Cancer Follow-up Research Articles

Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals

IntroductionLittle is known as to how prolonged screening recommendations for cervical cancer have affected compliance. ObjectiveWe examined compliance with repeat cervical cancer screening among U.S. women aged 30–64 who underwent index screening between 2013 and 2019. Study designThe IBM Watson Health MarketScan Database was used to identify commercially-insured women 30–64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5–4 years after index cytology and 4.5–6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. ResultsOf 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. ConclusionAppropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.

Evaluation of a remote monitoring app in head and neck cancer follow-up care.

A remote monitoring app was developed for head and neck cancer (HNC) follow-up during the SARS-CoV-2 pandemic. This mixed-methods study provides insight in the usability and patients' experiences with the app to develop recommendations for future use. Patients were invited to participate if they were treated for HNC, used the app at least once and were in clinical follow-up. A subset was selected for semi-structured interviews through purposive sampling considering gender and age. This study was conducted between September 2021-May 2022 at a Dutch university medical center. 135 of the 216 invited patients completed the questionnaire, resulting in a total mHealth usability score of 4.72 (± 1.13) out of 7. Thirteen semi-structured interviews revealed 12 barriers and 11 facilitators. Most of them occurred at the level of the app itself. For example, patients received no feedback when all their answers were normal. The app made patients feel more responsible over their follow-up, but could not fulfill the need for personal contact with the attending physician. Patients felt that the app could replace some of the outpatient follow-up visits. Our app is user-friendly, makes patients feel more in control and remote monitoring can reduce the frequency of outpatient follow-up visits. The barriers that emerged must be resolved before the app can be used in regular HNC follow-up. Future studies should investigate the appropriate ratio of remote monitoring to outpatient follow-up visits and the cost-effectiveness of remote monitoring in oncology care on a larger scale.

Evaluation of the capability and reproducibility of RECIST 1.1. measurements by technologists in breast cancer follow-up: a pilot study

The evaluation of tumor follow-up according to RECIST 1.1 has become essential in clinical practice given its role in therapeutic decision making. At the same time, radiologists are facing an increase in activity while facing a shortage. Radiographic technologists could contribute to the follow-up of these measures, but no studies have evaluated their ability to perform them. Ninety breast cancer patients were performed three CT follow-ups between September 2017 and August 2021. 270 follow-up treatment CT scans were analyzed including 445 target lesions. The rate of agreement of classifications RECIST 1.1 between five technologists and radiologists yielded moderate (k value between 0.47 and 0.52) and substantial (k value = 0.62 and k = 0.67) agreement values. 112 CT were classified as progressive disease (PD) by the radiologists, and 414 new lesions were identified. The analysis showed a percentage of strict agreement of progressive disease classification between reader-technologists and radiologists ranging from substantial to almost perfect agreement (range 73–97%). Analysis of intra-observer agreement was strong at almost perfect (k > 0.78) for 3 technologists. These results are encouraging regarding the ability of selected technologists to perform measurements according to RECIST 1.1 criteria by CT scan with good identification of disease progression.

MRI for detection, staging, and follow-up of prostate cancer: Synthesis of the PI-RADS v2.1, MET-RADS, PRECISE, and PI-RR guidelines

Prostate cancer is very common among men. Radiology, mainly through MRI, plays a key role in the different stages of prostate cancer: diagnosis, staging and treatment assessment. The correct management of MRI requires knowledge and proper use of the different guidelines developed for the acquisition, interpretation and reporting of MRI in diagnosis (PI-RADS guide), whole body staging (MET-RADS guide), active surveillance (PRECISE guide) and local recurrence (PI-RR guide) in prostate cancer. The objective of this article is to show an update and synthesis of the most relevant aspects of these MRI guidelines for an optimal use and thus providing a more effective management of prostate cancer.

