American Journal of Clinical Oncology-Cancer Clinical Trials最新文献

Objectives: Patients with cancer may be at higher risk of heart disease from anticancer therapies. However, there is limited data on the risks of heart disease mortality after primary cancer site surgery. This study sought to evaluate the incidence, timing, and risk factors of heart disease mortality after primary cancer site surgery.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to perform a retrospective population-based study of cancer patients who underwent primary surgical resection from 2000 to 2020. The incidence of heart disease mortality after primary cancer site surgery was described by standardized mortality ratios (SMRs) and the timing of heart disease mortality after surgery was characterized. Risk factors were identified using Fine and Gray competing risk analysis.

Results: Among the 1,390,585 cancer patients who underwent primary surgical resection from 2000 to 2020, 178,303 (12.8%) died of heart disease. The SMR of heart disease death after surgery was 6.85 (95% CI: 6.82-6.88, P<0.001). SMRs were highest in cancers of the brain and other nervous system, esophagus, liver and intrahepatic bile duct, pancreas, and lung and bronchus. Approximately 50% of all heart disease deaths occurred within the first 5 years after surgery for all cancers. Risk factors included older age, male sex, Black race, unmarried status, and rurality.

Conclusions: The incidence of death from heart disease was significantly elevated in patients who underwent primary cancer site surgery compared with the general US population. These findings can be used to guide surgical planning and follow-up strategies.

Cancer is a major health threat in sub-Saharan Africa (SSA). Patient navigation has emerged as a strategy to address this, but the scope and impact of patient navigation for cancer care in SSA remains unclear. We aimed to comprehensively map the existing literature on patient navigation interventions for cancer care in SSA. A scoping review was conducted using a standardized 3-step search strategy. Eligible studies involved a patient navigation intervention for cancer care in SSA. Data were extracted on study, participant and navigator characteristics, intervention outcomes and implementation barriers and facilitators. Twenty-two studies describing 20 distinct interventions across 10 countries were included. Most studies were descriptive, focused on breast and cervical cancers and targeted the treatment stage of care. Navigator roles included patient education, psychosocial support, care coordination, and attenuation of patient barriers to care. Patient navigation appeared feasible, acceptable, and beneficial across a variety of study populations in this setting, but limited funding was a commonly reported barrier to maintenance. Cancer patient navigation is a promising strategy to improve cancer outcomes in SSA. Strategic investment is needed to support sustainable scale-up and maximize the impact of cancer patient navigation in the region.

Logistic models are everywhere in scientific research, including clinical and health research. However, there is no practical report on research results that will utilize many available statistical tools but mostly 1 or 2 only, for a logistic model. We introduce 6 powerful statistical tools, forest plot, AUC curve, nomogram, and decision curve analysis, as well as bootstrapping sampling and cross validation, by applying head and neck cancer data to a logistic model. We hope that these tools will make the logistic model, and accordingly our research, more comprehensive and clinically more applicable. In the 6 parts of the article, we introduce each of the 6 statistical tools (methods) with relevant figures and interpretations on key statistical concepts to show how we can improve our understanding on the logistic model and the clinical prospects behind the data. The statistical tools we present in the current special communication for reporting research or clinical trials in a logistic model, if popularized among researchers and clinicians, will make a research conclusion more comprehensive, valid and clinically applicable to other cases.

Objectives: This practice parameter was revised collaboratively by the American College of Radiology (ACR), and American Radium Society (ARS). Image-guided radiation therapy (IGRT) uses various imaging modalities to maximize the accuracy and precision of radiation treatment delivery.

Methods: This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS.

Results: This practice parameter for IGRT addresses qualifications and responsibilities of personnel, clinical IGRT implementation, documentation, quality control and improvement, safety, and patient education. Since the publication of the ACR-ASTRO Practice Parameter in 2019, there is now more clarity as to what criteria and parameters need to be documented in the medical record, a better appreciation of the large amount of imaging data, how to interpret such data, as well as the complex interactions of multiple systems in the implementation of IGRT.

