Collision avoidance is critical in external beam radiotherapy to ensure patient safety and plan deliverability. Limited understanding of the collision-free treatment space risks both patient safety and unnecessary exclusion of useful beams-particularly in noncoplanar setups-resulting in suboptimal plans. Conventional methods (manual clearance checks or CT-based assessments, etc.) are either labor-intensive or fail to account for collision-prone anatomy outside the scan. We investigated and clinically implemented a virtual patient-specific clearance mapping system and evaluated its utility as a noncoplanar beam selection tool to improve plan quality.

The system integrates full-body, patient-specific surfaces-acquired during simulation using near-infrared imaging-with interactive 3D linac/couch models. Clearance mapping accuracy was validated through phantom measurements and a comparative analysis with manual clearance checks of 60 patients across treatment sites. Workflow efficiency data were reported over three years of clinical implementation. A workflow for patient-specific non coplanar beam selection was proposed and evaluated in 20 lung stereotactic body radiation therapy (SBRT) and 18 breast stereotactic partial breast irradiation (sPBI) cases.

The clearance mapping accuracy was within ± 1° (gantry/couch rotation) of phantom measurements. For 60 patients, the virtual predictions accurately identified all potential clearance issues, while manual verification missed 5 collision events. Virtual checks saved approximately 15 min of linac and therapist time per plan and eliminated an average 6.2-clinical hour planning delay. With the proposed beam selection workflow, noncoplanar replans for lung SBRT improved target conformality (Paddick Conformity Index from 0.89 to 0.91, p < 0.01) and reduced low dose spillage. For breast sPBI, heart mean dose was lowered (103 cGy to 68 cGy, p < 0.01). Delivery time increased by approx. 30s per plan.

The virtual clearance mapping system outperformed manual verification, streamlined clinical workflow, and could significantly improve plan quality through efficient noncoplanar beam selection. It has replaced manual verification at our institution.

Brazil has historically seen higher mortality among urban residents compared to rural counterparts, despite better self-reported health among urban residents and better access to healthcare services. However, recent trends in these urban-rural mortality differentials and the specific causes of death contributing to them have not been well documented. We address this gap by analyzing trends in adult life expectancy in Brazil's five macro-regions from 2006 to 2023. We decompose changes in the life expectancy gap by age, sex, and cause of death. Our findings reveal an emerging urban advantage in male life expectancy in Brazil, beginning in the mid-2000s and continuing until the start of the COVID-19 pandemic. For females, a small initial urban survival penalty had shifted to an urban advantage by 2019. The North and Northeast regions showed larger urban penalties for both sexes than the southern regions. For males, the emerging urban life expectancy advantage was primarily driven by a more rapid decrease in mortality from external causes among urban residents aged 20-39. For females, the urban advantage was fueled by relative gains in mortality from neoplasms, respiratory diseases, and external causes. The COVID-19 pandemic initially widened the urban mortality penalty or narrowed the urban advantage in 2020 due to higher COVID-19 mortality in urban areas. However, this trend reversed from 2021 to 2023, as the urban penalty in COVID-19 mortality turned into an urban advantage, reversing the relative gains seen in rural areas.

Alloplastic reconstruction is often required following segmental mandibular resection (SMR). Hardware-associated complications, especially hardware fractures, almost invariably necessitate explantation. Recent advances in manufacturing techniques promise potential advantages over traditional methods, including increased fracture resistance. However, to date, there is no scientific evidence confirming whether these benefits translate to real-life clinical conditions.

A total of 210 patients underwent SMR followed by alloplastic reconstruction between 2007 and 2019 at Hannover Medical School. The indications for SMR were tumor (n = 208; n = 196 squamous cell carcinoma) and osteoradionecrosis (n = 2). The mean patient age was 60.61 years, with a range of 14 to 89 years. The cohort comprised 146 male patients (69.52%) and 64 female patients (30.48%). Of these, 113 patients underwent reconstruction using hand-bent reconstruction plates (RP), while 97 received patient-specific implants (PSI). The incidence of hardware-related complications (HRC) was compared between the RP and PSI groups.

