Occupational exposure to solar ultraviolet radiation (UVR) is a major environmental risk factor for skin cancer. Outdoor workers accumulate high lifetime UVR exposure and therefore face an increased risk of developing actinic keratoses and skin cancer. Despite established recommendations for sun protection, adherence among outdoor workers remains low. Improving access to sunscreen and providing targeted health education may help reduce barriers to sun-protective behaviour among outdoor workers. Therefore, this study evaluated the effectiveness of a workplace intervention designed to increase sunscreen use among outdoor workers.

A non-randomised controlled intervention study was conducted among outdoor workers in Germany during one sun-exposure season (April-September 2025). Participants were assigned to either an intervention group or a control group. The intervention consisted of facilitated access to different sunscreen products combined with a brief structured health education on UVR risks and correct sunscreen use. Sunscreen use and sunburn occurrence were assessed using a questionnaire at baseline (T0), after three months (T1), and after six months (T2). The primary outcome was the proportion of workers reporting sunscreen use at least "sometimes". Longitudinal changes were analysed using generalised linear mixed models.

A total of 234 outdoor workers were enrolled, with 117 participants in each group. After six months, 97 participants in the intervention group and 86 in the control group completed the study. At baseline, 54.7% of participants in both groups reported sunscreen use in general at least sometimes. At T2, this proportion increased to 83.5% in the intervention group compared with 52.3% in the control group. The number of reported sunburns decreased over time in both groups, with a stronger reduction observed in the intervention group; however, the group × time interaction did not reach statistical significance.

A simple workplace intervention consisting of facilitated sunscreen provision and brief health education was associated with a substantial increase in sunscreen use over the six-month follow-up period. This low-threshold approach represents a feasible and scalable strategy for occupational skin cancer prevention.

The study was approved by the Ethics Committee of Osnabrück University and registered in the German Clinical Trials Register (DRKS00035178; registration date: 10 October 2024).

To identify distinct archetypes among adult cancer patients based on information-seeking patterns from symptom onset to treatment initiation, including the use of digital and emerging technologies such as generative AI, and to characterize the decision-making dilemmas associated with these pathways.

We conducted a cross-sectional study in Israel, between February 2025 and December 2025, among 205 adult cancer patients to examine patterns of information seeking and decision-making during the period from symptom onset to treatment initiation. Participants completed a structured questionnaire assessing reliance on multiple information sources-including medical professionals, family members, digital resources, and generative AI-based tools-before and after diagnosis, along with sociodemographic and clinical characteristics. Patient archetypes were identified using cluster analysis, and decision-making dilemmas were explored using two methods (investigator-led constant comparative analysis and LLM) for open-ended responses.

Four distinct information-seeking archetypes were identified: Digital Natives (27.6%), Family-Centered (38.8%), Balanced Traditional (25.0%), and Medical Professional-Focused (8.6%). Archetypes differed significantly by age, education, and the strongest differentiating factor (p = 0.005)-religiosity. Across archetypes, information seeking intensified after diagnosis, relying mostly on family members, internet sources, and additional medical professionals, whereas reliance on generative AI-based tools remained consistently low. Among respondents to the open-ended question, 86% reported significant decision-making dilemmas, most commonly related to treatment selection and choice of healthcare provider or facility.

The marked heterogeneity observed in patients' information-seeking and decision-making pathways highlights the inadequacy of one-size-fits-all approaches in early cancer care. Implementing tailored, culturally responsive decision support may better align care with patients' needs during this critical phase.

To evaluate the probability, timing, and predictors of ovarian function recovery after chemotherapy in premenopausal women with breast cancer.

The PubMed, Embase, Scopus, and Cochrane Library databases were searched systematically. Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated using random-effects models. Proportions were synthesized using restricted maximum likelihood with logit transformation. Subgroup analyses were conducted to explore factors associated with ovarian function recovery. PROSPERO registration: CRD420261343270.

A total of 34 studies, including 10,216 premenopausal women, were analyzed. The probability of ovarian function recovery at 12, 24, and 60 months after chemotherapy was 30.4% (95% CI, 17.5-47.3), 38.5% (95% CI, 15.6-68.1), and 43.4% (95% CI, 9.4-84.9), respectively. The mean time to recovery was 12.3 months (95% CI, 8.7-15.9). Older age (OR, 0.25; 95% CI, 0.12-0.50) and longer chemotherapy duration (OR, 0.68; 95% CI, 0.50-0.92) were associated with a lower probability of ovarian function recovery. In individual studies, higher pretreatment anti-Müllerian hormone levels appeared to be associated with improved recovery, although pooled estimates were not statistically significant.

