• Consensus from the Asian conference on tumor ablation working group on image-guided thermal ablation for lung tumor: 10 key questions and answers.
    2 days ago
    Percutaneous image-guided thermal ablation (IGTA) is increasingly utilized for the management of primary and metastatic lung tumors. Several academic societies across various countries have issued clinical practice guidelines, opinion statements, and recommendations for IGTA in the treatment of lung tumors. However, unresolved conceptual and practical challenges persist, underscoring the need for a more comprehensive consensus on the safe and effective application of IGTA, particularly in Asian countries. Consequently, the guideline committee of the Asian Conference on Tumor Ablation (ACTA) established a dedicated working group to develop recommendations for the clinical use of IGTA in lung tumors. Through a thorough analysis of current literature and key clinical questions, the ACTA working group identified 10 critical issues, including indications, modality selection, technical considerations, and management of complications. Following extensive discussions and iterative revisions, experts from Asia-Pacific countries have formulated a consensus to guide clinical practice.
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  • Ecological Momentary Assessment for Assessing Affect Patterns Associated With Depression in Cancer Survivors in Primary Care: A Pilot Study.
    2 days ago
    Depressive symptoms are common in cancer survivors. Recognizing depression can be complicated due to recall bias or oncological treatment-related symptoms including cognitive problems, which in turn may undermine the reliability of self-report questionnaires.

    To explore the feasibility and patient satisfaction of smartphone-based Ecological Momentary Assessment (EMA) in primary care cancer survivors.

    Patients > 18 years, curatively treated for cancer within the past two years, regardless whether they experienced depressive symptoms, were selected based on the GPs' health records. EMA questionnaires were sent three times daily for 6 weeks, covering positive and negative affect, along with related experiences. Patients received weekly EMA feedback reports. After the EMA period, they completed an evaluation questionnaire and participated in a follow-up phone call to discuss their EMA experiences.

    Patient recruitment achieved a reach of 17.0% who were invited for participation (158/931), of whom 33/158 agreed to participate yielding a response rate of 20.9%. Patients found the EMA questions clear and study participation easy with a completion rate of 67% among those who started. However, 64% felt the frequency of EMA prompts was excessive, with 52% considering the 6-week duration appropriate and 48% feeling it was too long. During phone call evaluations, patients reported becoming inattentive with filling out the EMA's. Weekly reports were viewed as relevant and provided valuable insights into levels and changes in their mood.

    The relatively low reach and response rate do not entirely support the feasibility and acceptability of a 6-week EMA in cancer survivors in primary care without depressive symptoms. EMA was, however, completed by a majority among those who started and was regarded as a user-friendly tool that offered valuable insights to individuals. It could potentially benefit cancer survivors or other patients who do experience depressive symptoms in primary care.
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  • "I Am Not the One That Caused Your Illness": Lung Cancer Stigma in Nigeria.
    2 days ago
    Global illness-related stigma is increasingly recognized as a formidable barrier to health-seeking behavior, engagement in care, and adherence to treatments across a range of disease conditions. Stigma is experienced by many patients with lung cancer (PwLC) in the United States; however, less is known about how lung cancer stigma operates in Nigeria.

    This qualitative study was conducted to describe lung cancer stigma and examine the cultural adaptability of the conceptual model of lung cancer stigma in Nigeria.

    Individual and small group interviews were conducted with PwLC (N = 16) at University College Hospital (UCH), Ibadan and at Obafemi Awolowo University Teaching Hospitals Complex (OAU), Ile-Ife.

    Data analyses revealed that overall, the responses mapped onto the conceptual model of lung cancer stigma and participants described their perceptions of others' stigmatizing attitudes or behaviors, consistent with "perceived stigma" as well as feelings of self-blame, guilt, shame, and regret, consistent with "internalized stigma." Participants also characterized both adaptive and maladaptive consequences of stigma, including distress/depression and constrained disclosure. Further, participants described some specific cultural contexts (moderators) that are important in understanding the landscape of lung cancer stigma in Nigeria, namely causal attributions, cancer as a spiritual attack, financial constraints, systemic delays, and non-disclosure by clinicians.

