Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer

Upregulation of Lactobacillus spp. in gut microbiota as a novel mechanism for environmental eustress-induced anti-pancreatic cancer effects

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy with limited effective treatment options. Emerging evidence links enriched environment (EE)-induced eustress to PDAC inhibition. However, the underlying mechanisms remain unclear. In this study, we explored the role of gut microbiota in PDAC-suppressive effects of EE. We demonstrated that depletion of gut microbiota with antibiotics abolished EE-induced tumor suppression, while fecal microbiota transplantation (FMT) from EE mice significantly inhibited tumor growth in both subcutaneous and orthotopic PDAC models housed in standard environment. 16S rRNA sequencing revealed that EE enhanced gut microbiota diversity and selectively enriched probiotic Lactobacillus, particularly L. reuteri. Treatment with L. reuteri significantly suppressed PDAC tumor growth and increased natural killer (NK) cell infiltration into the tumor microenvironment. Depletion of NK cells alleviated the anti-tumor effects of L. reuteri, underscoring the essential role of NK cell-mediated immunity in anti-tumor response. Clinical analysis of PDAC patients showed that higher fecal Lactobacillus abundance correlated with improved progression-free and overall survival, further supporting the therapeutic potential of L. reuteri in PDAC. Overall, this study identifies gut microbiota as a systemic regulator of PDAC under psychological stress. Supplementation of psychobiotic Lactobacillus may offer a novel therapeutic strategy for PDAC.

Associations of pretreatment emotional distress with adherence to therapy for patients with locally advanced rectal cancer: a post hoc analysis of the Chinese FOWARC phase 3 randomized clinical trial

BACKGROUND

Non-adherence in advanced rectal cancer therapy is common and severely impairs clinical outcomes. Although behavioral research suggests emotional factors influence adherence, limited evidence links pretreatment emotional distress (PED) to treatment adherence in rectal cancer patients.

METHODS

This post hoc analysis of a phase 3 randomized clinical trial was conducted from June 9, 2010, to February 15, 2015, involving 219 patients (assigned to receive neoadjuvant therapy with fluorouracil plus radiotherapy [group A, 67 patients], modified fluorouracil, leucovorin, and oxaliplatin [mFOLFOX6] plus radiotherapy [group B, 66 patients], or mFOLFOX6 alone [group C, 86 patients] followed by TME resection and postoperative adjuvant chemotherapy) with locally advanced rectal cancer from the main center. The PED of patients was measured through the emotional dimension items in the Quality of Life Questionnaire-Core Questionnaire (QLQ-C30). The primary outcome was adherence to therapy, with non-adherence defined as patients in groups A and B receiving fewer than ten cycles of chemotherapy or less than 37 Gy of radiotherapy, and patients in group C receiving fewer than ten cycles of chemotherapy. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for adherence by PED levels. Additionally, the structural equation model (SEM) was utilized to analyze the impact pathways of PED on adherence.

RESULTS

Among the 219 patients (142 men; mean age, 53.4 years) who completed the QLQ-C30 scale, 27.8% (61/219) demonstrated non-adherence to the treatment regimen. Multivariable analyses showed that each 1-point increase in PED score raised non-adherence risk by 4.37 times (OR: 4.37, 95% CI: 1.92-9.96, P < 0.001). The SEM analysis revealed that PED score was positively correlated with the risk of non-adherence (standardized regression coefficients [β] = 0.25, 95% CI: 0.11 to 0.28), while economic burden was positively correlated with PED (β = 0.17, 95% CI: 0.11 to 0.28), and could indirectly affect adherence through PED (β = 0.04, 95% CI: 0.01 to 0.09).

CONCLUSIONS

Higher levels of pretreatment emotional distress were associated with an increased risk of treatment non-adherence, thereby highlighting the potential significance of addressing emotional distress in cancer management.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01211210.