The probability of ovarian function recovery after chemotherapy remains limited in premenopausal women; although recovery improves over time, overall rates remain modest. This represents an important treatment-related outcome that should be addressed during pretreatment counseling, through early discussions of reproductive risks, multidisciplinary fertility preservation counseling, and consideration of established fertility preservation methods before cancer-directed therapy.

Postoperative disturbances in cerebrospinal fluid (CSF) dynamics remain a major complication after pediatric medulloblastoma (MB) resection and may necessitate permanent ventriculoperitoneal shunting (VPS). Existing risk assessment tools have important methodological limitations: many are derived from heterogeneous posterior fossa tumor cohorts and rely predominantly on static preoperative anatomical variables, with limited consideration of tumor-specific invasion patterns or postoperative biological factors. To identify multidimensional factors associated with delayed postoperative ventriculoperitoneal shunt (VPS) requirement after pediatric medulloblastoma resection and to explore how preoperative, pathological, molecular, and postoperative features contribute to modeled risk patterns. We retrospectively analyzed 269 pediatric patients with medulloblastoma who underwent tumor resection between January 2019 and January 2024. The primary endpoint was delayed postoperative hydrocephalus requiring VPS more than 2 weeks after tumor resection for persistent intracranial hypertension and progressive ventricular enlargement. Firth penalized logistic regression was designated as the primary association model. Model performance was assessed using C-statistics, calibration curves, decision curve analysis, and internal bootstrap validation. A multi-algorithm AUC heatmap and ElasticNet-based SHAP analysis were used as secondary exploratory analyses, and the nomogram was derived from the Firth model. Among 269 children treated between 2019 and 2024, 18 (6.7%) developed delayed postoperative hydrocephalus requiring VPS more than 2 weeks after resection. In the primary Firth model, postoperative hemorrhage (OR 22.40, 95% CI 4.24-118.0, P < 0.001) and choroid plexus invasion (OR 18.00, 95% CI 3.34-96.9, P < 0.001) showed the strongest positive associations, although the wide confidence intervals indicate substantial uncertainty. Auxiliary SHAP analysis identified postoperative hemorrhage and age as prominent global contributors, while choroid plexus invasion showed large contributions in positive cases and Group 3 and Group 4 displayed contrasting higher- and lower-risk patterns. The findings support a multi-hit pattern in which limited baseline CSF compensatory reserve may be followed by postoperative hemorrhagic or inflammatory insults. The proposed model is exploratory and is not yet ready for individual clinical decision-making. Its performance and feature-contribution patterns should be tested in prospectively enrolled multicenter cohorts using prespecified variables and the same endpoint.

Treatment sequencing for T1cN0M0 triple-negative breast cancer (TNBC) remains controversial because neoadjuvant chemotherapy (NACT) has not demonstrated improved overall survival (OS) compared to adjuvant chemotherapy (ACT). Using pathologic complete response (pCR) as an early, positive prognostic indicator, this study evaluates how Ki-67 expression levels impact pCR rates in T1cN0M0 TNBC to identify patients who benefit most from upfront chemotherapy.

The National Cancer Database (NCDB) was queried (2018-2022) for female patients aged ≥ 18 with T1N0M0 TNBC undergoing chemotherapy and surgery. Patients were grouped into NACT or ACT cohorts and balanced using inverse probability of treatment weighting (IPTW). Cox multivariate analysis evaluated OS predictors, while logistic regression identified factors associated with pCR. A ROC curve was created for Ki-67 expression in the setting of pCR and the maximum Youden index established a threshold value.

An analysis of 8,831 patients from the NCDB found no significant difference in OS between NACT and ACT, but multivariate analysis revealed lymphovascular invasion (LVI), invasive lobular subtype (ILC), and mixed invasive lobular/ductal subtype were associated with worse OS. In the NACT group, there was a 3.59 h for worse OS in non-pCR patients compared to those achieving pCR. Ki-67 expression was strongly associated with pCR rates, with Ki-67 ≥ 45.8% yielding a 45.3% pCR rate compared to 21.8% for Ki-67 < 45.8%.

