Marital status and survival in patients with cancer

Symptom Clusters and Sentinel Symptoms in Patients With Colorectal Cancer: A Network Analysis

Colorectal cancer (CRC) is one of the most common cancers globally. CRC is the second most prevalent form of cancer in China. The study aimed to construct symptom networks, identify core and sentinel symptoms and analyses the relationship between influencing factors and symptom clusters in CRC patients. We identified symptom clusters and their sentinel symptoms using exploratory factor analysis and the A priori Algorithm in 789 colorectal cancer patients (Yanji City, Jan 2020-Mar 2024). Core symptoms were determined according to the centrality index of the symptom network, while univariate and multifactorial analyses explored factors influencing core and sentinel symptoms in first-diagnosed patients. Four symptom clusters were identified: colorectal cancer-specific, gastrointestinal (feeling bloated as sentinel), insufficient energy (shortness of breath as sentinel), and disease symptom clusters. Core symptoms included changes in bowel habits, influenced by alcohol history and carcinoembryonic antigen (CEA). Feeling bloated was influenced by alcohol history and shortness of breath by alcohol history and marital status. These findings emphasize the importance of early screening and symptom management for at-risk individuals.

The impact of socioeconomic status on glioma survival: a retrospective analysis

PURPOSE

Although sociodemographic factors such as socioeconomic status (SES), travel time to health care, cohabitation status, and region of residence are observed to influence incidence and survival for several types of cancers, it is unclear whether similar effects have been observed in patients with glioma. This study investigates whether these factors affect survival for glioma patients.

METHODS

In this retrospective study, the Swedish National Quality Registry for Brain Tumors was used to identify 1,276 patients with glioma WHO grade I-IV for whom data were deposited between 2009 and 2013. The RISK North database, which links data from the National Cancer Quality Register with citizen demographic data from the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA), the Total Population Registry (TPR), and the Geography Database (GD), was utilized to assess survival in patients with glioma in relation to education level, cohabitation status, travel time to regional hospitals, and region of residence.

RESULTS

In the multivariable analysis, longer survival was observed among WHO grade III-IV glioma patients with higher education level (middle school (ref) HR: 1, high school HR: 0.81 CI [0.67-0.98], p = 0.033; university/college HR: 0.81 CI [0.66-1.00], p = 0.048). Survival was not associated with travel time, cohabitation status, or region of residence in the multivariable survival analysis.

CONCLUSION

Low education level was associated with reduced survival for patients with glioma WHO grade III and IV in multivariable survival analyses, but no differences in survival were found in relation to travel time, cohabitation status, or region of residence.

Prevalence and trends of cancer-related daily life limitations among gastrointestinal cancer survivors

PURPOSE

The number of gastrointestinal (GI) cancer survivors has increased substantially due to improvements in early detection and treatment, yet long-term functional patient outcomes remain poorly characterized. We sought to quantify the burden of activity limitations (AL) and functional limitations (FL) among GI cancer survivors compared with non-GI cancer survivors and the general U.S. population, as well as identify key predictors of cancer-related limitations.

METHODS

The National Health Interview Survey (NHIS), a nationally representative dataset (1997-2023), was queried to examine the prevalence and trends of cancer-related limitations among GI cancer survivors, non-GI cancer survivors, and the general U.S.

POPULATION

Multivariable logistic regression analyses identified independent predictors of AL and FL, adjusting for demographic and socioeconomic variables.

RESULTS

Among 5,513 GI cancer and 39,887 non-GI cancer survivors, 50.2% (Relative Risk [RR]: 1.23, 95% CI: 1.19-1.27) and 70.7% (RR: 1.07, 95% CI: 1.05-1.09) of GI cancer survivors reported AL and FL, respectively, compared with non-GI cancer survivors. The general U.S. population had a markedly lower prevalence of AL (13.5%; RR: 0.33, 95% CI: 0.33-0.34) and FL (35.7%; RR: 0.54, 95% CI: 0.53-0.54). GI cancer survivors were older (mean age: 69.1 vs. 65.3 vs. 36.1 years), more often single (8.8% vs. 8.6% vs. 28.3%), and more frequently received public insurance (75.1% vs. 68.9% vs. 27.4%) compared with non-GI cancer survivors and the general population (p < 0.05). In multivariable analysis, GI cancer survivors had 21% higher odds of AL (OR: 1.21, 95% CI: 1.11-1.32, p < 0.001) and 11% higher odds of FL (OR: 1.11, 95% CI: 1.00-1.19, p = 0.049).

CONCLUSIONS

GI cancer survivors face a significantly higher burden of functional limitations, influenced by demographic and socioeconomic factors.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing functional disparities through targeted rehabilitation and support services may improve long-term outcomes.

Challenges oncologists face when caring for hispanics living in puerto rico with colorectal cancer and multiple chronic conditions

BACKGROUND

Colorectal cancer (CRC) is the leading cause of cancer-related death in Puerto Rico, posing significant challenges for patients with multiple chronic conditions (MCC). This qualitative study aimed to explore oncologists' perspectives regarding the care of patients with CRC and MCC in Puerto Rico.

METHODS

We conducted semi-structured interviews in Spanish with nine oncologists providing care for patients with CRC in Puerto Rico. We reached data saturation. We performed thematic analysis to identify key patterns and themes within the interview data. The coding scheme evolved through team discussions, with discrepancies addressed for consistency. Quotes were translated from Spanish to English.

RESULTS

Five key themes were: (1) social determinants of health, (2) diagnosis pathways, (3) factors influencing treatment decisions, (4) survivorship and end-of-life care, and (5) care coordination and communication. Oncologists treating patients with CRC and MCC identified the lack of a social support network as a notable care coordination challenge. The health insurance system's pre-authorization requirements for procedures and treatments further complicated care delivery, particularly for older adults, who faced challenges navigating these administrative processes without sufficient support. A lack of transportation and local specialized care services was a noted barrier to comprehensive patient care. Communication between patients, physician and caregivers proved challenging when multiple physicians and procedures were involved with patient's care, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication primarily relied on phone calls or notes sent with the patient.

CONCLUSIONS

Oncologists caring for Hispanic older adults with CRC and MCC encounter complex challenges influenced by unmet social needs and the presence of comorbidities. Tailored approaches, culturally sensitive care, and improved coordination among physicians are vital to enhance the quality of care for this patient population.

Impact of marriage on diagnosis and survival in patients with urological cancers

The protective role of marriage has been identified in various cancers, but its effect on the overall urological system remains unclear. Patients diagnosed with bladder cancer (BCa), renal cell carcinoma (RCC), and upper tract urothelial carcinoma (UTUC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into married and unmarried groups based on their marital status. A binary multivariable logistic regression was used to explore the effect of marriage on the diagnosis of urological cancers. One-to-one propensity score matching (PSM) was employed to reduce baseline differences between the two groups. Multivariable Cox regression analysis and subgroup analysis were conducted to investigate the impact of marriage on cancer-specific survival (CSS). A total of 162,544 patients were included in the study, with a median follow-up period of 6.2 years (IQR 2.3-9.8 years). Among them, 104,706 (64.4%) were married, and 57,838 (35.6%) were unmarried. Married patients had a lower risk of being diagnosed with stage III/IV disease compared to unmarried patients (OR 0.94, 95% CI 0.92-0.96, p < 0.001), but this trend was only significant in BCa (OR 0.88, 95% CI 0.84-0.91, p < 0.001), but not in RCC (OR 0.98, 95% CI 0.94-1.01, p = 0.172) or UTUC (OR 1.03, 95% CI 0.95-1.12, p = 0.523). After PSM, 47,975 patients were included in each group, and marriage was found to be an independent protective prognostic factor for CSS (HR 0.81, 95% CI 0.79-0.83, p < 0.001), but this was not significant in UTUC (HR 0.95, 95% CI 0.88-1.03, p = 0.244). Across the entire urological system, marriage is an independent protective predictor for both diagnosis and survival, but the effect varies among different types of cancers.

The Survival Benefits of Chemotherapy for Undifferentiated Carcinoma With Osteoclast-Like Giant Cells of Pancreas: A Retrospective Analysis and Individual Participant Data Meta-Analysis

BACKGROUND AND AIM

Undifferentiated carcinoma with osteoclast-like giant cells of pancreas (UCOGCP) is a rare type of pancreatic adenocarcinoma (PDAC). However, the efficacy of chemotherapy in UCOGCP has not been evaluated so far due to the scarcity of cases. This study aims to evaluate the efficacy of chemotherapy in UCOGCP combined with previous individual participant data (IPD) and SEER database data.

METHODS

Forty-nine patients with UCOGCP were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Based on whether they had received chemotherapy or not, we divided UCOGCP patients into chemotherapy group (N = 32) and non-chemotherapy group (N = 17). The survival time of the chemotherapy group and non-chemotherapy group was assessed by Kaplan-Meier analysis and Cox analysis. IPD data for UCOGCP were collected in PubMed, Embase, Cochrane, and ScienceDirect. The results based on the SEER database were verified by IPD meta-analysis.

RESULTS

The Kaplan-Meier analysis indicated that patients who received chemotherapy experienced a longer survival time compared to those who did not (OS: p = 0.00061, CSS: p = 0.00047). Univariate (OS: HR: 0.31 [0.15, 0.63], p = 0.001; CSS: HR: 0.28 [0.13, 0.60], p = 0.001) and multivariate (OS: HR: 0.33 [0.14, 0.78], p = 0.012; CSS: HR: 0.30 [0.12, 0.73], p = 0.008) Cox regression showed that chemotherapy was the independent prognostic protective factor for UCOGCP. IPD meta-analysis showed that chemotherapy can significantly improve the prognosis of patients who received primary tumor resection (PTR, p = 0.0084).

CONCLUSION

In contrast to not receiving chemotherapy, chemotherapy is effective in prolonging survival in UCOGCP patients with or without PTR. This provides a foundation for the use of UCOGCP chemotherapy.

