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Background: The convergence of the economic crisis, COVID‐19 pandemic, and Beirut Blast has precipitated unprecedented challenges for the healthcare system in Lebanon, particularly for cancer patients. Amidst these crises, our study evaluates its contribution to a concerning trend of operating on more late‐stage and complex colorectal cancer (CRC) cases. Methods: We included 155 patients operated for CRC between 2017 and 2023. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; tumour, node, metastasis stage; lymphatic, vascular and perineural invasions; American Society of Anesthesiologists (ASA) score, presentation and previous history, and complications were examined. Results: Surgical outcomes remained relatively consistent before and after the crisis. However, there was a notable increase, with patients being 3.59 times more likely to undergo resection of adjacent organs in metastatic disease post‐crisis. Patient characteristics also exhibited notable shifts, with a 9.60‐fold increase in the likelihood of having an ASA score of at least 2 after the crisis. Additionally, there was a 5.36‐fold decrease in the odds of patients undergoing a colonoscopy before their diagnostic one post‐crisis. Preoperative carcinoembryonic antigen levels were significantly elevated post‐crisis compared to pre‐crisis levels. Pathological findings revealed increased odds of perineural, vascular, and lymphatic invasion post‐crisis. Additionally, there was a notable increase in the likelihood of hepatic synchronous metastases post‐crisis. Furthermore, a trend to operate on complicated diseases was noted with an increased number of colostomies. Conclusion: The economic crisis in Lebanon has profoundly affected early intervention and comprehensive treatment for CRC patients, resulting in a concerning rise in late‐stage cases requiring surgical intervention. [ABSTRACT FROM AUTHOR]

Simple Summary: This study compares two different strategies for using postoperative radiotherapy in patients with deep-seated grade 2–3 soft tissue sarcomas of the limbs and trunk wall. One treatment center routinely used postoperative radiotherapy for almost all patients (83%). The other center had a more restrictive approach to selecting patients for radiotherapy, and if the surgical margin was wider than 1 cm and/or a solid barrier was present, radiotherapy was not administered. This resulted in fewer patients (64%) receiving primary radiotherapy after surgery. By analyzing treatment outcomes over several years, we found no differences in local recurrence rates between the two approaches. Two national sarcoma centers have had different approaches for selecting patients with grade 2–3 deep-seated soft tissue sarcomas (STS) for postoperative radiotherapy (RT). We evaluated potential differences in local recurrence in patients treated at the two centers. At Sarcoma Center 1 (SC1), RT was the standard treatment for all tumors except certain small tumors excised with a margin wider than 1 cm. Sarcoma Center 2 (SC2) avoided RT for tumors regardless of tumor size if removed with a margin wider than 1 cm and/or a solid barrier. We included 386 patients (SC1/SC2 = 196/190) over 18 years of age diagnosed with a non-metastatic grade 2–3, deep-seated STS of the extremities or trunk wall, who underwent primary surgical treatment (only tumors excised with a negative margin) from 1 January 2000, to 31 December 2016. Kaplan–Meier survival analysis, competing risk analysis, and cause-specific Cox regression were applied. A total of 284 patients received primary RT, 163 (83%) at SC1 and 121 (64%) at SC2 (p < 0.001). The cumulative incidence of local recurrence at five years was 15% (95% CI: 10–19%) at SC1 and 14% (95% CI: 9–19%) at SC2. Multivariate analysis showed no significant differences in local recurrence between the centers. We concluded that when entering all available patients into the analysis using an intention-to-treat principle, a more selective approach to postoperative RT in patients with grade 2–3 deep-seated STS did not lead to a higher local recurrence rate. However, with this study design, we cannot rule out if the local recurrence rate could have been lower if RT was administered to all tumors removed with a margin wider than 1 cm and/or a solid barrier. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation–behavior) model for behavior change was used to inform strategic planning and Plan–Do–Study–Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with delays in beginning adjuvant therapy and prognosis impacts on non‐metastatic breast cancer patients. Methods: This assessment comprised a prospective cohort study concerning breast cancer patients treated at a public oncology centre. A time interval of ≥60 days between surgery and the beginning of the first adjuvant treatment was categorised as a delay. Factors associated with delays were evaluated through logistic regression analysis and the prognosis effects were assessed by a Cox regression analysis. Results: The median time interval between surgery and the first adjuvant treatment for the 401 women included in this study was of 57.0 days (37.0–93.0). Independent factors associated with delays comprised not presenting an overexpression of the HER‐2 protein, not having undergone neoadjuvant chemotherapy, and having undergone chemotherapy or other therapeutic modalities other than hormone therapy and chemotherapy as the first adjuvant treatment. Delays did not affect recurrence, distant metastasis, or death risks. Factors associated with recurrence and distant metastasis risks comprised a clinical staging ≥2B, having undergone neoadjuvant chemotherapy, presenting the luminal molecular subtype B and triple‐negative tumours, and having children. Factors associated with death comprised triple‐negative molecular tumours and neoadjuvant chemotherapy. Conclusion: Delays in beginning adjuvant treatment did not affect the prognosis of non‐metastatic breast cancer patients. Clinical and treatment‐related factors, on the other hand, were associated with delays, and recurrence, distant metastasis, and death risks. [ABSTRACT FROM AUTHOR]

Introduction: Cancer treatments frequently lead to cognitive impairments, affecting a substantial global population. Among various approaches, exercise has emerged as a promising strategy for rehabilitation. However, a comprehensive bibliometric analysis of research in this field is lacking. Methods: We conducted a bibliometric analysis of 10,345 articles sourced from the Web of Science database using the R package "bibliometrix". Our analysis examined publication trends, leading countries, journals, authors, institutions, keywords, and prevalent themes. Results: Over the past two decades, research on exercise interventions for cancer-related cognitive impairments (CRCI) has advanced significantly. Nonetheless, challenges persist in elucidating underlying mechanisms, developing innovative strategies, and creating effective tools. Conclusions: The number of publications notably increased from 1998 to 2023, although there has been a recent decline in citations. The United States (US) leads in both publications and citations, while China is showing increasing influence. Using Lotka's Law in our bibliometric analysis, we identified 58 key authors in the field of exercise interventions for CRCI. Leading institutions such as the University of Toronto and Duke University are at the forefront of this research. Although the Journal of Clinical Oncology has fewer publications, it remains influential. Current research focuses on exercise interventions to enhance the quality of life for cancer patients, with particular emphasis on cognitive rehabilitation in breast cancer and the challenges faced by survivors. Future research should delve deeper into intervention mechanisms, behavioral strategies, telemedicine, and precise cognitive assessment tools. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer and family caregivers often use avoidant coping strategies, such as delaying advance care planning discussions, which contribute to deterioration in their quality of life. Mindfulness-based interventions have shown promise in improving quality of life in this population but have rarely been applied to advance care planning. This pilot trial examined the preliminary efficacy of a group-based Mindfulness to Enhance Quality of Life and Support Advance Care Planning (MEANING) intervention for patient-caregiver dyads coping with advanced cancer. Primary outcomes were patient and caregiver quality of life or well-being, and secondary outcomes included patient advanced care planning engagement (self-efficacy and readiness) and other psychological and symptom outcomes. Methods: In this pilot trial, dyads coping with advanced cancer were recruited from five oncology clinics in the midwestern U.S. and randomized to six weekly group sessions of a mindfulness intervention (n = 33 dyads) or usual care (n = 22 dyads). Outcomes were assessed via surveys at baseline, post-intervention, and 1 month post-intervention. All available data were included in the multilevel models assessing intervention efficacy. Results: Patients in the MEANING condition experienced significant increases in existential well-being and self-efficacy for advance care planning across follow-ups, whereas usual care patients did not. Other group differences in outcomes were not statistically significant. These outcomes included other facets of patient well-being, caregiver quality of life, patient readiness for advance care planning, caregiver burden, and patient and caregiver depressive symptoms, anxiety, sleep disturbance, cognitive avoidance, and peaceful acceptance of cancer. However, only MEANING patients showed moderate increases in psychological well-being across follow-ups, and MEANING caregivers showed moderate increases in quality of life at 1-month follow-up. Certain psychological outcomes, such as caregiver burden at 1-month follow-up, also showed moderate improvement in the MEANING condition. Patients in both conditions reported small to moderate increases in readiness to engage in advance care planning. Conclusions: A mindfulness-based intervention showed promise in improving quality-of-life and advance care planning outcomes in patients and caregivers coping with advanced cancer and warrants further testing. Trial Registration: ClinicalTrials.gov NCT03257007. Registered 22 August 2017, https://clinicaltrials.gov/ct2/show/NCT03257007. [ABSTRACT FROM AUTHOR]

