Follow-up imaging is crucial in managing primary brain tumors, with changes in contrast enhancement often used as a marker of tumor activity. However, fluctuations of enhancement independent of tumor progression have been described in low grade tumors in the paediatric population. This study aims to characterize the phenomenon of spontaneous contrast enhancement fluctuations in pilocytic astrocytoma and other low-grade primary brain tumors in the adult population.

A retrospective review of our MRI database (2011-2021) identified cases of pilocytic astrocytomas, pilomyxoid astrocytoma and rosette-forming glioneuronal tumors with stable tumor size with enhancement changes in clinically stable adult patients off medical treatment. After excluding those without serial MRIs, we reviewed the MRIs and clinical records of 238 patients. Number of cases with enhancement fluctuations, mean duration of increasing enhancement prior to stability or decline and number of fluctuation cycles were recorded.

The cohort included 9 adult patients, 6 pilocytic astrocytomas, 1 pilomyxoid astrocytoma and 2 rosette-forming glioneuronal tumors. Four of these were unresected (44%), while five were residual or recurrent tumors (56%). Despite stable tumor size and clinical status, a variety of enhancement patterns over time were observed: 44% of cases (4/9) demonstrated new or increasing enhancement on follow-up, with subsequent regression of enhancement over a 1-4 year follow-up period. An additional 44% of cases (4/9) displayed cyclical increasing and decreasing enhancement over a longer 7-15 year follow-up period. Mean duration of increasing enhancement prior to stability or decline was 12.3 months (SD 7.1). One case exhibited complete spontaneous resolution of enhancement. Fluctuation in morphology of enhancement was also observed in 44% of cases (4/9).

This is the first study to describe spontaneous fluctuation of enhancement in pilocytic astrocytoma and other circumscribed low-grade brain tumors in an adult population. Awareness of this phenomenon is crucial to prevent misinterpretation of enhancement changes as evidence of tumor progression or regression in clinically stable patients, circumventing unnecessary treatment changes and interventions.

Patients from historically marginalized racial and ethnic groups are often underrepresented in symptom management research, but little is known about how to improve inclusivity and reach of these studies.

This mixed-methods study aimed to: 1) establish the feasibility and acceptability of study procedures for assessing symptoms and shared decision-making (SDM) among Black patients with advanced lung cancer; and 2) elicit participants' suggestions for improving study procedures.

Black patients with advanced lung cancer were recruited from three thoracic oncology clinics. Participants completed a baseline survey (T0), optional audio-recording of a routine oncology outpatient appointment, follow-up surveys one week (T1) and one month (T2) postappointment, and a semistructured exit interview examining experiences in the study and suggestions for improving future research. At each timepoint, participants completed the Treatment Acceptability and Preferences Questionnaire (TAPQ).

We approached 69 potentially eligible patients, 40 (58%) completed the eligibility screener, 35 (88%) were eligible, 30 (86%) consented, and 27 (90%) were retained through T2, exceeding our a priori thresholds of ≥70% enrollment and retention through T2. Participants rated study procedures as acceptable (TAPQ scores ≥3) in 88% of observations, exceeding our a priori threshold of ≥70%. Qualitative analysis identified three categories of themes: participants' motivation for participating, their overall experiences in the study, and recommendations for future research.

Research practices common in communication, palliative, and SDM studies were acceptable to most participants. Opportunities to improve were also identified. Findings can inform best practices in conducting inclusive palliative care and communication research.

Pain after breast cancer treatment affects up to 58% of women treated, with 25% reporting moderate to severe pain at long-term follow-up. Improved pain care interventions are needed to enhance patient outcomes and improve quality of life after breast cancer treatment. Integrating yoga with pain education holds potential value as part of pain care. We conducted a feasibility study to assess preliminary pain and quality of life outcomes from a 6-week integrated pain education and yoga program for women with persistent pain after breast cancer treatment. Interviews were conducted to assess the acceptability of the intervention. Pain intensity and interference, pain catastrophizing, pain self-efficacy, and quality of life questionnaires were compared before and immediately after the intervention. Semistructured interviews with thematic analyses were conducted to explore the experiences of participants, specifically the acceptability and appropriateness of the intervention. Six women (age 44-54) enrolled in the program. Pain severity, pain interference, and role function demonstrated significant differences postintervention (p < 0.05). Pain self-efficacy, the helplessness subscale of the Pain Catastrophizing Scale, global health status, and emotional function showed trends toward improvement. Five main themes emerged from qualitative analyses: (1) acceptability of the intervention; (2) pain reconceptualization; (3) development of pain self-efficacy and improved pain experiences; (4) improved mindful body attunement and stress-reduction strategies; and (5) increased commitment to adherence to endocrine therapy. An integrated pain education and yoga program for pain following breast cancer treatment is feasible, with preliminary data indicating positive pain-related outcomes. Future fully powered randomized controlled trials are warranted.

