Financial toxicity is associated with worse health outcomes among cancer survivors. It is unknown if financial navigation (FN) can meaningfully improve the health of survivors experiencing financial toxicity.

This analysis assesses changes in health-related quality of life (HRQoL) among cancer survivors receiving an FN intervention.

A single-arm Type II Hybrid Implementation-Effectiveness clinical trial was conducted at eight clinical oncology sites in North Carolina. Cancer survivors within five years of diagnosis or living with advanced disease with a COmprehensive Score for financial Toxicity (COST-FACIT) score of < 23, and the ability to read and understand English were recruited to receive the Lessening the Impact of Financial Toxicity (LIFT) intervention, which included a comprehensive intake and at least one check-in with a trained navigator. Participants completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical and Mental Health, Anxiety, Depression, and Psychosocial Illness Impact-Positive measures.

A total of N = 86 cancer survivors received the LIFT FN intervention and completed baseline and follow-up surveys. Receipt of LIFT FN was associated with statistically significant improvements in measures of global mental health (change: 1.72, 95% CI: 0.07, 3.38), depression (change: -2.07, 95% CI: -3.90, -0.25), and anxiety (change: -3.33, 95% CI: -5.42, -1.24). From baseline to follow-up, mean depression scores clinically improved from "mild" to "within normal limits," and mean anxiety scores clinically improved from "moderate" to "mild."

Our findings demonstrate that receipt of FN decreased anxiety and depression and improved global mental health. Findings highlight the crucial role of FN in cancer care.

NCT04931251.

Transparency regarding experts' conflicts of interest is important for the credibility of national clinical guidelines. We examined conflicts of interest among authors of the Norwegian Directorate of Health's action plans for cancer.

We asked the Norwegian Directorate of Health for access to disclosure forms completed by the authors of all 26 national action plans for cancer. We compared the information in these forms with information on potential conflicts of interest in the published action plans, the authors' PubMed-indexed articles published during the three years preceding the launch of the action plans, and public records of financial transfers from the pharmaceutical industry during the same period.

We obtained access to disclosure forms for 198/424 authors (47%) of the action plans. Conflicts of interest were reported in 49/198 forms (25%), while 63/424 authors (15%) had reported conflicts of interest in PubMed and 124/424 authors (29%) had registered financial transfers from the pharmaceutical industry. No information on conflicts of interest was provided in 3/26 action plans (12%), while 23/26 (88%) stated that none of the authors had conflicts of interest of significance. One or more authors reported potential conflicts of interest in their disclosure form for 23/26 action plans (89%), and potential conflicts of interest were identified for 24/26 action plans (92%) based on information from PubMed and the pharmaceutical industry database.

There was little agreement between the reporting of conflicts of interest in the action plans, the Norwegian Directorate of Health's disclosure forms and open access databases. The findings are limited by the fact that disclosure forms were unavailable for 53% of the authors and that the reported conflicts of interest were not subject to a qualitative assessment.

Anastomotic leakage is a serious complication of rectal cancer surgery, causing morbidity and increasing healthcare burden. A diverting stoma reduces anastomotic pressure but carries risks. A transanal tube near the anastomosis may reduce spasms and drain stool, potentially lowering leakage risk.

To evaluate the benefits and harms of a transanal tube for the prevention of anastomotic leakage in people undergoing rectal surgery, compared with no transanal tube.

We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via ProQuest, and four clinical trial registries. The latest search was conducted on 6 August 2025.

We included all randomised controlled trials (RCTs) that compared the use of a transanal tube with no intervention in adults undergoing rectal cancer surgery.

The critical outcomes were anastomotic leakage, surgical re-intervention due to anastomotic leakage, and any postoperative adverse events other than anastomotic leakage within 30 days postoperatively. Important outcomes included the overall incidence of anastomotic leakage, postoperative length of hospital stay, accidental early removal of the transanal tube, and tube-related complaints.

We used the Cochrane RoB 2 tool to assess risk of bias in the included RCTs.

