Veterans report greater comorbidity and psychosocial burden but have enhanced healthcare access through the Veterans Health Administration (VHA). We sought to characterize health-related quality of life (HRQoL) differences between veteran and civilian cancer survivors.

We analyzed cancer survivors from the 2017-2022 Behavioral Risk Factor Surveillance System. Outcomes included fair/poor general health, poor physical health, poor mental health, and activity-limiting poor health. Sex-stratified, survey-weighted Poisson regression with robust variance estimated incidence rate ratios (IRRs) for day-count outcomes and prevalence ratios (PRs) for binary outcomes, controlling for sociodemographic and clinical covariates.

Among 65,613 survivors (32,710 men; 32,903 women), 11,213 men (34.3%) and 753 women (2.3%) were veterans. Male veterans were older than civilian men (≥ 75 y: 54.4% vs. 25.9%), less likely to be employed (20.1% vs. 39.6%) or be college graduates (41.9% vs. 47.5%), and frequently reported history of cerebrovascular accident (9.8% vs. 5.7%) or coronary artery disease (25.4% vs. 15.9%) (all p < 0.001). Compared with female civilians, female veterans reported no differences in education, employment status, or history of chronic conditions (p > 0.05). Among female cancer survivors, veteran status was associated with higher prevalence of poor physical-health (aPR 1.35, 95% CI 1.02-1.77) and poor mental-health (aPR 1.45, 95% CI 1.06-1.98). Among males, veteran status was not associated with poor physical or mental health (all p > 0.05).

The findings highlight the importance of sex-responsive survivorship care integrating chronic-disease management, mental-health support, and social-risk screening across VHA and civilian systems.

The impact of sex on the efficacy of immune checkpoint inhibitors (ICIs) in curative treatments of solid tumors remains insufficiently explored. Optimal timing of ICIs is clinically relevant, with practice shifting toward broader adoption of neoadjuvant approaches.

To assess the association of patient sex and treatment timing with outcomes of ICI administration in curative treatments for solid tumors.

In this systematic review and meta-analysis, MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were systematically searched from January 1, 2010, to June 23, 2025, using controlled vocabulary combined with free-text search terms. A manual search in PubMed was conducted through August 10, 2025.

Reports of randomized phase 3 clinical trials investigating ICI treatment in non-sex-specific solid cancer types in curative settings, including surgery and radiotherapy or chemoradiotherapy as local therapies, were included.

Three authors were involved in data abstraction; data from each record were extracted independently by 2 of these 3 authors. Hazard ratios (HRs) and corresponding 95% CIs were calculated using random-effects meta-analysis. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Pooled HRs for overall survival (OS) and for time to the combined end point of disease-free, event-free, progression-free, and recurrence-free survival were analyzed overall, by sex, and by treatment timing relative to surgery.

A total of 62 reports of 38 trials comprising 31 721 patients (29.7% female and 70.3% male) were analyzed. ICIs were associated with improvement in OS (HR, 0.83; 95% CI, 0.79-0.89; P < .001) and the combined end points (HR, 0.73; 95% CI, 0.68-0.77; P < .001). No statistically significant sex-specific differences were observed for OS (females: HR, 0.76 [95% CI, 0.67-0.86]; males: HR, 0.78 [95% CI, 0.72-0.85]) or the combined end points (females: HR, 0.74 [95% CI, 0.69-0.79]; males: HR, 0.73 [95% CI, 0.67-0.78]). Neoadjuvant or perioperative ICIs were associated with better OS (HR, 0.77 [95% CI, 0.69-0.86]) and combined end point outcomes (HR, 0.64 [95% CI, 0.57-0.73]) compared with adjuvant-only use (OS: HR, 0.84 [95% CI, 0.78-0.91]; combined end points: HR, 0.74 [95% CI, 0.68-0.81]).

This systematic review and meta-analysis detected no statistically significant difference in survival outcomes associated with ICIs by patient sex, although female patients were underrepresented. In exploratory analyses, neoadjuvant or perioperative ICIs were associated with superior survival outcomes compared with strictly adjuvant administration, a finding that supports increased adoption of neoadjuvant ICI therapy approaches.

Blinatumomab, a novel immunotherapy administered as a 28-day continuous infusion, has fundamentally shifted the treatment paradigm for pediatric B-cell acute lymphoblastic leukemia (B-ALL) and is now considered a component of standard therapy for the most common childhood cancer. However, the care delivery challenges in transitioning from an experimental agent on a clinical trial to widespread clinical implementation are unknown.

