Lower limb lymphedema is a distressing complication after lymphadenectomy. Currently, no definite intervention for reducing the incidence of lower limb lymphedema has been established. This study identified risk factors for lower limb lymphedema following a gynecologic surgery with a 5-year follow-up. A total of 190 patients who underwent surgery, including pelvic lymphadenectomy, between 2011 and 2012 were enrolled and followed up for 5 years. Lymphedema was defined as International Society of Lymphology stage I or higher. The patients' physical characteristics, surgical methods, and adjuvant therapies were investigated and hazard ratios and 95% confidence intervals were calculated. Kaplan-Meier analysis was performed to assess the 5-year cumulative risk of lower limb lymphedema. Multivariate analysis revealed that adjuvant chemotherapy with docetaxel or paclitaxel and the number of lymph nodes removed ≥ 60 were the risk factors. The 5-year cumulative incidence of total lower limb lymphedema was 39.6%, 51.6% with adjuvant chemotherapy using taxanes, 49.1% with the removal of ≥ 60 lymph nodes. The incidence of lower limb lymphedema was highest in the first year. Since taxane administration and lymphadenectomy remain essential for optimizing patient prognosis, close monitoring of lower limbs is crucial in the first year after lymphadenectomy for patients with these risk factors.

Cervical cancer is the fourth most prevalent type of cancer in women globally. Early detection and treatment of precancerous cervical lesions and human papillomavirus (HPV) infection are strongly advised to decrease the incidence of cervical cancer and death. Cervical cancer is a major public health concern in low- and middle-income nations, where screening and treatment options are constrained. Thus, the main objective of this umbrella review was to determine the pooled uptake of cervical cancer screening and its determinants in Africa.

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this umbrella review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. We conduct a systematic and comprehensive search by using Google Scholar, PubMed, Scopus, Hinari, and Science Direct, from January 1, 2014, to September 20, 2024. The data were extracted using Microsoft Excel spreadsheet. The methodological quality of the included studies was examined using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The statistical analysis was carried out using STATA version 17, which includes descriptive analysis, forest plots for prevalence, funnel plot, and an Egger test to examine publication bias. A random-effects model was used to determine the pooled effect estimate. Publication bias was checked by using the funnel plot and Egger's tests.

This umbrella review included 11 systematic reviews and meta-analysis studies across Africa with a total of 143,327 study participants. The overall prevalence of cervical cancer screening practice in Africa was 20.94% (95% CI: 15.84%-26.04%). Women's level of knowledge (AOR: 3.22, 95% CI: 1.64-6.33), positive attitude toward CCS (AOR: 2.48, 95% CI: 2.18-2.81), perceived vulnerability to cervical cancer (AOR = 3.57, 95% CI: 2.75, 4.63), and history of STIs (AOR = 4.89, 95% CI: 3.14, 7.62) were significantly associated with cervical cancer screening practice. In conclusion, the combined estimate of cervical cancer screening use in Africa remains much lower (20.94%) than the World Health Organization (WHO) recommendations target (70%). It indicates that there is a large gap that requires being addressed in collaboration to reduce the burden of cervical cancer and its morbidity and mortality across the continent. Therefore, healthcare professionals, policymakers, and other stakeholders shall implement effective strategies such as empowering women, improving the knowledge and attitude towards cervical cancer screening, advocacy, and expanding screening programs to all eligible women to increase utilization of cervical cancer screening.

Breast cancer (BC) is the most common cancer in women worldwide and the most frequent cause of cancer death in women in low- and middle-income countries (LMIC). The incidence of BC in Africa is on the rise, expected to double by 2050, primarily owing to late presentation and weak health infrastructure in sub-Saharan Africa (SSA). This study addresses the lack of recent data on BC cases in the Eastern Cape Province of South Africa.

The objectives of this study were to describe the clinicopathological characteristics and molecular subtypes of BC and, in addition, to examine the association between the clinicopathological characteristics and the molecular subtypes of BC in a single tertiary hospital in the Eastern Cape Province of South Africa.

A two-year (2022-2023) retrospective cross-sectional clinical record review study was conducted on patients treated for invasive BC at a tertiary hospital in the Eastern Cape Province, South Africa. The demographic, clinical and pathological characteristics and molecular subtypes were reported. Associations were investigated between the BC molecular subtypes identified and the clinicopathological characteristics of the patients.

