IntroductionThis study aimed to evaluate the independent associations of myopenia, myosteatosis, and frailty with survival outcomes in older patients with prostate cancer undergoing definitive radiotherapy.MethodsA total of 124 patients aged ≥65 years who received definitive radiotherapy for localized or locally advanced prostate cancer between 2014 and 2023 were retrospectively analyzed. Myopenia and myosteatosis were quantified using the psoas muscle index (PMI) and Hounsfield unit average calculation (HUAC), respectively. Comorbidity-based frailty was assessed using the modified frailty index-11 (mFI-11). The cut-off points for the PMI and HUAC were determined using receiver operating characteristic (ROC) curve analysis. Univariate and parsimonious multivariable Cox regression analyses were used to examine the prognostic value of these markers for progression-free survival (PFS) and overall survival (OS).ResultsThe median age of the patients was 72 years (range: 65-87). According to the mFI-11, 47.6% of the patients were classified as frail. The cut-off values for PMI and HUAC were 2.0 cm²/m² and 37.7 HU, respectively. In univariate analysis, only PMI was significantly associated with both PFS (HR: 2.23, p = 0.02) and OS (HR: 2.45, p = 0.03). When entered separately into parsimonious multivariable Cox models adjusted for age and NCCN risk group, PMI remained an independent prognostic factor for both PFS (HR: 2.36, p = 0.01) and OS (HR: 2.40, p = 0.04), whereas mFI-11 and HUAC were not significantly associated with either endpoint.ConclusionAmong the evaluated body composition and frailty-related markers, only PMI-defined myopenia remained independently associated with both PFS and OS in older patients receiving definitive radiotherapy for localized or locally advanced prostate cancer. As PMI can be obtained opportunistically from routine planning CT, it may have value for prognostic stratification, although confirmation in external prospective datasets is required.

Following salvage chemotherapy (SC) and autologous stem-cell transplantation (ASCT), 30-60% of patients with relapsed/refractory Hodgkin lymphoma (r/rHL) experience disease relapse. Appropriate patient selection for consolidation radiotherapy (cRT) may improve outcomes. Positron-emission tomography (PET) is a powerful prognostic tool, with potential utility in PET-directed therapy. Predictive roles of post-SC metabolic and structural response assessments, and prognostic impact of peri-transplant cRT, were retrospectively evaluated in r/rHL patients from two tertiary hospitals, median follow-up >5 years. Five-year progression-free survival (PFS) was 65% (95%CI 55-74%). Metabolic response post-SC significantly predicted PFS. For patients with complete metabolic response (CMR) post-SC, structural residuum ≥2 cm suggested inferior PFS. Potential PFS advantages from cRT were observed in all subgroups with limited-stage r/rHL, regardless of response post-SC. Peri-transplant cRT may abrogate the negative predictive value of non-CMR or residual masses ≥2 cm in CMR post-SC. In advanced-stage r/rHL, post-SC non-CMR predicted for poor outcomes, warranting prioritization of alternative salvage strategies.

Se presenta el caso de una mujer de 51 años diagnosticada de carcinoma ductal de mama derecha sin antecedentes personales patológicos o heredofamiliares relevantes. Durante la evaluación de medicina del trabajo del Instituto Mexicano del Seguro Social para determinar una posible invalidez, no se identificó historia de exposición laboral a toxinas, radiación ionizante o químicos. Sin embargo, se encontró una alteración del ciclo circadiano de 9 años de duración con un total de 1,424 noches trabajadas y ausencia de medidas de prevención, que se asoció a sobrepeso y cambios en la actividad física por la actividad laboral. Por ello, se reconoció como enfermedad de trabajo, ya que se mostró la presencia de riesgos laborales para el cáncer de mama, y la necesidad de medidas de prevención entorno a los horarios de trabajo.

The rising cost of targeted breast cancer therapies challenges financial sustainability and equitable access in dual-tier health systems. In Malaysia, public cancer care is highly subsidized but budget constrained, shifting patients toward private services that are typically financed through out-of-pocket payments, private health insurance or employer-sponsored insurance. Rakan KKM (MOH's Friend) is a fee-for service initiative in selected public hospitals designed to provide lower-cost private care, with revenues reinvested into the public system. However, its financial implications for breast cancer pharmacotherapy remain uncertain. This manuscript presents a methodological protocol for a system dynamics (SD) model developed to evaluate the financial implications of Rakan KKM for breast cancer pharmacotherapy in Malaysia.