We used random-effects meta-analyses to calculate risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). If meta-analysis was not feasible, we summarised the findings narratively. Heterogeneity was assessed using the I² statistic, and substantial heterogeneity (I² > 50%) was explored via prespecified subgroup analysis. The certainty of evidence was evaluated with GRADE. Due to substantial heterogeneity in anastomotic leakage data, possibly influenced by diverting stoma status, we performed prespecified subgroup analyses according to diverting stoma status.

Four RCTs were included, involving 1318 participants: 666 in the transanal tube group and 652 in the no-intervention group.

All included studies were judged to have an overall risk of bias of "some concerns". Overall, the certainty of evidence ranged from very low to low because of the risk of bias, inconsistency, and imprecision. The evidence is very uncertain about the effect of a transanal tube on the risk of anastomotic leakage (RR 0.88, 95% CI 0.46 to 1.72; 4 RCTs, 1318 participants; very low-certainty evidence). The anticipated absolute risk of anastomotic leakage was 83 per 1000 in the no-intervention group and 73 per 1000 (95% CI 38 to 142) in the transanal tube group (NNT = 100). A test for subgroup differences suggested that the effect of a transanal tube differed according to diverting stoma status (P = 0.03). Among people without a diverting stoma, the RR for anastomotic leakage was 0.72 (95% CI 0.36 to 1.43; 3 RCTs, 911 participants). The anticipated absolute risk was 89 per 1000 in the no-intervention group and 64 per 1000 (95% CI 32 to 127) in the transanal tube group. Among people with a diverting stoma, the RR was 2.38 (95% CI 1.00 to 5.69; 2 RCTs, 250 participants). The anticipated absolute risk was 52 per 1000 in the no-intervention group and 124 per 1000 (95% CI 52 to 297) in the transanal tube group. A transanal tube may reduce the risk of surgical re-intervention for anastomotic leakage (RR 0.32, 95% CI 0.10 to 1.00; 3 RCTs, 1124 participants; low-certainty evidence). The anticipated absolute risk of surgical re-intervention for anastomotic leakage was 45 per 1000 in the no-intervention group and 14 per 1000 (95% CI 4 to 45) in the transanal tube group (NNT = 33). Among people without a diverting stoma, the RR for surgical re-intervention for anastomotic leakage was 0.25 (95% CI 0.07 to 0.94; 2 RCTs, 806 participants). The evidence is very uncertain about the effect of a transanal tube on the risk of postoperative adverse events other than anastomotic leakage (RR 1.19, 95% CI 0.76 to 1.88; 2 RCTs, 555 participants; very low-certainty evidence). The anticipated absolute risk was 174 per 1000 in the no-intervention group and 207 per 1000 (95% CI 132 to 327) in the transanal tube group (NNH = 30). Among people without a diverting stoma, the RR for postoperative adverse events other than anastomotic leakage was 1.39 (95% CI 0.94 to 2.04; 1 RCT, 398 participants). The evidence is very uncertain about the effect of a transanal tube on the risk of overall anastomotic leakage (RR 0.87, 95% CI 0.46 to 1.66; 4 RCTs, 1318 participants; very low-certainty evidence). The anticipated absolute risk of overall anastomotic leakage was 87 per 1000 in the no-intervention group and 76 per 1000 (95% CI 40 to 145) in the transanal tube group (NNT = 91). One RCT involving 398 participants, all without a diverting stoma, found that a transanal tube may reduce postoperative length of hospital stay (MD -3.25 days, 95% CI -4.55 to -1.95; low-certainty evidence). Accidental early transanal tube removal occurred in 2.7% (range 0-8.2%) of participants with a transanal tube. Tube-related complaints were reported in 25.2% of participants (range 1.9-46.4%).

A transanal tube may reduce the risk of surgical re-intervention for anastomotic leakage. However, its effect on anastomotic leakage remains uncertain. Subgroup analyses suggested that the effect may differ according to diverting stoma status, with more anastomotic leakage observed with a transanal tube among people with a diverting stoma. Future trials should report outcomes separately according to diverting stoma status and standardise transanal tube characteristics.

This Cochrane Review did not receive direct funding from any organisation.

