Lancet Oncol Research Articles

Wearable devices: underrepresentation in the ageing society

Wearable devices: underrepresentation in the ageing society

DGBI overlap: a model for a transdiagnostic approach?

Disorders of gut–brain interaction (DGBI) are highly prevalent chronic gastrointestinal symptoms that are categorised into 33 disorders delineated by gastrointestinal anatomic region. 1 Drossman DA Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016; 150: 1262-1279 Summary Full Text Full Text PDF Google Scholar DGBI can occur in isolation, but frequently are present in combinations that affect multiple anatomic regions. The coexistence of multiple DBGI in an individual, termed overlap, has been linked to worse disease severity and quality of life. 2 Sperber AD Freud T Aziz I et al. Greater overlap of Rome IV disorders of gut–brain interactions leads to increased disease severity and poorer quality of life. Clin Gastroenterol Hepatol. 2022; 20: e945-e956 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar However, the actual prevalence of DGBI overlap and associated features have remained unknown until Thomas Fairlie and colleagues 3 Fairlie T Shah A Talley NJ et al. Overlap of disorders of gut–brain interaction: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online May 18)https://doi.org/10.1016/S2468-1253(23)00102-4 Google Scholar conducted a systematic review and meta-analysis on the topic. Among 46 studies including 75 682 adults with DGBI, the authors found that over a third (n=24 424, pooled prevalence 36·5% [95% CI 30·7–42·6]) had DBGI overlap. 3 Fairlie T Shah A Talley NJ et al. Overlap of disorders of gut–brain interaction: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online May 18)https://doi.org/10.1016/S2468-1253(23)00102-4 Google Scholar Overlap occurred more frequently in participants recruited from tertiary health-care settings, suggesting worse gastrointestinal symptoms, and was associated with increased psychological symptom severity and lower quality of life scores. Taken together, the authors conclude that overlap is common and a feature of DGBI disease severity. Overlap of disorders of gut–brain interaction: a systematic review and meta-analysisOverlap of DGBI subtypes is frequent, and is more prevalent in tertiary care settings and associated with more severe symptom manifestations or psychological comorbidities. Despite the large sample size, the comparative analyses revealed substantial heterogeneity, and the results should be interpreted with caution. Full-Text PDF

Valbenazine as treatment for Huntington's disease chorea

Chorea, the prototypical movement disorder in Huntington's disease, is a syndrome characterised by abrupt involuntary movements resulting from a continuous flow of random muscle contractions. 1 Cardoso F Seppi K Mair KJ Wenning GK Poewe W Seminar on choreas. Lancet Neurol. 2006; 5: 589-602 Summary Full Text Full Text PDF PubMed Scopus (220) Google Scholar Symptomatic treatment of chorea in patients with Huntington's disease should be considered when it causes functional disability, discomfort, or social embarrassment. 1 Cardoso F Seppi K Mair KJ Wenning GK Poewe W Seminar on choreas. Lancet Neurol. 2006; 5: 589-602 Summary Full Text Full Text PDF PubMed Scopus (220) Google Scholar One mainstay of pharmacological treatment is to reduce dopaminergic neurotransmission via inhibition of vesicular monoamine transporter type 2 (VMAT2), leading to presynaptic dopamine depletion. 2 Bashir H Jankovic J Treatment options for chorea. Expert Rev Neurother. 2018; 18: 51-63 Crossref PubMed Scopus (31) Google Scholar , 3 Koch J Shi WX Dashtipour K VMAT2 inhibitors for the treatment of hyperkinetic movement disorders. Pharmacol Ther. 2020; 212107580 Crossref Scopus (5) Google Scholar Safety and efficacy of valbenazine for the treatment of chorea associated with Huntington's disease (KINECT-HD): a phase 3, randomised, double-blind, placebo-controlled trialIn individuals with Huntington's disease, valbenazine resulted in improvement in chorea compared with placebo and was well tolerated. Continued research is needed to confirm the long-term safety and effectiveness of this medication throughout the disease course in individuals with Huntington's disease-related chorea. Full-Text PDF

