History Of Cancer Research Articles

Evaluation of Knowledge, Attitudes, and Practices towards Colorectal Cancer in a Community in Mexico City: A Cross-Sectional Study Based on Surveys.

Colorectal cancer (CRC) is one of the most common and deadly neoplasms worldwide, with a growing burden in low- and middle-income countries, such as Mexico. This study seeks to evaluate the knowledge, attitudes, and practices related to CRC in a community in Mexico City. A cross-sectional survey was conducted between March and April 2023 among adults aged 45 to 74 residing in six neighborhoods of the Tlalpan borough in Mexico City. The questionnaire included sections on sociodemographic characteristics, medical family history, lifestyle habits, knowledge about CRC, attitudes towards prevention, and willingness to undergo screening. Data were analyzed using logistic regression models to identify factors associated with greater knowledge, attitudes, and practices. A total of 349 people were surveyed. A total of 35.2% reported knowing what CRC is, with greater knowledge of CRC being associated with higher education levels and having a family history of cancer. A total of 23.8% showed positive attitudes towards CRC screening, influenced by having a tertiary level of education. A total of 80.8% of participants expressed willingness to undergo CRC screening if offered, with lower intention observed among men. Levels of knowledge about CRC within the studied community are low, especially among those with lower education levels and without a family history of cancer. Intervention strategies should improve CRC education and foster positive attitudes towards early detection, particularly in high-risk groups.

Increased cancer incidence in patients with pre-existing heart failure: results from a French Nationwide Cohort study

Abstract Background It is unclear whether patients with a history of heart failure (HF) have an increased risk of developing cancer. Purpose To assess the incidence of cancer (all types) in patients with pre-existing HF compared with patients without known HF at a nationwide level. Secondary objectives include analysis by cancer site and impact on all-cause mortality. Methods We used the French National Administrative Health Data System (SNDS), a comprehensive database containing all health care information (outpatient and hospital) for 99% of the French population, to identify adult patients with a first diagnosis of HF (ICD-10 diagnosis code I50) between 2010 and 2019 and without a personal history of cancer before HF diagnosis. HF patients were matched for sex and age to HF-free and cancer-free individuals (3:1 ratio), randomly identified in the SNDS. Incident cancers were identified by corresponding ICD 10th codes. Results We found 330,867 adult patients with a first diagnosis of HF between 2010 and 2019, and 992,601 matched controls (54.7% women, mean age 77.7±13.5 years in both groups). There was an increased risk of a first cancer in HF patients as compared to controls: 28,151 (8.5%) in HF patients over a mean follow-up of 4.3±2.8 years vs. 77,325(7.8%) in controls over a mean follow-up of 4.9±2.8 years (unadjusted HR: 1.12 [1.11-1.13], P<0.001). The higher risk of new cancer in HF patients remained after adjustment for major comorbidities (i.e., ischemic heart disease, diabetes, arterial hypertension, renal dysfunction, morbid obesity), age, sex, year of diagnosis, region of residence, tobacco use and alcohol consumption (adjusted HR=1.06, [1.04-1.07]; P<0.0001). Overall, the estimated attributable risk of new cancer after HF was 16.53% (9.88-16.76%). This increased risk was observed for most solid malignancies (especially colorectal and lung cancer), and for multiple myeloma. We finally observed that the risk of all-cause mortality after cancer diagnosis was significantly higher in patients with pre-existing HF compared to controls (adjusted HR: 1.36 [1.33-1.39], P<0.001). Conclusions People with a history of HF have a higher risk of developing cancer than the general population. These findings suggest that cancer screening strategies should be encouraged in patients with HF.

Early rhythm control of atrial fibrillation in cancer survivors: a nationwide population-based cohort study

