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Aims: The Cancer Health Literacy – 30 (CHLT‐30) and Cancer Health Literacy – 6 (CHLT‐6) are widely used instruments to measure cancer health literacy and to identify individuals with limited cancer health literacy, respectively. This study evaluated the psychometric performance of both instruments in Chinese cancer patient population. Methods: The back‐translation method was used in cross‐cultural adaptation. Chinese versions, labeled as CHLT‐30‐Chinese and CHLT‐6‐Chinese, were administered to a diverse cross‐sectional sample of 602 cancer patients. Of these, 30 patients retook the instruments over a 2‐week interval to estimate test‐retest reliability. Classical and modern psychometric methods were used to estimate the item and test properties. Results: Model fit statistics confirmed the original measurement structures of CHLT‐30‐Chinese (one‐factor model) and CHLT‐6‐Chinese (latent class model with limited and adequate cancer health literacy classes) providing construct validity evidence. The CHLT‐30‐Chinese showed high internal consistency (Cronbach's α = 0.83; McDonald's Ω = 0.93) and 2‐week test‐retest reliability (r = 0.78). The CHLT‐6‐Chinese separated limited and adequate cancer health literacy classes well (entropy = 0.77) with the estimated prevalence rates of 19% and 81%, respectively. The CHLT‐6‐Chinese was highly precise in assigning cancer patients into two categories: limited and adequate cancer health literacy classes with probability of 0.95 and 0.90, respectively. Invariant measurement properties of both instruments were supported between male and female patients as well as patients with and without high school diploma. Conclusions: The findings support the psychometric properties of the CHLT‐30‐Chinese for measuring cancer health literacy as a continuous trait and CHLT‐6‐Chinese for identifying patients with limited cancer health literacy with high precision. The two tools are recommended for use in both daily practice and clinical trials. [ABSTRACT FROM AUTHOR]

The eighth edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage classification (TNM) for nasopharyngeal carcinoma (NPC) was launched. It remains unknown if incorporation of nonanatomic factors into the stage classification would better predict survival. We prospectively recruited 518 patients with nonmetastatic NPC treated with radical intensity‐modulated radiation therapy ± chemotherapy based on the eighth edition TNM. Recursive partitioning analysis (RPA) incorporating pretreatment plasma Epstein–Barr virus (EBV) DNA derived new stage groups. Multivariable analyses to calculate adjusted hazard ratios (AHRs) derived another set of stage groups. Five‐year progression‐free survival (PFS), overall survival (OS) and cancer‐specific survival (CSS) were: Stage I (PFS 100%, OS 90%, CSS 100%), II (PFS 88%, OS 84%, CSS 95%), III (PFS 84%, OS 84%, CSS 90%) and IVA (PFS 71%, OS 75%, CSS 80%) (p < 0.001, p = 0.066 and p = 0.002, respectively). RPA derived four new stages: RPA‐I (T1–T4 N0–N2 & EBV DNA <500 copies per mL; PFS 94%, OS 89%, CSS 96%), RPA‐II (T1–T4 N0–N2 & EBV DNA ≥500 copies per mL; PFS 80%, OS 83%, CSS 89%), RPA‐III (T1–T2 N3; PFS 64%, OS 83%, CSS 83%) and RPA‐IVA (T3–T4 N3; PFS 63%, OS 60% and CSS 68%) (all with p < 0.001). AHR using covariate adjustment also yielded a valid classification (I: T1–T2 N0–N2; II: T3–T4 N0–N2 or T1–T2 N3 and III: T3–T4 N3) (all with p < 0.001). However, RPA stages better predicted survival for PS and CSS after bootstrapping replications. Our RPA‐based stage groups revealed better survival prediction compared to the eighth edition TNM and the AHR stage groups. What's new? The AJCC/UICC TNM stage classification is the most widely accepted common language to describe the magnitude and spread of cancer. However, a new pretreatment staging system comprising both anatomic and non‐anatomic factors is warranted to improve survival prediction. Here, the authors propose new stage groups incorporating pretreatment plasma Epstein–Barr virus (EBV) DNA for non‐metastatic nasopharyngeal carcinoma (NPC). Their prospective study measuring pretreatment plasma EBV DNA in 518 completely staged non‐metastatic NPC patients who were later treated with intensity‐modulated radiation therapy with/without adjunct chemotherapy demonstrates significantly better survival prediction with the newly proposed stages as compared to the current edition TNM. [ABSTRACT FROM AUTHOR]

A do-not-resuscitate (DNR) order, or "advance directive," is commonly seen in the cases of palliative patients who express a wish to withhold specific resuscitative therapies in the event of a cardiac arrest. With recent technological advances, there are increasing numbers of palliative patients who undergo surgical interventions to treat their symptoms and discomfort. The decision to suspend DNR orders for palliative surgery is always a matter for debate. The present article describes a case and the ethical issues involved and gives some practical suggestions for those facing similar problems. We also review the latest DNR policy in Hong Kong. [ABSTRACT FROM AUTHOR]

Generative pre-trained transformer 4 (GPT-4) is an artificial intelligence (AI) system with a chat interface. The number of studies testing GPT-4 in clinical applications has been increasing. We hypothesized that GPT-4 would be able to suggest management strategies for medical issues in elderly oncology patients, similar to those provided by geriatricians. We compared the responses of GPT-4 to those of a geriatrician for four oncological patients. After these case conferences, none of the patients required admission for medical consultation. In three out of four scenarios, GPT-4 was able to offer a multidisciplinary approach in the first prompt. In all three scenarios, GPT-4 identified medication-related side effects and suggested appropriate medications in the first prompt. However, GPT-4 was unable to suggest initial dosages of medications to be used in the first prompt and was unable to suggest a more humanistic and non-pharmacological approach to anorexia, even with a follow-up prompt. In conclusion, GPT-4 may be used as a screening tool to provide potential rudimentary directions for management, which can then be reviewed by medical professionals before considering a formal consultation for more tailored and refined opinions from specialists., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2023, the Chinese Medical Association.)

Plasma Epstein-Barr virus (EBV) DNA titers have been used to monitor treatment response and provide prognostic information on survival for nasopharyngeal carcinoma (NPC). However, the long-term prognostic role of pretreatment and posttreatment titers after radical contemporaneous radiation therapy remains uncertain. We recruited 260 evaluable patients with non-metastatic NPC treated with radical intensity-modulated radiation therapy (IMRT) with or without adjunct chemotherapy. Plasma EBV DNA titers at baseline and then 8 weeks and 6 months after IMRT were measured. Cox regression models were employed to identify interaction between post-IMRT 8th week and 6th month undetectable titers and 3-year survival endpoints. Concordance indices (Ct) from time-dependent receiver-operating characteristics (TDROC) were compared between patients with post-IMRT undetectable and those with detectable titers. After a median follow-up duration of 3.4 years (range 1.4-4.6 years), patients with post-IMRT 8th week and 6th month undetectable plasma EBV DNA titers enjoyed longer 3-year survival endpoints than those who had detectable titers at the same time points. Post-IMRT 8th week, and more significantly, post-IMRT 6th month undetectable plasma EBV DNA were the only significant prognostic factors of 3-year survival endpoints. Ct values for all 3-year survival endpoints for both post-IMRT 8th week and 6th month undetectable plasma EBV DNA were significantly higher in those with stage IVA-IVB diseases compared to stage I-III counterparts. Early post-IMRT undetectable plasma EBV DNA titers were prognostic of 3-year survival endpoints in patients with non-metastatic NPC. Intensified treatment should be further explored for patients with persistently detectable titers after IMRT.