Effects of Socioeconomic Status on Colorectal Cancer Incidence and Clinical Outcome Differences Among Asian American Populations: A Systematic Review

Colorectal cancer (CRC) is a leading cause of cancer death among Asian Americans and Pacific Islanders (API) in the United States. Race, ethnicity, and socioeconomic status (SES) are known to impact outcomes of CRC, but the relationship is unclear in the context of the Asian American cohort and its diverse subgroups. This systematic review aims to gain insight into the relationship between CRC incidence and clinical outcomes in the Asian American community. A systematic literature search was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol using PubMed, Scopus, Excerpta Medica database (EMBASE), Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases, accessed on August 13, 2023. Of the 2225 studies identified, a total of 14 studies were included in the analysis. Four studies concluded that there was no association or variable response subgroup-specific to SES measurements in CRC incidence in the Asian American population. However, there was evidence that the incidence of CRC varies among Asian American subgroups, using varying measures of SES. Seven of the eight studies that measured mortality or survival as the primary outcome found decreased mortality and increased survival in the API population despite changes in SES. Out of the six studies that measured incidence, four studies found no association with SES. A study found that Chinese Americans had a significant decrease in the CRC incidence and mortality across all SES categories. Japanese Americans experienced a significant decrease in the lowest SES category, while Koreans and Filipinos experienced a significant increase in both the lowest and highest SES categories. Therefore, grouping various Asian American ethnicities as a single monolithic "Asian" category is misleading. Although the incidence of CRC was thought to be low and decreasing, this review identified various subgroup-specific trends among 24 different Asian American subsets. For example, there was a decrease in CRC rates in two ethnic groups and an increase in the other two ethnic groups. The potential causes of these varying CRC incidence rates are likely multifactorial and may include inadequate screening rates, lack of CRC education, and cultural barriers. Further studies are needed to understand these mechanisms. This review recommends a more detailed classification of the API ethnic population but not as a single monolithic entity as Asian. It also emphasizes preventative CRC screening within the API communities due to lower rates of CRC screening among them.

Sepsis as a cause of death among elderly cancer patients: an updated SEER database analysis 2000-2021

Background

Sepsis is an aggressive response to an infection leading to widespread inflammation, and may lead to death. It remains a significant challenge for cancer patients especially for the elderly due to their immunocompromised status and other comorbidities. So, this study aimed to assess the risk of mortality due to sepsis among elderly cancer patients and provide an updated evidence to the literature for better management outcomes.

Methods

We used data from the Surveillance, Epidemiology, and End Results (SEER) program. We included cancer patients who died due to sepsis between 2000 and 2021. The Standardized Mortality Ratio (SMR) for elderly cancer patients who died due to sepsis was calculated as observed/expected (O/E). We used 95% confidence intervals (CI) and the excess risk (ER) was per 100 000. Significance was achieved at 0.05.

Results

Out of 5 239 194 elderly cancer patients, 18 311 died from sepsis. Men represented 55% and the majority were Caucasians (82%). Death from sepsis along 10+ years of follow-up had a significant SMR with an O/E of 1.32 (P >0.05, 95% CI: 1.30-1.34, ER = 2.56) especially within the first year after cancer diagnosis (O/E = 3.00, P >0.05). Gastric cancer had an increased risk for sepsis death in the elderly (O/E = 2.55, P < 0.05, 95% CI: 2.28-2.85). Liver and intrahepatic bile cancer had a significant SMR for sepsis (O/E = 5.56, P < 0.05, 95% CI: 5.01-6.36). However, it had an insignificant risk for sepsis deaths along 120+ months of follow-up period (O/E = 1.21, 95% CI: 0.25-3.52, ER = 1.73).

Conclusion

Sepsis is a rapid silent killer targeting a vulnerable population. Although it had a declining mortality rate along 10+ years of follow up as the majority die due to other cancer-related and non-cancer-related causes, it still represents a certain threat to elderly cancer patients due to the immunosuppression of cancer treatment regimen and antibiotic resistance. Further studies are encouraged to focus on elderly cancer patients' health care and to intensify infection control measures.

Delays in phases of care from identification to treatment of suspicious lung nodules

Objectives

Shorter time to lung cancer diagnosis and treatment is associated with improved outcomes. We analyzed the time spent from nodule identification to treatment to identify targets for improving the timeliness of suspicious lung nodule care in a diverse patient population.

Methods

This was a retrospective cohort study of patients with suspicious lung nodules (suspected clinical stage I/II primary lung cancer) at a single academic medical center (2020-2022). Patients with suspected stage III/IV or nonprimary lung cancers were excluded. Multivariable Cox regressions were performed to assess factors associated with timeliness of care.

Results

Of 157 patients, 59% were female, 53% were Black, and mean age was 70 ± 8.6 years. Nodules were identified incidentally (52%) or via screening (48%). Treatment was surgery in 52% and stereotactic body radiotherapy in 44%, and 10.2% were benign. Median (interquartile range) times from referral to diagnosis and from referral to treatment were 34 (22-56) days and 65 (44-84) days, respectively. Consultation to biopsy (20 [12-34] days) and diagnosis to treatment (28 [8-43] days) were the longest phases of care. Longer time from referral to diagnosis was associated with Black race and widowed status, whereas longer time from referral to treatment was associated with female gender, widowed status, frailty, body mass index greater than 18.5, Eastern Cooperative Oncology Group performance status less than 2, bronchoscopic biopsy, and treatment with stereotactic body radiotherapy.

Conclusions

Increased time spent in suspicious lung nodule care is associated with demographic, social, and clinical factors. The longest phases are time from consultation to biopsy and from diagnosis to treatment. Improving multidisciplinary care coordination for vulnerable patient populations could improve the timeliness of suspicious lung nodule care.

Prevalence of breast cancer in ovarian cancer patients and its impact on patient survival: An analysis of the surveillance, epidemiology, and end results data

BACKGROUND

Patients with high-grade serous ovarian carcinoma (HGSOC) often have a personal and/or family history of breast cancers. However, the clinical association and underlying molecular interaction between breast cancer and HGSOC is not well understood. In this study, the clinical characteristics and outcomes of HGSOC patients with or without breast cancer were compared.

METHODS

Eligible patient information was extracted from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier and Cox proportional hazards regression models were used to determine survival outcomes and prognostic factors.

RESULTS

A total of 3065 HGSOC (ICD-O-3 code 8461/3) patients were identified from 1975 to 2020, among whom 239 (9.56%) had co-existing breast cancers. HGSOC with breast cancers tended to have more stage I-II ovarian cancer (20.92% vs 13.79%), less metastatic diseases (25.1% vs 32.13%) and had a higher probability of undergoing surgery (94.1% vs 87.9%). The overall survival of HGSOC patients with breast cancer was better than that of patients without breast cancer (HR = 0.77, 95% CI 0.65 to 0.91; P = 0.0015). Further, patients who developed ovarian cancer before breast cancer had better overall survival than those who developed breast cancer before or simultaneously with ovarian cancer (HR = 0.35, 95% CI 0.23 to 0.52; P < 0.001).

CONCLUSION

HGSOC combined with breast cancer is a common phenomenon. HGSOC patients with breast cancer, especially those diagnosed with ovarian cancer before breast cancer have a better prognosis. Further validation is warranted and more genetic and mechanistical study is needed.

[Partnership Status And Prevalence Of Mental Disorders In Women And Men With Cancer]

BACKGROUND

Patients facing the diagnosis of cancer are confronted with high stress levels, which increase the risk of developing a mental disorder. Being in a relationship moderates patients' mental health and can have a risk-reducing effect. We aim to describe the influence of partnership status on the 4-week-prevalence of mental disorders in cancer patients and how it varies by gender.

METHODS

As part of the secondary data analysis of a multicenter cross-sectional study, 1857 patients with cancer (51,6% women, age 18-75 years, Ø age 57 years, 79,7% in a partnership) were assessed using a written questionnaire and, for the diagnosis of psychological disorders (4-week prevalence), the CIDI-O interview. Frequency calculations and binary logistic analyses were carried out.

RESULTS

In the univariate analyses, the frequency of the presence of at least one mental disorder is significantly lower in patients who are in a relationship (25,4% vs. 35,3%, p<0,001). They are also less likely to simultaneously suffer from multiple mental disorders. These differences are also evident for individual classes of disorders. The multivariate gender-differentiated analysis confirms this trend. In addition to age and income as significant predictors, only men experience a significant protective effect of their relationship against the occurrence of a mental disorder (OR=2,5, p<0,001).

DISCUSSION

There has been very limited research on the links between partnership status, gender, and mental disorders in cancer patients. The results found in our analyses should be further explored, particularly regarding the protective role of partnership against developing mental disorders.

CONCLUSION

In the context of psycho-oncological care the status of living alone should be considered as a possible risk factor for developing mental disorders, especially in men.

Risk factors, prognostic factors and nomograms for distant metastasis in colorectal neuroendocrine neoplasms: a SEER-based study

Background

Distant metastasis is uncommon in colorectal neuroendocrine neoplasms (CRNENs). However, the prognosis of patients with distant metastasis is often poor, so it is crucial to detect distant metastasis in time. This article aims to study the risk factors and prognostic factors for the development of distant metastasis in patients with CRNENs and to construct two related nomograms.

Methods

Patient data were obtained through the Surveillance, Epidemiology, and End Results (SEER) database, and the inclusion population was identified according to inclusion and exclusion criteria. Logistic regression analysis was used to determine risk factors for distant metastasis in patients with CRNENs. Cox regression analysis was utilized to identify prognostic factors in patients with CRNENs with distant metastasis. Two nomograms were created and the predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, the calibration curve, and decision curve analysis (DCA) curves.

