Young adult cancer survivors (ages 18-39) often experience persistent treatment-related symptoms that negatively affect daily functioning, psychosocial well-being, and quality of life, yet report unmet educational needs for symptom management. Generative artificial intelligence (AI) technologies, such as large language model-powered chatbots, offer scalable, personalized, and empathetic symptom support but remain largely untested in young adults' survivorship care.

This qualitative descriptive study explored young adult cancer survivors' perspectives, preferences, and experiences related to the use of generative AI chatbots for oncology symptom management.

Eighteen post-treatment young adult cancer survivors who had completed cancer treatment within the past two years were recruited from the University of Michigan Rogel Cancer Center. Participants completed the PROMIS-29, PROMIS Self-Efficacy for Managing Symptoms, and the Digital Health Literacy Scale to quantify symptom burden, self-efficacy, and digital readiness. Semi-structured interviews explored experiences with cancer treatment-related symptoms and AI use, including preferences for personalization, tone, functionality, and data governance.

Qualitative analyses revealed three themes: (1) the need for personalized, emotionally supportive, and credible AI symptom guidance; (2) accessible and user-centered design drives engagement with AI symptom support; and (3) trust, privacy, and human oversight as preconditions for AI symptom support. Survivors viewed AI as a supplemental resource to enhance symptom monitoring, decision support, and emotional reassurance without replacing clinical care.

Generative AI chatbots were perceived as acceptable and potentially valuable for AYA symptom management. Findings can guide the development of tailored digital self-management interventions responsive to the complex and evolving needs of this population.

Strategies are needed to avoid chemotherapy in early stage HER2-positive (HER2 + ) breast cancer (BC). We conducted a neoadjuvant therapy trial with zanidatamab, a dual HER2-directed bispecific antibody, in patients with 1-3 cm, node-negative HER2 + BC. Primary endpoint was pathologic complete response (pCR). Secondary endpoints were radiographic response by ultrasound and magnetic resonance imaging. US and MRI, pathologic response by residual cancer burden (RCB), rate of adverse events, feasibility of accrual and biomarkers of response. Fifteen patients with HER2 IHC 3 + , and 5 with HER2 IHC 2 + /ISH + BC were enrolled. Patients received zanidatamab 20 mg/kg every 2 weeks for 6 (n = 11) or 10 doses (n = 9). Fourteen patients also received endocrine therapy. At 6 weeks, there was a significant decrease in tumor size and volume. At surgery, six patients (30%) had pCR, meeting the prespecified pCR target, and four had limited RCB (RCB-1; 20%). Treatment was well tolerated. All patients with pCR had HER2 IHC 3+ tumors, ERBB2 amplification on WES, PAM50 HER2-high subtype, and a trend towards higher HER2 mRNA expression (p = 0.06). In conclusion, de-escalation to HER2-targeted therapy alone may be feasible. Further research is needed to refine patient selection. This study is registered at ClinicalTrials.gov (NCT05035836).

Depression and personal income volatility are associated with adverse health outcomes through both shared and distinct pathways. However, their combined impact on long-term health outcomes remains poorly understood.

This nationwide cohort study used the National Health Insurance Service claims database of South Korea, including 735,922 adults aged 19-80 years newly diagnosed with depression in the pre-observation period (2008-2012). Depression was identified using International Classification of Diseases, Tenth Revision codes F32, F33, and F34.1. Personal income volatility was measured using the intraindividual standard deviation of annual percent income change from the same period and categorized into tertiles (low, medium, and high). Individuals were followed from the index date (January 1, 2013) through December 31, 2023 for all-cause mortality and hospitalizations across 15 major disease categories and 80 specific conditions. We estimated mortality using Cox proportional hazards regression and hospitalization using negative binomial regression, using overlap propensity score weighting across tertiles in a 1:1:1 ratio.