HRC occurred in 72 cases (34.29%). Exposure of the implant accounted for 47 cases (22.38%) while fractures occurred in 18 cases (8.57%), showing no significant difference between PSI and RP. Time from diagnosis until resection and reconstruction was not delayed due to the use of PSI.

The choice of alloplastic manufacturing method does not affect HRC rates. PSI is offering benefits beyond fracture resistance and does not delay SMR.

HRC remain challenging and may additionally impair patients' quality of life. In particular, hardware fractures often necessitate additional surgical interventions, underlining the need to identify the factors that contribute to their occurrence. To the best of the author's knowledge, this is the largest cohort study comparing RP and PSI with respect to HRC.

Little is known about the impact of treatment availability on the spiritual wellbeing of advanced cancer patients. The aim of this study was to examine the relationships between spiritual wellbeing and patient anxiety, depression, hope, and fear of cancer progression, depending on whether advanced cancer patients were able to access novel therapies.

Australian adult advanced cancer patients who had exhausted all therapeutic options were recruited to undergo comprehensive genomic profiling (CGP) to determine whether a novel treatment was available. Questionnaires were administered prior to testing and within 2 weeks of receiving CGP results. Spiritual wellbeing was measured using the FACIT-Sp-12. Structural equation modeling was used to examine the predictive and mediating relationships among spiritual wellbeing at both time points, mediated by anxiety, depression and hope subscales at time 1 on the fear of cancer progression.

Both questionnaires were completed by 397 patients. A total of 238 (60%) patients had actionable CGP results. At baseline, the spiritual wellbeing constructs of meaning, peace and faith were identified as explanatory variables. At time 1, measures of spiritual wellbeing (meaning, peace and faith), and of hope, anxiety and depression, were identified as mediating variables for the outcome of fear of cancer progression. The test results were non-significant in the model.

The level of spiritual wellbeing in advanced cancer patients undergoing CGP was not impacted by test results but influenced a number of patient outcomes. Efforts to support patient spiritual wellbeing in such cohorts is recommended.

Colorectal surgery is associated with a high incidence of postoperative complications regardless of the advances in surgical techniques and multidisciplinary treatment. Proteinuria is common in patients with malignancies, but few studies have investigated the association between preoperative proteinuria and patient prognoses, especially postoperative complications. We investigated the impact of proteinuria on patients undergoing colorectal surgery in a single-center, retrospective cohort study of 767 patients who underwent surgical resection for colorectal cancer between January 2016 and December 2022 at the National Hospital Organization Shikoku Cancer Center. Among them, 81 patients with preoperative proteinuria were compared with the control group of 686 patients without proteinuria. Our analyses revealed that the patients with proteinuria had malnutrition with a significantly lower prognostic nutritional index compared to the no-proteinuria control group (p<0.001). The proteinuria group had a significantly advanced tumor stage (p=0.005), experienced more bleeding during the surgery (p=0.002), and required more transfusions (p<0.001). Postoperative complications were significantly more frequent in the proteinuria group (p=0.03), thus demonstrating that proteinuria was independently associated with postoperative complications (p=0.045). Proteinuria in patients undergoing colorectal cancer surgery can therefore be considered a risk factor for postoperative complications.

