa L Sepulveda,Zvavahera M Chirenje,Nitesha Jeenarain,Logashvari Naidoo,Samantha Siva,Nishanta Singh,Kubashni Woeber,Zakir Gaffoor,Brenda Gati Mirembe,Flavia Matovu Kiweewa,Leila E Mansoor,Lameck Chinula,Sufia Dadabhai,Nelly R Mugo,Thesla Palanee-Phillips,Ruanne V Barnabas","doi":"10.1093/jnci/djaf336","DOIUrl":"https://doi.org/10.1093/jnci/djaf336","url":null,"abstract":"BACKGROUNDObservational data on the synergy between HPV infection and risk for HIV acquisition are needed. HPV clearance, associated with an influx of cells targeted by HIV, may increase HIV risk. This study examined the association between HPV and HIV acquisition using endocervical swabs collected in MTN-020/ASPIRE.METHODSHealthy, sexually active women without HIV participating in the ASPIRE dapivirine ring study in Malawi, South Africa, Uganda, and Zimbabwe, provided endocervical swabs monthly, which were tested for HPV-DNA. HPV status was classified into: prevalent, persistent (HPV+ for at least 4 months), HPV clearance (HPV+ followed by HPV-), HPV acquisition (HPV- followed by HPV+), and remaining HPV positive (two subsequent HPV+). Cox time-varying regression models were used to assess associations between HPV states and HIV acquisition.RESULTSAmong 91 HIV acquisition endpoints, HPV clearance increased HIV risk for high-risk types (16/18/31/33/35/45/52/58) (HR: 2.40, 95% CI: 1.59-3.62). Remaining HPV+ also showed a moderately increased risk (HR: 1.59, 95% CI: 1.07-2.35), while prevalent, persistent, and HPV acquisition events showed non-significant associations. Elevated HIV risk was also observed for clearance of HPV16/18, other high-risk types, low-risk types, and HPV6/11. There was also a dose-response relationship, with HIV risk increasing by 1.75-fold (95% CI: 1.55-1.96) for each additional HPV type cleared.CONCLUSIONSHPV clearance-related immune activation is strongly linked to HIV acquisition, likely due to increased CD4+ T cells and inflammation. These findings support HPV vaccination as a potential HIV prevention strategy and highlight the need to integrate HIV prevention into cervical cancer programs.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surveillance mammography in older women-should we press on?","authors":"Kimberly Feigin","doi":"10.1093/jnci/djaf303","DOIUrl":"https://doi.org/10.1093/jnci/djaf303","url":null,"abstract":"","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarsha Yap, Qingwei Luo, Jeff Cuff, David Goldsbury, Xue Qin Yu, Yoon-Jung Kang, Benjamin D T Gallagher, Eleonora Feletto, Marianne Weber, Preston Ngo, Melissa A Merritt, Karen Canfell, David P Smith, Julia Steinberg
Cancer survival in Australia has improved over time, but disparities by socioeconomic status (SES) persist. We analyzed data from the population-wide New South Wales Cancer Registry, including 942,241 individuals with invasive solid cancers diagnosed 1980-2019. We examined cancer-specific and all-cause deaths by area-based SES for all solid cancers and 12 common cancers, using competing risks regression alongside crude survival. Five-year cancer-specific survival for all cancers improved from 50.3% in 1980-89 to 73.3% in 2010-19. Risk of cancer death was higher for individuals living in most socio-economically disadvantaged areas (versus least disadvantaged areas), and differences increased over time: from sub-hazard ratio 1.04 (95%CI : 1.02-1.07) in 1980-89, to 1.35 (95%CI : 1.32-1.38) in 2010-19 (adjusting for age, sex, cancer type, cancer spread). Statistically significant and increasing differences were observed for prostate, breast, melanoma, colorectal, lung, bladder and stomach cancers. Disparities in cancer survival have continued to widen, requiring improved understanding and targeted interventions to address inequities.
