Cervical cancer remains a global health burden despite being largely preventable through vaccination, screening, and timely treatment. Delays in follow-up after abnormal screening undermine the effectiveness of organized cervical cancer screening programmes. In Flanders (Belgium), organized screening and reminder systems exist, yet 17.7% of women do not receive adequate follow-up after an abnormal Pap smear, highlighting the need to understand multilevel factors influencing timely follow-up.

Between September and November 2025, 14 semi-structured group interviews were conducted in person with 120 general practitioners and gynaecologists responsible for cervical cancer screening in Flanders. Interviews were audio-recorded, transcribed verbatim, and analysed in MaxQDA, using iterative thematic analysis combining deductive multilevel framework coding with inductive insights. Interviews were double-coded, with discrepancies resolved through discussion. Data collection and analysis proceeded concurrently until saturation and findings were validated with stakeholders.

Despite the organized screening programme, healthcare providers experience cervical cancer screening follow-up as a complex, fragmented, and non-standardized multi-step pathway. Delays were mainly attributed to provider- and system-level factors, including inconsistent communication, challenges in interdisciplinary responsibilities and collaboration, high workload, and poorly integrated digital systems. Patient-related factors, such as language barriers and health literacy played a secondary role. Current follow-up processes were described as relying heavily on individual provider initiative rather than on well-coordinated, system-level structures. To improve timely follow-up, healthcare providers recommended standardised and proactive communication, clearer task allocation and responsibility, better integrated digital systems, the optimisation of the existing reminder mechanism and enhanced patient education.

Delays in follow-up primarily reflect organisational and system-level weaknesses. Standardization, integrated digital systems, and clarified roles and responsibilities are key to reducing preventable delays. A "double safety net" combining provider oversight with informed patient involvement, alongside greater primary care engagement, may further enhance the continuity and timeliness of follow-up care.

Adolescents and young adults (AYAs) with hereditary cancer predisposition face high rates of lifetime cancer risk. Models to support their understanding of cancer risk have not been developed.

To assess the effect of an electronic chatbot-based cancer risk communication tool on AYAs' understanding of cancer risk.

This randomized clinical trial was conducted at the Dana-Farber Cancer Institute, Emory University/Children's Healthcare of Atlanta, University of Chicago, and University of Utah Huntsman Cancer Institute between December 20, 2022, and May 30, 2025 and compared cancer predisposition visits alone vs visits with an electronic chatbot-based cancer risk communication tool, AYA Risk Information and Screening Education, using baseline and follow-up surveys to assess changes in knowledge of cancer risk by age 30 years and over their lifetime, knowledge of recommended screening, and level of psychological distress. Eligible participants were English speakers aged 12 to 24 years, who had 1 of 9 hereditary cancer predisposition syndromes. The primary analysis was conducted according to the intention-to-treat principle. Data were analyzed from July 21 to September 3, 2025.

Chatbot-based intervention with cancer risk and recommended screening information tailored to each syndrome. Additional links to resource pages with chat summary content (learn), recommended age-based screening (plan), guidance about talking with peers (share), links to support organizations (connect), and coping and bereavement support (grow).

The primary outcome was knowledge of cancer risk. The secondary outcomes were knowledge of recommended screening and level of psychological distress.

Of 798 AYAs assessed, 106 AYAs were randomized and enrolled (54 to the intervention group and 52 to the control group). Participants' mean (SD) age was 18.3 (SD, 3.9) years, and 64% (68 of 106) were girls or women. At baseline, 38% of AYAs (20 of 52) in the control group and 52% (28 of 54) of AYAs in the intervention group had accurate knowledge of cancer risk by age 30 years. Following the clinic visit, 37% (19 of 52) of AYAs in the control group and 78% (42 of 54) in the chatbot-based intervention group had accurate knowledge, reflecting greater improvement in knowledge of cancer risk by age 30 years (OR, 3.50; 95% CI, 1.45-9.19; P = .005). AYAs in the intervention group had non-statistically significant improvements in knowledge of recommended screening (OR, 2.17; 95% CI, 0.85-5.59; P = .11) and reductions in distress compared with AYAs in the control group (distress thermometer, β = -0.50; 95% CI, -1.09 to 0.08; P = .09).

