Cancer Research Articles

Assessing fetal radiation dose from iodine-125 seeds in pregnant breast cancer patients: an updated model

Abstract Objective: The treatment of breast cancer during pregnancy requires careful consideration of consequences for both maternal and fetal health. In non-pregnant patients, the use of radioactive iodine-125 (125I)-seeds is standard practice for localising non-palpable breast tumors before breast-conserving surgery. However, the use of 125I-seeds in pregnant patients has been avoided due to concerns about fetal radiation exposure.
Approach: In this study a mathematical model was developed to estimate the fetal absorbed dose based on several factors: the radioactivity of the 125I-seed, the duration of implantation, and the distance between the 125I-seed and fetus as a function of maternal anatomy, gestational age, and fetal development. Three scenarios, representing a range of maternal and fetal anatomy, were evaluated, including a worst-case scenario from a radiation safety perspective.
Main results: The results show that the fetal absorbed dose varies across the three scenarios, with ranges of 0.0–0.4 mGy, 0.0–1.0 mGy, and 0.0–1.6 mGy, depending on when the 125I-seed was implanted and when it was removed. These dose ranges are similar to conventional diagnostic x-ray scans. The maximum calculated absorbed dose (1.6 mGy) is unlikely to be reached in practice and is well below the 100 mGy threshold associated with possible fetal malformations. The associated theoretical cancer risk increase (0.016%) is minimal.
Significance: The use of 125I-seeds as localisation method of breast tumors in pregnant patients results in low fetal radiation doses and should not be avoided due to dose concerns.

Dyadic effects of illness perception and maladaptive cognitive-emotional regulation strategies on the fear of cancer recurrence in breast cancer patients and spouses: an actor-partner interdependence mediation model

PurposeBreast cancer, as a stressful event, profoundly impacts the entire family, especially patients and their spouses. This study used a dyadic analysis approach to explore the dyadic effects of illness perception on the fear of cancer recurrence (FCR) and whether maladaptive cognitive-emotional regulation strategies acted as a mediator in breast cancer patient-spouse dyads.MethodsThis was a cross-sectional study, and 202 dyads of breast cancer patients and their spouses were enrolled. Illness perception, maladaptive cognitive-emotional regulation strategies, and FCR were assessed by the Brief Illness Perception Questionnaire (BIPQ), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Fear of Cancer Recurrence Inventory Short Form (FCRI-SF), respectively. Data were analyzed using the actor-partner interdependence mediation model.ResultsThis study found that, for patients and spouses, maladaptive cognitive-emotional regulation strategies mediated the actor effects of illness perception on FCR. That is, illness perception was positively related to their maladaptive cognitive-emotional regulation strategies, which increased the risk of FCR. Another important finding was that patients’ illness perception had significant direct and indirect effects on spouses’ FCR through spouses’ maladaptive cognitive-emotional regulation strategies.ConclusionsNegative illness perception perceived by patients and spouses can increase their FCR by adapting their maladaptive cognitive-emotional regulation strategies. Furthermore, illness perception perceived by patients can also increase spouses’ FCR through spouses’ maladaptive cognitive-emotional regulation strategies. Medical staff should identify vulnerable patients and spouses with higher illness perception and maladaptive cognitive-emotional regulation strategies and make focused interventions to decrease the risk of FCR of both breast cancer patients and their spouses.

Adding capivasertib to fulvestrant in patients with hormone receptor-positive advanced breast cancer: a cost-effectiveness analysis

ObjectiveCapivasertib, a novel pan-AKT inhibitor, shows significant antitumor activity against hormone receptor-positive advanced breast cancer. However, its cost-effectiveness of this treatment remains uncertain. This study aimed to evaluate the cost-effectiveness of capivasertib plus fulvestrant versus fulvestrant alone for advanced breast cancer treatment from the perspectives of healthcare payers in the United States. Meanwhile, a experimental analysis from the perspective of China, incorporating specific assumptions, was also conducted in this study.MethodsA partitioned survival model was constructed to project the progression of breast cancer. Overall survival (OS) and progression-free survival (PFS) data were obtained from the CAPItello-291 trial and extrapolated for long-term survival estimates. Direct medical costs and utility data were gathered. The primary outcome measure was incremental cost-utility ratio (ICUR) to evaluate the cost-effectiveness of treatment regimen. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of the results.ResultsThe base-case analysis estimated the ICUR for capivasertib plus fulvestrant versus fulvestrant alone to be $709,647 per quality-adjusted life-year (QALY) in the US. OWSA revealed that the results were sensitive to hazard ratio of OS and the cost of capivasertib. PSA demonstrated that capivasertib plus fulvestrant exhibited a 0% probability of cost-effectiveness in the US.ConclusionOur finding suggests that, at its current price, capivasertib plus fulvestrant regimen is unlikely to be a cost-effective option compared to fulvestrant alone for HR-positive advanced breast cancer patients from the perspective of healthcare system in the US. For the experimental analysis based on specific assumptions from Chinese perspective, the therapy regimen was also found to lack cost-effectiveness.