The protocol is available at doi.org/10.1002/14651858.CD015472.

Background and objectivesWilms tumor, a common childhood malignancy, has been hypothesized to be associated with environmental factors such as formaldehyde exposure. As a potential endocrine disruptor with reported pro-proliferative effects, the molecular mechanism underlying the role of formaldehyde in Wilms tumor remains unclear. This study systematically investigated the mechanisms linking formaldehyde exposure to Wilms tumor using network toxicology and transcriptomic analysis.MethodsTranscriptomic data were obtained from The Cancer Genome Atlas and Gene Expression Omnibus databases, whereas formaldehyde-related targets were predicted using the Search Tool for Interactions of Chemicals and Comparative Toxicogenomics databases. Candidate genes were screened through differential expression (|log2FC| > 2.5, p < 0.05) and weighted gene coexpression network analyses. Prognostic key genes were identified using univariate and Lasso-Cox regression, with nomogram construction and survival analysis. Single-cell RNA sequencing data (GSE223373) were further analyzed to characterize cellular heterogeneity and the cell-type-specific expression patterns of the identified key genes.ResultsSeventy-nine candidate genes associated with Wilms tumor were identified using multidimensional intersection analysis. These genes were significantly involved in pathways such as microRNAs in cancer and the cell cycle. Univariate Cox and Lasso-Cox regression analyses identified DCP1B and HAS2 as key genes closely associated with the prognosis of patients with Wilms tumor. Kaplan-Meier survival analysis demonstrated that higher expressions of DCP1B and HAS2 were significantly associated with better overall survival in these patients. The nomogram model constructed based on the two key genes demonstrated excellent calibration (area under the curve > 0.8) and clinical applicability. Network analysis identified NEAT1, the hsa-let-7 microRNA, and transcription factors such as PDX1 and E2F1 were as core regulatory nodes. Single-cell analysis demonstrated pronounced stromal expansion within Wilms tumor specimens and further revealed that DCP1B was preferentially enriched in tumor epithelial cells, whereas HAS2 exhibited a stromal-skewed distribution, predominantly within mesangial cells.ConclusionsDCP1B and HAS2 were identified as key prognostic genes for Wilms tumor. These findings suggest that formaldehyde exposure is associated with Wilms tumor pathogenesis through the potential involvement of cancer-associated microRNA pathways and cell cycle signaling, which could contribute to dysregulated cell proliferation and apoptosis.

Secure defect closure is critical in endoscopic full-thickness resection (EFTR). The through-the-scope twin clip (TTS-TC) is designed to overcome the shallow tissue grasping of titanium clips, facilitating deeper tissue apposition. This study evaluated the safety, clinical effectiveness, postoperative hospital stay, and hospitalization costs of the TTS-TC in gastric EFTR defect closure.

We retrospectively analyzed 121 patients with gastric lesions who underwent EFTR between June 2023 and June 2025. Patients were stratified into the TTS-TC group (n = 36) and the 10-mm titanium clip group (n = 85) based on the closure method. We compared procedure time, number of clips used, postoperative length of stay, incidence of intraoperative and postoperative adverse events, and hospitalization costs.

Both groups achieved definitive closure without major adverse events. Although the TTS-TC was preferred for larger and anatomically demanding lesions, subgroup analysis of defects >15 mm revealed that the TTS-TC group required significantly fewer clips and had a shorter median procedure time, with no statistically significant differences in postoperative length of stay or hospitalization costs. Multivariable regression analysis showed that the TTS-TC was independently associated with fewer clips used (p < 0.001), alongside a trend toward a shorter procedure time (p = 0.058).

In this retrospective observational comparison, the TTS-TC appears to be a safe and feasible option for closing gastric wall defects during EFTR, and demonstrates potential utility in managing selected large or anatomically challenging defects.

The morphological evolution of lung ablation zones following cryoablation (CA) remains incompletely characterized. This study aimed to describe CT pattern evolution up to 18 months and evaluate the 1-month pattern as an early marker of long-term morphological trajectory.