Machine Learning-Enabled Emotion Recognition by Multisource Throat Signals

Emotion monitoring plays a crucial role in mental health management. However, traditional methods of emotion recognition predominantly rely on subjective questionnaires or facial expression analyses, which are often inadequate for continuous and highly accurate monitoring. In this study, we propose a high-precision, fine-grained emotion recognition system based on multisource throat physiological signals. The system collects signals through optimized flexible multiporous skin sensors and analyzes them using machine learning models capable of efficiently capturing complex feature interactions. First, we adopt a two-step cross-linking strategy to modulate the porous structure of the sensitive layer to enable accurate detection of the diverse and weak physiological signals in the throat. By extracting four-dimensional features from the input of 7025 samples, the platform based on the Light Gradient Boosting Machine (LightGBM) efficiently captures their nonlinear interactions, ultimately achieving precise classification of five emotional states (relaxation, surprise, disgust, fear, and neutral) with an accuracy of 98.9%. Further validation on an independent data set reveals an average emotion recognition accuracy of 99.3%, demonstrating the system's robustness and reliability in real-world applications. This work provides a viable technological solution for real-time and continuous emotion monitoring, offering significant potential in mental health management and related fields.

Evaluation of efficacy and safety of targeted therapy and immune checkpoint inhibitors in metastatic colorectal cancer

BACKGROUND

Colorectal cancer (CRC) is among the most prevalent and deadly cancers globally, particularly in China. Treatment challenges remain in advanced and metastatic cases, especially in third- and fourth-line settings. The combination of targeted therapies with immune checkpoint inhibitors (ICIs) has shown potential in addressing the limitations of single-agent treatments.

AIM

To evaluate the efficacy and safety of targeted therapy (TT) alone and in combination with ICIs for metastatic CRC (mCRC).

METHODS

A multicenter retrospective observational study was conducted to evaluate the efficacy and safety of TT alone and in combination with ICIs for mCRC. A total of 99 patients treated with regorafenib or fruquintinib, with or without ICIs, were enrolled. Propensity score matching (PSM) and inverse probability weighting (IPW) were employed to balance baseline characteristics. The primary endpoint was progression-free survival (PFS), while overall survival (OS) and safety were secondary.

RESULTS

Patients who received combined therapy showed significantly longer median PFS rates compared to those who underwent TT in all analyses (original: 6.0 vs 3.4 months, P < 0.01; PSM: 6.15 vs 4.25 months, P < 0.05; IPW: 5.6 vs 3.3 months, P < 0.01). Although the median OS showed a trend toward improvement in the combination group, the difference was insignificant. Cox regression analysis revealed that combining TT with ICIs significantly reduced the risk of disease progression (hazard ratio = 0.38, P < 0.001). Adverse events (AEs) were generally manageable with both regimens, while serious AEs (grade 3-4) were primarily hypertension, fatigue, and reduced platelet counts. All AEs were controlled effectively by symptomatic treatment or discontinuation of the drug, and no treatment-related deaths were observed.

CONCLUSION

The combination of TT with ICIs offers a significant advantage in terms of PFS for patients with advanced mCRC, accompanied by a favorable safety profile. These findings underscore the benefits of combination therapy in this setting, warranting further investigation in larger prospective clinical trials.

Association Between Health-Related Quality of Life Measures and Survival Endpoints in Oncology Clinical Trials and in Clinical Decision Making: A Narrative Review

For decades, oncology research has primarily relied on survival-based endpoints, such as progression-free survival and overall survival, to evaluate treatment efficacy. However, recent studies and international guidelines underscore the importance of incorporating patient-reported outcomes through patient-reported outcomes measures (PROMs). PROMs provide a more comprehensive view of treatment effectiveness, integrating the concepts of 'living longer' and 'living better.' Health-related quality of life (HRQoL) improvements have an intrinsic value for the patient, with importance in the overall definition of treatment value. These findings have sparked discussions regarding the relationship between HRQoL and traditional survival endpoints, influencing both oncology clinical trials and their interpretation for decision-making processes in practice. To effectively integrate PROMs into research, the choice of study design, appropriate PROMs questionnaires, and timing of administration are critical. The clinician's ability to interpret HRQoL data with awareness is equally important to ensure good clinical decision making. A pivotal concept in this context is the minimum clinically important difference (MCID), which is essential to inform the interpretation of treatment effect size in terms of clinically relevant HRQoL changes. Incorporating PROMs fosters a patient-centered approach to cancer care, aligning treatment goals with individual preferences and values. By balancing survival outcomes with quality of life, and through empathetic communication, healthcare providers can deliver treatments that are not only effective but also resonate with patients' experiences and priorities.