Erythrocyte modified controlling nutritional status as a biomarker for predicting poor prognosis in post-surgery breast cancer patients

Nutrition and inflammation are closely related to prognosis in breast cancer patients. However, current nutritional and inflammatory measures predict disease free survival (DFS) of breast cancer are still different, and the most predictive measures remain unknown. This study aimed to compare the predictive effects of commonly used nutritional and inflammatory measures on DFS and to improve existing nutritional or inflammatory measures in order to develop a new model that is more effective for predicting postoperative recurrence and metastasis in breast cancer patients. The clinical data of 536 female breast cancer patients with invasive ductal carcinoma who underwent surgery at Shaoxing People’s Hospital from January 2012 to December 2018 were retrospectively evaluated. The predictive effects of nutritional and inflammatory indicators on DFS were evaluated. Machine learning was used to evaluate and rank laboratory indicators, select relatively important variables to modify nutritional or inflammatory indicators with the best predictive power, and evaluate their predictive role in patients’ postoperative recurrence and metastasis. Among various metrics predicting DFS, the CONUT score emerged paramount with an area under the curve (AUC) of 0.667. Interestingly, the combination of the erythrocyte levels with the CONUT score (ECONUT) achieved the highest AUC (0.722). The Kaplan-Meier survival analysis showed that the group exhibiting high ECONUT scores experiencing a notably poorer DFS. ECONUT was identified as an independent risk factor for postoperative DFS (P < 0.001). The ECONUT model could provide an effective assessment tool for predicting DFS in breast cancer patients.

Function of formyl peptide receptor 2 in adriamycin resistance of breast cancer

FPRL2 has been shown to be associated with a variety of tumours but has not been well studied in breast cancer. In this study, We combine molecular biology techniques with bioinformatics to analyze the role of FPRL2 in breast cancer and adriamycin resistance. By utilizing bioinformatics, we mine TCGA and GEO public databases to assess FPRL2 expression in breast cancer patients and its correlation with patient prognosis. Additionally, we employ the DepMap tool to probe the CCLE database, examining the relationship between FPRL2 gene effects and adriamycin sensitivity. Chemosensitivity of Adriamycin in breast cancer cells was tested by CCK-8 method. The apoptosis of breast cancer cells was determined by flow cytometry assay. Expression of p-ERK5 and p-AKT was determined by Western blot assay. Our results indicate that the expression level of FPRL2 in tumor tissues of breast cancer patients is significantly higher than that in normal tissues, and it correlates with poor prognosis in patients. Furthermore, the expression level of FPRL2 in tumor tissues of adriamycin-resistant breast cancer patients is also significantly higher than that in adriamycin-sensitive patients. The IC50 (Inhibitory Concentration 50). Of Adriamycin was significantly lower in FPRL2 silenced cells than those control cells. The apoptosis was markedly increased in FPRL2-silenced cells. p-ERK5 and p-AKT in breast cancer cells was significantly reduced after FPRL2 knocked down. In Conclusion, FPRL2 mediates Adriamycin resistance in breast cancer cells, and knockdown of FPRL2 increased apoptosis and decreased Adriamycin resistance in breast cancer cells.

