Oncology Research Articles

COVID-19 impact on incidence and stage at diagnosis of five prominent cancers: A French cancer registry-based study

The French healthcare system has been affected by the COVID-19 pandemic in 2020, including cancer care. In order to evaluate the impact of this pandemic on cancer incidence, the Isere Departmental Cancer Registry compared the actual 2020 incidence of melanoma, breast, colorectal, prostate and lung cancers with the expected 2020 incidence based on data collected by the Registry between 2015 and 2019, taking into account periods of lockdown and reopening. When available, cancer stages and/or prognostic scores were recorded. During the period of initial confinement, a 54%, 50% and 36,8% drop in incidence was observed for breast, prostate and colorectal cancer respectively. Although their annual incidence remained stable, a worsening trend emerged as a decline in the number of low stages/scores at diagnosis in favour of higher stages/scores towards the end of 2020. In contrast, a significant 17,8% drop was observed in annual incidence of melanoma, particularly for Breslow scores < 1 (-27,4%). However, this trend was noticeable before the lockdown, as well as the 14% reduction in the incidence of lung cancer in women, but not in men. The incidence of certain cancers was caught up over the year but the COVID-19 pandemic seems to be associated with a change in their severity at diagnosis throughout 2020. The downward trends in female lung cancer and melanoma incidence point to complex underlying phenomena. Further analysis is still needed to assess the global impact of the COVID-19 pandemic on cancer incidence.

CD34+ Hematopoietic Stem Cell Count as a Novel Predictor of Vascular Event in Sickle Cell Disease Patients

Abstract Background Sickle cell disease (SCD) is one of the most common genetic disorders, it not only has hematological pathophysiological consequences, but also has systemic pathological manifestations such as vascular events (VEs). Prior studies have described that VEs are associated with poor outcomes in the short term and decreased quality of life in patients over the long term. There is no standardized method for predicting vascular injury in Sickle cell disease patients. Aim of the Work Our aim is to evaluate circulating CD34 as a novel predictive marker of occurrence of vascular event in Children with Sickle Cell Disease in their steady state and relate levels to severity of VEs in the following 6 months. Patient and Methods This study was an exploratory study, conducted at Pediatrics Hematology- Oncology Unit at Ain Shams University Children’s Hospital, where 50 children with sickle cell disease were enrolled at their steady state (defined as 2 months free from any Vascular Event prior to the study), aged 6 months - 16 years. Flow cytometry was done for quantification of circulating CD34+ at inclusion and compared to age and sex matched control and patients were followed up for 6 months for vascular events. Results There is statistically significant higher level of CD34+ among SCD patients compared to age and sex matched control with p value &amp;lt; 0.001.Circulating CD34+ showed significantly higher level in patients who developed systemic vascular events after 6 months of follow up with p value 0.022. There was no statistically significant correlation between circulating CD34+ and severity of peripheral vascular events (or any need for hospitalization) on follow up. Conclusion CD34+ cell count at steady state may be a promising biomarker of further vascular event in children with SCD.

Idiopathic Intracranial Hypertension in a Breast Cancer Patient Receiving Adjuvant Paclitaxel: A Case Report and a Review of the Liter

Background: Paclitaxel is a cytotoxic drug belonging to the taxane family, widely used in medical oncology, such as in breast cancer, in which it has demonstrated great efficacy, whether as metastatic or adjuvant treatment. Paclitaxel's main toxicities are immediate anaphylactic reactions and peripheral neuropathy. The occurrence of idiopathic intracranial hypertension is an unusual event.  The Clinical Case: This is a 53-year-old Moroccan woman, treated for breast cancer; she was put on sequential adjuvant chemotherapy after surgery. She received 3 courses of Doxorubicin and Cyclophosphamide without incident and then we started weekly Paclitaxel. From the very first courses, the patient presented with continuous but moderate headaches, and a cerebral Magnetic Resonance Imaging (MRI) showed signs of idiopathic intracranial hypertension, which was confirmed and treated in the neurology department. The patient progressed well, allowing the 12 courses of paclitaxel to be continued.  Conclusion: Idiopathic intracranial hypertension is an unusual complication of paclitaxel. The occurrence of headache or other neurological symptoms in a patient being treated for breast cancer requires an urgent brain MRI, particularly to look for brain metastases.

