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Background: Although patients with melanoma of unknown primary (MUP) have a better prognosis than similar-staged melanoma patients with known primary, the occurrence of brain metastases (BM) entails a serious complication. This study provides an overview of the incidence, treatment patterns, and overall survival (OS) of adult patients with BM-MUP in the Netherlands. Methods: BM-MUP cases were retrieved from the Netherlands Cancer Registry. Patient, disease and treatment-related characteristics were summarised using descriptive statistics. Overall survival (OS) was calculated by the Kaplan–Meier method, and the impact of prognostic factors on OS was assessed using Cox proportional hazard regression analyses. Results: Among 1779 MUP patients, 450 were identified as BM-MUP (25.3%). Of these patients, 381 (84.7%) presented with BM along with other metastases, while 69 (15.3%) had BM only. BM-MUP patients were predominantly male (68.2%), and had a median age of 64 years at diagnosis (interquartile range 54–71 years). Over time, the proportion of BM along other metastatic sites increased, and the occurrence of BM decreased (p = 0.01). 1-Year OS improved for the total population, from 30.0% (95% confidence interval (CI): 19.8–40.9%) in 2011–2012 to 43.6% (95%CI: 34.5–52.3%) in 2019–2020, and median OS more than doubled from 4.2 months (95%CI: 3.3–6.2 months) to 9.8 months (95%CI: 7.0–13.2 months). Patient’s age, localisation of BM, presence of synchronous liver metastasis and treatment were identified as independent predictors of OS. Conclusion: Notwithstanding the progress made in OS for patients with BM-MUP in the past decade, their overall prognosis remains poor, and further efforts are needed to improve outcomes.

Background: Cancers of unknown primary (CUP) are metastatic tumours of which the site of origin cannot be identified. Guidelines regarding care for CUP patients are limitedly available, particularly for those who present with (synchronous) single or multiple brain metastases (BM-CUP). Knowledge on the incidence, approach and survival is scarce but is urgently needed to reveal current challenges and points for improvement in care for patients with BM-CUP. Methods: We performed a literature search on CUP patients and brain metastases in PubMed using the terms “CUP” OR “primary unknown tumour” AND “brain metastases”, focusing on reports published between 2017 and 2021. Variables considered were age, gender, presence and localisation of brain metastases, and prognosis. Also, information from the Dutch National Cancer Registry (NCR) was collected to review current practices in The Netherlands. Results: Ten international publications were identified on BM-CUP via the literature search, indicating a shortage of research on this subject. From the NCR, clinical metadata could be retrieved for a total of 1,419 BM-CUP patients. An increase in the proportion of BM-CUP patients from 8.1% to 10.1% was observed between 2009 and 2018. Incidence was slightly higher in men (54%). Cancer histology was not determined in most cases (42.7%). Presentation with multiple brain lesions was slightly more prevalent (52.9%). Among cases with known localization, most lesions were located in supratentorial areas (24.7%). Statistically significant associations were found for gender, age, and tumour histology in relation to BM-CUP incidence, and for age, histology, and tumour localisation in relation to survival (p <0.01). Discussion: Our search showed how little literature is currently available on BM-CUP. Our analyses of BM-CUP in The Netherlands showed significant associations in relation to incidence and survival. This research aims to contribute to better knowledge on the current challenges in

Background: Cancers of unknown primary (CUP) are metastatic tumours of which the site of origin cannot be identified. Guidelines regarding care for CUP patients are limitedly available, particularly for those who present with (synchronous) single or multiple brain metastases (BM-CUP). Knowledge on the incidence, approach and survival is scarce but is urgently needed to reveal current challenges and points for improvement in care for patients with BM-CUP. Methods: We performed a literature search on CUP patients and brain metastases in PubMed using the terms “CUP” OR “primary unknown tumour” AND “brain metastases”, focusing on reports published between 2017 and 2021. Variables considered were age, gender, presence and localisation of brain metastases, and prognosis. Also, information from the Dutch National Cancer Registry (NCR) was collected to review current practices in The Netherlands. Results: Ten international publications were identified on BM-CUP via the literature search, indicating a shortage of research on this subject. From the NCR, clinical metadata could be retrieved for a total of 1,419 BM-CUP patients. An increase in the proportion of BM-CUP patients from 8.1% to 10.1% was observed between 2009 and 2018. Incidence was slightly higher in men (54%). Cancer histology was not determined in most cases (42.7%). Presentation with multiple brain lesions was slightly more prevalent (52.9%). Among cases with known localization, most lesions were located in supratentorial areas (24.7%). Statistically significant associations were found for gender, age, and tumour histology in relation to BM-CUP incidence, and for age, histology, and tumour localisation in relation to survival (p <0.01). Discussion: Our search showed how little literature is currently available on BM-CUP. Our analyses of BM-CUP in The Netherlands showed significant associations in relation to incidence and survival. This research aims to contribute to better knowledge on the current challenges in

Purpose: Cancers of an unknown primary site (CUPs) have a dismal prognosis, and the situation is even worse for CUPs patients with brain metastases (BM-CUPs). This study aims to give better insight into the occurrence and survival of BM-CUPs patients. Methods: Cases were selected from the Netherlands Cancer Registry (1,430 BM-CUPs/17,140 CUPs). Baseline characteristics between CUPs patients with and without BM were tested using chi-square tests and Mann–Whitney U tests. Patients’ overall survival (OS) times were estimated by the Kaplan–Meier method and prognostic factors on OS was assessed using Cox proportional hazards regression analyses. Results: The proportion of BM-CUPs patients among CUPs increased from 8% in 2009–2010 to 10% in 2017–2018 (p < 0.001). Most patients presented with multiple brain lesions (53%). Survival of BM-CUPs improved over time: one-year OS increased from 10% for patients diagnosed in 2009–2010 to 17% (2017- 2018) (p < 0.01), and median survival times increased from 1.8 months to 2.2 months. Independent predictors of poor survival were multiple (HR 1.25; p < 0.01) or unknown (HR 1.48; p < 0.01) locations of BM, unknown/poorly/undifferentiated carcinoma histology (HR 1.53; p < 0.01), or clinical symptoms of BM (HR 1.74; p < 0.01), accompanying liver metastasis (HR 1.43; p < 0.01) and more than one metastatic site outside the brain compared to none (HR 1.52; p < 0.01). Conclusion: The incidence of patients with BM-CUPs is steadily increasing over time and overall prognosis remains dismal. Our results, however, show distinct patient subgroups that exhibit comparatively better outcomes, and more predictors may likely still be identified.

BACKGROUND: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. OBJECTIVE: The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women's preferences for e-screening and disclosure of mental health concerns. METHODS: Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin's tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs. RESULTS: Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.

Although most patients with gastro-oesophageal reflux disease (GERD) benefit from proton pump inhibitor (PPI) therapy, some experience only partial symptom relief.

Although most patients with gastro-oesophageal reflux disease (GERD) benefit from proton pump inhibitor (PPI) therapy, some experience only partial symptom relief.