A cross-sectional study of 73,390 women without ovarian cancer and the effect of age and benign gynecological diseases on serum CA125 levels.

e17500 Background: As an important tumor marker for follow-up and prognosis of ovarian cancer, CA125 is not suitable as a screening indicator due to its frequent elevation in many physiological or pathological condition, thus women are often puzzled by unaccountably elevated levels of CA125. While we have known that the CA125 level is differed by age and benign gynecological diseases, the specific trend of CA125 level changes is still not clear. We hope that this study will contribute to a more accurate and individual interpretation of CA125 by evaluating the baseline levels of CA125 in healthy women of different ages and analysis the association between benign gynecological diseases and CA125 level. Methods: This was a cross-sectional study enrolled 73390 women without ovarian cancer from January 2016 to December 2021 in three health examination centers. We have assessed the distribution of CA125 levels in different age groups and analyzed the variation trend of CA125 levels by age among women with normal ultrasonic results, as well as performed the correlation analysis between several benign gynecological diseases and CA125 levels. Results: 55422 women with normal ultrasonic results and CA125 level <200U/mL were included in the analysis of variations in CA125 depending on age. We observed CA125 levels were linearly associated with age (R2=0.0503, p<0.0001). Using the group <30 years as a baseline, average CA125 levels decreased by 3.4%, 10.1%, 42.6%, 40.5%, 31.8%, and 20.3% by every 10 years. With the increase of age, the downward trend of CA125 began to reverse at the age of 60, and it showed significantly difference between each adjacent subgroup (p<0.05). 8630 women were selected with abnormal ultrasonic results, we observed that CA125 was lower in women with uterine effusion, higher in endometrial hyperplasia, endometrial polyps, hydrosalpinx, ovarian cyst, adenomyosis and uterine fibroids. Age and all those diseases demonstrated possible associations (p<0.05) with CA125 levels ≥35U/ml in univariable logistic regressions. Multivariable analysis identified that ovarian cyst (p<0.001), adenomyosis (p<0.001) and uterine fibroids (p=0.018) were still significantly associated with abnormal CA125 level. Conclusions: With the increase of age, CA125 level generally showed a downward trend, but there is a slight increase in CA125 after age 60. Ovarian cyst, adenomyosis and uterine fibroids demonstrated significant associations with abnormal CA125 level. [Table: see text]

Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review.

Surveillance is the preferred management strategy for most men with clinical stage I testicular cancer after orchiectomy. However, frequent office visits, imaging tests, and laboratory studies place a significant burden on patients, which may contribute to poor compliance with guideline-recommended surveillance regimens. Identifying strategies to overcome these barriers may help improve quality of life, reduce costs, and improve adherence for patients. We reviewed evidence for three strategies that may help with surveillance redesign: telemedicine, implementing microRNA (miRNA) as a biomarker, and novel imaging protocols. A web-based literature search for novel imaging strategies, diagnostic utility of miRNA, and telehealth as they relate to early-stage testicular germ cell cancer was completed during the month of August 2022. We focused our search on contemporary PubMed-indexed and Google Scholar-registered manuscripts written in English. Supportive data sourced from current guideline statements were also included. Evidence was compiled for narrative review. Telemedicine is a safe and acceptable platform for urologic cancer follow-up care, but it requires further study specifically among men with testicular cancer. Access to care may either be improved or reduced depending on system- and patient-level characteristics and should be implemented with this in mind. miRNA may potentially be a helpful biomarker for men with localized disease, but further research on diagnostic accuracy and marker kinetics are needed before implementing it into routine surveillance strategies or using it to deviate from long-standing surveillance regiments. Novel imaging strategies with less frequent imaging and the use of magnetic resonance imaging (MRI) instead of computed tomography (CT) appear to be non-inferior in clinical trials. However, use of MRI requires expert radiologist availability and may be more costly with a lower ability to detect small, early recurrences when used in routine practice. Using telemedicine, integrating miRNA as a tumor marker, and adopting less intensive imaging strategies may improve guideline-concordant surveillance for men with localized testicular cancer. Future studies are needed to assess the risks and benefits of using these novel approaches separately or together.

Developing electronic clinical quality measures to assess the cancer diagnostic process.

