Breast cancer care for the aging population: a focus on age-related disparities in breast cancer treatment

OBJECTIVE

Breast cancer is a significant health issue for women worldwide and poses unique challenges for all ages. Older women face many concerns about breast cancer treatment and outcomes. This study aims to compare breast cancer management and outcomes across various age groups within a single-center experience in a region with an aging population, focusing specifically on women aged 70 and older to identify potential disparities in treatment and prognosis.

METHODS

We conducted a retrospective analysis of all female patients diagnosed with breast cancer at our local reference Breast Unit in northeastern Italy between January 2002 and July 2023. The primary outcome measures in this study were overall survival (OS), disease-free survival (DFS), cumulative loco-regional recurrences, and cumulative distant recurrences.

RESULTS

The study included 2478 women over 70 (31.12%), 4690 women aged between 45 and 69 (58.90%), and 795 women under 45 (9.98%). According to the study, older women were more likely to have advanced-stage cancer, whereas they received less aggressive treatment, including fewer adjuvant therapies and surgical interventions. We also observed worse prognoses in this group of patients if compared with women aged 45 to 69 years. Moreover, data showed that the incidence of breast cancer among older women has increased over time.

CONCLUSIONS

Our findings highlight the need for tailored treatment strategies for older breast cancer patients to balance treatment efficacy with quality-of-life considerations. These findings call for a strategic reevaluation of treatment protocols and emphasize the importance of personalized care, particularly for older women, to improve outcomes without sacrificing the quality of life while maintaining maximum survival potential.

Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis

BACKGROUND

The global cancer burden is rising, with early-onset cancers becoming more prevalent. We aimed to investigate the burden, trend and population disparity in 33 early-onset cancers from 2012 to 2021.

METHODS

Annual incidence, death, and disability-adjusted life years (DALY) numbers and rates for early-onset (15-49 years) cancer groups were calculated from Global Burden of Diseases (GBD) 2021 dataset, covering 2012-2021 across global, five SDI groupings, and 204 countries and territories. Estimated annual percentage change (EAPC) in the incidence, mortality and DALY rates was calculated to quantify temporal trends, while spearman correlation analysis was used to examine the correlation between rates, EAPC and SDI.

RESULTS

In 2021, there were 2.65 million new early-onset cancer cases excluding non-melanoma skin cancer (NMSC), resulting in 0.99 million deaths and 50.7 million DALYs. Breast, tracheal, bronchus and lung (TBL), cervical, colon and stomach cancers were the leading causes of DALYs. The DALY rate for early-onset cancer excluding NMSC changed from 65.7 million in 2012 to 67.0 million in 2021, with an estimated annual percentage change (EAPC) of -0.49%. While the DALY rate plateaued for females, it decreased by -0.95% for males. Ten of 33 cancer groups exhibited an EAPC > 0. The high SDI quintile had 1,100 DALYs per 100,000 caused by early-onset cancers excluding NMSC, with the highest declining trend in DALY and mortality rates, while the high-middle SDI quintile had the highest early-onset mortality rates. Rising trends in cancer incidence and mortality were especially notable among females in the middle, low-middle, and low SDI quintiles.

CONCLUSION

The global burden of early-onset cancer differs significantly by SDI quintile and gender. The increasing burden across multiple cancer groups poses a significant public health challenge. The rising burden of multiple cancer types is alarming, highlighting the need for increased policy support and targeted medical assistance to address the disparities in their impact.

Barriers to radiotherapy completion in breast cancer patients: A retrospective analysis from a tertiary hospital in Indonesia

INTRODUCTION

Breast cancer is the most common malignancy among women and a leading cause of cancer-related mortality in Indonesia. Radiotherapy is a crucial treatment modality to improve local control, reduce recurrence, and enhance survival rates. However, access to radiotherapy remains limited, leading to prolonged waiting times and potential treatment incompletion. This study aims to identify key predictors influencing radiotherapy completion and analyze waiting times in a resource-limited setting METHODS: A retrospective study was conducted on breast cancer patients who underwent radiotherapy between January 2018 and December 2019 at Hasan Sadikin General Hospital, Indonesia. Data were obtained from the Hospital-Based Cancer Registry (HBCR). Statistical analyses were performed using chi-square and Mann-Whitney U tests to assess factors influencing radiotherapy completion and waiting time.

RESULTS

279 Breast cancer patients were included. 77.8 % (n = 217) completed their prescribed radiotherapy. Significant predictors of completion include age, those older than 65 years old tend to do not complete their radiation treatment (p = 0.035). Those receiving treated using Linac radiotherapy had higher completion rates than those treated with Co-60. However, waiting time was not significantly associated with treatment completion (p = 0.427). The median radiotherapy waiting time was 8 weeks (0-40 weeks). Patients with metastatic disease (p < 0.001) and those receiving palliative intent radiotherapy (p < 0.001) experienced significantly shorter waiting times.

CONCLUSION

Radiotherapy completion rates among breast cancer patients in Indonesia remain suboptimal, with access disparities affecting treatment adherence. Addressing logistical and systemic barriers could improve outcomes and enhance cancer care delivery in resource-limited settings.

PLAIN LANGUAGE SUMMARY

Breast cancer is the most common cancer among women in Indonesia. Many patients require radiotherapy to prevent the disease from coming back and to improve survival. However, some patients do not complete their treatment due to long waiting times and other challenges. This study looks at how long patients wait for radiotherapy and what factors influence whether they complete treatment. We analyzed the medical records of 279 breast cancer patients who received radiotherapy at Hasan Sadikin General Hospital between 2018 and 2019. We examined their age, radiation therapy tools, waiting time, and whether they completed radiotherapy. We used statistical methods to find patterns and associations between these factors. Our findings suggest that certain groups of patients, especially older individuals and those undergoing curative treatment, may need additional support to complete their radiotherapy.

Long-term Follow-up for Survivors of Childhood Cancer in Saudi Arabia: A Multicenter Cross-Sectional Study

Background

With the advancement of childhood cancer therapy, long-term survivors are on the rise. Reports on childhood cancer survivors in Saudi Arabia are scarce. This study aims to assess the spectrum and burden of long-term complications among survivors of childhood cancer in Saudi Arabia.

Methods

This cross-sectional study, conducted at multiple cancer centers in Saudi Arabia, enrolled survivors who had been diagnosed with cancer before the age of 14 and had completed at least 5 years after completion of cancer therapy. The primary outcome was to estimate the prevalence of chronic health conditions (CHC) among these survivors. The secondary outcome was to assess the impact of primary cancer diagnosis and cancer therapies on the occurrence of CHC.

Results

A total of 305 survivors met the inclusion criteria as of July 2022. Females were 165 participants. The median follow-up and age at evaluation were 8.5 and 14 years, respectively. Leukemia was the most common cancer type (49.3%), followed by lymphoma (16.7%) and solid tumors (15.7%). Chemotherapy was administered to 287 survivors. Radiotherapy and surgery were used in 29.2% and 22.3% of cases, respectively. Seventy-eight percent of participants experienced at least 1 CHC, with 31.1% and 14.2% having 2 and 3 CHC, respectively. A multivariate logistic regression identified significant association between CHC and solid tumors compared to hematological malignancies (OR 2.2; 95% CI: 1.1-4.3; P = .023). Growth impairment was the most common CHC, followed by endocrinopathy. Radiotherapy was significantly associated with short stature (95% CI: 1.2-3.6; P = .008). The majority of CHC, 77.3%, were mild in severity, while 19.3% were moderate, 2.9% were severe, and .5% were life-threatening.

Conclusion

The long-term complications of childhood cancer have revealed a prevalent concern. To optimize health outcomes, it is essential to implement well-structured and long-term follow-up tailored to risk profiles, utilize cost-effective screening methods, and promote prospective clinical research and establishment of a registry.

Unaware and unpowered: evaluating patient perceptions and preferences of biosimilars in South Korea

Objectives

Biosimilars offer a promising solution to challenges related to healthcare budget sustainability. However, limited patient awareness and understanding often hinder their timely adoption. This cross-sectional survey evaluates the perceptions, preferences, and experiences of South Korean patients regarding biosimilars.

Methods

An anonymous, self-administered, web-based survey comprising up to 26 questions was conducted. Participants were recruited from Ewha Womans University Medical Centers from November 2023 to August 2024. The analysis focused on respondents with medical conditions typically treated with biologics, such as solid tumors, blood cancers, and autoimmune diseases.

Results

Out of 133 responses, 100 were analyzed after excluding 33 individuals with irrelevant medical conditions. Among these, 66% had heard of biosimilars, primarily through the internet (28.8%, 19 out of 66). However, 55% were unfamiliar with the definition of biosimilars, and 61% did not understand the difference between generics and biosimilars. While most respondents considered biosimilars comparable to originators in terms of safety (45%) and efficacy (41%), the primary concerns were a lack of confidence in their safety (50%) and efficacy (50%). Among patients who exclusively used either originators or biosimilars, 91.7% and 95%, respectively, cited their doctors' recommendations as the main reason for choosing their treatment.

Conclusion

Patients primarily rely on doctors' recommendations, yet their awareness and understanding of biosimilars remain limited. To enhance positive perceptions of biosimilars among patients, implementing diverse educational programs and actively involving a multidisciplinary health team is essential. Such initiatives will not only increase patient access to these treatments but also contribute to the long-term sustainability of healthcare systems by encouraging the broader adoption of biosimilars.

Human papillomavirus self-sampling in Asia: a systematic review

Background

Human papillomavirus (HPV) self-sampling may be an accurate and effective alternative sampling method to conventional cervical cancer screening methods. This systematic review compares the accuracy and acceptance of self-sampling to clinician sampling for HPV testing in Asia.

Methods

The PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched for publications published from the establishment of the database to 2023. The risk of bias was assessed using the QUADAS-2 tool for studies included in this review. All studies evaluating the accuracy and acceptance of HPV self-sampling, and agreement of self- and clinician-collected samples in Asia were included. The accuracy of each study was demonstrated through the sensitivity and specificity in diagnosing cervical intraepithelial neoplasia or cancer, as well as the detection rate of HPV. The agreement between the two sampling methods was assessed based on the detection outcomes of HPV. Acceptance was indicated by women's preferences for HPV self-sampling.