    PwLC experience stigma in Nigeria, which may get triggered during clinical interactions with oncology care clinicians. Communication skills trainings for clinicians in empathy and compassion may help mitigate lung cancer stigma and improve quality of care for PwLC in Nigeria.
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  • Nightshift work and risk of breast and prostate cancer: a systematic review and meta-analysis, 2012-2023.
    2 days ago
    The International Agency for Research on Cancer classifies night shift work as Group 2A, a probable human carcinogen. This study updates the evidence on the association between night shift work and the risk of breast and prostate cancer.

    Searches were conducted in PubMed and Web of Science. Case-control and cohort studies were included if they assessed night work as a risk factor for breast or prostate cancer, had =100 participants, provided full text in English or Spanish, scored =6 on the Newcastle-Ottawa Scale, and reported relative risks or odds ratio with 95% confidence interval. Heterogeneity and study quality were evaluated. Data synthesis followed PRISMA guidelines.

    Twenty-one studies including 586,890 participants were analysed. For breast cancer, significant association were found only in cohort studies, both overall (RR=0.82; 95%CI: 0.67-0.99; I2=91%) and for <10 years of night work (RR=0.75; 95% CI: 0.68-0.82; I2=0%). Average study quality was acceptable (score 7), although heterogeneity was substantial. For prostate cancer, case-control studies reported an OR of 1.14 (95%CI; 1.02-1.27; I2=25%). For exposures =10 years, both RR (2.20; 95%CI: 1.35-3.59) and OR (1.16; 95%CI: 1.03-1.30) were significant. Overall quality was moderate (score 6) with low heterogeneity (25%).

    Weak associations between night shift work and prostate cancer are observed in case-control studies and among individuals with =10 years of exposure, but no consistent association was found for breast cancer. These findings remain inconclusive and highlight the need for further research.
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  • Building a transdisciplinary network to improve survival in children with cancer in Colombia: seeds to forests.
    2 days ago
    Childhood cancer mortality is disproportionately higher in low- and middle-income countries than high-income countries. The World Health Organization Global Initiative for Childhood Cancer aims for a survival of 60% by 2030. This initiative prioritizes timely diagnosis, access to standardized therapy and supportive care, and prompt management of treatment-related complications. Collaborative work is linked to better performance of health systems and delivery of high-quality care. While collaborative strategies between high- and lower-income countries can advance cancer care in low- and middle-income countries, local and regional initiatives are essential to improve clinical outcomes. The high treatment-related mortality in children with cancer in low- and middle-income countries highlights the critical need to collaborate. To decrease treatment-related mortality in children with cancer in Colombia, a new model of transdisciplinary collaboration was built among Colombian scientific societies (pediatrics, pediatric hematology/oncology, infectious diseases, critical care), academic institutions, grassroots foundations, and the Colombian Childhood Cancer Clinical Outcomes Surveillance System: VIGICANCER. The network supports resource and knowledge exchange to tackle public health challenges related to accessing cancer care for children. It enables the design of targeted and tiered multilevel interventions to enhance quality of care for Colombian children and adolescents with cancer. This transdisciplinary network aims to improve survival in Colombian children with cancer and close the gap with high-income countries by establishing data-informed targets and developing a strategic roadmap to address sepsis, the most actionable cause of treatment-related mortality. Our ultimate goal is to reduce the number of years of life lost, thereby supporting societal progress in Latin America.
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  • Nurses' knowledge, attitude, and practice toward the sexual health of breast cancer patients.
    2 days ago
    This study explores the knowledge, attitude, and practice (KAP) regarding the sexual health of breast cancer patients among nurses in Nanjing, China.

    Conducted from June to July 2023 across six hospitals, this web-based cross-sectional study utilized a self-administered questionnaire, resulting in 252 valid responses, predominantly from female nurses (98.41%).

