Modeling how iso-caloric macronutrient substitutions are longitudinally associated with plasma kynurenines in colorectal cancer survivors up to 12 months post-treatment

Dietary intake of several macronutrients is associated with plasma kynurenines after colorectal cancer (CRC), and kynurenines have been linked to health-related outcomes. It is unknown how macronutrient substitution affects plasma kynurenines, which may be relevant for developing guidelines to improve post-CRC quality of life through dietary changes. Using iso-caloric substitution models, we investigated how substituting one macronutrient with another is longitudinally associated with plasma tryptophan, kynurenines, and kynurenine ratios in CRC survivors. Measurements were performed at 6-weeks, 6-months, and 12-months post-treatment in 247 stage I-III CRC survivors. Macronutrient intake was measured by 7-d dietary records and plasma kynurenines by LC/MS-MS. For analysis, we applied linear mixed models with false discovery rate (FDR) to adjust for multiple testing. After FDR adjustment, substituting 100 kcal/d of total carbohydrates with 100 kcal/d of total protein was associated with higher plasma concentrations of kynurenic acid (KA), xanthurenic acid (XA), and a higher kynurenic acid-to-quinolinic acid (KA/QA) ratio. Substituting 100 kcal/d of total carbohydrates with 100 kcal/d of total fat was associated with higher tryptophan concentrations, higher KA/QA ratio, and a lower kynurenine-to-tryptophan ratio (KTR) and hydroxykynurenine ratio (HKr). Substituting 100 kcal/d of total fat with 100 kcal/d of total protein was associated with higher XA concentrations. Altogether, iso-caloric macronutrient substitutions, particularly substituting carbohydrates with protein or fat, were longitudinally associated with higher concentrations of potentially favourable kynurenines and ratios (i.e., KA, XA, and KA/QA ratio) and lower ratios with pro-inflammatory or neurotoxic properties (i.e., KTR and HKr) in CRC survivors up to 12-months post-treatment.

Unmet Care Needs of Colorectal Cancer Survivors in Taiwan and Related Predictors

BACKGROUND

Despite advancements in medical technology and early cancer detection, many colorectal cancer (CRC) survivors report unmet care needs after completion of their cancer treatment that compromise their quality of life (QoL). Previous studies on the care needs of cancer survivors have yielded inconsistent results, and few studies have been conducted on survivors of CRC in Taiwan or on predictors of their unmet care needs.

PURPOSE

The purpose of this study was to examine the unmet care needs, psychological distress, and QoL of Taiwanese CRC survivors ( n = 100) as well as to assess the mean differences by sociodemographic characteristics in their unmet care needs and other related predictors after treatment completion.

METHODS

This cross-sectional study using a purposive sampling method was conducted at a regional hospital in northern Taiwan between October 2019 and February 2020. The measurements used in this study included Chinese Cancer Survivors' Unmet Needs, Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Colorectal Cancer Module 29. The independent t test and one-way analysis of variance were employed to assess sociodemographic differences in unmet care needs, and multivariate linear regression was used to identify significant predictors.

RESULTS

More than half of the participants (63.2%) reported at least one unmet care need, with the highest categories including information needs ("signs and symptoms of cancer recurrence" 31.7% and "information related to health promotion" 31.7%), "medical care needs" ("managing health with the medical team" 13.9%), and "physical/psychological effect needs ("concerns about cancer recurrence" 23.8%). Also, 7%-57% of the participants experienced differing degrees of distress symptoms including fatigue, intestinal and urogenital dysfunctions, and anxiety or depression. The results of the univariate analyses showed unmet needs to differ significantly by age ( p = .021), employment status ( p = .007), and chronic disease status ( p = .025). The findings revealed being of older age (β = 0.23, p = .049), being employed (β = 0.26, p = .014), and having a lower functional level (β = -0.31, p = .012) to be associated with significantly higher levels of unmet care needs, collectively accounting for nearly 27.3% of the variance (adjusted R2 = .273).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

CRC survivors continue to experience unmet care needs and various forms of physical-psychological distress for an average of almost 2 years after their completion of CRC treatment. The findings of this study may assist healthcare providers in identifying the major risk factors that interfere with survivor care needs following treatment, thus facilitating the development of timely interventions to mitigate the impact of cancer on this vulnerable population.

Factors influencing health-related quality of life in patients with bladder or kidney cancer: a prospective cohort study of the impact of nutritional status and frailty phenotype

PURPOSE

This study aimed to investigate the impact of nutritional status and frailty phenotype and the predictors of temporal changes on health-related quality of life (HRQoL) of patients with bladder or kidney cancer.

METHODS

Frailty phenotype, Patient-Generated Subjective Global Assessment, and Quality-of-life questionnaire Core-30 were applied twice to patients diagnosed with bladder or kidney cancer. Patients also completed a sociodemographic questionnaire, and clinical data were collected from records.

RESULTS

Sixty-two individuals completed the study, mostly male, with a mean age of 62.5 (± 11.4) years. The median time of follow-up was 14.5 months. Role functioning, emotional functioning, and fatigue improved over time (p < 0.05). The factors that negatively affected the long-term quality of life summary score were being female, malnourished, pre-frail and frail, cancer treatment, performance status, and lower income. Using the multivariate model, being malnourished (β =  - 7.25; 95% CI, - 10.78 to - 3.71; p < 0.001), frail (β =  - 7.25; 95% CI, - 13.39 to - 1.11; p = 0.021), and each one-point increase in performance status (β =  - 6.9; 95% CI, - 9.54 to - 4.26; p < 0.001), were the ones that most negatively impacted the HRQoL between the two assessments.

CONCLUSION

This study confirmed that frailty, nutritional status, and performance status are the main predictors of HRQoL of patients with bladder or kidney cancer over time.

IMPLICATIONS FOR CANCER SURVIVORS

These findings may be the first step towards highlighting the importance of preventing malnutrition and frailty, in favor of a better long-term QoL for cancer patients.

Monitoring the presence of human papillomavirus in public areas indicates non-sexual transmission of the virus and environmental risk

BACKGROUND

In light of the potential for non-sexual transmission of human papillomavirus (HPV), this study aims to investigate the presence of α-HPV in public sanitary environments to explore the possibility of environmental transmission.

METHODS

Over a 30-day period, environmental samples were collected from three distinct areas across four locations, chosen based on their potential infection risk. The samples were analyzed for 23 HPV genotypes using real-time PCR.

RESULTS

A total of 360 environmental samples were collected during 30 days, with 87 samples testing positive for HPV (24.17%, 87/360). The positivity rates at the four locations-public restrooms, community health centers, obstetrics and gynecology hospitals, and general hospitals-were 13.33%, 14.44%, 30.00%, and 38.89%, respectively. Among the different sampling areas, door handles, washbasins, and squat toilets showed positive rates of 5.00%, 14.17%, and 53.33%, respectively. Of the HPV-positive samples, 53.8% exhibited moderate to high viral concentrations as defined by this study. A total of 19 HPV genotypes were detected, with high-risk types accounting for 88.46% and low-risk types for 11.54%. The five most frequently detected genotypes were 51, 16, 52, 58, and 56.

CONCLUSION

HPV was detected in all four locations, with a more pronounced positivity rate found in general hospitals and obstetrics and gynecology hospitals. Squat toilets exhibited the highest positivity rate among sampling areas. High-risk HPV types were significantly more prevalent than low-risk types, and positive rates were higher in the high and medium concentration groups compared to the low concentration group. Notably, high-concentration HPV residues can persist for up to 7 h. These findings suggest that public restroom may serve as potential sources of HPV transmission, with shared public areas such as door handles, washbasins, and squat toilets representing possible routes for non-sexual transmission of the virus.

Investigating the impacts of alcohol outlet zoning policy on alcohol consumption and access to non-alcoholic services: A spatial agent-based simulation

Debates continue over the effectiveness of limiting alcohol outlet density in reducing alcohol consumption, and its broader impacts on access to non-alcoholic services in low-income urban communities remain underexplored. This study addresses this gap by investigating the impacts of alcohol outlet zoning policies on alcohol consumption and walkable access to non-alcoholic services in low-income urban communities with different baseline densities of liquor and grocery stores. We developed a spatial agent-based model of Baltimore City neighborhoods, simulating the closure of non-conforming liquor stores following the city's zoning code rewrite. The model was calibrated using national survey data and empirical research on alcohol consumption and walkable access to alcohol, food, lottery, and ATM outlets by subgroups. We observed non-linear relationships and differences by gender and employment status in the effects of liquor store closures on heavy drinking, with policies showing limited effectiveness in neighborhoods with high baseline liquor store density. While the policies had minimal impact on access to food and ATMs due to high prevalence of grocery stores, they reduced access to lottery services. Our modeling approach serves as a valuable decision-making tool for policymakers to explore hypothetical scenarios, identify tipping points of policy impacts, and provide actionable insights into the complex interactions between zoning policies and neighborhood dynamics concerning alcohol consumption and access to essential goods and services.

Global, Regional and National Burden of Stomach Cancer and Its Prediction in 25 Years: A Cross-Sectional Study of the Global Burden of Disease Study 2021

Aims/Background Given the tremendous threat of stomach cancer (SC) to global public health, detailed information and dynamic updates on the SC health burden are needed to mitigate the repercussions. In this article, we present a systematic analysis of the global burden and trends of SC using data from the Global Burden of Disease (GBD) Study 2021, aiming to provide insights for forming effective global management and prevention strategies. Methods Stomach cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs) and the corresponding age-standardized rates (ASRs) were estimated. Then, trends of the disease burden were analyzed using the estimated annual percentage changes (EAPC). Lastly, we made a unique attempt to use two powerful and versatile techniques, autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models, to provide more comprehensive and accurate forecasts for future trends in the disease burden. Results Despite the steady decreasing trend in age-standardized rates, the total numbers of incidence, prevalence, and deaths all increased from 1990 to 2021. Subgroup analysis demonstrated great disparities in different age and gender groups, sociodemographic index (SDI) quintiles, GBD regions and countries. Both the ARIMA and ES models demonstrated a persistent rise in SC cases and a concurrent decline in ASRs, with the trend being more pronounced in males. Conclusion Since SC is already a significant health issue globally, it is expected that the estimated disease burden will continue to rise in the future. Therefore, global coordinated efforts are needed to implement effective screening projects, consolidate preventive measures and formulate targeted treatments to alleviate the SC burden.