Although OS did not differ between NACT and ACT in T1cN0M0 TNBC, achieving pCR after NACT significantly improved survival. A Ki-67 threshold of ≥ 45.8% predicted higher pCR rates and can guide patient selection for upfront chemotherapy.

Not applicable.

Isavuconazole is a broad-spectrum antifungal agent approved for the treatment of invasive fungal infections (IFIs) in adults and, recently, in pediatric patients aged 1 year and older. Use in the pediatric setting remains limited, but available data indicate generally favorable safety and efficacy. This survey describes the institutional practices of use of isavuconazole across centers belonging to the Italian Association of Pediatric Hematology and Oncology (AIEOP). A 25-item web-based questionnaire, approved by the scientific board of the Infectious Working Group, was distributed to AIEOP centers between December 2024 and January 2025. The survey covered indications (prophylaxis and treatment), formulations and dosing, therapeutic drug monitoring (TDM), drug-drug interactions, and management of adverse events. In 22/49 (45%) responding centers, isavuconazole was available as capsules in 20/22 (91%) and as an intravenous formulation in 17/22 (77%). Primary prophylaxis was reported in 2/22 (9%), while secondary prophylaxis was reported in 12/22 (55%) centers, in patients diagnosed with possible (10/22, 45%) or probable (12/22, 55%) IFIs. In cases of Aspergillus spp. infection, 4/22 (18%) centers considered isavuconazole for first-line treatment, 14/22 (64%) for salvage treatment, and 5/22 (23%) for combination treatment. In cases of mucormycosis, 4/22 (18%) considered isavuconazole for first-line treatment, 9/22 (41%) for salvage treatment, and 5/22 (23%) for combination treatment. TDM was commonly adopted but varied across centers: 7/22 (32%) performed TDM between days 5 and 7, 4/22 (18%) only after the loading dose, and 5/22 (23%) did not perform TDM.Conclusion: The results of this study show a widespread, off-label, heterogeneous use of isavuconazole in AIEOP centers. Such variability indicates the need for more standardized indications, dosages, and monitoring strategies. What is known? • Isavuconazole is approved for invasive fungal infections in adults and, recently, in children aged =1 year, with favorable safety and efficacy, although pediatric experience remains limited. • Real-world use of isavuconazole in pediatric hematology-oncology has not been systematically described. What is new? • This national AIEOP survey shows widespread but heterogeneous use of isavuconazole, mainly as secondary prophylaxis and salvage therapy, with inconsistent therapeutic drug monitoring. • Standardized indications, dosing, and monitoring strategies are needed in pediatric onco-hematology.

Intracranial meningiomas may be induced after radiation exposure, for example following radiotherapy for CNS malignancies. However, data on their clinical characteristics and risk factors for recurrence remain limited. This study aimed to evaluate clinical features and independent predictors of progression-free survival in radiation-induced meningiomas compared to sporadic tumors.

All cases of radiation-induced (RI) intracranial meningiomas that underwent tumor resection at our institution between 2007 and 2023 were identified. Patients were matched to non-radiation-induced controls by propensity score using age, WHO grade, and Simpson grade as covariates (1:5 ratio). Demographics, tumor characteristics, and outcomes were compared. Survival was analyzed using Kaplan-Meier curves and Cox regression.

A total of 39 RI meningioma cases were matched to 195 non-exposed controls. After matching, there were no significant differences in age, WHO grade, or Simpson grade between groups, confirming adequate baseline balance. Prior cranial surgery was more frequent in the RI group (38.5% vs. 4.1%; p < 0.001), and adjuvant radiotherapy was more commonly administered (33.3% vs. 11.3%; p < 0.001). Relapse rate was significantly higher in RI tumors (28% vs. 17%; p = 0.001). In multivariate Cox regression, RI tumor status (HR 2.1; 95% CI 1.02-434; p = 0.04) and complete resection (HR 0.29; 95% CI 0.15-0.54; p < 0.001) were independent predictors of progression-free survival.

Radiation-induced meningioma status was associated with shorter progression-free survival following propensity score matching and multivariable adjustment. Complete resection was associated with improved PFS, supporting maximal safe resection when clinically feasible. However, residual measured and unmeasured confounding cannot be excluded, and the present findings should not be interpreted as evidence of intrinsically more aggressive tumor biology.