After breast cancer diagnosis, individuals have to cope with various psychological, social, and physical consequences. One such consequence is chronic pain, which can persist even after the completion of active treatments and detrimentally impact quality of life. The published literature highlights the impact of chronic pain on cognitive functions and on decision-making processes. However, little is known about the imbalance in decision-making among cancer survivors suffering from chronic pain. This study aims to explore the cognitive impairment associated with risky decision-making in breast cancer survivors experiencing chronic pain, using the Iowa Gambling Task (IGT). Sixty women voluntarily participated in this prospective, cross-sectional study. Among them, twenty had a history of breast cancer and exhibited a significant level of chronic pain, twenty had previously received a cancer diagnosis but did not experience chronic pain, and twenty had not been diagnosed with cancer. The results revealed that women with chronic pain tend to make significantly more disadvantageous choices in the IGT compared to the other groups. Moreover, participants with chronic pain tend to believe that circumstances will change regardless of their efforts to achieve something. This way of thinking may contribute to reinforcing the observed imbalance in decision-making. Our hypothesis suggests that chronic pain may trigger a "Cascade Effect", exerting multiple influences on decision-making and behaviors. The cognitive overload provoked by chronic pain in breast cancer survivors may not only affect individual cognitive functions, but also have a "Cascade Effect" on other psychological dimensions. [ABSTRACT FROM AUTHOR]

Background: The minimal important difference (MID) is a useful tool to interpret changes in patients' health-related quality of life. This study aims to estimate MIDs for interpreting within-patient change for both components of the EQ-5D-5L questionnaire [EQ-Visual Analogue Scale (EQ-VAS) and utility index] and domains of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) for cancer patients. Methods: Data were obtained from the Cancer 2015 dataset, a longitudinal cohort of Australian cancer patients. Anchor-based approaches were used to estimate MIDs for the EQ-5D-5L index-based utility index [Australia and the United States (US) tariff sets], EQ-VAS scores, and the EORTC QLQ-C30. Clinical [Eastern Cooperative Oncology Group (ECOG) performance status] and patient-reported (items 29 and 30 of the EORTC QLQ-C30 and the EQ-VAS) anchors were assessed for appropriateness by their correlation strength. Clinical change groups (CCGs) were defined a priori for improvement and deterioration based on estimates used in previous literature. MIDs were estimated via linear regression and distribution-based methods. Results: For the index-based utility scores in Australia, the anchor-defined MID estimates were 0.01 to 0.06 for improvement and − 0.04 to -0.03 for deterioration, with a weighted value of 0.03 for improvement and deterioration. The EQ-VAS MID estimate was 5 points for both improvement and deterioration. For the EORTC QLQ-C30, changes of at least 3.64 (improvement) and − 4.28 (deterioration) units on the physical functioning scale, 6.31 (improvement) and − 7.11 (deterioration) units on the role functioning scale, 4.65 (improvement) and − 3.41 (deterioration) units on the emotional functioning scale, and 5.41 (improvement) and − 5.56 (deterioration) units on the social functioning scale were estimated to be meaningful. Conclusion: This study identified lower MIDs for the EQ-5D-5L utility index, EQ-VAS, and EORTC QLQ-C30 domain scores, than those reported previously. The use of a real-world cancer-specific panel dataset may reflect smaller MID estimates that are more applicable to cancer patients in the clinical practice, rather than using MIDs that have been estimated from clinical trials. [ABSTRACT FROM AUTHOR]

AbstractReligious and spiritual (R/S) beliefs are crucial coping resources for cancer patients, yet there’s no standard spiritual assessment approach. We developed the ONC-5, an evidence-based model to quantify patients’ spiritual concerns in adult oncology. Seventy-one patients with diverse cancer diagnoses completed a survey and a semi-structured ONC-5 interview with a chaplain. Measures included the distress thermometer, PHQ-2, R/S struggle, and spiritual well-being. Thirty interviews were reviewed for inter-rater reliability. Spearman correlations assessed validity, and the concordance correlation coefficient (CCC) was calculated for inter-rater reliability. Results showed 20% of patients had moderate or severe spiritual concerns. ONC-5 scores correlated with R/S struggle (r = .247; p = .038) and spiritual well-being (r = −.247; p = .038). The CCC of 0.4411 indicated moderate agreement. The ONC-5 helps chaplains identify spiritual concerns, prioritize care, and measure improvements. More research is needed to test its validity and reliability in diverse populations. [ABSTRACT FROM AUTHOR]

Introduction: Cancers are amajor cause of childhood mortality worldwide especially in LMICs where underdiagnoses and lack of quality cancer data hampers effective cancer control efforts. This study aimed to document and describe the patterns and characteristics of childhood cancers in the North East geopolitical zone of Nigeria. Methods: This was a retrospective cross-sectional study that collected cancer data from 4 out of the 6 states in the North East of Nigeria. The data included all malignancies diagnosed in children aged 0-19 years between 2019 and 2022. The age-specific incidence rates were also calculated for the individual 5-year age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years). The crude incidence rates (CIR) were calculated as the weighted averages of the respective ASRs in each age range within 0-14 years and 0-19 years respectively. The cancers were grouped according to the International Incidence of Childhood Cancers, volume 3 (IICC3). Results: Cancers in people <20 years accounted for 7.3% of all cancers diagnosed over the same period. The crude incidence rates (CIR) for cancers in children and adolescents were 20.9 per million children aged 0-19 years and 18.8 per million children aged 0-14 years respectively, while the agestandardized rates (ASR) were 1.80 and 1.63 per million person-years respectively. There was a variation in the most commonly diagnosed cancers across all age groups. However, lymphomas were the most commonly diagnosed cancers overall, while CNS tumors were overwhelmingly rare. Conclusion: Despite data limitations, this study provides useful insights into patterns of cancers in the region and will hopefully provide a basis for the strengthening of pediatric oncology care, childhood cancer control programs and population-based cancer registries. [ABSTRACT FROM AUTHOR]

Background: Oncological patients have high information needs that are often unmet. Patient versions of oncological clinical practice guidelines (PVG) translate clinical practice guidelines into laypersons' language and might help to address patients' information needs. Currently, 30 oncological PVG have been published in Germany and more are being developed. Following a large multi-phase project on oncological PVGs in Germany, recommendations to improve use and dissemination of PVG were adopted in a multi-stakeholder workshop. Methods: Organisations representing users of PVGs (patients, medical personnel, and multipliers), creators, initiators/funding organisations of PVGs, and organisations with methodological expertise in the development of clinical practice guidelines or in patient health information were invited to participate. The workshop included a World Café for discussion of pre-selected recommendations and structured consensus procedure for of all recommendations. Recommendations with agreement of > 75% were approved, and in case of ≤ 75% agreement, recommendations were rejected. Results: The workshop took place on 24th April 2023 in Cologne, Germany. Overall, 23 people from 24 organisations participated in the discussion. Of 35 suggested recommendations 28 recommendations reached consensus and were approved. The recommendations referred to the topics dissemination (N = 13), design and format (N = 7), (digital) links (N = 5), digitalisation (N = 4), up-to-dateness (N = 3), and use of the PVG in collaboration between healthcare providers and patients (N = 3). Conclusion: The practical recommendations consider various perspectives and can help to improve use and dissemination of oncological PVG in Germany. The inclusion of different stakeholders could facilitate the transfer of the results into practice. [ABSTRACT FROM AUTHOR]