Study of Mortality Rate and its Causes among Egyptian Children and Adolescents with Cancer

Abstract Background There is little evidence about the burden of childhood cancers in Egypt. Knowledge about the current disease burden of childhood cancers is crucial to priorities cancer control plans and improve survival. Objective To describe the frequency of deaths among children diagnosed with cancer in the last 10 years. Patients and Methods This retrospective descriptive study was conducted in Pediatric Hematology /Oncology Unit, Children's Hospital, Ain Shams University. The data of 500 patients was collected from the database in the period from 1st September 2011 to 30th September 2021. The study included 500 Children less than 18 years diagnosed as solid and hematological malignancies. Results The median age of the included patients was 4.25 years, males represented 54.4%. The most common etiology of malignancies among the included patients were: acute lymphoblastic leukemia (31.8%) and acute myeloid leukemia (714.6%). Death was evident in 71.4% of the included patients. Among the dead cases 106 (74.12%) had late death; that occurred 5 years or more after diagnosis and 37(25.4%) had early death; that occurred within 30 days after diagnosis of the first neoplasm. The higher mortality was reported among acute lymphoblastic leukemia (52; 36.4%), acute myeloid leukemia (28; 19.6%), neuroblastoma (13; 9.1%) and brain tumors (10; 7.0%). Comparison between living and dead childhood cancer patients as regards the demographic and clinical data showed no significant difference regarding; age, gender, and residence (P-value= 0.591, 0.122 &amp; 0.077, respectively). Relapse was significantly increased among dead cases representing 32.9% (P-value= 0.000). Conclusion In our institute, childhood cancer patients’ mortality rate was 28.5% in the last 10 years. Early death occurred in (25.8%) among them; infection was the leading cause of death, while primary malignancy was the main cause of death among those who died late, which is almost comparable with international studies. Furthermore, the overall survival of our childhood with cancer was (67.30%) at 5 years from diagnosis. This is relatively better than the previous published Egyptian data and reaching international figures.

The Family Talk Intervention Among Families Affected by Severe Illness: Hospital Social Workers’ Experiences of Facilitators and Barriers to its Use in Clinical Practice

Hospital social workers (HSW) play an important role in health care, providing psychosocial support to families affected by severe illness, and having palliative care needs involving dependent children. However, there are few evidence-based family interventions for HSWs to apply when supporting these families. The Family Talk intervention (FTI), a psychosocial family-based intervention, was therefore evaluated in an effectiveness-implementation study. Within the study, HSWs were educated and trained in the use of FTI in clinical practice. This study examined HSWs’ experiences of barriers and facilitating factors during their initial use of FTI in clinical practice. Altogether, 10 semi-structured focus groups were held with HSWs (n = 38) employed in cancer care and specialized palliative home care for adults, pediatric hospital care, and a children’s hospice. Data were analyzed using content analysis. HSWs considered FTI to be a suitable psychosocial intervention for families affected by severe illness with dependent children. However, the way in which the care was organized acted either as a barrier or facilitator to the use of FTI, such as the HSWs’ integration in the team and their possibility to organize their own work. The HSWs’ work environment also impacted the use of FTI, where time and support from managers was seen as a significant facilitating factor, but which varied between the healthcare contexts. In conclusion, HSWs believed that FTI was a suitable family intervention for families involving dependent children where one family member had a severe illness. For successful initial implementation, strategies should be multi-functional, targeting the care organization and the work environment.

Dynamic Modeling of Cytokine-Dependent Proliferation Rates over Time in Cancer: Insights from Scientific Analysis

Cytokines play a crucial role in regulating cell proliferation rates in cancer, influencing tumor growth and progression. This work employs dynamic modeling to explore how cytokine signals modulate proliferation rates over time in the context of cancer. By integrating scientific analysis with mathematical modeling, we elucidate the complex interactions between cytokine signaling pathways and tumor cell dynamics, offering insights into potential therapeutic strategies and prognostic indicators. This analysis of cell proliferation dynamics highlights clear differences between healthy and leukemic cell compartments 1 and 2. Healthy cells show an initial phase of rapid exponential growth due to regulated division, which is crucial for maintaining tissue function. In leukemic cells exhibit delayed proliferation patterns. Understanding these distinctions is vital for designing precise therapies that can effectively target leukemia while minimizing harm to healthy tissues. This understanding drives the development of personalized treatment approaches aimed at enhancing outcomes in cancer care. Ongoing interdisciplinary collaboration is crucial to translating these insights into practical clinical applications that can improve patient outcomes and advance the field of cancer treatment

Advances in ovarian tumor stem cells and therapy.