Specific types of anxiety regarding radiation therapy in patients with breast cancer: a longitudinal study

PURPOSE

The radiotherapy categorical anxiety scale (RCAS) was designed to evaluate the specific types of radiation therapy (RT)-related anxiety in cancer patients. We translated RCAS into Chinese, evaluated its reliability and validity in breast cancer (BC) patients, and used it to evaluate changes in specific types and levels of RT-related anxiety throughout RT.

METHODS

This was a prospective, longitudinal study enrolling 504 Chinese BC patients receiving RT. The patients completed questionnaires assessing the specific types of RT-related anxiety (our Chinese version of RCAS), depression [Patient Health Questionnaire-9 (PHQ-9)], and anxiety [Generalized Anxiety Disorder-7 (GAD-7)] before, during, and after RT. Emotional distress (ED) was defined as a PHQ-9 or GAD-7 score of > 4. Generalized estimating equation was performed to evaluate changes in total and subscale scores on RCAS. Multivariable general linear models were used to explore independent predictors of baseline RCAS scores.

RESULTS

Our Chinese version of RCAS demonstrated high internal consistency (Cronbach's α = 0.89-0.92). Our data demonstrated a Kaiser-Meyer-Olkin measure of 0.946 and P < 0.001 on the Bartlett sphericity test, indicating their suitability for subsequent confirmatory factor analysis (CFA). CFA further demonstrated its adequate convergent and discriminant validity. The levels of anxiety related to RT environment decreased over time, whereas those of anxiety related to RT treatment efficacy remained stable throughout the treatment. Patients demonstrated higher scores on items regarding side effects and treatment efficacy of RT than on other items. ED before RT independently predicted for higher baseline RCAS score.

CONCLUSIONS

Our Chinese version of the RCAS can be used to quantitatively evaluate specific types of RT-related anxiety in Chinese BC patients. Clinicians should pay more attention to anxiety regarding the side effects and treatment efficacy of RT reported by their patients, particularly those with baseline ED.

Exploring the prevalence of atopic disease among adult cancer survivors: insights from the 2021 NHIS

Cancer survivors who undergo radiotherapy, immunotherapy, and chemotherapy experience a decline in immune system function. Atopic diseases (ADs) are associated with systemic immunosuppressant medications and exposure to environmental allergens. However, the relationship between cancer survivorship and the prevalence of ADs remains poorly understood. This study investigated whether the prevalence of ADs is increased among cancer survivors. A cross-sectional survey was conducted using data from the 2021 US National Health Interview Survey (NHIS). The data were on 28,617 adults aged 18 years and older. Data analysis was performed between May 11, 2024, and July 30, 2024. The NHIS participants reported whether they had a history of current hay fever, still asthma, current skin allergy, and/or current food allergy. A history of cancer was defined on the basis of self-reported data from the NHIS. The weighted prevalence and 95% confidence intervals (CIs) of ADs were calculated. Comparisons of AD prevalence between cancer survivors and the general population were conducted using chi-square tests and multiadjusted logistic regression models. Of the 28,617 adults sampled in the 2021 NHIS, the prevalence of ADs among the cancer survivors was as follows: current hay fever (54.5%; 95% CI, 52.6%-56.4%), persistent asthma (14.7%; 95% CI, 12.9%-13.9%), current skin allergy (13.6%; 95% CI, 10.1%-15.0%), and current food allergy (11.2%; 95% CI, 10.0%-12.4%). In multivariable logistic regression models adjusted for age, sex, race/ethnicity, family income, educational level, insurance status, body mass index, general health status, region, location, and comorbidity burden, the cancer survivors had significantly higher odds of ADs than did the general population. In particular, they had higher odds of current hay fever (aOR, 1.14; 95% CI, 1.05-1.23), persistent asthma (aOR, 1.17; 95% CI, 1.03-1.33), current skin allergy (aOR, 1.26; 95% CI, 1.13-1.41), and current food allergy (aOR, 1.22; 95% CI, 1.08-1.38). The findings of this cross-sectional study indicated that the prevalence of ADs was significantly higher in cancer survivors than in the general population. Future research is required to elucidate the underlying mechanisms, optimize treatment strategies, and enhance the overall well-being of individuals with ADs and a history of cancer.

