Cancer Outcomes Research Articles

Pretreatment Quality of Life and Substance Use Among Patients Diagnosed With Head and Neck Cancer

ABSTRACTBackgroundThere is a paucity of research on the effects of commonly used substances, such as cannabis and other drugs, on quality of life as a contributor to head and neck cancer (HNC) prognosis. We examined associations between non‐alcohol or tobacco substance use (cannabis and other illicit drug) and self‐reported quality of life in patients with HNC prior to starting treatment.MethodsThis was a cross‐sectional study of patients who presented for routine psych‐oncologevaluation prior to treatment between 11/2015 and 9/2022. Primary exposures were cannabis use (never, past, or current users) and current illicit drug use (yes/no). The primary outcome measure was the Functional Assessment of Cancer Therapy—Head and Neck (FACT‐HN) subscales (physical, social/family, functional and emotional). Linear regression models examined associations between pretreatment substance use and FACT‐HN subscales adjusting for demographic, socioeconomic, and clinical factors.ResultsOf 570 patients, 13.9% endorsed current cannabis and 13.9% current illicit drug use. The mean (SD) scores for FACT‐HN subscales were physical well‐being = 22.8 (5.0), social well‐being = 22.7 (5.5), emotional well‐being = 17.5 (4.5), and functional well‐being = 18.7 (6.9). In the adjusted models, cannabis use was not independently associated with any FACT‐HN subscales. However, patients who currently used illicit drugs reported worse emotional well‐being (β = −1.32; 95% CI −2.45 to −0.20). No independent association was found between current illicit drug use and other subscales (physical, social, and functional).ConclusionsIllicit drug use, but not cannabis use, is negatively associated with pretreatment emotional well‐being in patients with HNC. Further research exploring the relationships between longitudinal cannabis and illicit drug use and methods of consumption on QoL and cancer outcomes in patients with head and neck cancer is warranted.

Allostatic load and its impact on outcomes in cervical cancer

Allostatic load and its impact on outcomes in cervical cancer

Association of plasma cells with outcomes in ovarian cancer

Association of plasma cells with outcomes in ovarian cancer

Microenvironment cell populations are associated with clinical outcomes in high-grade serous ovarian cancer

Microenvironment cell populations are associated with clinical outcomes in high-grade serous ovarian cancer

Analysis of the Incidence and Outcomes of Breast Cancer in Women with Schizophrenia

ObjectiveBreast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis. MethodsThis retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity.We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients’ propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema. Results1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53% in 2011 and 0.53% in 2022, with a peak in 2017 (1.29%). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients.The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72%) compared to those on antipsychotics (60%), log-rank test p-value <0.0001. The risk of local recurrence (13.4% versus 22.6%, p-value <0.0001), chemotherapy need (41.2% versus 48.4%, p-value <0.0001), and lymphedema (7.7% versus 11.5%, p-value <0.0001) were also significantly lower in women who did not take antipsychotics. ConclusionBreast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.

Long-term outcome of invasive pure micropapillary breast cancer compared with invasive mixed micropapillary and invasive ductal breast cancer: a matched retrospective study.

Data on the prognostic impact of the micropapillary component in breast cancer are limited. The purpose of this study was to investigate the clinicopathological characteristics and long-term outcomes of pure and mixed invasive micropapillary breast cancer (IMPC) patients compared to invasive ductal cancer (IDC) patients. This retrospective study analysed all IMPC and IDC patients treated at the European Institute of Oncology (IEO) between 1997 and 2019. The overall cohort of IMPC patients was divided in two groups, pure and mixed IMPC. Each patient with mixed or pure IMPC was matched with one patient with IDC, based on year of surgery, age, pT, pN, and molecular subtype. A total of 30,115 IDC, 120 pure IMPC and 150 mixed IMPC patients were considered eligible. Compared to IDC, pure and mixed IMPC patients presented a higher rate of locally advanced disease (pT2-T3, pN2-N3), vascular invasion, and Luminal B subtype. After matching, pure and mixed IMPC showed a significant higher rate of vascular invasion compared to IDC patients (p < 0.001). Invasive disease-free survival was better in IDC compared to pure IMPC patients (p = 0.11). Long-term overall survival was significantly worse in pure IMPC group compared to IDC group (p = 0.004), being instead similar between mixed IMPC vs matched IDC (p = 0.07). These real-world data reported the worse prognosis of pure IMPC compared to IDC, highlighting the peculiar prognostic value of the micropapillary subtype itself in the decision-making process of IMPC management. An accurate pre-surgical diagnostic evaluation and a multidisciplinary approach are pivotal to best personalize its treatment.