Among 735,922 adults with a recorded diagnosis of depression (mean age 46.08 years; 499,404 [67.9%] women), a total of 1,770,856 hospitalizations and 90,087 deaths were observed over 7,622,456 person-years of follow-up (mean duration, 10.3 years). Higher income volatility was associated with increased risk of all-cause mortality (high vs. low tertile: hazard ratio [HR], 1.18 [95% confidence interval, 1.16-1.19]) and hospitalization (incidence rate ratio [IRR], 1.07 [1.06-1.08]). The associations between high income volatility and all-cause mortality were more pronounced among men (HR, 1.26 [1.24-1.28]) than women (HR, 1.12 [1.10-1.14]), and among adults aged 30-49 years (HR, 1.17 [1.14-1.21]). The associations with hospitalization were also more pronounced among men (IRR, 1.08 [1.07-1.10]) than women (IRR, 1.07 [1.06-1.08]), and among those aged 50-80 years (IRR, 1.09 [1.08-1.10]). Among the 15 disease categories, hospitalization risks associated with high income volatility were greatest for blood disorders (IRR, 1.47 [1.36-1.59]), endocrine diseases (IRR, 1.40 [1.34-1.46]), respiratory diseases (IRR, 1.35 [1.27-1.43]), and mental disorders (IRR, 1.26 [1.23-1.30]), and lowest for cancer and neoplasms (IRR, 0.96 [0.92-0.99]). Among the 80 conditions, hospitalization risks associated with high income volatility were greatest for hypertensive heart disease (IRR, 1.74 [1.50-2.02]), epilepsy/seizures (IRR, 1.58 [1.46-1.71]), malnutrition (IRR, 2.08 [1.34-3.22]), and nutritional anemia (IRR, 1.85 [1.60-2.13]), among others.

Income volatility is a risk factor for increased mortality and hospitalization among individuals with depression, separable from baseline income. These findings underscore income volatility as a critical but overlooked determinant of health in this population.

Offering individuals with gastro-oesophageal reflux a non-endoscopic capsule sponge test increased detection of Barrett's oesophagus (BO), a precursor to oesophageal adenocarcinoma. However, only 24% of individuals identified through general practitioner (GP) records participated. We therefore performed an implementation study to assess the feasibility of screening on a mobile unit and screening uptake among GP-invited and self-referred individuals.

In this implementation study, 3293 individuals aged ≥50 with a repeat proton pump inhibitor prescription were invited to participate by their GPs across three GP practices in the East of England between June 2021 and January 2023. Additionally, we advertised the study and allowed self-referrals. Eligibility was assessed based on age and reflux history. Eligible individuals were invited to an appointment. Acceptability was assessed after the appointment. Individuals with a positive capsule sponge test were referred for endoscopy.

Half of the GP-invited individuals responded, of whom 59.6% (n=952/1598) were interested. Among interested individuals who could be contacted, 66.3% (n=574/866) were eligible, and 532 participated. Of these, 502 (94%) successfully swallowed a capsule sponge, representing 15% of those invited and 87.5% of eligible individuals. Among 468 individuals who self-referred and could be contacted, 48.5% (n=227) were eligible, 217 participated, and 208 (96%) successfully swallowed a capsule sponge (39.6% of self-referred, 91.6% of eligible individuals). 9.4% (n=47/502) of GP-invited and 12.0% (n=25/208) of self-referred individuals were referred for endoscopy, with 4.2% (n=21/502) and 3.4% (n=7/208), respectively, diagnosed with BO (positive predictive value of endoscopy referral=42.4%), including three with dysplasia. Over 99% of participants said the capsule sponge test was acceptable.

Screening on a mobile unit is feasible. Identifying individuals at increased risk of BO from GP records is feasible, and encouraging self-referrals increases uptake. BO prevalence was similar among eligible participants who self-referred and those identified through GP records.

ISRCTN91655550.

Faecal haemoglobin (f-Hb) concentrations from two screening rounds improve colorectal cancer (CRC) risk prediction, but the value of longer longitudinal data remains uncertain. This study aimed to assess whether incorporating f-Hb data from three prior screening rounds improves risk stratification for CRC and advanced neoplasia (AN).

Using data from four rounds of the Dutch national CRC screening programme (1 January 2014 and 31 December 2022), prognostic models combining age, sex, and f-Hb concentrations were developed to predict CRC and AN. Multiple representations of longitudinal f-Hb were evaluated. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration, and information criteria. Risk reclassification was quantified using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The policy impact of risk-based referral, expressed as additional colonoscopies, was examined. External validation used data from a Dutch faecal immunochemical test pilot study.

Among 1 171 070 participants included, 2357 (0.2%) had CRC and 14 543 (1.2%) had AN. Models incorporating categorised f-Hb values from three prior rounds, age, and sex achieved the highest discrimination (AUC: AN 0.76 (0.75-0.77); CRC 0.73 (0.72-0.74)) and significantly improved reclassification (NRI and IDI, p<0.001). Participants in the highest 15% predicted risk had a 6.8-fold (95% CI 6.4 to 6.9) increased risk of AN and a 5.9-fold (95% CI 5.4 to 6.6) increased risk of CRC. Risk-based referral enabled earlier detection with minimal additional colonoscopy for both CRC and AN.