Background and objectives Cancer is a major health issue globally, and in India's Northeast Region (NER), it is experiencing the highest incidence, particularly among rural and tribal communities. However, screening rates are low, awareness is limited, and access to care is challenged by isolation, poor infrastructure, financial constraints, and dependence on traditional medicine. To address these gaps, this scoping review aimed to synthesise evidence on the multidimensional barriers to cancer care in the NER, examine how socioeconomic, cultural, health system, logistical, and geographical factors influence care-seeking behaviour, and identify facilitators that could improve access to screening, diagnosis, and treatment. Methods A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and EMBASE were searched for studies published from January 2010 to June 2025. Eligible studies that examined barriers or facilitators to cancer care in the 8 Northeastern States were thematically synthesised. Results Twelve studies were included; barriers were categorised into socioeconomic, health system, cultural, logistical, and geographical domains. Key issues included financial hardship, low health literacy, inadequate infrastructure, transport difficulties, and limited insurance coverage. Facilitators included family support, trust in community health workers, health education, outreach services, and financial incentives. Interpretation and conclusions Cancer care access in the NER is constrained by multidimensional barriers but supported by community and system- level facilitators. Decentralised services have expanded financial protection, and culturally tailored interventions are critical to strengthening cancer care in the region.

Background and objectives Despite a high incidence of hypopharyngeal cancer in northeast India, the role of dietary patterns and meal timing remains poorly understood. This study examined the association between inter-meal intervals, dietary patterns, and the risk of hypopharyngeal cancer in northeastern India. Methods A hospital-based case-control study was conducted at a tertiary cancer centre in northeastern India, enrolling 300 histologically confirmed cases with hypopharyngeal cancer and 300 frequency-matched controls between May 2023 and August 2024. Dietary intake and inter-meal intervals were assessed using a semi-quantitative food frequency questionnaire. Multivariable logistic regression calculated odds ratios and 95% confidence intervals, adjusting for demographics, socioeconomic status, alcohol consumption, smoking, and tobacco use, including areca nut consumption. Results Prolonged inter-meal intervals (≥5 h) conferred a nearly three-fold increased risk of hypopharyngeal cancer compared to intervals <4 h [adjusted odds ratio (OR) 2.69, 95% confidence interval (CI): 1.56-4.69]. Strong protective effects emerged for citrus fruits (highest tertile OR 0.13, 95% CI: 0.05-0.32) and leafy green vegetables (highest tertile OR 0.21, 95% CI: 0.09-0.49). Coffee consumption was inversely associated with the risk of hypopharyngeal cancer (OR 0.54, 95% CI: 0.30-0.94), while higher milk intake increased the risk of hypopharyngeal cancer (OR 2.06, 95% CI: 1.22-3.52). Interpretation and conclusions We provide epidemiological evidence linking prolonged inter-meal intervals to the risk of hypopharyngeal carcinoma in an Indian population. Meal timing patterns may be as important as dietary composition for cancer prevention, with implications for public health interventions in high-risk populations.

Background and objectives Head and neck cancers are aggressive tumours with a multidisciplinary treatment strategy. Concurrent chemoradiotherapy is recommended for locally advanced cases. The carboxyhaemoglobin level is higher in smokers, resulting in a hypoxic environment and radio resistance, which affect treatment outcomes. Data for effect of continued smoking is not available in the Indian setting. This study aims to compare treatment response, failure rate, patterns, and progression-free survival in current smokers vs. former smokers receiving definitive concurrent chemoradiotherapy for head and neck cancer. Methods We conducted this retrospective observational study in patients receiving definitive chemoradiotherapy for head and neck cancer with two groups: current smokers and former smokers. Both arms received weekly 40 mg/m2 cisplatin along with radiotherapy. Endpoints included treatment response, progression-free survival, and failure patterns. Results There were fewer complete treatment responses and more failures in current smokers receiving CRT, with a significant difference in progression-free survival. Interpretation & conclusions Continued smoking during definitive chemoradiotherapy for head and neck cancers resulted in poorer treatment outcomes. Integrating tobacco cessation in oncological care should be a standard of care in managing head and neck cancers.

The growing number of survivors of cancer in China has created an increasing need for survivorship care as many survivors face ongoing physical, psychological, and social challenges after treatment. Mobile health (mHealth) services, which are delivered through mobile devices and apps, have emerged as potential tools to support self-management, facilitate access to care, and improve quality of life. However, evidence on the prevalence, use patterns, and determinants of mHealth adoption among Chinese survivors of cancer remains limited.

