Oncology Research Articles

Pregnancy after cancer: FIGO Best practice advice.

Pregnancy after cancer: FIGO Best practice advice.

Personalized Care for Pancreatic Cancer: Harnessing Patient-Derived Organoids.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal cancers. Surgical resection combined with appropriate chemotherapy currently offers the best chance for long-term survival and potential cure. However, effective treatment is hindered by the limited chemotherapy options and the absence of reliable clinical tools to guide chemotherapy selection. Patient-derived organoids (PDOs) have emerged as a promising technology with the potential in precision medicine for PDAC. This review provides an overview of pancreatic organoid genesis, explores the role of PDOs in elucidating PDAC biology within clinically relevant contexts, and concludes by examining current literature on the utility of PDOs as biomarkers for personalized treatment strategies.

Fertility counseling in early-onset colorectal cancer and the impact of patient characteristics.

This study evaluated how frequently patients with early onset colorectal cancer received fertility counseling and whether patient characteristics affected the likelihood of receiving such counseling. We conducted a single-center retrospective review of all new patients seen by medical oncology for colorectal cancer who were age 55years or younger for men and 50years or younger for women. Associations between patient demographics and clinical characteristics with receipt of fertility counseling were explored using univariate analyses and multivariable logistical regression analyses. A total of 194 patients were included, of whom 15.5% received fertility counseling. Using multivariate analysis, we found that age < 40 (OR 15.587, p < 0.0001, 95% CI 4.841-50.191) and female sex (OR 3.979, p = 0.0292, 95% CI 1.150-13.770) were correlated with increased likelihood of fertility counseling. Patients living in areas of higher household income were more likely to receive fertility counseling, with a statistically significant difference between the 3rd and 1st quartiles of income (p = 0.0369, 95% CI 1.161-115.940). A majority of patients with EOCRC did not receive fertility counseling despite the known toxicities of CRC treatment modalities on fertility. Older age, male sex, and residence in areas of lower income were associated with decreased likelihood of receiving fertility counseling.

A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer

PurposeWomen diagnosed with breast cancer (BC) and gynecological cancer (GC) face psychological and existential challenges common to all cancers, such as anxiety and depression, along with specific issues related to body image and sexuality. Logotherapy and meaning-centered therapy (MCT) have shown positive effects on the psychological well-being of cancer patients.MethodsA systematic review was conducted following PRISMA guidelines to assess the impact of logotherapy and meaning-centered therapy (MCT) on women diagnosed with BC and GC from January 2014 to December 2024. Empirical research articles published in English were included, while literature reviews, meta-analyses, doctoral theses, preprints, books, and studies involving other cancer types or metastatic/comorbid conditions were excluded. The search was conducted across Web of Science, Scopus, and PubMed databases using terms like uterine cancer, ovarian cancer, breast cancer, mastectomy, logotherapy, and MCT. The Boolean operators AND and OR were used in the Title and search fields across all three databases, as well as in the Topic search field for the WoS database.ResultsOut of the 36 articles initially obtained, 29 remained after eliminating duplicates and, finally, six papers were selected. The included studies examined various psychological and existential issues in patients with breast and gynecological cancer, including anxiety, distress, depression, hopelessness, death anxiety, post-traumatic stress, perception of physical symptoms, quality of life, post-traumatic growth, spiritual well-being, and meaning in life.ConclusionFindings suggest that logotherapy decreases depressive symptoms, anxiety, and post-traumatic stress, whereas improves meaning in life, quality of life, physical symptom perception, and post-traumatic growth in women with BC and GC. Implementing logotherapy in cancer care units through a multidisciplinary approach could be valuable, considering biopsychosocial factors, and incorporating aspects of self-image and sexuality in treatment would also be beneficial.

Patient-level simulation models in cancer care: a systematic review

Patient-level simulation models in cancer care: a systematic review

Examining the Experience and Preferences of Patients with Advanced Cancer at a Tertiary Care Center.