A total of 282 patients met the study's inclusion criteria. Most patients were female (98.6%) and African (88.1%). The mean age of the patients was 58.7 years, with BC most prevalent in the age group >70 (25.2%) and postmenopausal (77.4%). Breast lump was the most common presenting complaint (98.6%), with 61% of patients presenting three months after noticing the anomaly. The most common tumour size (59.4%) was > 5 cm (mean = 6.37 ± 3.6), with the most common clinical T stage being T4 (50.4%). Lymph node involvement was seen in 50.4% of cases. Patients mostly presented in Stages III and IV of the disease (60.1%). Invasive ductal carcinoma not otherwise specified (NOS) was the most common histopathological subtype (86.2%). Grade 2 (56.2%) and Grade 3 (29.5%) BC accounted for the majority of cases. Luminal B was found in 47.4% of cases, Luminal A in 28.5%, triple negative breast cancer (TNBC) in 18.6% and human epidermal growth factor receptor 2 (HER2) enriched in 5.5% of cases, respectively.

In our setting, most patients consulted at a late stage of the disease with a large tumour size, positive lymph node status and a high histological grade. Luminal B tumours are the most common molecular subtype. These results indicate the need for more intensive breast cancer awareness campaigns, early detection, and timely referral and treatment.

Hematological malignancies (HMs) pose a severe threat to human health and contribute substantially to the disease burden in mainland China and Taiwan. Therefore, understanding their burden is crucial for informed decision-making and the effective allocation of healthcare resources.

This study utilized the latest data from the Global Burden of Disease 2021 study to describe the epidemiological indices of HMs in mainland China and Taiwan from 1990 to 2021. The future disease burden was projected for the next decade using the Bayesian age-period cohort (BAPC) model.

Between 1990 and 2021, mainland China experienced an increase in the prevalence and incidence of leukemia and lymphoma, while the mortality and disability-adjusted life years (DALYs) for these diseases declined. Conversely, Taiwan witnessed an overall increase in the prevalence, incidence, mortality, and DALYs of leukemia over the same period. Additionally, multiple myeloma (MM), myelodysplastic/myeloproliferative neoplasms, and other hematopoietic neoplasms have shown significant increases in prevalence, incidence, mortality, and DALYs in China. While the disease burden of myeloid leukemia decreased in mainland China, that of lymphoid neoplasms (including leukemia, lymphoma, and MM) increased, which was not observed in Taiwan. Predictions from the BAPC model suggest that the incidence of several lymphoid neoplasms and MM is expected to increase in mainland China and Taiwan.

Taiwan continues to face greater challenges in managing HMs compared to mainland China. MM imposes a significant burden on the Chinese population. The findings of this study provide valuable epidemiological insights for optimizing the allocation of medical resources.

Cancer imposes a substantial economic burden on patients that may be worse in patients with higher-stage disease due to the need for more therapy.

To investigate the out-of-pocket costs (OOPCs) attributable to the initial treatment of common cancers among privately insured individuals diagnosed at different stages.

This retrospective cohort study used administrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry to compare OOPCs of individuals diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs of similar individuals without cancer using difference-in-differences methods. Individuals living in the US between 2008 and 2022, aged younger than 65 years, insured through a large national private health insurer, and with 6 or more months of continuous enrollment were included. Data were analyzed from June 2024 through February 2025.

The presence or absence of an incident cancer diagnosis and disease stage from the SEER registry diagnosed from 2008 to 2019.

The primary outcome was OOPCs among individuals with breast, colorectal, and lung cancer diagnosed at different disease stages compared with those with no cancer diagnosis.

The cohort consisted of 46 158 patients (mean [SD] age at diagnosis, 46 [12] years; 30 733 female [66.6%]; 2543 Asian [5.5%], 4114 Black [8.9%], 3590 Hispanic [7.8%], and 31 099 White [67.4%]), including 19 656 patients with cancer and 26 502 patients without cancer in the control group. Among patients with cancer, 14 581 patients had breast cancer, 2842 patients had colorectal cancer, and 2233 patients had lung cancer. An incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month (95% CI, $528.01-$627.04 per month) for the 6 months after the diagnosis. Cost monotonically increased with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0 to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).