Background: While home is frequently expressed as the favorite place of death (PoD) among terminally ill cancer patients, various factors affect the fulfillment of this wish. The determinants of the PoD of cancer patients in countries without healthcare system-integrated palliative and supportive care have not been studied before. This study aimed at identifying the predictors of the PoD of patients who suffer from advanced cancer by developing a reliable predictive model among who received home-based palliative care in Iran as a representative of the countries with isolated provision of palliative care services. Methods: In a cross-sectional study, electronic records of 4083 advanced cancer patients enrolled in the Iranian Cancer Control Center (MACSA) palliative homecare program, who died between February 2018 and February 2020 were retrieved. Multivariable binary logistic regression analysis as well as subgroup analyses (location, sex, marital status, and tumor topography) was performed to identify the predictors of PoD. Results: Of the 2398 cases included (mean age (SD) = 64.17 (14.45) year, 1269 (%52.9) male), 1216 (50.7%) patients died at home. Older age, presence and intensity of medical homecare in the last two weeks and registration in the Tehran site of the program were associated with dying at home (P < 0.05). Gynecological or hematological cancers, presence and intensity of the calls received from the remote palliative care unit in the last two weeks were predictors of death at the hospital (p < 0.05). The model was internally and externally validated (AUC = 0.723 (95% CI = 0.702–0.745; P < 0.001) and AUC = 0.697 (95% CI = 0.631–0.763; P < 0.001) respectively). Conclusion: Our model highlights the demographic, illness-related and environmental determinants of the PoD in communities with patchy provision of palliative care. It also urges policymakers and service providers to identify and take the local determinant of the place of death into account to match the goals of palliative and supportive services with the patient preferences. [ABSTRACT FROM AUTHOR]

Background: Nivolumab, an immune checkpoint inhibitor used to treat several malignancies, is associated with immune-related adverse events (IrAEs). Original dosing for melanoma was 3 mg/kg (maximum 240 mg) every 2 weeks (Q2W). Based on simulation studies depicting similar efficacy and toxicity to original dosing, extended interval dosing of 6 mg/kg (maximum 480 mg) every 4 weeks (Q4W) was introduced. Objective: This study will compare safety between Q2W and Q4W dosing at BC Cancer in melanoma patients. Methods: Retrospective chart review for reported incidence, onset, and severity of IrAEs in melanoma patients treated with nivolumab Q2W and Q4W dosing was completed. Fisher's test was conducted for first incidence IrAEs using Microsoft Excel. Results: Seventy-one patients were identified (Q2W n = 35, Q4W n = 36). Baseline characteristics were similar in both groups. No statistically significant difference was found in incidence of IrAEs between Q2W and Q4W dosing (Q2W 40% vs Q4W 50%, p = 0.477). Rash was most common (Q2W 79% vs Q4W 50%) followed by hypothyroidism (Q2W 33% vs Q4W 20%). Median onset of IrAEs seemed later with Q4W dosing (Q2W cycle 1 vs Q4W cycle 4). Regardless of dosing, most IrAEs were grade 1–2 in severity (Q2W 100% vs Q4W 89%). Conclusion: Q4W dosing is associated with comparable incidence and potentially later onset of IrAEs compared to Q2W dosing. Most IrAEs in both dosing groups were similar and mild. Therefore, Q4W dosing offers a safe alternative to Q2W dosing while providing benefits including decreased workload for staff, decreased clinic visits, and viral exposure by patients. [ABSTRACT FROM AUTHOR]

Background: Lynch syndrome carriers ('carriers') are presented with complex, emotionally laden choices regarding management of increased genetic cancer risks. Decision aids encourage active involvement in values‐based health decisions. This paper aimed to address the research question: How do Lynch syndrome carriers make sense of their chances of developing cancer, and what are the implications for providing support with decision making about genetic cancer risk management? Methods: Adult carriers were recruited through a genetics service or involvement with Lynch Syndrome UK. Semi‐structured interviews explored lived experiences of carriers' access to care with a focus on decision support. Themes were constructed using framework analysis. These were developed into a conceptual model with recommendations for codevelopment of improved information and support including a tailored decision aid to complement integrated healthcare. Results: Twenty participants included 12 women and eight men, half with a history of cancer. Six overarching themes were: (1) finding balance with Lynch; (2) living 'on higher alert'; (3) managing uncertainty: 'I've thought about it a lot'; (4) burden of responsibility: 'It's on me'; (5) access to joined‐up care and support: 'There's something missing'; and (6) influence/pressure from others. Conclusions: This qualitative interview study provided in‐depth insights from Lynch syndrome carriers about their lived experiences, informed by their values. Recommendations to empower carriers to make sense of genetic cancer risks and support decisions included accessible, trusted information, educated healthcare professionals, shared decision making, and joined‐up integrated care pathways complemented by tailored decision aids. [ABSTRACT FROM AUTHOR]

Little is known about the best way to engage an adolescent oncology patient in decision-making. To integrate adolescent oncology patients most effectively in decision-making, it is important to understand their perceptions not only as adolescents but also as adult survivors who have had time to reflect upon their experience. The purpose of this study is to explore perceptions of survivors of pediatric cancer to better understand their attitudes toward participation in decision-making, decisional regret, and use of decision-support tools. An electronic survey tool, containing open- and closed-ended responses, was distributed to adult cancer survivors diagnosed and treated for cancer between the ages of 9 and 18 at a Midwestern, Comprehensive Cancer Center within a tertiary care academic hospital. Seventy responses were received. Nearly all respondents (96%) reported that decisions made on their behalf were consistent with their desires most/all the time. Almost one-fifth felt that increased involvement would have intensified their anxiety. Eighty-five percent did not regret choices made about their cancer treatment, and 88% would have made the same choices again. Respondents desired more targeted information on the long-term impacts of treatment (i.e., infertility, memory difficulties, mental health concerns), and they highlighted the importance of communication in the decision-making process. Adolescents want to participate in the decision-making process in a way that accommodates their understanding of the pathology and potential impacts of treatment. Our results suggest that developing a simple intervention to help facilitate provision of such anticipatory guidance may be helpful. [ABSTRACT FROM AUTHOR]

Simple Summary: This review explores the potential of artificial intelligence (AI) to predict the effectiveness of antibody-drug conjugates (ADCs) in cancer treatment. The problem addressed is the need for more accurate methods to predict how well cancer therapies will work, particularly in personalized medicine. This study's aim is to discuss how AI can enhance the precision of ADC therapy by analyzing data from clinical trials and molecular biomarkers. This review highlights that AI can significantly reduce the time and cost associated with drug discovery and improve the targeting of cancer cells, reducing side effects and increasing treatment efficacy. We conclude that as more data become available from ongoing clinical trials, AI has the potential to become a standard tool in predicting ADC responses, thereby improving patient outcomes and advancing cancer treatment. This research is valuable as it could lead to more effective and personalized cancer therapies, benefiting society by potentially saving lives and reducing healthcare costs. The medical research field has been tremendously galvanized to improve the prediction of therapy efficacy by the revolution in artificial intelligence (AI). An earnest desire to find better ways to predict the effectiveness of therapy with the use of AI has propelled the evolution of new models in which it can become more applicable in clinical settings such as breast cancer detection. However, in some instances, the U.S. Food and Drug Administration was obliged to back some previously approved inaccurate models for AI-based prognostic models because they eventually produce inaccurate prognoses for specific patients who might be at risk of heart failure. In light of instances in which the medical research community has often evolved some unrealistic expectations regarding the advances in AI and its potential use for medical purposes, implementing standard procedures for AI-based cancer models is critical. Specifically, models would have to meet some general parameters for standardization, transparency of their logistic modules, and avoidance of algorithm biases. In this review, we summarize the current knowledge about AI-based prognostic methods and describe how they may be used in the future for predicting antibody-drug conjugate efficacy in cancer patients. We also summarize the findings of recent late-phase clinical trials using these conjugates for cancer therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: Adolescents and young adults (AYAs) experiencing cancer have support needs that differ from older adult cancer patients. The aim of our qualitative study was to determine the holistic needs of AYA cancer survivors and to develop a patient-centered conceptual model of AYA survivorship care. Analysis of our interview results reveals eight key domains critical to holistic patient-centered AYA survivorship care. We offer a conceptual model that differs from current conceptual models of AYA survivorship care by centering the patient and their support systems, emphasizing the need for continuing supportive navigation, and the importance of repeated support along the identified domains over time. Purpose: Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results: Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research. [ABSTRACT FROM AUTHOR]