In this randomized clinical trial, use of a chatbot-based intervention combined with a cancer predisposition clinic visit improved knowledge of cancer risk by age 30 years over a clinic visit alone, without increasing distress. Combining human interaction in the clinic with personalized, accurate electronic information can support AYAs with cancer predisposition and other serious conditions.

ClinicalTrials.gov Identifier: NCT04323774.

Pathological fracture as the initial manifestation of malignancy is a clinical challenge requiring rapid treatment despite limited prognostic information. We aimed to describe definitive diagnoses and survival in patients presenting with a pathological fracture as initial manifestation of malignancy.

We performed a nationwide register-based cohort study using the Swedish Fracture Register (SFR) and Swedish Cancer Register (SCR), 2014-2023. We included patients with a pathological fracture classified as unknown in the SFR at treatment. Survival was analyzed using Kaplan-Meier and Cox regression.

We included 319 patients with a pathological fracture. Median age was 75 years (17-100), 50% men. A definitive tumor diagnosis was established in 215 patients (67%), most commonly a hematogenous malignancy. Age was associated with mortality (HR 1.03, 95% confidence interval [CI] 1.01-1.04). Compared with hematogenous malignancies, mortality was higher for bone (HR 2.9, CI 1.2-7.2), breast (HR 2.5, CI 1.2-5.1), kidney (HR 3.3, CI 1.7-6.5), lung (HR 6.3, CI 3.7-10.5), unknown (HR 8.1, CI 4.2-15.5), other (HR 10.3, CI 5.6-19.0), and gastrointestinal malignancies (HR 10.3, CI 4.5-23.7), and for patients without SCR registration (HR 19.7, CI 11.7-33.2). Prostate cancer, sex, fracture site, and treatment were not associated with increased mortality.

Hematogenous and lung malignancies were the most common in pathological fracture as initial manifestation of malignancy. Survival was short and varied substantially by tumor type. Age and primary tumor site were prognostic factors, emphasizing the importance of comprehensive diagnostic work-up to guide acute treatment.

The use of robot-assisted surgery (RAS) has increased markedly in China, but comparative evidence on its perioperative performance in cancer care is dispersed across specialties and study designs. This review synthesized Chinese evidence to examine the safety and effectiveness of da Vinci robot-assisted surgery (dV-RAS) relative to laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and open surgery across seven oncologic procedures. We systematically reviewed comparative studies published from 2010 to 2024 and pooled estimates for dV-RAS versus LAP/VATS or open surgery. Prespecified perioperative outcomes were conversion to open surgery, operative time, estimated blood loss, blood transfusion, hospital length of stay, postoperative complications, readmission, reoperation, and 30-day mortality. The review included 116 studies. Relative to LAP/VATS, dV-RAS was associated with lower odds of conversion to open surgery (odds ratio [OR] 0.26; 95% confidence interval [CI] 0.21-0.33; p < 0.01), less blood loss (mean difference [MD] - 32.48 mL; 95% CI - 40.86 to - 24.11; p < 0.01), lower odds of transfusion (OR 0.61; 95% CI 0.51-0.73; p < 0.01), a shorter hospital stay (MD - 1.06 days; 95% CI - 1.30 to - 0.82; p < 0.01), fewer 30-day postoperative complications (OR 0.67; 95% CI 0.61-0.73; p < 0.01), and fewer reoperations (OR 0.62; 95% CI 0.40-0.96; p = 0.03). Comparisons with open surgery likewise favored dV-RAS for blood loss, transfusion, length of stay, and postoperative complications. Operative time, readmission, and 30-day mortality did not differ significantly between approaches. Across seven oncologic procedures, pooled evidence from China indicated that dV-RAS was associated with better outcomes on several perioperative measures than LAP/VATS or open surgery. Because between-study heterogeneity was substantial and most included studies were retrospective, the findings should be interpreted cautiously and confirmed in higher-quality prospective research.