This retrospective single-center study included 58 lesions in 28 patients treated with CT-guided CA (triple-freeze protocol, 2020-2024). Non-contrast CT was performed at 1, 3, 6, 12, and 18 months. Ablation zones were classified into five patterns: cavity, nodular, fibrosis, atelectasis, and reversed halo sign (RHS). Univariate analyses explored factors associated with each pattern at 1 and 6 months.

At 1 month, cavity predominated (47%), followed by nodular (31%), fibrosis (10%), atelectasis (7%), and RHS (5%). By 6 months, fibrosis became the predominant pattern (43%); by 18 months (n = 34), it reached 65% and cavity disappeared. Median major axis decreased from 29 [22-34] mm to 17 [0-23] mm at 6 months (p < 0.001). Atelectasis at 1 month were associated with persistent atelectasis at 6 months (100%, 7/7 vs. 12/51, 24%; p < 0.001) and pleural contact (p = 0.016). The nodular pattern showed a non-significant trend toward fibrotic resolution (61% vs. 35%, p = 0.087). No procedural variable was associated with CT pattern.

The 1-month CT pattern may serve as an imaging marker of long-term ablation zone evolution. Atelectasis and RHS were associated with atelectasis, whereas fibrosis became the predominant pattern and cavity disappeared over time. These exploratory findings require prospective validation in larger cohorts.

Antibiotic use has been associated with cancer risk, but evidence regarding early-life antibiotic use and kidney cancer is limited. This study aimed to examine the association between long-term or recurrent antibiotic use (LRAU) during childhood or adolescence and kidney cancer risk and to assess the potential mediating role of adult adiposity.

This cohort study included 147,605 participants from the UK Biobank. We included participants with information on LRAU during childhood or adolescence who were free of cancer prior to baseline. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between LRAU during childhood or adolescence and kidney cancer risk. Mediation analyses were performed to evaluate the potential mediating role of adiposity.

LRAU during childhood or adolescence was associated with a 48% higher risk of incident kidney cancer after adjustment for potential confounders (HR 1.48, 95% CI 1.08-2.02). The proportion of the observed association between LRAU and kidney cancer mediated by adiposity measures ranged from 4.3% for waist-to-hip ratio to 13.2% for body fat percentage.

LRAU during childhood or adolescence was associated with a higher risk of kidney cancer, and mediation analyses suggested that adult adiposity may partially mediate this association. Further studies using prospectively recorded prescription and indication data are needed to replicate these findings.

Carcinomas commonly recur and progress rapidly after a period of remission following platinum-based therapy. This clinical scenario suggests that surviving drug-resistant tumor cells are dormant or slow-cycling before re-entering a rapid growth phase. Remodeling of the recurrent tumor microenvironment (TME) contributes to high rates of metastasis, but little is known about differences in TME remodeling before therapy and after recurrence. This study explores selection for cisplatin-resistant subpopulations of A549 lung adenocarcinoma cells in culture to derive populations for modeling features of the recurrent TME. A cisplatin dose of 25 μM killed approximately 80% of the cells while sparing enough cells to allow re-expansion of sufficient cell numbers for downstream experimentation. Expanded cisplatin-resistant derivatives (Cis-R A549) exhibited features of mesenchymal transition (EMT) such as cellular hypertrophy, loss of cell-cell contacts, and upregulation of alpha-smooth muscle actin mRNA. In 3D culture, Cis-R A549 spheroids were loosely aggregated and dysmorphic in comparison to the compact and spherical parent A549 spheroids. The Ki67 index of Cis-R A549 in 2D and 3D spheroid culture was markedly lower than that of parent A549, suggesting a state of pseudo-dormancy with slow cycling. Cis-R A549 upregulated multiple genes associated with the evolution of a more aggressive TME and displayed significantly increased proangiogenic capacity in a microphysiological model of tumor angiogenesis. This study establishes a methodological framework for engineering the recurrent TME with drug-resistant cancer cell line derivatives selected via high-dose exposure in culture. Increased angiogenesis induced by Cis-R A549 suggests that anti-angiogenic therapy may be more beneficial in the setting of recurrent disease following first-line therapies.

