Aims/Background Chronic obstructive pulmonary disease (COPD), chronic bronchitis, and bronchial asthma are common chronic airway inflammatory diseases that have been reported to be associated with increased risk for lung cancer and impact prognosis. The purpose of this study was to investigate the impact of different chronic airway inflammatory diseases on the pathological types and prognosis of lung cancer patients. Methods A total of 200 patients with newly diagnosed lung cancer were recruited from January 2021 to January 2024. The clinical data of patients were retrospectively analyzed. According to the pathological type of lung cancer, patients were divided into small cell lung cancer (SCLC) group (n = 38) and non-small cell lung cancer (NSCLC) group (n = 162). Logistic regression was used to analyze the risk factors for SCLC. Patients were divided into airway inflammation group (n = 113) and non-airway inflammation group (n = 87) in accordance with the presence of inflammatory airway diseases. Propensity score matching (PSM) was employed to balance clinical characteristics between airway inflammation and non-airway inflammation groups, followed by Kaplan-Meier analysis to analyze the influence of airway inflammation on the overall survival of lung cancer. Cox proportional hazard model was used to analyze the influencing factors on the prognosis of lung cancer patients. Results Among all patients, 87 cases (43.5%) were lung adenocarcinoma, 65 cases (32.5%) were squamous carcinoma, 38 cases (19.0%) were SCLC, and 6 cases (3.0%) were large cell carcinoma; 72 (36.0%), 49 (24.5%) and 9 (4.5%) cases had COPD, chronic bronchitis, and bronchial asthma, respectively. Of the COPD patients, 43.1% (31/72) had squamous carcinoma, 29.2% (21/72) had SCLC, and 22.2% (16/72) was lung adenocarcinoma. In chronic bronchitis, lung adenocarcinoma has the highest proportion (27/49, 55.1%), followed by squamous carcinoma (16/49, 32.7%), and SCLC accounted for 8.2% (4/49). Logistic regression analysis showed that COPD (p = 0.012, OR [95% CI] = 2.696 [1.247-5.829]) and body mass index (BMI) (p = 0.020, OR [95% CI] = 1.132 [1.020-1.256]) were the independent influencing factors of SCLC. The Kaplan-Meier survival curves showed that the overall survival rate in the airway inflammation group was significantly worse than that in the non-airway inflammation group after PSM (p = 0.033, HR [95% CI] = 1.960 [1.039-3.697]). Cox regression analysis displayed that SCLC (p < 0.001, HR [95% CI] = 10.678 [4.416-25.822]), clinical stages (III-IV) (p = 0.003, HR [95% CI] = 3.234 [1.501-6.969]) and COPD (p = 0.014, HR [95% CI] = 1.987 [1.152-3.427]) were the risk factors affecting prognosis, while surgical treatment (p = 0.022, HR [95% CI] = 0.336 [0.132-0.854]) was a protective factor for prognosis. Conclusion COPD, chronic bronchitis and asthma differ in the distribution of different pathologic types of lung cancer. The prognosis of lung cancer patients with chronic airway inflammatory diseases was worse than that of non-chronic airway inflammatory disease. COPD was a risk factor for SCLC and an independent risk factor affecting the prognosis of lung cancer patients.