Cutaneous melanoma

Cutaneous melanoma is a common cancer in Australia and New Zealand, Europe, and North America, and its incidence is still increasing in many regions. Ultraviolet (UV) radiation exposure (for example, through excessive sunlight exposure) remains the primary risk factor for melanoma; however, public awareness campaigns have led to a marked reduction in mortality. In addition to genetic damage from UV radiation, specific genetic alterations have been linked to melanoma. The stage of the tumour at the time of diagnosis is of greater importance for melanoma prognosis than in almost any other cancer. Context-dependent genetic mutations that attenuate tumour-suppressive mechanisms or activate growth-promoting signalling pathways are crucial factors in the development of cutaneous melanoma. In addition to external factors such as UV radiation, the tumour microenvironment can contribute to melanoma progression, invasion and metastasis. Cutaneous melanoma treatment has improved considerably over the past decade with the discovery and development of immune checkpoint inhibitors and therapy targeting BRAF and MEK. Over the next decade, several priorities are likely to influence melanoma research and management, including the continued advance of precision medicine methods to identify the most suitable patients for the most effective treatment, with the aim of improving clinical outcomes.

Gasotransmitter-Nanodonor for Spatial Regulation of Anxiety-Like Behavior and Bone Metastasis

Anxiety is highly prevalent among cancer patients, significantly impacting their prognosis. Current cancer therapies typically lack anxiolytic properties and may even exacerbate anxiety. Here, a gasotransmitter-nanodonors (GND) system is presented that exerts dual anxiolytic and anti-tumor effects via a "tumor-brain axis" strategy. The GND, synthesized by co-embedding Fe2⁺ and S2⁻ ions along with glucose oxidase (GOx) within bovine serum albumin (BSA) nanoparticles (FSG@AB), enables the controlled release of the gasotransmitter hydrogen sulfide (H₂S) in the acidic tumor microenvironment. H₂S and GOx synergistically deplete tumor energy sources, resulting in robust anti-tumor effects. Meanwhile, H₂S generated at the tumor site is transported through the bloodstream to the anterior cingulate cortex (ACC) in the brain, where it modulates neuronal activity. Specifically, in the ACC, H₂S upregulates glutamate transporter 1 (GLT-1), which reduces extracellular glutamate levels and attenuates the hyperactivity of glutamatergic neurons, thereby alleviating anxiety-like behavior. This study proposes a GND system that targets both oncological and psychiatric dimensions of cancer through the "tumor-brain axis" strategy, resulting in improved therapeutic outcomes.

Associations between social determinants of health and cardiovascular and cancer mortality in cancer survivors: a prospective cohort study

AIMS

The cause-specific mortality implications of social determinants of health (SDOH) in cancer survivors were unclear. This study aimed to explore associations between SDOH and cardiovascular and cancer mortality in cancer survivors.

METHODS AND RESULTS

Data from 2013 to 2017 National Health Interview Survey were used for this prospective cohort study. Social determinants of health were quantified using a 38 point, 6 domain score, with higher points indicating worse deprivation. Associations between SDOH and outcomes (primary: cardiovascular mortality; secondary: cancer and all-cause mortality) were assessed using cause-specific multivariable Cox regression, with cancer survivors and individuals without cancer modelled separately. Post hoc analyses were performed among cancer survivors to explore associations between each domain of SDOH and the risks of outcomes. Altogether, 37 882 individuals were analysed (4179 cancer survivors and 33 703 individuals without cancer). Among cancer survivors, worse SDOH was associated with higher cardiovascular [adjusted hazard ratio (aHR) 1.31 (1.02-1.68)], cancer [aHR 1.20 (1.01-1.42)], and all-cause mortality [aHR 1.16 (1.02-1.31)] when adjusted for demographics, comorbidities, and risk factors. Among individuals without cancer, SDOH was associated with cardiovascular mortality and all-cause when only adjusted for demographics, but not when further adjusted for comorbidities and risk factors; no associations between SDOH and cancer mortality were found. Among cancer survivors, psychological distress, economic stability, neighbourhood, physical environment and social cohesion, and food insecurity were varyingly associated with the outcomes.

CONCLUSION

Social determinants of health were independently associated with all-cause, cardiovascular, and cancer mortality among cancer survivors but not among individuals without cancer. Different domains of SDOH may have different prognostic importance.