Breast Imaging Reporting and Data System (BI-RADS) 4a nodules represent a diagnostic dilemma, with a malignancy rate ranging from 2% to 10%. The majority of these nodules prove benign after biopsy, leading to unnecessary invasive procedures, patient anxiety, and healthcare costs. Current clinical practice lacks a reliable, noninvasive tool to accurately distinguish benign from malignant BI-RADS 4a lesions. Emerging evidence suggests that integrating multiparametric ultrasound data with clinical factors through artificial intelligence may improve diagnostic precision, but a validated multimodal model specifically for this ambiguous category is lacking.

To develop and validate a multimodal artificial intelligence model that integrates ultrasound radiomics, hemodynamic features, and clinical data for the accurate differentiation of benign and malignant BI-RADS 4a breast nodules, with the ultimate goal of supporting clinical decisionmaking and safely reducing unnecessary biopsies.

This prospective, multicenter study enrolled 350 pathologically confirmed BI-RADS 4a nodules from 331 patients in one tertiary hospital and two secondary hospitals. Clinical data, grayscale ultrasound images, and hemodynamic parameters were collected for each nodule. Radiomics features were extracted from the ultrasound images. A multimodal fusion model was constructed using the Light Gradient Boosting Machine (LightGBM) algorithm following feature selection via Least Absolute Shrinkage and Selection Operator (LASSO) regression. The model was developed and hyperparameter-tuned on a training set (n = 260) using nested cross-validation and was evaluated on a temporally independent test set (n = 90). Model interpretability was enhanced using SHapley Additive exPlanations (SHAP).

On the independent test set, the multimodal LightGBM model demonstrated excellent diagnostic performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.95 (95% CI: 0.91-0.99), with a sensitivity of 100% (95% CI: 81.5%-100%) and a specificity of 86.1% (95% CI: 75.8%-93.1%). Its performance was significantly superior to baseline classifiers including Logistic Regression, Support Vector Machine, and Random Forest (all p < 0.05). SHAP analysis identified wavelet-transformed texture features, the presence of a penetrating vessel, and BRCA mutation status as the top predictors of malignancy. Applying this model could have potentially avoided 32.4% (24/74) of unnecessary biopsies on benign nodules while maintaining perfect sensitivity.

A multimodal AI model based on LightGBM can accurately differentiate benign and malignant BI-RADS 4a breast nodules. It shows significant potential as a clinical decision-support tool to reduce unnecessary biopsies without compromising sensitivity, enabling more precise management for this challenging patient population.

The role of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in node-positive breast cancer (N + BC) is evolving with opportunities to de-escalate surgery in those with complete axillary pathologic response. SLNB may lead to equivalent outcomes while avoiding the morbidity of axillary lymph node dissection (ALND).

This is a retrospective analysis of patients with N + BC who received NAC and targeted axillary dissection (TAD) with or without ALND from 2014 to 2021. Patients were categorized according to pathology of the previously positive radioactive seed marked lymph node into complete pathologic response (dSLN-) and persistent disease (dSLN+). We assessed the impact of axillary surgery on recurrence, disease-free survival (DFS), and overall survival (OS).

We included 284 female patients with median follow-up of 36.3 months. 128 patients had dSLN-of which 13 (10.2%) had ALND and 115 (89.9%) had TAD. There were 156 dSLN+ patients: 107 (68.6%) ALND and 49 TAD. In both groups, TAD resulted in similar mortality (dSLN-: 15.4% vs. 8.9%, p=.309; dSLN+: 9.3% vs. 10.2%, p = 1.000), DFS (dSLN-:19.6 mos vs. 30.7 mos, p=.166; dSLN+: 30 mos vs. 37 mos, p=.650) and OS (dSLN-: 49.3 mos vs. 45.8 mos, p=.868; dSLN+: 36.4 months vs. 36.2 months, p=.982) compared to ALND.

For patients with dSLN-, there was no difference in recurrence, mortality, DFS, or OS between ALND and TAD. While there was a higher frequency of recurrence in patients who had dSLN + and underwent ALND compared to TAD, there was no difference in DFS or OS.

Not applicable.