The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Perspectives on advanced care planning of adolescent and young adult cancer patients, families, and healthcare providers: A qualitative study based on the health belief model

Objective

Adolescents and young adults (AYAs) cancer patients face higher long-term and late-stage risks, so advance care planning (ACP) is an important way for them to participate autonomously in healthcare decision-making. However, in Chinese culture, discussing ACP with AYAs is challengeable due to their role as their family's hope, contributing to insufficient attention to this group in cancer care. This study aimed to explore the perceptions of AYA patients, their families, and healthcare providers about ACP based on the health belief model.

Methods

This study was a qualitative descriptive research using a phenomenological approach. 7 AYA patients and their 7 family members, as well as 8 healthcare providers from Hunan Province, China, underwent three focus group interviews. In addition, 15 AYA patients were recruited for semi-structured interviews, with data saturation being achieved. NVivo Pro 12.0 software was used for data management, and thematic analysis method was used for data analysis.

Results

Six main themes emerged from the data: perceived severity, perceived susceptibility, perceived benefits, perceived barriers, perceived self-efficacy, and action cues. These themes highlight how AYA cancer patients, their families, and healthcare providers perceive the threats of cancer, the potential advantages of engaging in ACP, the challenges they were facing, and the supportive actions needed to facilitate ACP discussions.

Conclusions

ACP can enhance patient autonomy, alleviate anxiety, improve family communication, and optimize resource utilization. However, promoting ACP in China need overcome cultural barriers, enhance education, and provide strong family and social support to encourage more active participation among young patients.

Experiences and perspectives regarding developmentally appropriate cancer services for adolescents and young adults with cancer: A mixed methods systematic review

BACKGROUND

Providing developmentally appropriate cancer services for adolescents and young adults is a challenge for the health sector. Current service approaches are fragmented and diverse, with amalgamation of adolescents and young adults' perspectives lacking in the literature. Whilst there has been progress in delivering care focused on adolescents and young adults, contemporary evidence is warranted to understand their experience to establish sustainable developmentally focused cancer care.

OBJECTIVE

To examine the experiences and perspectives regarding developmentally appropriate cancer services for adolescents and young adults with cancer.

DESIGN

This systematic review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews using a convergent integrated approach. Studies focused on the care experiences of adolescents and young adults with a cancer diagnosis between the ages of 15 to 39 years were included in the review. A key word search of six relevant databases identified 2513 records and 57 full text records were screened for eligibility.

RESULTS

16 qualitative studies, 12 quantitative studies and two mixed method studies were included in the analysis. Four synthesised findings were generated from 10 categories. Findings were conceptualised as: Developmentally appropriate information and communication, Decision-making process, Relationship, emotions and comfort, and Care environment. Findings highlighted information provided was inappropriate at the time of diagnosis and inadequate during treatment period and survivorship. They desired direct, open communication with healthcare providers and expected guidance in certain instances, however, also sought autonomy in decision-making. The support of family, peers and care-providers was considered invaluable to effectively cope with stressors. The need for cultivating an empathetic healthcare environment suitable for young people was also identified as a significant need.

CONCLUSIONS

This review affirmed that although significant effort has been invested, further work is needed to improve the cancer care experiences of adolescents and young people. The findings emphasise many preferences regarding how cancer services should be delivered, suggesting that services should be evaluated against these preferences. Ensuring developmental appropriateness is critical for the delivery of supportive cancer care.

REGISTRATION NUMBER

CRD42023413864 (PROSPERO).

Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15-24 in England

BACKGROUND

Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.

METHODS

Matched cohort study involving 401 young cancer survivors (aged 15-24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12-18(T2), and 24-36 months (T3) post-diagnosis.

RESULTS

Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p < 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p < 0.001) and T3 (OR = 0.59, p < 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: -0.07, p < 0.001; T2 and T3: -0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.

CONCLUSIONS

Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.

The burden and trends of depressive disorders in adolescent and young adults aged 15-29 in China, 1990-2021 and its prediction to 2030: Findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive disorders (DDs) are the leading causes of disability among adolescents and young adults (AYAs) in China. This study estimated the trends of DDs burden among AYAs in China over the last 32 years, and further predicted to 2030.

METHODS

Based on the Global Burden of Disease Study 2021, age-standardized incidence, prevalence, and years lived with disability (YLDs) rates were used to describe the DDs burden among AYAs (aged 15-29 years) in China. Estimated annual percentage changes were used to describe the temporal trends from 1990 to 2021. Bayesian age-period-cohort model was used to predict the future burden to 2030.

RESULTS

In 2021, the age-standardized incidence, prevalence, and YLDs rates (per 100,000) for DDs among AYAs in China were 1884.11 (95 % confidence interval [CI]: 1383.84, 2540.68), 1951.57 (95 % CI: 1527.28, 2459.70), and 323.36 (95 % CI: 208.27, 474.88), respectively. The burden was heavier in females and individuals aged 25-29. From 1990 to 2021, all groups showed a downward trend of DDs burden. Males showed an increase in DDs burden (mainly dysthymia) in most groups in 2019-2021, while the increases in DDs burden among females were mainly in 2010-2019. The main attributable risk factor was bullying victimization. Notably, although the DDs burden was predicted to decrease from 2022 to 2030, the dysthymia burden was predicted to increase.

CONCLUSIONS

The DDs burden among AYAs is a significant public health challenge in China. It is crucial to consider the disparities among different demographic characteristics, when formulating and implementing prevention strategies.

Burden of female diseases among adolescents and young adults aged 10-24 years in South Asia and Sub-Saharan Africa, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

INTRODUCTION

Female diseases pose significant challenges in South Asia and Sub-Saharan Africa, particularly among adolescent girls and young women, who often receive insufficient attention.

OBJECTIVES

To report patterns and trends of female diseases among adolescent girls and young females aged 10-24 years in South Asia and Sub-Saharan Africa from 1990 to 2021.

METHODS

We used data from the Global Burden of Disease Study 2021 for 51 countries in South Asia and Sub-Saharan Africa between 1990 and 2021. Joinpoint Regression was used to calculate annual average percentage changes and 95 % confidence intervals to quantify temporal trends.

RESULTS

In 2021, South Asia and Sub-Saharan Africa had high mortality rates of maternal disorders of 6.04 (95 % uncertainty intervals 5.02, 7.39) and 17.69 (14.37, 21.78) per 100,000 population, respectively. The mortality rates for female cancers were approximately 0.98 in both regions, and the incidence rates for gynecological diseases were 16472.83 and 14480.99, per 100,000 population, respectively. From 1990 to 2021, there was an increasing trend in the number of maternal disorder deaths in Sub-Saharan Africa, as well as in all metric rates for most female cancers in both regions, and disability-adjusted life years, prevalence, and incidence rates for gynecological diseases in South Asia. Several female diseases varied across countries and were increasingly affecting younger adolescents aged 10-14 years in both regions. Although countries with lower Socio-demographic Index had a heavier burden of female diseases, no significant association was observed between the Universal Health Coverage effective coverage index and death rates for female cancers or gynecological diseases.

CONCLUSIONS

The burden of female diseases remains high among young females in South Asia and Sub-Saharan Africa, with younger adolescents being particularly affected. This underscores the urgent need for targeted interventions and increased investment in healthcare infrastructure to reduce the burden of female diseases in these regions.

Enhancing Cancer Patient Navigation: Lessons from an Evaluation of Navigation Services in Alberta, Canada

Cancer patient navigation has emerged as a patient-centric intervention enabling equitable cancer care, by mitigating barriers patients encounter throughout their cancer journey. Cancer Care Alberta (CCA) implemented a professional navigation model over a decade ago and commissioned a program evaluation in response to evolving operational demands. The objectives were (1) to better understand the current state of CCA's cancer patient navigation program; (2) to explore the need for other specialized streams; and (3) to provide key recommendations to strengthen and grow the program. A mixed methods approach, including a survey, administrative data, and semi-structured interviews, captured patient-, staff-, and system-level insights. Findings revealed difficulties in identifying complex patients needing navigation, along with inconsistencies regarding intake practices, program awareness, referral pathways, standardized workflows, and a lack of programmatic supports, which contributed to variability in service delivery. A need for enhanced palliative navigation support also emerged. Approximately 25% of surveyed patients reported being unable to access perceived needed support before their first oncology consultation. These findings underscore the importance of early, targeted navigation for equity-deserving populations. Recommendations include harmonizing program structure, refining navigator roles, expanding navigation streams, standardizing processes, and enhancing equity-focused competencies. These findings offer a roadmap with which to improve person-centered cancer care.

Age-stratified associations between radiotherapy and SPMs for FPHNC: a population-based cohort study

BACKGROUND

Second primary malignancies (SPMs) account for over 30% of total deaths in head and neck cancer (HNC) patients. The increasing use of radiotherapy raises concerns about the elevated risk of radiation-associated SPMs. This study aimed to investigate the age-stratified association between radiotherapy and SPM risk in survivors of non-metastatic primary HNC.

METHODS

Using data from the Surveillance, Epidemiology, and End Results program (2004-2015), incidence rate ratios (IRRs) and standardized incidence ratios (SIRs) were evaluated for solid and hematologic SPMs associated with radiotherapy within different age groups. Follow-up for hematologic and solid SPMs began 2 and 5 years, respectively, after the diagnosis of first primary HNC. The IRRs for SPMs were compared between radiotherapy-exposed and unexposed groups using multivariable modified Poisson regression. The SIRs were computed as the ratio of observed cancers in the cohort to expected cases derived from sex-, age-, and calendar year-matched general population incidence rates.

