Thyroid cancer (TC) represents a growing global health burden with a significant increase in worldwide incidence. However, there are no comprehensive reports on TC incidence and its trend in Jordan to complement worldwide reports. This study investigates the incidence of TC in Jordan for the period 2000-2019.

Data were extracted from the Jordan Cancer Registry. Age- and sex-specific incidence rates, as well as overall age-standardized incidence rates (ASIRs), were computed and analyzed. ASIRs were computed using direct age standardization to the WHO world standard population.

In the period between 2000 and 2019, 3,857 new cases of TC were reported in Jordan; 23.9% occurred in males and 76.1% in females, with a male-to-female ratio of 1:3. Papillary TC constituted 79.2% of cases followed by follicular (9.2%) and medullary (2%) cancers. ASIR rose from 1.7 per 100,000 in 2000 to 5.6 per 100,000 in 2019 (P < .001) with an average ASIR of 4.1 (1.4 in males and 6.3 in females). The annual increase in ASIR was statistically significant in most years. The highest ASIR was in women aged 30-39 years. Mean incidence age was approximately 42.9 years (range, 2-90). Almost half of the patients were aged 30-49 years.

This study represents the most comprehensive and updated epidemiologic analysis of TC in Jordan, highlighting a significant rise in incidence between 2000 and 2019, particularly among women aged 30-39 years. By providing long-term national data, this study contributes to a wider framework aimed at improving cancer surveillance, contextualizing global TC trends, and guiding future research in Jordan, where national cancer control strategies remain an evolving priority.

Oregon's vast and complex terrain creates potential barriers for patients needing daily radiotherapy. The large geographic area and the lack of a standardized database to guide referrals make navigating regional radiation oncology (RO) resources and understanding treatment access across the state challenging.

This is a cross-sectional statewide analysis of RO centers and physicians in Oregon using geospatial information software to estimate resident-level access, RO center-specific capability, and facility-level population coverage by distance and drive-time in 2025. Additionally, regional all-cancer outcomes are summarized by mortality-to-incidence ratios (MIRs) based on proximity to RO access.

Oregon has 27 active RO centers, with a recent closure in Pendleton that previously served approximately 110,000 residents. Although 71% of the population lives within 10 miles of an RO facility, 54.5% of the state's land area lacks proximal access, leaving 434,855 residents (10.3%) more than 60 minutes from care. For many counties, the nearest center is located out-of-state at distances up to 137 miles. One-way drive-times vary widely but can exceed 2.5 hours. Despite statewide resource levels exceeding national averages (one linear accelerator per approximately 83,000 residents and one radiation oncologist per approximately 49,000 residents), there is limited access to brachytherapy and no proton therapy centers. Additionally, increasing geographic isolation from RO access is ecologically associated with worse all-cancer MIRs.

This study provides a comprehensive characterization of RO resources across Oregon. Results reveal substantial regional disparities in proximity, treatment capability, and outcomes, particularly in rural/remote counties that lack in-state RO options. By integrating geospatial, population, and outcome data, this work establishes a statewide baseline to identify persistent access gaps and serves as both a referral resource and a framework for future access studies.