Results

Sixty-seven studies including 117,279 adult, female participants were included in this review. The type of HPV screening, other intervention components, study design, sample size, follow-up period, analysis method, numerical outcomes, results, and limitations were extracted from each study. The sensitivity and specificity of HPV self-sampling in detecting cervical intraepithelial neoplasia were higher than 80% and 70%, consistent with the results of HPV clinician sampling. The consistency between self-sampling and clinician-sampling was high in most studies, and the kappa value was more than 0.7. Women had high acceptance of self-sampling but expressed some concerns.

Conclusion

Self-sampling for HPV testing can significantly improve cervical cancer screening coverage, especially in areas with limited medical resources or reluctance to accept physician sampling. In most studies, the accuracy and acceptance of HPV self-sampling was comparable to clinician sampling. However, the diagnostic criteria and HPV detection methods still need to be adjusted due to the low sensitivity of HPV self-sampling in some studies in China and India. Targeted health education should be carried out to improve the acceptance of HPV self-sampling in women.

Systematic review registration

https://inplasy.com/?s=INPLASY202520107, INPLASY202520107.

Understanding Loneliness Through Analysis of Twitter and Reddit Data: Comparative Study

BACKGROUND

Loneliness is a global public health issue contributing to a variety of mental and physical health issues. It increases the risk of life-threatening conditions and contributes to the burden on the economy in terms of the number of productive days lost. Loneliness is a highly varied concept, which is associated with multiple factors.

OBJECTIVE

This study aimed to understand loneliness through a comparative analysis of loneliness data on Twitter and Reddit, which are popular social media platforms. These platforms differ in terms of their use, as Twitter allows only short posts, while Reddit allows long posts in a forum setting.

METHODS

We collected global data on loneliness in October 2022. Twitter posts containing the words "lonely," "loneliness," "alone," "solitude," and "isolation" were collected. Reddit posts were extracted in March 2023. Using natural language processing techniques (valence aware dictionary for sentiment reasoning [VADER] tool from the natural language toolkit [NLTK]), the study identified and extracted relevant keywords and phrases related to loneliness from user-generated content on both platforms. The study used both sentiment analysis and the number of occurrences of a topic. Quantitative analysis was performed to determine the number of occurrences of a topic in tweets and posts, and overall meaningful topics were reported under a category.

RESULTS

The extracted data were subjected to comparative analysis to identify common themes and trends related to loneliness across Twitter and Reddit. A total of 100,000 collected tweets and 10,000 unique Reddit posts, including comments, were analyzed. The results of the study revealed the relationships of various social, political, and personal-emotional themes with the expression of loneliness on social media. Both platforms showed similar patterns in terms of themes and categories of discussion in conjunction with loneliness-related content. Both Reddit and Twitter addressed loneliness, but they differed in terms of focus. Reddit discussions were predominantly centered on personal-emotional themes, with a higher occurrence of these topics. Twitter, while still emphasizing personal-emotional themes, included a broader range of categories. Both platforms aligned with psychological linguistic features related to the self-expression of mental health issues. The key difference was in the range of topics, with Twitter having a wider variety of topics and Reddit having more focus on personal-emotional aspects.

CONCLUSIONS

Reddit posts provide detailed insights into data about the expression of loneliness, although at the cost of the diversity of themes and categories, which can be inferred from the data. These insights can guide future research using social media data to understand loneliness. The findings provide the basis for further comparative investigation of the expression of loneliness on different social media platforms and online platforms.

Anticancer efficacy of Spiruchostatin A: current insights into histone deacetylase inhibition and oncologic applications

Spiruchostatin A also referred to as YM753 and OBP801, a cyclic peptide-based natural product derived from Pseudomonas sp., is distinguished by its potent inhibition of Class I histone deacetylases (HDACs). The modulation of epigenetic mechanisms by HDAC inhibitors is fundamental for altering gene expression related to cell growth, apoptosis, and differentiation, highlighting their potential in oncologic therapies. This updated review assesses the antitumor efficacy of Spiruchostatin A across diverse cellular and animal models, scrutinizing its viability as a therapeutic agent against various cancers. A systematic literature review was executed by searching databases such as PubMed/MedLine, Scopus, and Web of Science from October 2022 to February 2023. The inclusion criteria focused on studies involving Spiruchostatin A in the context of cancer treatment, including in vitro and in vivo models. The review concentrated on the compound's mechanistic action, biological activity, and clinical applicability. Spiruchostatin A has demonstrated significant antitumor activities, including inducing apoptosis and inhibiting tumor growth effectively in multiple models. Its therapeutic potential is particularly noted in synergistic applications with other anticancer agents, enhancing its efficacy. Mechanistically, the compound facilitates chromatin relaxation and transcriptional activation of key tumor suppressor genes through increased histone acetylation. Spiruchostatin A exhibits substantial potential as an anticancer agent through effective HDAC inhibition and subsequent epigenetic modifications of cancer cell biology. However, comprehensive clinical trials are imperative to validate its efficacy and safety profiles comprehensively. Future research is warranted to elucidate detailed molecular mechanisms and to develop biomarkers for predicting treatment response. Comprehensive longitudinal clinical studies are also critical to establish Spiruchostatin A's role within the broader oncological therapeutic regimen, along with the exploration of its analogs for improved therapeutic outcomes.

Opportunities for Artificial Intelligence in Oncology: From the Lens of Clinicians and Patients

Much work has been published on artificial intelligence (AI) and oncology, with many focusing on an algorithm perspective. However, very few perspective articles have explicitly discussed the role of AI in oncology from the perspectives of the stakeholders-the clinicians and the patients. In this article, we delve into the opportunities of AI in oncology from the clinician's and patient's lens. From the clinician's perspective, we discuss reducing burnout, enhancing decision making, and leveraging vast data sets to provide evidence-based recommendations, eventually affecting diagnostic accuracy and treatment planning. From the patient's perspective, we discuss AI virtual concierge, which could improve the cancer care journey by facilitating patient education, mental health support, and personalized lifestyle wellness recommendations promoting a holistic approach to care. We aim to highlight the stakeholders' unmet needs and guide institutions to create innovative AI solutions in oncology. By addressing these perspectives, our article aims to bridge the gap between technological research advancements and their real-world AI-focused clinical applications in cancer care. Understanding and prioritizing the needs of the stakeholders will foster the development of impactful AI tools and intentional utilization of such technology, with an aim for clinical implementation and integration into workflows.

A mixed-methods preliminary evaluation of an innovative treatment for cervical precancer in El Salvador's screen-and-treat program

BACKGROUND

Cervical cancer remains a leading cause of cancer death for women worldwide. Screen-and-treat programs are a key strategy to reduce disease burden in low and middle-income countries (LMICs). Thermal ablation (TA) has emerged as a portable alternative to cryotherapy, the treatment typically used in screen-and-treat initiatives. Interest in TA is growing, but there is limited research on its implementation in public health settings. Here we present results from a preliminary evaluation of the barriers and facilitators of TA in El Salvador, one of the first countries to adopt a national HPV screen-and-treat program.

METHODS

This mixed-methods study took place between August 2022 to February 2023 across five clinics. The Practical, Robust Implementation and Sustainability Model (PRISM) was utilized to map findings to contextual factors that impact implementation and sustainability. Participants were frontline providers and women who presented for treatment after a positive HPV test. Providers took part in semi-structured interviews while women completed questionnaires. Additional data were collected from clinic records. Quantitative data were analyzed using inferential statistics and a rapid qualitative analysis approach was used for interviews.

RESULTS

Providers perceived TA as easier to use and more comfortable for patients, but cryotherapy was utilized 20% more frequently during the study period (cryotherapy treatments = 133 vs. TA treatments = 100). Although the two treatments have the same contraindications, a greater proportion of women were deemed eligible for treatment with TA vs. cryotherapy (95% vs. 79%, p < .001). There were discrepancies in provider and women's perceptions of pain and side-effects. While > 80% of women received counseling during the screen-and-treat process, misconceptions regarding screenings results and treatment remained.

CONCLUSIONS

The new treatment (TA) was highly acceptable to participants. However, there may be a need for additional provider training to support TA adoption and fidelity to program guidelines, while patients would benefit from more effective counseling. As LMICs strive to meet cervical cancer elimination targets set by the World Health Organization, it is expected that innovations will be quickly introduced to clinical practice. Thus, it is critical to understand the factors that impact their implementation and sustainability in these settings.

Determinants of oral cavity cancer recurrence in Pakistan: findings from a cross-sectional study using an institutional cancer registry

INTRODUCTION

Pakistan has a high prevalence of oral cavity cancer (OCC) with a significant recurrence rate. This study aims to explore the factors associated with OCC recurrence in Karachi, Pakistan.

METHODS

This cross-sectional study was conducted at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, using data from the AKUH Cancer Registry. A total of 1692 biopsy-confirmed cases of OCC including cancers of mucosal lip, tongue, gum, oral cavity floor, palate and other subsites like retromolar area, diagnosed between May 2011 and December 2020, were included in our study.

RESULTS

Of the 1692 patients, 611 (36.1%) experienced recurrence. Being male was associated with significantly increased odds of OCC recurrence compared to being female (Prevalence Odds Ratio (POR) = 1.70, 95% CI = 1.25-2.30). Moderately and poorly differentiated tumors had higher odds of recurrence (POR = 1.44, 95% CI = 1.02-2.02 and POR = 2.35, 95% CI = 1.49-3.71 respectively). Lymph node involvement was significantly associated with increased odds of recurrence. Patients with N1, N2 and N3 lymph node involvement had significantly higher odds of recurrence (POR = 1.45, 95% CI = 1.02-2.07 for N1, POR = 2.12, 95% CI = 1.57-2.87 for N2 and POR = 3.50, 95% CI = 1.72-7.11 for N3 respectively). Surgical treatment outside AKUH was associated with higher OCC recurrence (POR = 1.68, 95% CI = 1.12-2.50). Surgery alone (POR = 0.02, 95% CI = 0.00-0.16) and in combination with radiation (POR = 0.02, 95% CI = 0.00-0.16) or chemoradiation (POR = 0.04, 95% CI = 0.01-0.33) was protective against recurrence.

CONCLUSION

This study's findings identified factors increasing oral cavity cancer recurrence, highlighting the importance of considering these factors in the management and follow up of patients with OCC. Understanding these factors will not only help enhance patient care, but also improve patient education about their disease prognosis. Further research is needed to explore the underlying mechanisms and develop targeted interventions to improve outcomes for patients with OCC.