To characterize the clinical landscape of pediatric blinatumomab care-delivery practice and challenges in the US from the perspective of treating centers.

This survey study was conducted from February to March 2025 among US member institutions of the Children's Oncology Group (COG) across 44 states.

Institutional characteristics, including participation in the National Cancer Institute Community Oncology Research Program (NCORP), US census region, site-reported annual pediatric ALL patient volume, and prior blinatumomab experience, were assessed.

Incorporation of blinatumomab as standard therapy by pediatric B-ALL subtype; major outpatient care-delivery challenges defined as 4 or 5 on a 5-point Likert scale by more than 25% of centers.

Of 195 active US COG member institutions, 147 centers completed the survey and were successfully matched with a unique COG identifier, among which 35 institutions (23.8%) were NCORP participants. There were 32 institutions (21.8%) in Midwest, 30 institutions (20.4%) in Northeast, 60 institutions (40.8%) in South, and 25 institutions (17.0%) in West census regions. Most centers reported using blinatumomab as their institutional standard therapy for National Cancer Institute standard risk-average (134 centers [91.2%]), standard risk-high (144 centers [98.0%]), and high-risk (140 centers [95.2%]) B-ALL. Fewer centers reported using blinatumomab for infant (83 centers [56.5%]) or Philadelphia chromosome-positive (96 centers [65.3%]) B-ALL. The most common major outpatient blinatumomab site care-delivery challenges included lack of home care companies (75 centers [51.0%]), family distance to treating center (41 centers [27.9%]), and insurance coverage for home care companies (37 centers [25.2%]). There were 67 sites (45.6%) that reported having no home care company options for any patients.

In this study, challenges associated with pediatric blinatumomab home care were highly prevalent, with broader implications for health system infrastructure availability. These data highlight a need to plan for clinical implementation strategies alongside the development and testing of novel therapies.

Macrotrabecular-massive (MTM+) hepatocellular carcinoma (HCC) is associated with poor prognosis and early recurrence. We developed and validated a nomogram integrating magnetic resonance imaging LI-RADS features with deep learning (DL) habitat radiomics for preoperative prediction of MTM + HCC and stratifying patients according to recurrence-free survival (RFS).

In this retrospective multicenter study, 607 patients with early-stage HCC who underwent curative-intent surgical resection (mean age ± standard deviation, 59.6 ± 10.6 years; 474 males, 133 females) were divided into the training (n = 304), internal validation (n = 131), and external (n = 172) test sets. Liver Imaging Reporting and Data System (LI-RADS) features, LI-RADS categorization, and clinical features were analyzed. Finally, a nomogram integrating LI-RADS features, habitat radiomics, and DL features was developed using multivariate logistic regression. Multivariable Cox regression analyses were performed to identify independent prognostic factors.

At multivariable analysis, habitat radiomics score, DL score, alpha-fetoprotein (AFP), alanine transferase (ALT), and fat mass were independent predictors of MTM + HCC. The DL habitat radiomics nomogram demonstrated powerful performance with areas under the receiver operating characteristic curve (AUCs) of 0.897 (95% confidence interval [CI]: 0.854-0.940), 0.757 (95% CI: 0.674-0.827), and 0.858 (95% CI: 0.797-0.906) in the training, internal validation, and external test sets, respectively. After multivariable analysis, AFP (p < 0.001) and nomogram-predicted MTM state (p = 0.039) resulted as independent prognostic factors.

The nomogram integrating LI-RADS features, habitat radiomics, and DL features accurately identified patients with MTM + HCC and stratified patients by RFS.

Question Preoperative integrative methods for accurate prediction of MTM + HCC and postoperative recurrence risk stratification remain insufficient. Findings The nomogram integrating LI-RADS features and DL habitat radiomics effectively diagnosed MTM + HCC and showed superior diagnostic performance compared to the Clinical-radiologic model. Relevance statement The nomogram provides a robust, non-invasive tool for preoperative identification of MTM + HCC and recurrence risk stratification, facilitating surgical planning and postoperative surveillance strategies.

Thermal ablation of hepatocellular carcinoma (HCC) requires an adequate safety margin around the tumor to ensure treatment success. In this retrospective study, we evaluated an artificial intelligence (AI) pipeline for automatic safety margin assessment on computed tomography (CT) scans, with the goal of supporting radiologists in taking immediate clinical actions.