Background and Objectives: Cancer care has been transformed with the advent of new personalized and targeted therapies, and the integration of specialist palliative care (PC). Comparatively little is understood about the patient experience in this modern context. This study aims to examine the experience of oncology patients receiving treatment at a tertiary care center. Design, Settings, and Measurements: We recruited patients with advanced solid cancer (N = 200) from medical oncology clinics of the Duke Cancer Institute. Participants completed the modified COMPASS questionnaire (mCOMPASS), assessing a broad range of topics including quality of life (QoL), quality of care (QoC), health care utilization, and preferences for treatment and decision making. We summarized responses descriptively and used regression models to examine associations between variables of interest. Results: The survey response rate was 56.1%. Patients unaware of their advanced cancer diagnosis (21.2%) reported better QoL than patients who were aware of their diagnosis (+2.667, 95% CI: -4.459,9.793, p < 0.05). Despite all having advanced cancer diagnoses, most participants did not receive PC services (85.0%) and approximately half (49.2%) reported having an advance care plan (ACP). Those receiving PC services had lower (worse) mean QoL scores (-11.32, 95% CI: -19.26, -3.39, p < 0.05). Those reporting prognostic awareness were more likely to have an ACP and have discussed their treatment preferences with family members (p < 0.05). Conclusion: Patients with advanced cancer undergoing treatment at a large tertiary cancer center exhibit high QoL and awareness of PC, but the underuse of PC services persists. The relationship between poor prognostic awareness and better QoL warrants further examination.

Improving the usability of grading scales for drug-induced ototoxicity with a focus on real world data collection.

Chemotherapy induced ototoxicity (e.g. by cisplatin) is a regularly occurring although underreported challenge in clinical practice. Several reviews of ototoxicity monitoring throughout clinical trials reveal difficulty in estimating the incidence due to the use of different scales and classification systems. In this communication, we introduce a scale to improve the assessment of ototoxicity during routine cancer care incorporating patient reported outcomes. Combining and updating the existing ototoxicity scales to develop a new and universally applicable grading scale. The developed scale includes all types of ototoxicity (hearing loss as well as tinnitus) and combines audiogram measurements with patient reported outcomes. Using a single scale for assessing and grading ototoxicity in routine care as well as in clinical trials may improve the current understanding of the actual incidence and actual patient burden of this toxicity. In addition, it could enhance the opportunities for intervention and/or aural rehabilitation.

The benefits of telehealth in promoting equity in blood cancer care – results of a multi-stakeholder forum and narrative review

Aims Therapeutic advancements have significantly improved patient outcomes in blood cancers. However, stark racial and ethnic disparities persist in treatment and access to care. Telehealth offers a promising solution to these disparities by using electronic and telecommunication technologies to deliver healthcare services remotely. Ensuring access to telehealth depends not just on the technologies, but on the broader enabling environment, especially policy harmonization, communications infrastructure, and skills. This paper aims to advocate for the expanded use of telehealth in blood cancer management, highlighting its potential to improve equity and outcomes. Materials and methods An expert forum discussion results informed this narrative review which was performed to better understand the applied Telehealth solutions and the expected benefits. The forum discussion and the literature review findings were aggregated and reviewed by subject-matter experts and patient advocates with personal experience in blood cancer. Results Our review of the literature yielded 18 relevant papers. Studies included patients from various disease areas; some studies used broader definitions of cancer to include more patients (i.e., acute leukemias and malignant lymphomas), while others were more specific to a particular condition. The identified Telehealth solutions were classified into two groups: solutions focusing on electronic consultation (n = 10) and solutions focusing on a specific intervention to improve patients’ health status (n = 8). A larger variety of outcomes were found in these studies, including quality of life, patient and clinicians’ acceptance, adherence, costs, and resource use. Conclusions Initial findings demonstrate that telehealth can potentially improve patient outcomes for people living with blood cancer, including improved patient quality of life, increased clinician acceptance, better adherence, and reduced costs and resource use to the health system. While evidence for virtual consultations show promising results, further research is needed due to the variety of study settings evaluated in this review. Providers and health systems need additional data on the positive economic impact of Telehealth related to the diagnostic journey and access to treatment.