Fecal Immunochemical Tests (FIT) and Focus Groups: Tailoring Bilingual Cancer Screening Education

Virtual focus groups were conducted in English and in French to gather community feedback on colorectal cancer screening education materials, designed for use among immigrant and non-immigrant Black/African-American men in New York City. Participants were recruited from community health fair events, religious and cultural organizations, and an existing Community Advisory Board. Six total focus groups were conducted, four in English and two in French, with a total of 25 participants, until data saturation. Focus groups were audio recorded, transcribed, two were translated from French into English, and analyzed in NVivo software to develop and consolidate themes in participant responses. Focus groups revealed key knowledge gaps about colorectal cancer screening protocols and cancer risk heritability. Discussing racial health disparities may cause offense to some readers. Participants were interested to see root causes for racial health disparities discussed in health promotion material. Virtual focus groups can be used to gather community member feedback on health promotion materials. Real-time simultaneous language interpreting can be used if facilitator and audience do not speak the same language. Health educators should be mindful that the recommended screening age of 45 years for colorectal cancer is not generally known, and that individuals may believe that cancer is contagious. Readers may be offended by references to health disparities. Health educators should test health promotion materials with target audiences to ensure appropriateness and cultural sensitivity.

Physical activity and supportive care intervention preferences: a cross-sectional study of barriers in advanced cancer

PURPOSE

Physical activity may greatly benefit adults living with advanced cancer; however, barriers to physical activity and preferences for supportive care interventions are not well understood. This study investigates barriers to physical activity and differences in intervention preferences by demographic and clinical characteristics among adults with advanced cancer.

METHODS

Data came from a cross-sectional study of 247 adults with advanced cancer who visited the University of Wisconsin Carbone Cancer Centre from January 2021 to January 2023. The Godin-Shepard Leisure Score Index (insufficiently active, moderately active and active) was used to assess physical activity. Physical activity barriers were reported as mean scores (1-5: 'not at all' to 'a great deal'). Differences in intervention preferences were assessed using X2 tests.

RESULTS

Adults living with advanced cancer were insufficiently active (53%), moderately active (21%) or active (26%). Respondents identified several barriers to physical activity spanning tiredness (x̄=3.2), winter weather concerns (x̄=3.2) and lack of motivation (x̄=2.7). Respondents were most interested in a supportive care intervention designed to increase energy (88%) and improve physical health (86%) with physical therapy (73%), walking (72%) and resistance exercises (72%). Differences in preferences emerged by demographic characteristics and to a lesser extent by clinical characteristics.

CONCLUSIONS

Adults with advanced cancer reported several barriers to physical activity. Future interventions should emphasise increasing energy and physical health and include strategies to manage tiredness and winter weather concerns.

Molecular subtyping and target identification in triple negative breast cancer through immunohistochemistry biomarkers

BACKGROUND

The Triple-Negative Breast Cancer (TNBC) molecular subtyping and target identification based on Immunohistochemistry (IHC) is of considerable worth for routine use. Yet, literature on this topic is limited worldwide and needs to be enriched with data from different populations.

METHODS

We assessed the IHC expression of subtyping biomarkers (Cytokeratins 5, 14 and 17, Epidermal Growth Factor Receptor, Claudins 3 and 7, E-cadherin, Vimentin and Androgen receptor) and predictive biomarkers (Tumor-infiltrating lymphocytes (TILs) density, Breast Cancer Antigen 1 (BRCA1) and P53) in a cohort of TNBC patients. Clinicopathologic parameters and overall survival (OS) were investigated as well.

RESULTS

The patients were aged 50.11 ± 12.13y (more than 40y in 76.56% of patients), and 23.44% had a BC family history. They were in a non-advanced stage: 51.6% T2 stage, 56.2% negative lymph node involvement, 76.6% without metastasis and 64.1% grade II Scarff-Bloom-Richardson classification (SBR). The IHC subtypes were: 53.1% Basal-like1 (BL1), 6.3% Basal-like2 (BL2), 17.2% Mesenchymal (MES), 9.4% Luminal Androgen Receptor (LAR), 4.7% Mixed subtype and 9.4% "Unclassified" type. The LAR subtype involved the youngest patients (40.17 ± 8.68y, p = 0.02). The "Unclassified" subtype expressed the p53 mutated-type pattern more frequently (100%, p = 0.07). The BRCA1 mutated pattern and TILs infiltration were present in (23.44% and 37.5% of patients, respectively). The OS of the subtypes differed significantly (p = 0.007, log-rank test). The subtypes median OS were, respectively, 15.47 mo. (Unclassified), 18.94 mo. (BL2), 27.23 mo. (MES), 27.28 mo. (Mixed), 30.88 mo. (BL1), and 45.07 mo. (LAR). There was no difference in the OS following age, BRCA1 expression, p53 pattern and TILs density. Though, the OS following the TNM stage was different (p = 0.001). A multivariable Cox proportional hazards regression analysis showed that TNM staging and TNBC subtypes, independently influence the OS (p < 0.001 and p = 0.017, respectively). Hence, IHC is useful in TNBC subtyping for prognostic purposes and in the identification of therapeutic biomarkers. Further investigation is required to confirm our results and to implement IHC as a routine tool to improve patient's care.

Genetic Ancestry and Lung Cancer in Latin American Patients: A Crucial Step for Understanding a Diverse Population

Lung cancer is the second leading cause of cancer-related deaths in Latin America. While incidence and mortality rates are higher in other populations, the ``Hispanic paradox'' observed in US Hispanics reflects a lower mortality rate for mortality from non-small cell lung cancer (NSCLC) despite socioeconomic disparities, which may be related to epigenetic and cultural factors. Genetic studies have identified single nucleotide polymorphisms associated with ancestry as key contributors to lung cancer risk and outcomes, emphasizing the importance of genomic insights for early detection and personalized treatments. This narrative review explores the impact of genetic ancestry on lung cancer in Hispanic/Latino populations. We searched MEDLINE and Google Scholar for "((SNP) OR (germline) OR (variant)) AND (lung cancer) AND ((Hispanic) OR (Latin))," focusing on Latin American studies. We included articles published up to December 2024. Specific variation in genes such as XRCC1, CYP1A1, CYP1A2, SEMA3B, PADPRP, and mEPHX have been associated with increased lung cancer risk. Lung cancer incidence and prognosis vary significantly among Hispanics due to their diverse genetic ancestry. Understanding ancestry-specific genetic variations may help personalize treatment and improve outcomes for this population.

Healthcare utilization in the departments of obstetrics and gynecology during the first two years of the COVID-19 pandemic: time series analysis in Jining, China

INTRODUCTION

Healthcare utilization in China decreased precipitously during the initial outbreak of the COVID-19 pandemic, and women were disproportionately affected. As the COVID-19 pandemic has proven to be far more pervasive and persistent than many first surmised, a vital question is whether the utilization of non-COVID related healthcare has remained low under China's dynamic zero-COVID policy. This study aimed to estimate the initial and enduring collateral effects of the COVID-19 pandemic on the utilization of obstetrics and gynecology care at a tertiary hospital in Jining, Shandong Province, China.

METHODS

An interrupted time series analysis was conducted to estimate the impact of the COVID-19 pandemic and mobility restrictions on monthly counts of outpatient visits, inpatient admissions, and surgeries in the obstetrics and gynecology departments at a tertiary hospital in Jining, China. Outpatient visits and surgery volume were abstracted from the hospital's monthly healthcare delivery report, while inpatient admissions were obtained from de-identified individual electronic medical records of inpatients admitted between January 1, 2017 to December 31, 2021. Incidence Rate Ratios (IRRs) representing monthly service counts compared with counterfactual counts (had the pandemic not happened) and the volume (number) of patients lost due to the pandemic were estimated.

RESULTS

During the study period, there were a total of 1 181 120 outpatient visits, 89 550 inpatient admissions and 49 056 surgeries in the obstetrics department; and 847 124 outpatient visits, 42 644 inpatient admissions and 39 653 surgeries of these totals occurred in the gynecology department. Compared to the expected estimates had the pandemic not occurred, a 55.4% (95% CI: 52.6-57.9%; p < 0.001), 31.1% (95% CI: 27.2 - 34.7%; p < 0.001), and 27.6% (95% CI: 23.2- 31.8%; p < 0.001) decrease was observed in obstetric outpatient visits, inpatient admissions, and surgeries, respectively in the month of February 2020 when the lockdown was enforced; and a 87.4% (95% CI: 86.0 - 88.4%; p < 0.001), 74.6% (95% CI: 71.0 -79.2%; p < 0.001), and 75.5% (95% CI: 70.9 - 77.8%; p < 0.001) decrease was observed in gynecologic outpatient visits, inpatient admissions, and surgeries, respectively. As of December 2021, outpatient (IRR = 0.86; 95% CI: 0.80-0.94; p < 0.001), surgery (IRR = 0.88; 95% CI: 0.82-0.95; p < 0.001), and inpatient (IRR = 0.73; 95% CI: 0.68-0.79; p < 0.0001) services in the obstetrics department, and outpatient visits (IRR = 0.90; 95% CI: 0.82-0.89; p = 0.007) in the gynecology department had not fully recovered to pre-pandemic levels. Rural residents experienced a larger immediate decrease in inpatient care utilization in both obstetrics and gynecology in the month of February 2020, and the return to pre-pandemic levels in care utilization was also slower than that of urban residents.

CONCLUSIONS

The COVID-19 pandemic led to sizable disruptions in routine delivery and utilization of obstetrics and gynecology care. Disruptions were particularly substantial during the initial wave of the outbreak, and full recovery to pre-pandemic levels has not yet been achieved. The impact was more dramatic for women from rural areas, highlighting the need for policies and programs that address inequities in pandemic response and preparedness.

Global and East Asia tracheal, bronchus, and lung cancer trend analysis from 1990 to 2021 and forecast trend from 2021 to 2035

Background and Aims

This study aimed to evaluate the trends in incidence, mortality, and disability-adjusted life years (DALYs) for trachea, bronchus, and lung (TBL) cancer globally and in East Asia from 1990 to 2021.

Methods

We analyzed TBL cancer data from the Global Burden of Disease (GBD) 2021 study, focusing on five East Asian countries. Socioeconomic contexts were examined using sociodemographic indices. Trends in disease metrics were analyzed using time-segmented link-point regression to determine the average annual percentage change (AAPC). A Bayesian Age-Period-Cohort (BAPC) model was applied to forecast the future disease burden from 2022 to 2030.