RESULTS

The study included 75,209 2-year survivors, with 73.2% being male and a median age of 60 years. Of these, 58,063 had survived 5 years or more. Radiotherapy was associated with an increased risk of solid SPMs [IRR = 1.16, 95% confidence interval (CI) 1.08-1.24; P < 0.001]. The associations varied significantly among young (aged 15-39 years), middle-aged (aged 40 - 64 years), and elderly (aged 65-89 years) patients. Specifically, radiotherapy was associated with an increased risk of solid SPMs in middle-aged patients (IRR = 1.21, 95% CI 1.11-1.32; P < 0.001), and a decreased risk of hematologic SPMs in elderly patients (IRR = 0.77, 95% CI 0.60-0.99; P = 0.045). Compared with the general population, young patients had an elevated risk of radiotherapy-associated second primary non-Hodgkin lymphoma (SIR = 4.01, 95% CI 1.47-8.74). Middle-aged patients showed the highest SIR for SPMs in the bones/joints (SIR = 7.72, 95% CI 4.32-12.73), while elderly patients had the highest SIR for second primary esophageal malignancies (SIR = 3.87, 95% CI 2.91-5.05). Males were more likely to develop solid SPMs compared to females.

CONCLUSIONS

This study reveals an age-stratified association between radiotherapy and the risk of SPMs in HNC patients. These findings highlight the importance of considering patient age when making treatment decisions for HNC and suggest that long-term surveillance is necessary for high-risk groups.

Temporal trends in cross-country inequalities of early-onset pancreatic cancer: a comprehensive analysis for the global burden of disease study 2021

By 2040, pancreatic cancer is expected to become the second leading cause of cancer-related deaths in the U.S., with early-onset pancreatic cancer (EOPC) cases rising among adolescents and young adults. This study uses the global burden of disease (GBD) 2021 dataset to examine global, regional, and national EOPC trends and predicts the burden through 2050. The analysis covers EOPC burden from 1990 to 2021, focusing on age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years rate (ASDR). Annual percentage change (APC) and average annual percentage change (AAPC) were calculated via joinpoint regression. Clustering and frontier analysis based on the sociodemographic index (SDI) assessed the link between development levels and health outcomes. We used WHO-recommended health equity methods to quantify EOPC burden disparities and applied a Bayesian age-period-cohort (BAPC) model to project trends. In 2021, EOPC cases rose to 42,254, a 73% increase from 1990, while deaths reached 26,996, up 57%. Although ASIR, ASMR, and ASDR declined, ASPR rose (EAPC = 0.1). Central and Eastern Europe had the highest EOPC burden, with the fastest growth in Australasia (EAPC = 2.78) and Western Sub-Saharan Africa (EAPC = 2.25). Males had about double the burden of females, though female prevalence increased. The widening gap in health burden between low- and high-SDI regions is especially concerning. While EOPC currently affects high-SDI countries the most, there is a clear trend over time showing a gradual shift of EOPC burden towards low-SDI countries. By 2050, ASIR, ASPR, ASMR, and ASDR are projected to stabilize, with cases increasing until 2036, then decreasing. High-SDI countries bear a disproportionately high EOPC burden, with significant diagnostic and management challenges, particularly in Central and Eastern Europe. Rising global EOPC prevalence highlights the need to identify burden differences and risk factors across countries to develop targeted prevention and control strategies.

The Chinese version of the autonomy preference index for advanced cancer patients: a study on cultural adaptation based on cognitive interview

BACKGROUND

The global cancer burden is becoming increasingly severe. In the context of patient-centred medicine, respecting patients' autonomy and preferences is of paramount importance. However, there is currently a lack of scientific tools in China to measure the autonomous preferences of advanced cancer patients. We aim to optimise assessment tools for patients' autonomous preferences and validate their effectiveness, thereby filling a gap in related research, in hopes of improving the quality of medical care in China.

OBJECTIVES

① To assess the semantic clarity of entries of the Chinese Autonomy Preference Index (API) and determine whether patients can accurately comprehend their content. ② To validate the application effect of cognitive interviews in the translation of the scale into the Chinese culture and context.

METHODS

In March and April 2023, we selected 17 advanced cancer patients by convenience sampling in Zunyi, Guizhou, China, to participate in this study. We assessed their understanding of each item in the Chinese API scale through cognitive interviews and made the corresponding revisions to the scale items based on the interview results.

RESULTS

The respondents' understanding of various API entries after translation and adaptation was assessed. Based on the interview results, ambiguous entries were revised to create a refined Chinese version of the API. Ultimately, the API comprises two dimensions and 23 entries. The results of the first round of interviews revealed doubts or ambiguities in the semantic expression and understanding of 5 items, which were then revised following discussions by the research team. The second round of interviews confirmed that the interviewees could correctly understand the content of the entries without further modifications.

CONCLUSIONS

① Cognitive interviews can address discrepancies in the understanding of scale items among the target population and mitigate measurement errors stemming from item content ambiguity. ② Targeted questionnaire revisions have improved the accuracy, reliability, and applicability of the Chinese version of the API questionnaire. The Chinese version of the Autonomy-Preference-Index offers clinical healthcare professionals an effective measurement tool to assess the autonomous preferences of advanced cancer patients.

Global epidemiology of lower limb fractures: Trends, burden, and projections from the GBD 2021 study

BACKGROUND

Lower limb fractures are a significant global public health issue, imposing considerable social and economic burdens. Despite their prevalence, comprehensive analyses of the global epidemiology of lower limb fractures remain scarce. This study aims to address this gap.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed four types of lower limb fractures: fractures of foot bones excluding the ankle (FFB), hip fractures (FH), fractures of the patella, tibia or fibula, or ankle (FPTFA), and femur fractures excluding the femoral neck (FF), and conducted a detailed assessment of them.

RESULTS

FPTFA was the most burdensome fracture type, with Slovenia showing the highest age-standardized incidence rate (ASIR), and Saudi Arabia having the highest age-standardized prevalence rate (ASPR) and years lived with disability rate (ASYR). The burden of lower limb fractures increased with age, but FFB and FPTFA showed a "double peak" age distribution, with FFB most common in the 20-24 age group. Lower limb fractures were more prevalent in males among younger individuals and in females among older populations. From 1990 to 2021, the burden of lower limb fractures, excluding FH, decreased (EAPC <1), though the incidence of FF is projected to increase (EAPC = 0.14, 95 % CI 0.1-0.18) over the next decade.

CONCLUSION

Although the global burden of lower limb fractures, excluding FH, has decreased in recent years, vigilance is still needed. Given the projected rise in FF incidence over the next decade, preventive measures should be implemented early.

A global analysis of the burden of ischemic heart disease attributable to diet low in ω-3 fatty acids between 1990 and 2021

AIM

Ischemic heart disease (IHD) is a major contributor to global mortality and disability, imposing a significant health and economic burden on patients and society. Despite existing treatment options including medications and surgeries, their effectiveness remains limited, with issues such as suboptimal treatment outcomes and high recurrence rates. This study aims to investigate the relationship between low dietary intake of ω-3 fatty acids and the burden of IHD, hoping to provide new insights into the prevention and treatment of IHD.

METHOD

Using the Global Burden of Disease (GBD) 2021 dataset, we examined the impact of low ω-3 dietary intake on the burden of ischemic heart disease (IHD) between 1990 and 2021globally, regionally, temporally. The Joinpoint regression model was applied to analyze the trend of IHD burden attributed to low ω-3 dietary intake over time.

RESULTS

In 2021, the global IHD-related Disability-Adjusted Life Years (DALYs) and deaths caused by a low ω-3 diet was 15,511,020(95% UI: 3,098,820 to 25,946,110) and 627,340 (95% UI: 119,540 to 1,082,740), accounting for 8.23% (95% UI: 1.64-13.52%) of all IHD-related DALYs and 6.97% (95% UI: 1.33-11.76%) of all IHD deaths, respectively. From 1990 to 2021, there was a significant upward trend in DALYs and deaths, but age-standardized DALYs and death rates showed a declining trend. Regional analysis indicated that the burden of IHD was highest in South Asia and lowest in High-Income Asia Pacific regions. At the national level, India, China, the United States, and Pakistan had a higher burden of IHD. Furthermore, as the Socio-Demographic Index (SDI) increased, the burden of IHD caused by a low ω-3 diet gradually decreased.

CONCLUSION

This study untangles a significant association between a low ω-3 diet and the burden of IHD, emphasizing the importance of promoting healthy eating habits globally. Future research should further explore the impact of dietary changes on the burden of IHD and develop targeted public health policies to reduce the burden of IHD.

Cancer awareness among adolescents in Irish schools: A cross-sectional study

PURPOSE

The aim of this study was to assess adolescents' awareness of cancer signs and symptoms, cancer risk factors, cancer screening programmes, and perceived barriers to seeking medical advice.

METHODS

A cross-sectional survey was conducted using an adapted version of the adolescent cancer awareness tool which was originally modified from the Cancer Awareness Measure (CAM) (Version 2.1). The sample included 474 adolescents aged 15 to 18 years recruited from nine Irish schools between November 2021 and May 2022.

RESULTS

Awareness of cancer warning signs and symptoms was low when open-ended (recall) questions were used and relatively high for closed (recognition) questions. Unexplained lump or swelling was the most frequently identified cancer symptom. The least reported were difficulty swallowing and a sore that does not heal. Smoking was the most reported cancer risk factor. The least reported were not eating enough fruit and vegetables, a diet high in fat, and infection with viruses. Generally, females had greater awareness than males. The greatest barrier to seeking help was "worry about what the doctor might find" and the least reported barrier was "I don't feel respected by the doctor."