The purpose of this retrospective study was to examine the use of virtual visits (telemedicine) at our cancer rehabilitation outpatient clinics from March 2020 to August 2021, when virtual visits became morewidely available, and to identify any demographic and clinical variables making patients more likely to favor virtual over in-person visits. There were 3971 outpatient encounters (2020 virtual and 1951 inperson visits from a total of 1638 patients) in our cancer rehabilitation outpatient clinics during this time frame. Significant findings in both the univariate and multivariate analyses were race (P < 0.001 and P = 0.006, respectively), cancer type (P < 0.001 for both), and distance to the clinic (P < 0.001 for both). Our research showed that virtual visits were accepted by patientswith cancer, and that younger age (62 compared to 65), non-White race/ethnicity, solid tumor, and shorter distance to the clinic were associated with a preference for virtual over in-person visits. [ABSTRACT FROM AUTHOR]

PURPOSE: Routine collection of sexual orientation (SO) and gender identity (GI; collectively SOGI) in cancer clinics advances cancer care equity. METHODS: In 2022, NCI Community Oncology Research Program (NCORP) practice groups were asked about routine collection of SOGI data in the electronic health record. The proportions of practice groups reporting collection of SO and/or GI data were calculated, and practice group characteristics were assessed for associations. RESULTS: Of 271 practice groups nationwide, 42% (n = 112) collect SO data, 58% (n = 157) collect GI data, and 35% (n = 96) collect both. In multivariate analyses, SO data collection was associated with practice groups having minority outreach staff (odds ratio [OR], 2.07 [95% CI, 1.12 to 3.81]; P =.02); GI data collection was associated with practice groups located in the Northeastern United States (OR, 2.08 [95% CI, 0.73 to 5.91]; P =.045), and those with a higher proportion of new patients who were White (OR, 1.02 [95% CI, 1.01 to 1.04]; P <.001). Practice groups in the South were least likely to collect SOGI data (OR, 0.49 [95% CI, 0.26 to 0.94]; P =.004). There were no statistically significant differences in SO and/or GI collection on the basis of the practice group's proportion of Medicaid/Medicare patients, number of new patients with cancer per year, or practice ownership. CONCLUSION: Slightly over one third of NCORP practice groups report routinely collecting SOGI data. There are regional differences in data collection, underscoring the need to craft targeted, region-specific interventions focused on boosting the capture and recording of SOGI data in an affirming manner. [ABSTRACT FROM AUTHOR]

(1) Background: Tumor-specific standardized data are essential for AI-based progress in research, e.g., for predicting adverse events in patients with melanoma. Although there are oncological Fast Healthcare Interoperability Resources (FHIR) profiles, it is unclear how well these can represent malignant melanoma. (2) Methods: We created a methodology pipeline to assess to what extent an oncological FHIR profile, in combination with a standard FHIR specification, can represent a real-world data set. We extracted Electronic Health Record (EHR) data from a data platform, and identified and validated relevant features. We created a melanoma data model and mapped its features to the oncological HL7 FHIR Basisprofil Onkologie [Basic Profile Oncology] and the standard FHIR specification R4. (3) Results: We identified 216 features. Mapping showed that 45 out of 216 (20.83%) features could be mapped completely or with adjustments using the Basisprofil Onkologie [Basic Profile Oncology], and 129 (60.85%) features could be mapped using the standard FHIR specification. A total of 39 (18.06%) new, non-mappable features could be identified. (4) Conclusions: Our tumor-specific real-world melanoma data could be partially mapped using a combination of an oncological FHIR profile and a standard FHIR specification. However, important data features were lost or had to be mapped with self-defined extensions, resulting in limited interoperability. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of resilience on depression among patients with breast cancer from individual and familial perspectives by exploring the mediating and moderating effects of family resilience between individual resilience and depression. Methods: A questionnaire survey was conducted among 337 patients with breast cancer who were admitted to the Oncology Department of Jiangsu Province Hospital. The survey included demographic information, the Connor–Davidson Resilience Scale (CD-RISC), the Family Resilience Assessment Scale (FRAS), and the Chinese version of the Patient Health Questionnaire-9 (PHQ-9) for Depression. The relationship among individual resilience, family resilience, and depression was analyzed using hierarchical regression and bootstrap test to assess the mediating and moderating effects of family resilience. Results: The depression scores were (13.50 ± 5.16), the individual resilience scores were (48.62 ± 17.50), and the family resilience scores were (105.98 ± 24.35). Significant differences in depression scores were observed in terms of family monthly income, average weekly exercise before diagnosis, post-diagnosis interpersonal relationship quality, and overall sleep quality in the past month (p < 0.05). Patients with lower individual resilience had significantly higher depression scores than those with higher resilience (F = 24.314, p < 0.001), and similarly, patients with lower family resilience had higher depression scores than those with higher family resilience (F = 41.660, p < 0.001). Individual resilience and family resilience were significantly negatively correlated with depression (r = −0.447 and −0.441, respectively, p < 0.001). Hierarchical regression analysis and bootstrap test showed that family resilience (β = −0.310, p < 0.001) had a partial mediating effect between individual resilience (β = −0.321, p < 0.001) and depression. The indirect effect size was −0.038, the 95% CI was (−0.056, −0.020), and the direct effect ratio was 71.43%. The interaction of family resilience and individual resilience had a moderating effect on depression (B = 0.166, p < 0.001). Family resilience negatively moderated the relationship between individual resilience and depressive symptoms and enhanced the protective effect of individual resilience against depression with increasing family resilience. Conclusion: Family resilience has mediating and moderating effects between individual resilience and depression in patients with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Older cancer patients are vulnerable to poorer health outcomes during cancer treatment. Although the Thai elderly had their own preferences towards future medical care and advance care planning (ACP) could help cancer patients make informed decisions, Thai physicians report a low ACP engagement rate. Thus, this study aimed to explore the perceptions of older cancer patients and their families towards ACP engagement. Method: We used a qualitative approach to explore the perceptions of non-haematological cancer patients aged ≥ 60 years old and their primary caregivers. The study was conducted at the Oncology Radiotherapy Referral Center, Songklagarind Hospital in Southern Thailand. Semi-structured in-depth interviews were conducted with the patients and their caregivers. Thematic analysis was used to identify and analyze recurring patterns and themes of perceptions regarding ACP engagement within the interview transcripts. Results: Among the 138 families approached, 32 interviews were conducted. Three themes were found: (1) Advantageous opportunity: the patients believed ACP would help them realize their life values, and ensure that their preference would be respected; (2) contemplation and barriers to ACP: ACP is unfamiliar and unnecessary, might have low utility, worry patients and family members, take away optimism, would not be a proper activity for the patient at the current health situation; and (3) Cues for ACP initiation: perceived conformity with one's religion, awareness of the current cancer state, having multiple comorbidity or experience suffering related with medical care, wishing not to burden family, having close family members, and trust in physicians. Conclusion: ACP engagement could be hindered or promoted by perceptions of older patients and/ or their family members, as well as the communication skills of the care providers. Care professionals who aim to initiate ACP should minimize the potential barriers, make the ACP benefits salient, and watch for cues indicating a propitious time to start the ACP conversation. [ABSTRACT FROM AUTHOR]