    The mean scores indicated inadequate knowledge (8.82 ± 5.33), a positive attitude (38.43 ± 5.23), and inactive practice (27.75 ± 6.68) regarding patients' sexual health. Multivariate logistic regression identified that the lack of training on breast cancer sexual health was significantly associated with lower knowledge (OR = 0.31, p = 0.001), while job satisfaction correlated positively with knowledge levels (OR = 1.28, p = 0.018). Age (OR = 1.13, p = 0.001) and attitude (OR = 1.22, p < 0.001) were linked to higher levels of practice. Structural equation modeling revealed that knowledge significantly positively influenced attitude (β = 0.493, p < 0.001), and both knowledge and attitude directly affected practice (β = 0.563 and β = 0.897 respectively, p < 0.001).

    Overall, nurses demonstrated a need for improved knowledge and active practices concerning the sexual health of breast cancer patients.
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  • Treatment preferences in low-risk papillary thyroid microcarcinoma: a discrete choice experiment.
    2 days ago
    This study aims to assess treatment preferences among newly diagnosed low-risk papillary thyroid microcarcinoma (PTMC) patients and analyse the trade-offs they make in treatment decisions.

    Cross-sectional study.

    Conducted at the Fourth Affiliated Hospital of Harbin Medical University from June 2023 to April 2024, this study employed a discrete choice experiment. Participants were asked to choose among three treatment options with varying levels across seven attributes. A mixed logit model was used to analyse patient preferences, calculate the relative importance (RI) of attributes, and estimate marginal willingness to pay (mWTP). Subgroup analyses were also performed.

    The final sample of 418 participants yielded 11,286 observations. The most influential attribute affecting treatment choice was the 10-year risk of disease recurrence or progression (RI = 58.4%), followed by the risk of short-term complications (RI = 8.9%), treatment type (RI = 8.5%), length of hospital stay (RI = 7.7%), need for lifelong thyroid medication (RI = 7.3%), and out-of-pocket treatment costs (RI = 6.9%). The risk of permanent voice change had minimal impact (RI = 2.4%). Regarding treatment type, participants significantly preferred thermal ablation over open surgery, while endoscopic thyroidectomy was less preferred, and active surveillance was the least favoured option. The mWTP analysis reinforced these priorities. Additionally, sociodemographic and psychological factors also influenced preferences.

    These findings highlight the need for healthcare providers to clearly communicate the long-term impacts of different treatment options to support informed decision-making. They also underscore the importance of improving patient-centred care, enhancing health education, and addressing the issue of overtreatment in PTMC.
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  • Risk factors for lateral cervical lymph node metastasis in papillary thyroid carcinoma and to develop and validate a nomogram model.
    2 days ago
    To identify risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC) and to establish clinical prediction models.

    We retrospectively collected clinical data from 249 patients with PTC and suspected LLNM, 222 patients met the inclusion criteria. Based on postoperative pathology of the lateral compartment, 145 patients without metastasis were classified as the non-metastasis group, 77 patients with metastasis were classified as the metastasis group. All included patients were randomly assigned to training set and validation set. Univariate and multivariate logistic regression analyses were performed to screen predictors of LLNM and construct nomogram models for preoperative and postoperative prediction. Model performance was evaluated using the Hosmer-Lemeshow goodness-of-fit test, calibration curves with bootstrap resampling, receiver operating characteristic (ROC) curves and the area under the curve (AUC), as well as decision curve analysis (DCA).

    In preoperative analyses, age, maximum tumor diameter ≥1 cm on ultrasound, hyperechoic area in the lateral cervical lymph node, and lateral cervical lymph nodes perinodal vascularity were independent predictors of LLNM. In postoperative analyses, age, multifocality, pathological maximum tumor diameter ≥1 cm, and concomitant central lymph node metastasis were independent predictors. The AUCs for the preoperative model were 0.805 (training set) and 0.719 (validation set), and for the postoperative model were 0.885 (training set) and 0.762 (validation set). After 1,000 bootstrap resamples, the mean absolute errors (MAE) of the calibration curves were 0.047 and 0.066 for the preoperative model (training set and validation set), and 0.021 and 0.046 for the postoperative model.