Lifestyle, Environmental, Occupational, and Dietary Risk Factors in Small-Cell vs. Non-Small-Cell Advanced Lung Cancer Patients: Is There a Connection?

OBJECTIVES

(i) To evaluate the possible exposure of newly diagnosed lung cancer patients to selected lifestyle, environmental, occupational, and dietary risk factors and (ii) to assess the differences in exposures of small-cell (SCLC) and non-small-cell (NSCLC) lung cancer patients to those risk factors.

METHODS

In this study, 205 newly diagnosed patients with IIIB/IV stage of either SCLC or NSCLC (111 men vs. 94 women) from Vojvodina, Serbia, were surveyed for selected demographic characteristics, dietary and lifestyle habits, and environmental factors.

RESULTS

Most patients were long-term heavy smokers. The body mass index values of SCLC patients were higher than those of NSCLC patients. Women reported higher stress levels compared to men. Women diagnosed with lung adenocarcinoma were more often exposed to traffic pollution compared to men. Individual indoor coal combustion systems were more often used by SCLC patients of both sexes compared to other cancer types. Men were more frequent consumers of canned foods, which are potential sources of endocrine disruptors. Occupational exposure to lung cancer risk factors, in addition to tobacco smoking, may be crucial in lung cancer development with specific occupations.

CONCLUSIONS

Further research on environmental and occupational risk factors for lung cancer is urgent in order to unveil the etiopathogenesis of specific lung cancer types.

The study of transitional care on the psychological state of patients with advanced lung cancer chemotherapy

BACKGROUND

Lung cancer is one of the malignant tumors with the highest morbidity and mortality worldwide. Patients with an advanced stage need to face negative effects from chemotherapy, dread of dying, weakened role function and physical and mental suffering.

OBJECTIVES

To examine the effect of transitional care on the psychological state of patients with advanced lung cancer chemotherapy.

METHODS

Seventy-two patients with advanced lung cancer who underwent chemotherapy in our hospital were arbitrarily split into the experimental group (30 cases) and the control group (31 cases). The control group received routine discharge care, whereas the experimental group received transitional care. The scores were compared before the first chemotherapy, the day after the end of the first-cycle chemotherapy, and the third week after the end of the 4-week chemotherapy according to SCL-90, PSS, PFE-R, SES, QLQ-C30, the rate of unplanned re-diagnosis and nursing satisfactory.

RESULTS

There was no significant difference in all aspects of scores between the two groups before and after chemotherapy (P > 0.05). Whereas there were significant differences in emotional function, fatigue, insomnia, depression and interpersonal sensitivity between the two groups after 4 cycles of chemotherapy (P < 0.05). The scores of PSS and PFE-R decreased significantly in the two groups, and the SES and QLQ-C30 in the experimental group were significantly higher than those in the control group (all P < 0.05).

FINDINGS

Applying transitional care intervention can lessen patients' negative emotions since being discharged with advanced lung cancer following chemotherapy and diminish the rate of unplanned re-diagnosis.

Turning cold into hot: emerging strategies to fire up the tumor microenvironment

The tumor microenvironment (TME) is a complex, highly structured, and dynamic ecosystem that plays a pivotal role in the progression of both primary and metastatic tumors. Precise assessment of the dynamic spatiotemporal features of the TME is crucial for understanding cancer evolution and designing effective therapeutic strategies. Cancer is increasingly recognized as a systemic disease, influenced not only by the TME, but also by a multitude of systemic factors, including whole-body metabolism, gut microbiome, endocrine signaling, and circadian rhythm. In this review, we summarize the intrinsic, extrinsic, and systemic factors contributing to the formation of 'cold' tumors within the framework of the cancer-immunity cycle. Correspondingly, we discuss potential strategies for converting 'cold' tumors into 'hot' ones to enhance therapeutic efficacy.

Ansofaxine suppressed NSCLC progression by increasing sensitization to combination immunotherapy

INTRODUCTION

Depression negatively impacts the prognosis of various cancers, including lung cancer, by influencing antitumor immune responses and impairing immune cell function. Antidepressants may modulate the tumor immune microenvironment, enhancing immunotherapy efficacy. However, the specific mechanisms remain unclear. This study investigates the effects of the antidepressant Ansofaxine on immune therapy in non-small cell lung cancer (NSCLC) mice with comorbid depression.