Background: There is an often-held assumption that the engagement of clinicians and healthcare organizations in research improves healthcare performance at various levels. Previous reviews found up to 28 studies suggesting a positive association between the engagement of individuals and healthcare organizations in research and improvements in healthcare performance. The current study sought to provide an update. Methods: We updated our existing published systematic review by again addressing the question: Does research engagement (by clinicians and organizations) improve healthcare performance? The search covered the period 1 January 2012 to March 2024, in two phases. First, the formal updated search ran from 1 January 2012 to 31 May 2020, in any healthcare setting or country and focussed on English language publications. In this phase two searches identified 66 901 records. Later, a further check of key journals and citations to identified papers ran from May 2020 to March 2024. In total, 168 papers progressed to full-text appraisal; 62 were identified for inclusion in the update. Then we combined papers from our original and updated reviews. Results: In the combined review, the literature is dominated by papers from the United States (50/95) and mostly drawn from the Global North. Papers cover various clinical fields, with more on cancer than any other field; 86 of the 95 papers report positive results, of which 70 are purely positive and 16 positive/mixed, meaning there are some negative elements (i.e. aspects where there is a lack of healthcare improvement) in their findings. Conclusions: The updated review collates a substantial pool of studies, especially when combined with our original review, which are largely positive in terms of the impact of research engagement on processes of care and patient outcomes. Of the potential engagement mechanisms, the review highlights the important role played by research networks. The review also identifies various papers which consider how far there is a "dose effect" from differing amounts of research engagement. Additional lessons come from analyses of equity issues and negative papers. This review provides further evidence of contributions played by systems level research investments such as research networks on processes of care and patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: ImmunoPET involves tagging an antibody (a protein that targets cancer cells) with a radioactive substance that can be seen by imaging. This could non-invasively visualize where cancer is and how much of the target antigen is present, helping decide which patients should get radioimmunotherapy. This therapy uses the same antibody but with a different radioactive substance designed to kill cancer cells. ImmunoPET shows where the cancer is and how much there is, helping choose the right patients for treatment. It helps monitor how well the treatment is working, so adjustments can be made if necessary. It provides important data on how the antibody moves and clears in the body, which helps in calculating the right dose and optimizing the treatment plan. This strategy can lead to more targeted and personalized therapies with fewer side effects because it leverages the precision of antibodies and the powerful effects of radiation. The combination of immunoPET—where an antibody (Ab) is labeled with an isotope for PET imaging—and radioimmunotherapy (RIT), using the same antibody with a therapeutic isotope, offers significant advantages in cancer management. ImmunoPET allows non-invasive imaging of antigen expression, which aids in patient selection for subsequent radioimmunotherapy. It also facilitates the assessment of tumor response to therapy, allowing for treatment adjustments if necessary. In addition, immunoPET provides critical pharmacokinetic data, including antibody biodistribution and clearance rates, which are essential for dosimetry calculations and treatment protocol optimization. There are still challenges to overcome. Identifying appropriate target antigens that are selectively expressed on cancer cells while minimally expressed on normal tissues remains a major hurdle to reduce off-target toxicity. In addition, it is critical to optimize the pharmacokinetics of radiolabeled antibodies to maximize tumor uptake and minimize normal tissue uptake, particularly in vital organs such as the liver and kidney. This approach offers the potential for targeted and personalized cancer therapy with reduced systemic toxicity by exploiting the specificity of monoclonal antibodies and the cytotoxic effects of radiation. However, further research is needed to address remaining challenges and to optimize these technologies for clinical use. [ABSTRACT FROM AUTHOR]

Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. We conducted a literature review in MEDLINE, EMBASE, and Scopus from 1 January 1982 to 20 October 2023. Abstracts were screened against inclusion criteria, and eligible studies underwent a full-text review. Data was extracted from the included studies, and a framework analysis approach summarized the evidence regarding ketamine's use in patients with cancer. A total of 21 randomized clinical trials were included, and the quality of all the included studies was good or fair. Significant improvements in pain scores and reduced morphine consumption were consistently observed with intravenous ketamine administration for postoperative pain control, particularly when combined with other analgesics such as morphine. Ketamine was less effective when used as an analgesic for chronic pain management, with several studies on neuropathic pain or chemotherapy-induced neuropathy finding minimal significant effect on reduction of pain scores or morphine requirements. The efficacy of ketamine in pain management appears to depend on factors such as dosage, route of administration, and patient population. [ABSTRACT FROM AUTHOR]

This study determined the relationship between death anxiety and COVID-19 related fear and anxiety in women with breast cancer. This is a descriptive correlation-seeking study. The research included 140 women with breast cancer who visit the day treatment unit of the oncology department of a state university hospital. Personal Information Form, Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), and Death Anxiety Scale (DAS) were used to collect data. A significant difference was found between the DAS score and body mass index (p =.019) and between FCV-19S score and COVID-19 vaccination status (p =.007). As the fear of COVID-19 and coronavirus anxiety of women with breast cancer increase, death anxiety also increases. In conclusion, death anxiety should be taken into consideration for this patient group while maintaining the continuity of care for these patients now and in future pandemics. [ABSTRACT FROM AUTHOR]

Poor sleep during hospitalization can negatively affect patient health, well-being, and satisfaction. This nurse-led quality improvement project aimed to promote quality sleep on an inpatient telemetry medical-surgical oncology unit. Interventions included distributing sleep hygiene kits (eye masks, earplugs, lip balm, and aromatherapy), educating patients and staff, and redesigning workflows to limit sleep interruptions at night. Hospital Consumer Assessment of Healthcare Providers and Systems Survey scores for quietness at night increased from 66% to 76%, with fewer reported cases of delirium postimplementation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic performance of a thick-slab reconstruction obtained from an ultra-low-dose CT (termed thoracic tomogram) with standard-of-care low-dose CT (SOC-CT) for rapid interpretation and detection of pneumonia in hemato-oncology patients. Methods: Hemato-oncology patients with a working diagnosis of pneumonia underwent an SOC-CT followed by an ultra-low-dose CT, from which the thoracic tomogram (TT) was reconstructed. Three radiologists evaluated the TT and SOC-CT in the following categories: (I) infectious/inflammatory opacities, (II) small airways infectious/inflammatory changes, (III) atelectasis, (IV) pleural effusions, and (V) interstitial abnormalities. The TT interpretation time and radiation dose were recorded. Sensitivity, specificity, diagnostic accuracy, ROC, and AUC were calculated with the corresponding power analyses. The agreement between TT and SOC-CT was calculated by Correlation Coefficient for Repeated Measures (CCRM), and the Shrout-Fleiss intra-class correlations test was used to calculate interrater agreement. Results: Forty-seven patients (mean age 58.7 ± 14.9 years; 29 male) were prospectively enrolled. Sensitivity, specificity, accuracy, AUC, and Power for categories I/II/III/IV/V were: 94.9/99/97.9/0.971/100, 78/91.2/86.5/0.906/100, 88.6/100/97.2/0.941/100, 100/99.2/99.3/0.995/100, and 47.6/100/92.2/0.746/87.3. CCRM between TT and SOC-CT for the same categories were.97/.81/.92/.96/.62 with an interobserver agreement of.93/.88/.82/.96/.61. Mean interpretation time was 18.6 ± 5.4 seconds. The average effective radiation dose of TT was similar to a frontal and lateral chest X-ray (0.27 ± 0.08 vs 1.46 ± 0.64 mSv for SOC-CT; P <.01). Conclusion: Thoracic tomograms provide comparable diagnostic information to SOC-CT for the detection of pneumonia in immunocompromised patients at one-fifth of the radiation dose with high interobserver agreement. [ABSTRACT FROM AUTHOR]