A system dynamics model has been developed to model breast cancer disease progression across stages and patient movement between public, private and Rakan KKM care settings, integrating associated healthcare expenditures and revenue flows from the perspective of the Ministry of Health. An influence diagram was constructed through stakeholder engagement to identify key feedback mechanisms influencing access, affordability and system sustainability. Model parameterisation is complete, using national epidemiological data, published registries data, national drug acquisition cost estimates and expert elicitation from oncology clinicians and pharmacists. This protocol details the simulation framework where a status quo scenario is compared against intervention scenarios over a 10-year horizon. One-way sensitivity analysis and monte-carlo simulations address parameter and clinical uncertainties, while scenario analyses guided by the Diffusion of Innovation framework examine alternative uptake rates and capacity constraints.

This protocol describes a transparent and adaptable SD modelling approach to assess the fiscal sustainability of financing high-cost breast cancer therapies in mixed public-private systems by projecting how patient switching influences pharmacotherapy expenditure and the net resources potentially available to support public service investment through Rakan KKM.

Bacillus Calmette-Guérin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer (HR-NMIBC) with carcinoma in situ (CIS) is aggressive and treatment options are suboptimal. TAR-200, a novel intravesical drug-releasing system, received United States (US) Food and Drug Administration (FDA) approval on 09/09/2025 for this population. An economic model compared the cost per responder for US patients with BCG-unresponsive HR-NMIBC with CIS treated with TAR-200 versus other FDA-approved treatments.

A 15-month cost-per-responder model was developed from a Medicare payer perspective (2025 USD). Patients treated with TAR-200 monotherapy were compared to those treated with pembrolizumab, nadofaragene firadenovec (NF), nogapendekin alfa inbakicept (NAI)+BCG (with/without reinduction), or valrubicin based on published clinical trial data. Model inputs included costs for initial/subsequent treatment, medical visits, and radical cystectomy (RC). Outcomes comprised the total cost per patient achieving and sustaining complete response (CR) for ≥12 months, based on overall CR rates and digitized Kaplan-Meier curves and swimmer plots for the 12-month duration of response. Patients experiencing non-response received subsequent treatment or underwent an RC.

At 15 months, the proportion of patients achieving and sustaining CR for ≥12 months was 43.5% for TAR-200, 18.8% for pembrolizumab, 21.9% for NF, 26.8% for NAI+BCG (36.6% with reinduction), and 10.1% for valrubicin. The total cost per patient achieving and sustaining CR for ≥12 months was $1,892,569 for TAR-200, resulting in cost savings of $698,262 versus pembrolizumab, $406,840 versus NF, $832,346 versus NAI+BCG, and $1,541,999 versus valrubicin. Considering NAI+BCG reinduction, cost savings of $162,599 per patient achieving and sustaining CR for ≥12 months were observed for TAR-200 versus NAI+BCG.

Model inputs were based on trial publications, possibly limiting generalizability.

TAR-200 demonstrated the highest proportion of patients achieving and sustaining CR for ≥12 months, yielding substantial cost savings per responder compared to other FDA-approved treatments for BCG-unresponsive HR-NMIBC with CIS.

Prostate cancer (PCa) incidence and prognosis have changed substantially worldwide in recent decades, driven in part by early detection recommendations. Some countries such as the US have shown a rise in metastatic PCa incidence following recommendations against routine PCa screening around 2012.

To evaluate trends in PCa incidence, mortality, and relative survival across age and prognostic groups and guide policy and practice in Switzerland.

This cohort study included all registered cases of primary PCa based on data from the Swiss National Agency for Cancer Registration and the Swiss Federal Statistical Office from January 1, 1980, to December 31, 2021. Data were analyzed from January 8, 2024, until February 20, 2026.

Diagnosis of PCa.

Age-standardized incidence and mortality rates and relative survival to 10 years after diagnosis were estimated. Subgroup analyses were conducted by age, Surveillance, Epidemiology, and End Results stage, Union for International Cancer Control stage, and Gleason score.