    DCA showed a higher net clinical benefit of both models than the treat-all or treat-none strategies, indicating good predictive accuracy and clinical utility.
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  • Prediction of 131I uptake in lung metastases of differentiated thyroid cancer using deep learning.
    2 days ago
    An accurate assessment of 131I accumulation capacity in lung metastases of differentiated thyroid cancer (DTC) is pivotal for guiding radioiodine therapy and avoiding ineffective 131I administration. This study aimed to develop a deep convolutional neural network (DCNN) model to predict 131I uptake in lung metastases of DTC before radioiodine therapy.

    In this retrospective, multicenter, population-based cohort study, we collected chest CT image datasets for DTC patients with lung metastases from three hospitals in China. Pulmonary metastases were classified into two categories based on the post therapeutic 131I whole-body scan: 131I-avid (positive 131I uptake) and non-131I-avid (negative 131I uptake). For DCNN model development, patients were assigned to the primary dataset (140 patients with 131I-avid, 121 with non-131I-avid). For model validation, patients were assigned to the internal validation dataset (36 patients with 131I-avid, 23 with non-131I-avid), external validation dataset 1 (25 patients with 131I-avid, 18 with non-131I-avid), and external validation dataset 2 (23 patients with 131I-avid, 18 with non-131I-avid). Using these datasets, we assessed the performance of our model, ResNeSt50, and compared it with two models: Inception V3 and ResNet50.

    Compared to Inception V3 and ResNet50, our model, ResNeSt50, demonstrated the highest prediction performance in the internal (area under the curve [AUC] = 0.722, 95% confidence interval [CI] = 0.716-0.725), external validation dataset 1 (AUC = 0.720, 95% CI = 0.691-0.749), and external validation dataset 2 (AUC = 0.731, 95% CI = 0.713-0.748).

    We developed a simple and robust DCNN model for predicting the 131I uptake in lung metastases of DTC before radioiodine therapy, which can provide improved screening for patients who may benefit from 131I therapy.

    Chinese Clinical Trial Registry (ChiCTR), ChiCTR1800018047. Registered on 28 August 2018.
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  • Impact of SPY Elite Fluorescence Imaging on Complications and Healthcare Utilization in DIEP Flap Breast Reconstruction: An Interrupted Time Series Analysis.
    2 days ago
    The deep inferior epigastric perforator (DIEP) flap is a favored option for autologous breast reconstruction. However, complications related to insufficient perfusion, such as flap loss and fat necrosis, remain significant concerns. SPY Elite Fluorescence Imaging enables real-time tissue perfusion assessment during surgery, potentially reducing complications through superior visualization compared with clinical assessment alone. This study evaluates surgical outcomes and healthcare utilization patterns before and after the implementation of SPY imaging for DIEP flap breast reconstruction.

    This retrospective study examined 271 breast cancer patients undergoing DIEP flap reconstruction at Rigshospitalet, Copenhagen (November 2016-June 2024), with 164 in the SPY group and 107 in the non-SPY group. Outcomes included flap complications and frequency of postoperative visits.

    The interrupted time series revealed a significant decrease in complications over time (β = -0.110, p < 0.001) with SPY implementation. Overall rate of flap complications saw a relative risk reduction of 21.3%, explained by a reduction in rates of flap infection, flap loss, and seroma. Healthcare utilization decreased across all categories: hospital visits (-21.6%), doctor visits (-17.4%), and nurse visits (-23.6%). The number needed to treat to prevent one complication was 6.0.

    SPY imaging implementation was associated with significant reductions in flap complications and healthcare utilization. While our interrupted time series design strengthens causal inference by accounting for temporal trends and learning curves, the observational nature precludes definitive causal claims. The technology shows potential clinical and economic value. Prospective studies are needed to validate these findings and establish standardized protocols for optimal application.
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