Novel microsatellite instability test of sebaceous tumours to facilitate low-cost universal screening for Lynch syndrome

BACKGROUND

One in five patients with sebaceous tumours (STs) may have Lynch syndrome (LS), an inherited disorder that increases the risk of developing cancer. Patients with LS benefit from cancer surveillance and prevention programmes and immunotherapy. While universal tumour mismatch repair (MMR) deficiency testing is recommended in colorectal and endometrial cancers to screen for LS, there is no consensus screening strategy for STs, leading to low testing rates and inequity of care.

OBJECTIVES

To assess a low-cost and scalable sequencing-based microsatellite instability (MSI) assay, previously shown to enhance LS screening of colorectal cancers, for MMR deficiency detection in STs against the current clinical standard of immunohistochemistry (IHC).

METHODS

Consecutive ST cases (n = 107) were identified from the records of a single pathology department. MMR protein IHC staining was interpreted by a consultant histopathologist. MSI analysis used amplicon sequencing of 14 microsatellites and a naive Bayesian classifier to calculate the sample MSI score.

RESULTS

Loss of MMR protein expression was observed in 49/104 STs with interpretable IHC [47.1%, 95% confidence interval (CI) 37.3-57.2]. MMR deficiency was less frequent in carcinoma than in adenoma and sebaceoma (P = 4.74 × 10-3). The majority of MMR-deficient STs had concurrent loss of MSH2 and MSH6 expression. The MSI score achieved a receiver operator characteristic area under curve of 0.944 relative to IHC. Lower MSI scores were associated with MSH6 deficiency.

CONCLUSIONS

These data support MSI testing as an adjunct or alternative to MMR IHC in STs. Integration of STs into established LS screening pathways using this high-throughput methodology could increase testing and reduce costs.

Quality of life after two sequences of total neoadjuvant treatment in patients with locally advanced rectal cancer in the randomized CAO/ARO/AIO-12 phase 2 trial

BACKGROUND AND PURPOSE

In a multicenter phase 2 trial the sequence of chemoradiotherapy (CRT) followed by consolidation chemotherapy (CT) prior to total mesorectal excision demonstrated higher pathological complete response rates than induction CT before CRT. Here, we present findings on quality of life (QoL).

MATERIALS AND METHODS

Patients with rectal carcinoma (cT3-4 cN0-2) were randomly assigned to group A (CT+CRT; N=156) or group B (CRT+CT; N=150). This is a secondary QoL analysis (EORTC QLQ-C30+CR29, Wexner) before and during treatment and of disease-free patients during follow-up.

CLINICALTRIALS

gov identifier: XXXX.

RESULTS

At baseline, completed questionnaires were available for 86% (N=134/156; group A) and 89% (N=133/150; group B) of participants, with availability decreasing to 73% versus 64% at 1 year, 61% versus 59% at 2 years, and 51% versus 47% at 3 years. Global health status remained stable in both groups (range 0-100) with baseline scores of 65.2 (mean, SD=21.5; N=133; group A) and 64.7 (SD=23.2; N=131; group B) and with scores of 67.6 (SD=18.4; N=52) and 65.4 (SD=22.2; N=46), respectively, at 3 years. No statistically or clinically relevant differences were observed between groups in any QoL scale upon treatment completion or during follow-up. Both groups experienced declines in role functioning, body image, male impotence, and stool incontinence (Wexner), which did not fully recover over the follow-up period. Rectal blood/mucus discharge and anxiety improved during treatment.

CONCLUSIONS

QoL did not differ between the two total neoadjuvant treatment sequences. QoL domains with long lasting deterioration may serve as endpoints in future studies focused on organ preservation.

Long-term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers: A 20-year prospective cohort study

BACKGROUND AND AIMS

Amid questions about a perceived association between low-to-moderate alcohol consumption and reduced cardiovascular risk from recent studies, research examining the impact of alcohol consumption on cardiometabolic risk markers has reported inconsistent results. We measured the association between long-term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers.

DESIGN, SETTING AND PARTICIPANTS

A prospective cohort analysis was conducted using data from a population-based cohort (2001-2020) of 4708 Koreans aged 40-69 years who were free of chronic diseases, including metabolic syndrome, at baseline.

MEASUREMENTS

Alcohol consumption and incident cases related to cardiometabolic risk markers were assessed biennially using interviewer-administered questionnaires or health examinations. The average alcohol intake was calculated to reflect long-term consumption. Alcohol consumption was categorized as none or rarely (0-2 g/day), light (2 < -16 g/day, within guideline limits), medium (16 < -32 g/day) and heavy (>32 g/day).

FINDINGS

After full adjustment for covariates, light, medium or heavy alcohol consumption was positively associated with metabolic syndrome [hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.32-1.83], abdominal obesity (HR = 1.41, 95% CI = 1.17-1.70), hyperglycemia (HR = 1.91, 95% CI = 1.62-2.26), high blood pressure (HR = 2.04, 95% CI = 1.72-2.41) and hypertriglyceridemia (HR = 1.59, 95% CI = 1.30-1.93), with the results presented for heavy alcohol consumption only (p-values for trend <0.001 for all cases). By sex, positive associations between light alcohol intake and hyperglycemia and high blood pressure were observed only in women (p-values for interaction and p-values for trend <0.05 for all cases).

CONCLUSIONS

Long-term light (within guideline limits), medium or heavy alcohol consumption appears to be positively and linearly associated with incident health risk conditions related to cardiometabolic risk markers. The threshold dose of alcohol for developing hyperglycemia and high blood pressure appears to be lower in women.

The association between health-related quality of life and five-year overall survival among head and neck cancer patients: A prospective cohort study

OBJECTIVE

To estimate associations between health-related quality of life (HRQOL) at baseline (T0), six months after treatment (M6), and change in HRQOL (T0-M6) and five-year overall survival (OS) among head and neck cancer (HNC) patients, after adjusting for potential confounders. Furthermore, we explored whether personal, clinical, physical, psychological, social, lifestyle, HNC-related and biological factors moderate the association.

METHODS

Data of a prospective multi-center cohort study (NET-QUBIC) was used. In this specific study, patients with HRQOL data at T0 (n = 596), M6 (n = 489), and T0 and M6 (n = 463) were included. HRQOL was operationalized by the EORTC QLQ-C30 global quality of life subscale (QL) and summary score (SumSc). Cox regression analyses investigated associations between HRQOL and OS, adjusted for confounders, and explored which variables moderate the association.

RESULTS

Adjusted models showed that higher baseline QL (HR: 0.85 (95% CI: 0.76-0.96)) and SumSc (HR: 0.90 (95% CI: 0.81-0.99)) were associated with longer OS. Adjusted M6 models and adjusted T0-M6 models found no such association. The association between QL and OS was moderated by sex (significant among males) and mean arterial blood pressure (BP) (significant for patients with high BP). The association between SumSc and OS was moderated by coping (significant for patients with no avoidant coping style) and systemic BP (significant for patients with normal BP).

CONCLUSION

Higher HRQOL at baseline (how patients enter the cancer trajectory) was associated with longer OS, but (change in) HRQOL at 6 months (how they overcome cancer treatment) was not. This knowledge is important to personalize treatment plans.

Characterizing the Social Epigenome in Mexican Patients with Early-Onset Psychosis

Background: Psychosis is one of the leading causes of disability worldwide. Individuals with early-onset psychosis (EOP) tend to experience a worse prognosis and shorter life expectancy. The etiology of EOP remains unclear, but epigenetic mechanisms are known to serve as the interface between environmental exposures and biological processes to better understand its etiology. Objectives: We characterized the sociodemographic and clinical characteristics, as well as genome-wide epigenetic markers, in Mexican patients with EOP. Methods: We estimated epigenetic age, performed an epigenome-wide association study, and finally developed an epigenetic risk score (MRS) to predict manifestations of psychosis. Results: We found that patients with EOP have a higher epigenetic age using Wu's clock (p = 0.015). Moreover, accelerated epigenetic age was correlated with chronological age (PedBE clock, p = 0.046), global functioning (Wu's clock, p = 0.027), and psychiatric admissions (DNAmTL, p = 0.038). In addition, we observed that a reduction in years of schooling is associated with an increase on epigenetic age (Levine's clock, β = 5.07, p = 0.001). In our epigenome-wide association study, we identified eight CpGs associated with EOP. Noteworthy, a psychosis-methylation risk score (EOP-MRS) was associated with panic disorder (β = 1.36, p = 0.03), as well as auditory (β = 1.28, p = 0.04) and visual (β = 1.22, p = 0.04) hallucinations. Conclusions: Years of education have an impact on epigenetic age. Additionally, our study suggests associations of DNA methylation with EOP. Finally, we developed an MRS that associates clinical manifestations of psychosis.

The association of sweetened beverage intake with risk of type 2 diabetes in an Australian population: A longitudinal study

AIM

Globally, sugar intake from sugar-sweetened beverages (SSBs) exceeds the daily recommended limits for intake levels of free sugar. Artificially sweetened beverages (ASBs), widely used to replace SSBs, are increasingly linked to adverse health outcomes. Hence, we assessed the association of sweetened beverage intake (SSBs and ASBs) with the risk of type 2 diabetes (T2DM).

METHODS

Data from the Melbourne Collaborative Cohort Study (MCCS) on 36,608 individuals aged 40 to 69 years were used. Self-reported data on diabetes were collected. The frequency of SSBs and ASBs consumption was categorized as: never or < 1 time/month; 1-3 per month; 1-6 times per week; ≥1 time / day. The association of sweetened beverage intake with the incidence of T2DM was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic, and other confounders.

RESULTS

Intakes of SSBs and ASBs were associated with an increased risk of T2DM. A high intake (≥ 1 time/day) compared to a low intake (never or < 1 time / month) was associated with increased risk of T2DM for SSB intake (incidence risk ratio (IRR) = 1.23; 95% CI: 1.05-1.45; P for trend = 0.006) and for ASB intake (IRR = 1.38; 95% CI: 1.18-1.61; P for trend < 0.001). Further adjustment for body mass index (BMI) and waist-to hip ratio (WHR) eliminated the association for SSBs, but not ASBs intake.