Ovarian cancer is considered the most lethal among all gynecological malignancies due to its early metastatic dissemination, extensive spread, and malignant ascites. The current standard of care for advanced ovarian cancer involves a combination of cytoreductive surgery and chemotherapy utilizing platinum-based and taxane-based agents. Although initial treatment yields clinical remission in 70-80% of patients, the majority eventually develop treatment resistance and tumor recurrence. A growing body of evidence indicates the existence of cancer stem cells within diverse solid tumors, including ovarian cancer, which function as a subpopulation to propel tumor growth and disease advancement by means of drug resistance, recurrence, and metastasis. The presence of ovarian cancer stem cells is widely considered to be a significant contributor to the unfavorable clinical outcomes observed in patients with ovarian cancer, as they play a crucial role in mediating chemotherapy resistance, recurrence, and metastasis. Ovarian cancer stem cells possess the capacity to reassemble within the entirety of the tumor following conventional treatment, thereby instigating the recurrence of ovarian cancer and inducing resistance to treatment. Consequently, the creation of therapeutic approaches aimed at eliminating ovarian cancer stem cells holds great potential for the management of ovarian cancer. These cells are regarded as one of the most auspicious targets and mechanisms for the treatment of ovarian cancer. There is a pressing need for a comprehensive comprehension of the fundamental mechanisms of ovarian cancer's recurrence, metastasis, and drug resistance, alongside the development of effective strategies to overcome chemoresistance, metastasis, and recurrence. The implementation of cancer stem cell therapies may potentially augment the tumor cells' sensitivity to existing chemotherapy protocols, thereby mitigating the risks of tumor metastasis and recurrence, and ultimately improving the survival rates of ovarian cancer patients.

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

531 Research Priorities for Oesophageal Cancer : Results from a Priority Setting Partnership

Abstract Aim Oesophageal cancer is the seventh most common cancer worldwide and the sixth leading cause of cancer-related deaths, and it remains one of the hardest cancers to treat. Despite advances in the last decade, oesophageal cancer still has high morbidity and mortality burdens, and further research is needed to improve those outcomes. The aim of the Priority Setting Partnership was to bring together patients, family, caregivers, and the multidisciplinary healthcare team to identify and prioritise the most important unanswered questions for future research. Method Following the James Lind Alliance methodology, different stakeholders were asked to list their uncertainties about oesophageal cancer, which were then checked against existing evidence, categorised, and formed into questions. These then went through a survey for interim ranking, and those shortlisted were discussed at a final workshop to identify the Top 10 unanswered research questions. Results 230 responders to the initial survey, two-thirds of which were patients, revealed 365 uncertainties. After removing duplicates and previously answered questions, sixty-three remained for interim ranking, and twenty-five were shortlisted for the workshop. Participants agreed on their Top 10 priorities, which covered topics such as prevention, current and novel treatment options, nutrition, survivorship concerns, and risk factors for developing oesophageal cancer, particularly at a young age. Conclusions Patients, family members, carers, and healthcare professionals collaborated to identify the most important questions for oesophageal cancer research. The results can help direct funding and attention to the shared priorities of those with personal experiences living with and providing care for oesophageal cancer.

Are Sodium-Glucose Cotransporter-2 Inhibitors the Cherry on Top of Cardio-Oncology Care?

The increasing aging of the population combined with improvements in cancer detection and care has significantly improved the survival and quality of life of cancer patients. These benefits are hampered by the increase of cardiovascular diseases being heart failure the most frequent manifestation of cardiotoxicity and becoming the major cause of morbidity and mortality among cancer survivor. Current strategies to prevent cardiotoxicity involves different approaches such as optimal management of CV risk factors, use of statins and/or neurohormonal medications, and, in some cases, even the use of chelating agents. As a class, SGLT2-i have revolutionized the therapeutic horizon of HF patients independently of their ejection fraction or glycemic status. There is an abundance of data from translational and observational clinical studies supporting a potential beneficial role of SGLT2-i in mitigating the cardiotoxic effects of cancer patients receiving anthracyclines. These findings underscore the need for more robust clinical trials to investigate the effect on cardiovascular outcomes of the prophylactic SGLT2-i treatment in patients undergoing cancer treatment.