Results

Globally and in East Asia, significant increases were observed in the incidence, mortality, and DALYs related to TBL cancer from 1990 to 2021. China had the highest rates of incidence (934,704; 95% UI, 750,040 to 1,136,938), mortality (814,364; 95% UI, 652,636 to 987,795), and DALYs (18,920,203; 95% UI, 15,100,681 to 23,111,519), while Mongolia had the lowest. Ambient particulate matter pollution was identified as the main risk factor for TBL cancer mortality both globally and in most East Asian countries. Notably, global TBL cancer incidence spikes occurred during 1999-2012 and 2019-2021 (AAPC: 1.170 [95%, 1.115 to 1.225] and 1.658 [95%, 0.604 to 2.723], respectively). In Mongolia, TBL cancer incidence showed variable trends. The increases in global and East Asian DALY rates were attributed to population aging and growth, while epidemiological shifts have contributed to reduced rates. Except for Democratic People's Republic of Korea, DALY risk trends were generally declining across the other East Asian countries.

Conclusion

There has been a significant increase in the incidence and mortality rates of TBL cancer both globally and in East Asia from 1990 to 2021, with environmental particulate matter pollution potentially serving as a strongly correlated risk factor. There is an urgent need to enhance prevention, early detection, and treatment measures, particularly in high-risk regions.

A Review of Breast Cancer Surgeries in a Sub-urban Nigerian Tertiary Hospital and the Limitations of Breast-Conserving Surgery

Background

The surgical management of breast cancer involves either modified radical mastectomy or a conservative approach. Breast-conserving surgery is the preferred surgical treatment for early breast cancer in developed countries, while mastectomy is still more favoured by most centres in developing countries.

Objectives

To report some quality data on breast cancer surgeries from a sub-urban tertiary hospital in Nigeria.

Design

Retrospective analysis.

Methods

We retrospectively reviewed all breast cancer surgeries performed between January 2018 and December 2022 at the Irrua Specialist Teaching Hospital.

Results

A total of 105 female patients underwent breast cancer surgery. Their ages ranged between 27 and 85 years, with a mean of 48.8 years (SD = 12.2). The mean duration of symptoms before presentation was 12.3 ± 17.8 months (1-120 months), with 15.2% presenting with stage I and II disease and 84.7% presenting with stage III and IV disease. Invasive carcinoma NST was the most common histological type in 78 (74.3%) patients. The cancers were predominantly high grade (42.3%) and triple negative (41.5%). Only 9.5% of the patients had breast-conserving surgery, the others had mastectomy. Sixty-three patients (60%) received neoadjuvant chemotherapy while only 25.7% of patients had documented evidence of the completion of adjuvant radiotherapy.

Conclusion

The rate of breast-conserving surgery in this study was extremely low. This could be attributed to the advanced stage at presentation, predominance of aggressive tumours, limited access to radiation therapy, status of the medical system, and patient preferences.

Understanding stigma as a barrier to cancer prevention and treatment: a qualitative study among people living with HIV in Uganda and Zambia

OBJECTIVES

Extended life expectancy due to treatment improvements has increased the diagnosis of cancer among people living with HIV (PLWH) in Africa. Despite documented impacts of stigma on cancer preventive behaviours and care, little is known about the intersections of cancer and HIV stigma and the effects on prevention and care behaviours for both conditions. This study aims to examine experiences and drivers of cancer stigma and their associations with access to and utilisation of cancer prevention services among PLWH.

DESIGN

This was a qualitative study consisting of eight focus group discussions with PLWH and 14 key informant interviews with HIV healthcare providers collected in January 2024.

SETTING

Data were collected from two districts of Uganda and Zambia. In Uganda, the two selected districts were Arua, in the northern West Nile region, and Moroto, in the northeast Karamoja region. In Zambia, the study districts were Mongu, in the Western Province, and Chipata in the Eastern Province.

PARTICIPANTS

Each study district held two PLWH focus groups (one male, another female) with 5-7 participants per group and 3-4 key informant interviews for a total of 55 participants. PLWH and healthcare providers were eligible if they were (1) aged 18 years or older and (2) an HIV-positive client receiving antiretroviral therapy services at the participating clinic or working in a health services capacity at the clinic.

RESULTS

Cancer stigma drivers included widespread misconceptions about disease origins and outcomes, associations with other stigmatising conditions and behaviours such as HIV, TB, and substance use, limited treatment options that heightened fears of diagnosis and inadequate training of healthcare providers. Study participants noted that experiences of stigma led to reduced treatment-seeking behaviours among PLWH, increased social isolation, and poor cancer-related care practices within clinics. Recommended interventions to combat stigma included improved education for providers and patients, private counselling, and peer support.

CONCLUSIONS

Results underscore the presence and impacts of stigma in the study population, emphasising the need for research informing culturally sensitive interventions that enhance educational outreach and promote engagement in care among targeted populations.

TRIAL REGISTRATION NUMBER

This article is linked to an ongoing clinical trial registered on clinical trials.gov (clinical trial No: NCT05487807; Registration date: 27 November 2023) and relates to the pre-results stage.

Parental Reports on Late Effects and Follow-Up Needs: A Single-Center Assessment of Childhood Cancer Survivorship Care in Kenya

The WHO Global Initiative for Childhood Cancer will likely increase the number of childhood cancer survivors in resource-poor countries. This study explored survivorship care in Kenya through parental reports on late effects and the follow-up needs of childhood cancer survivors. Parents of Kenyan childhood cancer survivors (under 18 years old) who completed treatment for at least one year were interviewed using semi-structured questionnaires from 2021 to 2022. Parents of 54 survivors were interviewed. Survivors had solid tumors (52%) and hematological tumors (48%). Most (52%) received chemotherapy combined with either surgery or radiotherapy. Many survivors (72%) experienced symptoms according to their parents. The most prevalent symptoms were pain (37%), fatigue (26%), and ocular problems (26%). Eleven percent of parents observed limitations in the daily activities of the survivors. Parents of survivors with two or more symptoms were more likely to rate symptoms as moderate to severe (p = 0.016). Parents expressed concern about late effects (48%). Only 28% were informed about late effects at the hospital, despite 87% indicating they would have welcomed this information. Follow-up care was deemed important by 98%. Recommendations included providing education about late effects and organizing survivor meetings. Survivorship clinics should be established to ensure that follow-up information and care are accessible.

Association between conflict intensity and health outcomes in contemporary conflicts, while accounting for the vulnerability and functioning of healthcare services

BACKGROUND

Armed conflict can be described as human development in reverse. In addition to the direct consequences of violence, there are numerous ways in which armed conflict may have indirect effects on people's health and well-being. Studies give varying results, and health impacts seem to differ from context to context. We aimed to determine how conflict intensity is associated with health outcomes, accounting for existing vulnerabilities and the functioning of healthcare services in countries experiencing armed conflict.

METHOD

This study is based on panel data on conflict intensity, vulnerability, healthcare service functioning, and health outcomes in 42 conflict-affected countries between 2000 and 2019 and uses fixed-effects panel regression analysis to determine the associations between conflict intensity and health outcomes.

RESULTS

Conflict intensity was positively associated with the health outcomes included in this study. As the conflict intensity increased, the mortality and prevalence of these outcomes also increased, although this increase was not statistically significant for half the outcomes (8/16). After adjusting for the vulnerabilities and functioning of healthcare services, this positive association became significant for all health outcomes. Vulnerability and functioning of healthcare services were strong predictors of outcomes. Subgroup analysis revealed that conflict intensity was more significantly associated with outcomes in countries with high and medium vulnerability scores.

CONCLUSION

Existing vulnerabilities and healthcare system conditions are known to impact health outcomes. The association between conflict intensity and health outcomes strengthens when existing vulnerabilities and the state of healthcare services are considered. This underscores the importance of incorporating strategies to address socioeconomic inequities and strengthen healthcare system capacity in interventions for conflict-affected regions. This also raises additional concerns for long-term negative health effects related to the increasing trend of attacks on health care in contemporary conflicts.

Building a hereditary cancer program in Colombia: analysis of germline pathogenic and likely pathogenic variants spectrum in a high-risk cohort

Genetic studies in Latin America have expanded, but further efforts are needed to understand cancer susceptibility genes beyond BRCA1 and BRCA2, especially by characterizing the prevalence and spectrum of pathogenic or likely pathogenic variants (PVs) in the region. This study aimed to determine the frequency of hereditary cancer syndromes (HCS) in Colombians with solid tumors and to characterize the spectrum of PVs. Using data from the Colombia's largest Institutional Hereditary Cancer Program, we included patients aged ≥18 years with solid tumors who met HCS criteria and were offered genetic testing with a 105-cancer gene panel. We calculated the prevalence of PVs and HCS by cancer type (beyond breast) and gene. For patients with breast cancer, we examined genotype-phenotype correlations with molecular subtypes and stratified positivity rates by different genetic testing criteria. Among 769 patients, we identified 216 PVs in 43 genes in 197 patients (26%). Thirty-three PVs were recurrent. Autosomal HCS was found in 21% (160/769) of patients (159 dominant, one recessive), while 5% (37/769) were heterozygous carriers of PVs in autosomal recessive genes. In 42% (321/769) of the cases, only one or more variants of uncertain significance (VUS) were identified, whereas 33% (251/769) had neither PVs nor VUS detected (negative results). HCS prevalence varied by cancer type (11-26%). The triple-negative subtype and bilateral presentation were strong predictors of inherited breast cancer. Our study reveals a significant presence of PVs among high-risk Colombian patients with solid tumors, underscoring the importance of genetic counseling and testing in the region.

Balancing immunotherapy and corticosteroids in cancer treatment: dilemma or paradox?

Corticosteroids are widely used to prevent and treat chemotherapy-induced nausea and vomiting (CINV) due to their pleiotropic biological effects. However, concerns have been raised about their immunosuppressive properties when combined with immunotherapy. Specifically, their potential impact on the efficacy of immunotherapy, mainly immune checkpoint inhibitors (ICIs), remains a subject of debate. This manuscript discusses the mechanisms by which corticosteroids mitigate CINV, the challenges associated with their concurrent use with immunotherapy, and emerging therapeutic strategies evaluating dexamethasone-free regimens. A careful balance must be struck in corticosteroid use to effectively manage CINV while optimizing the outcomes of immunotherapy.