Including f-Hb data from three prior screening rounds improves CRC and AN risk prediction. Targeted referral of the highest risk individuals enables earlier detection with limited impact on colonoscopy capacity, supporting personalised CRC screening strategies.

Sinonasal mucosal melanoma (SNMM) is a rare and aggressive malignancy with few effective treatments. Unlike cutaneous melanoma, responses to immune checkpoint inhibitors (ICIs) in mucosal subtypes are typically modest. We describe a case of metastatic SNMM with a remarkable and durable response to ICIs despite therapy discontinuation following multiple severe immune-related adverse events (irAEs). Remarkably, the patient remained disease-free for over a year while on prolonged immunosuppression, including high-dose steroids for Guillain-Barré syndrome and risankizumab for ICI-induced psoriasis and psoriatic arthritis. This case suggests the following: (1) durable remission after limited ICI exposure can occur in metastatic SNMM, (2) severe multisystem irAEs may reflect robust antitumour immunity, and (3) biologic immunosuppressants such as IL-23 blockade may effectively control refractory irAEs without apparent compromise of oncologic outcomes. These findings highlight an exceptional therapeutic trajectory and raise new questions about the biology linking irAEs, immunotherapy efficacy and long-term disease control in mucosal melanoma.

In this paper, the impacts of climate change on cancer-related health risks and oncology care systems are examined, with a particular focus on the evolving professional role of oncology nurse navigators within climate-adaptive care. Although not a direct cause of disease, climate change reshapes the distribution of cancer risks and increases the vulnerability of treatment safety and continuity through multiple environmental pathways. Beyond the acute disruptions triggered by extreme weather events, climate change produces chronic and recurrent instability in cancer care, resulting in treatment delays, interregional referrals, and sustained psychological stress. In response, the role of the oncology nurse navigator must evolve to become highly attuned to the practical health risks and changing healthcare needs brought about by changing climatic conditions. This transformation involves conducting vulnerability assessments and risk stratification across environmental, disease-related, and socioeconomic dimensions; integrating climate and environmental signals into clinical judgments and decision-making; and implementing anticipatory interventions supported by innovative and digital tools. A climate-adaptive care network grounded in cross-sector collaboration is proposed to strengthen feedback mechanisms and system-level coordination. Finally, climate adaptation-related competencies should be integrated into oncology nurse navigator education and training using clearly defined and measurable competency-based modules that encompass climate-sensitive clinical judgment, telehealth practice, cross-sector governance, and quality improvement, with the aim of strengthening continuity and equity in cancer care under conditions of climate change.

Childhood cancer and its treatment place substantial demands on parents, causing significant disruptions in multiple areas of life. Parents report psychological, psychosocial, and economic consequences related to their child's illness. In Sweden, psychosocial support is available to parents via paediatric oncology care during cancer treatment; however, only a minority of parents have access to psychological support after treatment completion. Increasing and improving access to such support could enhance parental mental well-being and help prevent or alleviate negative consequences. One potential solution to provide support is the EJDeR intervention, a co-created workbook- and audio-administered, telephone-guided, low-intensity cognitive behavioural therapy (LICBT) intervention for parents of persons treated for cancer during childhood. Objectives are to examine the feasibility of (1) EJDeR delivered via workbooks, audio files and video case vignettes with telephone guidance from a parent guide, and (2) planned study procedures for a future superiority randomised controlled trial of EJDeR.

This is a parallel-group, two-arm, pilot randomised controlled trial with a 1:1 allocation ratio. A Parent Advisory Board (PAB) contributes to the research. We aim to recruit 60 parents of persons diagnosed with cancer at age 0-18 years whose treatment was completed 3 months to 5 years earlier. Participants will be randomly allocated to EJDeR plus usual care or usual care alone. EJDeR is delivered over 12 weeks via workbooks, audio files and video case vignettes, with telephone guidance from a parent guide. We will examine feasibility outcomes related to procedural, intervention, and methodological uncertainties using a priori progression criteria following a GO-AMEND-STOP progression framework. We will measure clinical (mental well-being, symptoms of depression, anxiety, and post-traumatic stress) and health economic (health-related quality of life and societal resource use) outcomes at baseline, post-treatment (12 weeks), and follow-up (6 months post-treatment). Data analysis is primarily descriptive.

This trial was approved by the Swedish Ethical Review Authority (Dnr 2025-09024-01, approval date: 2 February 2026). We will obtain written informed consent from all participants and disseminate findings in collaboration with the PAB through peer-reviewed publications, conference presentations, and non-academic dissemination activities such as co-writing plain language summaries and dissemination via childhood cancer organisations.

ISRCTN51549508.