Robotic neck dissection has emerged as a minimally invasive alternative to conventional open surgery, providing enhanced surgical precision, reduced morbidity, and improved cosmetic outcomes. Advances in technology and refinement of surgical techniques have broadened the applicability of robotic approaches in head and neck oncology. This study aims to describe a novel robotic approach for neck dissection and assess its technical feasibility, safety, and short-term perioperative outcomes.

Patients with early-stage oral cavity squamous cell carcinoma who did not require neck access for flap reconstruction were selected for the procedure. A bilateral infraclavicular approach for robotic neck dissection (BIRD) was performed with the Intuitive da Vinci Xi Surgical System. Outcomes assessed included lymph node yield, as well as intraoperative and postoperative complications.

Three patients underwent the BIRD procedure. All underwent selective neck dissection (levels I-IV) without a visible cervical scar. Lymph node yield ranged from 24 to 39, with a mean of 30. Intraoperative blood loss ranged from 150 to 225 ml (mean 183 ml). No major intraoperative complications, including vascular injury, chyle leak, conversion to open surgery, or re-exploration, were observed. Drain output was <25 ml per 24 hours by postoperative day 4 in all patients. Postoperative assessment revealed normal function of the spinal accessory, hypoglossal, and marginal mandibular nerves in all cases.

BIRD is a technically feasible approach for prophylactic neck dissection in early-stage oral cavity squamous cell carcinoma. It respects established oncologic principles in terms of lymph node yield, and is associated with acceptable short-term functional and cosmetic outcomes.

Depression is common among older adults with cancer. The USA-developed CARE (Cancer and Ageing: Reflection for Elders) psychotherapy intervention, specifically addresses the unique needs of older people (≥ 70 years) navigating the challenges of ageing, depression, and cancer.

To review and tailor the CARE resources to ensure they are culturally appropriate and acceptable for older Australians.

Semi-structured cognitive 'think aloud' interviews were conducted with older Australians (≥ 70 years) diagnosed with cancer. Participants reviewed the intervention resources for each session providing feedback on content relevance and understandability. Content analysis was used to analyse the interviews.

We completed 20 cognitive interviews. Participants had a mean age of 74 years (range 70-79) and most with a diagnosis of blood (55% n = 11) or breast cancer (45%, n = 9) within 10 years. Resource content resonated with participants and a telephone-delivered intervention was acceptable. Participants emphasised the need to simplify wording and modify language to reflect Australian culture. In Australia 'elders' is a cultural term used by First Nations peoples to identify a custodian of knowledge; most participants suggested changing this. For some participants, the analogy of ageism to racism used felt unfamiliar.

This study highlights that cultural adaptation of psycho-oncology interventions is required, even between English-speaking countries, to ensure cultural appropriateness and enhance feasibility, acceptability and to maximise uptake for older adults facing cancer and depression.

ImportanceHead and neck cancers (HNC) impose a significant economic burden on healthcare systems. Understanding the direct medical costs across different phases of care is crucial for resource allocation and cost-effectiveness evaluations, particularly in universal healthcare settings.ObjectiveTo quantify the direct medical costs of HNC over 60 months postdiagnosis and examine cost variations by cancer subsite, stage, and treatment modality.DesignPopulation-based, matched case-control study using administrative healthcare data.SettingOntario, Canada, a province with a publicly funded universal healthcare system.ParticipantsWe included 19,832 adults diagnosed with HNC between 2007 and 2020. Each case was matched with 5 noncancer controls based on age, sex, and comorbidity.ExposuresHNC diagnosis, categorized by cancer subsite, stage, and treatment modality.Main Outcome MeasuresMean per-person direct medical costs attributable to HNC over a 63-month period, analyzed by phase of care, cancer subsite, stage, and treatment modality.ResultsThe mean per-person cost attributable to HNC over 63 months was $53,812.9 ± $762.2. Costs peaked in the first 3 months postdiagnosis ($9709.7 ± $36.1 per month) and declined over time. Larynx/hypopharynx cancers incurred the highest costs across most phases. Advanced-stage cancers were associated with increased costs, with stage IV cancers nearly doubling the costs of stage I. Multimodal treatments, particularly surgery combined with chemoradiation, resulted in the highest costs across all phases (P < .01).ConclusionsHNC results in substantial healthcare costs, with significant variations by subsite, stage, and treatment modality. The highest costs occur in the early treatment phase and remain elevated for patients requiring multimodal therapies.RelevanceThese findings provide critical data for policymakers and health system authorities to optimize resource allocation and assess cost-effectiveness. Future research should explore indirect costs and the impact of early detection strategies to reduce the economic burden of HNC.Level of evidence3.

Cancer treatments and survival rates have significantly improved, yet distress in patients and their relatives remains overlooked, leaving them with needs unmet. One contributing factor is inadequate screening, which could be improved by digitalisation. This study examined differences in distress among outpatients, inpatients, and their relatives, along with acceptance and usability of digital screening tools.