Tumor protein 53 gene polymorphism, demographic attributes and associated risk factors among liver cancer patients in Calabar, Nigeria

Mutations in the TP53 gene had been attributed to the development of liver cancer. Hepatocellular carcinoma (HCC) and liver tumour are liver diseases having high mortality rates in several populations. There is no information on the TP53 gene polymorphism among liver diseases patients in Calabar, Nigeria. This study investigated the genetic polymorphism of TP53 among HCC and liver tumour in Calabar. This research was carried out in the University of Calabar Teaching Hospital, Calabar. Blood samples were collected from 35 clinically diagnosed hepatocellular carcinoma and 10 tumour patients and 10 healthy controls. DNA was extracted from all blood samples and Polymerase Chain Reaction (PCR) was performed using specific primers. The PCR amplicons were digested using Hae III restriction enzyme and the genotypic and allelic frequencies was determined. Demographic data among participants showed that males were 68.9% (31), females (31.1%; 14), sex ratio (2.2: 0.5), mean age was 41.51 ± 2.13 years with an odds ratio of 1.25. The distribution of participants according to marital status were 33(73.3%), 10(22.2%), and 2(4.4%) for married, single, and widowed respectively. The participants were from different extractions with varied representations of Yakurr (22.2%, 10), Efik (20%, 9), Boki (13.3%, 6), Ogoja (13.3%, 6), Annang (8.8%, 4), Ibibio (2.2%, 1) and Igbo (2.2%, 1) and respectively. Approximately, 64.7% (30) of the chronic liver diseases were from the Central and Northern part of Cross River State. The risk factors were HCV infection, HBsAg+, alcoholism, smoking, consumption of groundnuts that may have been contaminated with aflatoxin and family history of the disease. PCR product yielded 254 bp and digested PCR product showed homozygous TT mutation (27), heterozygous GT mutation (17) and homozygous GG wild type (1) in cases. The overall TP53 gene mutation frequency was 46.32% (44). The frequency of G allele, T allele, GG, GT and TT were 0.21, 0.79, 0.04, 0.33 and 0.62 respectively among cases, while GG (wild type) was only detected among controls in the study population. The genotypic and allelic frequencies conform to Hardy-Weinberg equilibrium meaning that the forces of evolution were not acting on the locus. There were significant differences in the genotypic proportions of the TP53 gene polymorphism among patients and controls. This study on the TP53 gene polymorphism will serve as baseline information on the molecular etiology of hepatocellular carcinoma and liver tumour in Cross River State.

Relationship between BMI and chemotherapy-induced peripheral neuropathy in cancer patients: a dose-response meta-analysis

OBJECTIVE

This meta-analysis aimed to evaluate the dose-response relationship between body mass index (BMI) and the risk of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients.

METHODS

We conducted a dose-response meta-analysis of 10 studies involving 6,841 cancer patients. Studies reporting BMI and CIPN outcomes were selected. The relationship between BMI and CIPN was assessed using random-effects models and restricted cubic splines to model the dose-response association.

RESULTS

Pooled analysis revealed a significant association between higher BMI and increased risk of CIPN, with an odds ratio (OR) of 1.55 (95% CI, 1.20-1.99). A dose-response analysis demonstrated a clear linear relationship between BMI and the risk of CIPN. For every 5 kg/m2 increase in BMI, the relative risk of CIPN increased by approximately 15%. Subgroup analyses showed stronger associations in breast cancer patients and those treated with taxane or platinum-based regimens. Sensitivity analyses confirmed the robustness of the results, and mild publication bias was observed.

CONCLUSIONS

Higher BMI is significantly associated with an increased risk of CIPN, with a dose-dependent effect. Weight management interventions, such as dietary modifications and physical activity, may reduce CIPN risk, particularly in patients with elevated BMI undergoing chemotherapy with neurotoxic regimens.

Patient-centeredness and determinant factors of palliative care service for adult cancer patients in public hospitals of addis Ababa, Ethiopia, 2024: cross-sectional mixed method study

INTRODUCTION

Providing patient centered palliative care is essential to enhance the wellbeing of patients with life-limiting illnesses and their families. As the demand for palliative care services increases and the cancer burden grows in Ethiopia, it is crucial to know how much these services are patient centered and what factors may determine it. Therefore, this study assess the level and determinant factors of patient-centeredness for adult cancer patients' palliative care services in public hospitals found in Addis Ababa.

METHOD AND MATERIALS

A cross-sectional mixed method was employed from May 16 to August 19, 2024. A total of 407 adult cancer patients, 7 key informant interviews and five in-depth interviews were included. The quantitative data was collected using Kobo collect tool version 2.023.21 and exported to STATA version 14 for analysis. Binary and multi-variable logistic regression with 95% Confidence Interval (CI) and Adjusted Odds Ratio (AOR) were fitted to identify factors associated with the patient-centeredness of care. Qualitative data was recorded, transcribed and thematically analyzed by using Open Code software version 4.0.1.

RESULTS

Patient-centeredness care for adult cancer patients was 77.9%. age group 30-39 (AOR: 3.52, 95% CI: 1.21, 10.21), being divorced (AOR: 0.14 95%, CI: 0.06, 0.37), monthly income > 12,000 Birr (AOR: 0.36, 95 CI: 0.156, 0.836), health literacy (AOR: 0.08, 95% CI: 0.02, 0.25), intimacy with the provider (AOR: 0.14 95% CI: 0.02, 0.75), service easiness (AOR: 0.34, 95% CI: 0.17, 0.67), and appointment waiting time (AOR: 0.4 95% CI: 0.19, 0.83) were found to be significant factors for patient-centeredness of palliative care service.

CONCLUSION AND RECOMMENDATIONS

The magnitude of patient-centered care for adult cancer patients in palliative care was 77.9%. Most patients felt respected and involved in decision-making, and their physical and emotional comfort was maintained. However, only one-third of them reported ease of access to services. Age, marital status, income, participation in decision-making, intimacy with providers, ease of access, and appointment length was the significant factors. Recommendations include improving service coordination, reducing waiting time, fostering emotional connections between patients and providers, and offering tailored support to single or widowed patients to enhance patient-centered care.

Understanding diagnostic delays among newly diagnosed breast cancer patients at a tertiary cancer care center in a low-middle-income country like Bangladesh

Breast cancer poses a significant health challenge for women globally, with survival rates varying widely between and within countries. The correlation between delayed diagnosis and lower survival rates is well-established, emphasizing the importance of addressing barriers to early presentation to improve survival rates in low-middle-income countries like Bangladesh. The objective of the study was to assess how often breast cancer patients present late, pinpoint the underlying reasons for the delay, and examine any potential links between delayed presentation and socio-demographic factors in our context. A prospective cross-sectional study was conducted at Ahsania Mission Cancer and General Hospital from July 2023 to December 2023. The study focused on newly diagnosed breast cancer patients attending the outpatient department. Following the provision of consent, the patient's information was obtained through face-to-face interviews and a review of their medical records. Diagnostic delay was defined as 90 days or more from the onset of symptoms to the initiation of medical treatment (by expert physicians). The collected data was stratified based on various socio-demographic variables, including age, marital status, education status, and socio-economic status. Data analysis and visualization were performed using Microsoft Excel and SPSS V 25. The study involved 242 participants; the majority (126, 52.06%) were aged 41 to 60 and came from a low-income, uneducated social background. Stage II breast cancer was the most common presentation (137, 56.6%). The average duration from diagnosis was 5.18 months, and nearly half of the patients (112, 46.28%) experienced more than 3 months of diagnostic delay. The delay in diagnosis was significantly associated with the patient's socio-economic status and the stage of cancer. The primary cause of delayed diagnosis was a lack of awareness about breast cancer symptoms, particularly the painless nature of breast lumps, which patients either did not notice or did not consider serious enough to seek medical attention, followed by the initial pursuit of alternative treatments. To facilitate earlier breast cancer diagnosis, policies should prioritize community-based education programs and adequate screening procedures, as well as expanded healthcare access.

Efficacy of Ayurvedic treatment given to cancer patients in the prevention of COVID-19 - A Retrospective Cohort Study at Integrated Cancer Treatment and Research Centre, Wagholi

BACKGROUND

Cancer patients are considered to have a higher risk of developing severe Coronavirus Disease 2019 (COVID-19) and a higher mortality rate. Moreover, poor prognosis observed in them is associated with multiple co-morbidities. Ayurveda can prove to be effective in preventing COVID-19 as well as improving clinical outcomes against COVID-19 in cancer patients.

OBJECTIVES

To evaluate the effect of Ayurvedic treatments given to cancer patients as also a preventive modality against COVID-19 infections.

METHODS

700 cancer patients were enrolled in the study. The demographic information regarding their age, sex, organs involved, stage, pre-existing comorbidities, Karnofsky score, addictions, undergoing conventional cancer treatment, type of conventional treatment, and duration of Ayurvedic cancer treatment was collected from the institutional records. These patients were interviewed telephonically or in person to obtain information related to their COVID-19 status from March 2020 to Sep 2021, which included a) whether they were affected with COVID-19 or not, b) If affected, the severity of COVID-19 symptoms, c) vaccination status, d) mortality, and e) if in contact with relative affected by COVID-19.

RESULTS

The surveyed cohort had 56 years as the median age, more female patients, Karnofsky score between 80 and 100, and hypertension as well as diabetes as major co-morbidities. During the 1st and 2nd waves, 34 (4.85%) and 65 patients (10.09 %) were COVID-19 positive while 4.91 % and 11.11% of patients with addictions were covid positive, respectively, the rest remained unaffected. There was no specific trend in % of COVID-19-positive cancer patients concerning stage, but those with stage IV undergoing conventional treatment showed increased prevalence (p < 0.001). Prolonged Ayurvedic treatment exhibited a decreasing trend in % COVID-19 positive patients, which is highly significant (p < 0.001). Specifically, those undergoing conventional therapy, and also received Ayurvedic treatment simultaneously for more than 3 years remained unaffected by COVID-19, which was statistically significant in both waves (p < 0.001).

CONCLUSION

Ayurvedic treatments given to cancer patients are effective in preventing COVID-19 infections in these patients.

COVID-19 lockdown-related treatment modifications did not impact the outcome of digestive cancers: the Clin-COVIDICA prospective study

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic modified the organization of cancer care pathways worldwide. Few prospective long-term data assessing these therapeutic modifications are available.