Prediction of clinical outcomes in ovarian cancer using genomic variation

Prediction of clinical outcomes in ovarian cancer using genomic variation

GPP06 Presentation Time: 9:45 AM: Early Clinical Outcomes of Cervical Cancer Treated with CT Based Image Guided Adaptive Brachytherapy Using IBS-GEC ESTRO-ABS Recommendations

GPP06 Presentation Time: 9:45 AM: Early Clinical Outcomes of Cervical Cancer Treated with CT Based Image Guided Adaptive Brachytherapy Using IBS-GEC ESTRO-ABS Recommendations

Spatial Architecture of Single-cell and Vasculature in Tumor Microenvironment Predicts Clinical Outcomes in Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited treatment options, which warrants the identification of novel therapeutic targets. Deciphering nuances in the tumor microenvironment (TME) may unveil insightful links between anti-tumor immunity and clinical outcomes, yet such connections remain underexplored. Here we employed a dataset derived from imaging mass cytometry of 71 TNBC patient specimens at single-cell resolution and performed in-depth quantifications with a suite of multi-scale computational algorithms. The TNBC TME reflected a heterogeneous ecosystem with high spatial and compositional heterogeneity. Spatial analysis identified ten recurrent cellular neighborhoods (CNs) – a collection of local TME characteristics with unique cell components. The prevalence of CNs enriched with B cells, fibroblasts, and tumor cells, in conjunction with vascular density and perivasculature immune profiles, could significantly enrich for long-term survivors. Furthermore, relative spatial colocalization of SMAhi fibroblasts and tumor cells compared to B cells correlated significantly with favorable clinical outcomes. Using a deep learning model trained on engineered spatial data, we can predict with high accuracy (mean AUC of 5-fold cross-validation = 0.71) how a separate cohort of patients in the NeoTRIP clinical trial will respond to treatment based on baseline TME features. These data reinforce that the TME architecture is structured in cellular compositions, spatial organizations, vasculature biology, and molecular profiles, and suggest novel imaging-based biomarkers for treatment development in the context of TNBC.

Efficacy of Atezolizumab in Subsequent Lines of Therapy for NSCLC Patients: Insights from Real-World Data

Immune checkpoint inhibitors (ICIs) like atezolizumab have improved outcomes in advanced non-small cell lung cancer (NSCLC) patients, especially in the second-line setting after progression on platinum-based chemotherapy. However, access to ICIs remains limited in many developing nations. This study evaluated the efficacy of atezolizumab as a second-line versus later-line treatment for advanced NSCLC patients in Serbia. Methods: This retrospective study involved 147 advanced NSCLC patients treated with atezolizumab following progression on prior platinum-based chemotherapy at two academic centers in Serbia. Data on demographics and clinical, pathological, and molecular characteristics were collected. Median progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and multivariable Cox proportional hazards regression identified outcome predictors. Results: The median PFS was 7.13 months, and median OS was 38.6 months. The overall response rate (ORR) was 15%, with a disease control rate (DCR) of 57.9%. No significant PFS differences were observed between patients treated with atezolizumab in the second line versus later lines. Patients with good performance status (ECOG 0–1) had significantly better PFS compared to those with poorer status (12.03 vs. 1.63 months, p &lt; 0.0001). Conclusions: Atezolizumab is effective in both second-line and later-line settings for advanced NSCLC, particularly in patients with good performance status. This highlights the importance of patient selection based on performance status, as well as the need for wider access to ICIs in resource-limited regions.