Multiparameter magnetic resonance imaging-based radiomics model for the prediction of rectal cancer metachronous liver metastasis

BACKGROUND The liver, as the main target organ for hematogenous metastasis of colorectal cancer, early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients. Herein, this study aims to investigate the application value of a combined machine learning (ML) based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis (MLM). AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer. METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023. All participants were randomly assigned to the training or validation queue in a 7:3 ratio. We first apply generalized linear regression model (GLRM) and random forest model (RFM) algorithm to construct an MLM prediction model in the training queue, and evaluate the discriminative power of the MLM prediction model using area under curve (AUC) and decision curve analysis (DCA). Then, the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups. RESULTS Among the 301 patients included in the study, 16.28% were ultimately diagnosed with MLM through pathological examination. Multivariate analysis showed that carcinoembryonic antigen, and magnetic resonance imaging radiomics were independent predictors of MLM. Then, the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation. The prediction performance of GLRM in the training and validation queue was 0.765 [95% confidence interval (CI): 0.710-0.820] and 0.767 (95%CI: 0.712-0.822), respectively. Compared with GLRM, RFM achieved superior performance with AUC of 0.919 (95%CI: 0.868-0.970) and 0.901 (95%CI: 0.850-0.952) in the training and validation queue, respectively. The DCA indicated that the predictive ability and net profit of clinical RFM were improved. CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models, the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.

Impact of Bone-Modifying Agents on Post-Bone Metastasis Survival Across Cancer Types

Background: Bone metastasis is associated with a poor prognosis. Bone-modifying agents (BMA) are commonly used for the prevention or treatment of skeletal-related events (SRE) in patients with bone metastasis; however, whether or not treatment with BMA improves survival remains unclear. In this study, we investigated whether BMA was involved in post-bone metastasis survival. Methods: A total of 539 cancer patients were retrospectively analyzed to identify significant independent factors in post-bone metastasis survival. Results: Among the overall population, patients with the following cancers had a median survival longer than 24 months: thyroid, 97.2 months; breast, 51.5 months; prostate, 47.2 months; and kidney, 38.8 months. In contrast, median post-bone metastasis survival was significantly shorter in gastrointestinal (GI) (6.5 months), head and neck (6.3 months), and urinary tract (3.4 months) cancers. In non-small cell lung cancer (NSCLC), the log-rank test demonstrated that the epidermal growth factor receptor (EGFR) mutation was a significant factor for post-bone metastasis survival: EGFR mutation (−) n = 67, median post-bone metastasis survival 11.5 months (95% CI: 6.0–15.2); EGFR mutation (+) n = 39, median post-bone metastasis survival 28.8 months (95% CI: 18.1–35.7) (p &lt; 0.05). Intriguingly, treatment with BMA was a significant positive prognostic factor: BMA (−) n = 203, median post-bone metastasis survival 7.8 months (95% CI: 5.8–12.5); BMA (+) n = 336, median post-bone metastasis survival 21.9 months (95% CI: 16.1–26.4) (p &lt; 0.001). Moreover, the Cox proportional hazards model showed that this was particularly evident in cancer types with poor prognosis such as GI cancer (hazard ratio [HR]: 0.62, 95% CI: 0.40–0.95; p &lt; 0.05) and NSCLC without the epidermal growth factor receptor (EGFR) mutation (HR: 0.56, 95% CI: 0.34–0.91; p &lt; 0.05). Conclusions: Treatment with BMA is recommended not only for the prevention and/or treatment of SRE, but also may have a positive impact on post-bone metastasis survival, particularly in cancers with typically poor post-bone metastasis survival such as GI cancer and NSCLC without the EGFR mutation.

Knockdown of the EEF1A2 gene reduces lung cancer brain metastasis by downregulating the BCL10/NFκB pathway