{"title":"Disparities in cancer survival by socioeconomic status: findings from a population-based study of 942,241 Australians from 1980 to 2019","authors":"Sarsha Yap, Qingwei Luo, Jeff Cuff, David Goldsbury, Xue Qin Yu, Yoon-Jung Kang, Benjamin D T Gallagher, Eleonora Feletto, Marianne Weber, Preston Ngo, Melissa A Merritt, Karen Canfell, David P Smith, Julia Steinberg","doi":"10.1093/jnci/djaf305","DOIUrl":"https://doi.org/10.1093/jnci/djaf305","url":null,"abstract":"Cancer survival in Australia has improved over time, but disparities by socioeconomic status (SES) persist. We analyzed data from the population-wide New South Wales Cancer Registry, including 942,241 individuals with invasive solid cancers diagnosed 1980-2019. We examined cancer-specific and all-cause deaths by area-based SES for all solid cancers and 12 common cancers, using competing risks regression alongside crude survival. Five-year cancer-specific survival for all cancers improved from 50.3% in 1980-89 to 73.3% in 2010-19. Risk of cancer death was higher for individuals living in most socio-economically disadvantaged areas (versus least disadvantaged areas), and differences increased over time: from sub-hazard ratio 1.04 (95%CI : 1.02-1.07) in 1980-89, to 1.35 (95%CI : 1.32-1.38) in 2010-19 (adjusting for age, sex, cancer type, cancer spread). Statistically significant and increasing differences were observed for prostate, breast, melanoma, colorectal, lung, bladder and stomach cancers. Disparities in cancer survival have continued to widen, requiring improved understanding and targeted interventions to address inequities.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fionnuala Crowley, Shane Belin, Tianxiu Wang, Allison Applebaum, Betty Ferrell, Roberta Flowers, Rebecca Sudore, Douglas White, Megan Crowley-Makota, Bernard Hammes, Robert Arnold, Yael Schenker
Background Advance care planning (ACP) may improve outcomes for patients with advanced cancer and their family caregivers, but the optimal approach is not known. This study compared the impact of facilitated vs patient-directed ACP on caregiver psychological symptoms and perceptions of goal-concordant EOL care. Methods Adult patients with advanced solid tumors and their caregivers were recruited from 8 oncology clinics in western Pennsylvania. Participants were randomly assigned to complete facilitated ACP with a trained nurse facilitator or patient-directed ACP using written and web-based tools. Caregivers were followed through bereavement and completed surveys assessing depression and anxiety symptoms (HADS, range 0-21, scores >7 indicative of significant symptoms), PTSD symptoms (IES-R, range 0-88, scores > 24 considered clinically significant), and validated measures of goal-concordant EOL care. Results Among 400 enrolled patients, 272 (68%) had an enrolled caregiver. Caregivers were predominantly female (73%), Caucasian (95%), and were spouses/partners (64%) of the patient with cancer. Among bereaved caregivers (n = 98), those in the facilitated ACP arm reported significantly fewer post-traumatic stress symptoms compared to the patient-directed arm (mean IES-R scores 23.9 vs 31.5, p = 0.01). Both depression and anxiety symptoms remained similar between arms (depression: 5.34 vs 5.87, p = 0.50; anxiety: 6.56 vs 6.72, p = 0.84) and low overall. Caregiver-reported goal-concordant care was higher in the facilitated ACP arm compared to the patient-directed arm (95.8% vs 75.5%, p = 0.01). Conclusion In this randomized trial comparing facilitated vs patient-directed ACP, a facilitated approach was associated with lower post-traumatic stress symptoms among bereaved caregivers and higher rates of goal-concordant EOL care.
背景：提前护理计划（ACP）可以改善晚期癌症患者及其家庭护理者的预后，但最佳方法尚不清楚。本研究比较了促进与患者导向的ACP对护理者心理症状和目标一致的EOL护理感知的影响。方法从宾夕法尼亚州西部8家肿瘤诊所招募成年晚期实体瘤患者及其护理人员。参与者被随机分配到由训练有素的护士协助完成辅助ACP或使用书面和基于网络的工具完成患者指导的ACP。护理人员在丧亲过程中被跟踪，并完成评估抑郁和焦虑症状（HADS，范围0-21，得分&；gt；7表示显著症状）、创伤后应激障碍症状（IES-R，范围0-88，得分&；gt； 24表示临床显著）的调查，以及目标一致EOL护理的验证措施。结果在400例入组患者中，272例（68%）有入组的护理人员。照顾者主要是女性（73%），白种人（95%），并且是癌症患者的配偶/伴侣（64%）。在丧失亲人的照顾者中（n = 98），与患者导向组相比，便利ACP组的人报告的创伤后应激症状显著减少（平均ees - r评分23.9比31.5,p = 0.01）。抑郁和焦虑症状在两组之间保持相似（抑郁：5.34 vs 5.87, p = 0.50；焦虑：6.56 vs 6.72, p = 0.84），总体较低。辅助ACP组的护理人员报告的目标一致性护理高于患者导向组（95.8% vs 75.5%, p = 0.01）。结论：在这项比较便利与患者导向ACP的随机试验中，便利的方法与丧失亲人的照顾者中较低的创伤后应激症状和较高的目标一致的EOL护理率相关。