Sinensetin inhibits the movement ability and tumor immune microenvironment of non-small cell lung cancer through the inactivation of AKT/β-catenin axis.

Although current treatment strategies have improved clinical outcomes of non-small cell lung cancer (NSCLC) patients, side effect and prognosis remain a hindrance. Thus, safer and more effective therapeutical drugs are needed for NSCLC. Sinensetin (Sin) is a flavonoid from citrus fruits, which exhibits antitumor effect on diverse cancers. However, the effect and mechanism of Sin on NSCLC remain unknown. In this study, NSCLC cell lines, and tumor-bearing mice were treated with Sin. The effect and mechanism of Sin were addressed using cell counting kit-8, transwell, enzyme-linked immunosorbent assay, hematoxylin and eosin, immunohistochemistry, and western blot analysis assays in both cell and animal models. Sin reduced the cell viability of A549 and H1299, with the IC50 of 81.46 µM and 93.15 µM, respectively. Sin decreased invaded cell numbers, the expression of N-cadherin and vascular endothelial growth factor A (VEGFA), while increased the E-cadherin level, the cytotoxicity of CD8+ T cells, and the concentration of interferon-γ (IFN-γ), interleukin-2 (IL-2), and tumor necrosis factor-α (TNF-α) in NSCLC cells. Mechanistically, Sin declined the expression of protein kinase B (AKT)/β-catenin pathway, which was restored with the application of SC79, an activator of AKT. The inhibitory role of Sin in NSCLC cell proliferation, invasion, epithelial-mesenchymal transition (EMT) and immune escape was reversed by the management of SC79. In vivo, Sin reduced tumor size and weight, and the expression of N-cadherin, VEGFA, and AKT/β-catenin pathway, but enhanced the level of E-cadherin and IFN-γ. Taken together, Sin suppressed cell growth, invasion, EMT and immune escape via AKT/β-catenin pathway in NSCLC.

Concordance of Bronchoscopic and Radiological Findings in Suspected Lung Cancer and its Outcome- A Cross Sectional Study in a Tertiary Care Hospital

Background: Bronchoscopy and CT thorax are the most common investigations utilized to screen and diagnose lung cancer. Their individual utility in diagnosing lung cancer has been described affirmatively in existing literature. Studies correlating the airway characteristics of the two modalities in lung cancer are limited. Objectives: To analyze and characterize lung lesions bronchoscopically and correlate the same radiologically by CT of the thorax and thus assess its positive predictive value. Methods: In this prospective study, 56 consecutive adults who presented to the Respiratory Medicine Department at a tertiary care hospital in South India from November 2018 to June 2020, having Clinico-radiological suspicion of malignancy and fulfilling study criteria, were recruited. They were subjected to CECT of thorax and bronchoscopy. All bronchoscopic procedures were performed using a protocolized number of passes for biopsy. The baseline demographic and clinical data, findings of bronchoscopy and CT and biopsy reports were recorded. Cohen’s kappa coefficient was used to estimate the agreement of findings on the two modalities. Statistical analysis was performed using SPSS software. Results: Bronchoscopy was normal in 22.14% of cases, the corresponding CTs also revealed normal airway. Bronchoscopy revealed airway lesions in 78.6% of cases; the corresponding CT revealed airway abnormalities in only 46.41% of cases; among these, 52.1% of cases revealed an exophytic growth. There was fair strength of agreement for the two modalities in the detection of airway lesions of lung cancer. (k = 0.38, p = &lt;0.001). CECT thorax has a negative predictive value of 44%, a sensitivity of 59.1% and a specificity of 100% at 95% CI in the detection of airway lesions. Conclusion: CT may not be definitive in the evaluation of lung cancer, especially in those with central disease. A combination of the two modalities may improve the diagnostic outcome in patients with lung cancer.

P007 PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform

P007 PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform

The Context of Poverty and Cancer: Denying Human Potential.