Aim: Brain metastases (BM) in patients with lung cancer (LC) are linked to unfavorable outcomes. The eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) is notably overexpressed across various cancer types and plays a role in promoting tumor initiation and progression. This research aimed to clarify the function of EEF1A2 in the context of lung cancer brain metastasis (LCBM) and to explore the mechanisms underlying its effects. Methods: To identify genes with differential expression between LC and LCBM samples, transcriptomic microarray analyses were conducted, confirming that EEF1A2 expression is elevated in LCBM. EEF1A2 expression levels were validated in multiple LC cell lines. PC9 and SPCA1 cells were transfected with lentiviral vectors carrying siRNAs targeting EEF1A2 to assess its role both in vitro and in vivo . Tandem mass tag proteomics was employed to identify proteins regulated by EEF1A2. The expression of EEF1A2, BCL10, and phosphorylated NF-κB in tumor tissues from LC and LCBM patients was analyzed. Results: Compared to the LC samples, the LCBM samples exhibited significantly higher levels of EEF1A2 expression. EEF1A2 knockdown in PC9 and SPCA1 cells resulted in substantial reductions in cell proliferation, migration, and invasion. Proteomic profiling revealed that BCL10 protein levels were markedly reduced in EEF1A2-knockdown cells. Additionally, there was a decrease in phosphorylated NF-κB, EGFR, and mesenchymal markers (N-cadherin, Twist, Snail, Slug, and Cdc42), along with an increase in E-cadherin expression. In a mouse model, EEF1A2 knockdown in PC9 cells significantly inhibited brain metastasis. Furthermore, patient samples presented elevated levels of EEF1A2, BCL10, and phosphorylated NF-κB in LCBM tissues than in LC tissues. Conclusion: Our research revealed that EEF1A2 is upregulated in LCBM, and that its knockdown suppresses brain metastasis by decreasing BCL10 expression, inhibiting NF-κB signaling, and reducing epithelial-mesenchymal transition markers. These results suggest that targeting EEF1A2 may be a promising therapeutic approach for preventing and treating brain metastasis in lung cancer patients.

Predicting Axillary Metastasis of Breast Cancer Patients with MRI Relaxometry

Background: Breast cancer is a leading cause of cancer-related mortality among women worldwide. Accurate staging, including the detection of axillary metastases, is vital for treatment planning. This study evaluates the efficacy of MRI relaxometry as a diagnostic tool for axillary lymph node metastases in breast cancer patients. Methods: A prospective study was conducted on 67 consecutive breast cancer patients. Relaxometry parameters, including T2Max, T2Min, and 1HAv, were assessed using 1.5 Tesla MRI. All axillary metastases were histologically confirmed using core-needle biopsy or surgical specimens. Statistical analyses included ROC curves, chi-square tests, and multivariate analysis to determine correlations between imaging findings and pathological results. Results: Significant associations were found between T2Min-ipsilateral (p = 0.018), 1HAv-ipsilateral (p = 0.003), and axillary metastases. ROC analysis demonstrated that T2Min-ipsilateral and 1HAv-ipsilateral have modest to acceptable discriminatory abilities (AUC = 0.681 and AUC = 0.740, respectively). Combined clinical and imaging models enhanced diagnostic accuracy (AUC = 0.749). Conclusions: MRI relaxometry improves the detection of axillary metastases in breast cancer, particularly when integrated with clinical and pathological evaluations.

Deep Radiogenomics Sequencing for Breast Tumor Gene-Phenotype Decoding Using Dynamic Contrast Magnetic Resonance Imaging

Abstract Purpose We aim to perform radiogenomic profiling of breast cancer tumors using dynamic contrast magnetic resonance imaging (MRI) for the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) genes. Methods The dataset used in the current study consists of imaging data of 922 biopsy-confirmed invasive breast cancer patients with ER, PR, and HER2 gene mutation status. Breast MR images, including a T1-weighted pre-contrast sequence and three post-contrast sequences, were enrolled for analysis. All images were corrected using N4 bias correction algorithms. Based on all images and tumor masks, a bounding box of 128 × 128 × 68 was chosen to include all tumor regions. All networks were implemented in 3D fashion with input sizes of 128 × 128 × 68, and four images were input to each network for multi-channel analysis. Data were randomly split into train/validation (80%) and test set (20%) with stratification in class (patient-wise), and all metrics were reported in 20% of the untouched test dataset. Results For ER prediction, SEResNet50 achieved an AUC mean of 0.695 (CI95%: 0.610–0.775), a sensitivity of 0.564, and a specificity of 0.787. For PR prediction, ResNet34 achieved an AUC mean of 0.658 (95% CI: 0.573–0.741), a sensitivity of 0.593, and a specificity of 0.734. For HER2 prediction, SEResNext101 achieved an AUC mean of 0.698 (95% CI: 0.560–0.822), a sensitivity of 0.750, and a specificity of 0.625. Conclusion The current study demonstrated the feasibility of imaging gene-phenotype decoding in breast tumors using MR images and deep learning algorithms with moderate performance.