{"title":"Advance Care Planning Impact on Caregivers and End-of-life Care in Advanced Cancer","authors":"Fionnuala Crowley, Shane Belin, Tianxiu Wang, Allison Applebaum, Betty Ferrell, Roberta Flowers, Rebecca Sudore, Douglas White, Megan Crowley-Makota, Bernard Hammes, Robert Arnold, Yael Schenker","doi":"10.1093/jnci/djaf331","DOIUrl":"https://doi.org/10.1093/jnci/djaf331","url":null,"abstract":"Background Advance care planning (ACP) may improve outcomes for patients with advanced cancer and their family caregivers, but the optimal approach is not known. This study compared the impact of facilitated vs patient-directed ACP on caregiver psychological symptoms and perceptions of goal-concordant EOL care. Methods Adult patients with advanced solid tumors and their caregivers were recruited from 8 oncology clinics in western Pennsylvania. Participants were randomly assigned to complete facilitated ACP with a trained nurse facilitator or patient-directed ACP using written and web-based tools. Caregivers were followed through bereavement and completed surveys assessing depression and anxiety symptoms (HADS, range 0-21, scores &gt;7 indicative of significant symptoms), PTSD symptoms (IES-R, range 0-88, scores &gt; 24 considered clinically significant), and validated measures of goal-concordant EOL care. Results Among 400 enrolled patients, 272 (68%) had an enrolled caregiver. Caregivers were predominantly female (73%), Caucasian (95%), and were spouses/partners (64%) of the patient with cancer. Among bereaved caregivers (n = 98), those in the facilitated ACP arm reported significantly fewer post-traumatic stress symptoms compared to the patient-directed arm (mean IES-R scores 23.9 vs 31.5, p = 0.01). Both depression and anxiety symptoms remained similar between arms (depression: 5.34 vs 5.87, p = 0.50; anxiety: 6.56 vs 6.72, p = 0.84) and low overall. Caregiver-reported goal-concordant care was higher in the facilitated ACP arm compared to the patient-directed arm (95.8% vs 75.5%, p = 0.01). Conclusion In this randomized trial comparing facilitated vs patient-directed ACP, a facilitated approach was associated with lower post-traumatic stress symptoms among bereaved caregivers and higher rates of goal-concordant EOL care.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145509576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background This study aimed to investigate the association of prediagnostic phytosterol intake (total phytosterols, β-sitosterol, campesterol, stigmasterol, β-sitostanol, and campestanol) with colorectal cancer (CRC)-specific and overall survival, and to explore the potential mediating role of systemic inflammation. Methods This study included 2,799 incident CRC patients enrolled in the Guangdong Colorectal Cancer Cohort between 2010 and 2021, who were prospectively followed until December 1, 2024. Usual dietary intake during the year before diagnosis was assessed using a validated food frequency questionnaire. Inflammatory markers were measured from fasting blood samples collected at enrollment, and the pan-immune-inflammation value (PIV) was calculated as neutrophil count × platelet count × monocyte count ÷ lymphocyte count. Multivariable Cox proportional hazards models and mediation analysis were conducted to assess associations between phytosterol intake, inflammation, and CRC survival, adjusting for demographic, clinical, and dietary confounders. Results During a median follow-up of 78.60 months, 717 deaths were recorded, of which 636 were attributable to CRC. Higher intakes of total phytosterols, β-sitosterol, and stigmasterol were significantly associated with improved CRC-specific survival (HRs for Q4 vs. Q1: 0.76 [95% CI: 0.60, 0.95], 0.71 [0.56, 0.90], and 0.75 [0.60, 0.95], respectively). Similar associations were observed for overall survival. The PIV showed a significant but modest mediating effect on the associations of β-sitosterol intake with CRC-specific and overall survival (indirect effect HRs = 0.99 [95% CI: 0.96, 1.00] for both; P = .016 and 0.018, respectively). Conclusions Higher prediagnostic dietary phytosterol intake was associated with improved CRC survival partially through inflammation-related pathways.