Poverty is a carcinogen and a leading cause of cancer disparities and overall mortality in the United States. Poverty is often viewed as an individual failure for "being poor," but in fact, poverty is structurally driven, intergenerational, and place-based that socially deprives and denies human potential. Disparities in timely cancer prevention, diagnosis, treatment, survivorship, and survival disproportionally impact people living in poverty and especially in persistent poverty areas, an extreme form of place-based poverty that affects communities over multiple generations. There has been some progress made to address place-based conditions that exacerbate poverty, such as the NCI's initiative on persistent poverty. However, gross inequality and cancer disparities continue to exist and persist. The time is now to accelerate the development of research-informed strategies and solutions with communities along with multisectoral collaborations with education, housing, occupation/workforce, foster care, criminal justice, transportation, and data collection systems. This commentary discusses the structural, place-based, and generational context of poverty, illustrates how entrenched inequities shape poor cancer outcomes, and describes opportunities for future research.

The impact of Medicaid expansion on cervical cancer outcomes

The impact of Medicaid expansion on cervical cancer outcomes

Metabolic syndrome and risks of breast cancer outcomes for luminal, triple-negative, and HER2-overexpressing subtypes.

We evaluated the association between metabolic syndrome (obesity plus two metabolic risk factors) and breast cancer outcomes according to molecular subtype. This population-based prospective cohort consisted of 3,267 women aged 20-69 diagnosed with a first primary invasive breast cancer from 2004-2015 in the Seattle-Puget Sound region. Breast cancer was categorized into three subtypes based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression: luminal (ER+), triple-negative (ER-/PR-/HER2-), and HER2-overexpressing (H2E) (ER-/HER2+). We used time-varying Cox models to assess the association between prevalent and incident metabolic syndrome and risks of recurrence, breast cancer-specific mortality, and all-cause mortality. Metabolic syndrome was associated with a greater risk of recurrence (HR:3.24; 95% CI:1.13-9.33) and breast cancer-specific mortality (HR:5.34; 95% CI:2.32-12.31) only for the H2E subtype, and greater risks of all-cause mortality for luminal (HR:1.92; 95% CI:1.37-2.68), H2E (HR:5.09; 95% CI:2.51-10.32), and all cases combined (HR:1.90; 95% CI:1.42,2.53). We also observed heterogeneity in recurrence and mortality outcomes across specific components of metabolic syndrome and molecular subtypes. Metabolic syndrome is associated with all-cause mortality among women with breast cancer and with breast cancer-specific mortality among women with the H2E subtype. These results highlight the importance of managing comorbidities to decrease the risk for adverse outcomes among breast cancer survivors.

AI machine learning survival models for the prediction of epithelial ovarian cancer outcomes

AI machine learning survival models for the prediction of epithelial ovarian cancer outcomes

Trends in malignant neoplasm of bone and articular cartilage related mortality among older adults in United States (1999–2020)

Introduction: Malignant neoplasms of bone and articular cartilage, although rare, are associated with substantial morbidity and mortality, posing a serious health burden. Understanding the trends in mortality related to these cancers is crucial for developing targeted interventions and improving patient outcomes. This study aims to analyze long-term mortality trends, identify demographic and geographic disparities, and uncover potential factors driving changes in mortality rates. Methods: This retrospective study analyzed mortality rates among individuals aged 65 and older from 1999 to 2020 using CDC WONDER death certificate data, abstracting demographics, geographic factors, and urban/rural status. Results: From 1999 to 2020, 18,205 adults aged 65 and older died from malignant neoplasms of bone and cartilage. The age-adjusted mortality rate (AAMR) started at 20 per 100,000 in 1999 and steadily declined until 2012 (APC: −1.12). However, from 2012 onwards, there was a notable reversal, with the AAMR rising sharply to 23.8 by 2020 (APC: 4.73). Men had higher mortality rates than women, with NH Black individuals showing the highest rates among races. Southern states and nonmetropolitan areas had elevated AAMRs, suggesting targeted interventions for better outcomes and lower death rates. Conclusion: The findings highlight significant inequities, with Southern states and nonmetropolitan areas showing elevated age-adjusted mortality rates (AAMRs). These geographic disparities underscore the urgent need for targeted public health interventions in these regions to improve cancer outcomes and reduce mortality. Addressing these gaps is essential for achieving more equitable health outcomes, particularly in high-risk populations.