Aims/Background Accurate identification of lymph node metastasis is critical for optimising surgical strategies in early-stage cervical cancer. This study aimed to analyse multiple clinicopathological factors which are potentially associated with lymph node metastasis to guide personalised lymphadenectomy decisions. Methods This retrospective cohort study included 266 patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IA1 to IIA2) who underwent surgical treatment at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, between 1 December 2014 and 31 December 2019. Patients were followed up every 3 months for the first 2 years, every 6 months for the next 3 years, and annually thereafter. The presence of lymph node metastasis was included as the primary outcome, while the associated factors as secondary outcomes. The univariate and multivariate logistic regression were performed to identify risk factors associated with lymph node metastasis. Results The mean age of the study participants (n = 266) was 44.26 years (standard deviation [SD] = 10.19), and the median follow-up duration was 48.7 months (range 12-72 months). Lymph node metastasis was observed in 15.41% of patients. The metastatic rates increased with advancing FIGO stage: IA1 and IA2 (0%), IB1 (13.44%), IB2 (15.00%), IIA1 (23.33%), and IIA2 (66.67%). Univariate analysis identified FIGO stage (p < 0.001), depth of stromal invasion (p < 0.001), tumour size (p = 0.017), parametrial invasion (p < 0.001), and lymphovascular space invasion (LVSI) (p < 0.001) as significantly associated risk factors for lymph node metastasis. Multivariate analysis identified tumour size ≥4 cm (adjusted odds ratio [OR]: 3.857; 95% confidence interval [CI]: 1.530-9.728; p = 0.004), FIGO stage II (adjusted OR: 8.247; 95% CI: 3.171-21.455; p < 0.001), LVSI (adjusted OR: 2.974; 95% CI: 1.344-6.632; p = 0.008), and parametrial invasion (adjusted OR: 5.585; 95% CI: 1.900-16.415; p = 0.002) as independent risk factors for nodal metastasis. Conclusion This study identifies several key clinicopathological factors associated with lymph node metastasis in early-stage cervical cancer. These findings underscore the importance of meticulous preoperative risk assessment and offer an evidence-based foundation for tailored surgical planning to improve patient outcomes.

Aims/Background Leukemia is the most prevalent pediatric malignancy and has a significant impact on the psychological, emotional well-being, and quality of life of affected children. This study aimed to evaluate the effects of family-centred continuity of care (FCCC) on the psychological state, self-esteem, and quality of life in children with leukemia. Methods A retrospective analysis was conducted on 243 pediatric leukemia patients admitted to the Fourth Hospital of Hebei Medical University between January 2019 and December 2022. Patients were divided into two groups: Routine care (n = 135), who received standard hospital care, and home care (n = 108), who received FCCC. Data were collected and analysed using the Self-Esteem Scale (SES), Screen for Child Anxiety Related Emotional Disorders (SCARED), Depression Self-Rating Scale for Children (DSRSC), and Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS). Results Post-intervention, the home care group demonstrated significant improvements in self-management, emotional and mental health functioning, and physical and social functioning (p < 0.05). The group also demonstrated decreased depression, enhanced self-esteem, improved quality of life, and reduced anxiety levels, indicating the efficacy of FCCC. Conclusion FCCC significantly enhances psychological well-being and quality of life in pediatric leukemia patients by integrating family members into the care process and offering emotional support and empowerment.

Cervical cancer (CC) screening participation remains suboptimal among vulnerable populations in France. This study aimed to develop and evaluate AppDate-You, a chatbot-based decision aid, to support women from socioeconomically disadvantaged areas in the French Occitanie region to make informed decisions about CC screening, particularly human papillomavirus self-sampling (HPVss).

This study aimed to explore the needs, preferences, and barriers related to CC screening and to design and validate a user-centered, empathetic, and effective chatbot-based decision aid to empower women experiencing socioeconomic challenges in France to make informed choices about HPVss.

The chatbot was developed following a validated framework for developing decision aids. The process included qualitative research involving online and in-person interviews and focus groups with women and health care professionals, followed by alpha testing with both groups and beta testing with women only. Participants included women (both French and non-French speaking) aged between 30 and 65 years from socioeconomically disadvantaged areas of the Occitanie region and health care professionals (general practitioners, gynecologists, and midwives) working with these populations. AppDate-You was made accessible through WhatsApp and Facebook Messenger, offering text-based and voice-based interactions and multimedia content.

The exploratory phase identified key barriers to screening and digital tool preferences. Prototype testing revealed great satisfaction with the chatbot's performance, educational value, and content quality. Contrary to the expectations of health care professionals, women from diverse backgrounds, including women who were older and socioeconomically disadvantaged, were willing and able to use the tool. Users-even those with limited digital literacy-found AppDate-You innovative, user-friendly, and informative. In the beta testing phase, 80% (12/15) of the participants expressed interest in HPVss. Some limitations were identified, such as the chatbot's occasional repetitive responses and the need for clearer medical terminology.

This study demonstrates the potential for artificial intelligence chatbots to improve access to health education and increase cervical screening intention among underserved populations. The user-centered approach resulted in a tool that effectively meets the needs of the target population.

RR2-10.2196/39288.