Electronic Medical Record-Based Nudge Intervention to Increase Comprehensive Molecular Genotyping in Patients With Metastatic Non-Small Cell Lung Cancer: Results From a Prospective Clinical Trial.

Less than half of the patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) undergo comprehensive molecular testing. We designed an electronic medical record (EMR)-based "nudge intervention" to prompt plasma-based molecular testing at the time of initial medical oncology consultation. A nonrandomized prospective trial was conducted at the University of Pennsylvania's academic practice and two affiliated community practices. Molecular genotyping was performed by tissue- and/or plasma-based next generation sequencing methods. Comprehensive testing was defined as testing for EGFR, ALK, BRAF, ROS1, MET, RET, KRAS, and NTRK. Guideline-concordant treatment was defined as the use of the appropriate first-line (1L) therapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Proportion of patients with comprehensive molecular genotyping results available at any time, molecular results available before 1L therapy, and guideline-concordant 1L treatment were compared between the preintervention and postintervention cohorts using Fisher's exact test or Pearson's chi-squared test. Five hundred and thirty-three patients were included, 376 in the preintervention cohort and 157 in the postintervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent comprehensive molecular testing in the postintervention versus the preintervention cohort (100% v 88%, P = <.001), had results of comprehensive molecular testing available before initiating 1L treatment (97.3% v 91.6%, P = .026), and received NCCN guideline-concordant care (89.8% v 78.2%, P = .035). Across three practice sites in a large health system, implementation of a provider team-focused EMR-based nudge intervention was feasible, and led to a higher number of patients with NSCLC undergoing comprehensive molecular genotyping. These findings demonstrate that behavioral nudges can promote molecular testing and should be studied further as a tool to improve guideline-concordant care in both community and academic sites.

Questionnaire survey and analysis of drug clinical research implementation capabilities of breast cancer treatment departments in Chinese hospitals

BackgroundClinical research competence determines the quality of clinical research and the reliability of research findings. We aimed to explore the clinical research implementation capabilities of breast cancer treatment departments in China. MethodsThis was a department-based cross-sectional study conducted in the form of electronic questionnaires on the Wenjuanxing platform from 7th August to 31st August 2023 among hospitals from the first batch of breast cancer standardized diagnosis and treatment quality control pilot centers in China. ResultsA total of 127 questionnaires from 122 hospitals were ultimately included in the analysis. Medical personnel involved in the clinical research of 118 (92.9 %) departments received good clinical practice (GCP) training. The steps of the approval process from research initiation to completion lasted 2–4 weeks or longer. The majority of departments initiated or participated in 2 or fewer clinical research projects over the past year. Among the differences between different departments, the Department of Medical Oncology had a better qualification profile and process and greater number of initiated and participated clinical studies than did the Department of Surgical Oncology. For needs and problems, most of the departments were strongly willing to undertake clinical research and receive professional training; the most common problem in the process of conducting studies was patient recruitment. ConclusionsMost departments generally exhibited complete capabilities for implementing clinical research. Improvements in implementation efficiency, quality of research and patient recruitment are still needed. Professional training and communication, as well as the recommendation of clinical research, are required in future development.

Study on the additional financial burden of breast cancer disease on cancer patients and their families. Financial toxicity in cancer.