149 participants including relatives, outpatients, and inpatients were randomised using established analogue screening versus digital screening with text-based instructions or digital screening with video-based instructions for the Distress Thermometer and rated their distress. Participants then provided ratings for usability and acceptance of digital screening measures.

Overall distress levels on average were high for all, inpatients, outpatients and relatives. There were no significant differences between groups in overall distress levels. Inpatients without wish for counseling reported greater physical distress and lower psychological and psychosocial distress than inpatients with wish for counseling, who were similar to relatives and outpatients. Participants expressed high overall satisfaction with digital screening measurements. Digital screening with text-based instructions seems to be superior to analogue screening or video-based screening, regardless of age and gender, when people have hands-on experience. Patients and relatives using analogue screening are more skeptical of digital screening, especially elderly and female users.

Our study offered valuable insights into the varying distress levels of inpatients, outpatients, and relatives, which leads to the implication that outpatients and relatives should also be screened closely. The decisive variable was wish for counseling. There is a need for more counseling options for both cancer patients and their relatives. Our findings support the use of digital screening methods for patients and relatives. The hands-on experience seems to be crucial for a higher acceptance.

This study aimed to examine health care use in a cross-sectional sample of Dutch cancer survivors > 2 years post-diagnosis.

The Dutch Federation of Cancer Patient Organizations (NFK), together with patient representatives and researchers, developed a cross-sectional online survey on life after cancer, which was distributed via email, websites, and social media.

The study included 5710 respondents (> 2 years post-diagnosis). Among those who reported long-term cancer/treatment-related consequences (approximately 89% of participants), one-third (33%) had received professional care or support for these issues in the past 3 months. Those reporting more cancer- or treatment related consequences, those diagnosed 2-5 years ago, those (probably) not (getting) better, and those currently under treatment were more likely to receive professional care or support. Care was primarily provided by medical specialists (47%), physical therapists (37%), and/or general practitioners (32%). 15% expressed a desire for care or support that they did not receive, indicating reasons such as a long time since diagnosis or affordability. Overall, 68% knew where to turn for help; among those with consequences, 19% received peer/volunteer support and 10% wanted it but did not receive it.

A significant proportion of long-term cancer survivors in our sample reported unmet support needs (15% for professional care, 10% for peer support). Efforts should focus on improving access to affordable professional care, expanding peer support networks, providing personalized long-term follow-up care, and reducing stigma around seeking help, particularly within the context of the Dutch healthcare system.

Metastatic breast cancer remains a leading cause of cancer-related mortality in women, often driven by molecular pathways that promote invasion and immune evasion. MicroRNA-200c (miR-200c) is a known tumor suppressor that inhibits epithelial-mesenchymal transition (EMT), while FOXP3, a transcription factor typically associated with regulatory T cells, is aberrantly expressed in breast cancer cells and may contribute to tumor progression. This study investigates whether targeting the miR-200c/FOXP3 axis can suppress metastasis in breast cancer.

Metastatic (MDA-MB-361, MDA-MB-468) and non-metastatic (MCF-7) breast cancer cell lines were transfected with miR-200c mimic or inhibitor. Cell proliferation, apoptosis, and invasion were assessed using MTT, Annexin V/PI staining, and transwell assays. FOXP3 mRNA and protein levels were quantified using qRT-PCR and immunohistochemistry. A metastatic mouse model was established via intracardiac injection of tumor cells, followed by treatment with miR-200c mimic, inhibitor, or Cisplatin.

MiR-200c overexpression significantly suppressed proliferation and invasion and enhanced apoptosis in metastatic cells. FOXP3 mRNA and protein expression were downregulated in mimic-treated cells and tissues, while miR-200c inhibition led to increased FOXP3 expression. In vivo, miR-200c mimic treatment reduced tumor burden and metastatic infiltration in the brain and lungs. A strong inverse correlation between miR-200c and FOXP3 was observed (r = - 0.82, p < 0.01).

MiR-200c restoration inhibits FOXP3 and suppresses metastatic progression in breast cancer. Targeting the miR-200c/FOXP3 axis presents a novel and promising therapeutic approach for advanced breast cancer.

In recent years, the classification of embryonal tumours (ETs) of the Central Nervous System (CNS) has significantly evolved to reflect their molecular biology. In the fifth edition of the World Health Organization CNS Tumours classification, published in 2021 (WHO CNS5), diagnostic criteria was clarified for some recognised tumour types. It also added several other newly-identified tumour types, whether definitive or provisional, that particularly affect children. Diagnosis of these neoplasms remains challenging due to these classification changes, the high levels of heterogeneity within the group of 'other CNS embryonal tumours', and the scarcity of data on their findings in imaging studies. This review aims to be a useful tool for neuroradiologists, describing the imaging characteristics of this group of neoplasms and providing brief clinical and diagnostic descriptions.