Abstract Background Though early rhythm control (ERC) in patients with atrial fibrillation (AF) is effective in reducing stroke, the benefit of ERC has not been well-elucidated in cancer survivors. This study aimed to compare the risk of ischemic stroke between ERC and usual care in cancer survivors with AF and cancer. Methods This nationwide observational study was conducted using the Korean National Health Insurance Service database. Patients aged 20 years or older with newly diagnosed AF between 2009 and 2018 were included. Patients who received rhythm control therapy within 1-year of AF diagnosis were defined as the ERC group, while the remaining patients were defined as the usual care group. The risk of ischemic stroke in the ERC group compared to the usual care group was evaluated in long-term cancer survivors (cancer diagnosis ≥5 years) and the non-cancer group. Results A total of 591,692 patients were included in the study (18,747 patients [3.2 %] with cancer, mean age 65.7±14.6 years, 53.7% men, mean CHA2DS2-VASc score 3.3±2.0). The proportion of patients receiving ERC was slightly higher in cancer survivors compared to the non-cancer group (28.0% vs 25.3%, p<0.001). During a mean 4-year follow-up, incident stroke occurred in 52,500 patients (1,338 in cancer survivors, 51,182 in non-cancer). The ERC group showed a lower risk of stroke than the usual care group, regardless of the presence of cancer history(Figure); adjusted hazard ratio [95% confidence interval] 0.67 [0.58-0.76] in cancer survivors, 0.76 [0.74-0.78] in the non-cancer group (p-for-interaction=0.125). The effect of ERC on the risk of ischemic stroke in cancer group was consistent across all subgroups, including different cancer types or use of chemotherapy. Conclusion ERC was associated with a lower risk of ischemic stroke among long-term cancer survivors. An integrated approach incorporating appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.

Clinical Assessment and Genetic Testing for Hereditary Polyposis Syndromes in an Italian Cohort of Patients with Colorectal Polyps.

Background: Hereditary polyposis syndromes are clinically and genetically heterogeneous conditions associated with increased colorectal cancer risk. They are classified based on polyp histology, inheritance mode, causal gene, and colonic and extracolonic manifestations. Their diagnosis is challenging due to overlapping and heterogeneous clinical presentations. Methods: A multigene next-generation sequencing panel was used to screen 75 index cases with colorectal polyps and a personal/family history of cancer for key hereditary polyposis-associated genes (APC, BMPR1A, MUTYH, PTEN, SMAD4, and STK11) in order to identify germline genetic variants. Results: In the screened index cases, we found 14 pathogenic variants involving APC, MUTYH, SMAD4, and STK11 and 6 variants of uncertain significance involving APC, BMPR1A, and SMAD4. In this cohort, four patients not fulfilling the recommended eligibility criteria of current National Comprehensive Cancer Network (NCCN) guidelines for genetic testing were molecularly diagnosed with a hereditary polyposis syndrome. Conclusions: Our findings indicate that stringent NCCN eligibility criteria for molecular screening may lead to missing some of the patients affected by hereditary polyposis syndromes. This highlights the need for a careful evaluation of patients' clinical manifestations, polyp number, age of polyp onset, and family history to select appropriate candidates for molecular diagnosis of these conditions.

Comparative characteristics of the blood cytokine profile in gastritis in schoolchildren with a family predisposition to gastric cancer and peptic ulcer

The formation of diseases of the gastric and duodenum in the adult population begins at school age. Among the leading risk factors for their formation are family predisposition (to peptic ulcer disease (PU), gastric cancer). The basis for their formation is gastritis, the course of which is actively influenced by cytokines. Aim. To study the characteristics of cytokine levels in blood serum in schoolchildren with gastritis and a family history of gastric cancer and peptic ulcer. A total of 179 schoolchildren with gastroenterological complaints were examined. All subjects underwent an endoscopic examination with biopsies taken from the antrum of the gastric and morphological confirmation of gastritis (Sydney classification). The presence of H. pylori was also determined by morphological method. The level of cytokines in the blood (IL-2, IL-4, IL-8, IL-18, IL- 1β, IFNα, TNFα) was determined by ELISA. The study found that schoolchildren with a burden of ulcer had a decreased IL-1β in comparison with children without aggravation (p = 0.005), and with children with a burden of cancer (p = 0.030). Also, IFNα was increased in schoolchildren with a burden of ulcerative disease (p = 0.001) and gastric cancer (p = 0.038). A decrease in IL-1β was found in children with aggravated ulcer disease, both with H. pylori infection (p = 0.048) and without it (p = 0.043). IL-1β plays an important role in the immune response to H. pylori infection. In addition, it is known that during H. pylori infection the level of IL-1β increases, which is accompanied by inhibition of gastric acidity. There was a decrease in IL-1β and an increase in IFNα in children with aggravated ulcer disease, regardless of the activity of inflammation. In addition, they observed an increase in TNFα (p = 0.04) with high gastritis activity (stage 2-3). In addition, in children with ulcer burden and high gastritis activity, IL-4 is increased (p = 0.018). Thus, in children with a family history of both peptic ulcers and gastric cancer, there are features of the association of specific cytokines with gastritis, as well as its activity and H. pylori infection.