Breast cancer is among the most frequently diagnosed cancers worldwide, with 2.3 million new cases reported annually. The condition causes a social and economic impact known as financial toxicity of cancer. The study aims to explore the extra expenses borne by patients and their families on being diagnosed with breast cancer. An observational, descriptive, cross-sectional study was conducted. The data was collected between November 2021 and March 2022 at the Medical Oncology Service in Complejo Asistencial Universitario de Salamanca, Spain. The variables under investigation were additional economic costs, physical disability (as measured by the Barthel Index), instrumental activities of daily living (as measured by the Lawton-Brody Scale), and caregiver burden (measured using the ZARIT scale). The final sample size was N = 107. The study yielded the following outcomes: the median age was 55 years old and the majority of participants were female, with a proportion of 99.1%. The incidence rates for stage I and II were 31.8 and 35.5%, respectively. The median Barthel score was 100 points, while the Lawton and Brody score were 8 points and the ECOG score was 2 points. The analysis of primary caregiver burden resulted in a median ZARIT score of 15 points. The expenses related solely to the cancer diagnosis totaled 1511.22 euros per year (316.82 euros for pharmaceuticals; 487.85 euros for orthopedic equipment; 140.19 euros for home help; and 566.36 euros for housing adaptation or transfer to a hospital). The average annual income before diagnosis was 19962.62 euros. However, after being diagnosed with breast cancer, there is a significant income decrease of 15.91%, resulting in a reduced average annual income of 16785.98 euros. Additionally, a significant correlation was found between total expenditure and the level of dependency (p = 0.032) and functional status (p = 0.045). These findings indicate that breast cancer patients experience a considerable economic burden, which worsens as their functional status deteriorates. Therefore, we believe policies should be implemented to help control this economic deterioration resulting from a serious health condition.

227 Retrospective Study to Assess Axillary Management and Oncological Outcome After Neoadjuvant Chemotherapy for Patients with Breast Cancer

Abstract Aim Evaluation of the effect of neoadjuvant chemotherapy on axillary nodal status. The secondary objective was to evaluate the percentage of patients who are eligible for SLNB after neoadjuvant chemotherapy. Method This retrospective study was conducted by collecting data during the period from October 2019 to July 2021. The study included 64 patients who had biopsy-proven locally advanced breast cancer with clinically or radiologically positive axillary LNs, had been receiving neoadjuvant chemotherapy at the Clinical Oncology Department, and underwent surgery after neoadjuvant therapy at the surgical oncology unit of Alexandria Main University Hospital. Exclusion criteria were as follows: Patients with early-stage breast cancer, metastatic stage IV breast cancer, unfit/refusing neoadjuvant therapy, aged less than 18 years or more than 75 years or clinically and radiologically negative axilla. Data were collected retrospectively to assess the oncological and surgical outcomes after completing NAC. The files of 450 patients were reviewed, and only 64 patients were eligible patients to be included in our study. Results Complete pathological response (ypT0ypN0) was found in six of the 64 patients in our study. Four patients were triple-negative, and two patients were HER2-enriched biological subtype. One patient was T1, one patient was T2, one patient was T3, and three patients were T4. One patient was N1, four patients were N2, and one patient was N3. Conclusions Post-neoadjuvant ultrasound is essential for assessment of axillary response. Approximately 44.4% of patients with negative post-neoadjuvant axillary ultrasound can avoid unnecessary ALN clearance. Accurate axillary staging is the cornerstone for omission of axillary clearance after neoadjuvant among patients.

Ceftriaxone-resistant viridans streptococci bacteraemia among patients treated at a large comprehensive cancer care centre: a retrospective eighteen-year study.

Viridans streptococci (VS) are opportunistic oral commensals and a common cause of bacteraemia in neutropenic patients. In this retrospective single centre cohort study, we investigated the prevalence of ceftriaxone resistance in VS (CRO-R VS) blood isolates between January 2005 and December 2022 from patients treated at a tertiary care hospital. Blood culture isolates were identified using biochemicals and mass spectrometry. Susceptibility testing was performed by Kirby-Bauer and Epsilometer tests. Demographic data, clinical outcomes and antimicrobial use were assessed through electronic medical record review. Among 791 patients with VS bacteraemia, 31 (4%) had confirmed CRO-R VS bacteraemia over the 18-year period; 20/31 (65%) were patients also treated at the Fred Hutchinson Cancer Center and were the focus of this study. Of these 20 patients, 18 (90%) had a known haematologic malignancy; 14 (70%) had undergone haematopoietic cell transplant (HCT); 18 (90%) were neutropenic at the time of culture. Two (10%) patients died within 30 days of CRO-R VS bacteraemia. All the CRO-R isolates (20/20) were members of the Streptococcus mitis group, 12 were multi-drug resistant; all were susceptible to vancomycin. Most patients received vancomycin once blood cultures were positive for a Gram-positive organism. During the study period, the frequency of VS isolate susceptibility testing increased; however, there was no concomitant increase in the percentage of CRO-R isolates at our facility. These data are important in an era where cefepime monotherapy is often used and reinforces the importance of routine resistance testing among VS bacteraemia.