METHODS

Chronic unpredictable mild stress (CUMS) and Lewis lung cancer cells (LLC) model was established in mice. Ansofaxine and a combination of triple immunotherapy (anti-PD-1, anti-TNFR2, and anti-PTP1B) were treated in mice to monitor tumor growth and survival rates. Flow cytometry and immunohistochemistry were employed to analyze the dynamics of the immune system, while ELISA kits were used to quantify neurotransmitter levels.

RESULTS

Depression accelerated NSCLC progression, evidenced by increased tumor volume, spleen size, and reduced survival rates. Flow cytometry analysis demonstrated a reduction in the population of immune effector cells, with an increase in the proportion of immunosuppressive cells. Ansofaxine inhibited LLC cell proliferation and migration, enhancing apoptosis more effectively than venlafaxine and fluoxetine. Combined with triple immunotherapy, Ansofaxine improved survival rates and enhanced immune responses, increasing CD8+ T cell proportions and decreasing Tregs. Ansofaxine also restored serum serotonin and norepinephrine levels in depressed mice, reduced corticosterone, and decreased PD-L1 and TNFR2 expression in tumor tissues.

CONCLUSION

The findings suggest that Ansofaxine may represent a promising therapeutic approach for NSCLC patients with comorbid depression, potentially enhancing both mental well-being and cancer-related outcomes.

Neuroscience of cancer: unraveling the complex interplay between the nervous system, the tumor and the tumor immune microenvironment

The study of the multifaceted interactions between neuroscience and cancer is an emerging field with significant implications for understanding tumor biology and the innovation in therapeutic approaches. Increasing evidence suggests that neurological functions are connected with tumorigenesis. In particular, the peripheral and central nervous systems, synapse, neurotransmitters, and neurotrophins affect tumor progression and metastasis through various regulatory approaches and the tumor immune microenvironment. In this review, we summarized the neurological functions that affect tumorigenesis and metastasis, which are controlled by the central and peripheral nervous systems. We also explored the roles of neurotransmitters and neurotrophins in cancer progression. Moreover, we examined the interplay between the nervous system and the tumor immune microenvironment. We have also identified drugs that target the nervous system for cancer treatment. In this review we present the work supporting that therapeutic agent targeting the nervous system could have significant potential to improve cancer therapy.

Impact of Psychological Factors on Survival in Metastatic Esophagogastric Cancer: Secondary Analysis of a Randomized Controlled Trial

PURPOSE

Early interdisciplinary supportive care (ESC), including psychological interventions, can improve the survival of patients with metastatic esophagogastric cancer (EGC). The purpose of the study was to evaluate the association between psychological factors and survival in patients with metastatic EGC.

METHODS

A secondary analysis was conducted for an open-label randomized controlled trial of ESC, in which 246 patients with EGC completed a distress measure (the distress thermometer) and a depression symptom measure (the Patient Health Questionnaire-9 [PHQ-9]) at baseline before cancer treatments. Cox regression was applied to explore the influence of psychological distress and depressive symptoms on overall survival (OS) and progression-free survival (PFS).

RESULTS

Patients with moderate depressive symptoms (PHQ-9 ≥8) had shorter PFS (3.5 v 6.0 months, P < .001) and shorter OS (10.7 v 15.0 months, P = .001) than those without. Patients with significant psychological distress had worse PFS (4.8 v 6.3 months, P = .035) and worse OS (13.4 v 15.5 months, P = .039) than those without. After controlling for performance status, group, sex, primary tumor site, tumor histology, and age, only depressive symptoms remained associated with worse PFS (adjusted hazard ratio [HR], 2.02 [95% CI, 1.41 to 2.91]; P < .001) and worse OS (adjusted HR, 1.70 [95% CI, 1.17 to 2.47]; P = .006).

CONCLUSION

This study shows that depressive symptoms at baseline were associated with poor survival in patients with newly diagnosed metastatic EGC. Therefore, screening and preventive intervention for depression should be integrated into routine cancer care for this population.