Design: A multi‐methods, single‐centre pilot comprising a quasi‐experimental pre‐/post‐test design and an exploratory qualitative study. Setting: A rural Australian hospital and health service. Participants: Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. Intervention: The intervention comprised a 12‐week virtual care program delivered via teleconference by a specialist nurse, using a pre‐existing connected care platform. The program was tailored to the post‐operative recovery journey targeting post‐operative care, psychoeducation, problem‐solving and goal setting. Main Outcome Measures: Primary outcome: program acceptability. Secondary outcomes: quality of life; prostate cancer‐related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post‐intervention (T2); and 12 weeks post‐intervention (T3). Results: Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. Conclusions: This pilot has shown that a tailored nurse‐led virtual care program, incorporating post‐surgical follow‐up and integrated low‐intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods: We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results: The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion: The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings. [ABSTRACT FROM AUTHOR]

Background: One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology–hematology ward. Methods: a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology–hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. Results: fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259–0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). Conclusions: ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects. [ABSTRACT FROM AUTHOR]

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Background: Yoga may reduce negative cancer- and treatment-related effects and help improve a range of outcomes, including flexibility, mindfulness, and quality of life among adults affected by cancer. Yet there is little evidence for the role of yoga among young adults (18-39 years) affected by cancer. Purpose: The purpose of this study was to explore the experiences of young adults affected by cancer in an 8-week yoga intervention delivered by videoconference. Methods: Young adults who were diagnosed with cancer between the ages of 18 and 39 years, at any stage of the cancer trajectory, who were living in Canada, and who completed an 8-week yoga intervention were approached to complete a semi-structured interview. A social constructivist paradigm was adopted. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results: Twenty-eight young adults (Mean age = 34.67±5.11 years; n=25 female) with varied cancer diagnoses participated. Participants' perspectives were represented across 6 themes: (1) I was juggling a number of challenges and changes throughout the yoga intervention; (2) I noticed some improvements in my mental and physical health; (3) I made time to discover new strategies to take care of myself; (4) I was able to see what my body is capable of; (5) I was held accountable and I appreciated that, and; (6) I was able to be around similar others in a safe (virtual) space. Conclusions: Findings suggest that an 8-week yoga intervention may offer some benefits for young adults affected by cancer. Self-care, self-compassion, mindfulness, feelings of physical competence, establishing a routine, and being around similar others were viewed as important components of the intervention and may have contributed to the benefits experienced. Findings underscore the potential utility of yoga as a supportive care intervention for young adults affected by cancer. [ABSTRACT FROM AUTHOR]

Abstract Cancer patients experience psychological symptoms such as depression during the cancer treatment period, which increases the burden of symptoms. Depression severity can be assessed using the beck depression inventory (BDI II). The purpose of the study was to use BDI-II scores to measure depression symptoms in cancer patients at a large tertiary hospital in Palestine. A convenience sample of 271 cancer patients was used for a cross-sectional survey. There are descriptions of demographic, clinical, and lifestyle aspects. In addition, the BDI-II is a tool for determining the severity of depression. Two hundred seventy-one patients participated in the survey, for a 95% response rate. Patients ranged in age from 18 to 84 years, with an average age of 47 years. The male-to-female ratio was approximately 1:1, and 59.4% of the patients were outpatients, 153 (56.5%) of whom had hematologic malignancies. Most cancer patients (n = 104, 38.4%) had minimal depression, while 22.5%, 22.1%, and 17.0% had mild, moderate, and severe depression, respectively. Education level, economic status, smoking status, and age were significantly associated with depression. The BDI-II is a useful instrument for monitoring depressive symptoms. The findings support the practice of routinely testing cancer patients for depressive symptoms as part of standard care and referring patients who are at a higher risk of developing psychological morbidity to specialists for treatment as needed.

Introduction: Physician-review websites (PRWs) are commonly used by patients while searching for a surgeon. There is no current literature investigating the factors that contribute to online one-star reviews of musculoskeletal oncology surgeons. This retrospective study aims to identify these factors to determine areas of care affecting patient's subjective reviews. Methods: Patient ratings and comments regarding musculoskeletal oncology surgeons from the Musculoskeletal Tumor Society (MSTS) were collected from Vitals.com. One-star reviews with comments were then classified as either operative or nonoperative. These complaints were then further classified based on content including wait time, uncontrolled pain, time spent with the physician, surgical outcomes, medical staff/institutional complaints, and bedside manner. Results: A total of 169 reviews (375 complaints) from 181 physicians were included. Of these complaints, 198 were from patients in the operative category while 177 were from patients in the nonoperative category. Bedside manner was the most common complaint. Operative patients reported higher instances of uncontrolled pain in their reviews, whereas nonoperative patients more frequently cited wait time. No significant difference in the complaints that mentioned the amount of time spent with the physician, bedside manner, a disagreement with the plan, or the medical staff or institution was found. Conclusion: Online one-star reviews of musculoskeletal oncology surgeons on Vitals.com referenced both surgical and non-surgical aspects of patient encounters, with bedside manner being the most popular complaint overall. Surgical patients were more likely to complain of uncontrolled pain whereas non-operative patients were more likely to complain of wait time. Type of study: Outcomes 2c. [ABSTRACT FROM AUTHOR]

Background: Half of all patients with cancer use complementary medicine. Given the benefits and risks associated with complementary medicine use, contact between complementary medicine practitioners and conventional healthcare providers (oncologists, nurses) is important for monitoring the health and well-being of mutual patients with cancer. Research on occurrence of such interprofessional contact is scarce. This study aims to describe complementary medicine practitioners' experiences with contact with conventional healthcare providers about mutual patients with cancer and the importance they attach to patient disclosure of complementary medicine use to their conventional healthcare provider. Predictors for interprofessional contact are explored. Methods: An online survey was administered among complementary medicine practitioners who treat patients with cancer or cancer survivors and who are member of a professional association in the Netherlands. Results: The survey was completed by 1481 complementary medicine practitioners. 40% of the participants reported to have contact with conventional healthcare providers of patients with cancer. Only 13% of the complementary medicine practitioners experienced conventional healthcare providers as open to communication with them. An explorative logistic regression showed that openness of conventional healthcare providers as experienced by complementary medicine practitioners was the most important predictor for the occurrence of interprofessional contact (OR = 8.12, 95% CI 5.12–12.86, p <.001). Most complementary medicine practitioners (82%) considered it important that patients disclose complementary medicine use to their conventional healthcare provider and 49% of the participants always motivates their patients to do so. Conclusions: Interprofessional contact with conventional healthcare providers in oncology occurs but is not routine for most complementary medicine practitioners. More than one-third of the surveyed complementary medicine practitioners experienced conventional healthcare providers as not open to communication with them. The openness of conventional healthcare providers as experienced by complementary practitioners is an important predictor for interprofessional contact to take place. Most complementary practitioners acknowledge the importance of patient disclosure of complementary medicine use to their conventional healthcare provider. Open communication about the topic of complementary medicine use between complementary practitioners, conventional healthcare providers and patients prevents overlooking relevant medical information and facilitates optimal monitoring of health and safety of patients with cancer. [ABSTRACT FROM AUTHOR]