Modern radiotherapy modalities have increased treatment precision and clinical effectiveness. However, the economic evidence that underpins their adoption is highly heterogeneous, with substantial variation in costing methods, data sources, analytic designs (trial-based, real-world/observational and decision-analytic modelling), perspectives and the treatment of uncertainty. We propose a systematic mapping review to characterise the peer-reviewed evidence base and identify methodological gaps relevant to health technology assessment and policy-making. This systematic mapping review aims to: (1) systematically catalogue the published, peer-reviewed evidence and the methodological approaches used in economic evaluations of modern radiotherapy; (2) identify methodological trends, including the uptake and implementation of value of information analysis and (3) highlight evidence gaps by tumour type, geographical region and methodological approach.

Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we searched PubMed (MEDLINE), Embase, Scopus, Web of Science Core Collection and EconLit for economic evaluations of radiotherapy published from 2005 onwards, with an initial search on 24 February 2026 and a planned search update before synthesis. Study selection is ongoing; extraction and quality appraisal in duplicate have not been undertaken and no results are reported. Reporting completeness, methodological limitations and uncertainty will be appraised as three separate dimensions using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist, the Bias in Economic Evaluation (ECOBIAS) checklist and the TRansparent Uncertainty ASsessmenT (TRUST) framework, applied descriptively and not combined into a single quality score. Methodological information will be extracted, including model structure (eg, Markov model), analytical perspective (eg, healthcare payer), time horizon, costing approach (eg, diagnosis-related group (DRG)-based) and utility measurement (eg, EQ-5D). The methods used to assess uncertainty will be mapped for all studies, with the ECOBIAS checklist and the TRUST framework only applied to decision-analytic model-based evaluations. Findings will be synthesised descriptively as an evidence gap map and visualised as heat maps and bubble plots. A conceptual co-occurrence network, analysed in R with visualisation in VOSviewer, will map how modalities, tumour sites and economic characteristics cluster across studies. No meta-analysis is planned, given the expected heterogeneity of our findings.

This review does not require ethical approval, as it will use data from previously published studies. The results will be disseminated through peer-reviewed publications, conference presentations and open-access releases of data extraction files and visual maps in the Open Science Framework (OSF).

This review protocol was prospectively registered (9 February 2026) in the OSF Registries (DOI: 10.17605/OSF.IO/6W2TJ).

To investigate the relationship between body mass index (BMI) and the risk of Bethesda VI cytological classification in thyroid nodules, and to analyse its non-linear characteristics.

Multicentre retrospective cross-sectional study.

Four tertiary hospitals in Guangzhou, China.

A total of 2246 patients with thyroid nodules who underwent fine-needle aspiration biopsy from January 2018 to June 2024, including 1770 with Bethesda II (benign) and 476 with Bethesda VI (malignant) cytology. Sex distribution: 481 male and 1765 female. Mean age was 50.0 years (IQR 38.0-59.0) in the benign group and 42.0 years (IQR 32.0-52.0) in the malignant group.

The primary outcome was Bethesda VI cytological classification (malignant cytological outcome). Secondary measures included BMI, fasting plasma glucose (FPG), triglycerides (TG), total cholesterol and aspartate aminotransferase to alanine aminotransferase ratio.

A total of 2246 patients were ultimately included in this study, comprising 1770 in the benign group and 476 in the malignant group. Statistically significant differences were observed between the two groups in terms of gender distribution, age, BMI, maximum nodule diameter and multiple metabolic indicators. Compared with the benign group, the malignant group had a younger age, a higher proportion of men, and significantly higher BMI, FPG and TG levels (all p<0.05). Multivariate logistic regression analysis showed that when adjusted only for age and sex, a 1 kg/m² increase in BMI was associated with odds of Bethesda VI cytological classification increased by 6% (OR=1.06, 95% CI 1.02 to 1.09, p=0.002); after adjusting for FPG and TG, the association was no longer statistically significant (OR=1.03, 95% CI 0.98 to 1.08, p=0.214); and after adjusting for all metabolic markers, the association was further attenuated (OR=1.01, 95% CI 0.96 to 1.06, p=0.751). Smoothed curve fitting suggested a potential non-linear pattern, with an exploratory inflection point around 26.1 kg/m² in the age-adjusted and sex-adjusted model. However, this pattern was attenuated and no longer statistically significant after further adjustment for glucose and lipid metabolism markers.

There is a positive association between BMI and the risk of Bethesda VI cytological classification in thyroid nodules, and this association may be partly explained by abnormalities in glucose and lipid metabolism. Clinical evaluations should focus more on patients' metabolic status rather than BMI alone.