CONCLUSIONS

Both sugar and artificially sweetened beverages were linked to an increased risk of T2DM. The findings highlight the need for public health measures to control the intake of sweetened beverages.

A narrative review on alcohol and alimentary tract cancer with special emphasis on acetaldehyde and oxidative stress

Approximately 4% of all cancer cases worldwide are caused by alcohol consumption (oropharynx, larynx, esophagus, stomach, colorectum, liver and the female breast). Various mechanisms contribute to ethanol-mediated carcinogenesis, including the action of acetaldehyde, the first metabolite of ethanol oxidation and oxidative stress primarily promoted through the induction of cytochrome P4502E1. Acetaldehyde is toxic and carcinogenic, binds to DNA and proteins, inhibits the oxidative defense- and the nuclear repair system, and prevents DNA methylation. High levels of acetaldehyde occur through increased production in the presence of a hyperactive alcohol dehydrogenase (ADH1C*1,1) or decreased degradation in the presence of low active aldehyde dehydrogenase (ALDH2*1,2). In addition, microbes of the upper alimentary tract and the colorectum effectively produce acetaldehyde from ethanol. In addition, ethanol induces cytochrome P4502E1 resulting in an enhanced ethanol metabolism and the generation of reactive oxygen species (ROS). ROS may cause lipid peroxidation (LPO) with the LPO-products 4-hydroxynonenal or malondialdehyde, which may form highly carcinogenic etheno DNA-adducts CYP2E1 is also involved in the activation of a variety of dietary and tobacco procarcinogens and in the degradation of retinoic acid. Alcohol also influences tumor promotion, such as epigenetics with a change in DNA methylation and histone modification, and affects a variety of cancer genes and signaling pathways. Preventive measures include reducing alcohol consumption, quitting smoking and keeping good oral hygiene. Alcohol consumers - especially when they smoke or belong to genetic risk groups - should be regularly checked for cancer of the upper alimentary tract, for alcohol- associated liver disease, and for breast cancer. Cessation or reduction of alcohol consumption definitively reduces cancer risk.

Allergic disease and risk of multiple myeloma: A case-control study

BACKGROUND AND AIMS

Multiple myeloma (MM) is responsible for significant morbidity and mortality, yet our knowledge regarding MM aetiology remains limited. We investigated whether a history of allergic conditions is associated with MM risk.

METHODS

Incident cases (n = 782) of MM were recruited via cancer registries in Victoria and NSW. Controls (n = 733) were siblings (n = 436) or spouses (n = 297) of cases. Unconditional logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for associations between self-reported allergic conditions (asthma, eczema, food allergy, hay fever) and MM risk.

RESULTS

Eczema was inversely associated with MM risk (OR = 0.54, 95 %CI = 0.42-0.70), as was a combined history of food allergy and eczema (OR = 0.52, 95 %CI = 0.29-0.93). There was an inverse association between a history of any allergic condition (compared with none) and risk of MM (OR = 0.68, 95 %CI = 0.55-0.84). In the mean-centred dose-risk analysis the OR was 0.87 (95 %CI = 0.73-1.04) per additional allergic condition of interest. No notable associations were identified for food allergy, asthma, or hay fever alone.

CONCLUSIONS AND FUTURE DIRECTIONS

We found that a history of allergic disease, particularly eczema, was associated with reduced MM risk. Further research is recommended to confirm findings and investigate potential mechanisms.

Impact of sleep disturbances due to low anterior resection syndrome on the quality of life of patients with rectal cancer

PURPOSE

We aimed to analyze the effects of nighttime symptoms on quality of life of patients with low anterior resection syndrome (LARS) and determine the correlation between nighttime symptoms and insomnia.

METHODS

A single-center observational study was conducted on patients with rectal adenocarcinoma who underwent sphincter-preserving surgery at Seoul National University Hospital between 2019 and 2023. Eligible patients were surveyed during routine outpatient follow-up. The primary outcomes were bowel function assessed by the Low Anterior Resection Syndrome (LARS) score including nighttime symptoms and sleep disturbance evaluated using the Insomnia Severity Index (ISI).

RESULTS

Among 100 patients, 85 (85.0 ​%), nine (9.0 ​%), and six (6.0 ​%) underwent low anterior, ultra-low anterior, and intersphincteric resection, respectively; 86 (86.0 ​%) had LARS, and 58 (58.0 ​%) had nighttime symptoms. Further, 69 patients (98.6 ​%) met the criteria for insomnia. The LARS score and ISI were positively correlated (p ​= ​0.047). Differences in the frequency of bowel movements (p ​= ​0.015) and nighttime symptoms (p ​= ​0.046) were noted between the no/mild insomnia and moderate/severe insomnia groups. Physical and social functioning were lower (p ​= ​0.004 and p ​= ​0.007, respectively) and stool frequency (p ​= ​0.018), embarrassment caused by defecation pattern (p ​= ​0.025), and sore skin around the anus (p ​= ​0.006) were more severe in the moderate/severe insomnia group.

CONCLUSIONS

LARS and insomnia showed a significant correlation; no significant correlation was found between the occurrence of nighttime symptoms and insomnia.

The positive relationship between the Alternative Healthy Diet Index and serum klotho levels: A cross-sectional analysis in middle-to-older Americans

BACKGROUND AND AIM

The Alternative Healthy Eating Index (AHEI-2010) is a dietary index associated with chronic diseases and serves as an important metric for assessing the healthiness of one's diet. Serum Soluble Klotho (S-Klotho) is a protein related to anti-aging. There is currently a lack of research on the relationship between AHEI and S-Klotho. This study evaluated the relationship between the AHEI index and S-Klotho in the U.S. middle-aged and elderly population from the National Health and Nutrition Examination Survey (NHANES) 2011-2016.

METHODOLOGY

This study includes 6,305 middle-aged and elderly participants (aged 40-79 years old). The interrelationship between the AHEI-2010 and S-klotho concentration was explored using multivariate regression models, and the nonlinear relationship between the two was investigated through curve fitting. The stability of this relationship in different populations was explored through subgroup analysis.

RESULTS

There was a positive correlation between AHEI and S-klotho (β=1.1, 95% CI: 0.1, 2.1, P = 0.035). The multivariate-adjusted β and 95% confidence intervals (CIs) from the lowest to the highest AHEI-2010 categories (＜31.9, 31.9-39.3, 39.3-47.9, and > 47.9) were 0.0 (reference), 15.7 (-13.5, 44.9), 12.5 (-16.5, 41.6), and 31.9 (2.9, 60.9), respectively. The curve fitting found that the relationship between AHEI-2010 and S-Klotho is essentially linear, with S-Klotho levels increasing linearly as AHEI improves.

CONCLUSION

AHEI is positively associated with S-Klotho levels in American middle-to-older adults. Further research is needed to elucidate the causal relationship and specific mechanisms.

Cigarette smoke modulates methylation levels of LEF1-AS1 and impedes its expression: An experimental study

INTRODUCTION

Cigarette smoke (CS) contains carcinogenic substances and influences genetic regulation and epigenetic modifications, such as DNA methylation. It plays a role in the development of various cancers, including colon, bladder, lung cancer, and leukemia. Long non-coding RNAs play a significant role in controlling several pathways in the cell, including lymphoid enhancer-binding factor 1 antisense RNA 1 (LEF1-AS1), which is found overexpressed in lung, oral, glioblastoma, and colon cancers and downregulated in leukemias. We investigated the impact of CS on DNA methylation of the promoter region of LEF1-AS1 as well as its expression in endothelial cells.

METHODS

This experimental study was designed to investigate the effects of cigarette smoke on the methylation status of the promoter region of LEF1-AS1 in smoker and non-smoker samples and its expression in relevant cell models. To measure the alternations of DNA methylation, extracted DNA samples from 64 male subjects (32 smokers and 32 non-smokers) were bisulfite-treated and amplified using polymerase chain reaction (PCR) with methylation-specific PCR primers. Furthermore, to define the impact of CS on LEF1-AS1 expression, human umbilical vein endothelial cells (HUVECs) were fed with media containing CS for 3 and 6 hours. The expression analysis of LEF1-AS1 was performed using the GTEx (Genotype-Tissue Expression) database, including an assessment of its expression in various cancers such as lung and brain cancers. The functional analysis of the LEF1-AS1 gene was conducted across multiple tissues using data from the GENT2 databases, along with meta-survival and functional enrichment analysis.

RESULTS

The results indicated an average increase of 19.8% in DNA methylation of the promoter region of LEF1-AS1 in the samples from the smokers compared with those from the non-smokers, as well as a significant reduction of LEF1-AS1 expression level in the HUVECs (45% and 83%) after treatment with CS (3 and 6 Hours), respectively. LEF1-AS1 expression varied significantly across tumor types when compared to their normal counterparts. Some cancers, such as lung and brain, showed increased expression, suggesting cancer-specific overexpression of LEF1-AS1. Variability in expression across cancers and normal tissues implies potential heterogeneity in gene regulation. A meta-survival analysis of the LEF1-AS1 gene (e.g. GSE31546, GSE31548, GSE19188), revealed hazard ratios (HR) ranging widely, with some studies (e.g. GSE31546, HR=12.02) suggesting increased risk, though confidence intervals often included 1, indicating uncertainty. Low heterogeneity (I2=16%, p=0.26) suggests consistency among studies, but the overall findings lack strong statistical significance.

CONCLUSIONS

Our findings indicate that CS alters LEF1-AS1 DNA methylation and causes an inhibition of LEF1-AS1 expression.

Flexibility in patient-reported outcome and health-related quality of life measurement: The EORTC Quality of Life Group measurement strategy

The development of the first European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) health-related quality of life (HRQoL) questionnaires contributed to the systematic uptake of HRQoL as an endpoint in cancer clinical trials, and to the measurement of HRQoL for individual assessment in routine care. Following a modular approach, these patient-reported outcome (PRO) measures (PROMs) ensure that both generic and disease-specific issues are assessed, enabling comparison of PROs across groups and studies. The application of a comprehensive and continually refined methodology for developing and updating these PROMs has been crucial in supporting their psychometric and cross-cultural validity, and their continued implementation in clinical research. However, the advancement of measurement science, the more widespread implementation of PROMs, and the significant evolution of anti-cancer therapies over the last decades have highlighted the need to adopt more flexible approaches to PRO assessment to ensure that PROMs remain relevant and fit-for-purpose. The QLG has responded to this call by implementing more tailored PRO measurement approaches through the development and release of the computerised adaptive test (CAT) version of the EORTC QLQ-C30 (i.e., the EORTC CAT Core) and the EORTC Item Library. The EORTC Item Library is an interactive online platform that allows for the creation of customised questionnaires (item lists) from the pool of available items derived from established EORTC QLG PROMs. The aim of this article is to describe the current EORTC QLG approach to PRO measurement in oncology, covering important historical developments and best practice recommendations.