Impact of Telemedicine for Lung Cancer Care during the COVID-19 Pandemic: Interrupted Time Series Analysis

Introduction: The COVID-19 pandemic greatly challenged the health systems and cancer care. Objective: To estimate the impact of telemedicine on outpatient visits (OPV) to reduce disease exposure for patients and healthcare providers and minimize the effect on cancer care continuum during the COVID-19 pandemic. Method: Longitudinal quasi-experimental time series using the institutional electronic medical records from January 2018 to December 2021, considering the implementation of telemedicine services in the first and second waves of COVID-19 in March and November 2020, respectively. The primary outcomes were a mean (A) monthly-overall-OPV, (B) monthlyin- person-OPV, (C) monthly-overall-cancer-OPV, and (D) monthly-in-person-cancer-OPV. Results: A total of 5,918 OPV were analyzed. 55.3% of the visits were for females, 87% were White, and the mean age was 66 years. Telemedicine accounted for 25.8% of the visits and 27.7% were cancer-related. White, Black, and Asian patients had a similar percentage of use of telemedicine (26.3%, 25.0%, and 26.8%), while Latinos were less likely to use telemedicine (18%, p=0.018). For outcomes (A) and (C), including telemedicine, the COVID-19 surges did not significantly impact the mean OPV. When telemedicine was not used, there was a statistically significant decline in overall in-person OPV (B) and cancer (D). In the first COVID-19 surge, telemedicine prevented a decrease in monthly-overall-OPV of 59.1% (p=0.001) and 40.9% (p=0.019) for cancer. In the second surge, these values were 64.4% (p=0.001) for monthly-overall-OPV and 59.8% for cancer (p=0.001). Conclusion: The use of telemedicine positively impacted the care for cancer patients in a thoracic surgery service.

Immunotherapy-Boosted Stereotactic Ablative Radiotherapy in Inoperable Early-Stage Non-Small Cell Lung Cancer.

The combination of stereotactic ablative radiotherapy (SABR) with immune checkpoint inhibitors, known as iSABR, marks a significant evolution in treating early-stage, inoperable non-small cell lung cancer (NSCLC). Managing these cases requires a multidisciplinary approach involving radiation and medical oncologists. Clinical evidence from a meta-analysis of seven studies, including 462 patients, indicates that iSABR may offer better outcomes than SABR alone. The analysis showed significantly improved progression-free survival (PFS) rates at 1-, 2-, and 3-year follow-ups for iSABR compared to SABR. There was also a trend toward better overall survival (OS) with iSABR. Subgroup analyses highlighted enhanced 3-year PFS with programmed death-1 (PD-1) inhibitors and doses per fraction ≥ 12.5Gy. While iSABR slightly increased the risk of grade ≥ 3 adverse events like pneumonitis, fatigue, and skin reactions, these risks are generally manageable within a multidisciplinary treatment framework. In conclusion, iSABR demonstrates potential benefits and manageable risks in phase I/II trials for early-stage, inoperable NSCLC, with improved PFS and acceptable toxicity. These findings warrant further investigation in a larger phase III prospective randomized controlled trial to validate efficacy, optimize protocols, and establish long-term safety.

‘More stressful than cancer’: treatment experiences lived during Hurricane Maria among breast and colorectal cancer patients in Puerto Rico

BackgroundIn September 2017, Hurricane Maria, a Category 4 storm, struck Puerto Rico, causing widespread structural damage, prolonged power outages, and severe flooding. The devastation profoundly affected the island’s infrastructure and population. Patients with chronic diseases, particularly cancer, face distinct challenges and healthcare needs during and after disasters. This study examined and documented the narratives of breast and colorectal cancer patients regarding their experiences with cancer care and treatment disruptions during Hurricanes Irma and Maria in Puerto Rico diagnosed six months before September 2017.MethodsA total of three focus groups were conducted in San Juan and Ponce. Colorectal and breast cancer patients were recruited in collaboration with the Puerto Rico Central Cancer Registry. The interviews were coded using a grounded theory approach.Results40% of the participants interviewed reported that their treatment was interrupted due to hurricane Maria. Focus groups narratives indicated that the most prevalent themes were (a) barriers and facilitators related to their cancer treatment, (b) experiences in treatment, and (c) stressors related to the hurricane. Participants discussed their struggles regarding their treatment experience, access to care during and after the hurricane and describe household challenges due to lack of electricity and water, which deter their intention to continue their treatment.ConclusionStressors directly linked with the disaster were most challenging to cope with. Our data highlights the impending need to address cancer patients in future emergency plans to minimize the delay in continuing cancer care.