Palliative care (PC) use patterns may have changed in recent years due to increased adoption of telehealth and the availability of more advanced practice clinicians who specialize in PC delivery.

To describe changes in the use of specialty PC during the last year of life among Medicare beneficiaries who had cancers with poor prognoses (cancers that commonly caused death, rare cancers with high mortality rates, or solid tumors with concurrent nonlymphatic metastases; hereinafter termed poor-prognosis cancers).

This retrospective cohort study includes all US Medicare fee-for-service beneficiaries who died from poor-prognosis cancers between January 1, 2018, and December 31, 2023, and received care in hospital and outpatient settings.

Encounters with a PC specialist.

The primary outcome was the proportion of decedents with any specialty PC encounter in their last year of life. Secondary outcomes included mean number of PC encounters among decedents with at least 1 encounter with a PC specialist and telehealth use. PC specialists were clinicians who self-identified as a PC specialist or were clinicians with 80% or more of their Medicare encounters focused on PC.

The cohort included 1 508 103 decedents (mean [SD] age, 79.6 [8.0] years; 54.6% male) with poor-prognosis cancers. Between 2018 and 2023, the proportion of decedents with at least 1 PC encounter increased from 29.84% to 37.21% (adjusted change, 7.21 [95% CI, 6.30-8.12] percentage points; relative change, 24.2%). The proportion who received outpatient PC increased from 10.66% to 20.56% (adjusted change, 9.41 [95% CI, 8.33-10.48] percentage points; relative change, 88.2%). In 2023, 22.84% of all decedents received PC from advanced practice clinicians vs 15.60% by self-designated PC physicians and 9.92% by other physicians. Telehealth was used for 18.2% of all outpatient palliative care encounters in 2023. Decedent characteristics associated with not receiving specialty PC included older age, lower income, and living in nonmetropolitan areas.

In this cohort study of decedents who had poor-prognosis cancers, an increasing proportion received any specialty PC. Advanced practice specialists were the most common clinician type who delivered specialty PC, and telehealth was used for a substantial proportion of outpatient visits. Despite these changes, only a minority of patients received specialty PC, and low use of specialty PC among certain subpopulations persisted, suggesting that different strategies are needed to overcome these barriers.

The US Preventive Services Task Force (USPSTF) recommends annual computed tomographic (CT) screening for individuals aged 50 to 80 years at high risk of lung cancer. Other countries are issuing similar recommendations, with some opting for biennial screening to reduce the burden of screening. However, it is unknown whether benefits of annual screening can be preserved when adapting the interval to age, sex, and smoking history.

To evaluate the health outcomes and costs of adaptive lung cancer screening intervals relative to annual screening.

This economic evaluation used comparative modeling methods with 3 models: 2 Cancer Intervention and Surveillance Modeling Network models and the OncoSim model from the Canadian Partnership Against Cancer. Screening of the US 1965 birth cohort with adaptive intervals was evaluated according to age, sex, and smoking exposure. Simulated outcomes are recorded from 2005 to 2065 for subpopulations of 200 000 individuals with smoking history of 10 to less than 20, 20 to less than 30, and 30 or greater pack-years (PY) for each sex. This evaluation was conducted between September 19, 2023, to December 1, 2024.

Low-dose regular CT screening among those eligible per USPSTF 2021 recommendations.

Strategy effectiveness was evaluated as lung cancer deaths prevented and life-years gained relative to annual screening. Screening burden is measured by the number of CT screens. To determine cost-effectiveness, quality-adjusted life-years (QALYs) gained and Surveillance, Epidemiology, and End Results- and Medicare-derived costs of treatment were calculated, as well as CT and follow-up examination costs. A willingness-to-pay (WTP) threshold of $100 000/QALY for cost-effectiveness was assumed.

Biennial screening at 50 to 60 years of age, followed by annual screening, reduced CT requirements while preserving most benefits. This strategy preserved 95.9% (intermodel range, 93.5%-97.5%) of lung cancer deaths prevented, compared with annual screening, with 20.6% (intermodel range, 19.3%-21.9%) fewer screens. Annual screening from 50 to 80 years of age was not cost-effective at a WTP threshold of $100 000/QALY. Cost-effective strategies varied by risk group, but all cost-effective strategies started with biennial screening and moved to annual screening at 60 years of age or a PY threshold of 30 to 40 was reached.