Measures of diagnostic performance in cancer are underdeveloped. Electronic clinical quality measures (eCQMs) to assess quality of cancer diagnosis could help quantify and improve diagnostic performance. We developed 2 eCQMs to assess diagnostic evaluation of red-flag clinical findings for colorectal (CRC; based on abnormal stool-based cancer screening tests or labs suggestive of iron deficiency anemia) and lung (abnormal chest imaging) cancer. The 2 eCQMs quantified rates of red-flag follow-up in CRC and lung cancer using electronic health record data repositories at 2 large healthcare systems. Each measure used clinical data to identify abnormal results, evidence of appropriate follow-up, and exclusions that signified follow-up was unnecessary. Clinicians reviewed 100 positive and 20 negative randomly selected records for each eCQM at each site to validate accuracy and categorized missed opportunities related to system, provider, or patient factors. We implemented the CRC eCQM at both sites, while the lung cancer eCQM was only implemented at the VA due to lack of structured data indicating level of cancer suspicion on most chest imaging results at Geisinger. For the CRC eCQM, the rate of appropriate follow-up was 36.0% (26 746/74 314 patients) in the VA after removing clinical exclusions and 41.1% at Geisinger (1009/2461 patients; P < .001). Similarly, the rate of appropriate evaluation for lung cancer in the VA was 61.5% (25 166/40 924 patients). Reviewers most frequently attributed missed opportunities at both sites to provider factors (84 of 157). We implemented 2 eCQMs to evaluate the diagnostic process in cancer at 2 large health systems. Health care organizations can use these eCQMs to monitor diagnostic performance related to cancer.

Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment.

It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors' preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. Attributes identified can be used in future DCE studies to elicit cancer survivors' preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.

Digital solution in the follow-up of early breast cancer a randomized study

Background After primary treatment, patients with early breast cancer (EBC) are followed-up for at least 5 years. At the Helsinki University Hospital (HUS) surveillance includes appointments at 1, 3 and 5 years, and between pre-planned visits a phone call service operated by a nurse practitioner for counseling about symptoms related to side-effects or potential recurrence. In 2015 HUS launched a digital solution for cancer patients. This study was designed to find out patient preference, Health related (HR) quality of life (QOL) and satisfaction with a digital solution compared to a phone call service during the first year of follow-up. Material and methods Patients with EBC were randomized at the final visit of radiotherapy to surveillance by phone calls or by the digital Noona solution during the first year outside pre-planned visits. After six months the groups were crossed over to the other arm. Primary endpoint was patient preference for either follow-up method among those who had contacted the study nurse at least once by both phone service and digital solution. Results Out of the 765 patients randomized, 142 had contacted the hospital with both methods and were eligible for inclusion in the analyses of the present study. Out of the 142 patients, 56 preferred phone calls, 43 the digital solution while 43 considered both modalities equal. Preference for the digital solution was higher among patients aged 65 or less. There were no differences in HR QoL or overall satisfaction between the modalities. However, the patients rated the timeliness of response better while using the digital solution. Conclusion Of the patients 30% preferred the digital solution, 40% phone calls while 30% found them equal as the primary follow-up method for EBC during the first year outside pre-planned visits. There is a need to include also digital solutions in surveillance of EBC. ClinicalTrials.gov Identifier NCT04980989

Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings

This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings. Data were from 2016 to 2019 and were analyzed in 2022, reflecting sites within the Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations Research Center, part of the Population-based Research to Optimize the Screening Process consortium, including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients (i.e., no previous abnormalities) by race and ethnicity as captured in the electronic health record, using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression was conducted to assess how clinical, socioeconomic, and structural characteristics mediate observed differences. Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year study period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%,) and Asian/Pacific Islander (66.5%) than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by the distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for a variety of clinical and sociodemographic factors (risk ratio=1.14, CI=1.12, 1.16). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing (versus receiving co-testing). Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001). In a large cohort receiving care across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% coverage targets. Lower screening for Black patients was attenuated by controlling for insurance and site of care, underscoring the role of systemic inequity. In addition, it is crucial to improve follow-up after abnormalities are identified, which was low for all populations.