{"title":"Prediagnostic dietary phytosterol intake, inflammatory biomarkers, and colorectal cancer survival: a cohort study","authors":"Tiantian Wu, Qingjian Ou, Huan Xu, Yuanyuan Chen, Fangting Lin, Yujing Fang, Caixia Zhang","doi":"10.1093/jnci/djaf325","DOIUrl":"https://doi.org/10.1093/jnci/djaf325","url":null,"abstract":"Background This study aimed to investigate the association of prediagnostic phytosterol intake (total phytosterols, β-sitosterol, campesterol, stigmasterol, β-sitostanol, and campestanol) with colorectal cancer (CRC)-specific and overall survival, and to explore the potential mediating role of systemic inflammation. Methods This study included 2,799 incident CRC patients enrolled in the Guangdong Colorectal Cancer Cohort between 2010 and 2021, who were prospectively followed until December 1, 2024. Usual dietary intake during the year before diagnosis was assessed using a validated food frequency questionnaire. Inflammatory markers were measured from fasting blood samples collected at enrollment, and the pan-immune-inflammation value (PIV) was calculated as neutrophil count × platelet count × monocyte count ÷ lymphocyte count. Multivariable Cox proportional hazards models and mediation analysis were conducted to assess associations between phytosterol intake, inflammation, and CRC survival, adjusting for demographic, clinical, and dietary confounders. Results During a median follow-up of 78.60 months, 717 deaths were recorded, of which 636 were attributable to CRC. Higher intakes of total phytosterols, β-sitosterol, and stigmasterol were significantly associated with improved CRC-specific survival (HRs for Q4 vs. Q1: 0.76 [95% CI: 0.60, 0.95], 0.71 [0.56, 0.90], and 0.75 [0.60, 0.95], respectively). Similar associations were observed for overall survival. The PIV showed a significant but modest mediating effect on the associations of β-sitosterol intake with CRC-specific and overall survival (indirect effect HRs = 0.99 [95% CI: 0.96, 1.00] for both; P = .016 and 0.018, respectively). Conclusions Higher prediagnostic dietary phytosterol intake was associated with improved CRC survival partially through inflammation-related pathways.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trevor Kauer,Courtny L Franco,Dominique D Munroe,Mark Doescher,Electra D Paskett,Wade T Swenson,Katherine Y Tossas,James R Cerhan,Janice Krieger
Rural health disparities in the United States remain poorly understood, in part due to inconsistent definitions of "rurality" and the failure to integrate both geographic and socially constructed dimensions of place. This commentary draws from insights shared during the panel "Addressing Diversity in Cancer Prevention, Control, and Survivorship Within Rural Communities" at the 2024 Transforming Community and Rural Healthcare (TCRH) conference. Panelists emphasized the limitations of current rural-urban classification systems, which often overlook the intersectional identities, cultural heterogeneity, and lived experiences of rural populations. They advocated for integrating community-based participatory research (CBPR) and identity-based approaches to define rurality more holistically. Such methods prioritize self-identification, social determinants of health (SDOH), and localized knowledge, allowing for a more accurate assessment of cancer disparities and the development of equitable interventions. The commentary outlines how geophysical and census-based metrics, while convenient, can misrepresent rural communities and inadvertently perpetuate disparities in cancer care access, outcomes, and policy. The authors argue for an identity- and community-centered conceptualization of rurality that is dynamic, inclusive, and responsive to the complexity of rural life.
{"title":"Redefining Rurality: Adopting an Identity-Based and Community-Engaged Approach to Defining Rural Cancer Disparities.","authors":"Trevor Kauer,Courtny L Franco,Dominique D Munroe,Mark Doescher,Electra D Paskett,Wade T Swenson,Katherine Y Tossas,James R Cerhan,Janice Krieger","doi":"10.1093/jnci/djaf329","DOIUrl":"https://doi.org/10.1093/jnci/djaf329","url":null,"abstract":"Rural health disparities in the United States remain poorly understood, in part due to inconsistent definitions of \"rurality\" and the failure to integrate both geographic and socially constructed dimensions of place. This commentary draws from insights shared during the panel \"Addressing Diversity in Cancer Prevention, Control, and Survivorship Within Rural Communities\" at the 2024 Transforming Community and Rural Healthcare (TCRH) conference. Panelists emphasized the limitations of current rural-urban classification systems, which often overlook the intersectional identities, cultural heterogeneity, and lived experiences of rural populations. They advocated for integrating community-based participatory research (CBPR) and identity-based approaches to define rurality more holistically. Such methods prioritize self-identification, social determinants of health (SDOH), and localized knowledge, allowing for a more accurate assessment of cancer disparities and the development of equitable interventions. The commentary outlines how geophysical and census-based metrics, while convenient, can misrepresent rural communities and inadvertently perpetuate disparities in cancer care access, outcomes, and policy. The authors argue for an identity- and community-centered conceptualization of rurality that is dynamic, inclusive, and responsive to the complexity of rural life.