Longitudinal associations of dietary intake with fatigue in colorectal cancer survivors up to 1 year post-treatment, and the potential mediating role of the kynurenine pathway

INTRODUCTION

A healthy diet may help to reduce cancer-related fatigue, but evidence is limited and mechanisms remain unclear. Both diet and fatigue following colorectal cancer (CRC) have been linked to metabolites (kynurenines) of the kynurenine pathway (KP). We investigated longitudinal associations between dietary intake and fatigue, and the potential mediating role of the KP, in CRC survivors up to 1 year post-treatment.

METHODS

Measurements at 6 weeks, 6 months, and 1 year post-treatment were performed in 209 stage I-III CRC survivors. Diet was assessed by 7-day food records. Plasma kynurenines were analyzed using LC-MS/MS. Fatigue, including subjective fatigue, was assessed using validated questionnaires. To analyse longitudinal associations between diet and fatigue and to explore potential mediation by the KP, we used confounder-adjusted multilevel parallel-multiple mediator models with all kynurenines included simultaneously, and simple mediator models with established KP ratios to estimate total (c: diet-fatigue), direct (c': diet-fatigue, while controlling for mediators), metabolite-specific indirect (ab: diet-metabolite-fatigue), and total indirect (ab: diet-metabolites-fatigue) effects.

RESULTS

Higher intake of total carbohydrates and mono- and disaccharides was longitudinally associated with more subjective fatigue, while higher intake of plant protein, total fat, and unsaturated fats was associated with less subjective fatigue (c). Most associations remained statistically significant after controlling for KP metabolites, except for mono- and disaccharides (c'). All kynurenines simultaneously did not mediate longitudinal associations between diet and subjective fatigue (ab). The kynurenic acid-to-quinolinic acid (KA/QA) ratio significantly mediated associations of intakes of carbohydrate, mono- and disaccharides, alcohol, magnesium, and zinc with subjective fatigue, whereas the HKr significantly mediated the association between polysaccharide intake and subjective fatigue (ab).

CONCLUSION

Our findings suggest that carbohydrate intake is associated with greater fatigue, while protein and fat intake are associated with lower fatigue in CRC survivors up to 1 year post-treatment. While all KP metabolites simultaneously did not significantly mediate associations between diet and fatigue in our population, the KA/QA ratio and HKr were significant mediators in several diet-fatigue associations. These results should be repeated in larger observational studies.

Alcohol intake and pancreatic cancer risk: An analysis from 30 prospective studies across Asia, Australia, Europe, and North America

BACKGROUND

Alcohol is a known carcinogen, yet the evidence for an association with pancreatic cancer risk is considered as limited or inconclusive by international expert panels. We examined the association between alcohol intake and pancreatic cancer risk in a large consortium of prospective studies.

METHODS AND FINDINGS

Population-based individual-level data was pooled from 30 cohorts across four continents, including Asia, Australia, Europe, and North America. A total of 2,494,432 participants without cancer at baseline (62% women, 84% European ancestries, 70% alcohol drinkers [alcohol intake ≥ 0.1 g/day], 47% never smokers) were recruited between 1980 and 2013 at the median age of 57 years and 10,067 incident pancreatic cancer cases were recorded. In age- and sex-stratified Cox proportional hazards models adjusted for smoking history, diabetes status, body mass index, height, education, race and ethnicity, and physical activity, pancreatic cancer hazard ratios (HR) and 95% confidence intervals (CI) were estimated for categories of alcohol intake and in continuous for a 10 g/day increase. Potential heterogeneity by sex, smoking status, geographic regions, and type of alcoholic beverage was investigated. Alcohol intake was positively associated with pancreatic cancer risk, with HR30-to-<60 g/day and HR≥60 g/day equal to 1.12 (95% CI [1.03,1.21]) and 1.32 (95% CI [1.18,1.47]), respectively, compared to intake of 0.1 to <5 g/day. A 10 g/day increment of alcohol intake was associated with a 3% increased pancreatic cancer risk overall (HR: 1.03; 95% CI [1.02,1.04]; pvalue < 0.001) and among never smokers (HR: 1.03; 95% CI [1.01,1.06]; pvalue = 0.006), with no evidence of heterogeneity by sex (pheterogeneity = 0.274) or smoking status (pheterogeneity = 0.624). Associations were consistent in Europe-Australia (HR10 g/day = 1.03, 95% CI [1.00,1.05]; pvalue = 0.042) and North America (HR10 g/day = 1.03, 95% CI [1.02,1.05]; pvalue < 0.001), while no association was observed in cohorts from Asia (HR10 g/day = 1.00, 95% CI [0.96,1.03]; pvalue = 0.800; pheterogeneity = 0.003). Positive associations with pancreatic cancer risk were found for alcohol intake from beer (HR10 g/day = 1.02, 95% CI [1.00,1.04]; pvalue = 0.015) and spirits/liquor (HR10 g/day = 1.04, 95% CI [1.03,1.06]; pvalue < 0.001), but not wine (HR10 g/day = 1.00, 95% CI [0.98,1.03]; pvalue = 0.827). The differential associations across geographic regions and types of alcoholic beverages might reflect differences in drinking habits and deserve more investigations.

CONCLUSIONS

Findings from this large-scale pooled analysis support a modest positive association between alcohol intake and pancreatic cancer risk, irrespective of sex and smoking status. Associations were particularly evident for baseline alcohol intake of at least 15 g/day in women and 30 g/day in men.

Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center

PURPOSE

Colorectal cancer (CRC) significantly impacts the quality of life (QoL) of survivors, yet detailed assessments of long-term QoL are sparse. This study evaluates QoL among CRC survivors, examining the influence of different treatments and patient characteristics on outcomes.

METHODS

We conducted a cross-sectional study at a tertiary cancer center in Portugal, enrolling CRC patients who underwent curative surgery from 2013 to 2022. QoL was assessed using the EORTC QLQ-C30 and QLQ-CR29 at 1-, 3-, 5-, and 10-year follow-up intervals. Subgroup analyses were performed based on tumor location, radiotherapy administration, chemotherapy administration, presence of a stoma, and time since treatment, with sociodemographic and clinical factors examined on univariate and multivariate analysis.

RESULTS

Of the 825 eligible patients, 324 were invited and 179 participated (response rate: 55.2%). Overall, patients reported high global QoL and functional scores with low symptom scores, comparable to those of the general population. However, rectal cancer survivors experienced poorer outcomes in role and social functioning, body image, and symptom management. Those receiving radiotherapy or chemotherapy reported more symptoms, with chemotherapy recipients showing lower functional scores. Patients with a stoma had significantly lower QoL across functional and symptom scales. Long-term survivors reported decreased physical functioning. Multivariate analysis identified female gender, open surgery, and chemotherapy as factors associated with reduced QoL.

CONCLUSION

This study highlights significant disparities in QoL outcomes between CRC survivors, with QoL influenced by gender, cancer location, radiotherapy or chemotherapy, stoma presence, and survivorship duration, underscoring the need for personalized support programs and tailored care plans.

Drinking pattern and time lag of alcohol consumption with colorectal cancer risk in US men and women

BACKGROUND

Association between light to moderate alcohol consumption and colorectal cancer (CRC) incidence remains understudied, especially regarding drinking pattern, beverage type, and temporal aspects.

METHODS

Hazard ratios (HRs) and 95% confidence intervals (CIs) for time to CRC diagnosis were estimated among 137 710 participants. Estimates based on remote (eg, >10 years before follow-up) and recent (eg, the preceding 10 years before follow-up) alcohol intake, using different cutoffs (eg, 8, 10, 12 years) and mutual adjustment, enabled separating independent effects and investigating time lag of alcohol-CRC association.

RESULTS

In total, 3599 CRC cases were documented over 3 decades. Light to moderate drinking was associated with an increased CRC risk only in men: HR (95% CI) for 5-14.9 and 15-29.9 vs 0 g/day of alcohol intake was 1.19 (1.01 to 1.41) and 1.38 (1.13 to 1.67). In women, that for 0.1-4.9 and 5-14.9 vs 0 g/day of alcohol was 1.07 (0.96 to 1.20) and 1.05 (0.91 to 1.20). Drinkers with both high drinking frequency and daily intake had the highest CRC risk, suggesting total alcohol intake was the critical factor. We estimated the time lag between alcohol consumption and CRC occurrence to be 8 to 12 years. Former drinkers did not experience a significant reduction in CRC risk even after 10 years of quitting or reducing consumption.

CONCLUSIONS

Based on 2 cohorts of health professionals, our findings suggest that the increased risk of CRC associated with alcohol intake is driven mainly by total quantity and remote intake. Former drinkers did not experience an immediate reduction in CRC risk after quitting or reducing consumption.

Effect of Melatonin on Oxaliplatin Induced Neuropathy in Patients Receiving Folfox Chemotherapy Regimens for Stage II-IV Colorectal Cancer: A Randomized, Placebo Controlled, Double Blind Trial

Background and Aims

Peripheral neuropathy is a major side effect of oxaliplatin-based chemotherapy. The aim of this placebo-controlled double-blind randomized study was to evaluate the effect of melatonin on prevention of oxaliplatin induced peripheral neuropathy (OXIPN) in patients receiving oxaliplatin for colorectal cancer.

Methods

Patients with stage II-IV colorectal cancer, who were to receive oxaliplatin-based chemotherapy, were enrolled according to the inclusion criteria and randomly assigned to take either melatonin (20 mg/day) or placebo, during chemotherapy and 1 month after. Neuropathy was assessed by several patient- and physician-based reports, including the National Cancer Institute Common Terminology Criteria for Adverse Events scale (NCI-CTCAE), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20) scale, and oxaliplatin specific scale (OSS).