Whole-Body MRI in Musculoskeletal Oncology: A Comprehensive Review with Recommendations.

Whole-body (WB) MRI has emerged as an attractive method for oncologic evaluation, potentially replacing conventional imaging modalities and providing a one-step wide-coverage assessment of both the skeleton and soft tissues. In addition to providing anatomic information, WB MRI may also yield a functional analysis with the inclusion of diffusion-weighted imaging (DWI). DWI translates microstructural changes, resulting in an excellent alternative to fluorodeoxyglucose PET/CT. WB MRI (with DWI) offers comparable accuracy to PET/CT and has the advantage of avoiding ionizing radiation. Technological advances and the development of faster protocols have prompted greater accessibility of WB MRI, with growing applications in routine practice for the diagnosis, staging, and follow-up of cancer. This review discusses the technical considerations, clinical applications, and accuracy of WB MRI in musculoskeletal oncology. Keywords: Pediatrics, MR Imaging, Skeletal-Axial, Skeletal-Appendicular, Soft Tissues/Skin, Bone Marrow, Extremities, Oncology, Musculoskeletal Imaging © RSNA, 2023.

Risk factors of lymph node metastasis in patients with T1b gallbladder cancer

BACKGROUND: Whether radical surgery or simple cholecystectomy should be performed on patients with stage T1b gallbladder cancer remains controversial. To explore the effect of lymph node metastasis on the prognosis of patients with stage T1b gallbladder cancer is very crucial for guiding the treatment and follow-up of T1b gallbladder cancer patients.METHODS: A retrospective analysis of the surveillance, epidemiology and end results (SEER) database was performed. Patients with stage T1b gallbladder cancer that underwent surgery and pathologic nodal staging were identified. Logistic regression and Cox regression were performed to identify independent predictors and prognostic factors, respectively.RESULTS: Of 427 patients (age: 69.1±13.2 years, 72.1% females), 31 (7.2%) had lymph node metastasis. In multivariable analysis, higher histology grade was independent risk factor associated with the diagnosis of the patient lymph node metastasis. In the entire cohort, lymph node metastasis indicated a worse overall survival (HR [95%CI]: 3.83 (1.54-9.47), P<0.01) and disease-specific survival (HR [95%CI]: 3.46(1.54-7.82), P<0.01) in multivariable analysis. Lymph node metastasis, in multivariable analysis, showed statistical difference for worse OS (HR [95%CI]: 4.04(1.20-13.65), P=0.02) and DSS (HR [95%CI]: 3.25(1.10-9.57), P=0.03) in moderately differentiation group.CONCLUSIONS: Higher histology grade was an independent risk factor for lymph node metastasis. Lymph node metastasis was an independent prognostic factor of worse OS and DSS. Lymph node metastasis showed statistical difference for worse OS and DSS in moderately and advanced differentiation groups, a finding that could guide the choice of surgery.

Development of a Pap-Hub to Ensure Up-to-Date Cervical Cancer Screening and Follow-Up [ID: 1375247

INTRODUCTION: Complex American Society for Colposcopy and Cervical Pathology guidelines for cervical cancer screening compound challenges in ensuring proper follow-up for patients. We describe a “Pap-Hub” system for coordinating up-to-date screening and follow-up for patients and report preliminary outcomes on 10 years of data. METHODS: A retrospective analysis of Pap smear screening and follow-up data was conducted for patients in two health care systems (A and B) using the “Pap-Hub.” Clinician and patient surveys were administered to detail thoughts on systems effect on care coordination. RESULTS: Institution A managed 99,708 patients over 3 years. 76,842 patients (77%) had all recommended screening, follow-up, and or HPV vaccinations. Of these patients, 56,910 (74%) were screened and 60,744 (79%) completed their vaccination series. Institution B managed 81,795 patients over 3 years. 61,484 (75%) had all recommended screening, follow-up, and or HPV vaccinations. Of these patients, 46,630 (76%) were screened, and 46,756 (76%) completed their vaccination series. Screening rates at both institutions equaled or exceeded national rates each year. 50 patient survey responses have been completed. Forty-four patients (88%) reported that the system made results “much easier to understand” compared to electronic messages or letters. Ten percent (n=5) and 76% (n=38) of patients felt that it made them “more likely” or “much more likely” to follow up, respectively. CONCLUSION: The Pap-Hub system simplifies cervical cancer screening and follow-up. With ongoing data analysis and increasing patient and clinician survey responses, we aim to describe the scope of its effect for over 200,000 patients over 10 years.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