Results

We included 9,142 patients with CRNENs and 859 patients with distant metastasis. Age, race, marital status, primary site, histological grade, T stage, N stage, and tumor size were independent risk factors. Age, primary site, histological grade, N stage, tumor size, dissected lymph nodes, and surgery were independent prognostic factors. The constructed nomogram can predict the occurrence and prognosis of distant metastasis in patients with CRNENs.

Conclusions

The nomogram developed in this paper may contribute to the diagnosis and prognosis of distant metastasis in patients with CRNENs and may help clinicians make better clinical decisions.

Socioeconomic disparities: a more important risk factor for advanced-stage oral cancer in Florida than smoking?

PURPOSE

To explore the associations between sociodemographic factors with advanced-stage oral cavity cancer (OCC) presentation among Floridians.

METHODS

Demographic and cancer data on OCC patients (n = 7,826) diagnosed between 2010 and 2017 were retrieved from the Florida Cancer Data System (FCDS). Census tract median income and percentage of population with a bachelor's degree or higher were used to infer income and education. Pearson's chi-square tests of independence were used to compare sociodemographic factors between racial/ethnic groups and staging groups. Multinomial logistic regression analyzed predictors of advanced disease. Incidence and percent late-stage diagnosis versus income were mapped using ArcGIS Pro.

RESULTS

Among 5,252 cases analyzed: 5.7% were Black, 82.4% White Non-Hispanic, 61.5% male, 63.3% publicly insured, 6.5% uninsured, 58.7% current or former smokers, and 73.0% urban residents. Black patients were more likely to present with advanced disease, be single/unmarried, uninsured, and less likely to be former smokers. Male sex, Black race, non-married status, no insurance, Medicaid, VA/military insurance, and lower educational status were associated with increased risk of regional vs. early disease in multivariable analysis (MVA) (p < 0.05). These factors, in addition to Medicare, were associated with distant disease in MVA. Geospatial mapping revealed higher rates of regional and distant disease presentation in the Tampa Bay and Orlando areas.

CONCLUSION

Black race, male sex, non-married status, lower education, Medicaid, VA/Military insurance and no insurance were associated with advanced OCC in Florida. Smoking status was not associated with advanced disease presentation after adjusting for sociodemographic variables.

Cumulative deficits frailty index and relationship status predict survival in multiple myeloma

ABSTRACT

Several tools have been proposed for assessing frailty in multiple myeloma (MM), but most are based on clinical trial data sets. There are also limited data on the association between frailty and patient-reported outcomes and on the prognostic value of social determinants of health. This study evaluates the prognostic impact of frailty, based on the cumulative deficit frailty index (FI), and relationship and socioeconomic status (SES) in patients with newly diagnosed MM. This retrospective study included 515 patients with MM seen at Mayo Clinic (Rochester, MN) at diagnosis between 2005 and 2018. The FI was calculated using patient-reported data on activities of daily living and comorbidity data, with items scored as 0, 0.5, or 1, in which 1 indicated a deficit. The FI was calculated by dividing the total score by the number of nonmissing items. Frailty was defined as FI ≥0.15; 61% were nonfrail, and 39% were frail. Frailty and nonmarried/relationship status were associated with higher disease stage, decreased the likelihood of early transplantation, and independently associated with decreased survival. SES was not independently associated with survival. Frail patients reported worse scores for fatigue, pain, and quality of life. Approximately a quarter of patients had a deterioration in frailty status at 3 to 12 months, and <10% had improvement. In conclusion, a cumulative deficit FI was associated with higher symptom burden and decreased survival in a real-world cohort of patients with newly diagnosed MM. Frailty status is dynamic and should be reassessed during treatment. Social support has prognostic value and should be evaluated in clinical practice.

Five-year overall and specific survival of breast cancer in great Cuiaba (MT), Brazil

OBJECTIVE

To analyze the overall and cancer-specific five-year survival rates for female breast cancer in Greater Cuiabá, Mato Grosso, Brazil.

METHODS

A non-concurrent, population-based cohort study using the Population-Based Cancer Registry of Greater Cuiabá (Cuiabá and Varzea Grande), including women diagnosed with breast cancer from 2008 to 2013, followed through 2018 in the regional mortality database. The sample consisted of a total of 1,220 women. Five-year survival analysis was performed using Kaplan-Meier curves and the Cox proportional hazards regression model, computing hazard ratios for variable estimation. Survival curves were compared using the log-rank test (p<0.05). Probabilistic linkage technique by the RecLink III software and survival analysis were conducted using STATA software version 12.0.

RESULTS

There was no statistical difference between the overall (OS) and cancer-specific survival (SS) rates (OS 78.0%, 95%CI 75.6-80.2; SS 81.0%, 95%CI 78.7-83.2). Women with lower educational levels (OS=58.33%; SS=64.89%) and those without a partner (OS 64.81%; SS 70.41%) exhibited poorer survival.

CONCLUSION

This study demonstrates that educational level and marital status significantly impact both overall and cancer-specific survival rates for female breast cancer. There is a need to propose policies that address the profile of women with lower survival rates.

Prognosis of keratinizing squamous cell carcinoma of the female reproductive system: A retrospective study

Objective: The aim of this study was to compare the competing risk model with the Cox model to evaluate prognostic markers in females with keratinized squamous cell carcinoma of the reproductive system and to develop predictive models. Methods: Patients with keratinizing squamous cell carcinoma of the female reproductive system were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Using the cumulative incidence function (CIF) and Gray's test for univariate analysis, the competing risk and Cox models were used for multivariate analysis. A nomogram was developed based on the results of the competing risk model, and the C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the model's discrimination ability. The clinical validity of the model was assessed using calibration plots and decision curve analysis (DCA). Results: In this investigation, competing risk model analysis revealed that age, marital status, tumor size, AJCC stage, surgery, radiotherapy, chemotherapy, postoperative lymph node dissection, surgery and radiotherapy, and income were significant factors affecting the prognosis of patients with keratinizing squamous cell carcinoma of the female reproductive system. Based on these results, a nomogram for predicting the 3-year, 5-year, and 8-year survival rates was established. The nomogram demonstrated better clinical utility than the AJCC staging system. Conclusion: For the first time, the competing risk model was used in this study to assess the prognostic risk factors of keratinizing squamous cell carcinoma of the female reproductive system. The results may help clinicians make better clinical judgments. Additionally, we developed a nomogram to predict the likelihood of cancer-specific death (CSD) in patients at 3, 5, and 8 years. Physicians may use our nomogram to more accurately forecast the likelihood of CSD compared to the AJCC staging system.

Nomogram for predicting survival in breast cancer with lung metastasis based on SEER data

Background

The incidence of breast cancer (BC) has been steadily increasing, highlighting the need for a predictive model to assess the survival prognosis of BC patients. The objective of this research was to formulate a prognostic nomogram framework tailored to forecast survival among individuals diagnosed with BC with lung metastasis (BCLM).

Methods

Our information was sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Individuals who were diagnosed with BC from 2010 to 2015 were selected. The 4,309 collected participants were randomly separated into a training cohort (n=3,231) and a validation cohort (n=1,078). In this study, age, marital status, race, tumor location, laterality, type of primary surgery, surgical margin, tumor grade, tumor (T) stage, node (N) stage, as well as the use of radiotherapy and chemotherapy, were identified as potential prognostic factors. The overall survival (OS) and breast cancer-specific survival (CSS) were defined as the primary endpoints of this study. Univariate and multivariate analyses were conducted to assess the impact of different factors on prognosis. Structured nomograms were developed to improve the prediction of OS and CSS. The concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were employed to estimate the performance of the nomogram.

Results

The nomograms incorporated age, marital status, race, primary surgery or not, BC subtype, grade, T stage, and the use of chemotherapy or not. The C-index for OS was 0.77, and it was 0.77 in CSS for the training group. The C-indexes for the control group of OS and CSS prediction were 0.78 and 0.78, respectively. ROC curves, calibration plots, and DCA curves displayed excellent predictive validity. The results indicate a median survival time of 1.67 years [95% confidence interval (CI): 1.58-1.83], with a total of 3,640 deaths recorded. Survival time was found to be associated with factors such as age, marital status, race, whether primary site surgery was performed, BC subtype, tumor grade, T stage, and the administration of chemotherapy.

Conclusions

Nomograms were created to predict OS and CSS for individuals diagnosed with BCLM. The nomogram has a reliable and valid prediction power; it could perhaps assist physicians in calculating patients' mortality risk.

Development and evaluation of a multivariable prediction model for overall survival in advanced stage pulmonary carcinoid using machine learning

BACKGROUND

Evidence is limited on whether patients with advanced pulmonary carcinoid (APC) benefit from comprehensive pulmonary resection (CPR), chemotherapy, or radiotherapy. Existing prognostic models for APC are limited and do not guide treatment selection. This study aims to develop and evaluate a multivariable machine learning model to predict overall survival in APC patients and provide a web-based prognostic tool.

METHODS

Clinical data of APC patients were obtained from SEER database. Propensity score matching reduced retrospective study bias. Kaplan-Meier analysis evaluated survival differences between CPR vs. nonCPR, chemotherapy (Chem) vs. no chemotherapy (nonChem), and radiotherapy (Radio) vs. no radiotherapy (nonRadio). Univariate and multivariate Cox regression identified survival-associated variables. Using these clinical variables, 91 machine learning models were developed to predict APC survival, and the best model led to a web-based prognostic tool.

RESULTS

Among 1077 APC patients, 37.0 % underwent CPR, 30.2 % received chemotherapy, and 19.9 % received radiotherapy. After matching, overall survival was significantly improved in the CPR compared to the nonCPR. However, there were no significant differences in survival between the Chem and nonChem groups or between the Radio and nonRadio groups. Eight out of 13 clinical variables were significant prognostic variables. Models with eight variables reached a mean C-index of 0.770 and a 5-year AUC of 0.835. Using all 13 variables, a C-index of 0.785 and an AUC of 0.850 was achieved. An online tool (https://apcmodel.shinyapps.io/APCsp/) displays survival curves for different treatments.