Results

From a total of 80 selected patients, 54 completed the study and were evaluated for the final analysis. Grade 3 neuropathy measured by NCI-CTCAE and OSS in the melatonin arm was significantly lower than the placebo group. But according to EORTC QLQ-CIPN20 scale, no statistically significant difference was observed between the groups. In addition, melatonin use did not improve patients' quality of life compared with placebo.

Conclusion

Reduction in grade 3 neuropathy based on NCI-CTCAE and OSS can be of great importance, as it is the higher-grade neuropathy that may lead to functional impairment. Given that to date no medication has been approved for prevention of OXIPN and considering the limited number of patients in the present study, conducting a larger clinical trial on the effect of melatonin may lead to beneficial results in this group of patients. Trial Registration: Study registered (Date: 23 July, 2018) in the Iranian Registry of Clinical Trials (IRCT); IRCT20170326033139N1 (https://www.irct.ir/search/result?query=IRCT20170326033139N1).

Factors influencing the quality of life in survivors of differentiated thyroid cancer based on patient-reported outcomes: a single-center cross-sectional study

Purpose

While the prognosis for differentiated thyroid cancer (DTC) is favorable, the health-related quality of life (QOL) of survivors is not well understood. This study aims to investigate the factors influencing the QOL of DTC survivors.

Methods

A total of 860 DTC survivors who underwent thyroidectomy were surveyed. Participants completed the Chinese version of the Thyroid Cancer-Specific Quality of Life (THYCA-QOL) questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-C30 (EORTC QLQ-C30), and additional related questions. Multivariate regression analyses identified factors affecting survivors' QOL.

Results

Among the survivors, 65 patients (7.6%) reported long-term postoperative complaints, including fatigue, throat discomfort, neck/shoulder stiffness, weight gain, and insomnia, among others. The average THYCA-QOL summary score was 20.29, with the highest scores in problems with scar, psychological problems, gained weight, less interest in sex, and sympathetic problems. The average EORTC QLQ-C30 summary score was 82.59, with lower scores for emotional and cognitive on the functional scales, and higher scores for fatigue and insomnia on the symptom scales. Women, BMI ≥ 28, higher T-stage (T3 + 4), permanent hypoparathyroidism, recurrence reoperation, and more postoperative complaints were associated with poorer thyroid cancer-specific QOL, while age over 45 years was associated with better QOL. Longer postoperative follow-up (>6 months) and drinking were correlated with higher QLQ-C30 summary scores, while recurrence reoperation and postoperative complaints were associated with worse QOL.

Conclusions

The QOL of DTC survivors is influenced by multiple factors, with some patients experiencing long-term complaints. Attention to the QOL and postoperative complaints in DTC survivors is essential.

An internet-delivered psychoeducational intervention (Fex-Can 2.0) targeting fertility-related distress and sexual dysfunction in young adults diagnosed with cancer: Study protocol of a randomized controlled trial with an internal pilot phase

BACKGROUND

While previous literature has continuously demonstrated the negative effects of cancer and its treatment on fertility and sexuality, evidence-based interventions to alleviate fertility-related distress and sexual dysfunction are lacking. This study protocol describes the internal pilot study and randomized controlled trial of an internet-delivered psychoeducational intervention: Fex-Can 2.0. The primary objective is to determine efficacy of Fex-Can 2.0 in terms of reduction of fertility-related distress and sexual dysfunction at end of the 12-week intervention. The internal pilot study will assess feasibility of the study, determined according to pre-specified progression criteria and individual interviews.

METHODS

The study has a randomized controlled design, with an internal pilot phase. The intervention group will receive Fex-Can 2.0, consisting of psychoeducational- and behavior change content. The control group will be allocated to standard care. Primary outcomes are fertility-related distress (RCAC) and sexual function and satisfaction (PROMIS SexFS Brief Sexual Profile). Secondary outcomes include body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), need satisfaction and frustration scale (NSFS), fertility- and sex-related knowledge, and self-efficacy related to fertility and sex life. Outcomes will be assessed at baseline, directly after the intervention, and 12 weeks later. During the internal pilot, data on trial recruitment, data collection, drop out, and adherence will be collected to assess feasibility. Semi-structured interviews will be conducted to further assess acceptability of Fex-Can 2.0.

CONCLUSIONS

This randomized controlled trial aims to evaluate whether Fex-Can 2.0 is superior to standard care, in terms of reducing fertility-related distress and sexual dysfunction in young adults diagnosed with cancer. If proven efficacious, the Fex-Can 2.0 intervention may be a valuable resource in health care, with the potential to significantly improve the care of young adults experiencing fertility-related distress and/or sexual dysfunction following cancer.

TRIAL REGISTRATION

ClinicalTrials.gov ISRCTN18040643.

Burden of myelodysplastic syndromes: a systematic literature review of economic burden

OBJECTIVE

To identify and synthesize available evidence on the economic burden for myelodysplastic syndromes (MDS).

METHODS

A systematic search was conducted in EMBASE and MEDLINE on July 13, 2021 to identify studies that report original data on the economic burden of MDS. Included studies were reviewed independently and in duplicate by two reviewers. Data on study design, patient characteristics and economic burden were extracted using a standardized form developed by the team. All costs were converted to 2023 USD and then a descriptive analysis was conducted.

RESULTS

77 publications from 61 unique studies reporting the economic burden of MDS were identified. Most were database studies (n = 34, 55.7%) and were conducted in the United States (n = 34, 55.7%). The most common outcome considered was total costs for MDS (n = 32, 52.5%). Total annual costs ranged from $6777 to $521,141 and differed according to treatment modality [best supportive care versus hypomethylating agents (HMAs)] and patient status (risk status and transfusion dependent). Broadly, costs were greater among patients with high-risk MDS compared to low-risk patients as well as those receiving HMAs and transfusions. Other costs and resource use outcomes (outpatient, inpatient costs, etc.) were not directly comparable across studies due to heterogeneity and lack of reporting of cost components.

CONCLUSION

This systematic literature review provides insight into the economic burden of MDS, which can be substantial. More research is needed to explore specific cost components as well as economic outcomes among subgroups of patients, such as newly diagnosed patients or patients classified as high risk.

The Impact of Lifestyle Medicine on Quality of Life in Female Breast Cancer Survivors: A Systematic Review

Objectives: This systematic review aims to critically evaluate the outcomes and characteristics of lifestyle medicine interventions among breast cancer survivors (BCS), with a particular emphasis on improvements in various dimensions of quality of life (QoL). Methods: A comprehensive search of the literature was conducted to identify original articles published in English from September 2012 to July 2024. Databases included PubMed, Embase, and secondary sources such as BMC, Sage Journals, Korea Science and Google Scholar. Eligible studies encompassed randomized controlled trials, observational studies, and quasi-experimental designs that assessed the impact of lifestyle medicine interventions on female BCS. The search period extended from March 2023 to July 4, 2024. Results: A total of eight studies were included, four of which demonstrated high methodological quality, while the remainder exhibited moderate to low quality. Due to the exploratory nature of the field and the heterogeneity of the outcomes, a meta-analysis was not performed. Instead, results were synthesized through stratified analysis. Notable improvements were observed in general health-related QoL indicators, including reductions in fatigue, body mass index (BMI), and physical pain, as well as enhancements in sleep quality and mental health status. Several studies, despite being interventional, did not report statistical analyses. Conclusion: The findings suggest that lifestyle medicine interventions can exert a beneficial effect on the QoL of female BCS. These results highlight the importance of integrating comprehensive lifestyle strategies into survivorship care. Further robust studies addressing all six pillars of lifestyle medicine are warranted to substantiate and expand these preliminary observations.

Trends and projections of the global and regional burden of multiple myeloma in adults aged 40 and over, 1990-2044

The objective is to examine the data from the global burden of disease (GBD) 2021 to report on the global, regional, and national trends and rates related to the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for multiple myeloma in adults aged 40 and above. Data from the GBD 2021 was used in this study to evaluate the rates of incidence, prevalence, mortality, and DALYs related to multiple myeloma across global, regional, and national scales. To analyze these trends, joinpoint regression was applied to calculate the average annual percentage changes (AAPC). Further, the analysis was divided according to age, gender, region, and socio-demographic index (SDI). Projections extending to 2044 were also generated using the Nordpred model. From 1990 to 2021, an upward trend has been observed globally in the incidence, prevalence, mortality, and DALYs of multiple myeloma among adults aged 40 and older, with average annual percentage changes (AAPCs) of 0.53 (95% CI 0.41-0.64), 1.2 (95% CI 1.07-1.33), 0.19 (95% CI 0.07-0.31), and 0.15 (95% CI 0.04-0.26), respectively. Notably, middle SDI countries exhibited the most accelerated disease progression, demonstrating a 2.34 (95% CI 2.19-2.48) annual increase in age-standardized incidence rate (ASIR)-over fourfold higher than the global average. The increasing global burden of multiple myeloma in adults aged 40 and older, especially in areas and nations with lower SDI levels, underscores the pressing requirement for customized public health initiatives and policies to tackle this escalating issue.

Optimizing Nutritional Care with Machine Learning: Identifying Sarcopenia Risk Through Body Composition Parameters in Cancer Patients-Insights from the NUTritional and Sarcopenia RIsk SCREENing Project (NUTRISCREEN)

Background/Objectives: Cancer and related treatments can impair body composition (BC), increasing the risk of malnutrition and sarcopenia, poor prognosis, and Health-Related Quality of Life (HRQoL). To enhance BC parameter interpretation through Bioelectrical Impedance Analysis (BIA), we developed a predictive model based on unsupervised approaches including Principal Component Analysis (PCA) and k-means clustering for sarcopenia risk in cancer patients at the Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (Naples). Methods: Sarcopenia and malnutrition risks were assessed using the NRS-2002 and SARC-F questionnaires, anthropometric measurements, and BIA. HRQoL was evaluated with the EORTC QLQ-C30 questionnaire. PCA and clustering analysis were performed to identify different BC profiles. Results: Data from 879 cancer patients (mean age: 63 ± 12.5 years) were collected: 117 patients (13%) and 128 (15%) were at risk of malnutrition and sarcopenia, respectively. PCA analysis identified three main components, and k-means determined three clusters, namely HMP (High Muscle Profile), MMP (Moderate Muscle Profile), and LMP (Low Muscle Profile). Patients in LMP were older, with a higher prevalence of comorbidities, malnutrition, and sarcopenia. In the multivariable analysis, age, lung cancer site, diabetes, and malnutrition risk were significantly associated with an increased risk of sarcopenia; among the clusters, patients in LMP had an increased risk of sarcopenia (+62%, p = 0.006). Conclusions: The NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), provides a personalized nutritional pathway for early screening of malnutrition and sarcopenia. Using an unsupervised approach, we provide distinct BC profiles and valuable insights into the factors associated with sarcopenia risk. This approach in clinical practice could help define risk categories, ensure the most appropriate nutritional strategies, and improve patient outcomes by providing data-driven care.