Background: Shared decision making (SDM) is the process by which patients and clinicians exchange information and preferences to come to joint healthcare decisions. Clinical dashboards can support SDM by collecting, distilling, and presenting critical information, such as patient-reported outcomes (PROs), to be shared at points of care and in between appointments. We describe the implementation strategies and outcomes of a multistakeholder collaborative process known as "co-design" to develop a PRO-informed clinical dashboard to support SDM for patients with advanced cancer or chronic kidney disease (CKD). Methods: Across 14 sessions, two multidisciplinary teams comprising patients, care partners, clinicians, and other stakeholders iteratively co-designed an SDM dashboard for either advanced cancer (N = 25) or CKD (N = 24). Eligible patients, care partners, and frontline clinicians were identified by six physician champions. The co-design process included four key steps: (1) define "the problem", (2) establish context of use, (3) build a consensus on design, and (4) define and test specifications. We also evaluated our success in implementing the co-design strategy using measures of fidelity, acceptability, adoption, feasibility, and effectiveness which were collected throughout the process. Results: Mean (M) scores across implementation measures of the co-design process were high, including observer-rated fidelity and adoption of co-design practices (M = 19.1 on a 7–21 scale, N = 36 ratings across 9 sessions), as well as acceptability based on the perceived degree of SDM that occurred during the co-design process (M = 10.4 on a 0 to 12 adapted collaboRATE scale). Capturing the feasibility and adoption of convening multistakeholder co-design teams, min–max normalized scores (ranging from 0 to 1) of stakeholder representation demonstrated that, on average, 95% of stakeholder types were represented for cancer sessions (M = 0.95) and 85% for CKD sessions (M = 0.85). The co-design process was rated as either "fully" or "partially" effective by 100% of respondents, in creating a dashboard that met its intended objective. Conclusions: A co-design process was successfully implemented to develop SDM clinical dashboards for advanced cancer and CKD care. We discuss key strategies and learnings from this process that may aid others in the development and uptake of patient-centered healthcare innovations. [ABSTRACT FROM AUTHOR]

Objective: Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well‐being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre‐appointment anxiety and illness uncertainty affect patient–provider communication in breast cancer surgical consultations and subsequent post‐appointment well‐being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient–provider communication. Methods: This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre‐appointment anxiety influences pre‐appointment patient uncertainty, patient–provider communication during the appointment, and subsequent post‐appointment uncertainty. Results: The proposed model achieved good fit to the data such that more pre‐appointment anxiety was associated with more pre‐appointment uncertainty, more pre‐appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post‐appointment uncertainty. Conclusions: Results indicate breast cancer patients with anxiety pre‐appointment are at‐risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety. [ABSTRACT FROM AUTHOR]

Virtual patients and digital patients/twins are two similar concepts gaining increasing attention in health care with goals to accelerate drug development and improve patients' survival, but with their own limitations. Although methods have been proposed to generate virtual patient populations using mechanistic models, there are limited number of applications in immuno-oncology research. Furthermore, due to the stricter requirements of digital twins, they are often generated in a study-specific manner with models customized to particular clinical settings (e.g., treatment, cancer, and data types). Here, we discuss the challenges for virtual patient generation in immuno-oncology with our most recent experiences, initiatives to develop digital twins, and how research on these two concepts can inform each other. [ABSTRACT FROM AUTHOR]

Background: The PAROLE-Onco program was introduced in the province of Quebec, Canada in 2019. It integrates accompanying patients (APs), i.e., people who have been affected by cancer, into the clinical team as full members. These APs use their experiential knowledge with people undergoing treatment and with clinical teams. The aim of this paper is to evaluate, within the framework of two university medical centers, the perceptions of breast cancer patients who receive support from APs, particularly in terms of their active involvement in their care trajectory. Methods: A qualitative study based on semi-structured interviews with accompanied patients was performed. Fourteen individual interviews were conducted between July and September 2021 with women presenting different profiles in terms of age, education, professional status, type of treatment, family situation, and clinical background. The data were analyzed using thematic analysis, focusing on patients' perceptions of APs' contributions and suggested improvements for accessing AP support. Results: Three themes emerged from the semi-structured interviews: communication modalities used to connect patients with their APs, the characteristics of the support provided by APs, and the perceived effects of this support on the patients. Patients expressed a preference for telephone communication, highlighting its convenience and accessibility. The support provided by APs included emotional and informational support, neutrality, and adaptability. This relationship improved patient communication, reduced anxiety, helped regain control, and enhanced overall quality of life. The results emphasized the added value of APs in complementing the support offered by healthcare professionals. Patients noted the critical role of APs in helping them navigate the healthcare system, better understand their treatment processes, and manage their emotions. The ability of APs to provide practical advice and emotional reassurance was particularly valued. Overall, the findings underscored the significant impact of AP support on patients' experiences and highlighted areas for enhancing this service. Conclusion: This study highlights, during the care trajectory of people affected by breast cancer, APs' contribution to patients' emotional well-being because they improve, in particular, the management of emotions and communication with health professionals. Plain english summary: In 2019, we initiated the PAROLE-Onco program in Quebec, Canada, to support cancer patients by integrating Accompanying Patients (APs) into the medical team. These individuals, who have personally experienced cancer, join as full team members, sharing their insights with both patients and medical staff. Our study delved into the perceptions of breast cancer patients at two university hospitals regarding APs' involvement in their care trajectory. Through interviews with 14 women of diverse backgrounds and cancer experiences, we found that APs were instrumental in enhancing communication with doctors, facilitating the expression of challenging emotions, and aiding in treatment decisions. Patients valued the inclusion of APs in their care team and expressed gratitude for their support. Nonetheless, some encountered difficulties in reaching out to APs due to a lack of awareness or challenges involved in connecting. Overall, our research underscores the positive impact of involving APs in the care of breast cancer patients, and of enhancing emotional well-being and communication throughout the treatment journey. [ABSTRACT FROM AUTHOR]

Background: Cancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores. Methods: A single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman's correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses. Results: 2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%. Conclusion: Malnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition. [ABSTRACT FROM AUTHOR]

Fatigue is one of the most common side effects of immunotherapy, affecting 78-96% of patients. The mechanism is not fully understood, but may relate to the pro-inflammatory state induced by immunotherapy. Compared to chemotherapy, immunotherapy has less impact on quality of life and allows patients to maintain satisfactory quality of life for longer. However, fatigue can still significantly affect patients' physical capabilities and ability to participate in enjoyable activities. Guidelines recommend assessing fatigue and quality of life from diagnosis and throughout treatment. Multiple validated tools exist to measure fatigue objectively. Management approaches include both pharmacological and non-pharmacological methods. Exercise, particularly aerobic and yoga, appears to be one of the most effective non-pharmacological interventions for improving fatigue and quality of life. Overall, while immunotherapy-related fatigue impacts quality of life, it seems to do so to a lesser degree than other cancer treatments. More research is needed on optimal management strategies. [ABSTRACT FROM AUTHOR]

Background: Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. Aim: To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. Method: Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. Results: Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = –0.93 [95% CI –1.47, –0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. Conclusion: CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly. [ABSTRACT FROM AUTHOR]

Introduction: Survival data reported by randomised controlled trials are collected in a highly selected patient population and can thus only be transferred to a limited extent to real-world patients: the patients in routine care are mostly older, present with more comorbidities and a worse general state of health. This so-called efficacy-effectiveness gap typically results in inferior survival data in routine healthcare. Methods: Six prospective clinical tumour registries recruited a total of 11,679 patients receiving systemic therapy in haemato-oncological practices in Germany between 2006 and 2020. For these patients with advanced colorectal cancer, breast cancer, lung cancer, pancreatic cancer, renal cell cancer, and lymphatic neoplasms, overall survival was analysed. A comprehensive literature search was performed to identify suitable pivotal randomised controlled trials. Results: Median overall survival of patients treated in German routine care, with advanced colorectal, breast, lung, and pancreatic cancer, as well as with diffuse large B‐cell lymphoma and multiple myeloma, is not shorter than the respective survival data reported in trials. Patients with advanced renal cell carcinoma, chronic lymphocytic leukaemia, or indolent non-Hodgkin lymphoma showed slightly lower survival rates compared to clinical trials. Conclusions: Despite less favourable patient characteristics, survival data from patients with cancer treated in ambulatory routine care in Germany are in range with results from randomised controlled studies. [ABSTRACT FROM AUTHOR]