Tuberculous Pleurisy in a Patient with a History of Breast Cancer: Diagnostic Challenges and Management Options

Background: Tuberculosis (TB) and cancer are increasingly prevalent diseases that can be challenging to diagnose due to similarities in clinical and radiological findings. This case report describes a 46-year-old woman with a history of breast cancer who developed tuberculous pleurisy (TP). Case presentation: A 46-year-old woman who underwent mastectomy and chemotherapy for BC in 2023 had hypertension, but no history of TB. The patient presented with dry cough, fever, and stomach discomfort, with an oxygen saturation level of 60%, but no respiratory distress before their appointment. Microscopy and culture tests were negative for Mycobacterium TB, A positive result was observed with an IFN-γ level of 0.35 IU/ml and 26% of the negative control after TB antigen stimulation. Histological analysis using hematoxylin and eosin staining showed Langhans giant cells, epithelioid cell granulomas, caseous necrosis, and necrotic foci. These findings indicate granulomatous inflammation with no signs of malignancy. Following the diagnosis, the patient received a daily dose of 300 mg isoniazid, 600 mg rifampin, 1500 mg pyrazinamide, and 10 mg pyridoxine for six months without any adverse effects. Conclusion: Physicians must employ a combination of diagnostic techniques, including morphological and microbiological confirmation, to accurately diagnose pleural effusion in this patient population.

Pre-malignant conditions diagnosed following a positive cancer signal from a multi-cancer early detection test.

Blood-based tests for multi-cancer early detection (MCED) are being developed to facilitate the detection of various cancer types. The Detecting cancers Earlier Through Elective mutation-based blood Collection and Testing study (DETECT-A) study evaluated an MCED test in 9,911 women, age 65-75, without personal history of cancer. In a post-hoc analysis, we report on the detection of precancerous neoplasms consequent to MCED testing and follow-up. Participants with positive baseline and confirmatory MCED testing underwent 2-deoxy-2[fluorine-18] fluoro-D-glucose positron emission tomography-computed tomography (PET-CT) and diagnostic evaluation as indicated by PET-CT results. We reviewed the electronic health records of participants with a precancerous neoplasm and summarized their clinical course. MCED results were positive in 134 participants. Clinically significant pre-malignant conditions were identified in three of these participants: A 71-year-old with an ovarian mucinous cystadenoma, a 67-year-old with an appendiceal mucinous neoplasm, and a 70-year-old with colon adenomas displaying high-grade dysplasia. All three participants underwent surgical treatment and remain alive and cancer-free as of last follow up. The diagnostic evaluation of a positive MCED test may occasionally reveal clinically significant pre-cancerous conditions amenable to interventions. The frequency of such findings and their clinical impact warrants further study.

PALB2 analysis in the diagnostic process of breast cancer: An Italian monocentric experience.

The clinical utility of germline BRCA1 and BRCA2 testing is well established in patients with family history suggestive for hereditary breast and ovarian cancer syndrome. Recently, germline PALB2 pathogenic variants were also associated with an increased risk of breast and other cancers and, in the Italian population, it has been described in few studies without a systematic germline analysis of BRCA1, BRCA2 and PALB2. In this study, we described ASST Sette Laghi cancer genetic counselling services' experience in the analysis of 402 patients with suspected breast and ovarian cancer syndrome, by using BRCA1, BRCA2 and PALB2 germline genetic test. The frequency of PALB2 pathogenic variants was 1.2% compared to 3.5% and 3.2% for BRCA1 and BRCA2, respectively, whereas class 3 variants were detected in 0.3% and 0.5% of the BRCA1 and BRCA2 investigated patients, respectively. PALB2 pathogenic variants were identified in patients with a strong family history for breast cancer. Moreover, PALB2 variants were significantly associated with a younger age of breast cancer onset (mean age, 40.25 years) compared to wild-type patients (mean age 51.2 years, p-value = 0.0331). Similar to BRCA-associated breast cancer, the majority of PALB2 breast cancers were identified at an advanced clinical stage. Pedigree analysis revealed a family history of breast and ovarian cancer syndrome in all PALB2 pathogenic variants carriers (early breast cancer onset, bilateral breast cancer and ovarian cancer). In conclusion, the germline analysis of BRCA1, BRCA2 and PALB2 should be included in breast cancer clinical practice as a not negligible number of PALB2 carriers could be identified and referred to specific surveillance protocols.

Why do older adults stop cancer screening? Findings from the Medicare Current Beneficiary Survey.