Epigenetic and genetic profiling of comorbidity patterns among substance dependence diagnoses

This study investigated the genetic and epigenetic mechanisms underlying the comorbidity of five substance dependence diagnoses (SDs; alcohol, AD; cannabis, CaD; cocaine, CoD; opioid, OD; tobacco, TD). A latent class analysis (LCA) was performed on 22,668 individuals from six cohorts to identify comorbid DSM-IV SD patterns. In subsets of this sample, we tested SD-latent classes with respect to polygenic overlap of psychiatric and psychosocial traits in 7659 individuals of European descent and epigenome-wide changes in 886 individuals of African, European, and Admixed-American descents. The LCA identified four latent classes related to SD comorbidities: AD + TD, CoD + TD, AD + CoD + OD + TD (i.e., polysubstance addiction, PSU), and TD. In the epigenome-wide association analysis, SPATA4 cg02833127 was associated with CoD + TD, AD + TD, and PSU latent classes. AD + TD latent class was also associated with CpG sites located on ARID1B, NOTCH1, SERTAD4, and SIN3B, while additional epigenome-wide significant associations with CoD + TD latent class were observed in ANO6 and MOV10 genes. PSU-latent class was also associated with a differentially methylated region in LDB1. We also observed shared polygenic score (PGS) associations for PSU, AD + TD, and CoD + TD latent classes (i.e., attention-deficit hyperactivity disorder, anxiety, educational attainment, and schizophrenia PGS). In contrast, TD-latent class was exclusively associated with posttraumatic stress disorder-PGS. Other specific associations were observed for PSU-latent class (subjective wellbeing-PGS and neuroticism-PGS) and AD + TD-latent class (bipolar disorder-PGS). In conclusion, we identified shared and unique genetic and epigenetic mechanisms underlying SD comorbidity patterns. These findings highlight the importance of modeling the co-occurrence of SD diagnoses when investigating the molecular basis of addiction-related traits.

Canadian consensus for the assessment and testing of Lynch syndrome

BACKGROUND

Lynch syndrome (LS) is an autosomal dominant cancer predisposition syndrome caused by a germline pathogenic variant, or epigenetic silencing, of a mismatch repair (MMR) gene, leading to a wide cancer spectrum with gene-specific penetrance. Ascertainment, assessment and testing of LS individuals is complex. A Canadian national guideline is needed to ensure equitable access to patient care across the country.

METHODS

The Canadian Lynch Syndrome (CDN-LS) working group was formed in 2021, consisting of 37 multidisciplinary LS experts and patient partners. To formulate consensus statements, a national environmental scan, Canadian clinical survey and literature review were undertaken. The e-Delphi method was used to reach consensus statements among the CDN-LS group.

RESULTS

The CDN-LS group voted on 21 statements, and 18 statements were adopted with over 80% agreement, including 16 statements that had over 90% agreement. These statements provide comprehensive guidelines on universal MMR reflex testing, cascade tumour testing (MLH1 promoter methylation, BRAF, somatic MMR), germline testing, therapeutics and patient advocacy.

CONCLUSION

This is the first comprehensive Canadian guideline for LS providing guidance to genetic specialists, laboratories, primary care providers and healthcare providers caring for patients with LS. It is endorsed by the Canadian College of Medical Genetics and the Canadian Association of Genetic Counsellors. The consensus statements are presented as a model for standard of care that improves equitable access to health services for LS across the country. Future work should include a national consensus on LS surveillance, with a goal to harmonise LS care across all provincial and territorial healthcare authorities.

Causes of DNA mismatch repair deficiency in sebaceous skin lesions demonstrating loss of MLH1 protein expression: constitutional over somatic MLH1 promoter methylation

Approximately 30% of sebaceous skin lesions (or sebaceous neoplasia) demonstrate DNA mismatch repair (MMR)-deficiency. MMR-deficiency can be caused by Lynch syndrome, resulting from germline pathogenic variants in the DNA MMR genes MLH1, MSH2, MSH6 and PMS2, but other causes include somatic MLH1 gene promoter hypermethylation, constitutional MLH1 gene promoter hypermethylation (MLH1 epimutation), or biallelic somatic MMR gene mutations. In colorectal (CRCs) and endometrial cancers (ECs), tumour MMR-deficiency showing loss of MLH1 and PMS2 protein expression (MLH1/PMS2-deficiency) is predominantly caused by somatic MLH1 hypermethylation, however, it is not clear if somatic MLH1 hypermethylation is a cause of MLH1/PMS2-deficiency in sebaceous neoplasia. This study investigated the causes of MLH1/PMS2-deficiency in 28 cases with sebaceous neoplasia. Germline pathogenic variants in MLH1 were identified in 11 of 28 cases. Of the remaining 17 non-Lynch syndrome cases, two (11.8%) were positive for MLH1 hypermethylation in blood-derived DNA (constitutional MLH1 epimutations). The corresponding sebaceous tissue of these two cases also showed MLH1 hypermethylation. None of the other eight cases with sufficient sebaceous tissue-derived DNA for testing showed somatic MLH1 hypermethylation. Multi-gene panel testing of sebaceous tissue and matched blood-derived DNA identified four cases with biallelic somatic MLH1 mutations as the cause of MLH1/PMS2-deficiency. No cause of MLH1/PMS2-deficiency could be identified in one case. This study demonstrates that biallelic somatic MLH1 mutations and constitutional MLH1 epimutations underlie MLH1/PMS2-deficiency in sebaceous neoplasms after excluding Lynch syndrome. Unlike CRCs and ECs, somatic MLH1 hypermethylation was not identified suggesting it is not a common cause of MLH1/PMS2-deficiency in sebaceous neoplasia.

Epigenetic profiles integrated with transcriptomic reveal the difference between COPD and PRISm in KOCOSS-NIH

In 2023, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) introduced a provision regarding preserved ratio-impaired spirometry (PRISm), a presumed pre-stage of Chronic Obstructive Pulmonary Disease (COPD), into the COPD guidelines. However, further research in this area is needed. Our study aimed to investigate the epigenetic differences between PRISm and COPD. EWAS (n = 572) and RNA-sequencing (n = 60) were performed on blood samples from the COPD registry, and EWAS was replicated in the KoGES cohort data (n = 98). Our findings revealed significant epigenetic differences between patients with PRISm and COPD. 39,980 CpG-sites displayed differential methylation between PRISm and COPD. Seven gene regions-EEF1A2, EMP2, EPCAM, MTSS1L, ARHGEF10, HYDIN, and FADS2 were not only differentially methylated but also exhibited differential expression. The consistency of differential methylation of CpG sites in five genes, excluding ARHGEF10 and MTSS1L, was replicated in the KoGES study, affirming the distinction between COPD and PRISm. Our research identified seven gene regions as critical contributors related to the modulation of gene expression, including CpG sites that differentiate COPD from PRISm. These results highlight the significance of DNA methylation changes in distinguishing PRISm from COPD and shed light on potential mechanisms by which methylation alterations impact lung function.

Implementing Personalized Cancer Medicine: Insights from a Qualitative Interview Study

Background: Personalized cancer medicine (PCM) tailors cancer treatments based on individual genetic profiles, enabling more precise and effective therapies. Despite its potential, integrating PCM into clinical practice remains challenging because of organizational and systemic barriers. This study examined the factors influencing PCM implementation at a major cancer center in Stockholm, Sweden. Methods: We conducted semi-structured interviews with 16 medical professionals and management staff from Karolinska University Hospital and Karolinska Institutet. Content analysis was used to identify key themes related to PCM implementation. This study followed the established Consolidated Criteria for Reporting Qualitative Research guidelines to ensure methodological rigor and transparency. Results: Informants framed PCM as both a technological innovation and a patient-centered approach. However, significant barriers to implementation were identified, including organizational inertia, fragmented funding models, and ethical challenges related to access and equity. Structural silos between academic and healthcare institutions complicate integration. Key facilitators include leadership commitment, cross-sectoral collaboration, and a supportive policy environment. Participants emphasized the need for integrated infrastructure, real-time data-sharing mechanisms, and interdisciplinary training programs to support PCM. Conclusions: Successful PCM implementation requires overcoming entrenched organizational and systemic barriers through a multi-stakeholder approach involving healthcare providers, researchers, policymakers, and patient advocates. The findings underscore the necessity of a "third-form organization" to mediate between academia and clinical care. Addressing these challenges requires adaptive governance models, evidence-based policy reforms, and sustainable funding frameworks. Future research should explore comparative contexts to enhance the scalability and generalizability of PCM integration strategies.

Waist Circumference, a Body Shape Index, and Molecular Subtypes of Colorectal Cancer: A Pooled Analysis of Four Cohort Studies

BACKGROUND

Waist circumference (WC) and its allometric counterpart, "a body shape index" (ABSI), are risk factors for colorectal cancer; however, it is uncertain whether associations with these body measurements are limited to specific molecular subtypes of the disease.

METHODS

Data from 2,772 colorectal cancer cases and 3,521 controls were pooled from four cohort studies within the Genetics and Epidemiology of Colorectal Cancer Consortium. Four molecular markers (BRAF mutation, KRAS mutation, CpG island methylator phenotype, and microsatellite instability) were analyzed individually and in combination (Jass types). Multivariable logistic and multinomial logistic models were used to assess the associations of WC and ABSI with overall colorectal cancer risk and, in case-only analyses, to evaluate heterogeneity by molecular subtype, respectively.

RESULTS

Higher WC (ORper 5 cm = 1.06, 95% confidence interval, 1.04-1.09) and ABSI (ORper 1-SD = 1.07, 95% confidence interval, 1.00-1.14) were associated with elevated colorectal cancer risk. There was no evidence of heterogeneity between the molecular subtypes. No difference was observed regarding the influence of WC and ABSI on the four major molecular markers in proximal colon, distal colon, and rectal cancers, as well as in early- and late-onset colorectal cancers. Associations did not differ in the Jass-type analysis.