A mixed methods evaluation of patient perspectives on the implementation of an electronic health record-integrated patient-reported symptom and needs monitoring program in cancer care

BackgroundAs cancer centers have increased focus on patient-centered, evidenced-based care, implementing efficient programs that facilitate effective patient-clinician communication remains critical. We implemented an electronic health record-integrated patient-reported symptom and needs monitoring program (‘cPRO’ for cancer patient-reported outcomes). To aid evaluation of cPRO implementation, we asked patients receiving care in one of three geographical regions of an academic healthcare system about their experiences.MethodsUsing a sequential mixed-methods approach, we collected feedback in two waves. Wave 1 included virtual focus groups and interviews with patients who had completed cPRO. In Wave 2, we administered a structured survey to systematically examine Wave 1 themes. All participants had a diagnosed malignancy and received at least 2 invitations to complete cPRO. We used rapid and traditional qualitative methods to analyze Wave 1 data and focused on identifying facilitators and barriers to cPRO implementation. Wave 2 data were analyzed descriptively.ResultsParticipants (n = 180) were on average 62.9 years old; were majority female, White, non-Hispanic, and married; and represented various cancer types and phases of treatment. Wave 1 participants (n = 37) identified facilitators, including cPRO’s perceived value and favorable usability, and barriers, including confusion about cPRO’s purpose and various considerations for responding. High levels of clinician engagement with, and patient education on, cPRO were described as facilitators while low levels were described as barriers. Wave 2 (n = 143) data demonstrated high endorsement rates of cPRO’s usability on domains such as navigability (91.6%), comprehensibility (98.7%), and relevance (82.4%). Wave 2 data also indicated low rates of understanding cPRO’s purpose (56.7%), education from care teams about cPRO (22.5%), and discussing results of cPRO with care teams (16.3%).ConclusionsWhile patients reported high value and ease of use when completing cPRO, they also reported areas of confusion, emphasizing the importance of patient education on the purpose and use of cPRO and clinician engagement to sustain participation. These results guided successful implementation changes and will inform future improvements.

The role of a dedicated Oncology Nurse Navigator in the surgical oncology pathways: 1 year experience from a General Surgery Unit in central Italy with follow up.

The Nurse Navigator is a highly specialized nurse with technical and non-technical skills that offers individualized assistance to cancer patients, their family and caregivers to overcome health system barriers and facilitate access to care. This role was introduced in the General Surgery Unit of the Madonna del Soccorso Hospital in San Benedetto del Tronto from 1st January 2023. The primary endpoint is to compare the times taken for each step of the diagnostic-therapeutic pathway comparing the study group followed by Oncology Nurse Navigator (ONN) and the group not followed by this role. The secondary endpoints, only for the study group, were the number of patient contacts with the ONN and the time slots; the number of examinations and consultations organized by ONN; the evaluation of patient satisfaction at discharge; the number and type of problems noted during follow-up contact at 7 and 30days after discharge. A prospective court study with historical control was conducted from 1st January 2023 in Madonna del Soccorso Hospital, Italy. The study group consists of all cancer patients cared for by ONN. The control group was created by selecting the same number of patients as the study group but taken care of in the previous 3years (from 2020 to 2022) and, therefore, without the presence of the Nurse Navigator. The control group data come from clinical documentation. The number and time slots of contact with the ONN were recorded through the use of a company mobile phone active 24/7 through phone calls and messages. The number of examinations and consultations is known through online requests. The satisfaction assessment was carried out through the use of externally validated questionnaire Patient Satisfaction with Cancer Care (PSCC). The follow-up was performed by telephone and recorded on documentation according to established parameters. A total of 200 patients were analyzed. Both the study and control groups included 100 patients each. The average time between the first contact with the patient and the execution of the diagnostic test was 7days in the cases compared to 28days in the control group. The waiting time for the Multi-Disciplinary Team discussion (MDT) was 3 days for the study group compared to 6days in the control group. The average time taken for the first oncological visit was 3days in the study group compared to 18days in the controls. The time from first contact to the operating session was 20days compared to 45 in controls. Each patient had an average of 10 phone calls with the ONN. For all patients accompanied at the first diagnosis, at least 2 radiological and laboratory tests were organized. Oncology appointment for treatment evaluations after delivery of the histological report was communicated within a maximum of 3 working days. A patient satisfaction questionnaire achieved a response rate of 100%, with an average score of 87.0/90. The telephone follow-up had a response rate of 100% of patients and revealed a decrease in problems at the 30-day check-up compared to that of 7days after discharge. (Activity of Daily Living 20% vs 8%; nutritional problems 40% vs 21%, pain 18% vs 2%; surgical wounds 45% vs 1%; mobilization 8% vs 0%). The data demonstrate that ONN service improves the quality and outcomes of surgical oncology patients' pathway. The professional role of the ONN, with predefined technical and non-technical skills, should also be officially recognized by the healthcare system and hospital administration.