Tonsillectomy in adults—to do or not to do

Recurrent acute tonsillitis describes the repeated occurrence of acute bacterial infections of palatine tonsils with symptom-free intervals. Acute tonsillitis accounts for around a third of respiratory tract infections in primary care among people of all ages, 1 Petersen I Johnson AM Islam A Duckworth G Livermore DM Hayward AC Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007; 335: 982 Crossref PubMed Scopus (210) Google Scholar with an estimated 600 million symptomatic cases of group A streptococcus tonsillitis worldwide annually. 2 Carapetis JR Steer AC Mulholland EK Weber M The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005; 5: 685-694 Summary Full Text Full Text PDF PubMed Scopus (1995) Google Scholar Recurrent episodes occur in 12% of patients with tonsillitis—ie, around 12 000 per 100 000 people. 3 Kvestad E Kværner KJ Røysamb E Tambs K Harris JR Magnus P Heritability of recurrent tonsillitis. Arch Otolaryngol Head Neck Surg. 2005; 131: 383-387 Crossref PubMed Scopus (26) Google Scholar Beyond the relation to group A streptococcus infections, little is known about risk factors for the development of recurrent acute tonsillitis. 4 Roberts AL Connolly KL Kirse DJ et al. Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage. BMC Pediatr. 2012; 12: 3 Crossref PubMed Scopus (97) Google Scholar Recurrent acute tonsillitis could be a genetic immunosusceptibility disease because patients younger than 12 years show some subclinical antibody deficiency and aberrant T-cell function 5 Dan JM Havenar-Daughton C Kendric K et al. Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Sci Transl Med. 2019; 11eaau3776 Crossref PubMed Scopus (1) Google Scholar and many undergo tonsillectomy. More than 30 000 tonsillectomies are performed annually in the UK. 6 Keltie K Donne A Daniel M et al. Paediatric tonsillectomy in England: a cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008–2019). Clin Otolaryngol. 2021; 46: 552-561 Crossref PubMed Scopus (16) Google Scholar Tonsillectomy can produce severe postoperative pain, complicated by postoperative bleeding which can result in death in rare cases. Clearly, we need evidence-based policies to guide health-care professionals for the indication of tonsillectomy. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Unfortunately, not much has changed in the past 40 years. National guidelines are still based on the Paradise criteria from 1984, 8 Paradise JL Bluestone CD Bachman RZ et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children—results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984; 310: 674-683 Crossref PubMed Google Scholar stating that a tonsillectomy is indicated when around seven or more treated tonsillitis episodes occur in 1 year. The Paradise criteria were based on paediatrics clinical trials and later extrapolated for adult guidelines without any justifying research in the adult population. Thus, the 2014 Cochrane Review concluded that the effectiveness of tonsillectomy is low. 9 Burton MJ Glasziou PP Chong LY Venekamp RP Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014; 2014CD001802 PubMed Google Scholar Until now, there was no basis to make confident decisions using national guidelines. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trialCompared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. Full-Text PDF Open Access

Cultural adaptation of interventions for common mental disorders

Most psychological interventions are developed and the evidence for their efficacy established in Western contexts. Such interventions often need to be culturally adapted when they are used in populations other than those for which they were developed. Cultural adaptation is the systematic modification of an evidence-based treatment or intervention protocol to consider the patient's language, culture, and context. 1 Bernal G Jiménez-Chafey MI Domenech Rodríguez MM Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof Psychol Res Pract. 2009; 40: 361-368 Crossref Scopus (449) Google Scholar Cultural adaptation is widely accepted as essential for the effective implementation of mental health interventions and achievement of mental health equity globally and within populations challenged by health disparities. 2 Wang Z Yang G Guo Y Harnessing the opportunity to achieve health equity in China. Lancet Public Health. 2021; 6: e867-e868 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 3 Ellis DM Draheim AA Anderson PL Culturally adapted digital mental health interventions for ethnic/racial minorities: a systematic review and meta-analysis. J Consult Clin Psychol. 2022; 90: 717-733 Crossref Scopus (4) Google Scholar , 4 Harper Shehadeh M Heim E Chowdhary N Maercker A Albanese E Cultural adaptation of minimally guided interventions for common mental disorders: a systematic review and meta-analysis. JMIR Ment Health. 2016; 3: e44 Crossref Google Scholar However, no systematic overview of studies of culturally sensitive interventions in people of Chinese descent, who represent more than a sixth of the global population had been done Efficacy of culturally adapted interventions for common mental disorders in people of Chinese descent: a systematic review and meta-analysisPsychological interventions can be transported across cultures with appropriate modifications. Adaptations to interventions can be made by modifying evidence-based interventions, or in culturally specific ways that are rooted in the sociocultural context. However, findings are limited by the insufficient reporting of interventions and cultural adaptations. Full-Text PDF Open Access

The Case Files

The Case Files

The long view of vaccination to secure the future

The long view of vaccination to secure the future

Mass drug administration in neglected tropical diseases: beyond elimination

Mass drug administration in neglected tropical diseases: beyond elimination

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough

SARS-CoV-2 in low-income countries: the need for sustained genomic surveillance

SARS-CoV-2 in low-income countries: the need for sustained genomic surveillance

Impact of the human papillomavirus vaccine in low-resource settings

Impact of the human papillomavirus vaccine in low-resource settings

Is RAPIDO too rapid for rectal cancer?

Is RAPIDO too rapid for rectal cancer?

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

The Importance of Patient-Focused Drug Development in Pemphigus and Pemphigoid

Report: Adverse outcomes in adolescence following early childhood disadvantage

Published by The Lancet Public Health, April 2023

Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1–2 cm

Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1–2 cm

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

Plain language summary of the updated results from the CROWN study comparing lorlatinib with crizotinib in people with advanced non-small-cell lung cancer.