CONCLUSIONS

Overall recognition of symptoms or risk factors of cancer was higher than recall. Several modifiable barriers to medical help-seeking were identified. Findings from this study suggest further exploration using a qualitative approach to investigate the factors influencing adolescents' cancer awareness and barriers to help-seeking.

Global, regional, and national burden of liver cancer in adolescents and young adults from 1990 to 2021: an analysis of the global burden of disease study 2021 and forecast to 2040

Background

The global burden of liver cancer among adolescents and young adults (AYAs) has often been underestimated, despite significant shifts in its etiology. This study analyzes the disease burden of liver cancer in AYAs from 1990 to 2021 and forecasts trends up to 2040 using data from the Global Burden of Disease Study 2021. Our goal is to provide insights that can inform resource allocation and policy planning.

Methods

Incidence, mortality, and disability-adjusted life years (DALYs) data were extracted and estimated annual percentage changes calculated to assess trends. Correlation between age-standardized rates and sociodemographic index (SDI) was analyzed using Spearman correlation, and future trends were predicted using the Bayesian age-period-cohort model.

Findings

Globally, there were 24,348 new liver cancer cases and 19,270 deaths among AYAs in 2021, with decreases in age-standardized rates for incidence, mortality, and DALYs from 1990 to 2021. East Asia bears the highest burden, with males experiencing significantly higher rates than females. The burden increases with age, peaking at 35-39 years. Higher SDI is associated with lower incidence, mortality, and DALYs. While HBV remains the leading cause, NASH is the fastest-growing contributor to liver cancer incidence and mortality. Projections indicate a continued decline in liver cancer burden among AYAs, though female cases are expected to rise.

Interpretation

Despite a gradual decline in liver cancer burden among AYAs, NASH is emerging as a significant and rising cause of incidence and mortality. Regional and gender disparities persist, highlighting the need for tailored prevention and healthcare strategies to alleviate the liver cancer AYA's burden globally.

A comparative assessment of rheumatoid arthritis burden: trends in China, the US, India, Europe, and globally from 1990 to 2021 and forecasts to 2030 utilizing GBD data

BACKGROUND

Rheumatoid arthritis (RA) is a pervasive chronic inflammatory condition exerting a substantial impact on global morbidity and mortality. This study provides an in-depth analysis of the epidemiological trends of RA across China, America, India, and Europe as well as at a global level from 1990 to 2021, with forward-looking projections extending to 2030.

METHODS

Leveraging data from the Global Burden of Disease (GBD) database, a comparative assessment of the age-standardized (AS) incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) rate (ASDR) for RA was performed. Trends were evaluated and future burdens forecasted using Joinpoint regression and autoregressive integrated moving average (ARIMA) models.

RESULTS

Between 1990 and 2021, a global upsurge in RA incidence was observed, with India experiencing the most rapid growth and America consistently recording the highest ASIR, albeit with a diminishing increment rate. The prevalence escalated across all regions, with America exhibiting the highest ASPR. Mortality rates generally trended downward, with India registering the highest ASMR by 2021, contrasting with the lowest rates in America and Europe. Disability trends, quantified by ASDR, exhibited relative stability, yet a notable increase was observed in India. ARIMA model-based projections anticipate a continued rise in RA incidence and prevalence by 2030, with mortality and disability rates anticipated to exhibit minor oscillations.

CONCLUSION

The escalating burden of RA, particularly in developing nations, underscores an urgent need for enhanced healthcare policies focused on early diagnosis, intervention, and disability mitigation. The projections indicate enduring public health challenges attributed to RA in the forthcoming decade.

Analysis of trends in cancer mortality and the years of life lost in six provinces in northwest China from 2013 to 2021

Cancer is a major cause of death and morbidity in China. We aimed to analyze the trends in cancer mortality in six provinces in northwest China (Xinjiang Uyghur Autonomous Region, Qinghai Province, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, and Inner Mongolia Autonomous Region) from 2013 to 2021 and to explore the effect of cancer on life expectancy and the years of life lost. Based on cancer mortality data and demographic data from national surveillance units in six northwestern provinces from 2013 to 2021 in the National Cause-of-Death Surveillance, we calculated crude mortality rates, age-standardized mortality rates, life expectancy, cause-eliminated life expectancy, potential gains in life expectancy (PGLEs), years of life lost (YLL), YLL rates, and average years of life lost. Joinpoint software was used to calculate the average annual percentage change and annual percentage change (APC) for cancer mortality. Arriaga's decomposition method was used to estimate the contribution of cancer to life expectancy in each age group. The age-standardized mortality rate for cancer in the six provinces in northwest China was stable overall from 2013 to 2021 but exhibited a decreasing trend from 2017 to 2021 (APC = - 5.64%, p = 0.047), male cancer age-standardized mortality rates were consistently higher than those of women and plateaued, women exhibited a decreasing trend after 2017 (APC = - 5.56%, p = 0.032), and the standardized mortality rate was higher and stable for those aged ≥ 65 years. Compared with the study area population in 2013, that in 2021 increased by 1.01 years in life expectancy, and changes in cancer mortality contributed positively to the increase in life expectancy, contributing 0.217 years or 21.38% of the increase in life expectancy. The greatest positive effect was in the 0-1 year age group (0.066 years, 6.48%), and the greatest negative effect was in the ≥ 85 years age group (- 0.026 years, - 2.56%). At a 1.06-year increase in cancer cause-eliminated life expectancy, PGLEs increased by 0.047 years, with the highest increase in PGLEs in urban areas (0.091 years) and an upward trend in YLL rates in the study area population from 2013 to 2021 (average annual percentage change = 2.16, p = 0.001). Average years of life lost presented a stable trend. Cancer age-standardized mortality rate in the study region from 2013 to 2021 was stable overall but has exhibited a decline in recent years. However, the disease burden of YLL has continued to increase. Preventive interventions targeting male groups and the elderly population need to be strengthened.

Colon, colorectal and all cancer incidence increase in the Young due to appendix reclassification

INTRODUCTION

Increases in colon and colorectal cancer incidence among adolescents and young adults (AYAs) have been reported progressively. Most of the increase may be due to an artifact caused by reclassifying appendiceal carcinoids/neuroendocrine tumor (NET) as malignant.

METHODS

Age-adjusted incidence and survival data were obtained from the Surveillance, Epidemiology, and End Results (SEER) SEER22 database.

RESULTS

In AYAs during 2000-2020, appendix cancer had an average annual percent change (AAPC) in incidence increase that in males was 3.7 times greater than the next most increasing cancer (AAPC12.8,95%CI: 10.9-14.6 vs AAPC3.4 [kidney] , 95%CI : 2.7-3.5) and correspondingly in females 2.9-fold greater (AAPC14.6,95%CI : 11.9-17.3 vs AAPC4.2 [pancreas], 95%CI : 3.6-4.8). From 2000-2009 to 2015-2020, appendix cancer incidence increased 17-,6.5-and 2.5-fold in children 0-14, AYAs 15-39, and adults 40-49 years of age, respectively. Carcinoid/NET accounted for 95%, 90% and 80% of appendix cancer increase in the three age groups, respectively. In 3,446 AYAs diagnosed during 2010-2020 with 'malignant' appendix NET, the 6-year cancer specific survival was 99.4% (95%CI , 99.0%to99.6%). From 2000-2009 to 2015-2020, colon carcinoma incidence in AYAs increased 61% with the appendix included, and only 11% with the appendix excluded.

CONCLUSIONS

Reclassification of appendix NET/carcinoids as malignant has artifactually increased the incidence of colon, colorectum, and all cancer in children and AYAs. Appendix NET/carcinoids are rarely fatal in < 40 year-olds and should not be considered as cancer and included in colorectal cancer analyses. To the extent that the appendix artifact occurs in 40-49 year-olds, recommendations for starting colorectal cancer screening earlier may be affected.\.

Trends, age shifts, and potential delayed peaks post-pandemic of early-onset brain and central nervous system cancers in individuals aged 20-49: a cross-sectional study

BACKGROUND

Central nervous system (CNS) cancers are highly lethal and increasingly affect younger populations aged 20-49, posing significant challenges to global healthcare systems. Current research on early-onset CNS cancer trends is limited and outdated, with uncertain impacts from the COVID-19 pandemic. This study explores the epidemiology of early-onset CNS cancer and the pandemic's effects.

METHODS

We analyzed incidence, mortality, and disability-adjusted life years (DALYs) rates for early-onset CNS cancer (age 20-49) from 2019 to 2021 using GBD 2021 data. The global data were categorized into five regions based on the Socio-Demographic Index (SDI), reflecting income, education, and fertility rates. Trends over the past 30 years were examined using estimated annual percentage change (EAPC), average annual percentage change (AAPC), and joinpoint analysis, with a focus on 2019-2021. The Bayesian age-period-cohort (BAPC) model predicted post-pandemic impacts on CNS cancer metrics.