Conclusions: This practice parameter assists practitioners in the clinical use of IGRT. IGRT should complement and be used in combination with other quality assurance processes. IGRT is a rapidly evolving field, and practitioners should have a thorough understanding of its strengths and potential limitations.

Objectives: To investigate the association between social determinants of health, as measured by the social vulnerability index (SVI), with outcomes in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).

Methods: This study included patients from Illinois with HPV-OPSCC from 2007 to 2022. State-level SVI measured neighborhood-level disadvantage and associations between SVI and clinicodemographic factors, clinical presentation, and outcomes were analyzed using logistic regression for advanced preliminary staging, while survival and recurrence were assessed within the framework of a Cox proportional hazards model.

Results: Higher overall (high vulnerability) and racial-ethnicity SVI scores were significantly associated with increased odds of advanced clinical staging (OR=1.12, P =0.041; OR=1.16, P =0.026) on univariable analysis. Multivariable analysis showed that minority race was significantly associated with advanced clinical staging (OR=5.50, P <0.001). Overall survival was significantly associated with insurance payer type and age, where Medicaid/uninsured status had higher mortality compared with Medicare in both the univariable and multivariable setting (HR=4.47, P =0.006; HR=7.93, P =0.019). The same held for age, where increased age at diagnosis was significantly associated with higher mortality (HR=1.07, P <0.001; HR=1.10, P <0.001). Recurrence-free survival was significantly associated with age (HR=1.04, P =0.004) and payer type, with Medicaid/uninsured patients having 4 times the hazard of patients with Medicare (HR=4.16, P =0.009).

Conclusions: Higher overall and racial ethnicity SVI may be associated with advanced clinical staging upon presentation. Individual factors such as race, age, and insurance status are significantly associated with patient prognosis.

Objectives: Human papillomavirus (HPV)-associated oropharynx cancer (OPC) requires accurate staging to guide treatment and de-escalation clinical trial enrollment. MRI provides superior soft tissue contrast and assessment of tumor depth of invasion compared with CT with contrast and FDG-PET/CT. This study aims to evaluate the prevalence of HPV-associated OPC tumor upstaging and newly identified retropharyngeal lymph node (RPLN) metastases with MRI.

Methods: Fifty consecutive patients with newly diagnosed, previously untreated HPV-associated OPC planned for treatment with primary radiotherapy at Memorial Sloan Kettering Cancer Center from March 04, 2024, to July 09, 2024, were included. All had histologic confirmation of p16-positive squamous cell carcinoma. Tumor staging and nodal assessment were independently completed by a radiation oncologist and a diagnostic neuroradiologist according to the eighth edition of the American Joint Committee on Cancer. MRI findings were compared with CT with contrast and FDG-PET/CT.

Results: The median patient age was 65, 84% were male, and 80% had <10 pack years of smoking history. Primary tumor sites included the base of tongue (50%), tonsil (48%), and glossotonsillar sulcus (2%). The rate of tumor upstaging with MRI was 12% (6/50), all 6 cases upstaged from T2 or T3 to T4. MRI identified RPLN metastases in 10% (5/50) of cases not identified on CT or PET/CT. Overall, 18% (9/50) of patients had either primary tumor upstaging or newly identified RPLN metastases based on MRI.

Conclusions: MRI leads to meaningful changes in tumor stage and RPLN detection in HPV-associated OPC. Staging MRI should be incorporated into treatment planning and de-escalation clinical trial enrollment.

Objectives: A survey was conducted to evaluate perceptions, use, and information sources of medical cannabis (MC) among patients with head and neck cancer and identify opportunities for providers to clarify its use.

Methods: Two hundred eighty-nine consecutive patients with head and neck cancer seen in the radiation oncology department at a single institution in CA (October 2022 to June 2023; November 2023 to January 2024) were screened for eligibility and invited to participate. Surveys were emailed. Demographic/clinical data were collected and recorded from the electronic health record and surveys, including age, gender, race, ethnicity, metastatic status, COVID-19 vaccination status, substance use history, relationship and employment status, and education level. Associations between clinical/socioeconomic factors and perception/use of MC were analyzed using χ 2 tests.