New and costly therapies for myasthenia gravis (MG) have been approved during the last years, and many more are in the pipeline. Cost-benefit analyses are needed as part of defining start and stop criteria for such treatments. In this systematic review, we examine healthcare costs associated with MG: METHODS: A systematic literature search combined the word "myasthenia gravis" with "health resources", and "costs". 1374 records were identified initially, and 44 were included in the final review.

Direct costs include treatment and follow-up in the primary and specialist health care. They were estimated to €3 500-12 000 per MG patient per year in the Nordic countries, similar in other European countries, and higher in United States. Indirect costs include productivity loss, welfare payments, time loss due to medical follow-up, and productivity loss for caregivers. They were estimated to €2 500-8 700 per patient per year in the Nordic countries, the highest figures appearing when all indirect costs were accounted for. A marked reduction in working capacity and an increase in welfare payments due to MG have been reported. Intangible costs include value of lost life-years and reduced quality of life, which are rarely assessed, but have been estimated to be half of the total societal MG costs.

Total costs of MG need to be included together with the expected benefits from new treatments when performing cost-benefit analyses. Precise knowledge of such costs is essential for healthcare planning and to ensure the availability of optimal treatments.

Colorectal cancer surgery has a higher risk of complications for patients carrying excess weight. Preoperative weight loss might reduce this risk. However, it is unclear how patients perceive engagement with an intensive weight-loss programme in the short window between diagnosis and surgery. This qualitative study, embedded within the CARE randomised controlled trial, aimed to understand the acceptability and experiences of following an intensive weight-loss programme with dietetic support as prehabilitation before colorectal cancer surgery.

Thirty-one participants (65% male, mean (SD) BMI 36.0 (5.5) kg/m², 65 (7) years) took part in a semi-structured interview based on the Theoretical Framework of Acceptability after following the programme for an average of 24 (12) days and 12 (7) days before surgery. Data were thematically analysed using the four constructs of Normalisation Process Theory (NPT).

Participants understood, via interactions with healthcare professionals, that the programme could potentially make their operation technically easier and expedite hospital discharge (coherence). Continued adherence was supported by the dietitians (cognitive participation), and improvements in health markers and rapid weight loss helped to reframe some participants' views that their bodies were failing due to cancer (reflexive monitoring). However, some families' distrust of the programme's safety, social eating occasions, and side effects prevented full acceptability and total adherence (collective action). This highlighted how collective action sometimes overrode the consistently strong coherence, cognitive participation, and reflexive monitoring components of NPT.

The weight-loss programme was mostly acceptable to people who had already joined the intervention. Addressing challenges with collective action may support more patients to adhere.

ISRCTN39207707, Registration date 13/03/2023.

Beyond physical challenges, cancer can cause psychological and cognitive challenges for patients, caregivers, and family members. Digital health interventions show promise in addressing these issues. However, evidence on their applicability in daily cancer care is limited. The objective of this systematic review is to evaluate the internal and external validity of digital health interventions targeting psychological and cognitive impairments in cancer patients, caregivers, and family members, using the RE-AIM framework. This systematic review was conducted following the PRISMA guidelines, using Pubmed/MEDLINE, Scopus, and PsychINFO databases. Data were extracted using data forms based on the RE-AIM framework. The methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies (QATQS). A total of 191 studies involving 29.907 patients and caregivers met the inclusion criteria. Included studies were randomized controlled trials and nonrandomized studies of interventions related to digital health, using an online or hybrid format. The reach, implementation, and effectiveness domains were most frequently reported, while adoption and maintenance were the most unreported domains within the RE-AIM framework. Despite reporting on reach, effectiveness, and implementation, limited data on external validity restricts the impact and scalability of digital health interventions in cancer care. Future research should endeavor to address current challenges and improve the use of digital health interventions in cancer care.