In this economic evaluation of lung cancer screening, biennial screening for participants younger than 60 years and those with less than 30 PY of smoking exposure maintained screening benefits relative to annual screening. Resource-constricted screening programs may consider adaptive intervals.

Brain metastasis (BM) significantly impacts survival and quality of life. Traditional whole-brain radiotherapy (WBRT) is associated with severe neurocognitive decline. Modern techniques like hippocampal-avoidance WBRT (HA-WBRT) with memantine may improve outcomes.

To assess neurocognitive outcomes following HA-WBRT with a simultaneous integrated boost (SIB) and memantine in patients with oligo brain metastases.

This prospective study, from September 2019 to March 2022, included 36 participants with oligo brain metastases. Inclusion criteria were age ≥18, histologically proven cancer, and KPS ≥70. Neurocognition and quality of life were assessed at baseline, 6 weeks, 3 months, and 6 months using Mini-Mental State Examination (MMSE), Trail Making Test Parts A and B (TMT A and B), Hopkins Verbal Learning Test (HVLT), and the EORTC BN20 questionnaire. All patients received oral memantine 10 mg BD from the start of radiotherapy up to 12 weeks post-therapy.

The study enrolled 36 patients, with a median age 50.5 years and a median follow-up of 8 months. Neurocognitive assessments showed significant improvements over time, except for TMT A. MMSE scores increased significantly from a baseline median 21.0 to 23.4 at 6 months (P < 0.0001). European Organisation for Research and Treatment of cancer (EORTC) quality of life (QOL) scores improved significantly from a baseline median 32.0 to 24.4 at 6 months (P < 0.0001). TMT B and HVLT scores also improved significantly. The complete response rate at 3 months was 26%, with a partial response rate of 56%. Median survival was 9.6 months.

HA-WBRT with SIB and memantine is a valid option for BM patients, resulting in significantly better neurocognitive function and quality of life. Despite higher doses to the hippocampi, neurocognitive function improved significantly within 3 months post-radiotherapy. Further studies are needed to analyses survival and neurocognitive outcomes.

In this study, we aimed to observe the prognostic significance of the pan-immune-inflammation value (PIV) score calculated at the time of diagnosis in patients with locally advanced rectal cancer, as well as its effect on treatment response, survival, and prognosis.

This retrospective, single-center observational study was designed to analyze patients with nonmetastatic (stages II-III) rectal cancer who received neoadjuvant treatment, categorized into two groups: PIV-L (n = 67, 50%) and PIV-H (n = 67, 50%). The median PIV score was used for cutoff determination. Survival analysis was applied. Univariate and multivariate Cox regression analyses were used to determine prognostic factors.

Preoperative clinical lymph node status (p = 0.011), liver metastasis (p = 0.028), carcinoembryonic antigen (CEA; p = 0.013), and cancer antigen 19.9 (CA19.9; p = 0.040) levels; pathological complete response (p = 0.035); tumor regression score (p = 0.030); postoperative lymph node status (p = 0.019); tumor deposits (p = 0.035); and budding (p = 0.043) were statistically different between the groups. The 5- and 10-year overall survival (OS) rates were 77% versus 69% and 62% versus 38% in the PIV-L and PIV-H groups, respectively (p = 0.032). While the PIV score was prognostic for OS in univariate analysis (HR: 1.85, 95% CI: 1.04-3.31, p = 0.035), a result of insignificance was obtained in multivariate analysis (HR: 1.76, 95% CI: 0.98-3.01 p = 0.056). The 5- and 10-year disease-free survival (DFS) rates were 67% versus 54% and 56% versus 39% in the PIV-L and PIV-H groups, respectively, with the PIV-H group showing a statistically significantly lower rate (p = 0.048). For DFS, the PIV score was found to be a statistically insignificant prognostic factor in univariate analysis (HR: 0.052, 95% CI: 0.99-2.86, p = 0.052) and recognized as an independent prognostic factor in multivariate analysis (HR: 1.87, 95% CI: 1.08-3.26, p = 0.026).