Prostate and breast cancer screening are prevalent among older adults, even among those unlikely to benefit. We aimed to evaluate why older adults stop cancer screening, including the role of physician recommendations. We used nationally representative data from the 2019 Medicare Current Beneficiary Survey (MCBS). We included women aged 76 and older without a history of breast cancer and men aged 71 and older without a history of prostate cancer. The primary outcome was reason for discontinuing screening, categorized as follows: (1) physician recommendation against screening; (2) absence of a recommendation to screen; and (3) patient-driven reason, such as patient preferences or beliefs. We evaluated reasons for screening discontinuation by health status and educational attainment using age-stratified multinomial logistic regression. The sample included 7350 participants representing a weighted population of 22,498,715. Overall, 53% of women underwent screening mammography in the past year or intended to continue screening. Among those who stopped screening, 5% reported a recommendation to stop screening from their doctor, 48% reported no recommendation, and 32% reported a patient-driven reason for cessation. Findings did not differ by educational attainment or health status, including among the oldest patients. For men, 61% were screened with PSA in the past year or intended to continue. Among those who stopped, 3% reported a recommendation against screening, 54% reported no recommendation, and 27% reported a patient-driven reason for cessation. Men with higher educational attainment were more likely to report that their physician recommended against screening (4% vs. 1%, p = 0.01) and that their doctor did not recommend screening (58% vs. 47%, p = 0.01). Reasons for screening cessation did not differ by health status, including among the oldest patients. Cancer screening remains common, even among those with limited potential for benefit, but discussions around screening cessation are rare. Improving communication between patients and physicians may improve screening decision quality.

Association of Fusobacterium nucleatum Levels by ddPCR in Oral Rinse Samples With Periodontal Disease in Oral Squamous Cell Carcinoma Patients and in Controls.

The role of microbiome, particularly Fusobacterium nucleatum (Fn), in periodontal disease and oral squamous cell carcinoma (OSCC) has been recently explored. This study aimed to evaluate the Fn presence and its levels in oral rinse samples from Brazilian OSCC patients and healthy individuals and its association with sociodemographic, clinical, and oral health features. In this case-control study, 80 participants were included, 31 OSCC patients and 49 individuals without a cancer history. Clinical data were collected, and an oral exam was done on a subset of the cohort. Fn levels were evaluated by droplet digital PCR (ddPCR) in oral rinse samples and were categorized as Fn-high or Fn-low based on the median number of copies per reaction. OSCC patients showed higher levels of Fn (68%, p = 0.03) than controls, and all OSCC cases were diagnosed with periodontal disease (100%, p = 1.0). In the univariate analysis, Fn-high level was more frequently present in OSCC cases compared to controls (p = 0.01). It was also observed that Fn-high level OSCC cases were significantly associated with self-reported non-white ethnicity (71.4%, p = 0.01) and had more infiltrative lesions (57.1%, p = 0.02) than Fn-low OSCC cases. Fn-high levels in oral rinse samples, were significantly more prevalent among OSCC than in controls. In OSCC patients, Fn-high levels were associated with non-white ethnicity and lesions with infiltrative clinical aspects. Among OSCC cases, all had periodontal disease.

Oncometabolites at the crossroads of genetic, epigenetic and ecological alterations in cancer.

By the time a tumor reaches clinical detectability, it contains around 108-109 cells. However, during tumor formation, significant cell loss occurs due to cell death. In some estimates, it could take up to a thousand cell generations, over a ~ 20-year life-span of a tumor, to reach clinical detectability, which would correspond to a "theoretical" generation of ~1030 cells. These rough calculations indicate that cancers are under negative selection. The fact that they thrive implies that they "evolve", and that their evolutionary trajectories are shaped by the pressure of the environment. Evolvability of a cancer is a function of its heterogeneity, which could be at the genetic, epigenetic, and ecological/microenvironmental levels [1]. These principles were summarized in a proposed classification in which Evo (evolutionary) and Eco (ecological) indexes are used to label cancers[1]. The Evo index addresses cancer cell-autonomous heterogeneity (genetic/epigenetic). The Eco index describes the ecological landscape (non-cell-autonomous) in terms of hazards to cancer survival and resources available. The reciprocal influence of Evo and Eco components is critical, as it can trigger self-sustaining loops that shape cancer evolvability [2]. Among the various hallmarks of cancer [3], metabolic alterations appear unique in that they intersect with both Evo and Eco components. This is partly because altered metabolism leads to the accumulation of oncometabolites. These oncometabolites have traditionally been viewed as mediators of non-cell-autonomous alterations in the cancer microenvironment. However, they are now increasingly recognized as inducers of genetic and epigenetic modifications. Thus, oncometabolites are uniquely positioned at the crossroads of genetic, epigenetic and ecological alterations in cancer. In this review, the mechanisms of action of oncometabolites will be summarized, together with their roles in the Evo and Eco phenotypic components of cancer evolvability. An evolutionary perspective of the impact of oncometabolites on the natural history of cancer will be presented.