Brazil has substantial capacity to contribute to global clinical research, supported by its population size, epidemiological diversity, and the Unified Health System (SUS). Despite this potential, the country has been described in policy documents and stakeholder discussions as being underrepresented in international clinical trials, reflecting persistent regulatory, operational, and structural barriers. Law No. 14.874/2024 was discussed as representing a major regulatory milestone, although its impact depends on effective implementation and system-level coordination. This article is based on a structured, multistakeholder deliberative process conducted during the First Annual Clinical Research Meeting (Encontro Anual de pesquisa Clinica-in Brazilian Portuguese), held in Brazil in May 2025. The meeting convened 20 speakers from industry, research organizations, clinical investigators, public and private research centers, patient advocacy groups, civil society, and health policy. Discussions were organized through plenary sessions and thematic working groups. A qualitative synthesis was conducted after the meeting to identify convergent policy directions and areas of divergence. Key challenges identified during the deliberative process included regulatory predictability, taxation and importation of research supplies, mandatory post-trial access, underutilization of SUS, workforce constraints, logistical bottlenecks, regional inequities, and limited public trust. Convergent policy directions discussed by participants emphasized effective secondary regulation of Law No. 14.874/2024, digital transformation, stronger integration of clinical research within SUS, workforce professionalization, patient-centered trial designs, and differentiated approaches for rare diseases and priority populations. Strengthening Brazil's clinical research ecosystem was described by participants as requiring coordinated policy action, transparent governance, and sustained investment. The policy directions synthesized here, derived from multistakeholder deliberation, are intended to inform regulatory development and institutional strategies rather than to serve as a formal consensus statement or implementation plan.

Disparities in health care access and resource availability in middle-income countries often lead to suboptimal management of localized bladder urothelial carcinoma (UC). However, real-world data describing treatment patterns and outcomes in these settings remain limited.

This multicenter, retrospective, real-world study included patients with high-risk non-muscle-invasive (HR-NMIBC) and localized muscle-invasive bladder cancer (MIBC) diagnosed between 2017 and 2022 across nine cancer centers in a middle-income setting. Treatment data and clinical outcomes were collected from medical records and analyzed using descriptive statistics and Kaplan-Meier survival estimates.

Among 343 patients analyzed, 217 (63.3%) had HR-NMIBC, of whom only 29.5% received adjuvant Bacillus Calmette-Guérin (BCG), often substituted with intravesical gemcitabine because of supply shortages. BCG exposure was associated with superior overall and cancer-specific survival compared with non-BCG patients. In the muscle-invasive cohort (n = 126; 36.7%), cystectomy was performed in 48.4% and significantly improved survival. Perioperative chemotherapy remained limited, with only 39.3% receiving neoadjuvant therapy, and just one third receiving cisplatin-based regimens that conferred the greatest survival benefit.

This multicenter real-world study exposes major gaps in the management of localized UC in a middle-income setting. Limited access to BCG, perioperative chemotherapy, and cystectomy remain key barriers to guideline-concordant care, underscoring the urgent need for policy actions to improve treatment delivery and outcomes in comparable health care systems.

Accessing timely childhood cancer care is a significant challenge in low- and middle-income countries. Primary health care workers are key patient navigators through specialized care referral systems. Understanding their perspectives on childhood cancer is critical in improving access to care.

A cross-sectional study was conducted from January to June 2023 in Bungoma County, Kenya. The in-charges of 144 level 2 and 3 facilities completed a semistructured questionnaire on childhood cancer perspectives, traditional, complementary, and alternative medicine (TCAM), referral barriers, and health insurance. Descriptive statistical analysis was performed. For baseline data, frequency distributions were calculated. Mann-Whitney test, chi-square test, and Fisher's exact test were performed for comparisons of perspectives and health beliefs.

Of 144 facilities, 125 (86%) were level 2 and 19 (13%) were level 3. Only 14% of the facilities offered full insurance from the National Health Insurance Fund. Most in-charges believed that cancer was caused by chemical exposure (98%) or maternal drug use (90%), whereas 25% cited supernatural causes. Financial barriers were the main obstacle to accessing childhood cancer care (90%), with 69% believing that families could not afford health insurance. TCAM use was common, with 50% of respondents supporting its combination with chemotherapy. The participants concluded that referral barriers included financial constraints, lack of insurance, and family fears.

We found that delays in childhood cancer care in Western Kenya arises from a combination of provider misconceptions, culturally embedded TCAM use, rigid referral systems, financial inadequacy, lack of insurance, and family fears and beliefs. This study contributes uniquely by focusing on primary health care facility in-charges, whose perspectives directly shape the navigation pathway through the referral system.