Community prevention and standardized clinical treatment jointly improve cancer outcome: Real-world evidence from an esophageal cancer patient cohort study

Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma (ESCC) in China. However, the joint impact of prevention and treatment on the long-term overall survival (OS) of ESCC patients remains largely unknown. We consecutively recruited 13,255 ESCC patients from two Chinese centers: the Northern center, located in a high-risk area with abundant screening programs; and the Southern center, situated in a non-high-risk area with improved clinical practices. Inter-center comparison, longitudinal intra-center comparison, and a simulation analysis were conducted to investigate the influence of tumor downstaging and high-quality clinical treatment on OS. During a follow-up period of 12.52 years, the Northern center exhibited higher median survival than the Southern center (6.22 vs. 3.15 years; HRadjusted = 0.73, 95% CI: 0.69–0.77). Mediation analysis demonstrated that its OS advantage was largely (77.7%) attributed to earlier TNM stage (stage 0–II: 51.3% vs. 24.6%). In temporal analyses, patient survival in the Southern center gradually improved (median survival during 2015–2018 vs. 2009–2014: 3.58 vs. 2.93 years; HRadjusted = 0.86, 95% CI: 0.79–0.94), coinciding with the progress of treatment-related indices (completeness of TNM staging in discharge diagnosis [from 53.7% to 99.6%], adoption of minimally invasive esophagectomy [from 0.0% to 51.1%] and right thoracic esophagectomy [from 12.4% to 86.4%], etc.). Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival. Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival. Establishing a comprehensive strategy that integrates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.

The Potential Impact of a Single-Dose HPV Vaccination Schedule on Cervical Cancer Outcomes in Kenya: A Mathematical Modelling and Health Economic Analysis

Background: Human Papillomavirus (HPV) is the primary cause of cervical cancer. Single-dose HPV vaccination can effectively prevent high-risk HPV infection that causes cervical cancer and accelerate progress toward achieving cervical cancer elimination goals. We modelled the potential impact of adopting single-dose HPV vaccination strategies on health and economic outcomes in Kenya, where a two-dose schedule is the current standard. Methods: Using a validated compartmental transmission model of HPV and HIV in Kenya, we evaluated the costs from the payer’s perspective to vaccinate girls by age 10 with either one or two doses and increasing coverage levels (0%, 70%, 77%, 90%). Additionally, we modelled single-dose strategies supplemented with either catch-up vaccination of adolescent girls and young women or vaccination for all by age 10, funded with the first five-years of cost savings of switching from a two- to one-dose schedule. Costs and outcomes were discounted at 3% annually, and incremental cost-effectiveness ratios (ICERs) were calculated per disability-adjusted-life-year (DALY) averted. Results: All one-dose and the two-dose 90% coverage strategies were on the efficiency frontier, dominating the remaining two-dose strategies. The two-dose 90% coverage strategy had a substantially higher ICER (US$6508.80/DALY averted) than the one-dose 90% coverage (US$197.44/DALY averted). Transitioning from a two- to one-dose schedule could result in US$21.4 Million saved over the first five years, which could potentially fund 2.75 million supplemental HPV vaccinations. With this re-investment, all two-dose HPV vaccination scenarios would be dominated. The greatest DALYs were averted with the single-dose HPV vaccination schedule at 90% coverage supplemented with catch-up for 11–24-year-old girls, which had an ICER of US$78.73/DALYs averted. Conclusions: Considering the logistical and cost burdens of a two-dose schedule, a one-dose schedule for girls by age 10 would generate savings that could be leveraged for catch-up vaccination for older girls and accelerate cervical cancer elimination in Kenya.