Matched oligoclonal bands: Diagnostic utility and clinical characteristics.

To describe patient clinical characteristics associated with matched oligoclonal bands (OCB). A retrospective review at the University of Utah examined patients with matched OCB from 2015 to 2020. Clinical data, diagnosis, and outcomes were collected. Patients were classified with either multiple sclerosis (MS), other inflammatory neurologic disorder (other-IND), or noninflammatory neurologic disorder (NIND). Of 539 identified patients, 436 (53.4% female) were matched-only, while 103 (43.7% female) were matched + unique. Patients with matched-only bands were older (57.4 ± 16 vs. 52 ± 14.2, p < 0.001) and more likely to have a history of autoimmune disease (40.1% vs. 28.2%, p = 0.024) and/or cancer (28.7% vs. 16.5%, p = 0.012). Patients with matched + unique bands were more likely to have CSF pleocytosis (52.4% vs. 25.9%, p < 0.001), high IgG index (52.2% vs. 7.6%, p < 0.001), and an abnormal MRI (86.9% vs. 63.1%, p < 0.001). More than two-thirds of matched-only patients had NIND, while 33% and 41.7% of matched + unique patients had MS and other-IND, respectively. Patients exhibiting matched-only bands and a high IgG index demonstrated a significantly higher incidence of other-IND compared to those with matched-only bands and a normal IgG index (55.6% vs. 30.4%, p = 0.013). While Kaplan-Meier survival curves demonstrated higher mortality in the matched-only cohort compared to the matched + unique cohort (p = 0.02), multivariable Cox regression analysis showed this difference was not statistically significant when adjusting for various factors. A history of cancer was the significant predictor of increased mortality risk (Hazard ratio = 3.147, 95% CI [2.196, 4.51]). Patients with matched only versus matched + unique OCB have distinct clinical profiles.

A Rare Case of Orbital Metastasis from Invasive Lobular Carcinoma: Challenges of 18F-FDG PET/CT and the Search for Consensus on Imaging.

Invasive lobular carcinoma (ILC) frequently underlies orbital metastasis. A 74-y-old woman, who was current with mammograms and had no cancer history, presented to her ophthalmologist with visual complaints and was found to have metastatic ILC. MRI was contraindicated, and an 18F-FDG PET/CT scan revealed a mildly hypermetabolic right orbital mass and low uptake in the left subareolar breast, suggestive of metastatic ILC. Small studies have found that in ILC, 16α-18F-fluoroestradiol and fibroblast activation protein inhibitors are more avid than 18F-FDG. There is currently no consensus regarding imaging for ILC. Many people have contraindications to MRI, and the higher rate of false-negative findings on mammography for ILC than for other breast cancers makes this patient population more vulnerable to inaccurate staging, incorrect assessment of tumor burden, and, consequently, insufficient treatment. We provide this interesting case to highlight the potential of 18F-fluoroestradiol PET/CT and fibroblast activation protein inhibitors over 18F-FDG in this breast cancer subtype.

Nursing students' knowledge and related factors towards skin cancer: A systematic review

This systematic review aims to examine the nursing students' knowledge and related factors towards skin cancer. In order to conduct this comprehensive and review study, articles were searched from the earliest to April 1, 2023 using keywords extracted from Medical Subject Headings such as "knowledge", "skin cancer", and "nursing students" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The appraisal tool for cross-sectional studies (AXIS tool) was used to evaluate the quality of the studies included in this article. In total, 2,841 nursing students participated in five cross-sectional studies. The average age of the students was 20.93 (SD=1.89). 78.07% of the students in this study were female. 19.70% of students had a history of skin cancer in their family member. The average nursing students' knowledge and related factors towards skin cancer was 14.78 (SD=2.68) out of 25 which suggests a moderate level of knowledge. Factors such as year of study, female gender, age, using cosmetics, using depilatory wax, using epilating appliance, skin cancer caused by sun exposure, and protection of information have a significant positive relationship with nursing students' knowledge about skin cancer. However, knowledge had a negative relationship with factors such as using shaving, having mole, and having swelling. Additionally, the factors of father education, place of residence, sunburn frequency, source information had a significant relationship with nursing students' knowledge about skin cancer. According to the results of this review, the knowledge of nursing students in skin cancer is moderate. Therefore, nursing professors may contribute to the development of nursing students' knowledge by providing an online or physical education platform related to skin cancer.