In this study of individuals with private insurance, patients faced high OOPCs after an incident diagnosis of cancer, with patients with more advanced cancer having the highest OOPCs. Further research is needed to determine the clinical and financial effects of increased OOPCs for patients with cancer.

Women with ovarian cancer are at high risk of malnutrition and muscle loss due to advanced-stage diagnosis and treatment toxicities. Evidence-based guidelines recommend screening for malnutrition and sarcopenia to prevent associated adverse consequences, including reduced survival. This study aimed to describe awareness and perceptions of nutrition-related issues and practices in ovarian cancer among Australian healthcare professionals.

A national survey was completed between November 2023 and March 2024. The 24-item survey evaluated awareness and perceptions of nutrition-related issues, screening and referral practices for malnutrition and sarcopenia at specific timepoints (from diagnosis, during, and/or post-treatment) and barriers to nutrition care in ovarian cancer.

Professionals (n = 57) were predominantly nurses (39%), dietitians (23%), or surgeons (19%). The most reported nutrition-related issues at diagnosis were weight loss (67%), overweight/obesity (54%), and sarcopenia (44%). During treatment, weight loss (70%) and sarcopenia (65%) were prominent, while post-treatment, weight gain (46%) and sarcopenia (39%) were most reported. The perceived clinical importance of malnutrition and sarcopenia varied according to professional discipline. Professionals identified chemotherapy as the treatment with the highest nutrition risk (97%), and 75% reported observing self-initiated dietary changes during treatment, yet 18% indicated their health services did not screen for nutrition risk, and 58% did not screen for sarcopenia. Key barriers were lack of established processes for sarcopenia screening (75%), limited dietetic services (60%), and lack of specific referral pathways (58%).

The perceived importance of malnutrition and sarcopenia in ovarian cancer varies according to professional discipline despite robust evidence of the importance to clinical outcomes.

The value of adjuvant immunotherapy in patients with resectable stage III non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy remains unclear. This study aimed to evaluate the prognostic impact of additional adjuvant immunotherapy in patients with stage III NSCLC.

Patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by radical surgery, with or without adjuvant immunotherapy, were retrospectively enrolled across two hospitals. Event-free survival (EFS) and overall survival (OS) were assessed from the initiation of neoadjuvant treatment and were estimated by the Kaplan‒Meier method. One-to-one propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize confounding.

A total of 184 eligible patients were enrolled, of whom 105 (57.1%) received adjuvant immunotherapy and 79 (42.9%) did not. After 1:1 PSM, the addition of adjuvant immunotherapy did not significantly improve EFS (2-year EFS: 62.3% vs. 66.1%, P = 0.653) or OS (2-year OS: 92.7% vs. 89.6%, P = 0.196). Subgroup analyses, stratified by the pathological complete response (pCR) status, further confirmed that adjuvant immunotherapy did not significantly improve survival in either the pCR subgroup or the non-pCR subgroup. Similar results were obtained after IPTW. Exploratory analysis revealed that 3 cycles of neoadjuvant immunotherapy might be more beneficial than 2 (pCR: 40.8% vs. 30.6%, P = 0.292; 2-year EFS: 75.0% vs. 54.5%, P = 0.111) or 4 (pCR: 42.1% vs. 36.8%, P = 0.740; 2-year EFS: 63.2% vs. 51.5%, P = 0.343) cycles.

The addition of adjuvant immunotherapy to neoadjuvant chemoimmunotherapy may not be necessary in patients with resectable stage III NSCLC. Three cycles of neoadjuvant immunotherapy appear to be an appropriate treatment regimen for neoadjuvant chemoimmunotherapy.