A call for nurse practitioner-led cancer survivorship clinics: The need for development and adoption within Ontario, Canada.

The growing prevalence of cancer survivors requiring comprehensive follow-up care after the completion of treatment is placing a significant strain on the Canadian healthcare system (Moura et al., 2022). Given the current landscape and the higher workload demands that are further exacerbated by shortages in healthcare staffing, the oncology specialist-led care, as the standard model for survivorship care is unsustainable and suboptimal in addressing a broad range of physical, psychosocial, supportive, informational, and rehabilitative needs of cancer survivors (Brennan et al., 2010; Canadian Partnership Against Cancer & Canadian Association of Provincial Cancer Agencies, 2010). Nurse-led models of survivorship care provided by oncology nurse practitioners (NPs) have been shown to be safe, effective, feasible, and appropriate for follow-up care (Chan et al., 2018). In the province of Ontario, survivorship care is provided mostly by physicians. Specialized NP-led survivorship clinics or programs are currently lacking based on a recent environmental scan. This paper outlines current barriers and opportunities in NP-led survivorship care. This is a call to action and for advocacy regarding the examination of oncology services and outlines the need for the development and implementation of NP-led survivorship clinics in Ontario, Canada.

Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening.

The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part I of a two-part series that focuses on prostate cancer screening. Please refer to Part II for discussion of initial and repeat biopsies as well as biopsy technique. The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsy, and biopsy technique. Prostate-specific antigen (PSA)-based prostate cancer screening in combination with shared decision-making (SDM) is recommended. Current data regarding risk from population-based cohorts provide a basis for longer screening intervals and tailored screening, and the use of available online risk calculators is encouraged.

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy.

The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part II of a two-part series focusing on initial and repeat biopsies, and biopsy technique. Please refer to Part I for discussion of initial prostate cancer screening recommendations. The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsies, and biopsy technique. The evaluation of prostate cancer risk should be focused on the detection of clinically significant prostate cancer (Grade Group 2 or higher [GG2+]). The use of laboratory biomarkers, prostate MRI, and biopsy techniques described herein may improve detection and safety when a prostate biopsy is deemed necessary following prostate cancer screening.

Detection of the ADGRG6 hotspot mutations in urine for bladder cancer early screening by ARMS-qPCR.

In bladder cancer, recurrent ADGRG6 enhancer hotspot mutations (chr. 6: 142,706,206 G>A, chr. 6:142,706,209 C>T) were reported at a high mutation rate of approximately 50%. Thus, ADGRG6 enhancer mutation status might be a candidate for diagnostic biomarker. To improve test efficacy, an amplification refractory mutation system combined with quantitative real-time PCR (ARMS-qPCR) assay was developed to detect the ADGRG6 mutations in a patient as a clinical diagnostic test. To validate the performance of the ARMS-qPCR assay, artificial plasmids, cell DNA reference standard were used as templates, respectively. To test the clinical diagnostic ability, we detected the cell free DNA (cfDNA) and sediment DNA (sDNA) of 30 bladder cancer patients' urine by ARMS-qPCR comparing with Sanger sequencing, followed by the droplet digital PCR to confirm the results. We also tested the urine of 100 healthy individuals and 90 patients whose diagnoses urinary tract infections or urinary stones but not bladder cancer. Sensitivity of 100% and specificity of 96.7% were achieved when the mutation rate of the artificial plasmid was 1%, and sensitivity of 96.7% and specificity of 100% were achieved when the mutation frequency of the reference standard was 0.5%. Sanger sequencing and ARMS-qPCR both detected 30 cases of bladder cancer with 93.3% agreement. For the remaining unmatched sites, ARMS-qPCR results were consistent with droplet digital PCR. Among 100 healthy individuals, three of them carried hotspot mutations by way of ARMS-qPCR. Of 90 patients with urinary tract infections or urinary stones, no mutations were found by ARMS-qPCR. Based on clinical detection, the ARMS-qPCR assay's sensitivity is 83.3%, specificity is 98.4%. We here present a novel urine test for ADGRG6 hotspot mutations with high accuracy and sensitivity, which may potentially serve as a rapid and non-invasive tool for bladder cancer early screening and follow-up relapse monitoring.