We included CT scans from patients with primary liver cancer treated at the local university hospital with radiofrequency ablation (RFA) between 2010 and 2022. The study group consisted of 43 randomly picked lesions with local tumor progression, with an average diameter of 35 mm [24-45] (median [interquartile range]). For comparison, we randomly selected 96 lesions showing no local tumor progression via propensity matching (diameter 28 mm [17-37]). To calculate the minimum ablative margin (MAM), we coregistered the intraprocedural patient scans with a recently proposed AI-based image registration model.

Overall, 139 HCC cases were evaluated, with an average follow-up interval of 25 months [8-42] (median, interquartile range). The calculated MAM was found to be a significant predictor of local tumor progression (odds ratio 0.42, 95% confidence interval 0.35-0.50, p = 0.001). Significant differences in local tumor protection rate were found between the lesions grouped by MAM (p < 0.001).

Our AI-driven pipeline enabled fast and reliable assessment of the efficacy of RFA of HCC in relation to ablative margins.

The ablative margins have been automatically quantified using a novel method that combines AI-based segmentation with AI-driven image registration. By delivering robust margin quantification quickly, the proposed pipeline can help clinicians in assessing ablative margins intraoperatively.

An AI-driven tool can rapidly and automatically measure the treatment margin after liver cancer ablation. Inadequate safety margins calculated with the proposed pipeline are associated with a higher risk of local tumor recurrence. A MAM of 2.50 mm suffices to lower the risk of local tumor progression to below 10%.

This study aimed to assess the effects of inhaled lavender essential oil aromatherapy on sleep quality, pain, and anxiety in intensive care unit patients following curative surgery for early-stage hepatocellular carcinoma.

In this prospective two-group quasi-experimental study, 52 adults who underwent elective curative hepatic resection at a tertiary medical center in northern Taiwan were enrolled between 2022 and 2023. Patients were enrolled sequentially according to the recruitment period, with the control group receiving usual postoperative ICU care alone and the intervention group receiving inhaled lavender aromatherapy as an adjunct to usual postoperative ICU care. On the evenings of postoperative days 1 and 2, two drops of lavender essential oil were applied to gauze held near the patient's nose for 10 breaths and then fixed to the collar from 20:00 until 08:00 the following morning. Sleep quality, pain, and anxiety were assessed using the Richards-Campbell Sleep Questionnaire, Critical Care Pain Observation Tool, and Visual Analogue Scale for Anxiety, respectively, at baseline (T0) and two postoperative follow-up assessments (T1 and T2). Longitudinal changes were analyzed using generalized estimating equations.

Fifty-two patients were analyzed (26 per group), with no significant differences in measured demographic or clinical characteristics between groups. In the adjusted GEE analyses, significant group × time interactions were observed for pain (CPOT; Wald χ² = 23.41, p < .001), anxiety (VAS-A; Wald χ² = 9.38, p = .009), and sleep quality (RCSQ; Wald χ² = 8.33, p = .016). At T2, compared with usual care, the lavender aromatherapy group had significantly lower CPOT and VAS-A scores and higher RCSQ scores. The adjusted between-group difference in RCSQ at T2 was 14.81 points (95% CI 4.82-24.80), suggesting a potentially clinically meaningful improvement in sleep quality.

The findings suggest that inhaled lavender essential oil aromatherapy, when used as an adjunct to usual postoperative ICU care, may improve sleep quality and reduce pain and anxiety in patients following curative resection for early-stage hepatocellular carcinoma.

Despite advances in pharmacological management, cancer-related pain remains highly prevalent. Psychological processes such as pain catastrophizing and pain acceptance may shape pain perception, yet their independent and cross-national contributions remain underexamined.

This study examined psychological, clinical, and contextual predictors of pain intensity among patients with cancer in Oman and Lebanon and explored the statistical mediating role of pain catastrophizing in the association between country and pain intensity.

A comparative cross-sectional study of 200 adult oncology patients (100 per country). Participants completed the Numeric Rating Scale (NRS), the Chronic Pain Acceptance Questionnaire (CPAQ), and the Pain Catastrophizing Scale (PCS). Descriptive statistics, Pearson correlations, multiple linear regression, and mediation analysis using PROCESS were performed.

Lebanese participants reported significantly higher pain intensity and catastrophizing scores, whereas Omani participants reported higher pain acceptance. Pain intensity was positively correlated with catastrophizing (r = 0.53, p < 0.001) and negatively correlated with acceptance (r = -0.35, p < 0.001). In multivariable regression, pain catastrophizing (B = 0.05, p = 0.002), country (B = 1.29, p = 0.04), and analgesic use (B = 2.37, p < 0.001) independently predicted pain intensity (adjusted R² = 0.44). Pain acceptance did not remain independently significant. Exploratory mediation analysis indicated that pain catastrophizing statistically partially mediated the association between country and pain intensity (indirect effect B = 1.23, p < 0.001).