Hypoglossal neuropathy is the most common lower cranial neuropathy detected as a delayed sequelae of Human Papillomavirus (HPV) -driven oropharyngeal cancer (OPC). Needle electromyography (EMG) is the gold standard for electrodiagnostic testing, but it is invasive and relies on subjective interpretation of the EMG signal. This study explores the potential of non-invasive high-density surface electromyography (HDSEMG) to detect and quantify hypoglossal neuropathy in OPC survivors.

In an exploratory study, examine the feasibility of HDSEMG for rapid, non-invasive screening of hypoglossal nerve (CN XII) function and estimate the prevalence of hypoglossal neuropathy before and after oropharyngeal radiotherapy, and associate with patient-reported and clinician-graded functional outcomes. Machine learning performance will be measured through sensitivity, specificity, and F1 score, with a target area under the curve > 0.7 based on literature-reported EMG sensitivity and specificity.

This protocol will recruit patients aged ≥ 18 years who receive radiation therapy for OPC at MD Anderson Cancer Center (MDACC) between 2024-2025 and consent to experimental HDSEMG testing. Sanchez Research Lab (The University of Utah, Salt Lake City, UT) will perform data analysis. Clinical data-including electrical impedance measurement (EIM), patient-reported outcomes, dysphagia grading, tongue functions, fibrosis grading, and needle EMG-will be collected from n = 36 patients. Features extracted from HDSEMG will be correlated with other clinical outcomes and used to train a machine learning classifier to quantify the severity of hypoglossal neuropathy.

Based on Breast Cancer Statistics, 2025, breast cancer is a leading cause of death among women in the United States. Geographic disparities and associated risk factors influence breast cancer mortality over time and across spatial areas within the state of Kansas.

This study investigates the spatial and temporal distribution of breast cancer mortality in Kansas, analyzing associations with socioeconomic, healthcare, and behavioral characteristics while accounting for geographic heterogeneity and temporality.

Using data from 105 counties within Kansas, breast cancer mortality was modeled using known count distributions. Within these model frameworks, two approaches to spatial units were implemented: using county-level units and creating spatial clusters of counties. These models incorporated both spatially structured and unstructured effects with different correlation structures. Key socioeconomic, healthcare, and behavioral factors were analyzed. Model performance was evaluated using the Deviance Information Criterion (DIC), Widely Applicable Information Criterion (WAIC), and Marginal Log Likelihood.

The Poisson BYM2 model provided the best fit for the county analysis (DIC = 1305.02, WAIC = 1308.40) and the spatial cluster analysis (DIC = 2435.90, WAIC = 2420.70). The percent of females who binge drink alcohol was significant in the county analysis. In contrast, the average percent of females who binge drink alcohol, the average percent of females who smoke tobacco, the average percentage of females with diabetes, and the average percent of females were significant in the spatial cluster analysis. The relative risk of breast cancer mortality did not change significantly over time in the county analysis, but it did in the cluster analysis.

Spatial and temporal models provide valuable insights into the risk of breast cancer mortality in Kansas, within the county analysis and the spatial cluster analysis. Public health officials should focus on providing resources and equitable healthcare in high-risk counties and high-risk spatial clusters through targeted interventions to improve access to healthcare and breast cancer outcomes.