The study included 142 665 cases of primary PCa registered in Switzerland between 1980 and 2021, 100 102 (70.2%) of which were men aged 60 to 79 years. From 1980 to 2004, PCa incidence increased to 226.6 (95% CI, 218.8-234.7) per 100 000 men; it decreased markedly to 173.5 (95% CI, 168.9-178.2) per 100 000 men between 2011 and 2014, then increased again to 220.6 (95% CI, 216.0-225.3) per 100 000 men in 2021. These trends were primarily observed for localized, stage I to II PCa and PCa with a Gleason score of 7 or less in men aged 50 to 79 years. Incidence of distant and stage IV PCa increased after 2011, while incidence of PCa with a Gleason score of 8 to 10 remained relatively stable. PCa mortality declined continuously from the early 1990s to 34.8 (95% CI, 32.9-36.8) per 100 000 men in 2021, while 10-year relative survival increased from 46.2% (95% CI, 43.7%-48.8%) in 1982 to 1991 to 88.5% (95% CI, 86.6%-90.5%) in 2012 to 2021. The 10-year relative survival among men with localized PCa (99.2%; 95% CI, 96.0%-102.4%) was similar compared with men from the general population.

In this population-based cohort study, trends in PCa incidence in Switzerland suggest that overdiagnosis of lower-risk PCa increased and that there was a concurrent rise in cancers diagnosed in advanced stages alongside improvements in overall prognosis. These findings further suggest substantial potential for optimizing early detection of PCa.

Cancer-related cognitive impairment (CRCI) is a frequent side effect of cancer and its treatment that can persist well after treatment completion, with major impacts on quality of life, daily living activities, and return to work. This randomised pilot study assesses the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation program-'Responding to Cognitive Concerns" (eReCog)-in people with low perceived cognitive function after chemotherapy for aggressive lymphoma within the past 5 years and were in remission. Potential efficacy was also explored.

Participants were randomised one-to-one to receive usual care or eReCog plus usual care. The 4-week eReCog program consists of four online modules based on the principles of cognitive behavioral therapy. Operational, neuropsychological test and patient-reported outcome measures (PROMs) data were collected before randomisation and approximately 8 weeks later to assess trial outcomes. Primary feasibility outcomes included recruitment and retention rates (a priori progression criteria: ≥ 3 patients/month and ≥ 80% of participants complete the trial, respectively). Feasibility data were summarised using a rate or proportion, as appropriate, with 95% confidence intervals. Neuropsychological test and PROMs data were analyzed using analysis of covariance.

38 of 53 eligible participants consented to participate over 10 months (3.8 patients/month, 95% CI [2.7, 5.2]), 19 were randomised to each arm, and 36 of 38 (95%, 95% CI [83, 99]) completed the trial, indicating acceptable feasibility. Acceptable feasibility was also found for all four secondary outcomes: adherence to, usability of, and intrinsic motivation to engage with eReCog; and compliance with assessments. A large-sized difference favoring the intervention arm was observed on the SCWT Word score measuring processing speed. Medium-sized differences were observed on other neuropsychological test and PROM scales, but confidence intervals were wide and included zero.

Recruitment and retention rates, compliance with assessments and favorable changes on potential outcome measures suggest a large-scale, appropriately powered trial is warranted, as do findings that eReCog is acceptable to the study population.

Australian New Zealand Clinical Trials Registry ACTRN 12623000705684.

The diagnosis and surgery of lung cancer may cause greater role changes and more volatile adaptive process in the family.

To analyze the overall trajectory and characteristics at various periods in family resilience and vulnerability among lung cancer surgery patients.

Twenty-four lung cancer surgery patients from a tertiary A hospital in Hunan Province were selected using the purposive sampling method. Semi-structured, in-depth interviews were conducted at five time points: admission (T0), 2 weeks after surgery (T1), 3 months after surgery (T2), 6 months after surgery (T3), and 1 year after surgery (T4). Nvivo12.0 was utilized to store and analyze the data.

Family resilience and vulnerability of lung cancer surgery patients exhibited a trajectory of initial decline followed by stabilization, which can be divided into three periods: shock and initial coping period (T0), adjustment and adaption period (T1-T2), and stabilization period (T3-T4). For each period, family resilience and vulnerability showed different traits.

This study confirms that family resilience in lung cancer patients is an evolving and dynamic process with characteristics at different periods. Medical staff should focus on both the trends and characteristics of family resilience and vulnerability and provide targeted support.

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can assess kidney function, but artifacts and complex post-processing limit its use. We calculated estimated glomerular filtration rate (eGFR) and renal plasma flow (RPF) by combining a population-based arterial input function (pAIF) with a whole-kidney pharmacokinetic model (WKPM). We also compared DCE-MRI eGFR and RPF with serum eGFR and arterial spin labeling (ASL) derived RPF, respectively.