Refinement of a meaning-centered counseling program for Chinese patients with advanced cancer: integrating cultural adaptation and implementation science approaches

Abstract Background This mixed methods study identified needed refinements to a telehealth-delivered cultural and linguistic adaptation of Meaning-Centered Psychotherapy for Chinese patients with advanced cancer (MCP-Ch) to enhance acceptability, comprehensibility, and implementation of the intervention in usual care settings, guided by the Ecological Validity Model (EVM) and the Practical, Robust Implementation and Sustainability Model (PRISM). Methods Fifteen purposively sampled mental health professionals who work with Chinese cancer patients completed surveys providing Likert-scale ratings on acceptability and comprehensibility of MCP-Ch content (guided by the EVM) and pre-implementation factors (guided by PRISM), followed by semi-structured interviews. Survey data were descriptively summarized and linked to qualitative interview data. Three analysts independently coded the transcripts according to EVM and PRISM domains; discrepancies were resolved through discussion and consensus. Results Quantitative findings showed high appropriateness and relevance of MCP-Ch across five EVM domains of Language, Metaphors/Stories, Goals, Content, and Concepts. Qualitative analysis yielded 23 inductive codes under the seven EVM domains: (1) Language (3 subcodes), (2) Persons (2 subcodes), (3) Metaphors/Stories (2 subcodes), (4) Methods (8 subcodes), (5) Content (2 subcodes), (6) Goals (4 subcodes), and (7) Concepts (2 subcodes). Themes based on PRISM included (1) Intervention characteristics (organizational perspective, 7 subcodes; and patient perspective, 6 subcodes) (2) External environment (2 subcodes), (3) Implementation and sustainability infrastructure (4 subcodes), and (4) Recipients (organizational characteristics, 5 subcodes; and patient characteristics, 4 subcodes). Conclusion Recommendations for next steps include increasing the MCP-Ch protocol’s flexibility and adaptability to allow interventionists to flexibly tailor MCP-Ch material to meet patients’ individual needs, simplifying content to improve comprehension and acceptability, providing additional training to Chinese-serving providers to increase adoption and sustainability, and considering interpreter-assisted delivery to increase access. Findings yielded important information to maximize cultural relevance as well as the implementation and sustainability potential of MCP-Ch in real-world settings.

Cardiovascular safety of 5-fluorouracil and capecitabine in colorectal cancer patients: real-world evidence

BackgroundFluoropyrimidines, including 5-fluorouracil and capecitabine, are the most common chemotherapeutic agents for colorectal carcinoma. Although previous studies have suggested varying degrees of cardiotoxicity with these drugs, there is a notable lack of large-scale investigations with appropriate control groups. This study aimed to evaluate cardiovascular outcome among colorectal carcinoma patients treated with fluoropyrimidines.MethodsA retrospective propensity score- matched cohort study was conducted in patients diagnosed with colorectal carcinoma between January 1, 1993 and December 31, 2021 at public hospitals in Hong Kong. Cardiovascular outcomes in patients prescribed fluoropyrimidines were compared with controls. Further analyses to compare 5-fluroracil and capecitabine were performed.ResultsA total of 51,888 colorectal carcinoma patients were identified. After 1:1 propensity score matching, 21,216 patients were included in the final analysis, with 10,608 patients in each group. 1.06% patients experienced a major adverse cardiovascular event (MACE) at 1 year. There was no significant difference in MACE risk between the two groups (HR 0.91, 95% confidence interval (95%CI): 0.70–1.18, p = 0.46). Risk of cardiovascular death was similar between the two groups (HR 1.05, 95%CI: 0.69–1.60, p = 0.82). Subgroup analysis did not demonstrate a statistically significant elevated risk of MACE during fluoropyrimidine use in high-risk patient groups. Further comparison of 5-fluorouracil and capecitabine did not reveal a difference in MACE (0.80% vs. 0.98%; HR 1.09, 95%CI: 0.64–1.85, p < 0.75).ConclusionFluoropyrimidine use in patients with colorectal carcinoma did not increase the risk of MACE, cardiovascular death, or other specific cardiovascular conditions. There was no significant difference in cardiovascular risk between 5-fluorouracil and capecitabine.Graphical

Eldecalcitol Add-On to Risedronate Reduces Bone Loss from Aromatase Inhibitors in Postmenopausal Breast Cancer Patients.