This study aimed to examine the prevalence and patterns of mHealth use among adult survivors of cancer in China and identify sociodemographic and clinical factors associated with adoption.

We conducted a multicenter cross-sectional survey study between February 13, 2024, and September 21, 2024, at 4 tertiary cancer care centers in China. Adult survivors of cancer were recruited using convenience sampling. Data were collected through structured face-to-face questionnaires assessing sociodemographic and clinical characteristics, mHealth use, perceived needs, concerns, and user experience. Missing data were limited and handled using complete-case analysis after the Little test supported consistency with missing completely at random. Descriptive analyses summarized participant characteristics and mHealth-related variables. Group differences were examined using chi-square tests and 2-tailed independent-sample t tests. Significant variables in univariate analyses were entered into a multivariable logistic regression model.

Of 1152 participants, 364 (31.6%) reported prior mHealth use. Use was concentrated in practical functions, particularly appointment booking (301/364, 82.7%), online consultation (244/364, 67%), and viewing examination or laboratory reports (215/364, 59.1%), with WeChat-based platforms being the most commonly used access channel (244/364, 67%). Participants reported high demand for clinical guidance (917/1152, 79.6%) and direct communication with health care professionals (901/1152, 78.2%), whereas common concerns included leakage of private information (694/1152, 60.2%) and inaccurate illness judgment (633/1152, 54.9%). In multivariable analysis, mHealth use was significantly associated with younger age, higher educational level, annual household income of at least ¥100,000 (US $14,527.90), widowed or divorced marital status, living alone, and treatment dissatisfaction; cancer type and time since diagnosis were not significant predictors.

mHealth use among adult survivors of cancer in China is established but uneven, with use concentrated in practical service functions rather than comprehensive survivorship support. Uptake was significantly associated with age, socioeconomic position, social circumstances, and treatment experience but not with clinical characteristics. Survivors reported a strong demand for clinically relevant and communication-oriented functions but also expressed substantial concerns about privacy, accuracy, reimbursement, and physician authenticity. Future survivorship mHealth services should prioritize clinical relevance, trust, integration with formal care, and equitable implementation to achieve broader and more meaningful use.

There is a significant gap in treatment outcomes and services for the adolescent and young adult (AYA, age 15-39 years) cancer population globally. Improving outcomes requires active participation from health care professionals, policymakers, and patients. In Latin America (LATAM), little is known about the treatment experiences of AYAs diagnosed with cancer. Their perspectives are crucial for developing a comprehensive approach to AYA cancer care in this region. Therefore, we sought to explore the treatment experiences of AYA cancer survivors in LATAM and identify key areas for improving cancer care.

This qualitative, exploratory study used convenience sampling to conduct semistructured focus group discussions (FGDs). Between August 2022 and May 2023, FGDs were conducted over Zoom with participants from Peru, Mexico, the Dominican Republic, Guatemala, Costa Rica, Honduras, and El Salvador. Participants were asked to share their thoughts and experiences regarding their diagnosis, treatment process, information received during and after treatment, types of facilities, available services and staff, and their primary needs throughout treatment. We identified common themes in the AYA cancer care experience in these through inductive analysis, along with recommendations for improvement.

Twenty-four survivors (16 female and eight male) participated in eight focus groups. Six themes emerged: access to treatment, diagnosis and information disclosure, being an AYA during treatment, the illness experience, post-treatment challenges, and recommendations for care. Key issues included inadequate information about diagnosis and treatment, emotional distress from disrupted schooling, lack of regular psychological support, limited interaction with peers during treatment, and feeling unprepared for life after treatment.

The findings underscore the need for improved communication and empathy from doctors, enhanced psychosocial support, better provision of information throughout treatment, and facilitated contact with fellow survivors to improve care for this unique patient population.