The use of complementary and alternative medicine among cancer patients in Hawaii

Complementary and alternative medicine (CAM) are medical products and practices that are not part of standard medical care. Various studies demonstrate benefits of CAM use in alleviating cancer related side effects. However, data involving the use of CAM therapies among cancer patients is limited. Hawaii has a unique and diverse population and trends in CAM use could reveal important aspects of cancer care. We distributed questionnaires to various cancer treatment centers across Oahu. The questionnaires were optional and anonymous. We evaluated 126 questionnaires and analyzed CAM use. We collected participant data including: cancer type, treatments used (surgery, radiation, chemotherapy) and patient demographics (age, gender, ethnicity, income, religion). We found that at least one CAM therapy is used by a majority of patients 72/126 (57.1%), while 54 (42.9%) do not use any CAM therapy. Among the CAM therapies, meditation and herbal supplements were most commonly used 26 (36.1%), followed by massage 25 (34.7%), yoga 18 (25%), CBD 17 (23.6%), THC 16 (22.2%), and acupuncture 14 (19.4%). Stress reduction was the most common symptom benefit noted for meditation, herbal supplement, massage, and yoga. Anxiety was another symptom benefit reported for meditation. THC and CBD are used for sleep, however, CBS was also used for pain reduction together with acupuncture. Among the patients who use CAM therapy (n = 72), 80.6% are female (n = 58) while only 8.3% are male (n = 6). Furthermore only, 18.3% (n = 23) of our respondents have spoken to a clinician about CAM. We discovered that stress reduction is a symptom benefit associated with the most commonly used CAM therapies by cancer patients in Hawaii. Other symptom benefits involve anxiety, pain, and sleep. The modalities utilized were similar to nonpharmacologic therapies recommended by the NCCN guidelines for cancer survivorship, with the exception of herbal supplements. There is a lack of physician discussion regarding CAM use, which could impact the cancer burden in Hawaii.

A rising tide lifts all boats in the personalized cancer care continuum for mNSCLC: bridging inequities in NGS fosters equity in targeted treatment.

Next-generation sequencing (NGS) testing in patients with metastatic non-small cell lung cancer (mNSCLC) identifies actionable driver oncogenes (ADO) and targeted treatment (TT). Potential inequities were evaluated in NGS testing and TT in patients with mNSCLC. This retrospective study used a nationwide electronic health record-derived deidentified database for patients ≥18 years diagnosed with mNSCLC between 4/2018 and 4/2024, ≥2 recorded visits, and follow-up ≥90 days post diagnosis. For TT, patients must have received NGS testing before first-line (1L) treatment and harbored ≥1 1L ADO. A total of 15392 patients with mNSCLC were included: 66% with commercial insurance, 16% with Medicare, 12% with other, 4% with Medicaid, and 3% with other government insurance. Patients with commercial insurance had significantly higher odds of receiving NGS testing vs Medicare, Medicaid, or other insurance. While patient characteristics varied across insurances, the effect of insurance type on NGS testing did not differ by race/ethnicity, age, or socioeconomic status (SES). Site of care was a significant effect modifier, with increased odds of NGS testing for community vs academic settings for commercial, Medicare, and other insurance and decreased odds for Medicaid. When all patients received NGS testing, significantly lower odds of receiving TT occurred for patients with SES 2 vs SES 1 (lowest); higher odds occurred for Asian vs white patients. Insurance is a key contributor to inequity in NGS testing. When all patients received NGS testing, equity was achieved in patients receiving TT, except those with lower SES, who potentially did not qualify for Medicaid.

The Effectiveness and Safety of Integrative Traditional Asian Medicine Therapy in Lung Cancer Patients Undergoing Cancer Standard Treatment: A Protocol for Systematic Review and Meta-analysis

BackgroundLung cancer remains one of the leading causes of cancer-related mortality worldwide, significantly impacting patient quality of life. Integrating Traditional Asian Medicine (TAM), such as acupuncture and herbal medicine, with standard cancer treatments may offer additional therapeutic benefits by improving efficacy and reducing adverse effects. However, the clinical evidence supporting this approach is inconsistent, necessitating a systematic evaluation.MethodsThis study protocol outlines a systematic review and meta-analysis to evaluate the effectiveness and safety of TAM as an adjunctive therapy for lung cancer patients undergoing standard treatments. Eligible studies include randomized controlled trials published in English, Korean, or Chinese up to June 2024. Data will be extracted from domestic and international databases, including PubMed, EMBASE, and KMBASE. Primary outcomes will assess tumor response using RECIST criteria, while secondary outcomes include survival rates, quality of life, and adverse effects. Statistical heterogeneity will guide the choice of fixed- or random-effects models during meta-analysis.DiscussionThis protocol aims to generate high-quality evidence supporting the integration of TAM in lung cancer care. Findings from this review may contribute to the development of clinical practice guidelines, enhancing patient outcomes and informing future research in integrative oncology.Trial RegistrationThis study has been registered in PROSPERO with the registration number CRD42024523418 on March 22, 2024.