CONCLUSION

The developed prognostic model enables individualized survival predictions and supports evidence-based treatment decisions for APC patients.

A narrative review on the psychosocial domains of the impact of organ transplantation

This review explores organ transplantation, spanning historical developments, psychosocial impacts, and future directions. In the pre-transplantation phase, evaluations of psychosocial factors, including substance use, mental health, and social support, are essential for successful outcomes. However, linking total psychosocial risk scores to post-transplant outcomes remains challenging despite available tools and assessments. Patient selection criteria and psychological assessments are pivotal in achieving successful transplantation outcomes. The age of donors significantly impacts transplant outcomes across various organs, highlighting the urgency of addressing organ shortages. Meticulous patient selection, including thorough psychosocial evaluations, ensures recipients possess the necessary emotional resilience and support systems for successful transplantation. Both pre- and post-transplantation psychological evaluation processes are crucial for assessing and supporting individuals throughout the transplant journey. Posttransplant evaluations continue to monitor adjustment difficulties, medication adherence, and complex emotions, enabling timely intervention and personalized support. The waiting period before transplantation presents significant challenges, including uncertainty, anxiety, and social isolation. Robust emotional support and coping mechanisms are crucial during this transitional phase, fostering resilience and hope among waitlist candidates. Psychological challenges during and after transplantation, including anxiety, depression, and sleep disturbances, are common among recipients. Coping mechanisms, such as religious/spiritual approaches, social support, and participation in support groups, play pivotal roles in patient adjustment and recovery. Ethical considerations are paramount in ensuring fair and effective transplantation practices, including organ allocation, adherence to post-transplant care, financial burdens, and the interplay between medical and psychosocial factors.

Patient-Reported Distress in Individuals With Head and Neck Cancer

Importance

Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC.

Objective

To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC.

Design, Setting, and Participants

This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis.

Main Outcomes and Measures

The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains.

Results

A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n = 31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1.05-2.50]). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR, 2.03 [95% CI, 1.02-4.08]). Other factors associated with significant clinical distress included tobacco use (aOR, 2.14 [95% CI, 1.02-4.50]) and reported practical problems (aOR, 2.08 [95% CI, 1.17-3.69]).

Conclusion and Relevance

Independent of race or sociodemographic factors, the results of this retrospective cohort study underscore the need for social and emotional support in mitigating distress and optimizing mental health care in this patient population. Further studies should explore distress trajectories across the HNC continuum and their impact on HNC outcomes.

Race and Ethnicity Disparities in Cardiovascular and Cancer Mortality: the Role of Socioeconomic Status-a Systematic Review and Meta-analysis

To clarify the role of socioeconomic status (SES) in cardiovascular and cancer mortality disparities observed between Black, Hispanic, and Asian compared to White adults, we conducted a meta-analysis of the longitudinal research in the USA. A PubMed, Ovid Medline, Web of Science, and EBSCO search was performed from January 1995 to May 2023. Two authors independently screened the studies and conducted risk assessments, with conflicts resolved via consensus. Studies were required to analyze mortality data using Cox proportional hazard regression. Random-effects models were used to pool hazard ratios (HR) and reporting followed PRISMA guidelines. Twenty-two studies with cardiovascular mortality (White and Black (n = 22), Hispanic (n = 7), and Asian (n = 3) adults) and twenty-three with cancer mortality endpoints (White and Black (n = 23), Hispanic (n = 11), and Asian (n = 10) adults) were included. The meta-analytic sample for cardiovascular mortality endpoints was 6,199,049 adults (White = 4,891,735; Black = 935,002; Hispanic = 295,623; Asian = 76,689), while for cancer-specific mortality endpoints was 7,745,180 adults (White = 5,988,392; Black= 1,070,447; Hispanic= 484,848; Asian = 201,493). Median follow-up was 10 and 11 years in cohorts with cardiovascular and cancer mortality endpoints, respectively. Adjustments for SES attenuated the higher risk for cardiovascular (HR, 1.46; 95% CI, 1.30-1.64) and cancer mortality (HR, 1.35; 95% CI, 1.32-1.38) of Black compared to White adults by 25% (HR, 1.21; 95% CI, 1.15-1.28) and 19% (HR, 1.16; 95% CI, 1.13-1.18), respectively. However, the Hispanic cardiovascular (HR, 0.79; 95% CI, 0.73-0.85) and Asian cancer mortality (HR, 0.81; 95% CI, 0.76-0.86) advantage were independent of SES. These findings emphasize the need to develop strategies focused on SES to reduce cardiovascular and cancer mortality in Black adults.

A population-based study using nomograms to predict overall and cancer-specific survival in HPV-associated CSCC

Constructing and validating two nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) in cutaneous squamous cell carcinoma (CSCC) correlated with human papillomavirus (HPV) infection was the main goal of this study. We constructed predictive models for OS and CSS incidence in HPV infection-associated CSCC using information from 2238 patients in the Surveillance, Epidemiology, and End Results (SEER) database and screened the variables by LASSO regression, Cox univariate regression, and Cox multifactorial regression models, which were calibrated and validated by internal and external cohorts. Finally, all patients were categorized into intermediate-risk, low-risk, and high-risk groups based on the optimal threshold calculated from the total score. Multivariate analysis showed that HPV infection status, marital status, tumor metastatic stage, surgical status, radiotherapy status, lymph node biopsy, local lymph node dissection, primary tumor status, and bone metastasis were risk factors for OS and CSS. The C index, the time-dependent area under the receiver-operating characteristic curve, and the column-line diagrams of the calibration plot were among the excellent-performance metrics that were effectively displayed. Moreover, the decision curve analysis of the two nomograms consistently revealed their favorable net benefits spanning 1, 2, and 3 years. In addition, the survival curves indicate that each of the two risk classification systems clearly differentiates high, medium, and low risk groups. These meticulously crafted nomograms stand poised to serve as indispensable instruments in clinical practice, empowering clinicians to adeptly communicate with patients regarding their prognostic outlook over the forthcoming 1, 2, and 3 years.

A Novel Nomogram for the Prediction and Evaluation of Prognosis in Patients with Early-onset Kidney Cancer: a Population-based Study

Background: Early-onset kidney cancer (EOKC) is often associated with genetic factors and a high risk of metastasis. However, there is a lack of accurate prediction models for the prognosis of EOKC. The aim of this study is to establish an effective nomogram for predicting and evaluating the prognosis of patients with EOKC. Methods: The patients with EOKC were selected from the latest SEER database during 2004-2015. Patients between 2004 and 2014 were randomly divided into a training cohort and a validation cohort at a ratio of 7:3, and patients in 2015 were used for temporal external validation. Additionally, we included patients from First Hospital of Shanxi Medical University between 2013 and 2021 for spatial external validation. The performance of the nomogram was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Patients were stratified based on the nomogram, and Kaplan-Meier (KM) curves were plotted to compare the survival probability of patients. Results: In the temporal and spatial external validation cohort, the C-index of the nomogram for OS was 0.872 and 0.875, respectively, and the C-index of the nomogram for CSS were 0.872 and 0.851, respectively. In the temporal external validation cohort, the 1-year, 3-year and 5-year AUC of the nomogram for OS were 0.906, 0.899 and 0.876, respectively. In addition, the AUC showed that the nomogram had also high predictive ability for CSS. The calibration curves and DCA also indicated that the nomogram had a strong clinical utility. The KM curve revealed that patients in the low-risk group had a better prognosis than those in the high-risk group. Conclusion: Our study developed a novel high-performance nomogram for assessing the prognosis of patients with EOKC, and it has great potential for clinicians to assess patient prognosis and formulate effective intervention and follow-up strategies.

A dyadic stress induction tool for experimental investigation of adult patients with cancer and their family caregivers

BACKGROUND

Medical illnesses are major stressors not only for the patients but also for their family caregivers, yet existing tools are inadequate to assess mechanistic response patterns to such stressors.

PURPOSE

We sought to validate a stress induction task that pertains to close relationships and health-related concerns with adult patients with cancer and their family caregivers.

METHODS

Patients newly diagnosed with colorectal cancer (n = 123, 56 years old, 34% female, 60% Hispanic, 6.5 months post-diagnosis) and their family caregivers (55 years old, 66% female, 59% Hispanic) underwent an experimental session during which both individuals imagined a scenario where one person is hit by a car (patient) and the partner (caregiver) has no means to provide or seek out help for the victim. The session consisted of 6 phases: baseline, scenario provision, speech preparation, speech by caregiver, speech by patient, and recovery.

RESULTS

Results of general linear modeling with repeated measures revealed that the task induced significant affective, stress, and cardiovascular responses in both patients and caregivers. Stress reactivity and recovery patterns, however, varied by patients versus caregivers, stress induction phases, and the types of assessment.

CONCLUSIONS

Findings suggest the newly developed stress task as an acceptable tool for studying stress regulation in medical and family contexts. With further validation, this tool may help identify psychological and physiological pathways to improve the stress coping outcomes of adult patients with cancer and their family caregivers.

Predictive ability of the Cancer and Aging Research Group chemotherapy toxicity calculator in hematologic malignancy

INTRODUCTION

Chemotherapy toxicity tools are rarely studied in patients with hematologic malignancy (HM). The primary aim of this pilot study was to determine the predictive ability of the Cancer and Aging Research Group (CARG) chemo-toxicity calculator in estimating grade 3-5 toxicity in patients with HM.

MATERIALS AND METHODS

Patients 60 years and older with HM were prospectively evaluated using the CARG chemo-toxicity calculator. Discrimination and calibration were checked by applying the published model in our data. Additionally, a full geriatric assessment (GA), the Short Physical Performance Battery (SPPB), and health related quality of life (HRQoL) were captured longitudinally at the start of treatment and at end of study. Secondary aims explored the association of GA metrics with chemo-related toxicities and survival.