It has not been determined which descriptor spread through air spaces (STAS) should be incorporated into the context of the ninth Tumor, Node and Metastasis (TNM) staging system: the T or the uncertain resection [R(un)] category. A multicenter retrospective cohort of 807 patients with pathological stage I lung adenocarcinoma was included in this study to assess the feasibility of incorporating STAS into the T descriptor or the R(un) category by analyzing recurrence-free survival (RFS) and overall survival (OS). Decision curve analysis (DCA) was performed to evaluate the standardized net benefit of the proposed T (nT) and that of the proposed residual tumor classification (nR) versus the current staging systems. Log-rank tests indicated that patients with pT1/STAS-positive lung adenocarcinoma had similar RFS and OS to patients with pT2a disease irrespective of R status. Regarding STAS as an indicator for upgrading R0 to R(un), comparable survival was observed between pT1-2a/STAS-positive patients undergoing R0 segmentectomy and pT1-2a patients undergoing R(un) segmentectomy. We further assessed the effects of the combination of STAS with either T or R category on survival in a validation cohort. Subgroup analyses stratified by surgical procedures further identified the consistency of the nT category in discriminating RFS and OS. However, the separation of nR0 and nR(un) disease in pT2a tumors treated by lobectomy or segmentectomy was not sufficiently distinguished. DCA further corroborated a greater predictive capability of nT versus the current T category. In conclusion, STAS might be preferentially considered as an indicator for upgrading pT1 disease into pT2a in the future TNM staging system.

Prostate cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines offer varying recommendations on prostate cancer screening, and most are focused on men aged 50-69. In this study, we examined key risk factors for prostate cancer in men under 50, emphasizing race/ethnicity and family history to better understand the distribution of higher-grade disease in this younger population.

This retrospective analysis utilized data from our hospital's prostate cancer screening program collected between 2014 and 2024. In our cohort, a total of 312 men under 50 years of age underwent prostate biopsy. We assessed the association of Gleason scores, race/ethnicity, family history, and PSA levels using descriptive statistics analyses.

Among 312 participants, the largest subgroup was White or Caucasian (n = 202, 64.7%), followed by Black or African American (n = 47, 15.1%), Hispanic or Latino (n = 46, 14.7%), and Asian or Pacific Islander (n = 17, 5.5%). Black or African American men showed a higher proportion of Gleason 7 and above compared with other racial/ethnic groups. A positive first-degree family history was also more frequent among Black or African American men and was correlated with elevated Gleason scores and elevated PSA levels in multiple racial/ethnic categories.

In our cohort of men under 50, both race/ethnicity and a positive family history are closely associated with higher-grade prostate cancer. These findings suggest that younger men from high-risk backgrounds may benefit from early detection strategies.

To investigate rural cancer survivors' self-reported reasons for perceived delays in initial cancer detection and treatment.

Within a cohort study, adult cancer survivors who had travelled > 50 km for cancer care, staying at subsidised accommodation lodges in city centres in Queensland, Australia, were invited to complete a structured interview on perceived delays in: (i) seeking medical attention, (ii) receiving their diagnosis and (iii) commencing treatment. Content analysis was used to map self-reported reasons for perceived delays at each step, which were then categorised based on the perceived source: (i) personal, (ii) healthcare professional, (iii) healthcare system or (iv) other. The self-reported reasons and perceived sources were summarised using descriptive statistics.

Six hundred and eighty-six rural cancer survivors completed the interview (18% breast, 15% head and neck, 12% prostate and 12% skin cancer). Almost half (n = 320, 47%) of participants perceived a delay at one or more steps. Delays in seeking medical attention were perceived by 132 (19%) participants, mostly related to personal factors (n = 67, 51%), including misinterpreting (n = 19, 28%) signs and symptoms. Delays in diagnosis were perceived by 161 (23%) participants, mostly related to healthcare professional factors (n = 86, 53%), including requiring further opinions or testing for diagnosis (n = 30, 35%). Delays in commencing treatment were perceived by 157 (23%) participants, mostly due to healthcare system factors (n = 57, 37%), including long waitlists (n = 39, 68%). Of the participants who perceived a delay in commencing treatment, comparison with timeframes recommended in the relevant Optimal Care Pathway identified that 57% of perceived delays were actual delays.

Perceived delays in the pathway to initial cancer detection and treatment are common among rural cancer survivors. Improvements in patient-clinician communication could reduce perceived delays, particularly in diagnosis and treatment. Promoting early help-seeking, participation in cancer screening and improving access to diagnostic and treatment infrastructure may also improve care experiences.