A higher pretreatment PIV score was associated with poorer clinicopathological features, a worse treatment response, lower survival rates, and a poor prognosis for DFS.

Reirradiation is becoming more frequent in clinical practice. However, workflows and practices vary widely between clinics, as general guidelines are scarce or lacking in practical detail. This paper presents comprehensive national Danish consensus recommendations covering all steps of the reirradiation workflow. The aim is to standardise and improve reirradiation treatment quality and provide guidance for much-needed large-scale clinical trials.

An expert panel was formed comprising physicians, clinical physicists, and clinical researchers from all Danish radiotherapy centres. An in-person 2-day workshop was followed by multiple online meetings. Recommendations were based on expert consensus, supported by review of existing literature, and were reviewed by all Danish Multidisciplinary Cancer Groups before publication.

Reirradiation cases should be designated clearly as such at each workflow step. Review of patient cases at multidisciplinary reirradiation conferences is encouraged. Immobilisation, positioning, and motion management should resemble that of previous treatment(s) as closely as possible. Information on previous dose should be used in planning and evaluation. The degree of complexity (e.g. summation of dose maxima, rigid/deformable image registration, 3D dose accumulation) should reflect the clinical situation as well as the extent/quality of available information. Dose should always be converted to an equieffective dose before summation. Daily image-guidance and regular evaluation of delivered dose are recommended. We provide guidance on quality assurance of dose mapping and guidelines for clinical reirradiation trials.

We present national consensus guidelines for site-independent reirradiation treatment workflows. The guidelines have been approved by the site-specific Danish Multidisciplinary Cancer Groups.

Immune checkpoint inhibitors represent an effective therapeutic approach for advanced gastric cancer. Their efficacy largely depends on the status of tumor biomarkers including human epidermal growth factor receptor 2 (HER2), programmed death-ligand 1 (PD-L1; combined positive score ≥1), and microsatellite instability-high (MSI-H). To noninvasively evaluate these biomarkers, researchers have developed radiomic models for individual biomarker prediction. However, in clinical practice, holistic prediction of these biomarkers as an integrated system is more efficient. Currently, the feasibility of implementing radiomics-based comprehensive biomarker prediction remains unclear, requiring further investigation.

This study aimed to develop a radiomics-based predictive model using multiphase computed tomography (CT) images to holistically evaluate HER2, PD-L1, and MSI-H status in patients with gastric cancer.

A retrospective analysis was conducted on 461 patients with gastric cancer who underwent radical gastrectomy between 2019 and 2022. Clinical data, contrast-enhanced CT images (arterial phase [AP] and portal venous phase [PP]), and pathological results were collected. Patients were categorized into two groups: (1) the programmed cell death protein-1 inhibitor panel-positive group, comprising patients with HER2 overexpression, PD-L1 positive, or MSI-H status; and (2) the negative group, comprising patients without HER2 amplification, PD-L1 negative, or microsatellite instability-low or microsatellite stable condition. Radiomic features (including first-order statistics, shape features, and wavelet-derived textures) were extracted from both AP and PP images, yielding 1834 features per phase. Least absolute shrinkage and selection operator regression was applied to select key features. In total, 3 models were constructed using the Extreme Gradient Boosting algorithm: AP-only (8 features), PP-only (22 features), and a fused model combining AP and PP features (20 features: 6 AP and 14 PP features). Model performance was evaluated using area under the curve (AUC), sensitivity, specificity, and decision curve analysis.

Of the 461 patients, 147 patients (31.9%) were classified into the panel-positive group. The clinical features were similar between the 2 groups. The fused model demonstrated superior performance in the test set (AUC 0.82, 95% CI 0.68-0.95), significantly outperforming AP-only (AUC 0.61, 95% CI 0.47-0.74) and PP-only models (AUC 0.70, 95% CI 0.49-0.91). Sensitivity and specificity for the AP-only, PP-only, and the fused model were 0.33 and 0.85; 0.50 and 0.86; and 0.60 and 0.83, respectively. Decision curve analysis confirmed that the fused model provided higher clinical net benefit across threshold probabilities.

The construction of integrated biomarker prediction models through radiomics demonstrates technical feasibility, offering a promising methodology for comprehensive tumor characterization.