We report a 45-year-old woman with a papillary tumor of the pineal region (PTPR), a neuroepithelial neoplasm of the pineal gland, who presented with a one-year history of headaches, visual disturbance, and gait impairment and was found to have a pineal mass with obstructive hydrocephalus. She underwent endoscopic third ventriculostomy (ETV) with biopsy; the initial radiologic impression favored pineocytoma. Immunohistochemistry was nondiagnostic on the limited sample, and the diagnosis of PTPR was established only after review at two academic neuropathology centers. DNA methylation profiling was obtained for definitive molecular classification, with the result not yet available for review at the time of reporting. The lesion was resected via an interhemispheric transcallosal approach, but the patient developed recurrent hydrocephalus due to ETV failure, requiring a ventriculoperitoneal shunt. She completed adjuvant radiotherapy and showed no recurrence on the most recent surveillance MRI. In this patient, PTPR posed two challenges: diagnostic overlap with pineocytoma that required specialized and molecular workup, and persistent hydrocephalus after ETV failure that ultimately required permanent cerebrospinal fluid diversion.

The clinical translation of cancer nanomedicine remains constrained by inefficient intracellular delivery, poor subcellular specificity, and limited tumor accumulation, highlighting the need for more precise drug delivery strategies. Organelle-targeted nanocarriers have emerged as a promising platform for enhancing therapeutic efficacy by directing drugs to specific intracellular compartments, including the nucleus, mitochondria, lysosomes, and endoplasmic reticulum. However, the design principles governing efficient organelle-specific delivery and the barriers limiting clinical translation remain incompletely understood. This review provides a mechanistic framework linking nanoparticle physicochemical properties-including size, surface charge, ligand functionalization, and stimuli responsiveness to intracellular trafficking, organelle targeting, and therapeutic performance. We critically discuss the biological barriers encountered during delivery, including cellular uptake, endosomal escape, cytosolic transport, and organelle membrane penetration, together with current engineering strategies to overcome these challenges. Organelle-specific targeting approaches are comparatively evaluated to highlight their therapeutic advantages, limitations, and suitable clinical applications. Beyond summarizing recent advances, this review examines the major translational hurdles that impede clinical implementation, including non-specific biodistribution, manufacturing scalability, regulatory challenges, and the lack of standardized preclinical evaluation models. Emerging solutions such as hierarchical targeting, charge-reversal systems, size-transformable nanocarriers, and multifunctional theranostic platforms are discussed as strategies to improve clinical feasibility. Finally, we propose practical design guidelines and future research priorities that integrate nanomaterial engineering, predictive biological models, and scalable manufacturing to facilitate the development of clinically translatable organelle-targeted nanomedicines.

In situ vaccination (ISV) is a local tumor-directed immunotherapy strategy that uses a treated tumor as an endogenous, patient-specific source of tumor antigens and a site of immune activation, with the goal of converting local treatment into systemic and durable antitumor immunity. Depending on the modality, ISV induces immunogenic cell death, other forms of tumor-cell stress or death, or local innate immune activation, thereby increasing antigen availability, promoting type I interferon signaling, and supporting dendritic cell-mediated cross-priming of tumor-reactive T cells capable of mediating both local and systemic antitumor immunity, including regression of untreated lesions. Across immunocompetent preclinical models, ISV can generate durable local tumor control, abscopal responses, and long-term immune memory, particularly when combined with modalities that amplify antigen release or inflammatory signaling. Early clinical studies employing intratumoral innate immune agonists, radiotherapy-based regimens, cytokines, and oncolytic viruses demonstrate clinical feasibility, favorable safety profiles, and emerging evidence of systemic efficacy in selected tumor types. In this review, we discuss the immunologic principles underlying ISV and organize the field according to major triggering modalities, including radiotherapy, ablation, and light-based therapies, selected chemotherapies, innate immune agonists, cytokines, and oncolytic viruses. We further highlight emerging intratumoral delivery platforms, such as lipid nanoparticles, injectable hydrogels, and biodegradable scaffolds, that enable precise spatial and temporal control of immune activation within the tumor microenvironment. Finally, we review the evidence that locally initiated antitumor immunity can extend beyond the treated lesion to control untreated lesions and metastatic disease, and discuss the challenges associated with achieving durable systemic efficacy and preventing recurrence.