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah Ophoff,Daniel Bos,N Tjarda Van Heek,Ben J Witteman,Johannes H W De Wilt,Karteek Popuri,M Faisal Beg,Renate M Winkels,Fränzel J B Van Duijnhoven,Edward L Giovannucci,Ellen Kampman,Dieuwertje E Kok
BACKGROUNDLiver fat accumulation has been associated with impaired colorectal cancer prognosis. Associations may differ for colon and rectal cancer due to different disease mechanisms and dissemination patterns. Here, we investigated associations between liver fat and cancer recurrence, recurrence-free survival (RFS), and overall survival (OS) among 1596 individuals with stage I-III colon or rectal cancer.METHODSWithin a prospective cohort study, we used data from adults recently diagnosed with colon (n = 1080) or rectal (n = 516) cancer. Liver fat was evaluated using routine contrast-enhanced CT-scans taken at diagnosis. Cox proportional hazards regression analyses adjusted for clinical and lifestyle-related variables were used to obtain hazard ratios (HRs) and 95% confidence intervals (95%CIs).RESULTSDuring a median follow-up of 6.4 and 8.8 years, 247 (15%) recurrences (12% for colon and 22% for rectal cancer) and 418 (26%) deaths (25% for colon and 29% for rectal cancer) occurred respectively. More liver fat was associated with an increased recurrence risk (HRT3vsT1 1.60, 95%CI 1.02 to 2.50), worse RFS (HRT3vsT1 1.45, 95%CI 1.05 to 2.00), and OS (HRT3vsT1 1.67, 95%CI 1.20 to 2.33) among individuals with colon cancer. Liver fat was not associated with recurrence (HRT3vsT1 0.70, 95%CI 0.42 to 1.18), RFS (HRT3vsT1 0.87, 95%CI 0.59 to 1.30), or OS (HRT3vsT1 1.15, 95%CI 0.74 to 1.80) among individuals with rectal cancer.CONCLUSIONMore liver fat was associated with poor clinical outcomes in patients with stage I-III colon cancer. Further studies are needed to confirm these findings and explore mechanistic routes linking liver fat to colon cancer prognosis.
{"title":"Liver fat and clinical outcomes in individuals with stage I-iii Colon or rectal cancer.","authors":"Deborah Ophoff,Daniel Bos,N Tjarda Van Heek,Ben J Witteman,Johannes H W De Wilt,Karteek Popuri,M Faisal Beg,Renate M Winkels,Fränzel J B Van Duijnhoven,Edward L Giovannucci,Ellen Kampman,Dieuwertje E Kok","doi":"10.1093/jnci/djaf324","DOIUrl":"https://doi.org/10.1093/jnci/djaf324","url":null,"abstract":"BACKGROUNDLiver fat accumulation has been associated with impaired colorectal cancer prognosis. Associations may differ for colon and rectal cancer due to different disease mechanisms and dissemination patterns. Here, we investigated associations between liver fat and cancer recurrence, recurrence-free survival (RFS), and overall survival (OS) among 1596 individuals with stage I-III colon or rectal cancer.METHODSWithin a prospective cohort study, we used data from adults recently diagnosed with colon (n = 1080) or rectal (n = 516) cancer. Liver fat was evaluated using routine contrast-enhanced CT-scans taken at diagnosis. Cox proportional hazards regression analyses adjusted for clinical and lifestyle-related variables were used to obtain hazard ratios (HRs) and 95% confidence intervals (95%CIs).RESULTSDuring a median follow-up of 6.4 and 8.8 years, 247 (15%) recurrences (12% for colon and 22% for rectal cancer) and 418 (26%) deaths (25% for colon and 29% for rectal cancer) occurred respectively. More liver fat was associated with an increased recurrence risk (HRT3vsT1 1.60, 95%CI 1.02 to 2.50), worse RFS (HRT3vsT1 1.45, 95%CI 1.05 to 2.00), and OS (HRT3vsT1 1.67, 95%CI 1.20 to 2.33) among individuals with colon cancer. Liver fat was not associated with recurrence (HRT3vsT1 0.70, 95%CI 0.42 to 1.18), RFS (HRT3vsT1 0.87, 95%CI 0.59 to 1.30), or OS (HRT3vsT1 1.15, 95%CI 0.74 to 1.80) among individuals with rectal cancer.CONCLUSIONMore liver fat was associated with poor clinical outcomes in patients with stage I-III colon cancer. Further studies are needed to confirm these findings and explore mechanistic routes linking liver fat to colon cancer prognosis.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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