METHODS

Clin-COVIDICA was a prospective cohort aiming at determining the clinical impact of COVID-19-related therapeutic modifications in patients with digestive cancer in our center. All consecutive patients undergoing an oncologic treatment for a digestive cancer from March 1 to April 30, 2020, were enrolled in the cohort and followed-up for 24 months. The primary endpoint was progression-free survival (PFS). Secondary endpoints included COVID-19 rate, adverse events (AE) and overall survival (OS). Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test.

RESULTS

Of the 401 patients included, 39.6% were female, mean age was 68 years old and most frequent tumor were colorectal (50.0%) and pancreatic (17.9%) cancers. All in all, 55 patients (13.7%) have undergone therapeutic modifications. The most frequent were a switch to an oral drug (capecitabine, 30.9%), treatment holidays (29.1%) and treatment cancellation (18.2%). Considering patients with palliative treatment (n = 339), there was a non-significant trend for longer OS (52.0 months versus 36.4 months, p = 0.07) and a significant longer PFS (15.4 months versus 6.2 months, p = 0.009) in patients with therapeutic modifications. There were more all grades AEs in patients without therapeutic modifications (84.4% vs. 65.5%, p = < 0.001), but more severe AEs (grade 3-5) among patients with therapeutic modifications (18.2% versus 8.7%, p = 0.048), especially for patients with a switch to an oral drug, which resulted in 8 severe adverse events and one death. Six patients (1.5%) had a COVID-19, with one COVID-19-related death and one definitive cancellation of a curative surgery due to the consequences of COVID-19.

DISCUSSION

We observed no negative survival impact of therapeutic modifications due to the COVID-19 pandemic in digestive cancer management. This may be due to the selection of patients with less aggressive disease. More severe AEs were observed upon therapeutic modifications, especially switching to oral capecitabine.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT04389684; date of registration (15/05/2020).

Priority setting for improved leukemia management and research in South Africa: a modified Delphi study

PURPOSE

In resource-limited environments, setting priorities for leukemia care becomes essential to ensure effective and efficient use of available resources. This study aimed to identify the key areas of leukemia care and services by determining their prioritization within the South African healthcare system and developing a set of improvement and research priorities.

METHODS

A two-round modified Delphi method was used to identify leukemia care priorities and rank areas of leukemia management improvement and research priorities. Healthcare professional experts comprised of Clinical Hematologists and Hematopathologists. In round 1, participants independently rated the importance of 125 iterative statements on leukemia care and services derived from literature. In round 2, agreement within the expert participants was considered to finalize the list of priority statements and 17 improvement and research priorities were ranked based on level of importance.

RESULTS

In total, a list of 67 priority statements reached consensus, and 17 improvement and research priorities were established. A high agreement (≥ 90%) was reached for 24 statements within the six themes, these included accurate and advanced diagnostic techniques, factors in determining treatment strategies (e.g., risk stratification), supportive care measures (e.g., pain management and infection prevention), ensuring adequate healthcare workforce, and creating multidisciplinary teams. The highest ranked improvement and research priorities were timely delivery of diagnosis and treatments and biomarker development for early detection, prognosis, and treatment response.

CONCLUSION

This study identified key priorities for leukemia care within the South African healthcare system, providing an evidence-based framework through expert consensus.

Role of AI in empowering and redefining the oncology care landscape: perspective from a developing nation

Early diagnosis and accurate prognosis play a pivotal role in the clinical management of cancer and in preventing cancer-related mortalities. The burgeoning population of Asia in general and South Asian countries like India in particular pose significant challenges to the healthcare system. Regrettably, the demand for healthcare services in India far exceeds the available resources, resulting in overcrowded hospitals, prolonged wait times, and inadequate facilities. The scarcity of trained manpower in rural settings, lack of awareness and low penetrance of screening programs further compounded the problem. Artificial Intelligence (AI), driven by advancements in machine learning, deep learning, and natural language processing, can profoundly transform the underlying shortcomings in the healthcare industry, more for populous nations like India. With about 1.4 million cancer cases reported annually and 0.9 million deaths, India has a significant cancer burden that surpassed several nations. Further, India's diverse and large ethnic population is a data goldmine for healthcare research. Under these circumstances, AI-assisted technology, coupled with digital health solutions, could support effective oncology care and reduce the economic burden of GDP loss in terms of years of potential productive life lost (YPPLL) due to India's stupendous cancer burden. This review explores different aspects of cancer management, such as prevention, diagnosis, precision treatment, prognosis, and drug discovery, where AI has demonstrated promising clinical results. By harnessing the capabilities of AI in oncology research, healthcare professionals can enhance their ability to diagnose cancers at earlier stages, leading to more effective treatments and improved patient outcomes. With continued research and development, AI and digital health can play a transformative role in mitigating the challenges posed by the growing population and advancing the fight against cancer in India. Moreover, AI-driven technologies can assist in tailoring personalized treatment plans, optimizing therapeutic strategies, and supporting oncologists in making well-informed decisions. However, it is essential to ensure responsible implementation and address potential ethical and privacy concerns associated with using AI in healthcare.

Metric-Guided Conformal Bounds for Probabilistic Image Reconstruction

Modern deep learning reconstruction algorithms generate impressively realistic scans from sparse inputs, but can often produce significant inaccuracies. This makes it difficult to provide statistically guaranteed claims about the true state of a subject from scans reconstructed by these algorithms. In this study, we propose a framework for computing provably valid prediction bounds on claims derived from probabilistic black-box image reconstruction algorithms. The key insights behind our framework are to represent reconstructed scans with a derived clinical metric of interest, and to calibrate bounds on the ground truth metric with conformal prediction (CP) using a prior calibration dataset. These bounds convey interpretable feedback about the subject's state, and can also be used to retrieve nearest-neighbor reconstructed scans for visual inspection. We demonstrate the utility of this framework on sparse-view computed tomography (CT) for fat mass quantification and radiotherapy planning tasks. Results show that our framework produces bounds with better semantical interpretation than conventional pixel-based bounding approaches. Furthermore, we can flag dangerous outlier reconstructions that look plausible but have statistically unlikely metric values.

The association between long-term PM2.5 exposure and risk for pancreatic cancer: an application of social informatics

There is a profound need to identify modifiable risk factors to screen and prevent pancreatic cancer. Air pollution, including fine particulate matter (PM2.5), is increasingly recognized as a risk factor for cancer. We conducted a case-control study using data from the electronic health record (EHR) of Duke University Health System, 15-year residential history, NASA satellite fine particulate matter (PM2.5), and neighborhood socioeconomic data. Using deterministic and probabilistic linkage algorithms, we linked residential history and EHR data to quantify long-term PM2.5 exposure. Logistic regression models quantified the association between a 1 interquartile range (IQR) increase in PM2.5 concentration and pancreatic cancer risk. The study included 203 cases and 5027 controls (median age of 59 years, 62% female, 26% Black). Individuals with pancreatic cancer had higher average annual exposure (9.4 μg/m3) as compared to an IQR increase in average annual PM2.5, which was associated with greater odds of pancreatic cancer (odds ratio = 1.20; 95% CI, 1.00-1.44). These findings highlight the link between elevated PM2.5 exposure and increased pancreatic cancer risk. They may inform screening strategies for high-risk populations and guide air pollution policies to mitigate exposure. This article is part of a Special Collection on Environmental Epidemiology.

How are we allocating physicians to deal with breast cancer in men and women in Brazil?

BACKGROUND

Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC), though rare, may be overlooked by both public health authorities and clinicians. Both diseases exhibit similarities, and understanding their behavior over time is crucial to grasping their annual impact on many citizens. Furthermore, analyzing if medical personnel are well allocated and influence disease outcomes in a limited setting such as the Public Health System (PHS) is of utmost importance.

METHODS

This ecological study utilized secondary data from 2008 to 2020 to explore the relationship between the number of doctors per 100,000 inhabitants and mortality from FBC and MBC in Brazil. All data were sourced from Brazil's PHS. Mortality rates were analyzed by age and standardized according to the World Health Organization's population figures. The number of physicians was calculated per 100,000 inhabitants. A linear regression analysis was performed using a stepwise selection/backward elimination approach.

RESULTS

Between 2008 and 2020, Brazil recorded 195,969 breast cancer-related deaths among adults, including 2,220 male victims. The majority of these deaths occurred in the Southeast region among patients older than 50 years. Although both MBC and FBC demonstrated increasing trends over the study period, no correlation was found between the number of physicians and mortality rates for MBC. Conversely, an increase in primary care physicians over the years was positively correlated with mortality rates for FBC (p < 0.05). In addition, the number of physicians in the PHS (β = -0.163; 95% CI: -0.240 to -0.085; p = 0.002), oncologists (β = -0.507; 95% CI: -0.881 to -0.134; p = 0.015), and radiotherapists (β = -6.402; 95% CI: -12.357 to -0.446; p = 0.039) all showed an inverse association with FBC mortality.

CONCLUSIONS

The increasing trends in FBC and MBC underscore the need for urgent monitoring. Lower FBC mortality correlates with higher numbers of physicians and specialized care, highlighting the critical role of healthcare workforce capacity and the strategic allocation of specialized personnel in enhancing patient outcomes.

Identification of novel diagnostic and prognostic microRNAs in sarcoma on TCGA dataset: bioinformatics and machine learning approach

The discovery of unique microRNA (miR) patterns and their corresponding genes in sarcoma patients indicates their involvement in cancer development and suggests their potential use in medical management. MiRs were identified from The Cancer Genome Atlas (TCGA) dataset, with a Deep Neural Network (DNN) employed for novel miR identification. MiRDB facilitated target predictions. Functional enrichment analysis, identify critical pathways, protein-protein interaction network, and diseases/clinical data correlations were explored. COX regression, Kaplan-Meier analyses, and CombioROC was also utilized. The population consisted of 119 females and 142 males, and 1046 miRs were uncovered. Ten miRs was selected for further analysis using DNN. Upon analyzing for gene ontology, it was found that these genes showed enrichment in various activities. We identified a significant association between the overall survival rate of sarcoma patients and miRs levels. The combination of miR.3688 and miR.3936 achieved the greatest diagnostic standing. MiRs have the capability to screen sarcoma patients to identify undetected tumors, predict prognosis, and pinpoint prospective targets for treatment. Further large clinical trials are required to validate our findings.