RESULTS

In 2021, global cases of early-onset CNS cancer rose to 50 201.7 (95% UI, 42 864.1-58 187.5), with deaths increasing to 25 023.1 (95% UI, 20 973.8-29 670.8) and DALYs reaching 1 483 019.4 (95% UI, 1 240 923.4-1 756 043.3). The incidence rate increased to 2.1 (95% UI, 1.8-2.5), while mortality rates remained stable at 1.1 (95% UI, 0.9-1.2), and DALY rates decreased to 62.6 (95% UI, 52.4-74.1). Over the past two decades, the incidence of early-onset CNS cancer has steadily increased, particularly in regions with a high SDI and in emerging economies. Although there was a decline in early-onset CNS cancer-related metrics during the pandemic, it is anticipated that global incidence rates will peak between 2035 and 2040.

CONCLUSION

This study provides a comprehensive overview of early-onset CNS cancer trends. Despite stable mortality rates, the increasing incidence suggests a growing global burden, with a delayed peak expected due to the pandemic. These findings highlight the need for preventive and control policies targeting early-onset CNS cancer.

Assessing and projecting the global impacts of Alzheimer's disease

Background

This study aims to assess the global burden of Alzheimer's disease (AD) from 1990 to 2030, with a focus on incidence, mortality, and disability-adjusted life years (DALY).

Methods

Data on the incidence rates, DALY rates, and death rates of AD across various geographic populations from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Generalized Additive Models (GAMs) were employed to forecast the disease burden from 2022 to 2030.

Results

The projected global burden of Alzheimer's disease from 2022 to 2030 indicates a decrease in DALYs, with an Estimated Annual Percentage Change (EAPC) of -1.44 (95% CI: -1.45, -1.42). Similarly, death rates and incidence rates also show a decline, with EAPCs of -1.80 (95% CI: -1.83, -1.77) and -1.27 (95% CI: -1.29, -1.26) respectively. Gender-specific analysis reveals that the projected global incidence EAPC from 2022 to 2030 is estimated at -1.73 (95% CI: -1.75, -1.70) for males and -1.03 (95% CI: -1.04, -1.02) for females. Regionally, Andean Latin America and the Caribbean exhibit the highest positive EAPCs for DALYs at 0.94 (95% CI: 0.93, 0.94) and 0.59 (95% CI: 0.59, 0.60) respectively, while Eastern Europe shows the lowest EAPC at -16.31 (95% CI: -18.60, -13.95). Country-specific projections highlight Cyprus and Serbia with the highest positive EAPCs for DALYs at 12.55 (95% CI: 11.21, 13.91) and 9.6416 (95% CI: 8.86, 10.4333) respectively. On the other hand, Bahrain and Armenia exhibit significant negative EAPCs at -87.28 (95% CI: -94.66, -69.70) and -85.41 (95% CI: -92.80, -70.41). An analysis based on the Socio-Demographic Index (SDI) reveals that regions with higher SDI values have greater burdens of AD, with countries having SDI ≥ 0.8 showing significantly higher age-standardized Incidence Rates (ASIR), age-standardized Death Rates (ASDR), and age-standardized DALY rates compared to those with SDI < 0.8.

Conclusion

From 1990 to 2030, global burden of AD is projected to decrease, with significant gender and regional disparities. Regions with higher SDI show higher disease burdens, underscoring the necessity for targeted interventions and customized public health strategies to effectively address AD in varied socio-economic settings.

Adverse health outcomes and health-related quality of life (HRQoL) among long-term adolescent and young adult (AYA) brain tumour survivors: results from the population-based SURVAYA study

PURPOSE

Adolescent and young adult (AYA) malignant brain tumour (BT) survivors are at risk of adverse health outcomes, which may impact their health-related quality of life (HRQoL). This study aimed to investigate the (1) prevalence of physical and psychological adverse health outcomes, (2) the HRQoL, and (3) the association of adverse health outcomes and HRQoL among long-term AYA-BT survivors. Adverse health outcomes and HRQoL were compared to other AYA cancer (AYAC) survivors.

METHODS

A cross-sectional secondary data analysis of the SURVAYA study among 133 AYA-BT and 3877 AYAC survivors was conducted. Participant self-reported adverse health outcomes and HRQoL scores were analysed and compared between the two populations. Associations with HRQoL were assessed using linear regression modelling with AIC-based backward elimination.

RESULTS

AYA-BT survivors faced significant issues of fatigue (47.6%), future uncertainty (45.2%), and medical conditions like vision (34.4%), speech, taste, or smell (26.2%) impairments, cancer recurrence, and metastasis (25.4%). Neurocognitive symptoms were identified as BT-specific issues (13.6-33.6%). Compared to AYAC survivors, AYA-BT survivors reported significantly (p < 0.05) lower functioning scores on the role, cognitive, emotional, and social HRQoL, with cognitive (56.0%) and emotional (40.0%) domains being the most affected. Adverse health outcomes were negatively associated with HRQoL, ranging from small to large clinical relevance.

CONCLUSION

Long-term AYA-BT survivors were identified as a highly burdened population, affected by multifaceted issues and multidimensional detriments in HRQoL years beyond their cancer diagnosis. This study highlights the necessity of long-term follow-up and a holistic, multidisciplinary approach to survivorship care to ultimately improve the quality of AYA-BT survivorship.

Global temporal trends and projections of hepatitis B-related cirrhosis among adolescents and young adults from 1990 to 2035: an analysis based on the global burden of disease study 2021

Background

Chronic hepatitis B and cirrhosis pose significant global health threats. Few studies have explored the disease burden and mortality trend of cirrhosis caused by hepatitis B virus infection among adolescents and young adults (AYAs, aged 15-39 years). This study aimed to assess the disease burden and trends.

Methods

Publicly available data were obtained from the 2021 GBD database. The rates of incidence, mortality, and disability-adjusted life years were calculated at the global, regional, and national levels. Temporal trends were assessed using joinpoint regression analysis, while the Bayesian age-period-cohort model was used to predict future trends.

Results

From 1990 to 2021, the global incidence rate of hepatitis B-related cirrhosis decreased from 111.33 (95% uncertainty interval: 89.18 to 134.98) to 67.75 (54.06 to 82.71) per 100,000 with an average annual percentage change of -1.58 (95% confidence interval: -1.66 to -1.51, p < 0.001). However, between 1990 and 2021, the incidence numbers in the 30-34 and 35-39 age groups increased by 23.75 and 21.24%, respectively. The number of deaths in low and low-middle Socio-demographic Index (SDI) areas increased by 79.51 and 20.62%, respectively. Moreover, it is predicted that the numbers of incidences and deaths will continue to rise in areas with low SDI. At the regional level, Central Sub-Saharan Africa had the highest incidence and mortality rates. In 2021, Somalia and the Democratic Republic of Congo had the highest incidence rates, whereas Kiribati and Cambodia had the highest mortality rates.

Conclusion

The overall burden of hepatitis B-related cirrhosis among AYAs has decreased over the past three decades. Nevertheless, there was a slight increase in the incidence number among individuals aged 30-39 years. The substantial burden and predicted rise in the numbers of incidences and deaths in low SDI areas underscore the need for sustained and targeted public health interventions.

Long-term trends in the burden of pulmonary arterial hypertension in China and worldwide: new insights based on GBD 2021

Background

Pulmonary arterial hypertension (PAH) poses a significant health challenge globally, with China experiencing a notable increase in its burden. Understanding the trends and factors contributing to PAH is crucial for developing effective public health strategies.

Methods

This study utilized data from the Global Burden of Disease (GBD) 2021 database to estimate the burden of PAH in China and worldwide from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was employed to analyze differences in PAH burden across age, gender, and time periods, and to project global epidemiological trends until 2036.

Results

From 1990 to 2021, the incidence and prevalence of PAH in China increased by 80.59% and 86.74%, respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an annual percentage change (AAPC) of -0.07% and 0.25%, respectively. Conversely, the age-standardized disability-adjusted life year (DALY) rate and age-standardized mortality rate (ASMR) have been declining since 1990, with AAPC of -1.90% and -1.26%, respectively. Females and the 50-70 years age group experienced a higher PAH burden compared to males. Projections indicate that ASPR, ASMR, and age-standardized death rate (ASDR) will stabilize with minimal variation over the next decade.

Discussion

The findings highlight the age-related burden of PAH in China, particularly affecting older populations and women. The projected stabilization of PAH metrics over the next decade underscores the need for continued monitoring and targeted interventions. This study's comprehensive analysis of PAH burden over three decades provides valuable insights for policymakers and healthcare providers, necessitating concerted efforts to address this critical health issue.

Disability-Adjusted Life Years (DALYs) due to Breast, Cervical, Colorectal and Oral Cancers in Taiwan Regions

BACKGROUND

Cancer is a leading cause of death globally, with significant variations in incidence and mortality rates among different cancer types and regions. In Taiwan, breast cancer (BC), cervical cancer (CxCa), colorectal cancer (CRC), and oral cancer (OC) are prevalent and have prompted government-led screening programs to mitigate their impact. This study aims to assess the burden of these cancers at the county scale using disability-adjusted life years (DALYs) as a metric, focusing on the years 2010, 2015, 2018, 2019, and 2020.

METHODS

Data on cancer incidence, mortality, disability weights, and treatment outcomes were sourced from the Taiwan HPA, Ministry of Health and Welfare, and Taiwan Cancer Registry. Years of life lost (YLLs) and years lived with disability (YLDs) were calculated for each cancer, considering age, stage, and treatment. The correlation between cancer screening rates and disease burden also conducted.