Unraveling the peripheral nervous System's role in tumor: A Double-edged Sword

The peripheral nervous system (PNS) includes all nerves outside the brain and spinal cord, comprising various cells like neurons and glial cells, such as schwann and satellite cells. The PNS is increasingly recognized for its bidirectional interactions with tumors, exhibiting both pro- and anti-tumor effects. Our review delves into the complex mechanisms underlying these interactions, highlighting recent findings that challenge the conventional understanding of PNS's role in tumorigenesis. We emphasize the contradictory results in the literature and propose novel perspectives on how these discrepancies can be resolved. By focusing on the PNS's influence on tumor initiation, progression, and microenvironment remodeling, we provide a comprehensive analysis that goes beyond the structural description of the PNS. Our review suggests that a deeper comprehension of the PNS-tumor crosstalk is pivotal for developing targeted anticancer strategies. We conclude by emphasizing the need for future research to unravel the intricate dynamics of the PNS in cancer, which may lead to innovative diagnostic tools and therapeutic approaches.

The Mindful Compassion Program Integrated with Body-Mind-Spirit Empowerment for Reducing Depression in Lung Cancer Patient-Caregiver Dyads

Objective: This study compared the long-term effects of a mindful compassion program on improving depression in lung cancer patients, both in patient-caregiver dyads and in patient-only groups, and examined the moderating roles of anxiety and quality of life (QOL). Method: Participants consisted of 56 dyads, who were randomly assigned to either the dyadic or patient-only groups. Data collection included various assessments at different time points: baseline (T0), end of intervention (T1), and follow-up at the 5th month (T2), 8th month (T3), and 14th month (T4). Results: Patients in the dyadic group experienced a significant reduction in depressive symptoms. The dyadic intervention was particularly beneficial for younger patients and those with higher baseline QOL symptom distress. Improvements in patients' mindfulness and self-compassion contributed to reduced depression by enhancing general health and lowering anxiety. Additionally, caregivers' self-compassion played a role in reducing patients' depression by improving patients' QOL functioning and decreasing anxiety. Conclusions: Mindfulness and compassion interventions, whether provided dyadically or individually, can be tailored to each patient's specific condition.

Metastatic brain tumors: from development to cutting-edge treatment

Metastatic brain tumors, also called brain metastasis (BM), represent a challenging complication of advanced tumors. Tumors that commonly metastasize to the brain include lung cancer and breast cancer. In recent years, the prognosis for BM patients has improved, and significant advancements have been made in both clinical and preclinical research. This review focuses on BM originating from lung cancer and breast cancer. We briefly overview the history and epidemiology of BM, as well as the current diagnostic and treatment paradigms. Additionally, we summarize multiomics evidence on the mechanisms of tumor occurrence and development in the era of artificial intelligence and discuss the role of the tumor microenvironment. Preclinically, we introduce the establishment of BM models, detailed molecular mechanisms, and cutting-edge treatment methods. BM is primarily treated with a comprehensive approach, including local treatments such as surgery and radiotherapy. For lung cancer, targeted therapy and immunotherapy have shown efficacy, while in breast cancer, monoclonal antibodies, tyrosine kinase inhibitors, and antibody-drug conjugates are effective in BM. Multiomics approaches assist in clinical diagnosis and treatment, revealing the complex mechanisms of BM. Moreover, preclinical agents often need to cross the blood-brain barrier to achieve high intracranial concentrations, including small-molecule inhibitors, nanoparticles, and peptide drugs. Addressing BM is imperative.

Global unmet psychosocial needs in cancer care: health policy

Preventable psychosocial suffering is an unmet need in patients with cancer around the world, significantly compromising quality of life and impairing cancer health outcomes. This narrative review overviews the global prevalence of emotional distress and cancer-related needs and the access barriers to psychosocial care. The COVID-19 pandemic has served only to amplify the need for psychosocial care, exacerbating the inadequacy of available psychosocial resources, particularly in low- and middle-income countries. Proposed solutions include implementing routine screening for emotional distress, addressing stigma related to mental health needs, and increased attention to the psychosocial dimensions of cancer care in oncology training and interprofessional models of care. There is an urgent need to address health policy issues such as resource allocation in cancer control plans and to embrace technological innovation in order to fill the universal gaps to providing more equitable psychosocial cancer care.

Funding

None.