Radiomic and clinical model for predicting atypical ductal hyperplasia upgrades and potentially reduce unnecessary surgical treatments

ObjectiveTo identify patients with atypical ductal hyperplasia (ADH) at low risk of upgrading to carcinoma. This study aims to assess the performance of radiomics combined with clinical factors to predict occult breast cancer among women diagnosed with ADH. MethodsThis study retrospectively included microcalcification clusters of patients who underwent Mx and VABB with a diagnosis of ADH at a tertiary center from January 2015 to May 2023. Clinical and radiological data (age, cluster size, BI-RADS classification, mammographic density, breast cancer history, residual microcalcifications) were collected. Surgical outcomes were used to determine upgrade. Four logistic regression models were developed to predict the risk of upgrade. The performance was evaluated using the area under the receiver operating characteristic curve (AUC) and performance scores. ResultsA total of 143 patients with 153 clusters were included. Twelve radiomic features and six clinical factors were selected for model development. The sample was split into 107 training and 46 test cases. Clinical features achieved an AUC of 0.72 (0.60–0.84), radiomic features an AUC of 0.73 (0.61–0.85). Radiomic features with “cluster size” and “age” improved the AUC to 0.79 (0.67–0.91). The best model, incorporating all data, achieved an AUC of 0.82 (0.71–0.92), a specificity of 0.89 (0.75, 0.97), and NPV of 0.92 (0.78–0.98). ConclusionThis study demonstrates the potential of radiomic as a valuable tool for reducing unnecessary treatments for patient classified as “low risk of ADH upgrade”. Combining radiomic information with clinical data improved the accuracy of risk prediction.

Effects of personal cancer history and genomic risk information on mothers' psychological adaptation to inherited breast/ovarian cancer syndrome.

This study aimed to understand long-term coping responses of mothers (N = 287) receiving genetic counseling and testing (GCT) for hereditary breast/ovarian cancer (HBOC) syndrome. Psychological characteristics, including cancer-specific distress (Impact of Events Scale-Revised, α = .85) and coping (Brief COPE, α = .93) were assessed via structured personal communication, along with epidemiologic items assessing personal and family history of cancer. Genetic risk was determined by BRCA1/2 carriage. A principal component analysis was conducted on the coping measure to reduce its summary score to active coping (α = .91) with nine approach-oriented strategies responsive to stress. A multivariable regression model examined the main and interacting effects of clinical and psychological characteristics on maternal coping. Personal cancer history (F = 4.99, df = 1, p = .026), BRCA test result (F = 22.20, df = 1, p < .001), and cancer-specific distress (F = 17.80, df = 1, p < .001) were associated with greater engagement in active coping strategies. When controlling for cancer-specific distress, the interaction between personal cancer history and genetic test results was significant, such that women previously unaffected by cancer who received positive BRCA results reported the greatest levels of active coping (F = 7.92, p < .001). These findings indicate that previous cancer history, genetic risk, and psychological distress independently and jointly impact how women adapt to the threat of cancer over time.

Association of initial serum sodium change and clinical outcome in patients with diabetes receiving sodium-glucose cotransporter-2 inhibitor therapy: A multicentre database analysis in Taiwan.