Bladder cancer (BCa) is a histologically and molecularly heterogeneous disease and is one of the leading causes of cancer death globally. The main risk factors are sex (with incidence 3 to 4 times higher in men), tobacco usage, occupational exposure to carcinogens, and persistent infections, such as those caused by Schistosoma haematobium. Urine and the bladder were recently confirmed to be non-sterile, prompting investigations into the urinary and intratumoral microbiomes and their roles in tumor stage, prognosis, and therapy response. In this context, the role of the urinary and intratumoral microbiome in bladder carcinoma is among the most promising areas in translational uro-oncology. Recent evidence demonstrates the presence and diversity of microbial communities in both urine and bladder cancer tissue, with patterns associated with tumor stage and prognosis. Chronic inflammation, genotoxin production, altered carcinogen metabolism, and modulation of the immune microenvironment are biological processes that provide a rationale for the functional role of these microorganisms in the bladder. Furthermore, microbial profiles have been correlated with responses to intravesical therapies (such as BCG - Bacillus Calmette-Guérin) and, potentially, with systemic immunotherapies. The microbiome can help identify predictors of treatment response and potential adjuvant interventions, and offers a non-invasive, translational pathway for diagnosis and surveillance. This review summarizes current evidence on the microbiome in bladder cancer patients and its prognostic and therapeutic potential.

Women with ovarian cancer may be at increased risk of severe COVID-19 outcomes. This study aimed to compare mortality and clinical outcomes between women with severe COVID-19, with and without a history of ovarian cancer. We conducted a matched case-control study using national surveillance data. Cases included women with severe COVID-19 and a history of ovarian cancer; controls were women with severe COVID-19 without such history. Matching was done at a 1:4 ratio using age, comorbidities, vaccination status, diagnosis date, and region. The primary outcome was COVID-19-related mortality. A total of 474 ovarian cancer cases and 1,896 controls were included. Mortality was significantly higher in women with ovarian cancer (54.9 vs 32.7%, P<0.001). Multivariate analysis showed that ovarian cancer increased the risk of death (OR: 2.76, 95%CI: 2.22-3.43). Age also influenced mortality: OR 2.57 (95%CI: 2.11-3.13) for women aged 65-84, and OR 3.86 (95%CI: 2.52-5.97) for those 85 and older. Vaccination provided protection: complete vaccination (OR: 0.67, 95%CI: 0.51-0.88) and complete vaccination plus booster (OR: 0.35, 95%CI: 0.27-0.47). Women with ovarian cancer had a significantly higher risk of death from severe COVID-19. Vaccination, particularly with a booster, was associated with 65% reduced mortality.

The aim of this meta-analysis was to determine the efficacy and safety of percutaneous irreversible electroporation combined with immunotherapy compared with irreversible electroporation alone in patients with locally advanced pancreatic cancer.

We systematically searched Embase, Cochrane Central Register of Controlled Trials, and PubMed/Medline for relevant studies. The outcomes of interest were progression-free survival, overall survival, carbohydrate antigen 19-9 (CA 19-9) levels, and adverse events. Progression-free survival and overall survival were assessed using pooled hazard ratios (HR), odds ratios (OR) were used for adverse events, and mean differences (MD) for CA 19-9.

Four studies involving 310 patients were included in the pooled analysis. Irreversible electroporation combined with immunotherapy significantly prolonged progression-free survival compared with irreversible electroporation alone (hazard ratio [HR], 0.56; 95%CI=0.39 - 0.80; p<0.01; I2=10%). Additionally, patients who received irreversible electroporation plus immunotherapy achieved a greater overall survival compared with irreversible electroporation alone (HR=0.52; 95%CI=0.37 - 0.73; p<0.01; I2=0%). The pooled results for CA 19-9 showed significantly lower levels in patients receiving irreversible electroporation and immunotherapy compared with those receiving irreversible electroporation alone (MD: -70.18U/L; 95%CI=-121.07 - -19.29; p<0.01; I2=98%). No significant difference in the occurrence of adverse events such as nausea and vomiting (OR=1.58; 95%CI=0.71 - 3.49; p=0.26; I2=0%) and gastroparesis (OR=0.88; 95%CI=0.23 - 3.40; p=0.85; I2=0%) was not observed between the groups.

Combined therapy using percutaneous irreversible electroporation and systemic immunotherapy offers a safe and effective treatment approach for locally advanced pancreatic cancer, with irreversible electroporation potentially enhancing the efficacy of systemic immunotherapy in combined applications.

ID CRD42024562216.