Aromatase inhibitors (AIs) cause bone loss and increase fracture risk in women with hormone receptor-positive early-stage breast cancer (HR+EBC). Bone antiresorptive agents are recommended for patients at risk of fragility fractures. Eldecalcitol, combined with bisphosphonate, increases bone mineral density (BMD) in primary osteoporosis. To determine the effect of eldecalcitol (0.75 ug/day) add-on therapy to risedronate (17.5 mg/week) on bone quantity and quality in women treated with AI. Open-label randomized control trial. Postmenopausal women with HR+EBC (TNM stage 0-3A) treated with risedronate for more than 12 months. 200 patients were enrolled; 196 patients were eligible for the full analysis set after excluding those without follow-up BMD data. Participants were advised to take vitamin D and calcium, yet many were vitamin D deficient or insufficient. Participants were randomly assigned in a 1:1 ratio to receive either eldecalcitol add-on therapy or risedronate monotherapy. Primary outcome was the group difference in the change of LS-BMD in 24 months. Secondary outcomes included FN-BMD, TH-BMD, trabecular bone score (TBS), and the incidence of vertebral and non-vertebral fractures. The increase at LS-, FN-, and TH-BMD at 24 months was larger in the add-on therapy group than in the monotherapy group, with a group difference (add-on therapy minus monotherapy) estimate of 0.020 g/cm2 (95% confidence interval (CI): 0.010-0.029 g/cm2, p< 0.001) for LS-BMD. The incidence rate ratio (add-on therapy/monotherapy) for morphometric vertebral fractures was 0.292 (95% CI: 0.080-1.061, p= 0.061). No group difference was detected in the change in TBS. Eldecalcitol add-on therapy increased LS-BMD in osteopenic to osteoporotic postmenopausal women treated with an AI and risedronate.

Validity and Reliability of the Spanish Version of Godin-Shephard Leisure-Time Physical Activity Questionnaire in Prostate Cancer Patients

Background: Prostate cancer is highly prevalent in Spanish men. Although physical activity has benefits on several factors in prostate cancer survivors, this is diminished after medical oncology treatment. Cancer-related fatigue is one of the main barriers to physical activity, leading to a decrease in activity levels in these patients. Therefore, it is essential to assess physical activity in an efficient and simple way in order to design rehabilitation programmes for this population. Objective: The aim was to translate and adapt the Godin–Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) for Spanish-speaking prostate cancer patients and to assess its validity and reliability using the International Physical Activity Questionnaire (IPAQ) as a reference standard. Methods: Following Beaton’s guidelines, the GSLTPAQ was back-translated and cross-culturally adapted. Validity and reliability were assessed with a sample of thirty prostate cancer patients. Internal consistency and test-retest variability were also evaluated. Results: The Spanish GSLTPAQ demonstrated excellent validity, with high correlations with the IPAQ for light (r = 0.924), moderate (r = 0.931), and vigorous activities (r = 0.882). Internal consistency was strong (Cronbach’s alpha: 0.845–0.950). Test-retest reliability showed strong intraclass correlation coefficients (ICCs) for all activity levels, indicating good reliability. Conclusions: The Spanish version of the GSLTPAQ is a valid and reliable tool for assessing physical activity in prostate cancer patients. It shows strong correlations with the IPAQ, excellent internal consistency, and test-retest reliability.

What Research Approach to Understanding and Analyzing the Perceptions and Practices of Breast Cancer Patients?

Health and illness are intertwined concepts in anthropological studies that require understanding and interpretation, especially when related to chronic and incurable diseases like breast cancer. Patients must adhere to treatment protocols and may also seek other remedies linked to traditional medicine and the community's folk knowledge. Patients can be influenced by social interactions and communication with others, particularly with the advancement of technological and social communication methods. This creates a perception of suffering that may extend beyond the medical concept to interpretations and unknown realms in understanding those perceptions and therapeutic practices of traditional medicine. Keywords: The patient, breast cancer, anthropology, perceptions, traditional medicine.