RESULTS

The analysis highlights significant trends in cancer mortality, incidence, and disease burden in Taiwan from 2010 to 2020. BC and CRC showed rising ASMR and DALYs rates, while CxCa experienced consistent declines. OC had a fluctuating pattern, particularly in eastern regions. YLLs contributed significantly to DALYs for all cancers, emphasizing premature mortality's role in the disease burden. Screening rates, particularly for BC and CxCa, correlated with changes in burden, with BC rates increasing and CxCa decreasing, reflecting the impact of preventive measures on cancer outcomes.

CONCLUSIONS

The findings underscore the importance of targeted interventions and evidence-informed resource allocation to address regional differences in cancer burden in Taiwan.

Evolving Dynamics of Colorectal Cancer in High Socio-Demographic Regions

BACKGROUND

Colorectal cancer (CRC) poses a significant global health challenge, with evolving demographic trends emphasizing the need for accurate forecasting models. Existing forecasting models lack comprehensive coverage. By integrating machine learning algorithms, this study aims to provide more accurate and precise predictions, filling critical gaps in understanding CRC incidence, death, and disability-adjusted life year (DALY) rate trends, especially in high socio-demographic index (SDI) regions. Specific emphasis is placed on exploring age-, sex-, and country-specific variations in CRC trends.

MATERIALS AND METHODS

An ensemble forecasting algorithm integrating Simple Linear Regression, Exponential Smoothing, and Autoregressive Integrated Moving Average, capable of handling a short time series was developed and validated, utilizing a dataset encompassing age-, sex-, and country-specific CRC incidence, mortality, and DALY rates.

RESULTS

Our forecasting models reveal rising trends in CRC burden in the 15-49 years age group (young-onset) and decreasing trends in CRC burden in the 50-74 years age group (late-onset) in high SDI regions with sex-specific variations in incidence, mortality, and DALY rates. Some inflection points for demographic shifts in CRC disease burden, particularly death rates, were identified as early as within the next 5 years. We predict a shift in CRC burden towards females, particularly in older adults.

CONCLUSION

A novel multifactor model was developed for comparing the incidence, mortality, and DALY rates of young- and late-onset CRC in high SDI regions. The rising incidence of young-onset CRC in high SDI regions underscores the need for proactive health strategies. By refining predictive models, adjusting screening guidelines to target younger, high-risk populations, and investing in public awareness and research, we can facilitate early detection and improve outcomes. This study addresses a significant gap in CRC forecasting and provides a robust framework for anticipating demographic shifts in CRC burden, making it an indispensable tool for healthcare planning.

Multidisciplinary adolescent and young adult neuro-oncology clinic: Clinical cases, practice challenges, and future perspectives

Background

The distinct tumor histopathology, molecular features, and psychosocial needs among adolescents and young adults (AYA) with brain tumors pose challenges within traditional healthcare systems. Establishing a multidisciplinary AYA neuro-oncology clinic has been proposed to address these gaps in care. This is the first study to describe the framework and patient profile of a multidisciplinary AYA neuro-oncology clinic in a quaternary cancer center in Canada.

Methods

Clinic framework was outlined and patients seen from December 2022 to June 2024 were included. Demographic profiles, tumor characteristics, treatment details, clinical trial enrollment, and allied health referrals were collected. Barriers encountered were summarized.

Results

The clinic is composed of specialists in pediatric and adult neuro-oncology with seamless referrals to neurosurgery, radiation oncology, and allied health teams. A total of 100 patients (males 54%, females 46%) were seen with a median age of 24 years. Pediatric-type low-grade glioma (PLGG) was the leading diagnosis. BRAF alterations were the primary molecular drivers. Twenty-nine patients received active neuro-oncology management in the clinic. Overall, 77 patients underwent at least one surgery, 31 patients received radiotherapy, and 43 patients received chemotherapy. Trametinib was the primary targeted treatment prescribed. Three patients were eligible and enrolled in clinical trials. Barriers identified included a lack of peer support groups and a paucity of available clinical trials.

Conclusions

This study provides insight into the clinical profile of patients seen in a multidisciplinary AYA neuro-oncology clinic in Canada. Multidisciplinary care is feasible and integral in addressing the multifaceted needs of AYAs with brain tumors.

Global, regional, and national burden of acute lymphoblastic leukemia in children: Epidemiological trends analysis from 1990 to 2021

Children are the main susceptible group to acute lymphoblastic leukemia (ALL), and the lack of sufficient data has impeded a comprehensive understanding of its global impact. This study analyzed the annual numbers and rates of incidence, deaths, and disability-adjusted life years (DALYs) of childhood ALL from 1990 to 2021, disaggregated by age group, gender, and socio-demographic index (SDI) at the global, regional, and national levels, based on the 2021 Global Burden of Disease (GBD) database. Although global deaths and DALYs rates for childhood ALL showed declining trends, the incidence rate fluctuated. Incidence rates in high SDI regions were higher, but deaths and DALY rates were lower. Moreover, the burden in Sub-Saharan Africa and other low SDI countries was growing. The burden on boys has been higher than on girls in this period. This study underscored improving prevention and treatment measures are critical to control the persistent global burden of children ALL.

Current status of nucleic acid therapy and its new progress in cancer treatment

Nucleic acid is an essential biopolymer in all living cells, performing the functions of storing and transmitting genetic information and synthesizing protein. In recent decades, with the progress of science and biotechnology and the continuous exploration of the functions performed by nucleic acid, more and more studies have confirmed that nucleic acid therapy for living organisms has great medical therapeutic potential. Nucleic acid drugs began to become independent therapeutic agents. As a new therapeutic method, nucleic acid therapy plays an important role in the treatment of genetic diseases, viral infections and cancers. There are currently 19 nucleic acid drugs approved by the Food and Drug Administration (FDA). In the following review, we start from principles and advantages of nucleic acid therapy, and briefly describe development history of nucleic acid drugs. And then we give examples of various RNA therapeutic drugs, including antisense oligonucleotides (ASO), mRNA vaccines, small interfering RNA (siRNA) and microRNA (miRNA), aptamers, and small activating RNA (saRNA). In addition, we also focused on the current status of nucleic acid drugs used in cancer therapy and the breakthrough in recent years. Clinical trials of nucleic acid drugs for cancer treatment are under way, conventional radiotherapy and chemotherapy combined with the immunotherapies such as checkpoint inhibitors and nucleic acid drugs may be the main prospects for successful cancer treatment.

The current and future global burden of cancer among adolescents and young adults: a population-based study

BACKGROUND

Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15-39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality.

METHODS

In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15-39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision.

FINDINGS

An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 vs 28·3; mortality ASR 13·1 vs 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase).

INTERPRETATION

Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities.

FUNDING

None.

Burden of gastrointestinal cancers among adolescent and young adults in Asia-Pacific region: trends from 1990 to 2019 and future predictions to 2044

BACKGROUND

Gastrointestinal cancer is a significant cause of cancer incidence and mortality. Nevertheless, the epidemiology of the burden among adolescents and young adults (AYAs, aged 15-39 years) remains limited in the Asia-Pacific region, despite the region's significant population. This study aims to explore the gastrointestinal cancer burden among AYAs in the Asia-Pacific region for the year 2019, while also analysing trends from 1990 to 2019 and projecting future trends up to 2044.

METHODS

Annual case numbers, age-standardized rates of incidence, death, and disability-adjusted life-years (DALYs) and their estimated annual percentage changes (EAPCs) for gastrointestinal cancers were derived from the Global Burden of Disease, Injuries, and Risk Factors Study 2019. Trends over the next 25 years have also been predicted.

RESULTS

In 2019, there were 117,714 incident cases, 61,578 deaths and 3,483,053 DALYs due to gastrointestinal cancers in the Asia-Pacific region, accounting for 68.5%, 67.6% and 72.4%, respectively, of global gastrointestinal cancers in this population. The highest age-standardized rates occurred in countries with a middle Socio-demographic Index. From 1990 to 2019, there was a decline in the age-standardized rates of incidence, death and DALY attributed to gastrointestinal cancers, with EAPC of -1.10, -2.48 and -2.44, respectively. These rates are expected to stabilize over 25 years, with notable variations in individual gastrointestinal cancers.

CONCLUSIONS

Gastrointestinal cancers among AYAs in the Asia-Pacific region have posed a significant burden over the past 30 years and are expected to persist in the coming years.

Actionability of Synthetic Data in a Heterogeneous and Rare Health Care Demographic: Adolescents and Young Adults With Cancer

PURPOSE

Research on rare diseases and atypical health care demographics is often slowed by high interparticipant heterogeneity and overall scarcity of data. Synthetic data (SD) have been proposed as means for data sharing, enlargement, and diversification, by artificially generating real phenomena while obscuring the real patient data. The utility of SD is actively scrutinized in health care research, but the role of sample size for actionability of SD is insufficiently explored. We aim to understand the interplay of actionability and sample size by generating SD sets of varying sizes from gradually diminishing amounts of real individuals' data. We evaluate the actionability of SD in a highly heterogeneous and rare demographic: adolescents and young adults (AYAs) with cancer.

METHODS

A population-based cross-sectional cohort study of 3,735 AYAs was subsampled at random to produce 13 training data sets of varying sample sizes. We studied four distinct generator architectures built on the open-source Synthetic Data Vault library. Each architecture was used to generate SD of varying sizes on the basis of each aforementioned training subsets. SD actionability was assessed by comparing the resulting SD with their respective real data against three metrics-veracity, utility, and privacy concealment.

RESULTS

All examined generator architectures yielded actionable data when generating SD with sizes similar to the real data. Large SD sample size increased veracity but generally increased privacy risks. Using fewer training participants led to faster convergence in veracity, but partially exacerbated privacy concealment issues.