CONCLUSIONS

Higher WC and ABSI were associated with elevated colorectal cancer risk; however, they do not differentially influence all four major molecular mutations involved in colorectal carcinogenesis but underscore the importance of maintaining a healthy body weight in colorectal cancer prevention.

IMPACT

The proposed results have potential utility in colorectal cancer prevention.

Insulin and Insulin-like Growth Factor and Risk of Postmenopausal Estrogen Receptor-Positive Breast Cancer: A Case-Cohort Analysis

BACKGROUND

Higher concentration of insulin-like growth factor-1 (IGF-1) increases postmenopausal breast cancer risk, but evidence for insulin and c-peptide is limited. Furthermore, not all studies have accounted for potential confounding by biomarkers from other biological pathways, and not all were restricted to estrogen receptor (ER)-positive breast cancer.

METHODS

This was a case-cohort study of 1,223 postmenopausal women (347 with ER-positive breast cancer) from the Melbourne Collaborative Cohort Study. We measured insulin, c-peptide, IGF-1, insulin-like growth factor binding protein-3, and biomarkers of inflammatory and sex-steroid hormone pathways. Poisson regression with a robust variance estimator was used to estimate risk ratios (RR) and 95% confidence intervals (95% CI) for ER-positive breast cancer per doubling plasma concentration and for quartiles, without and with adjustment for other, potentially confounding biomarkers.

RESULTS

ER-positive breast cancer risk was not associated with doubling of insulin (RR = 0.97, 95% CI, 0.82-1.14) or c-peptide (RR = 1.01, 95% CI, 0.80-1.26). Risk seemed to decrease with doubling IGF-1 (RR = 0.80, 95% CI, 0.62-1.03) and insulin-like growth factor binding protein-3 (RR = 0.62, 95% CI, 0.41-0.90). RRs were not meaningfully different when exposures were modeled as quartiles. RRs were less than unity but imprecise after adjustment for inflammatory and sex-steroid hormone biomarkers.

CONCLUSIONS

Circulating insulin, c-peptide, and IGF-1 were not positively associated with risk of ER-positive breast cancer in this case-cohort analysis of postmenopausal women.

IMPACT

Associations between insulin and c-peptide and risk of ER-positive breast cancer in postmenopausal women are likely to be weak.

Methylome-wide association analyses of lipids and modifying effects of behavioral factors in diverse race and ethnicity participants

Circulating lipid concentrations are clinically associated with cardiometabolic diseases. The phenotypic variance explained by identified genetic variants remains limited, highlighting the importance of searching for additional factors beyond genetic sequence variants. DNA methylation has been linked to lipid concentrations in previous studies, although most of the studies harbored moderate sample sizes and exhibited underrepresentation of non-European ancestry populations. In addition, knowledge of nongenetic factors on lipid profiles is extremely limited. In the Population Architecture Using Genomics and Epidemiology (PAGE) Study, we performed methylome-wide association analysis on 9,561 participants from diverse race and ethnicity backgrounds for HDL-c, LDL-c, TC, and TG levels, and also tested interactions between smoking or alcohol intake and methylation in their association with lipid levels. We identified novel CpG sites at 16 loci (P < 1.18E-7) with successful replication on 3,215 participants. One additional novel locus was identified in the self-reported White participants (P = 4.66E-8). Although no additional CpG sites were identified in the genome-wide interaction analysis, 13 reported CpG sites showed significant heterogeneous association across smoking or alcohol intake strata. By mapping novel and reported CpG sites to genes, we identified enriched pathways directly linked to lipid metabolism as well as ones spanning various biological functions. These findings provide new insights into the regulation of lipid concentrations.

Physical activity and DNA methylation-based markers of ageing in 6208 middle-aged and older Australians: cross-sectional and longitudinal analyses

Epigenetic age quantifies biological age using DNA methylation information and is a potential pathway by which physical activity benefits general health. We aimed to assess the cross-sectional and longitudinal associations between physical activity and epigenetic age in middle-aged and older Australians. Blood DNA methylation data for 6208 participants (40% female) in the Melbourne Collaborative Cohort Study (MCCS) were available at baseline (1990-1994, mean age, 59 years) and, of those, for 1009 at follow-up (2003-2007, mean age, 69 years). Physical activity measurements (weighted scores at baseline and follow-up and total MET hours per week at follow-up) were calculated from self-reported questionnaire data. Five blood methylation-based markers of ageing (PCGrimAge, PCPhenoAge, bAge, DNAmFitAge, and DunedinPACE) and four fitness-related markers (DNAmGaitspeed, DNAmGripmax, DNAmVO2max, and DNAmFEV1) were calculated and adjusted for age. Linear regression was used to examine the cross-sectional and longitudinal associations between physical activity and epigenetic age. Effect modification by age, sex, and BMI was assessed. At baseline, a standard deviation (SD) increment in physical activity was associated with 0.03-SD (DNAmFitAge, 95%CI = 0.01, 0.06, P = 0.02) to 0.07-SD (bAge, 95%CI = 0.04, 0.09, P = 2 × 10-8) lower epigenetic age. These associations were attenuated after adjustment for other lifestyle variables. Only weak evidence was found for the longitudinal association (N = 1009) of changes in physical activity and epigenetic age (e.g. DNAmFitAge: adjusted β =  - 0.04, 95%CI =  - 0.08, 0.01). The associations were not modified by age, sex, or BMI. In middle-aged and older Australians, higher levels of self-reported physical activity were associated with slightly lower epigenetic age.

Prospective Multicenter Observational Study on Postoperative Quality of Life According to Type of Gastrectomy for Gastric Cancer

PURPOSE

This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer.

MATERIALS AND METHODS

A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery.

RESULTS

Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both). Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064).

CONCLUSIONS

Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Intratumoural pks+Escherichia coli is associated with risk of metachronous colorectal cancer and adenoma development in people with Lynch syndrome

BACKGROUND

The adverse gut microbiome may underlie the variability in risks of colorectal cancer (CRC) and metachronous CRC in people with Lynch syndrome (LS). The role of pks+/-Escherichia coli (pks+/-E. coli), Enterotoxigenic Bacteroides fragilis (ETBF), and Fusobacterium nucleatum (Fn) in CRCs and adenomas in people with LS is unknown.

METHODS

A total of 358 LS cases, including 386 CRCs, 90 adenomas, 195 normal colonic mucosa DNA from the Australasian Colon Cancer Family Registry were tested using multiplex TaqMan qPCR. Logistic regression was used to compare the intratumoural prevalence of each bacteria in Lynch CRCs with 1336 sporadic CRCs. Cox proportional-hazards regression estimated the associations of each bacteria with the risk of metachronous CRC and neoplasia.

FINDINGS

Pks+ E. coli (odds ratio [95% confidence interval] = 1.60 [1.08-2.35], P = 0.017), pks-E. coli (3.87 [2.58-5.80], P < 0.001) and Fn (19.47 [13.32-28.87], P < 0.001) were significantly enriched in LS CRCs when compared with sporadic CRCs. Pks+ E. coli in the initial CRC was associated with an increased risk of metachronous CRC (hazard ratio [95% confidence interval] = 2.32 [1.29-4.17], P = 0.005) and metachronous colorectal neoplasia (1.51 [1.02-2.23], P = 0.040) when compared with CRCs without pks+ E. coli.

INTERPRETATION

Pks+ E. coli, pks-E. coli, and Fn are enriched within LS CRCs, suggesting possible roles in CRC development in LS. Having intratumoural pks+ E. coli is associated with increased risk of metachronous CRC, suggesting that, if validated, people with LS might benefit from pks+ E. coli screening and eradication.

FUNDING

This work was funded by an NHMRC Investigator grant (GNT1194896) and a Cancer Australia/Cancer Council NSW co-funded grant (GNT2012914).

Prognostic value of baseline EORTC QLQ-C30 scores for overall survival across 46 clinical trials covering 17 cancer types: a validation study

Background

A pooled data analysis by Quinten et al. (2009) found three European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) health-related quality of life (HRQoL) scales to be prognostic for survival: physical functioning, pain and appetite loss. This study aims to replicate these findings in an independent data set comprising a broader cancer population.

Methods

Data were obtained from 46 clinical trials across three cancer research networks conducted between 1996 and 2013 that assessed HRQoL using the EORTC QLQ-C30. A stratified Cox proportional hazards model was employed to assess the prognostic significance of baseline QLQ-C30 scale scores on overall survival, adjusting for socio-demographic and clinical variables. Stepwise model selection was done at 5% significance level. Model stability and prognostic accuracy were evaluated via bootstrapping and the C index respectively.

Findings

Data from 16,210 patients reporting HRQoL at baseline, spanning 17 cancer types, was used. The stratified multivariable model confirmed that better physical functioning (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.93-0.96), lower pain (HR, 1.02; 95% CI, 1.01-1.03), and appetite loss (HR, 1.04; 95% CI, 1.03-1.05) were significantly associated with survival. Additionally, global health status/QoL, dyspnoea, emotional and cognitive functioning were found to be prognostic for survival. This final model, encompassing sociodemographic, clinical, and HRQoL variables, achieved a corrected C index of 0.74, marking a 48% enhancement in discriminatory ability. Bootstrap evaluation indicated no major instability issues.

Interpretation

These results support previous findings that baseline physical functioning, pain, and appetite loss scores, along with four other scales from the EORTC QLQ-C30, predict survival in cancer patients.

Funding

EORTC Quality of Life Group.