RESULTS

One hundred forty-five patients were approached, 118 patients consented, and 97 patients were evaluable. Most patients were newly diagnosed (n = 91). The median CARG score was 9 (range 4-18). The CARG score was not validated in our cohort of older patients with HM, with area under the receiver operation characteristic curve being 0.53 (95 % CI: 0.41-0.65). In multivariable analysis, after controlling for disease type, risk factors associated with grade 3-5 toxicity included living alone (hazard ratio [HR] 4.24, 95 %CI: 2.07-8.68, p < 0.001), increase in body mass index (HR 1.06, 95 %CI: 1.01-1.12, p = 0.03) and a higher social activities score (HR 1.27, 95 %CI: 1.06-1.51, p = 0.01). In multivariable analysis of overall survival, the only prognostic factor was an objective marker of physical function (SPPB score HR = 0.85, 95 %CI:0.78-0.93, p < 0.001).

DISCUSSION

The CARG chemo-toxicity calculator was not predictive of grade 3-5 toxicity in patients with hematologic malignancy. The SPPB was associated with overall survival in multivariable analysis, suggesting future use as an objective biomarker in HM. We also report a comprehensive trajectory of function, QoL, psychosocial well-being, and cognition among older adults with HM. The predictive accuracy of the CARG chemo-toxicity calculator may be affected by the diverse range of HM treatment options that are not traditional chemotherapy.

How Do People Feel About Mates?

Where do positive feelings about a romantic or sexual partner come from? This article offers an overview of-and imposes some structure on-the enormous literature on mate evaluation, from initial attraction to long-term relationship settings. First, we differentiate between research that identifies the factors that predict positive evaluation on average (i.e., normative desirability) and research that attempts to document for whom certain factors are more versus less positive (i.e., heterogeneity in desirability). Second, we review the positive biases that tend to dominate the evaluative process, as well as the promising (and sorely needed) new methods in this research space. Third, we cover contemporary perspectives on the mechanisms that explain how evaluations shift and change over the entire relationship arc. Fourth and finally, we discuss how diversifying the samples and perspectives in mate evaluation research will address novel and generative questions about culture, stigma, and socioeconomic status.

Comparison of postoperative survival prognosis between early-onset and late-onset esophageal cancer: A Population-based study

The prognosis of non-distant metastatic early-onset esophageal cancer (EC) patients undergoing surgical treatment remains unclear, this study aims to compare the prognosis of early-onset and late-onset EC. Information on non-distant metastatic EC patients who underwent surgical treatment and were initially diagnosed between 2004 and 2015 was collected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance the baseline differences between early-onset and late-onset EC patients. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI). The Kaplan-Meier method and log-rank test were used to compare the overall survival (OS) between the two groups of patients. Atotal of 5320 EC patients were included, with 571 in the early-onset group and 4749 in the late-onset group. Multivariate Cox regression analysis showed that early-onset EC patients had better OS (HR = 0.732, 95% CI: 0.655-0.819, p<0.001). Using PSM analysis at a 1:1 ratio, we matched 557 early-onset EC patients with 557 late-onset EC patients. After matching, the multivariate Cox regression model still showed a favorable prognosis for early-onset EC (HR = 0.728, 95% CI: 0.630-0.842, p<0.001). Additionally, subgroup analysis indicated that early-onset EC patients had better long-term prognosis. Non-distant metastatic early-onset EC patients undergoing surgical treatment demonstrated better OS outcomes, confirmed by regression analysis and subgroup analysis in the matched cohort.

The intersection of melanoma survival and social determinants of health in the United States: A systematic review

Background

Despite recent improvements in melanoma survival rates, persistent inequalities pose barriers to care for some patients.

Objective

To assess the influence of social determinants of health (SDoH) on melanoma treatment outcomes.

Methods

A systematic review (Prospective Register of Systematic Reviews CRD42022346854) of manuscripts that examined the association between SDoH and melanoma treatment-related outcomes in the United States was conducted using 5 databases.

Results

The analysis encompassed data from 12 retrospective manuscripts. The SDoH domains most frequently investigated were health care access and quality (n = 6 manuscripts, 50%) and economic stability (n = 7, 58.3%). Other domains included social and community context (n = 5, 41.7%) and education access (n = 3, 25%). These findings revealed significant correlations between poor melanoma survival and low levels of economic stability, limited education, government health insurance, and being uninsured and unmarried.

Limitations

Many SDoH were not analyzed at the patient level. SDoH are vast categories, but manuscripts usually analyze one aspect of a particular category.

Conclusions

These results highlight the need for physicians to recognize the substantial impact of SDoH on melanoma outcomes and to adopt more comprehensive strategies focused on patient-centered care. Integrating social support mechanisms into clinical practice emerges as a key mechanism to promote equitable and effective interventions.

Social Determinants of Health and Limitation of Life-Sustaining Therapy in Neurocritical Care: A CHoRUS Pilot Project

BACKGROUND

Social determinants of health (SDOH) have been linked to neurocritical care outcomes. We sought to examine the extent to which SDOH explain differences in decisions regarding life-sustaining therapy, a key outcome determinant. We specifically investigated the association of a patient's home geography, individual-level SDOH, and neighborhood-level SDOH with subsequent early limitation of life-sustaining therapy (eLLST) and early withdrawal of life-sustaining therapy (eWLST), adjusting for admission severity.

METHODS

We developed unique methods within the Bridge to Artificial Intelligence for Clinical Care (Bridge2AI for Clinical Care) Collaborative Hospital Repository Uniting Standards for Equitable Artificial Intelligence (CHoRUS) program to extract individual-level SDOH from electronic health records and neighborhood-level SDOH from privacy-preserving geomapping. We piloted these methods to a 7 years retrospective cohort of consecutive neuroscience intensive care unit admissions (2016-2022) at two large academic medical centers within an eastern Massachusetts health care system, examining associations between home census tract and subsequent occurrence of eLLST and eWLST. We matched contextual neighborhood-level SDOH information to each census tract using public data sets, quantifying Social Vulnerability Index overall scores and subscores. We examined the association of individual-level SDOH and neighborhood-level SDOH with subsequent eLLST and eWLST through geographic, logistic, and machine learning models, adjusting for admission severity using admission Glasgow Coma Scale scores and disorders of consciousness grades.

RESULTS

Among 20,660 neuroscience intensive care unit admissions (18,780 unique patients), eLLST and eWLST varied geographically and were independently associated with individual-level SDOH and neighborhood-level SDOH across diagnoses. Individual-level SDOH factors (age, marital status, and race) were strongly associated with eLLST, predicting eLLST more strongly than admission severity. Individual-level SDOH were more strongly predictive of eLLST than neighborhood-level SDOH.

CONCLUSIONS

Across diagnoses, eLLST varied by home geography and was predicted by individual-level SDOH and neighborhood-level SDOH more so than by admission severity. Structured shared decision-making tools may therefore represent tools for health equity. Additionally, these findings provide a major warning: prognostic and artificial intelligence models seeking to predict outcomes such as mortality or emergence from disorders of consciousness may be encoded with self-fulfilling biases of geography and demographics.

Marital status as an independent prognostic factor for survival in women with vaginal cancer: evidence from the SEER database analysis

This study aimed to evaluate the influence of marital status on the survival outcomes of women diagnosed with vaginal cancer, considering the potential role of sociodemographic factors in patient prognosis. Utilizing data from the Surveillance, Epidemiology, and End Results database, the study included 6046 women with primary vaginal cancer diagnosed between 2000 and 2020. The propensity score matching (PSM) method was employed to balance comparison groups and account for confounding factors. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), with Cox proportional-hazards regression models used for statistical analysis. Married patients exhibited better survival outcomes than their unmarried counterparts [OS: hazard ratio = 1.520, 95% confidence interval (CI) = 1.430-1.630, P < 0.001; CSS: hazard ratio = 1.380, 95% CI = 1.270-1.490, P < 0.001]. Subgroup analyses stratified by age and race highlighted a significant survival benefit for married individuals, particularly those aged 50-69 years and white patients. After PSM, the widowed subgroup within the unmarried category showed worse survival outcomes (OS: hazard ratio = 1.580, 95% CI = 1.430-1.750, P < 0.001; CSS: hazard ratio = 1.360, 95% CI = 1.200-1.530, P < 0.001). This study demonstrates that marital status serves as an independent prognostic factor for OS and CSS among patients with primary vaginal cancer, which supports that unmarried people need more individualized care strategies.

Individualised prediction of chemotherapy benefit in early-onset colorectal cancer

PURPOSES

Whether patients with early-onset colorectal cancer (EOCRC) receive chemotherapy has been controversial, so our study aimed to screen patients with EOCRC who benefit from chemotherapy.

METHODS

A total of 2166 EOCRC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into chemotherapy and non-chemotherapy groups, propensity score matching (PSM) was performed to balance the differences between the groups, and the Kaplan-Meier method was used to calculate the cancer-specific survival (CSS) of EOCRC patients. Multifactorial COX regression analysis was used to identify independent prognostic factors for CSS and to construct a nomogram for predicting CSS in EOCRC patients. The overall risk score was calculated based on Nomogram, and EOCRC patients were classified into high-risk and low-risk groups to assess further chemotherapy's therapeutic effect on patients with different risk stratification.

RESULTS

Before PSM, patients in the chemotherapy group had poorer CSS (p < 0.001). After PSM, there was no significant difference in patient CSS between the two groups (p = 0.057). Independent prognostic factors (Race, Grade, Pathology, AJCC.N, AJCC.M, CEA, Marital. Status) were screened according to multifactorial COX regression analyses and included in the Nomogram predicting CSS in EOCRC patients. A risk stratification system for EOCRC patients was further developed, and the results showed that chemotherapy had no significant effect on CSS in the low-risk group of patients, but in the high-risk group, chemotherapy significantly improved CSS in EOCRC patients.