CONCLUSION

SD is a potentially promising option for data sharing and data augmentation, yet sample size plays a significant role in its actionability. SD generation should go hand-in-hand with consistent scrutiny, and sample size should be carefully considered in this process.

Global cancer statistics of young adults and its changes in the past decade: Incidence and mortality from GLOBOCAN 2022

OBJECTIVES

This study aimed to assess the disease burden of cancer in young adults globally and the changes between 2012 and 2022.

STUDY DESIGN

A comprehensive analysis of global cancer statistics of young adults based on data provided by GLOBOCAN 2022.

METHODS

The incidence and mortality estimates for cancer in young adults in 2012 and 2022 were obtained from the publication by Fidler et al. and GLOBOCAN 2022, respectively. Data were displayed descriptively and compared at the sex, global, regional, national and human development index (HDI) levels. Associations between HDI rank and cancer incidence and mortality were explored by Pearson correlation analysis.

RESULTS

In 2022, the number of new cancer cases and deaths in young adults were estimated to be 1,227,907 and 349,550, respectively, with the age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR) of 49.5 and 14.2 per 100,000 population. In young adults, 47.22 % of new cases were breast, thyroid and cervical cancer, while the leading causes of cancer-related death were breast, leukaemia and cervical cancer. Compared to 2012, the number of new cases and the ASIR increased by 25.89 % and 14.32 %, respectively, while the number of deaths and the ASMR decreased by 2.03 % and 10.69 %, respectively. However, cancer burden and its changes varied substantially across geographical regions, HDI levels and cancer types. In general, infection-related cancers were more common in less developed regions, but their incidence decreased significantly, while Westernised lifestyle-related cancers were more common in developed countries and their incidence is increasing.

CONCLUSIONS

Cancer contributes substantially to health-related burdens in young adults and the overall incidence has increased dramatically in the past decade. However, the incidence and mortality of cancer in this age group varied considerably by sex, cancer type, region, country and HDI level.

Global, regional, and national burden of gastrointestinal cancers among adolescents and young adults from 1990 to 2019, and burden prediction to 2040

BACKGROUND

Gastrointestinal (GI) cancers have heavily burdened public health. Few studies reported GI cancer burden among adolescents and young adults (AYA). To address this gap, we explored the burden of GI cancer among people aged 15-39.

METHODS

We retrieved data from the Global Burden of Disease Study 2019 Data Resources. The average annual percent change (AAPC) of rates was calculated by linear regression analysis of the natural logarithm. Bayesian age-period-cohort model was applied to predict the future burden.

RESULTS

In 2019, there were 171,857 (95% uncertain interval [95% UI]: 157,092-187,974) new GI cancer cases with a rate of 5.79/100,000 (95% UI: 5.29-6.33) and 91,033 (95% UI: 83,156-99,399) deaths at a rate of 3.07/100,000 (95% UI: 2.80-3.35) among AYA. The number of prevalent cases and disability-adjusted life years (DALYs) were 722,573 (95% UI: 660,806-789,476) and 5,151,294 (95% UI: 4,706,065-56,188,77), with rates of 24.35/100,000 (95% UI: 22.27-26.60) and 173.57/100,000 (95% UI: 158.57-189.32) respectively. The overall rates of mortality (AAPC = -1.281, p < 0.001) and DALY (AAPC = -1.283, p < 0.001) of GI cancers declined during the past 30 years, while the incidence rate (AAPC = -0.270, p = 0.074) remained stable and the prevalence rate (AAPC = 1.066, p < 0.001) increased. The burden of colorectal cancer (CRC) and pancreatic cancer increased, while those of stomach cancer (SC) and liver cancer (LC) declined. Among the 21 GBD regions, East Asia exhibited the highest burden, while within the five SDI regions, high-middle SDI locations showed the highest rates across all four indicators. CRC, SC, and LC emerged as the primary culprits, attaining a position within the top ten absolute DALYs for all AYA cancers. There were predicted to be 315,792 new cases and 174,068 deaths of GI cancers among AYA in 2040.

CONCLUSIONS

Despite the decrease in mortality and DALY rates of GI cancers among AYA, they remain prevalent. The burden varied with locations, SDI levels, sexes, and cancer types. Sufficient attention and multi-party cooperation are needed to control the widespread public health issue.

Psychometric evaluation of the spiritual perspective scale for adolescents and young adults with cancer

Objective

To evaluate the reliability and validity of the spiritual perspective scale (SPS) for adolescents and young adults with cancer.

Methods

The study was conducted with 277 adolescents and young adults with cancer aged 10-24 years who were recruited from Taiwan and Korea. The reliability of the SPS was assessed using Cronbach's α. Its factor structure was determined by exploratory factor analysis. Known-group validity was tested by comparing resilience scores between two groups and between countries using t test.

Results

Cronbach's α values for the SPS was 0.94, and item-total correlation values ranged from 0.53 to 0.84. Factor analysis generated two factors (spiritual behaviors and spiritual beliefs) that explained 78.02% of the total variance, with factor loadings ranging from 0.51 to 0.94. Participants with lower resilience had significantly lower spirituality scores compared to those with higher resilience (t = 3.13, P = 0.002). The SPS scores were not significantly different between participants in Taiwan and Korea (t = 1.09, P = 0.276). However, the spiritual beliefs subscale scores did show a significant difference between these groups (t = 2.74, P = 0.007).

Conclusions

The spiritual perspective scale is a valid and reliable tool for measuring the spirituality of adolescents and young adults with cancer in Taiwan and Korea. The SPS showed sensitivity in detecting variations in spiritual beliefs between adolescents and young adults with cancer in Taiwan and Korea.

Risk factors behind the increase of early-onset cancer in Italian adolescents and young adults: An investigation from the Italian AYA Working group

The incidence of early-onset cancers in adolescents and young adults (AYA) has been increasing worldwide since the 1990s. In Italy, a significant increased rate of 1.6 % per year has been reported for early-onset cancers among females between 2008 and 2016. This is mainly attributable to melanoma, thyroid, breast and endometrial cancer. The aim of our work was to describe temporal trends of the main established lifestyle risk factors (tobacco use, alcohol consumption, obesity, physical inactivity, dietary westernization and reproductive factors) over the last 20 years in the Italian AYA population. Available data on behavioural risk factors, individual and household daily life have been obtained and elaborated from PASSI, ISTAT and Eurostat reports. Lowering age of smoking initiation, an increase in alcohol drinkers among young females, and an obesity and overweight epidemic, particularly among children and adolescents as a result of physical inactivity and dietary habits, may be contributing factors behind this cancer epidemic, especially among females. In-depth investigations are needed to understand the exact role of each contributing factor, the effects of exposure to nicotine-containing products and environmental factors such as endocrine disruptors that could play a role in this phenomenon.

Global, Regional, and National Burden of Brain and Central Nervous System Cancers for Males from 1990 to 2021 and Its Predicted Level in the Next 25 Years

BACKGROUND

A study of the global burden of cerebral and central nervous system (CNS) cancers from the Global Burden of Diseases (GBD) indicates that these cancers significantly contribute to morbidity and mortality internationally. To fully understand the global impact of CNS cancer, expanded research efforts are essential. We analyzed the temporal trend of the disease burden from 1990 to 2021 and made projections for the expected burden from 2020 through 2044.

METHODS

We tapped into GBD 2021 Study data to evaluate CNS cancer incidence and trends among males. Prevalence was assessed with DisMod-MR, trends via cluster analysis, and estimated annual percentage change (EAPC) calculated via linear regression. Forecasts for 2022-2044 used APC and BAPC models, with a p value <0.05 considered significant. Analyses relied on R software 4.0.2.

RESULTS

In 2021, males experienced between 148,118 and 232,469 new brain and CNS cancer cases, indicating increased global burden from 1990 to 2021. An observed link between the prevalence's EAPCs and Human Development Indices (HDIs) suggests higher incidence in more developed regions. Projections using the APC model suggest rising numbers of cases and losses in disability-adjusted life years (DALYs) from 2020 to 2044, while age-standardized rates are expected to decrease overall.

CONCLUSIONS

In summary, a higher Socio-Demographic Index (SDI) correlates with better outcomes for CNS cancer due to early medical interventions in regions with strong healthcare systems. This demonstrates the need for equitable healthcare policies that focus on improving diagnostic capabilities and professional training to enhance survival rates universally.

Global cancer statistics for adolescents and young adults: population based study

BACKGROUND

Accurate and up-to-date estimates of the global cancer burden in adolescents and young adults (AYA) are scarce. This study aims to assess the global burden and trends of AYA cancer, with a focus on socioeconomic disparities, to inform global cancer control strategies.

METHODS

AYA cancer, defined as cancer occurring in individuals aged 15-39, was analyzed using data from the Global Burden of Disease (GBD) 2021 study and the Global Cancer Observatory (GLOBOCAN) 2022 project. We examined the global burden by age, sex, geographic location, and Human Development Index (HDI), as well as its temporal trends. Primary outcomes included age-standardized incidence and mortality rates (ASIR, ASMR) and the average annual percent change (AAPC).