Navigating Emergency Management of Cancer Patients: A Retrospective Study on First-Time, End-Stage, and Other Established Diagnoses in a High Turnover Emergency County Hospital

Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data are available about emergency care’s role in treating patients with cancer. This study aims to determine the burden of end-stage and first-time diagnosis of cancer on emergency care in a high-turnover emergency care center. Materials and Methods: A retrospective observational study was conducted to identify patients requesting emergent aid for cancer-related symptoms in the Emergency Department of “St. Spiridon” Hospital from Iasi (Romania) between 1 October 2022 and 30 September 2023. The proportion and demographic characteristics of end-stage patients and those who received a first-time diagnosis during the emergency visit were evaluated. Risk analysis was performed to understand these patients’ care needs (such as medical care, surgical care, specialty consults, intensive care, ward admission, and other hospital transfers) and immediate care outcomes (such as in-hospital mortality and home discharge). Results: 2318 patients with cancer requested emergent care (patient presentation rate of 3.08%), of which 444 (19.15%) were diagnosed for the first time, and 616 (26.57%) were at the end-stage. First-time diagnosed patients had a significantly different distribution of cancer types (p &lt; 0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12–3.32; p &lt; 0.001; OR 3.28, 95% CI: 2.48–4.35, p &lt; 0.001; OR 2.09, 95% CI: 1.70–2.59; p &lt; 0.001, respectively) but were less severe, while end-stage patients were more likely to address repeatedly to the emergency room (OR 1.86, 95% CI: 1.32–2.59; p = 0.001) and had higher odds of needing intensive care, assisted ventilation and death (OR-4.63, 95% CI: 1.10–19.45, p = 0.04; OR 2.59, 95% CI: 1.57–4.28; p &lt; 0.001, and OR 4.06, 95% CI: 1.73–9.54; p = 0.001, respectively). Conclusions: The emergency department often carries the weight of diagnosing patients with cancer and treating patients with end-stage disease. These data highlight the importance of prehospital care, particularly for cancer screening and palliative care, and the importance of fostering multidisciplinary collaboration in the emergency room with oncologists, geriatricians, and palliative care specialists to improve patient outcomes.

Cancer in the elderly in India: Challenges, attitudes, and strategies for improvement

: India’s elderly population faces growing cancer incidences, with unique challenges rooted in cultural, socioeconomic, and healthcare disparities. Limited health literacy, delayed medical intervention, gender biases, and inadequate healthcare infrastructure, particularly in rural areas, worsen the issue. Social stigma and psychological barriers further hinder prompt cancer diagnosis and treatment, leaving many elderly patients vulnerable to advanced-stage diagnoses.:This study aims to identify and analyse the key challenges faced by elderly cancer patients in India, including cultural attitudes, access to healthcare, financial constraints, and psychosocial impacts. Additionally, the goal is to propose strategies for improving cancer care, prevention, and support for this demographic.A mixed-methods approach was utilised, incorporating quantitative and qualitative analyses to assess challenges in elderly cancer care in India. This review synthesises data from studies published between 2018 and 2023, using information from national cancer registries, Indian Council of Medical Research (ICMR) reports, and peer-reviewed literature. Studies included addressed socio-cultural, economic, and psychological barriers in elderly cancer care across India, focusing on gaps in knowledge and intervention strategies. The analysis revealed that 60% of cancers and 70% of cancer-related deaths occur in individuals aged 65 and above. Low health literacy, delayed diagnosis, and financial constraints were identified as the primary barriers. Significant treatment aversion was noted, with 58% of elderly patients perceiving chemotherapy as harmful. Rural areas lacked adequate healthcare facilities, contributing to delayed diagnosis and treatment. Psychosocial issues, including depression and anxiety, were prevalent and often aggravated by social isolation and stigma.: Addressing these issues requires a multifaceted approach, including policy interventions to expand healthcare access in rural areas, enhance health literacy, and provide financial support for elderly patients. Collaborative efforts involving government, non-governmental organisations, and community leaders are essential to improve early diagnosis, treatment accessibility, and quality of life for elderly cancer patients in India.