CONCLUSIONS

We developed a clinical risk model by combining different risk factors, which can accurately screen those with high-risk EOCRC for benefit from chemotherapy. For low-risk EOCRC patients, our results did not observe a better survival benefit from chemotherapy, and more prospective studies are needed in the future to prove our conclusions.

The benefit of sentinel lymph node biopsy in elderly patients with melanoma: A retrospective analysis of SEER Medicare data (2010-2018)

BACKGROUND

Sentinel lymph node status is critical for melanoma staging and treatment. However, the factors influencing SLNB and its oncologic benefits in elderly patients are unclear.

METHODS

We conducted a retrospective analysis of patients aged ≥65 with clinically node-negative melanoma and Breslow depth ≥1 ​mm, using Surveillance, Epidemiology, and End Results Medicare database (2010-2018). Multivariable logistic regression assessed SLNB likelihood by demographic and clinical factors, and Cox-proportional hazard models evaluated overall and melanoma-specific mortality (MSM) for SLNB recipients versus non-recipients.

RESULTS

Of 13,160 melanoma patients, 62.29 ​% underwent SLNB. SLNB was linked to reduced all-cause mortality (HR: 0.65 [95%CI 0.61-0.70]) and MSM (HR: 0.76 [95%CI 0.67-0.85]). Older age, non-White race, male sex, and unmarried status was associated with decreased SLNB likelihood, while cardiopulmonary, neurologic, and secondary cancer comorbidities were associated with increased SLNB likelihood.

CONCLUSIONS

Though less frequently performed, SLNB is associated with lower mortality in elderly melanoma patients. Advanced age alone should not contraindicate SLNB.

Prognostic nomogram models for elderly patients with differentiated thyroid carcinoma: A population-based study

This study aimed to develop and validate a prognostic model for elderly patients with differentiated thyroid carcinoma (DTC) based on various demographic and clinical parameters in order to accurately predict patient outcomes. Patients who were diagnosed with DTC and were over 55 years old between 2010 and 2019 were identified from the Surveillance, Epidemiology, and End Results database. The patients were then randomly divided into a training set and a validation set in a 7:3 ratio, and patients from our center were included as an external validation group. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors, which were then utilized to develop nomograms for predicting the prognosis. The discriminative ability of the nomograms was evaluated using the concordance index, and the calibration was assessed using calibration plots. The clinical usefulness and benefits of the predictive models were determined through decision curve analysis. The findings of the stepwise Cox regression analysis revealed that several variables, including age, marital status, sex, multifocality, T stage, N stage, and M stage, were significantly associated with overall survival in elderly patients with DTC. Additionally, age, tumor size, multifocality, T stage, N stage, and M stage were identified as the primary determinants of cancer specific survival in elderly patients with DTC. Using these predictors, nomograms were constructed to estimate the probability of overall survival and cancer specific survival. The nomograms demonstrated a high level of predictive accuracy, as evidenced by the concordance index, and the calibration plots indicated that the predicted outcomes were consistent with the actual outcomes. Furthermore, the decision curve analysis demonstrated that the nomograms provided substantial clinical net benefit, indicating their utility in clinical practice.

Predictive models and treatment efficacy for liver cancer patients with bone metastases: A comprehensive analysis of prognostic factors and nomogram development

Background

Bone metastasis considerably undermines the prognosis of advanced primary liver cancer patients. Though its impact is well-recognized, the clinical field still lacks robust predictive models that can accurately forecast patient outcomes and aid in treatment effectiveness evaluation. Addressing this gap is paramount for improving patient management and survival.

Materials and methods

We conducted an extensive analysis using data from the SEER database (2010-2020). COX regression analysis was applied to identify prognostic factors for primary liver cancer with bone metastasis (PLCBM). Nomograms were developed and validated to predict survival outcomes in PLCBM patients. Additionally, propensity score matching and Kaplan-Meier survival analyses lent additional insight by dissecting the survival advantage conferred by various treatment strategies.

Results

A total of 470 patients with PLCBM were included in our study. The median overall survival (OS) and cancer-specific survival (CSS) for these patients were both 5 months. We unveiled several independent prognosticators for OS and CSS, spanning demographic to therapeutic parameters like marital status, cancer grade, histological type, and treatments received. This discovery enabled the formulation of two novel nomograms-now verified to eclipse the predictive prowess of the traditional TNM staging system regarding discrimination and clinical utility. Additionally, propensity score matching analysis showed the effectiveness of surgeries, radiotherapy, and chemotherapy in improving OS and CSS outcomes for PLCBM patients.

Conclusions

Our investigation stands out by introducing pioneering nomograms for prognostic evaluation in PLCBM, a leap forward compared to existing tools. Far exceeding mere academic exercise, these nomograms hold immense clinical value, serving as a foundation for nuanced risk stratification systems and delivering dynamic, interactive guides, allowing healthcare professionals and patients to assess individual bone metastasis survival probabilities and personalize treatment selection.

Is chemotherapy beneficial? A retrospective study of chemotherapy in patients with invasive intraductal papillary-mucinous carcinoma

Background and aim

Whether chemotherapy can improve the prognosis of invasive intraductal papillary-mucinous carcinoma (IPMC) still remains unclear. The aim of this study is to observe the difference in survival time of patients with invasive IPMC receiving or not receiving chemotherapy.

Methods

117 patients with invasive IPMC were included in The Surveillance, Epidemiology, and End Results (SEER) database. These patients were subsequently divided into two subgroups according to whether they received chemotherapy or not: the non-chemotherapy group (patients who did not receivechemotherapy, N = 58), the chemotherapy group (patients who received chemotherapy, N = 59). The overall survival (OS) and cancer specific survival (CSS) of two treatment groups were evaluated.

Results

Before adjusting for pathology grade, the Kaplan-Meier analysis showed that the difference of survival time is not significant between non-chemotherapy group and chemotherapy group (P > 0.05), but the land-mark analysis showed that short-term death risk of the chemotherapy group is significantly lower than non-chemotherapy group (P < 0.05). After adjust the pathology grade, survival time of the chemotherapy group is significantly longer than non-chemotherapy group (P < 0.05). Univariate and multivariate Cox regression showed that chemotherapy was an independent prognostic protective factor for invasive IPMC (P < 0.05). Land-mark analysis showed that short-term death risk of the chemotherapy group is significantly lower than non-chemotherapy group in N1-N2 subgroup (P < 0.05).

Conclusion

Chemotherapy is an independent protective factor IPMC, especially reducing the risk of short-term death for IPMC patients with lymph node metastasis.

Changes in the overall survival of patients with metastatic renal cell carcinoma in the era of immune-checkpoint inhibitors

BACKGROUND

The advent of immune checkpoint inhibitors (ICI) has brought about a significant transformation in the treatment of immunogenic tumors. On November 23, 2015, the United States Food and Drug Administration approved Nivolumab to treat metastatic renal cell carcinoma (RCC). We aimed to assess potential changes in the survival rates of patients with metastatic RCC at a population level after the approval of Nivolumab.

METHODS

We used data from the latest version of the Surveillance, Epidemiology, and End Results (SEER) database which encompasses data up to the year 2020. We included patients with age ≥ 20 years who were diagnosed with 'distant' RCC from 2011 through 2020. Based on the approval of Nivolumab, the period from 2011 to 2020 was further grouped into 2011-2015 (pre-ICI era) and 2016-2020 (ICI era).

RESULTS

The median overall survival (OS) was 8 months in the pre-ICI era compared to 11 months in the ICI era (log-rank test, χ2 = 102.53, p < 0.001). Patients diagnosed with metastatic RCC in the ICI era had a significantly lower risk of dying [Cox proportional Hazard Ratio of 0.77, 95 % CI (0.74-0.80)] compared to patients diagnosed in the pre-ICI era. Additionally, patients under the age of 75 had a lower risk of death compared to those aged 75 years or older. Patients who received chemotherapy (systemic therapy), radiotherapy, or surgery faced a significantly lower risk of mortality. Individuals with metastasis to the brain, bone, liver, or lung had a significantly higher risk of death than those without metastasis to these locations. Marital status also played a role, as married individuals had a significantly lower risk of death compared to those who were divorced, separated, or widowed at the time of diagnosis. Furthermore, income level influenced survival, with patients earning a median annual household income of more than USD 75,000 exhibiting a significantly lower risk of mortality compared to those earning between USD 50,000 and USD 74,000. There was no significant difference in survival observed between non-Hispanic blacks and non-Hispanic whites.

CONCLUSION

The advent of immune checkpoint inhibitors has led to a substantial improvement in the median overall survival of individuals diagnosed with metastatic renal cell carcinoma.

Nomogram for predicting cardiovascular mortality in patients with gastrointestinal stromal tumor: A population-based study

This research aimed to develop and validate a clinical nomogram for predicting the probability of cardiovascular death (CVD) in patients with gastrointestinal stromal tumors (GIST). Information regarding patients diagnosed with GIST was extracted from the surveillance, epidemiology, and end results database. The multivariable competing risk model and multivariable Cox regression model were utilized to determine the independent predictive factors. A comparison was made between the results obtained from the 2 models. A nomogram was built to visualize the competing risk model. The nomogram's performance was assessed utilizing concordance index, calibrate curve, decision curve analysis, and risk stratification. A total of 9028 cases were enrolled for final analysis, with CVD accounting for 12.8% of all deaths since GIST diagnosis. The multivariate analysis of competing risks revealed that age, chemotherapy and marital status were identified as independent risk factors for CVD in GIST individuals. The nomogram model exhibited good calibration and strong discriminative ability, indicating its effectiveness in predicting outcomes, with a concordance index of 0.788 (95% confidence interval: 0.753-0.823) in the training set, and 0.744 (95% confidence interval: 0.673-0.815) in the validation set. Decision curve analysis indicated that the prediction model had good clinical practicability. Additionally, risk stratification analysis efficiently divided GIST individuals into high- and low-risk populations for CVD. This was the first research to construct and validate a predictive nomogram using a competing risk model to estimate the individual probabilities of CVD in GIST patients. The nomogram can assist clinicians in making personalized treatment and monitoring plans.