To review the clinical, molecular, and imaging landscape of posterior fossa (PF) ependymoma and outline current management principles guiding surgical and adjuvant treatment decisions.

We performed a narrative review of the contemporary literature on molecular classification, imaging characteristics, and treatment outcomes of PF ependymoma, focusing on distinctions between posterior fossa group A (PFA) and group B (PFB) tumors.

PFA and PFB ependymomas are molecularly and clinically distinct. PFA tumors predominate in younger children, follow a more aggressive course, and show loss of H3K27me3, EZHIP overexpression, Moreover, in PFA tumors 1q gain and/or 6q loss defines a very high-risk group with increased recurrence and metastasis. PFB tumors arise more often in older patients, generally retain H3K27me3, harbor numerous arm-level chromosomal gains/losses, and carry more favorable outcomes. On MRI, PFA tumors more frequently show larger volume, hydrocephalus, lateral extension, skull base involvement, and lower apparent diffusion coefficient values. Gross total resection remains the most important prognostic factor and should be pursued whenever safe. Focal postoperative radiotherapy may be standard for localized disease, while chemotherapy has only a limited adjunctive role. Recurrence, especially among PFA tumors, is managed with early detection, repeat resection, and selective re-irradiation; 1q gain and 6q loss are enriched at relapse.

PF ependymoma comprises two biologically and clinically distinct entities. Maximal safe resection and focal radiotherapy remain the backbone of treatment, but integrating molecular subgrouping, imaging biomarkers, and modern radiotherapeutic techniques into surgical and adjuvant planning offers the clearest path to improved outcomes, particularly for high-risk PFA tumors.

To describe patient characteristics, treatment patterns and real-world survival in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) who received chemotherapy in the post-endocrine therapy (ET) setting where cytotoxic agents are the mainstay of treatment.

This retrospective, observational cohort study utilized data from the US nationwide Flatiron Health Research Database. Women aged ≥ 18 years with HR+/HER2 - mBC who received chemotherapy post-ET from January 1, 2015, to December 31, 2024, were included. Patient characteristics, treatment patterns, real-world overall survival (rwOS), and time to next treatment or death (rwTTNTD) were described post-ET.

5041 patients were included; median age was 63 years at mBC diagnosis. Most were non-Hispanic White (63%) and treated in the community setting (82%) and had Eastern Cooperative Oncology Group performance status 0-1 (59%) at the start of first-line treatment (1L) post-ET, recurrent mBC (68%), and ≥ 2 prior lines of ET-based treatment in the mBC setting (65%). Median time from mBC diagnosis to 1L post-ET was 19 months. Most patients (97%) received chemotherapy 1L post-ET. Median (95% CI) rwOS from start of 1L post-ET was 13.5 (13.0-14.1) months. 30% of patients who initiated 1L post-ET did not survive to the next treatment line; there was a decrease in rwOS with each subsequent treatment. Similar findings were observed for rwTTNTD.

These findings reinforce the high unmet need in patients with HR+/HER2 - mBC whose disease has become resistant to ET, highlighting the need for effective treatments in this setting.

Despite established clinical guidelines recommending sexual health screening in oncology care, significant gaps in provider-patient communication persist. This study examined the experiences of gynecologic oncology providers regarding sexual health communication to guide the design of a targeted training intervention.

Semi-structured interviews were conducted with 21 gynecologic oncology healthcare providers, including gynecologic oncologists, nurse practitioners, and physician assistants, practicing across three large healthcare systems in a single Midwestern U.S. state. Interviews were conducted via Zoom, audio recorded, professionally transcribed, and analyzed using inductive thematic analysis.

Two overarching themes were identified: contextual variability of sexual health communication and factors influencing sexual health communication. Providers described variability in the initiation, timing, and content of sexual health discussions, with advanced practice providers reporting greater comfort initiating these conversations than physicians. Key barriers included perceived time constraints, provider and patient discomfort, age-related assumptions, cultural and linguistic challenges, and uncertainty about professional scope of practice. Notably, providers demonstrated awareness of these barriers yet reported difficulty translating that awareness into consistent practice.

Gynecologic oncology providers recognize the importance of sexual health communication but face substantial structural, interpersonal, and cultural barriers that limit consistent implementation. Findings support the need for accessible, skills-based training and system-level strategies that embed sexual health communication as a routine component of gynecologic cancer survivorship care.