RANO criteria for response assessment of brain metastases based on amino acid PET imaging.

Novel diagnostic and therapeutic opportunities are needed to improve medical care and outcome of patients with brain metastases, a frequent and severe complication of several cancer types. Currently, magnetic resonance imaging (MRI) is the primary method used for detection, treatment planning and disease monitoring in patients with brain metastases, but this method has limitations. These limitations mean that MRI can inform on lesion size but cannot directly measure the activity or viability of tumor tissue. Positron emission tomography (PET) imaging, however, can visualize metabolically active tumor cells and is therefore increasingly incorporated into cancer care to assess tumor burden and response to treatment. Here, we define the PET Response Assessment in Neuro-Oncology (RANO) for brain metastasis (BM) 1.0 criteria for metabolic response assessment of brain metastases using amino acid PET. By introducing an innovative endpoint for next-generation clinical trials, the PET RANO BM 1.0 criteria aim to facilitate development of novel therapies for patients with brain metastases.

The role of nanomedicine and artificial intelligence in cancer health care: individual applications and emerging integrations-a narrative review.

Cancer remains one of the deadliest diseases globally, significantly impacting patients' quality of life. Addressing the rising incidence of cancer deaths necessitates innovative approaches such as nanomedicine and artificial intelligence (AI). The convergence of nanomedicine and AI represents a transformative frontier in cancer healthcare, promising unprecedented advancements in diagnosis, treatment, and patient management. This narrative review explores the distinct applications of nanomedicine and AI in oncology, alongside their synergistic potential. Nanomedicine leverages nanoparticles for targeted drug delivery, enhancing therapeutic efficacy while minimizing adverse effects. Concurrently, AI algorithms facilitate early cancer detection, personalized treatment planning, and predictive analytics, thereby optimizing clinical outcomes. Emerging integrations of these technologies could transform cancer care by facilitating precise, personalized, and adaptive treatment strategies. This review synthesizes current research, highlights innovative individual applications, and discusses the emerging integrations of nanomedicine and AI in oncology. The goal is to provide a comprehensive understanding of how these cutting-edge technologies can collaboratively improve cancer diagnosis, treatment, and patient prognosis.

A Vision for Gastrin-Releasing Peptide Receptor Targeting for Imaging and Therapy: Perspective from Academia and Industry.

The gastrin-releasing peptide receptor (GRPR) is overexpressed in various cancers, including prostate cancer, breast cancer, small cell and non-small cell lung cancer, uterine and ovarian cancer, colon cancer, and gastrointestinal stromal tumors. This makes GRPR a multicancer target for theranostics, that is, molecular imaging and therapy. Here, we explore the current state of GRPR-targeted theranostics from bench to bedside, highlighting the preclinical development of various GRPR-targeting compounds and clinical applications. We review the role of GRPR-targeted molecular imaging for all stages of prostate cancer, breast cancer, and other tumors and provide a quo vadis GRPR. We aimed to offer a comprehensive overview of GRPR-targeted theranostics to inform researchers, clinicians, pharma, and regulators of the potential benefits and emerging opportunities in the pursuit of personalized precision cancer care.