Long-term trends in the incidence of male breast cancer and nomogram for predicting survival in male breast cancer patients: a population-based epidemiologic study

Male breast cancer (MBC) is rare, and due to the absence of male-specific screening programs, many patients are diagnosed at advanced stages and older ages. This study aims to analyze the long-term trend of MBC incidence and develop a competing risk model to improve survival rates. MBC data from the Surveillance, Epidemiology, and End Results (SEER) database (1975–2019) were analyzed using the Age-Period-Cohort (APC) model to examine trends in age, period, and birth cohort effects of MBC incidence. A competing risk model was used to build a nomogram predicting breast cancer-specific survival (BCSS) for MBC patients, with model accuracy assessed using the concordance index (C-index) and calibration curves. These results were compared with the nomogram established by Cox model. Comparisons were made with traditional AJCC staging system using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). APC analysis showed MBC incidence increases with age, while period and birth cohort effects were not significant. A total of 2,057 patients were included in the competing risk analysis, which identified factors like older age, estrogen receptor (ER) negative, progesterone receptor (PR) negative, and advanced AJCC stage as being associated with shorter survival. The competing risk model demonstrated excellent predictive ability, surpassing the AJCC staging system in both accuracy and clinical utility. In contrast, the Cox regression model overestimated the risk of endpoint events and failed to provide accurate effect estimates. The high incidence and poor prognosis of MBC in the elderly population emphasize the need for improved screening and early diagnosis in high-risk groups. Our competing risk model, compared to the Cox model, more accurately reflects real-world conditions. Additionally, we have developed a competing risk nomogram to assist in identifying high-risk individuals and guiding clinical decision-making.

Pan-cancer secreted proteome and skeletal muscle regulation: insight from a proteogenomic data-driven knowledge base.

Large-scale, pan-cancer analysis is enabled by data driven knowledge bases that link tumor molecular profiles with phenotypes. A debilitating cancer-related phenotype is skeletal muscle loss, or cachexia, which occurs partly from tumor products secreted into circulation. Using the LinkedOmicsKB knowledge base assembled from the Clinical Proteomics Tumor Analysis Consortium proteogenomic analysis, along with catalogs of human secretome proteins, ligand-receptor pairs and molecular signatures, we sought to identify candidate pan-cancer proteins secreted to blood that could regulate skeletal muscle phenotypes in multiple solid cancers. Tumor proteins having significant pan-cancer associations with muscle were referenced against secretome proteins secreted to blood from the Human Protein Atlas, then verified as increased in paired tumor vs. normal tissues in pan-cancer manner. This workflow revealed seven secreted proteins from cancers afflicting kidneys, head and neck, lungs and pancreas that classified as protein-binding activity modulator, extracellular matrix protein or intercellular signaling molecule. Concordance of these biomarkers with validated molecular signatures of cachexia and senescence supported relevance to muscle and cachexia disease biology, and high tumor expression of the biomarker set associated with lower overall survival. In this article, we discuss avenues by which skeletal muscle and cachexia may be regulated by these candidate pan-cancer proteins secreted to blood, and conceptualize a strategy that considers them collectively as a biomarker signature with potential for refinement by data analytics and radiogenomics for predictive testing of future risk in a non-invasive, blood-based panel amenable to broad uptake and early management.

Prognostic significance of programmed cell death 1 expression on CD8+T cells in various cancers: a systematic review and meta-analysis

BackgroundIncreased PD-1 expression on CD8+ T cells is considered as a hallmark for T-cell exhaustion, and is thought to be related to the prognosis of cancer patients. However, discrepant results have made it difficult to apply PD-1+CD8+T cells and tumor prognosis to clinical practice. Therefore, we conducted a meta-analysis to evaluate its prognostic value in human cancers.MethodsPRISMA reporting guidelines were strictly followed for conducting the current meta-analysis. The PubMed, Web of Science, Embase databases were searched from inception to November 2024. The pooled Hazard Ratio (HR) along with 95% confidence intervals (CIs) of each article were combined for the associations of PD-1+CD8+ T cells with overall survival (OS), progression- free survival (PFS) and disease-free survival(DFS). Subgroup analyses were performed for area, specimen type, cancer type, treatment, detected method and cancer stage.ResultsA total of 20 studies (23 cohorts, 3086 cancer patients) were included in our study. The expression PD-1+CD8+ T cells in cancer patients tended to predict poor overall survival (OS) (HR: 1.379, 95%CI: 1.084-1.753, p= 0.009), and unfavorable disease-free survival(DFS) (HR: 1.468, 95%CI: 0.931-2.316, p=0.099), though it did not reach statistical significance. Begg’s and Egger’s test demonstrated that no obvious publication bias was exist.ConclusionsHigh PD-1 expression on CD8+ T cells is associated with worse survival outcomes, which can be potentially used as a prognostic marker of malignant tumor.