The study aimed to assess the impact of varying degrees of initial serum sodium change among patients with type 2 diabetes (T2D) starting sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy and their subsequent clinical outcome. We used medical data from a multicentre health care provider in Taiwan and recruited 4400 patients with T2D with baseline normal serum sodium (135-145 mmol/L) and follow-up serum sodium measures available after 3 months of SGLT2i treatment from 1 June 2016 to 31 December 2021. After a median of 2.9 (2.4, 3.4) months of SGLT2i treatment, overall, there was a minimal change in serum sodium levels (from 139.6 ± 2.4 to 139.5 ± 3.7 mmol/L). Most patients (87.8%) maintained normal sodium levels, while 8.6% (n = 378) experienced hyponatraemia (<135 mmol/L) and 3.6% (n = 158) hypernatraemia (>145 mmol/L). Factors independently associated with hyponatraemia included cancer history, chronic lung disease, insulin use, higher glycated haemoglobin, impaired liver function, lower baseline sodium and greater initial decline in kidney function. Conversely, factors linked to hypernatraemia included older age, absence of cancer history, loop diuretic and non-steroidal anti-inflammatory drug use, higher baseline sodium and a lesser initial decline in kidney function. Over a median of 26.0 months of follow-up, hyponatraemia shortly after starting SGLT2i therapy was associated with significantly increased risks of major adverse cardiovascular events [hazard ratio (HR): 2.52; 95% confidence interval (CI): 1.83-3.48], heart failure for hospitalization (HR: 1.66; 95% CI: 1.16-2.37), major adverse renal events (HR: 2.27; 95% CI: 1.73-2.96) and all-cause death (HR: 2.98; 95% CI: 2.17-4.11) after adjusting for clinically relevant factors. Non-linear analysis indicated that a more pronounced initial decline in serum sodium levels correlated steeply with higher risks of these adverse events. While most patients with T2D maintain stable serum sodium homeostasis on SGLT2i therapy, a subset may experience dysnatraemic events with potential worse clinical consequences. Physicians should be vigilant about monitoring sodium levels and considering the associated risks when initiating SGLT2i therapy in patients with risk.

Combined external radiotherapy and single-fraction palliative high-dose-rate interstitial brachytherapy for a patient with a base of tongue cancer who had a previous radiation history.

Only a few studies have explored whether high-dose-rate interstitial brachytherapy (HDR-ISBT) can be indicated as a palliative/symptomatic treatment. We present the good results of palliative treatment using HDR-ISBT combined with external beam radiotherapy (ERT) in a patient of base of tongue cancer (cT4aN1M0). The patient was an 81-year-old male who complained of local pain. He had a previous irradiation history for head and neck cancer receiving ERT with systemic chemotherapy and radical surgery 15years ago. Since it might be difficult for him to receive radical radiation doses using ERT alone, palliative ERT of relatively lower doses of 37.5Gy in 15 fractions was selected. One month after ERT, HDR-ISBT was implemented as a booster. Considering the burden on physical condition, single-fraction HDR-ISBT was selected. We employed a new technique in which we did not penetrate the ventral surface of the tongue to reduce the risk of infection and bleeding. The planning-aim dose was 9.5Gy. The dose that covered 90% of the clinical target volume was 9.6Gy. The treatment ended without any problems. Acute complications were not observed. The tumor size decreased, and local pain disappeared at post-treatment day 84. No late complications were observed. Two years and 8months after the treatment, the patient is alive without any obvious recurrence. Additional single-fraction HDR-ISBT boost may be a useful modality as a palliative/symptomatic intent. The implantation technique and dose-fraction schedule may be important for the safe treatment of older patients or those with poor performance status.

Analysis of the incidence of low viral load/low-level viremia and its associated factors in patients with HBV-related primary liver cancer