Results: Of 258 eligible patients, 122 completed the survey. Most reported reliance on the internet for MC information (70%); only 20% reported consulting with their cancer treatment team. Most (75%) agreed MC can help reduce cancer-related symptoms. Some agreed or were neutral regarding the potential of MC to cure cancer (37%) or prolong life (61%). Overall, 61% of patients reported having used MC, primarily for recreation (72%) or symptom relief (37%). MC use was more common among white ( P =0.001), unmarried ( P =0.001), and tobacco-using individuals ( P =0.045). COVID-vaccinated individuals more often believed MC reduces symptoms ( P =0.015).

Conclusion: Many patients rely on unregulated sources regarding MC. This highlights the potential for improved provider-patient discussions to support informed decision-making regarding risks, benefits, and questions of MC in cancer care.

Objectives: Breast cancer (BC) remains a critical public health issue where early detection significantly improves outcomes. Despite advancements, disparities in screening awareness and access persist, particularly in underserved populations. This study evaluates a comprehensive, technology-driven educational campaign designed to empower individuals to advocate for their breast health, bridging gaps in knowledge and accessibility.

Methods: Between 10/1/22 and 12/2/22, a multiplatform campaign was conducted with IRB approval. The initiative utilized traditional media, including televised ads and educational videos, and digital tools such as a mobile app and website in English and Spanish. Central to this campaign was an interactive risk calculator, offering personalized BC screening recommendations. Data collection included user demographics, platform engagement metrics, and the identification of high-risk individuals. A cost-effectiveness analysis was conducted using campaign budget data.

Results: The campaign reached 673,920 individuals through televised ads and 152,672 impressions by digital ads. The website garnered 930 unique impressions, while the app recorded 2752 downloads across 131 countries. The risk calculator was completed 637 times, identifying 72 high-risk individuals. Follow-up data revealed ongoing engagement, with the calculator used an additional 1468 times. The cost per conversion was $1.62, and the cost to identify a high-risk individual was $209.27, demonstrating remarkable cost-efficiency.

Conclusions: This campaign successfully increased BC awareness and early detection efforts, leveraging a cost-effective, multiplatform approach. The integration of personalized tools like the risk calculator underscores the potential of digital interventions in health education. Future efforts should build on this model to further enhance reach and health outcomes.

Objectives: This paper examines the life and research of Otto Warburg (1883 to 1970), who identified the so-called Warburg effect. Warburg personal life and scientific career were notable.

Methods: This study summarizes the key aspects of his life, the Warburg effect, and its significance in prostate cancer.

Results: Despite being classified as non-Aryan, Warburg continued his research as the director of the Kaiser Wilhelm Institute for Cell Physiology during World War II. He also cohabited openly with a male partner. The Warburg effect is a metabolic hallmark of cancer, where cells preferentially utilize glycolysis over oxidative phosphorylation, even in the presence of oxygen. This metabolic shift confers key advantages to tumor survival, including rapid ATP production, biosynthetic support for proliferation, and resistance to apoptosis. In prostate cancer, the metabolism undergoes a unique transformation. Normal prostate cells are characterized by citrate secretion; however, as malignancy develops, the cells adapt to oxidative metabolism. At the metastatic stage, the Warburg effect becomes more pronounced and is influenced by the tumor microenvironment and interactions with cancer-associated fibroblasts and bone marrow adipocytes. These metabolic changes have significant clinical implications. While FDG-PET scans serve as a diagnostic tool in many cancers, their utility in early-stage prostate cancer is limited owing to its delayed metabolic shift. Metabolic-targeted therapies, such as dichloroacetate (DCA) and glycolysis inhibitors, are emerging as promising strategies to enhance the efficacy of chemotherapy and radiotherapy.

Conclusions: Elucidating the role of metabolic reprogramming in prostate cancer could reveal new avenues for treatment, particularly for castration-resistant and metastatic diseases.