RESULTS

In 2022, an estimated 1,300,196 incidental cases and 377,621 cancer-related deaths occurred among AYAs worldwide, with an ASIR of 40.3 per 100,000 and an ASMR of 11.8 per 100,000. The most common cancers were breast, thyroid, and cervical, while the leading causes of death were breast, cervical, and leukemia. The incidence and mortality were disproportionately higher among females (ASIR: 52.9 for females vs. 28.3 for males; ASMR: 13.1 for females vs. 10.6 for males). Countries with higher HDI experienced a higher incidence of AYA cancers (ASIR: 32.0 [low HDI] vs. 54.8 [very high HDI]), while countries with lower HDI faced a disproportionately higher mortality burden (ASMR: 17.2 [low HDI] vs. 8.4 [very high HDI]) despite their relatively low incidence. Disproportionality and regression measures highlighted significant HDI-related inequalities. AYA cancer incidence was stable from 2000 to 2011 (AAPC: - 0.04) but increased from 2012 to 2021 (AAPC: 0.53), driven by growing gonadal and colorectal cancers. Mortality decreased substantially from 2000 to 2011 (AAPC: - 1.64), but the decline slowed from 2012 (AAPC: - 0.32) probably due to increased deaths from gonadal cancers. These trends varied by sex, cancer type, geography, and HDI.

CONCLUSION

AYA cancers present a significant and growing global burden, with marked disparities across sex, geographic locations, and HDI levels. Policymakers should prioritize equitable resource allocation and implement targeted interventions to reduce these inequalities, particularly in low-HDI regions and with regard to gonadal cancers.

Global burden, trends, and cross-country inequalities of urinary tract infections in adolescents and young adults, 1990 to 2019

BACKGROUND

Limited studies have evaluated the global burden, trends, and cross-country inequalities for urinary tract infections (UTIs) in adolescents and young adults (AYAs).

METHODS

Age-standardized incidence rate, age-standardized mortality rate, and age-standardized Disability-Adjusted Life Years (DALYs) rate were used to describe the UTI burden. The estimated annual percentage changes were calculated to evaluate the temporal trends from 1990 to 2019. The slope index of inequality and concentration index were utilized to quantify the distributive inequalities.

RESULTS

From 1990 to 2019, a significant increase in age-standardized incidence rate (estimated annual percentage change =0.22%, 95% confidence interval 0.19%-0.26%) was found for UTIs in AYAs, and the increasing trend was more pronounced in males than females. Significant decreases in age-standardized mortality rate and age-standardized DALY rate were found in females but not in males. The slope index of inequality changed from 21.80 DALYs per 100,000 in 1990 to 20.91 DALYs per 100,000 in 2019 for UTIs in AYAs. Moreover, the concentration index showed -0.23 in 1990 and -0.14 in 2019.

DISCUSSION

Countries with lower sociodemographic development levels shouldered a disproportionately higher UTI burden.

CONCLUSIONS

UTIs remain an ongoing health burden for AYAs globally, with substantial heterogeneities found across countries, sex, and age groups.

Global, regional, and national trends in the burden of breast cancer among individuals aged 70 years and older from 1990 to 2021: an analysis based on the global burden of disease study 2021

BACKGROUND

Breast cancer poses a substantial health challenge for the world's over-70 population. However, data on the impact and epidemiology of breast cancer in this age group are limited. We aimed to evaluate global, regional, and national breast cancer trends among those aged 70 and older between 1990 and 2021.

METHODS

In this trend analysis based on the 2021 Global Burden of Diseases (GBD), we report on the incidence rates and Global Burden of Diseases (GBD) disability-adjusted life years (DALYs) counts, as well as the incidence rates per 100,000 individuals and average annual percentage changes (AAPCs) for breast cancer among individuals aged 70 and above at the global, regional, and national levels. We analyzed these global trends by age, sex, and socio-developmental index (SDI). Joinpoint regression elucidates pivotal trend shifts.

RESULTS

From 1990 to 2021, the global incidence of breast cancer in the over-70 population modestly increased from 104 to 107 per 100,000, with significant trend changes in 1995, 2005, and 2018. Regionally, High-income North America had the highest incidence in 2021, while North Africa and the Middle East saw the steepest rise in incidence and DALYs. The only decrease was in the High SDI quintile. The 70-74 age group experienced the largest increase globally, with rates rising from 86.3 to 90 per 100,000 (AAPC 0.27).

CONCLUSION

From 1990 to 2021, global breast cancer incidence in the over-70 population saw a slight uptick, contrasted by a significant reduction in DALYs, likely due to progress in endocrine and targeted therapies. This underscores the critical need for enhanced screening and personalized treatments for older patients.

Early-onset cancers: Biological bases and clinical implications

Since the nineties, the incidence of sporadic early-onset (EO) cancers has been rising worldwide. The underlying reasons are still unknown. However, identifying them is vital for advancing both prevention and intervention. Here, we exploit available knowledge derived from clinical observations to formulate testable hypotheses aimed at defining the causal factors of this epidemic and discuss how to experimentally test them. We explore the potential impact of exposome changes from the millennials to contemporary young generations, considering both environmental exposures and enhanced susceptibilities to EO-cancer development. We emphasize how establishing the time required for an EO cancer to develop is relevant to defining future screening strategies. Finally, we discuss the importance of integrating multi-dimensional data from international collaborations to generate comprehensive knowledge and translate these findings back into clinical practice.

Molecular Profile as an Outcome Predictor in Glioblastoma along with MRI Features and Surgical Resection: A Scoping Review

Glioblastoma (GBM) is one of the most aggressive malignant tumors of the brain. We queried PubMed for articles about molecular predictor markers in GBM. This scoping review aims to analyze the most important outcome predictors in patients with GBM and to compare these factors in terms of absolute months of survival benefit and percentages. Performing a gross total resection for patients with GBM undergoing optimal chemo- and radiotherapy provides a significant benefit in overall survival compared to those patients who received a subtotal or partial resection. However, compared to IDH-Wildtype GBMs, patients with IDH-Mutant 1/2 GBMs have an increased survival. MGMT promoter methylation status is another strong outcome predictor for patients with GBM. In the reviewed literature, patients with methylated MGMT promoter lived approximately 50% to 90% longer than those with an unmethylated MGMT gene promoter. Moreover, KPS is an important predictor of survival and quality of life, demonstrating that we should refrain from aggressive surgery in important brain areas. As new therapies (such as TTFs) emerge, we are optimistic that the overall median survival will increase, even for IDH-Wildtype GBMs. In conclusion, molecular profiles are stronger outcome predictors than the extent of neurosurgical resection for GBM.

Perspectives of non-physician partners on barriers and facilitators to AYA cancer care in Latin America

BACKGROUND

Cancer is the fourth leading cause of death in adolescents and young adults (AYA) worldwide. Although successful treatment of cancer in AYA has increased in recent years in most of the world, this is not true for many low- and middle-income countries (LMIC) where over 80% of all AYA live. This study investigated the needs of AYA with cancer in parts of Latin America (LATAM) through the perspectives of non-physician health care providers and partners.

METHODS

Semi-structured interviews (in Spanish) were conducted with non-physician partners from Mexico, Peru, Central America, and the Caribbean over Zoom. Participants were recruited through previously identified local physicians and international non-physician professionals working in these countries. Transcripts were coded and key themes identified until thematic saturation was reached (Atlas.ti).

FINDINGS

Thirty participants representing eight countries were interviewed, providing 1202 min of transcript data. Data were organized into barriers, facilitators, and strategies to improve the delivery of health care for AYA with cancer in LATAM at the patient- (e.g., financial barriers, continued schooling), parent- (e.g., limited medical literacy, advocacy), and hospital-level (e.g., structural barriers, increasing funding).

INTERPRETATION

There are many similarities in the barriers and facilitators to AYA care between LATAM and high-income countries (HIC); however, some characteristics are more unique to LATAM, for example, strict age restrictions for pediatric care and abandonment of therapy. As LATAM countries continue to build cancer control programs, there is an opportunity to consider our identified barriers, facilitators, and strategies to address the unique needs of AYA with cancer.

The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis

PURPOSE

In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS.

DATA SOURCES

PubMed, EMBASE, and Cochrane Library.

METHODS

We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported.

RESULTS

Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97).

CONCLUSIONS

Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.

Burden of gastrointestinal cancers among people younger than 50 years in China, 1990 to 2019

OBJECTIVES

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades.

STUDY DESIGN

A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030.

RESULTS

In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75-4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020-2030.

CONCLUSIONS

The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge.

Trend analysis of hematological tumors in adolescents and young adults from 1990 to 2019 and predictive trends from 2020 to 2044: A Global Burden of Disease study

INTRODUCTION

Cancer constitutes the primary disease spectrum contributing to the Global Burden of Disease (GBD). Adolescents and young adults (AYA) aged 15-39 have received relatively less attention regarding tumor prevention, diagnosis, and treatment compared to older adults and children. This study aimed to analyze the changes in the disease burden of hematological malignancies among the global AYA over the past three decades based on the GBD database.

METHODS

The changes in the disease burden of hematological malignancies were analyzed among the AYA over the past three decades based on the information from the GBD database. The future trends were predicted using the Nordpred package in R.

RESULTS

Our results showed that leukemia ranked first as the leading tumor burden among AYA in 2019, but the incidence rate and mortality rate of leukemia decreased year by year, with a projected age-standardized incidence rate (ASIR) of 1.65/100,000 for females and 2.40/100,000 for males by the year 2044. In addition, the incidence of non-Hodgkin's lymphoma has been gradually increasing in recent years, with an ASIR of 1.73/100,000 from 2020 to 2024. The results may serve as a basis for developing strategies to reduce the burden of hematological malignancies in the AYA population in different regions.