In a prospective single-center study, 43 patients (30 M/13 F, 59.0 ± 11.8 y) with renal masses underwent multiparametric 1.5-T MRI, before and 3 months after nephrectomy (n = 15), including coronal, fat-saturated volumetric DCE-MRI (5-s temporal resolution) and background-suppressed pseudocontinuous ASL. DCE-MRI eGFR and RPF were measured by WKPM, incorporating individual-based arterial input function (iAIF) and population-based arterial input function (pAIF) as inputs. Pearson correlation, Bland-Altman analysis, and Mann-Whitney U statistics were used.

Serum eGFR (mean 67.55 mL/min/1.73 m²) and DCE-MRI (mean eGFR pAIF 59.49, iAIF 63.60 mL/min/1.73 m²) were measured in 51 MRIs: correlation with serum eGFR was stronger for pAIF (r = 0.61, p < 0.001) than iAIF (r = 0.33, p = 0.018), with comparable Bland-Altman bias (-11.9% and -9.1%, respectively). RPF was measured by both DCE-MRI and ASL in 21 MRIs: mean RPF was 229.3 (ASL), 229.7 (pAIF), and 390.4 (iAIF) mL/min (p = 0.018). Correlation of pAIF RPF with ASL-derived RPF (r = 0.65, p < 0.001) was stronger than for iAIF RPF (r = 0.53, p = 0.014), with lower Bland-Altman bias (pAIF -1.0% versus iAIF 39.5%).

DCE-MRI using pAIF and WKPM provides simplified, robust single-kidney function estimates.

This study proposes a simplified DCE-MRI post-processing method using a population-based arterial input function combined with a whole-kidney pharmacokinetic model. It avoids complex corticomedullary segmentation and minimizes aortic region-of-interest variability, and enables clinically feasible estimation of single-kidney function, supporting broader adoption of renal DCE-MRI in clinical practice.

Population-based arterial input function reduces inter-observer variability and sensitivity to aortic region-of-interest placement artifacts. Whole-kidney modeling avoids complex segmentation of the cortex and medulla regions. DCE-MRI using population-AIF and whole-kidney modeling yields eGFR and RPF significantly correlated with serum and ASL references. Streamlined post-processing workflow supports broader routine clinical use of DCE-MRI.

Maintaining a relative dose intensity (RDI) ≥ 85% during chemotherapy is established as a critical threshold for optimal outcomes in early breast cancer. This study investigates whether the prognostic impact of reduced RDI differs based on the presence of chemotherapy-induced neutropenia requiring treatment modifications (rCIN).

We analyzed 730 patients with early breast cancer receiving anthracycline/cyclophosphamide and taxane-based chemotherapy at the University Hospital Tübingen between 2014 and 2021. rCIN was defined as any dose reduction > 15%, delay ≥ 5 days, or discontinuation attributed to neutropenia per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Patients were stratified into four groups based on RDI (≥ 85% vs. < 85%) and rCIN status. Differences in overall survival (OS) and disease-free survival (DFS) were assessed by Kaplan-Meier analysis, and predictors of DFS were evaluated by Cox regression.

rCIN occurred in 21.8% of patients, with 59.7% of rCIN patients receiving RDI < 85% versus 16.1% of non-rCIN patients (p < 0.001). Despite lower RDI, rCIN patients maintained similar pathological complete response rates after neoadjuvant therapy. In Kaplan-Meier analysis, patients with RDI < 85% without rCIN had significantly worse DFS and OS than the reference group with RDI ≥ 85% without rCIN (DFS p = 0.003; OS p = 0.002), while patients with RDI < 85% with rCIN showed comparable survival to high-RDI groups (all pairwise p > 0.170). Direct comparison between the two reduced-RDI groups was not statistically significant for either DFS or OS (DFS p = 0.055; OS p = 0.159). Cox regression confirmed RDI < 85% as a negative prognostic factor (HR 2.53; 95% CI 1.38-4.65; p = 0.003). The rCIN × RDI < 85% interaction term was not statistically significant (HR 0.44; 95% CI 0.12-1.60; p = 0.212).

In this retrospective cohort, reduced RDI was associated with poorer outcomes, particularly in patients without rCIN. By contrast, patients with RDI < 85% and rCIN showed no significant differences in Kaplan-Meier survival, and similar pathological complete response rates were observed despite lower RDI in the neoadjuvant subgroup. These findings are hypothesis-generating and require confirmation in larger prospective studies.