Impact of socioeconomic status on cancer care in Southeast Texas: a retrospective population-based cohort study

Background Gastrointestinal (GI) cancers are the third leading cause of cancer-related mortality worldwide. Disparities in healthcare frequently stem from variations in socioeconomic status (SES). This study investigated the influence of socioeconomic factors such as gender, race, age, and geography on time to treatment initiation (TTI) and survival outcomes. Methods The study analyzed SES data, including age, race, geography, and insurance status, from GI cancer patients treated at Baptist Hospitals of Southeast Texas (BHSET) from 2012 to 2017. Logistic regression was performed for risk association. The primary outcomes were survival time and TTI. Results Of 517 GI cancer patients, 359 had colorectal cancer. African Americans had higher treatment delays (odds ratio [OR]: 5.89, confidence interval [CI]: 4.02–8.62) than Caucasians (OR: 0.16, CI: 0.11–0.23). Patients >80 years had poorer survival (OR: 2.91, CI: 1.80–4.72) than younger ones. Those living 30 + miles from BHSET had longer TTI (OR: 1.85, CI: 1.19–2.87), especially within the colorectal cancer cohort (OR: 2.20, CI: 1.29–3.74). Medicare Advantage was linked to longer TTI (OR: 1.50, CI: 1.01–2.23). Medicare patients without supplemental insurance had lower survival overall (OR: 1.79, CI: 1.05–3.06) and among colorectal cancer patients (OR: 2.13, CI: 1.14–3.98). Conclusion Addressing SES disparities and implementing targeted interventions is imperative to ensure equitable access to timely and effective cancer care.

Transforming Lung Cancer Care: Advancements in Screening, Treatment, and Survivorship

Transforming Lung Cancer Care: Advancements in Screening, Treatment, and Survivorship

Antiretroviral Drugs Impact Autophagy: Opportunities for Drug Repurposing.

Autophagy is an evolutionarily conserved process in which intracellular macromolecules are degraded in a lysosomal-dependent manner. It is central to cellular energy homeostasis and to quality control of intracellular components. A decline in autophagic activity is associated with aging, and contributes to the development of various age-associated pathologies, including cancer. There is an ongoing need to develop chemotherapeutic agents to improve morbidity and mortality for those diagnosed with cancer, as well as to decrease the cost of cancer care. Autophagic programs are altered in cancer cells to support survival in genetically and metabolically unstable environments, making autophagy an attractive target for new chemotherapy. Antiretroviral drugs, which have dramatically increased the life- and health spans of people with human immunodeficiency virus (HIV) (PWH), have offered promise in the treatment of cancer. One mechanism underlying the antineoplastic effects of antiretroviral drugs is the alteration of cancer cell autophagy that can potentiate cell death. Antiretroviral drugs could be repurposed into the cancer chemotherapy arsenal. A more complete understanding of the impact of antiretroviral drugs on autophagy is essential for effective repurposing. This review summarizes our knowledge of the effects of antiretroviral drugs on autophagy as potential adjunctive chemotherapeutic agents, and highlights gaps to be addressed to reposition antiretroviral drugs into the antineoplastic arsenal successfully.