DNA signature and occult blood in stool led to diagnosis of an early-onset metastatic rectal cancer in a young pregnant woman: a case report

Background

Colorectal cancer (CRC) is the third most common form of cancer worldwide in terms of incidence and the second in terms of mortality with 1.9 million new cases and 930,000 deaths reported in 2020. Corresponding numbers in the U.S. are 150,000 and 53,000, respectively. Although the majority of CRCs in the U.S. and other high-income countries are in adults aged 50 and older, there has recently been a considerable rise in early-onset CRC, so that 17,930 cases in the U.S. (12% of total cases) are diagnosed in individuals younger than age 50, representing the equivalent of 49 new cases per day. Early diagnosis is essential to improve the prognosis and reduce the number of cancer-related deaths. Here we report the case of a young pregnant woman, who was diagnosed with CRC with the help of the ColoAlert™ multitargeted stool test.

Case Description

In this case study, a young pregnant woman presented with obstipation, rectal bleeding, and pelvic pain, symptoms that were ascribed to her pregnancy. On her own, she performed a multitarget stool test (ColoAlert™) that showed occult blood as well as a very high level of human DNA, both known to be associated with presence of CRC. After testing, she was referred for rectoscopy (during her 21st week of pregnancy), which showed an exophytic, semicircular tumor 10 cm from anus in the rectosigmoid junction. Histology confirmed adenocarcinoma in rectum. Further examination showed perirectal infiltration as well as metastases to both liver and adrenal gland.

Conclusions

This case report shows the importance of considering CRC as a possible diagnosis in young people. It also demonstrates the usefulness of multitarget stool testing that in this case led to the endoscopic confirmation of the diagnosis followed by an immediate start of potential life-saving treatment.

Global burden, risk factor analysis, and prediction study of leukaemia from 1990 to 2030

Background

Leukaemia is a devastating disease with an incidence that progressively increases with advancing age. The World Health Organization has designated 2021-30 as the decade of healthy ageing, highlighting the need to address age-related diseases. We estimated the disease burden of leukaemia and forecasted it by 2030.

Methods

Based on the Global Burden of Disease 2019 database, we systematically analysed the geographical distribution of leukaemia and its subtypes. We used Joinpoint regression and Bayesian age-period-cohort models to evaluate incidence and mortality trends from 1990 to 2019 and projections through 2030. We analysed five leukaemia subtypes and the impact of age, gender, and social development. Decomposition analysis revealed the effects of disease burden on ageing and population growth. We used frontier analysis to illustrate the potential of each country to reduce its burden based on its development levels.

Results

Globally, the absolute numbers of leukaemia incidence and mortality have increased, while the age-standardised rates (ASRs) have shown a decreasing trend. The disease burden was more pronounced in men, the elderly, and regions with a high socio-demographic index (SDI), where ageing and population growth played varying roles across subtypes. From 2000 to 2006, disease burdens were most effectively controlled. Global ASRs of incidence might stabilise, while ASRs of death are expected to decrease until 2030. Frontier analysis showed that middle and high-middle SDI countries have the most improvement potential. Smoking and high body mass index were the main risk factors for leukaemia-related mortality and disability-adjusted life years.

Conclusions

The absolute number of leukaemia cases has increased worldwide, but there has been a sharp decline in ASRs over the past decade, primarily driven by population growth and ageing. Countries with middle and high-middle SDI urgently need to take action to address this challenge.

Changes in Time Perception and Coping Strategies in Young Adults With Cancer: A Qualitative Study

BACKGROUND

A cancer diagnosis is a traumatic event. Youths, in the most crucial stage in a person's life course, are more susceptible to the influence of cancer. The diagnosis disrupts the original life and time plans of young adults with cancer, resulting in a reconstruction of time perception and changes in coping strategies.

OBJECTIVE

The aim of this study was to explore the changes in time perception and coping strategies in young adults with cancer.

METHODS

A phenomenological research methodology was used in the qualitative study. Thirty-one young adults with cancer were recruited. Semistructured interviews were conducted with them, and the interview data were analyzed using Colaizzi's 7-step analysis method.

RESULTS

The study revealed 3 themes related to changes in time perception: perceived alterations in the speed of time, changes in remaining available time, and shifts in time preferences. Five themes were identified regarding coping strategies for changes in time perception: self-regulation of emotions, establishing spiritual beliefs, planning time effectively, returning to family life, and closure of the inner self.

CONCLUSIONS

Identifying changes in time perception among young adults with cancer through the speed of time, remaining available time, and time preference and guiding patients in adopting positive coping strategies can offer more effective cancer support and care for patients.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should pay attention to the changes in time perception in young adults with cancer and guide them to cope positively.

Application of image recognition technology in pathological diagnosis of blood smears

Traditional manual blood smear diagnosis methods are time-consuming and prone to errors, often relying heavily on the experience of clinical laboratory analysts for accuracy. As breakthroughs in key technologies such as neural networks and deep learning continue to drive digital transformation in the medical field, image recognition technology is increasingly being leveraged to enhance existing medical processes. In recent years, advancements in computer technology have led to improved efficiency in the identification of blood cells in blood smears through the use of image recognition technology. This paper provides a comprehensive summary of the methods and steps involved in utilizing image recognition algorithms for diagnosing diseases in blood smears, with a focus on malaria and leukemia. Furthermore, it offers a forward-looking research direction for the development of a comprehensive blood cell pathological detection system.

The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study

OBJECTIVE

To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).

DESIGN

Population-Based Study.

SETTING

Data sourced from the Global Burden of Disease Study 2019.

POPULATION

Individuals diagnosed with FeBGCs.

METHODS

Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.

MAIN OUTCOME MEASURES

The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.

RESULTS

In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.

CONCLUSIONS

The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.

Targeting IGF2BP1 alleviated benzene hematotoxicity by reprogramming BCAA metabolism and fatty acid oxidation

Benzene is the main environmental pollutant and risk factor of childhood leukemia and chronic benzene poisoning. Benzene exposure leads to hematopoietic stem and progenitor cell (HSPC) dysfunction and abnormal blood cell counts. However, the key regulatory targets and mechanisms of benzene hematotoxicity are unclear. In this study, we constructed a benzene-induced hematopoietic damage mouse model to explore the underlying mechanisms. We identified that Insulin like growth factor 2 mRNA binding protein 1 (IGF2BP1) was significantly reduced in benzene-exposed mice. Moreover, targeting IGF2BP1 effectively mitigated damages to hematopoietic function and hematopoietic molecule expression caused by benzene in mice. On the mechanics, by metabolomics and transcriptomics, we discovered that branched-chain amino acid (BCAA) metabolism and fatty acid oxidation were key metabolic pathways, and Branched-chain amino acid transaminase 1 (BCAT1) and Carnitine palmitoyltransferase 1a (CPT1A) were critical metabolic enzymes involved in IGF2BP1-mediated hematopoietic injury process. The expression of the above molecules in the benzene exposure population was also examined and consistent with animal experiments. In conclusion, targeting IGF2BP1 alleviated hematopoietic injury caused by benzene exposure, possibly due to the reprogramming of BCAA metabolism and fatty acid oxidation via BCAT1 and CPT1A metabolic enzymes. IGF2BP1 is a potential regulatory and therapeutic target for benzene hematotoxicity.

Racial Disparities in Cancer Stage at Diagnosis and Survival for Adolescents and Young Adults

Importance

There are limited studies assessing stage at diagnosis and risk of death among all 5 federally defined races in the US among adolescent and young adult (AYA) patients with cancer.

Objective

To identify racial disparities in stage at diagnosis and survival among AYA patients with cancer.

Design, Setting, and Participants

This retrospective cohort study used data from a US national hospital-based oncology database on AYA patients, aged 15 to 39 years, with the 10 deadliest cancers among AYA patients who received a diagnosis from January 1, 2004, to December 31, 2017, with 6 months or more of follow-up. Analyses by race were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (hereafter, White). White patients served as the majority reference group. Statistical analysis was performed from November 2022 to September 2023.

Main Outcomes and Measures

The primary end points were late stage at diagnosis (logistic regression with adjusted odds ratios [AORs] and 95% CIs) and overall survival (log-rank tests and Cox proportional hazards regression with adjusted hazard ratios [AHRs] and 95% CIs).

Results

A total of 291 899 AYA patients (median age, 33 years [IQR, 28-37 years]; 186 549 female patients [64%]; 189 812 [65%] with stage I or II cancers) were evaluated. The cohort included 1457 American Indian or Alaska Native patients (1%), 8412 Asian patients (3%), 40 851 Black patients (14%), 987 Native Hawaiian or Other Pacific Islander patients (0.3%), and 240 192 White patients (82%). Cancers included breast (n = 79 195 [27%]), lymphoma (n = 45 500 [16%]), melanoma (n = 36 724 [13%]), testis (n = 31 413 [11%]), central nervous system (n = 26 070 [9%]), colon or rectum (n = 22 545 [8%]), cervix (n = 20 923 [7%]), sarcoma (n = 14 951 [5%]), ovary (n = 8982 [3%]), and lung (n = 5596 [2%]). Risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Overall survival differed by race for all cancer sites, except cancers of the central nervous system and ovary. Risk of death was higher for American Indian or Alaska Native (AHR, 1.15; 95% CI, 1.02-1.30), Black (AHR, 1.22; 95% CI, 1.19-1.26), and Native Hawaiian or Other Pacific Islander (AHR, 1.25; 95% CI, 1.09-1.44) patients but lower for Asian patients (AHR, 0.90; 95% CI, 0.85-0.95) compared with White patients.

Conclusions and Relevance

This cohort study of AYA patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.