Pain catastrophizing emerged as the most salient psychological predictor of cancer pain intensity and partially explained cross-national differences. Integrating culturally informed cognitive interventions with pharmacological treatment may improve pain outcomes in oncology settings.

Chimeric antigen receptor (CAR) T-cell therapy, including axicabtagene ciloleucel (axi-cel), is efficacious for older patients. However, patients aged 65 + are at risk for more severe neurotoxicity after infusion than younger patients, and post-infusion cognitive outcomes in older patients are unknown. This study assessed changes in objective neurocognitive performance in patients age 65 + compared to those younger than 65 in the first year after axi-cel and examined clinical factors influencing these changes. In patients with large B-cell lymphoma, neuropsychological assessments were conducted prior to initiation of axi-cel and at 30, 90, and 360 days after infusion. Mixed effects models were used to investigate age differences in changes in overall cognition (e.g., total neuropsychological performance [TNP]) and specific domains (i.e., attention, executive function, verbal ability, immediate and delayed memory, and visuospatial abilities). Among 155 participants (63% male, 90% White), older adults (n = 69) were more likely than younger adults (48% vs. 34%, p < 0.05) to demonstrate overall neurocognitive impairment before infusion. However, older adults demonstrated greater recovery of cognitive abilities (e.g., immediate verbal memory and delayed memory) over time (ps < 0.01). These results suggest that CAR T-cell therapy may have a less detrimental impact on neurocognitive performance in older patients compared to younger patients.

Interventional pain procedures (IPPs) are increasingly considered earlier for cancer-related pain, yet the clinical predictors and prognostic relevance of early analgesic response to IPP remain unclear. We aimed to identify predictors of early response and evaluate its implication for 1-year survival outcomes.

This retrospective cohort study included 349 hospitalized cancer patients undergoing their first inpatient IPP. Early analgesic response was defined by changes in daily mean NRS scores and morphine equivalent daily dose (MEDD) over a 48-h peri-procedural period. Based on these criteria, patients were categorized into overall responders and non-responders. Independent predictors of this early response were identified using multivariable logistic regression, and 1-year survival outcomes were evaluated using Kaplan-Meier analysis with the log-rank test and multivariable Cox proportional hazards regression.

Among 349 patients, overall responders (25.5%) were independently associated with higher baseline NRS (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.63-2.83; P < 0.001) and lower baseline MEDD (OR, 0.95 per 10-mg increase; 95% CI, 0.92-0.98; P < 0.001). In multivariable Cox regression, early analgesic response was not independently associated with 1-year mortality (adjusted hazard ratio for non-responders vs. overall responders, 1.26; 95% CI, 0.90-1.77; P = 0.176), although univariable analysis indicated a significant survival advantage (log-rank test, P = 0.037).

Higher pain intensity and lower opioid use predict a favorable early analgesic response to IPP, suggesting an optimal therapeutic window for cancer-related pain intervention. Early analgesic response to IPP may serve as an exploratory prognostic indicator in patients with cancer-related pain.

Although telerehabilitation can improve access to exercise programs for cancer survivors, it is not known if these programs lead to ongoing change in exercise habits. This study explored participant experiences of exercise 4 months after finishing specialized cancer exercise-based telerehabilitation.

A qualitative study embedded in a randomized controlled trial evaluated exercise-based cancer telerehabilitation delivered in groups. Data were collected via semistructured interviews that were audio-recorded and transcribed verbatim. Seventeen adult cancer survivors (age 21 to 80) were purposively sampled 4 months after completing exercise-based cancer telerehabilitation. Data were coded independently by two researchers and analyzed inductively within an interpretive description framework.

The overarching theme was telerehabilitation was perceived to facilitate positive exercise intentions. Participants said they were empowered to exercise through knowledge, opportunity, and connection gained through telerehabilitation. They described acting on their positive intentions to exercise to varying degrees following telerehabilitation, depending on their context. A subtheme was that exercise was challenging in their new reality created by cancer. Comorbidities, ongoing side effects, previous exercise experience, and personal factors were considered by some to influence their ability to exercise.

Telerehabilitation may facilitate positive intent to maintain exercise. Cancer survivors may need ongoing support after telerehabilitation to act on positive exercise intentions due to health-related difficulties.

Participation in telerehabilitation may be a positive first step to initiate exercise, but ongoing support to maintain positive behavior changes is likely to be needed for people without previous exercise experience.