Coordinating under constraint: a qualitative study of communication and teamwork along Ethiopia’s cervical cancer care continuum

BackgroundAs Ethiopia expands cervical cancer screening services, it urgently needs information to develop appropriate post-screening diagnostic and treatment services for women with abnormal results. Quality cancer care requires extensive coordination among multidisciplinary provider teams. This study explores experiences coordinating care among providers at multiple levels of the cancer-care continuum in Ethiopia.MethodsFrom February 2020 to January 2022, we conducted four focus group discussions (FGDs) and ten key-informant interviews with 34 purposively selected healthcare providers: health extension workers (HEWs) in communities; midwives and nurses at health centers; obstetrician-gynecologists at regional hospitals, and oncology nurses, oncologists, and pathologists at tertiary hospitals. FGDs and interviews were conducted in Amharic and audio-recorded. Audio transcripts were then simultaneously transcribed and translated into English for analysis. Investigators performed thematic analysis using inductive and deductive codes.ResultsWe found four themes: resource scarcity, care centralization, lack of formal coordination mechanisms, and recommendations. Themes were dynamically connected by eight sub-themes. Providers valued teamwork and coordination. However, severe shortages of cancer specialists and high patient loads left little time for communication and hampered the formation of stable care teams. Facilities lacked formal coordination systems, such as patient navigators and case managers. The relative centralization of cancer care specialists and equipment in the capital exacerbated coordination problems. It impeded pre- and post-treatment care communication between tertiary and secondary facilities and caused secondary facilities to unnecessarily refer patients because they lacked the resources to treat them locally. Referral communication was unidirectional, with lower-level providers communicating regularly to higher-level facilities but rarely receiving feedback. The exception was regular, structured feedback from primary facilities to HEWs. Lower-level providers wanted to learn whether their referrals were appropriate or completed, and many used informal channels to gain this information. Respondents recommend decentralizing cancer care services, significantly increasing staff and equipment investments, and adding liaison staff at secondary hospitals to track and communicate patient progress and counsel patients for referral.ConclusionsOur findings underscore the need to rapidly increase cancer specialist staff and regional cancer centers in Ethiopia and highlight the importance of developing robust coordination and feedback mechanisms at secondary and tertiary facilities.

Immunotherapy for resectable lung cancer.

Lung cancer remains a significant global health challenge, demanding innovative treatment strategies. Immune checkpoint blockade has revolutionized cancer care, leading to improved survival across advanced malignancies and has now become a standard therapy for earlier stage, resectable lung cancer. This review article consolidates the current landscape and future prospects of neoadjuvant and perioperative immunotherapy in lung cancer. The authors outline key findings from clinical trials in resectable lung cancer, including early efficacy, safety profiles, and emerging impact on disease recurrence, and overall survival. Additionally, this review elucidates the challenges encountered, including patient selection criteria, optimal treatment schedules, immune-related adverse events, and impact on surgery. This comprehensive analysis amalgamates current evidence with future directions, providing a roadmap for clinicians, researchers, and stakeholders to navigate the dynamic realm of immunotherapy for surgically resectable lung cancer.

EXERT-BCN: An Exercise Regimen Designed to Improve Body Composition, Functional Capacity, and Strength After Treatment for Breast Cancer With Nutrition Optimization.

Effective methods to improve body composition and metabolic/hormonal dysregulation are central to breast cancer care. We hypothesized that a nutrition regimen focused on food quality and an observed exercise regimen using high-load resistance training during or after cancer treatment would improve body composition and functional capacity. Forty-four women with breast cancer, including survivors on therapy and in surveillance, excluding chemotherapy, underwent a continuously monitored dose-escalated exercise regimen utilizing heavy weights and linear progression in an exercise oncology facility along with a diet focused on food quality and adequate protein intake. Dietary strategy was discussed during each exercise session and twice monthly meetings. Pre- and post-workout assessment of body composition, functional mobility, balance, activity levels, and quality of life were compared via paired T-test and Wilcoxon signed-rank test. Forty-four women completed the protocol, with a median age of 54 years and BMI of 30.3. Most participants reported cancer-related symptoms (79.5%). Across compound exercises, composite load lifted increased by 36.5% (P < .001) and bilateral Y-balance scores increased 18% (P < .001). A 6.6% reduction in body fat was observed (1.8 kg; P < .001) alongside a 1.4% increase in muscle mass (0.5 kg; P = .003). Resting metabolic rate increased by 0.8% (P = .018). Significant improvements were uniformly demonstrated across quality-of-life scores (European Quality of Life 5-Dimension Score, Patient Health Questionnaire 9 Depression Scale, and Generalized Anxiety Disorder 7 questionnaires). A 3-month regimen of nutrition counseling and high-intensity resistance training promoted significant muscle mass gain and adipose tissue loss, alongside significant improvements across body composition, strength, mobility, and functional status, and patient-reported quality of life.