Objectives Access to early phase trials for children with relapsed, refractory or progressive (RRPD) cancer is limited in Canada. Patients and families face barriers to access trials, which are poorly understood. The aims of this study were to assess availability of early phase trials and examine the impact of distance from home to study centre on trial enrolment among paediatric oncology patients with RRPD. Methods Oncology patients ≤18 years at diagnosis who later had RRPD were identified retrospectively via registry at the only quaternary paediatric oncology centre in British Columbia (BC). We determined if distance to home, as calculated using geocoding software, was predictive of trial offer or enrolment. Results Between January 2015 and July 2021, 266 patients experienced 396 RRPD events. Seventy-five patients (28.2%) were eligible for an early phase trial at least once. At first eligible event, 61 patients (22.9%) were offered trial (median age 11.8 years; 69.0% male; 46.0% with CNS tumour) and thirty patients (11.3%) enrolled. Distance was not associated with odds of offer (OR 1.01, CI 0.98 to 1.05) or enrolment (OR 0.99, CI 0.95 to 1.03) on univariate or multivariable analysis adjusted for sex and disease (OR 0.93, CI 0.86 to 1.00). For offered patients, 2-year event-free survival (EFS) and overall survival (OS) were 39.1% (CI 28.0% to 54.8%) and 51.8% (CI 39.9% to 67.2%), respectively. EFS/OS did not differ with distance or enrolment, but varied by disease (EFS P = 0.002, OS P < 0.0001). Conclusions Children in BC with cancer and RRPD have limited access to early phase trials. Distance was not predictive of enrolment, suggesting that families travel to access therapy. [ABSTRACT FROM AUTHOR]

Failure to identify and treat depression and anxiety affecting 10% of patients with cancer, increases the disease burden. This study aimed to assess the psychological well-being of newly diagnosed patients in a tertiary healthcare centre in Lebanon. In this cross-sectional study, data were collected for 187 adult patients, from medical records and interviews using standardised questionnaires (Personal health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7). Karnofsky performance status was also assessed, and incidence was calculated using descriptive statistics, chi-square, and T-tests. The rates of moderate or severe anxiety, minimal anxiety, mild depression, moderate or severe depression, and suicidality are 14.9%, 35.6%, 40.7% 22.7% and 6.2%, respectively. Participants with a past history of seeking help from mental health services (OR: 3.978, CI: (1.680–9.415), p = 0.002), those developing cancer-related complications (OR: 3.039, CI: (1.187–7.777), p = 0.020), and those who had an Eastern Cooperative Oncology Group of ≥2 (OR: 5.306, CI: (1.582–17.797), p = 0.007) were independently associated with depression (diagnosed with PHQ-9) in multivariate logistic regression analysis. Patients with cancer exhibit higher evidence of depression and anxiety and should have a thorough psychiatric history and additional psychiatric care. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of squamous carcinoma of the oropharynx (OPSCC) has presented an increase worldwide, a fact that occurs along with a phenomenon of epidemiological transition, whose pathogenesis is linked to human papilloma virus (HPV) in a significant part of the cases. Published evidence at the Latin American level is scarce. The present study aims to evaluate the epidemiological and clinical characteristics of patients with oropharyngeal cancer treated in a public oncology reference centre in Chile. Methodology: A cross-sectional study was carried out. Patients with histological confirmation of OPSCC aged 18 years or older, referred to the National Cancer Institute of Chile between 2012 and 2023 were included. The association with HPV was determined by immunohistochemistry for p16. Results: 178 patients were analysed, most of them in locoregionally advanced stages involving the palatine tonsil. Seventy-seven percent were male, with a median age of 60 years. Sixty-seven percent of patients were positive for p16, with a progressive increase to 85% in the last 2 years of the study. The p16(+) patients were younger and had fewer classical risk factors. Primary treatment was radiotherapy in 94% of patients. Conclusion: The epidemiological profile of patients with OPSCC treated in a Chilean public oncology referral centre reflects the epidemiological transition observed in developed countries. This change justifies the need to adapt health policies and conduct research that considers the characteristics of this new epidemiological profile. [ABSTRACT FROM AUTHOR]

Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit the patients who can access trials, without any convincing evidence that these restrictions impact patient safety. Similarly, regulatory, organizational, and institutional hurdles can delay trial activation, ultimately making some studies irrelevant. Additional issues during trial conduct (e.g., mandatory in-person visits, central confirmation of standard biomarkers, and inflexible drug dosage modification) contribute to making trials non-patient-centric. These real-life observations from experienced clinical trialists can seem nonsensical to investigators and patients alike, who are trying to bring effective drugs to patients with cancer. In this review, we delve into these issues in detail, and discuss potential solutions to make clinical trials more accessible to patients. [ABSTRACT FROM AUTHOR]

Opioid therapy is a cornerstone for treatment of cancer-related pain, but standardized management practices for patients with cancer and aberrant urine drug test (UDT) results are lacking. To identify the prevalence of UDT ordering (both screening and definitive testing) in the oncology setting and to examine clinician management practices for patients with cancer on opioid therapy with aberrant definitive UDT results. We conducted a retrospective chart review of patients with cancer on opioid therapy at an academic cancer center in the United States. Outcomes included UDT ordering patterns and clinician management practices in response to aberrant definitive UDT results. Our study revealed an overall UDT ordering rate of 3.7% among 10,371 patients with cancer on opioid therapy. Among 143 patients for whom definitive UDTs were ordered, oncologists only ordered 14 (9.8%) UDTs, while palliative care ordered the majority (n = 129; 90.2%). Fifty-five (38.5%) patients had aberrant results, and the most common aberrancy was presence of illicit drugs 22 [15.4%]. Clinicians rarely made medication changes (20 [36.4%]) when UDT results were aberrant, and in the setting of possible fentanyl use (n = 8), only 3 (37.5%) patients were started/switched to methadone, and none were started/switched to buprenorphine. Overall UDT ordering was infrequent for patients with cancer on opioid therapy, especially by oncologists, and clinicians rarely made prescribing changes when definitive UDT results were aberrant. More definitive guidance related to UDT ordering and opioid management are needed for patients with cancer and aberrant UDT results. [ABSTRACT FROM AUTHOR]

Depression, frequently associated with cancer, significantly impacts health outcomes, necessitating effective treatments. This systematic review and meta-analysis aim to synthesize and critically evaluate the evidence from randomized controlled trials (RCTs) for the efficacy of nurse-led psychological interventions in managing depression among adult cancer patients. It focuses on the unique contribution of these interventions to improving depression management in oncology care, an underrepresented area in the existing literature. We conducted a comprehensive search in databases including Scopus, Medline, CINAHL, and PsycINFO, applying strict criteria to select RCTs assessing nurse-led psychological interventions for depression in cancer patients. We used the Cochrane Risk of Bias 2 tool to assess study quality. Out of 425 screened abstracts, nine papers describing seven distinct interventions involving 1463 participants were selected. The overall effect size estimate of −0.75 (95% confidence interval: −1.23 to −0.27) indicates significant effectiveness of these interventions in reducing depression compared to treatment as usual. Additionally, the calculated prediction interval highlights the variability in effectiveness across different settings, suggesting that contextual factors play a crucial role in the success of these interventions. The findings advocate for the integration of nurse-led psychological interventions into standard cancer care, highlighting their efficacy in improving depressive symptoms in adult cancer patients. These interventions show promise but require further refinement and research to optimize their effectiveness across diverse patient groups and healthcare settings. This review underscores the potential of nurse-led psychological interventions in enriching oncology care and addresses a critical gap in the existing body of research. [ABSTRACT FROM AUTHOR]