Quality of Life in Adolescents and Young Adults with Cleft Lip and Palate with and Without Speech Therapy During COVID-19

ObjectiveCleft-related speech concerns can affect the quality of life (QOL) in patients with cleft lip and palate (CLP). During the coronavirus disease 2019 (COVID-19), in-person speech therapy (ST) was restricted due to fear of getting infected. This study aimed to compare QOL in patients with CLP with and without ST during the pandemic.DesignCross-sectional StudySettingCLP team at Tehran University of Medical Sciences (TUMS).Patients/ParticipantsThirty-six CLP subjects with a mean age of 17.33 ± 4 years participated in two groups, including with and without ST. Fifteen subjects had cleft palate only (CPO) and others had CLP.InterventionsST group received at least 10 ST sessions, and group without ST didn't receive ST during COVID-19.Main Outcome Measure(s)A virtual link of demographic and QOL adolescent cleft (QoLAdoCleft) questionnaires were sent to fill out. Results were extracted and transferred to SPSS.ResultsTotal and subscales' scores of QoLAdoCleft were lower in ST group than without ST but differences between them weren't statistically significant (P > .05). Furthermore, according to cleft type, there weren't any statistically significant differences in total, physical, and social subscales of QoLAdoCleft (P > .05); however, psychological subscale in CLP had a higher significant score than CPO (P < .05).ConclusionsQOL was weak in all patients with CLP, and receiving/not receiving ST couldn't make noticeable differences between them. It seems; COVID-19 pandemic can have an adverse effect on these results. Also, subjects with CLP had weaker psychological than CPO due to negative psychosocial feedback related to Orofacial deformities received from society.

Food-based indexes and their association with dietary inflammation

Chronic inflammation is associated with an increased risk of noncommunicable diseases, prompting an intensified interest in the diet-disease relationship for modulating inflammation. Diet quality indexes are widely used to quantify dietary patterns. However, the optimal tool for assessing dietary quality in relation to chronic inflammation remains unclear. The objective of this study was to synthesize the literature on food-based diet quality indexes and their association with chronic inflammation. A systematic scoping review of scientific databases was conducted from inception to March 2024. Studies describing the development and validation of original dietary inflammatory indexes or assessed associations between established indexes and inflammatory biomarkers were included. Studies that predominantly focused on nutrient-based indexes were excluded. Forty-three food-based indexes, evaluated across 65 studies, were categorized into 4 distinct groups based on dietary patterns (n = 18), dietary guidelines (n = 14), dietary inflammatory potential (n = 6), and therapeutic diets (n = 5). Established indexes based on the Mediterranean diet and dietary guidelines were the most extensively utilized, demonstrating inverse associations with several inflammatory biomarkers across diverse populations. The Anti-Inflammatory Diet Index, Dietary Inflammation Score, and Empirical Dietary Inflammatory Index were identified as robust, empirically derived indexes to assess diet quality based on their inflammatory potential. The dietary composition of the evaluated indexes ranged from 4 to 28 dietary components, with fruits, vegetables, whole grains, and legumes consistently classified as favorable, whereas red/processed meats and added sugars were unfavorable. This scoping review identified several promising food-based indexes for assessing inflammation-related diet quality. Methodological variations and inconsistencies in algorithms underscore the need for further validation across diverse populations. Future research should consider the scoring methods, dietary composition, and validated inflammatory biomarkers when selecting indexes to evaluate diet-inflammation associations. Understanding the characteristics that underpin these indexes informs their application in nutrition research and clinical practice.

Clinical and Multiomic Features Differentiate Young Black and White Breast Cancer Cohorts Derived by Machine Learning Approaches

BACKGROUND

There are documented differences in Breast cancer (BrCA) presentations and outcomes between Black and White patients. In addition to molecular factors, socioeconomic, racial, and clinical factors result in disparities in outcomes for women in the United States. Using machine learning and unsupervised biclustering methods within a multiomics framework, here we sought to shed light on the biological and clinical underpinnings of observed differences between Black and White BrCA patients.

MATERIALS AND METHODS

We examined The Cancer Genome Atlas BrCA samples from stage II patients aged 50 or younger that are Black (BAA50) or White (W50) (n = 139 patients; 36 BAA50 and 103 W50) These patients were chosen because marked differences in survival were observed in an earlier study. A variety of multiomic data sets were analyzed to further characterize the clinical and molecular disparities for insights.

RESULTS

We coupled RNAseq data with protein-protein interaction as well as BrCA-specific protein co-expression network data to identify 2 novel biclusters. These biclusters are significantly associated with clinical features including race, number of lymph nodes involved with disease, estrogen receptor status, progesterone receptor status and menopausal status. There were also differentially mutated genes. Using DNA methylation data, we identified differentially methylated genes. Machine learning algorithms were trained on differential methylation values of driver genes. The trained algorithms were successful in predicting the bicluster assignment of each sample.

CONCLUSION

These results demonstrate that there was a significant association between the cluster membership and BAA50 and W50 cohorts, indicating that these biclusters accurately stratify these cohorts.

Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium

BACKGROUND

Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent.

OBJECTIVES

This study aims to pool data from studies conducted around the world to evaluate the relationships among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer.

METHODS

This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models.

RESULTS

Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival; however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75; 95% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76; 95% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71; 95% CI: 0.56, 0.91), tomatoes (aHR: 0.72; 95% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71; 95% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids.

CONCLUSIONS

Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.

Dietary factors and DNA methylation-based markers of ageing in 5310 middle-aged and older Australian adults

The role of nutrition in healthy ageing is acknowledged but details of optimal dietary composition are still uncertain. We aimed to investigate the cross-sectional associations between dietary exposures, including macronutrient composition, food groups, specific foods, and overall diet quality, with methylation-based markers of ageing. Blood DNA methylation data from 5310 participants (mean age 59 years) in the Melbourne Collaborative Cohort Study were used to calculate five methylation-based measures of ageing: PCGrimAge, PCPhenoAge, DunedinPACE, ZhangAge, TelomereAge. For a range of dietary exposures, we estimated (i) the 'equal-mass substitution effect', which quantifies the effect of adding the component of interest to the diet while keeping overall food mass constant, and (ii) the 'total effect', which quantifies the effect of adding the component of interest to the current diet. For 'equal-mass substitution effects', the strongest association for macronutrients was for fibre intake (e.g. DunedinPACE, per 12 g/day - 0.10 [standard deviations]; 95%CI - 0.15, - 0.05, p < 0.001). Associations were positive for protein (e.g. PCGrimAge, per 33 g/day 0.04; 95%CI 0.01-0.08, p = 0.005). For food groups, the evidence tended to be weak, though sugar-sweetened drinks showed positive associations, as did artificially-sweetened drinks (e.g. DunedinPACE, per 91 g/day 0.06, 95%CI 0.03-0.08, p < 0.001). 'Total effect' estimates were generally very similar. Scores reflecting overall diet quality suggested that healthier diets were associated with lower levels of ageing markers. High intakes of fibre and low intakes of protein and sweetened drinks, as well as overall healthy diets, showed the most consistent associations with lower methylation-based ageing in our study.

The state of individual participant data sharing for the highest-revenue medicines

BackgroundAmid growing emphasis from pharmaceutical companies, advocacy groups, and regulatory bodies for sharing of individual participant data, recent audits reveal limited sharing, particularly for high-revenue medicines. Therefore, this study aimed to assess the individual participant data-sharing eligibility of clinical trials supporting the Food and Drug Administration approval of the top 30 highest-revenue medicines for 2021.MethodsA cross-sectional analysis was conducted on 316 clinical trials supporting approval of the top 30 revenue-generating medicines of 2021. The study assessed whether these trials were eligible for individual participant data sharing, defined as being publicly listed on a data-sharing platform or confirmed by the trial sponsors as in scope for independent researcher individual participant data investigations. Information was gathered from various sources including ClinicalTrials.gov, the European Union Clinical Trials Register, and PubMed. Key factors such as the trial phase, completion dates, and the nature of the data-sharing process were also examined.ResultsOf the 316 trials, 201 (64%) were confirmed eligible for sharing, meaning they were either publicly listed on a data-sharing platform or confirmed by the trial sponsors as in scope for independent researcher individual participant data investigations. A total of 102 (32%) were confirmed ineligible, and for 13 (4%), the sponsor indicated that a full research proposal would be required to determine eligibility. The analysis also revealed a higher rate of individual participant data sharing among companies that utilized independent platforms, such as Vivli, for managing their individual participant data-sharing process. Trials not marked as completed had significantly lower eligibility for individual participant data sharing.ConclusionThis study highlights that a substantial portion of trials for top revenue-generating medicines are eligible for individual participant data sharing. However, challenges persist, particularly for trials that are marked as ongoing and for trials where the sharing processes are managed internally by pharmaceutical companies. Data-sharing rates could be improved by adopting open-access individual participant data-sharing models or using independent platforms. Standardizing policies to facilitate immediate individual participant data availability for approved medicines is necessary.

Practice patterns, experiences, and challenges of German oncology health care staff with smoking cessation in patients with cancer: a cross-sectional survey study

PURPOSE

Often, cancer patients do not receive education about the negative consequences of smoking on the treatment outcome. To support cancer patients in the process of smoking cessation, it is essential to involve oncology staff. This study aims to learn about the experiences and attitudes from the point of view of oncology staff and, thus, how a smoking intervention should be designed. The study aims to engage all oncology staff due to the unclear responsibility for providing smoking cessation education, support, and motivating cancer patients to quit smoking.

METHODS

N = 354 German oncology staff (oncologists, nurses, psycho-oncologists, others) filled out a 5-point Likert scale-based questionnaire regarding practices, potential barriers, and attitudes towards smoking cessation between October 2021 and June 2022. The questionnaire was developed by Derksen et al. (2020), translated and slightly modified for the use of this study. It was distributed to all leading oncology staff in our Cancer Center Network with a request to share with all oncology staff. Flyers were also handed out in all oncology wards and outpatient clinics in the same Cancer Center Network.

RESULTS

Most oncology staff ask cancer patients about their current smoking status (curative, M = 2.27; SD = 1.59; palliative, M = 2.90; SD = 1.83), but they rarely treat or refer patients for a smoking cessation intervention (curative, M = 4.78; SD = 1.20; palliative, M = 4.99; SD = 1.06). Smoking behavior of curative cancer patients is addressed more than that of palliative cancer patients (d =  - 37). Regression analyses of key dependent variables showed that profession, setting, and the belief that continued smoking affects treatment outcome explained the variance of asking patients if they smoke, advising to stop smoking and lack of time (without profession).

CONCLUSION

Involving oncology staff in motivating cancer patients who smoke to quit and referring them to smoking cessation services should take the different attitudes and knowledge of the staff into account to improve treatment that supports tobacco cessation.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer patients have special needs when it comes to a cessation program. In the long term, survivors will benefit from tailored smoking cessation education and services provided by oncology staff to help them quit smoking after a cancer diagnosis.