Objective: To retrospectively analyze the viral levels and associated factors in patients with hepatitis B virus (HBV)-related primary liver cancer (PHC) in real-world settings and further explore the correlation between low viral load (LVL) and/or low-level viremia (LLV) and PHC. Methods: Five hundred twenty-four cases with HBV-related PHC with complete pathologically confirmed data from 2013 to 2020 were included. Percentages (%) were used to express their viral load, antiviral (oral) status, patient compliance, presence or absence of cirrhosis, family history of liver cancer, and others. LVL definition: After excluding detection errors by PCR method, serum HBV DNA <50-2 000 IU/ml, and those who had received antiviral drug treatment were called LLV. Antiviral treatment (AVT) rate definition: As of the confirmed diagnosis of PHC, those who had been regularly treated using oral antiviral drugs for six months or more (≥6 months). Results: General situation: The ratio of male to female enrolled patients was 15.90:1 (493/31). Patients aged >40 years accounted for 91.98% (482 cases). Hepatitis B surface antigen (HBsAg) positivity condition: The ratio of HBsAg-positive to HBsAg-negative/anti-HBc-positive (HBsAg-/anti-HBc+) PHC patients was 5.89:1 (448/76). Among the 76 HBsAg-/anti-HBc+patients, the ratio of HBsAg-/anti-HBs+/anti-HBc+ to HBsAg-/anti-HBs-/anti-HBc+ patients was 0.95:1 (37/39). Hepatitis B e antigen (HBeA) positivity condition: The ratio of HBeAg-negative to HBeAg-positive cases was 3.23:1 (400/124). HBV DNA level condition: The medical history records of 75.00% of patients (393/524) had traceable HBV DNA test reports. Out of 393 patients, 45.04% (177/393) accounted for undetectable HBV DNA, 13.49% (53/393) accounted for LVL, 41.48% (163/393) accounted for HBV DNA exceeding the upper limit of LVL, and 4.07% (16/393) accounted for LLV. Among HBsAg-positive and HBsAg-/anti-HBc+ patients, the HBV DNA positivity rates were 59.12% (214/362) and 6.45% (2/31), respectively. Antiviral treatment condition: Among the 448 HBsAg-positive PHC patients, the total AVT rate was 18.08% (81/448), of which seven patients did not have their HBV DNA results traced back. Among them, the AVT rate of 148 patients with HBV DNA lower than the lowest detection value was 41.22% (61/148); the AVT rate of 53 patients with LVL was 18.87% (10/53); and the AVT rate of 163 patients with HBV DNA≥LVL upper limit was 1.84% (3/163). Liver cirrhosis and family history condition: 348 patients (66.41%) had liver cirrhosis. 67 patients (12.79%) had a distinct family history of HBV-related liver cirrhosis and liver cancer. Alpha-fetoprotein (AFP) condition: 514 patients underwent AFP testing, with 30.93% of the patients had normal AFP levels, and 69.07% had AFP levels exceeding the upper limit of normal values (355/514). Among them, 10 μg/L<AFP<400 μg/L and>400 μg/L accounted for 34.44% (177/514) and 34.63% (178/514), respectively. Tissue typing condition: 99.05% (519/524) were hepatocellular carcinoma, and well-differentiated and moderately differentiated cases accounted for only 8.59%. Conclusions: In the real world, comprehensive, timely screening, standardized, and effective antiviral treatment have not yet been achieved for patients with chronic hepatitis B, resulting in the persistence of HBsAg and/or HBV DNA positivity (especially LVL and/or LLV). Although LVL does not account for a high proportion among all HBV-related PHC populations, the vast majority of LVL populations have not received any antiviral treatment. In addition, some PHC populations with HBV DNA>2 000 IU/ml have not received standard antiviral treatment before the onset of the disease, which should be paid attention to. At the same time, HBsAg-/anti-HBc+ populations may have latent HBV infection and may even progress to PHC. Notably, PHC may still occur after HBeAg seronegative conversion.

Nurse-Led Care Versus Consultant-Led Usual Care in Patients with Thyroid Cancer: A Longitudinal Interventional Study

Background: The prognosis of thyroid cancer treatment is unsatisfactory in the presence of different independent parameters, such as older age, which may worsen the quality of life and mental health of patients. It is necessary to improve the quality of life and mental health of patients with thyroid cancer. Objectives: This study evaluated the nurse-led care impact as psycho-oncological support on anxiety and quality of life of patients with a history of thyroid cancer, comparing it to a consultant-led usual care and a non-care. Methods: Patients received half an hour of nurse-led care (NC cohort, n = 105), or consultant-led usual care (UC cohort, n = 125), or did not receive healthcare professional-led care (PO cohort, n = 135) at the institute during treatment and a follow-up period of 12 months. The EORTC QLQ-C30 Chinese version was used to assess the quality of life. Anxiety and depression were evaluated, using the Hospital Anxiety and Depression Scale. Results: Before the healthcare professional-led care, the quality of life scale score was 35 (36 - 33) and all patients had definitive anxiety and depression (scale score ≥ 11). After 12 months of the healthcare professional-led care, patients in the NC cohort showed improved quality of life and decreased anxiety and depression as compared to them before the healthcare professional-led care conditions and those of patients in the UC and PO cohorts after 12 months of the healthcare professional-led care (P &lt; 0.001 for all). A higher number of patients survived in the NC cohort than in the UC (P = 0.0327) and PO (P = 0.0014) cohorts. Personal satisfaction of patients was higher in the NC cohort than in the UC and PO cohorts (P &lt; 0.001 for both). Patient satisfaction was higher in the UC cohort than in the PO cohort (P &lt; 0.001). Conclusions: Supportive cancer care after surgery or during follow-up is necessary in patients with thyroid cancer. Nurse-led care had beneficial effects on the quality of life, psychological conditions, survival, and personal satisfaction of patients with thyroid cancer during the follow-up period.