Potential predictive biomarkers in antitumor immunotherapy: navigating the future of antitumor treatment and immune checkpoint inhibitor efficacy

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment modality, offering promising outcomes for various malignancies. However, the efficacy of ICIs varies among patients, highlighting the essential need of accurate predictive biomarkers. This review synthesizes the current understanding of biomarkers for ICI therapy, and discusses the clinical utility and limitations of these biomarkers in predicting treatment outcomes. It discusses three US Food and Drug Administration (FDA)-approved biomarkers, programmed cell death ligand 1 (PD-L1) expression, tumor mutational burden (TMB), and microsatellite instability (MSI), and explores other potential biomarkers, including tumor immune microenvironment (TIME)-related signatures, human leukocyte antigen (HLA) diversity, non-invasive biomarkers such as circulating tumor DNA (ctDNA), and combination biomarker strategies. The review also addresses multivariable predictive models integrating multiple features of patients, tumors, and TIME, which could be a promising approach to enhance predictive accuracy. The existing challenges are also pointed out, such as the tumor heterogeneity, the inconstant nature of TIME, nonuniformed thresholds and standardization approaches. The review concludes by emphasizing the importance of biomarker research in realizing the potential of personalized immunotherapy, with the goal of improving patient selection, treatment strategies, and overall outcomes in cancer treatment.

A Longitudinal Correlational Study of Psychological Resilience, Depression Disorder, and Brain Functional-Structural Hybrid Connectome in Breast Cancer

Purposes: To evaluate the association between psychological resilience, depression disorder (DD), and brain functional-structural hybrid connectome in patients with breast cancer before treatment (T0) and at 1 year. Methods: Between February 2017 and October 2019, 172 patients were longitudinally enrolled from a multicenter trial named as Be Resilient to Breast Cancer (BRBC) and completed resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) before the T0. Data-driven multivoxel pattern analysis (MVPA) and correlational tractography (CT) were performed to identify distinct functional-structural hybrid connectome. DD was diagnosed by psychiatry physicians according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Psychological resilience was collected by Resilience Scale Specific to Cancer (RS-SC) and tested as the mediation variable between hybrid connectome and DD. Results: Of the total sample of 172, 14.5% (N = 25) were diagnosed with DD. High psychological resilience was associated with a lower risk of DD (hazard ratio (HR) = 0.37, 95% confidence interval (CI), 0.17-0.82, p=0.0368). Frontal pole right (88.0%) in rs-fMRI and arcuate fasciculus_L (75.2%) in DTI were identified as main significant brain areas. Psychological resilience accounted for 10.01%-12.14% of direct effect between brain functional-structural hybrid connectome and 1-year DD. Conclusion: Psychological resilience predicts DD at 1 year and mediates the association between brain functional-structural hybrid connectome and DD at 1 year in patients diagnosed with breast cancer. Trial Registration: ClinicalTrials.gov identifier: NCT03026374.

Anxiety and Depression in Advanced and Metastatic Lung Cancer Patients-Correlations with Performance Status and Type of Treatment

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients' quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients' performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3-4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care.

Early Changes in Nutritional Status of Elderly Patients with Lung Cancer Undergoing Chemotherapy Are Positively Related with Symptoms of Depression: A Prospective Follow-Up Study

This study aims to assess early effects of chemotherapy on symptom alleviation, nutritional status, and mental health in elderly patients with advanced non-small-cell lung cancer (NSCLC). This prospective study included 45 NSCLC patients (32 males, 13 females) aged 65-82 years (mean age 70.0 ± 4.5 years) with good performance status. Assessments were conducted immediately after diagnosis and after two chemotherapy cycles, focusing on nutritional status (assessed with MNA questionnaire), quality of life (QoL, based on FACT-L and FACT-TOI questionnaires), lung cancer-related symptoms (based on LCSS), and mental health (based on PHQ-9 questionnaire). Despite significant alleviation of symptoms like cough, dyspnea, and body weight loss, there was no significant correlation between changes in symptoms burden and changes in nutritional status (r2 = 0.122, P = 0.427), and change of patients' mental condition (r2 = -0.141, P = 0.255). No significant QoL changes were noted, but a decrease in severe depression frequency was observed. The improvement of patients' mental condition was related strictly to the improvement of nutritional status (r2 = -0.589, P < 0.001). The study highlights the vital link between nutritional status and mental health in elderly NSCLC patients, emphasizing the need for integrated care approaches that address both aspects to enhance treatment effectiveness and patient well-being.