Detection and Molecular Characterization of Circulating Tumour Cells: Challenges for the Clinical Setting.

Over the last decade, liquid biopsy has gained much attention as a powerful tool in personalized medicine since it enables monitoring cancer evolution and follow-up of cancer patients in real time. Through minimally invasive procedures, liquid biopsy provides important information through the analysis of circulating tumour cells (CTCs) and circulating tumour-derived material, such as circulating tumour DNA (ctDNA), circulating miRNAs (cfmiRNAs) and extracellular vehicles (EVs). CTC analysis has already had an important impact on the prognosis, detection of minimal residual disease (MRD), treatment selection and monitoring of cancer patients. Numerous clinical trials nowadays include a liquid biopsy arm. CTC analysis is now an exponentially expanding field in almost all types of solid cancers. Functional studies, mainly based on CTC-derived cell-lines and CTC-derived explants (CDx), provide important insights into the metastatic process. The purpose of this review is to summarize the latest findings on the clinical significance of CTCs for the management of cancer patients, covering the last four years. This review focuses on providing a comprehensive overview of CTC analysis in breast, prostate and non-small-cell lung cancer. The unique potential of CTC single-cell analysis for understanding metastasis biology, and the importance of quality control and standardization of methodologies used in this field, is also discussed.

Are education and cohabitation associated with health-related quality of life and self-management during breast cancer follow-up? A longitudinal study

Background Oncologist-led follow-up after breast cancer (BC) is increasingly replaced with less intensive follow-up based on higher self-management, which may overburden the less resourceful patients. We examined whether socioeconomic factors measured recently after the implementation of a new follow-up program for BC patients were associated with health-related quality of life (HRQoL) and self-management 12 months later. Methodology Between January and August 2017, we invited 1773 patients in Region Zealand, Denmark, to participate in baseline and 12 months follow-up questionnaires. The patients had surgery for low- and intermediate risk BC 1–10 years prior to the survey, and they had recently been allocated to the new follow-up program of either patient-initiated follow-up, or in-person or telephone follow-up with a nurse, based on patients’ preferences. We examined associations between socioeconomic factors (education and cohabitation) at baseline and two outcomes: HRQoL (EORTC QLQ-C30 and QLQ-BR23) and self-management factors (health care provider, confidence in follow-up, contact at symptoms of concern, and self-efficacy) at 12 months follow-up. Sensitivity analyses were performed according to time since diagnosis (≤ 5 > 5 years). Furthermore, we investigated whether treatment and self-management factors modified the associations. Results A total of 987 patients were included in the analyses. We found no statistically significant associations between socioeconomic factors and HRQoL, except in patients ≤ 5 years from diagnosis. For self-management patients with short education were more likely to report that they had not experience relevant symptoms of concern compared to those with medium/long education (OR 1.75 95% CI: 1.04; 2.95). We found no clear patterns indicating that treatment or self-management factors modified the associations between socioeconomics’ and HRQoL. Conclusion Overall socioeconomic factors did not influence HRQoL and self-management factors except for experiencing and reporting relevant symptoms of concern. Socioeconomic factors may, however, influence HRQoL in patients within five years of diagnosis.