Prostate cancer screening in the Middle East and North Africa: a cross-sectional study on current practices

BACKGROUND

Prostate cancer is a substantial health concern in the Middle East and North Africa region, with many cases diagnosed at advanced stages, a high mortality to incidence ratio, and low prostate cancer awareness. This study aimed to evaluate prostate cancer screening practices in the region to inform effective early detection and management strategies.

METHODS

A cross-sectional survey was conducted from July 1, 2023, to November 8, 2024, among physicians from 19 countries in the Middle East and North Africa region. The study used a validated questionnaire to assess prostate cancer screening practices, barriers, and educational needs.

RESULTS

The survey had a response rate of 96.8% and 1163 participants. Of these participants, 34.7% routinely performed prostate cancer screenings, with 61.1% using prostate-specific antigen tests. The primary barrier was lack of patient awareness (51.2%). In addition, 65.3% of participants had no formal training. To improve screening rates, participants suggested better patient education (63.5%), increased training for health-care professionals (41.9%), and improved access to screening equipment (38.9%).

CONCLUSION

This study revealed that prostate cancer screening rates were low, with barriers including a lack of patient awareness and formal training among physicians. Addressing these issues through culturally tailored education programs may improve early detection rates and ultimately reduce the burden of prostate cancer in the Middle East and North Africa region.

Epidemiology and Clinical Outcomes of Childhood Central Nervous System Cancers in a Large Low/Middle-Income Country Pediatric Oncology Center: A Report on 5,051 Kids

BACKGROUND

Central nervous system (CNS) tumors are the leading cause of cancer-related deaths in children. Although most cases come from low- and middle-income countries (LMIC) where their prognosis is worse, few epidemiologic studies are conducted in these regions.

METHODS

We conducted a registry-based cohort study for childhood CNS tumors at Children's Cancer Hospital, Egypt, over 15 years. Unified treatment protocols were implemented. Survival analyses were conducted using the Kaplan-Meier function. Cases were additionally annotated using the International Classification of Childhood Cancer-3 classification.

RESULTS

In total, 5,051 children ≤18 years of age were identified, accounting for 20% of all childhood cancers treated at Children's Cancer Hospital, Egypt. The most common tumor sites were the posterior fossa (36.8%) and brainstem (17.7%). Pathologies were predominantly astrocytic (n = 1,360; 26.9%) and embryonal (n = 1,003; 19.9%) in origin. The 5-year overall survival (OS) and event-free survival for all cases were 64.6% and 51.8%, respectively. More specifically, 1,421 low-grade gliomas were identified, with a 5-year OS of 91.1%. Medulloblastoma (n = 801) recorded a 5-year OS of 66%. The entity with the worst prognosis was diffuse intrinsic pontine glioma (n = 633), with a 5-year OS of 3.2%.

CONCLUSIONS

We report on a large number of childhood CNS tumors from an LMIC. This study underscores the need to understand the burden of childhood brain tumors and its outcomes in resource-constrained settings.

IMPACT

This study reports on the epidemiology and clinical outcomes of 5,000+ children with CNS tumors from a specialized LMIC center. Despite the lack of many sophisticated and advanced facilities, LMICs can improve the clinical end-results with experience and augmented efforts.

Cost-Effectiveness of Pembrolizumab With Chemoradiotherapy for Locally Advanced Cervical Cancer

Importance

The KEYNOTE-A18 trial demonstrated that adding concurrent and adjuvant pembrolizumab to chemoradiotherapy and brachytherapy significantly improved survival in patients with newly diagnosed, locally advanced cervical cancer. However, considering the annual global incidence of 660 000 cases of cervical cancer, including 13 820 in the US in 2024, incorporating this regimen into the standard of care could have substantial health care economic implications for both patients and the health care system.

Objective

To determine the cost-effectiveness of adding pembrolizumab to the first-line treatment of newly diagnosed, locally advanced cervical cancer.

Design, Setting, and Participants

This economic evaluation created a Markov model simulating 50-year outcomes to evaluate cost-effectiveness from the payer perspective for patients receiving either pembrolizumab or placebo in addition to chemoradiotherapy plus brachytherapy. Probabilities, including disease progression, survival, and treatment-related toxic effects, were derived from KEYNOTE-A18 clinical trial data in patients with newly diagnosed, locally advanced cervical cancer. Costs and health utilities were obtained from published literature; 1-way, 3-way, and probabilistic sensitivity analyses were used to assess model uncertainty. Data analyses were conducted from April to November 2024.

Exposure

Pembrolizumab.

Main Outcomes and Measures

Costs, measured in 2024 US dollars, and effectiveness, measured in quality-adjusted life-years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of $100 000 per QALY was chosen, below which pembrolizumab would be considered cost-effective.

Results

KEYNOTE-A18 enrolled 1060 patients (529 in pembrolizumab group, 531 in placebo group). The median age was 50 years. Pembrolizumab increased costs by $257 000 and effectiveness by 1.40 QALYs, yielding an incremental cost-effectiveness ratio of $183 400 per QALY. The addition of pembrolizumab became cost-effective if its monthly cost was decreased from $16 990 to $9190 (a 45.6% reduction) or its maximum duration of 24 months was decreased to 10 months. The model was insensitive to assumptions about treatment-related toxic effects, progression-free survival, and overall survival. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100 000 per QALY, the addition of pembrolizumab was cost-effective 37.3% of the time.

Conclusions and Relevance

In this economic evaluation of adding concurrent and adjuvant pembrolizumab to first-line treatment of newly diagnosed, locally advanced cervical cancer, this regimen was not cost-effective at current prices despite data demonstrating improved survival with this regimen.

Patterns of Care and Outcomes Among Women With Locally Advanced Cervical Cancer Treated With Curative Intent at a Tertiary Center in South Africa

OBJECTIVE

Cervical cancer is the leading cause of cancer-related deaths for women in South Africa. The standard of care treatment for locally advanced cervical cancer (LACC) is external beam radiation followed by brachytherapy with concurrent platinum-based chemotherapy. There exists a paucity of data regarding the treatment regimens received by women with LACC in South Africa. The aim of this study is to assess the patterns of care and survival for patients with LACC treated with curative intent at a tertiary care center in South Africa.

MATERIALS AND METHODS

This is a retrospective review of cervical cancer patients with histologically confirmed LACC (stage IB2-IVA) who underwent radiation with curative intent at Groote Schuur Hospital in Cape Town, South Africa between July 2013 and July 2018. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier method. Cox proportional hazards modeling analyzed patient and treatment factor associations with survival. Logistic regression modeling was performed to assess factors associated with the receipt of chemotherapy and baseline hemoglobin.

RESULTS

Among 278 patients, 28.4% (n = 79) of women had co-infection with HIV, and 64.8% (n = 180) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2-year OS (87.4% vs. 52.8%, p < 0.001) and DFS (80.2% vs. 58.3%, p < 0.001) compared to those receiving radiation alone. Factors associated with improved OS were receipt of chemotherapy (HR 0.32, p = 0.005) and higher baseline hemoglobin (HR 0.86, p = 0.018). Upon multivariate logistic regression, adjusting for age, stage, and HIV status, patients with stage III/IV disease were less likely to receive chemotherapy (HR 48.17, p < 0.001) and were less likely to have hemoglobin ≥ 10 g/dL (HR 0.20, p < 0.001).

CONCLUSIONS

Addition of chemotherapy to standard radiation improved OS in women with LACC, regardless of HIV status. Our findings add to a body of literature highlighting the importance of providing concurrent chemoradiotherapy to all patients with LACC, including persons living with HIV and those with stage III/IV disease.

Critical Diagnostic Delay Thresholds in Breast Cancer: A Molecular Subtype-Based Causal Analysis From Saudi Arabia

Introduction Diagnostic delays in breast cancer can significantly affect treatment outcomes. Currently, the causal mechanisms and critical time thresholds remain poorly defined across the different molecular subtypes of breast cancer. We investigated the relationship between diagnostic delays and breast cancer outcomes based on the data from our center, with a focus on identifying actionable intervention points within the diagnostic pathway. Methods We conducted a retrospective cohort study of 802 breast cancer patients treated at King Fahad Specialist Hospital in Qassim Province, Saudi Arabia (2017-2024). Using directed acyclic graphs and mediation analysis, we quantified the causal pathways through which delays impact the outcomes. Markov chain modeling was utilized to determine the molecular subtype-specific critical thresholds where stage migration probability exceeds 10%. Results We found that 589 patients (73.5%) experienced high-risk delays (over two months). Stage migration emerged as the primary mediator, accounting for 67.3% (95% CI: 58.4-76.1%) of the total effect of delays on survival. We have identified multiple critical thresholds across molecular subtypes: 38 days for triple-negative, 52 days for HER2-positive, and 85 days for ER+/PR+/HER2- tumors. Hazard ratios for mortality increased progressively with delay duration, from 1.18 (95% CI: 1.05-1.32) for delays of two weeks to one month to 2.35 (95% CI: 2.06-2.67) for delays that are equal to or more than one year, translating to an average 3.40 life years lost per patient. Conclusions The impact of diagnostic delays on breast cancer outcomes is fundamentally governed by tumor biology, with significant vulnerability thresholds aligned with molecular aggressiveness. Our findings support applying a biologically informed triage system where molecular characteristics determine maximum acceptable diagnostic intervals. Using the suggested approach, we may achieve a better balance in the resource constraints with biological imperatives, and possibly improve survival outcomes without proportional increases in healthcare expenditure.

The St. Jude Global Academy: A Multifaceted Education Program to Expand Pediatric Oncology Workforce Capacity

There is currently a global shortage of healthcare professionals equipped to handle the rising burden of childhood cancer. St. Jude Global is an initiative to improve survival rates of children with cancer worldwide while improving access to quality care. One of the overriding goals of St. Jude Global is focused on education: the training of the clinical workforce needed to expand quality care for all children with cancer. Herein, we describe the St. Jude Global Academy (SJGA) and its programs. The three main workstreams of the SJGA are: clinical training programs, courses, and distance learning. St. Jude collaborates with eight institutions in seven low- and middle-income countries to train pediatric subspecialists. Each year, approximately 20 new fellows start at these clinical training programs. To date, 92 specialists have been trained. The SJGA's courses create educational opportunities that provide a structured learning experience in key areas that are relevant to pediatric cancer care. To date, 1081 participants from 372 institutions in 84 countries have successfully completed these educational opportunities. Cure4Kids is the SJGA's distance learning platform. Over 9000 healthcare professionals in 177 countries use Cure4Kids. The platform receives 1400 visits and over 13,000 page views per day. The SJGA's multifaceted approach encompasses various disciplines and skills, providing healthcare professionals from around the world the skills to address the needs of children diagnosed with cancer in their respected institutions. These efforts are essential for building workforce capacity to improve outcomes.

Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy

This commentary discusses the implementation of online adaptive radiation therapy (oART) in cancer treatment within the context of current challenges faced by radiation therapy professionals. oART enables modifications to treatment plans based on daily imaging, enhancing target accuracy while minimising harm to surrounding organs. Despite its potential to improve patient outcomes, the application of oART is hindered by notable barriers, particularly in human resources. A global shortage of skilled radiation professionals such as radiation therapists or therapeutic radiographers (RTTs), medical physicists and radiation oncologists, along with training challenges in online adaptive techniques, hinders oART implementation and sustainability. Moreover, geographical disparities limit access to advanced training programs, leaving RTTs and their patients in underserved regions at a disadvantage. There is growing global evidence that RTTs are being successfully trained to lead adaptive fractions in both cone-beam computed tomography and magnetic resonance imaging guided oART. This commentary proposes the notion of standards for a global training curriculum to address barriers and expand RTT capabilities in delivering oART. By leveraging artificial intelligence and fostering interdisciplinary collaboration, the radiation therapy field can enhance efficiency and accuracy in oART. Successful training models from leading institutions illustrate the importance of hands-on experience and ongoing mentorship. A coordinated effort among stakeholders is essential to establish a comprehensive global training framework, ultimately improving patient access to oART and elevating standards of care worldwide.

Mapping Behavioral Research in Post-Treatment Cancer Care in Sub-Saharan Africa: A Scoping Review

OBJECTIVE

This scoping review explores the multifaceted experience of cancer survivorship in Sub-Saharan Africa (SSA), with a focus on the post-treatment phase. The primary objective is to examine the psychosocial, cultural, and economic factors that influence post-treatment survivorship care and outcomes.

METHODS

A comprehensive literature review was conducted using databases such as Web of Science Core Collection to identify studies published between 2000 and 2023. Eligible studies focused on post-treatment cancer survivorship in SSA. Data were extracted, analyzed, and synthesized to identify key themes and research gaps.

RESULTS

The review identified substantial psychological distress among survivors, including depression, anxiety, and insomnia, often exacerbated by financial toxicity and limited access to psychosocial support services. Cultural factors, such as spiritual beliefs, reliance on traditional healers, and cancer-related stigma, influenced healthcare-seeking behaviors and overall well-being. Despite these challenges, social support networks, religiosity, and targeted psychosocial interventions improved emotional resilience and quality of life. However, major gaps remain, including insufficient integration of cultural beliefs into survivorship care, inadequate long-term follow-up (LTFU) programs, limited oncofertility support, and a lack of regionally diverse and longitudinal data.

CONCLUSIONS

Cancer survivorship in SSA is shaped by intricate psychosocial, cultural, and economic dynamics that extend beyond clinical care. Addressing these challenges requires culturally sensitive, evidence-based interventions, including financial counseling, spiritual care integration, and the establishment of structured LTFU programs. Additionally, expanding access to oncofertility support and integrating culturally relevant psychosocial services can further enhance survivorship outcomes. Strengthening collaboration between policymakers, healthcare providers, and researchers-through interdisciplinary task forces, psycho-oncology workforce development, and community-driven initiatives-is essential for improving post-treatment outcomes and advancing cancer survivorship care in SSA.

Under-Representation and Under-Reporting of Minoritized Racial and Ethnic Groups in Clinical Trials on Immune Checkpoint Inhibitors

PURPOSE

Minoritized racial/ethnic groups are historically under-represented in cancer clinical trials, which may be exacerbated in recent trials on immune checkpoint inhibitors (ICIs). We examined the representation and reporting of the racial/ethnic composition of participants in clinical trials on ICIs.

METHODS

We examined English full-text trials on ICIs published from 2007 to 2022. Information on trial characteristics and racial/ethnic composition of participants was extracted from published papers or ClinicalTrials.gov. Differences in participation by publication year, ICI agent, and cancer site were analyzed. Enrollment-incidence ratio (EIR) was calculated to compare the proportion of minoritized racial/ethnic group patients in US-based trials against age-adjusted cancer incidence data available for the US population. An EIR > 1 signified over-representation, whereas an EIR <1 signified under-representation.

RESULTS

Of the 471 trials examined, racial composition was unreported in 146 (31%), whereas Hispanic/Latinx ethnicity was unreported in 278 (59%). Only 30 (6%) trials reported race/ethnicity-specific results. In US-only trials (n = 174), White patients were over-represented (EIR, 1.20 [95% CI, 1.17 to 1.22]), whereas Hispanic/Latinx patients were the most under-represented (EIR, 0.35 [95% CI, 0.24 to 0.48]), followed by Black/African American patients (EIR, 0.66 [95% CI, 0.54 to 0.79]). Subgroup analyses consistently indicated over-representation of White patients across publication years (EIR, 1.19-1.24), ICI classes (EIR, 1.16-1.23), and cancer sites (EIR, 1.11-1.31), whereas Hispanic/Latinx patients were consistently under-represented. An upward trend of trial representation and reporting was observed for all minoritized racial/ethnic groups over time (trend P values ≤.05).

CONCLUSION

Disparities in the representation and reporting of minoritized racial/ethnic groups persist in recent trials on ICIs, necessitating collaborative efforts for improved diversity and equitable cancer treatment access.

Second-Line Treatment Options for Patients with Metastatic Triple-Negative Breast Cancer: A Review of the Clinical Evidence

Metastatic triple-negative breast cancer has a poor prognosis and poses significant therapeutic challenges. Until recently, limited therapeutic options have been available for patients with advanced disease after failure of first-line chemotherapy. The aim of this review is to assess the current evidence supporting second-line treatment options in patients with metastatic triple-negative breast cancer. Evidence was reviewed from controlled clinical trials in which eribulin, vinorelbine, capecitabine, gemcitabine, gemcitabine plus carboplatin, fam-trastuzumab-deruxtecan, sacituzumab govitecan, olaparib, and talazoparib were used in the second-line treatment for metastatic breast cancer, either as study drugs or as comparators. The benefit of treatment was evaluated using the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale. Based on the evidence review, sacituzumab govitecan was identified as the preferred second-line treatment option for patients with metastatic triple-negative breast cancer, supported by clinical evidence and consensus across international clinical guidelines. Olaparib and talazoparib are of use in patients with human epidermal growth factor receptor 2-negative metastatic breast cancer and germline BRCA1/2 mutations. Exploratory data for fam-trastuzumab-deruxtecan suggest a survival benefit in human epidermal growth factor receptor 2-low, hormone-receptor-negative patients, but further solid evidence is required. Other chemotherapies with lower European Society for Medical Oncology-Magnitude of Clinical Benefit Scale scores may continue to be useful in highly selected patients.

Development and implementation of a 3d-HDR brachytherapy program for cervical cancer in a sub-Saharan African centre

BACKGROUND

Cervical cancer is the second most common cancer among women in Nigeria where, the gap between need for, and access to, radiation therapy including brachytherapy is significant. This report documents the implementation of the first three-dimensional high-dose-rate (3D-HDR) brachytherapy service for cervical cancer in Nigeria.

PURPOSE

This report details the steps taken to implement the 3D-HDR brachytherapy program, the challenges faced, and the adaptive strategies employed to overcome them. Our objective is to provide a guide for teams and centers in similar resource-restricted settings to implement 3D-HDR brachytherapy services, by leveraging our shared experience and lessons learned.

METHOD AND METERIALS

The implementation process required investment in infrastructure: creating a dedicated brachytherapy suite equipped with modern technology; and human capital: conducting both virtual and hands-on training for staff; and involving international experts during the initial treatment phases. Quality assurance protocols were established to ensure the accuracy and safety of treatments. Key adaptations included extensive remote training, international experts flying in for the initiation phase, and preemptively re-ordering the radioisotope to prevent delays.

RESULTS

The 3D-HDR brachytherapy program was successfully implemented, with five cases treated in the first 2 months despite challenges such as high equipment costs, expertise and proficiency needs, and source replacement delays. Continuous training and quality assurance measures ensured the program's sustainability and effectiveness.

CONCLUSIONS

Implementing a 3D-HDR brachytherapy program in a system with restricted resources is possible with thorough planning, flexible strategies, and adaptive measures. We document our experience to provide insights for other institutions aiming to establish similar programs. Collaboration and innovative financial strategies are essential for ensuring sustainable access to cancer treatment in the region. Strategies such as remote training and proactive resource management, are critical for overcoming implementation barriers.

Strengthening molecular testing capacity in Colombia: Challenges and opportunities

The COVID-19 pandemic has accelerated efforts to enhance pathogen detection using molecular biology techniques. This study examines the expansion of molecular testing capacity in Colombia, identifying strengths and areas for improvement in the existing infrastructure. The study began with the creation of a database inventorying laboratories based on publicly available data from government entities and active web searches. Ten laboratories were selected for detailed characterization. Structured surveys assessed their testing capacity and progress in implementing molecular-based diagnostic tests for various infectious diseases. The strategy for identifying laboratories showed a total of 311 laboratories. Of these, 65 % (n = 202) are private and 21 % (n = 65) are state-owned, mainly public health laboratories, and the remaining 14 % (n = 44) are affiliated with academic institutions. The highest concentration of these labs is in Bogotá, Antioquia, and Valle del Cauca, primarily in urban areas. Key limitations affecting testing laboratories in Colombia include: i) infrastructure (26.2 %), highlighting the need for standardized facility guidelines; ii) quality and documentation (16.7 %), requiring stronger quality management systems; iii) biosafety (14.3 %), emphasizing the need for continuous waste management, especially in public labs; and iv) human talent (10.7 %), needing better policies for staff retention, particularly in government institutions. Strengthening laboratories can establish a comprehensive national molecular testing system. Integrating molecular tests into health system diagnostic algorithms and implementing sustainable laboratory strategies will address human health challenges and support the "One Health" approach for animal and environmental health.