This summary shows the updated results of an ongoing research study called CROWN that was published in The Lancet Respiratory Medicine in December 2022. In the CROWN study, researchers looked at the effects of two study medicines called lorlatinib and crizotinib. The study included people with advanced non-small-cell lung cancer (NSCLC) that had not been treated previously. All people in the study had cancer cells with changes (known as alterations) in a gene called anaplastic lymphoma kinase, or ALK. This ALK gene is involved in cancer growth. In this updated study, researchers looked at the continued benefit in people who took lorlatinib compared with people who took crizotinib after 3years. After 3years of being observed, people who took lorlatinib were more likely to be alive without their cancer getting worse than people who took crizotinib. At 3years, 64% of people who took lorlatinib were alive without their cancer getting worse compared with 19% of people who took crizotinib. The cancer was less likely to have spread within or to the brain in people who took lorlatinib than in people who took crizotinib. After 3years of being observed, 61% of people were still taking lorlatinib and 8% of people were still taking crizotinib. People who took lorlatinib had more severe side effects than people who took crizotinib. However, these side effects were manageable. The most common side effects with lorlatinib were high levels of cholesterol or high levels of triglycerides (a type of fat) in the blood. Life-threatening side effects were seen in 13% of people who took lorlatinib and 8% in crizotinib. Two people who took lorlatinib died because of side effects from lorlatinib. The updated results from the CROWN study showed that a larger percentage of people who took lorlatinib continued to benefit from their treatment after being observed for 3years compared with those who took crizotinib. Clinical Trial Registration: NCT03052608 (phase 3 CROWN study) (ClinicalTrials.gov).

Annual review of capillary electrophoresis technology in 2022

This article provides a detailed review of capillary electrophoresis (CE) technology in 2022, summarizing a total of 881 CE technology-related articles searched from ISI Web of Science using the keywords "capillary electrophoresis mass spectrometry" or "capillary isoelectric focusing" or "micellar electrokinetic chromatography" or "capillary electrophoresis" (excluding "capillary electrochromatography""microchip" "microfluidic" "capillary monolithic column"). The review focuses on 16 articles published in Lancet Global Health, ACS Central Science, Microbiome, Trends in Food Science & Technology, TrAC-Trends in Analytical Chemistry, Journal of Pharmaceutical Analysis, Journal of Cachexia, Sarcopenia and Muscle, Food Hydrocolloids, Science of the Total Environment, and Carbohydrate Polymers with impact factors (IFs) greater than 10.0, and 46 articles published in Analytical Chemistry, Analytica Chimica Acta, Talanta, and Food Chemistry with IFs between 5.0 and 10.0. A comprehensive overview of representative CE works published in Journal of Chromatography A, Electrophoresis, and important Chinese core journals (Peking University) with IFs<5.0 is also provided. Based on IFs, this review introduces representative works on CE to facilitate readers' understanding of important research advances in CE technology over the last year.

Metastatic prostate cancer management: 20 years of progress

Since 1940, patients with metastatic prostate cancer were given androgen deprivation therapy alone. In 2013, the addition of docetaxel improved progression-free survival and overall survival in patients with metastatic hormone-sensitive prostate cancer. 1 Gravis G Fizazi K Joly F et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013; 14: 149-158 Summary Full Text Full Text PDF PubMed Scopus (528) Google Scholar , 2 Sweeney CJ Chen YH Carducci M et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015; 373: 737-746 Crossref PubMed Scopus (1831) Google Scholar After 2013, the combination of abiraterone acetate plus prednisolone with androgen deprivation therapy increased overall survival, as did the addition of other androgen receptor signalling inhibitors (such as enzalutamide or apalutamide) to standard androgen deprivation therapy. 3 James ND de Bono JS Spears MR et al. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017; 377: 338-351 Crossref PubMed Scopus (1091) Google Scholar , 4 Davis ID Martin AJ Stockler MR et al. Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med. 2019; 381: 121-131 Crossref PubMed Scopus (734) Google Scholar , 5 Chi KN Chowdhury S Bjartell A et al. Apalutamide in patients with metastatic castration-sensitive prostate cancer: final survival analysis of the randomized, double-blind, phase III TITAN study. J Clin Oncol. 2021; 39: 2294-2303 Crossref PubMed Scopus (124) Google Scholar In 2022, the triple combination of androgen deprivation therapy, docetaxel, and abiraterone or darolutamide showed improved overall survival compared with androgen deprivation therapy plus docetaxel. 6 Fizazi K Foulon S Carles J et al. Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design. Lancet. 2022; 399: 1695-1707 Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar , 7 Smith MR Hussain M Saad F et al. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. N Engl J Med. 2022; 386: 1132-1142 Crossref PubMed Scopus (153) Google Scholar Abiraterone acetate plus prednisolone with or without enzalutamide for patients with metastatic prostate cancer starting androgen deprivation therapy: final results from two randomised phase 3 trials of the STAMPEDE platform protocolEnzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. Full-Text PDF Open Access

Focal Therapy for Prostate Cancer: Evolutionary Parallels to Breast Cancer Treatment. Letter.

Focal Therapy for Prostate Cancer: Evolutionary Parallels to Breast Cancer Treatment. Letter.