Evolution of transmissible cancers: An adaptive, plastic strategy of selfish genetic elements?

A growing number of studies have applied evolutionary and ecological principles to understanding cancer. However, few such studies have examined whether phenotypic plasticity--the ability of a single individual or genome to respond differently to different environmental circumstances--can impact the origin and spread of cancer. Here, we propose the adaptive horizontal transmission hypothesis to explain how flexible decision-making by selfish genetic elements can cause them to spread from the genome of their original host into the genomes of other hosts through the evolution of transmissible cancers. Specifically, we hypothesize that such cancers appear when the likelihood of successful vertical transmission is sufficiently low relative to the likelihood of successful horizontal transmission. We develop an evolutionary optimization model of this hypothesis, highlight empirical findings that support it, and offer suggestions for future research. Generally, phenotypically plastic selfish genetic elements might play an important role in the evolution of transmissible cancers.

Development and validation of a prognostic nomogram for esophageal cancer patients based on SEER Asian population

This study aims to develop and validate a nomogram for predicting overall survival (OS) in Asian patients with Esophageal Cancer (EC). Data from Asian EC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for initial variable selection, followed by multivariate Cox regression analysis to identify independent prognostic factors. A nomogram was subsequently constructed based on these factors. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves and calibration curves, while the clinical utility of the nomogram was assessed through decision curve analysis (DCA). The LASSO regression and multivariate Cox regression analysis identified age, sex, marital status, tumor size, M stage, surgery, and chemotherapy as independent prognostic factors. The ROC curve results demonstrated that the area under the curve (AUC) values for predicting 1-year, 3-year, and 5-year OS in the training cohort were 0.770, 0.756, and 0.783, respectively. In the validation cohort, the AUC values were 0.814, 0.763, and 0.771, respectively. Calibration curves indicated a high concordance between predicted and actual OS. The DCA demonstrated that the nomogram has significant clinical applicability. This nomogram provides reliable predictions and valuable guidance for personalized survival estimates and high-risk patient identification.

Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure

Importance

The widowhood effect, in which mortality increases and function decreases in the period following spousal death, may be heightened in older adults with functional impairment and serious illnesses, such as cancer, dementia, or organ failure, who are highly reliant on others, particularly spouses, for support. Yet there are limited data on widowhood among people with these conditions.

Objective

To determine the association of widowhood with function and mortality among older adults with dementia, cancer, or organ failure.

Design, Setting, and Participants

This longitudinal cohort study used population-based, nationally representative data from the Health and Retirement Study database linked to Medicare claims from 2008 to 2018. Participants were married or partnered community-dwelling adults aged 65 years and older with and without cancer, organ failure, or dementia and functional impairment (function score <9 of 11 points), matched on widowhood event and with follow-up until death or disenrollment. Analyses were conducted from September 2021 to May 2024.

Exposure

Widowhood.

Main Outcomes and Measures

Function score (range 0-11 points; 1 point for independence with each activity of daily living [ADL] or instrumental activity of daily living [IADL]; higher score indicates better function) and 1-year mortality.

Results

Among 13 824 participants (mean [SD] age, 70.1 [5.5] years; 6416 [46.4%] female; mean [SD] baseline function score, 10.2 [1.6] points; 1-year mortality: 0.4%) included, 5732 experienced widowhood. There were 319 matched pairs of people with dementia, 1738 matched pairs without dementia, 95 matched pairs with cancer, 2637 matched pairs without cancer, 85 matched pairs with organ failure, and 2705 matched pairs without organ failure. Compared with participants without these illnesses, widowhood was associated with a decline in function immediately following widowhood for people with cancer (change, -1.17 [95% CI, -2.10 to -0.23] points) or dementia (change, -1.00 [95% CI, -1.52 to -0.48] points) but not organ failure (change, -0.84 [95% CI, -1.69 to 0.00] points). Widowhood was also associated with increased 1-year mortality among people with cancer (hazard ratio [HR], 1.08 [95% CI, 1.04 to 1.13]) or dementia (HR, 1.14 [95% CI, 1.02 to 1.27]) but not organ failure (HR, 1.02 [95% CI, 0.98 to 1.06]).

Conclusions and Relevance

This cohort study found that widowhood was associated with increased functional decline and increased mortality in older adults with functional impairment and dementia or cancer. These findings suggest that persons with these conditions with high caregiver burden may experience a greater widowhood effect.

Association of marital status with cardiovascular death risk in patients with lung cancer: A population-based study

Background

To investigate the association of marital status on cardiovascular death risk in lung cancer patients.

Methods

Using data from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2011 to 2015 (N = 118,293), the association between marital status and cardiovascular death (CVD) risk in patients with lung cancer was assessed by competing-risks regression models.

Results

Unmarried status was associated with increased risk of cardiovascular death in lung cancer patients [hazard ratio (HR)  =  1.398, 95 % confidence interval (CI): 1.268-1.542], which remained significant even after adjusting for potential covariates (HR = 1.407, 95 % CI: 1.276-1.551). Further unmarried subgroups analysis showed that the different unmarried status were associated with increased cardiovascular death risk as follows: single (HR = 1.397, 95 % CI: 1.236-1.1.580), separated (HR = 1.630, 95 % CI: 1.153-2.305), divorced (HR = 1.318, 95 % CI: 1.158-1.500), and widowed (HR = 1.561, 95 % CI: 1.393-1.749). Further subgroup analysis by sex revealed that compared to male lung cancer patients with married, CVD risk was significant increased in their counterparts with widowed (adjusted HR = 1.509, 95 % CI: 1.291-1.764, P<0.001), single (adjusted HR = 1.361, 95 % CI: 1.168-1.585, P<0.001) and divorced (adjusted HR = 1.353, 95 % CI: 1.177-1.555, P<0.001) rather than those with separated. However, similar phenomena was only observed in female lung cancer patients with widowed (adjusted HR = 1.414, 95 % CI: 1.220-1.640, P<0.001) and single (adjusted HR = 1.438, 95 % CI: 1.195-1.730, P<0.001).

Conclusion

Unmarried status was associated with increased cardiovascular death risk in patients with lung cancer, which highlighted that more attention and humanistic/supportive care should be offered to unmarried lung cancer patients for improving the prognosis.

Marital status shows no protective effect on perioperative outcomes after robotic-assisted pulmonary lobectomy

Background

Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).

Methods

We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (N = 473). The Unmarried group included never married, divorced, and widowed individuals (N = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's t-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at p ≤ 0.05 .

Results

Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups.

Conclusion

This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.

Proportion trends, cancer stage, and survival of patients with cancer diagnosed through emergency and nonemergency departments: a nationwide cohort study

Introduction

To reduce mortality, the Taiwan government has vigorously promoted free cancer screening and preventive health screening services. Cancers are usually advanced by the time they are discovered in the emergency department. Through this study, we aimed to understand the characteristics of cancer patients diagnosed through the emergency department and thus identify high-risk populations by comparing cancer staging and survival rates in patients diagnosed in the emergency department and those diagnosed in the non-emergency department.

Methods

The retrospective study enrolled a total of 389,043 patients over the age of 20 who were newly diagnosed with one of the five major cancers (including lung cancer, colorectal cancer, breast cancer, prostate cancer, and oral cancer) between 2008 and 2017 and analyzed their diagnostic pathway, cancer stage at diagnosis, and survival time.

Results

Of the study participants, 59,423 patients (about 15.3%) were diagnosed with cancer through the emergency department. We found that a sizable proportion of older people and patients with low education and low incomes were diagnosed through emergency department visits, and those with a health condition comorbidity severity of 3 had the highest proportion diagnosed by the emergency department, advanced stages at diagnosis, and risk of death. These can be classified as high-risk groups. In addition, 76.4% of patients diagnosed in the emergency department had advanced cancer, and the risk of death was 1.46 times higher than that of patients diagnosed in the non-emergency department. Although cancer screening is available, it does not reduce the proportion of patients with advanced cancer who are diagnosed through or at the time of diagnosis in the emergency department.

Conclusions

The present study found that the government's cancer screening did not affect the proportion or number of cancers diagnosed through emergency department visits. Therefore, the government should focus on more cancer screening, health education in high-risk groups, and strengthening the link between emergency and oncology departments to reduce the risk of death for patients diagnosed through emergency department visits.

Sociodemographic and clinicopathologic characteristics of patients treated with high dose rate prostate brachytherapy in Nigeria

Introduction

Prostate cancer is the most commonly diagnosed malignancy in adult males. High dose rate brachytherapy (HDRB) recently became available in the country for the management of localized prostate cancer in addition to other treatment modalities. HDRB offers a less invasive option to radical prostatectomy and also has a better side effects profile.

Aim

To report the socio-demographic features of the patients treated with HDRB, the clinicopathologic pattern of their disease and possible predictors of these features.

Methods

A retrospective study of patients with histopathologically confirmed prostate cancer, who had HDRB at the Department of Radiation Oncology, University College Hospital, Ibadan, Nigeria, between July 2020 and 2023 was done. Patients' socio-demographic and clinicopathologic characteristics were extracted from their treatment records.

Results

A total of 73 patients had HDRB within the period under review. The median age was 66 years (51-78 years). About 40% had prostate cancer diagnosed following routine prostate-specific antigen (PSA) screening. The median screening PSA was 20.5 ng/mL (5.83-75.35 ng/mL). About a quarter (24.7%) were asymptomatic at presentation while frequency (60.3%), nocturia (45.2%) and urgency (35.6%) were the most common symptoms. The median initial PSA was 26.00 ng/mL (5.10-124.50 ng/mL) and the median PSA before brachytherapy was 6.25 ng/mL (0.03-175.30 ng/mL), the majority (75.3%) had androgen deprivation therapy before brachytherapy. Forty-seven patients (64.4%) presented with TNM stages 1 and 2 while grade group 2 (24.7%) and high risk (76.7%) were the commonest grade group and risk group, respectively. There was a significant association between age group and TNM stage (p = 0.043), level of education (LOE) and TNM stage (p = 0.037) as well as PSA screening and grade group (p = 0.007).

Conclusion

The majority of the patients who presented for prostate brachytherapy were elderly, had higher initial PSA, were in the high-risk group and had early-stage disease. About 25% of the patients were asymptomatic at presentation. Patients with tertiary LOE and elderly patients presented more with stage 1 and 2 diseases.

Mental Health Challenges in Cancer Patients: A Cross-Sectional Analysis of Depression and Anxiety

Advancements in cancer treatment and early detection have extended survival rates, transforming many cancers into chronic conditions. However, cancer diagnosis and treatment can trigger significant psychological distress, including depression and anxiety, impacting patient outcomes and care. This study aimed to examine the prevalence of and identify the risk factors for depression and anxiety among cancer patients. A cross-sectional study was conducted, including patients under the care of the oncology department at a tertiary medical center between June 2021 and October 2023. Depression and anxiety were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. Logistic regression analysis identified risk factors for depression and anxiety. The study population included 159 patients, with 40.3% reporting worsening mental health, but only about half of them received therapy. Among the study participants, 22.6% experienced symptoms of depression and 30.2% experienced symptoms of anxiety. Single-cancer patients and those with metastases were at increased risk for depression, while those with a disease duration of more than a year and patients with female-specific cancer were more likely to experience anxiety. Given the high prevalence of mental health deterioration in cancer patients, closer monitoring and validated assessment tools are essential to improve depression and anxiety diagnosis and facilitate early interventions.

A nomogram and risk stratification system for predicting survival in T1-2N0-1 breast cancer patients with liver metastasis in females: a population-based study

PURPOSE

Liver was one of the most common distant metastatic sites in breast cancer. Patients with distant metastasis were identified as American Joint Committee on Cancer (AJCC) stage IV indicating poor prognosis. However, few studies have predicted the survival in females with T1-2N0-1 breast cancer who developed liver metastasis. This study aimed to explore the clinical features of these patients and establish a nomogram to predict their overall survival.

RESULTS

1923 patients were randomly divided into training (n = 1154) and validation (n = 769) cohorts. Univariate and multivariate analysis showed that age, marital status, race, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), chemotherapy, surgery and bone metastasis, brain metastasis were considered the independent prognostic indicators. We developed a nomogram according to these ten parameters. The consistency index (c-index) was 0.72 (95% confidence interval CI 0.70-0.74) in the training cohort, 0.72 (95% CI 0.69-0.74) in the validation cohort. Calibration plots indicated that the nomogram-predicted survival was consistent with the recorded 1-, 3- and 5-year prognoses. Decision curve analysis curves in both the training and validation cohorts demonstrated that the nomogram showed better prediction than the AJCC TNM (8th) staging system. Kaplan Meier curve based on the risk stratification system showed that the low-risk group had a better prognosis than the high-risk group (P < 0.001).

CONCLUSIONS

A predictive nomogram and risk stratification system were constructed to assess prognosis in T1-2N0-1 breast cancer patients with liver metastasis in females. The risk model established in this study had good predictive performance and could provide personalized clinical decision-making for future clinical work.

Evolving patterns in systemic treatment utilization and survival among older patients with advanced cutaneous melanoma

INTRODUCTION

In the last decade, melanoma treatment has improved significantly. However, data on population-level treatment utilization and survival trends among older patients is limited. This study aimed to analyze trends in systemic anticancer therapy (Rx), including the uptake of immune checkpoint inhibitors (ICIs), in conjunction with trends in cause-specific survival among older patients (66+) diagnosed with advanced melanoma (2008-2019).

METHODS

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare Condensed Resource to assess any Rx utilization among patients first diagnosed with advanced melanoma in 2008-2010, 2011-2014, and 2015-2019, stratified by stage, and type of first-line Rx among patients receiving Rx. The SEER dataset was used to evaluate trends in cause-specific survival by year of diagnosis.

RESULTS

Rx utilization (any type) almost doubled, from 28.6% (2008-2010) to 55.4% (2015-2019) for stage 3 melanoma, and from 35.5% to 68.0% for stage 4 melanoma. In 2008-2010, the standard first-line treatment was cytokines/cytotoxic chemotherapy/other. By 2015-2019, only 5.1% (stage 3) and <3.6% (stage 4) of patients receiving Rx received these agents, as ICIs emerged as the dominant treatment. Both 1-year and 5-year cause-specific survival significantly improved since 2010 for stage 4 and since 2013 for stage 3.

CONCLUSIONS

This study shows a significant rise in Rx utilization and a rapid transition from cytokines/cytotoxic chemotherapy to ICIs, reflecting a rapid uptake of highly effective treatment in a previously challenging disease with limited options before 2011. The documented survival improvement aligns with the adoption of these novel treatments, underscoring their significant impact on real-world patient outcomes.

Estimating the prevalence of mental disorders in patients with newly diagnosed cancer in relation to socioeconomic status: a multicenter prospective observational study

BACKGROUND

The purpose of this study was to provide the 4-week prevalence estimates of mental disorders in newly diagnosed cancer patients in relation to socioeconomic status (SES).

PATIENTS AND METHODS

We enrolled newly diagnosed patients with a confirmed solid tumor within 2 months of diagnosis. We calculated patients' SES on the basis of their educational level, professional qualification, income and occupational status. We used the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Clinical Version (SCID-5-CV) to assess the 4-week prevalence of mental disorders in addition to a comorbidity questionnaire to assess the level of physical impairment.

RESULTS

We identified a total of 1702 patients with mixed cancers after reviewing their medical records and contacting them in person or by post due to coronavirus pandemic patient safety restrictions. 1030 patients (53.2% men, mean age 60.2 years) had completed SCID-5-CV. When weighted according to the SES distribution to account for over- and under-sampling of SES groups, 20.9% [95% confidence interval (CI) 18.1% to 23.6%] of patients were diagnosed with any mental disorder. The most prevalent were depressive disorders (9.9%, 95% CI 7.9% to 11.9%), trauma and stress-related disorders (6.3%, 95% CI 4.7% to 7.9%) and anxiety disorders (4.2%, 95% CI 2.9% to 5.6%). We found no difference in any mental disorder between patients with high, medium or low SES. Multivariate logistic regression analyses revealed higher proportion of patients with any mental disorder in patients younger than 60 years [odds ratio (OR) 0.42; P < 0.001], in patients without a partner (OR 1.84; P < 0.001), in women with tumor in female genital organs (OR 2.45; P < 0.002) and in those with a higher level of impairment (OR 1.05, 95% CI 1.03-1.07; P < 0.001).

CONCLUSIONS

SES had no significant influence on mental comorbidity in early cancer survivorship.

Unmarried Status Effect on Stage at Presentation and Treatment Patterns in Non-Metastatic Upper Tract Urothelial Carcinoma Patients

BACKGROUND

Unmarried status has been associated with higher proportions of locally advanced stage and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused on the association between unmarried status and advanced stage (T3-4N0-2) at presentation and lower nephroureterectomy (RNU) and systemic therapy (ST) rates in non-metastatic upper tract urothelial carcinoma (UTUC) patients.

METHODS

Using the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, all non-metastatic UTUC patients were identified. Multivariable logistic regression models (LRMs) tested for differences in stage at presentation and treatment (RNU and ST) according to marital status (married vs unmarried), in a sex-specific fashion.

RESULTS

Of all 8544 non-metastatic UTUC patients, 4748 (56%) were male vs 3190 (44%) were female. Of all 4748 male UTUC patients, 1191 (25%) were unmarried. Of all 3190 female UTUC patients, 1608 (50%) were unmarried. In multivariable LRMs predicting RNU, unmarried status was an independent predictor of lower RNU rates in male (Odds Ratio [OR]: 0.56; P < .001), but not in female (OR: 0.81; P = .1) non-metastatic UTUC patients. In multivariable LRMs predicting ST exposure, unmarried status was an independent predictor of lower ST rates in both male (OR:0.73; P = .03) and female (OR:0.64; P < .001) UTUC patients. In multivariable LRMs predicting locally advanced stage (T3-4N0-2), unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male (OR: 0.95; P = .5) or female (OR: 0.99; P = .9) UTUC patients.

CONCLUSIONS

Unmarried male UTUC patients appear at risk of less being able to access RNU, relative to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Conversely, unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male or female UTUC patients.

Pair bond quality influences social conditioned place preference expression, passive coping behavior, and central oxytocin receptor expression following partner loss in male prairie voles

The dissolving of social bonds is disruptive and leads to increased stress responsivity and a strong desire for reunion. The oxytocin (OXT) system is critical for the formation of social attachments, such as pair bonds, and is also involved in social recognition, social memory, and social vigilance. Therefore, long-term changes in the OXT system resulting from cohabitation and pair bonding may contribute to reunion-seeking behavior. Here, we employed social conditioned place preference (SCPP) and the forced swim test (FST) to examine sensitivity to partner-associated contexts and passive stress coping following a period of partner separation. We found that opposite-sex cohabitation led to SCPP formation only in male prairie voles with a strong preference for their partner, and this SCPP was maintained following short-term loss of a pair bonded partner. Furthermore, pair bonded males that were separated from their partner displayed more passive stress-coping than those that were not bonded to their lost partner, suggesting that differences in prairie vole mating tactics (i.e. formation of a bond or not) influence the behavioral response to partner separation. Finally, we found changes in OXTR binding that may reflect variation in loss-related behavioral phenotypes based on different mating strategies.