JNCI Cancer Spectrum

Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation), and with community organizations (eg, food banks, housing assistance programs)...

BACKGROUND: Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships. METHODS: Cross-sectional analysis of data from the Childhood Cancer Survivor Study (CCSS) between 1970 and 1999, and self-reported financial information from 2017-2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code...

BACKGROUND: This Phase 1 b/2 study assessed the efficacy, in terms of objective response rate (ORR) of the FGFR1/2/3 kinase inhibitor derazantinib as monotherapy or in combination with atezolizumab in patients with metastatic urothelial cancer (mUC) and FGFR1-3 genetic aberrations (FGFR1-3GA). METHODS: This multicenter, open-label study comprised 5 substudies. In Substudies 1 and 5, patients with mUC with FGFR1-3GA received derazantinib monotherapy (300 mg QD in Substudy 1, 200 mg BID in Substudy 5)...

Recent studies propose fallopian tubes as the tissue origin for many ovarian epithelial cancers. To further support this paradigm, we assessed whether salpingectomy for treating ectopic pregnancy had a protective effect using the Taiwan Longitudinal National-Health-Research Database. We identified 316,882 women with surgical treatment for ectopic pregnancy and 3,168,820 age- and index-date-matched controls from 2000-2016. In a nested cohort, 91.5% of cases underwent unilateral salpingectomy, suggesting that most surgically managed patients have salpingectomy...

Women with high mammographic density (MD) have an increased risk of breast cancer. They may be offered contrast-enhanced mammogram (CEM) to improve breast cancer screening performance. Using a cohort of women receiving CEM, we evaluated whether conventional and modified MD measures were associated with breast cancer. Sixty-six cases with newly diagnosed unilateral breast cancer were frequency-matched on age to 133 cancer-free controls. On low-energy cranio-caudal CEMs (equivalent to standard mammogram), we measured quantitative MD using CUMULUS software at the conventional intensity threshold ("Cumulus") and higher-than-conventional thresholds ("Altocumulus", "Cirrocumulus")...

PURPOSE: Cancer survivors commonly report cognitive declines after cancer therapy. Due to the complex etiology of cancer-related cognitive decline (CRCD), predicting who will be at risk of CRCD remains a clinical challenge. We developed a model to predict breast cancer survivors who would experience CRCD after systematic treatment. PATIENTS AND METHODS.: We used the Thinking and Living with Cancer study, a large ongoing multisite prospective study of older breast cancer survivors with complete assessments pre-systemic therapy, 12-months and 24-months after initiation of systemic therapy...

BACKGROUND: Pediatric and Adolescent and Young Adult (AYA) cancer patients and caregivers are at high risk for financial toxicity and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of FINassist (Financial and Insurance Navigation Assistance), a novel interdisciplinary financial and legal navigation intervention for pediatric oncology patients and caregivers. METHODS: We used a single-arm feasibility and acceptability trial design in the Division of Pediatric Oncology and Hematology and collected pre- and post- intervention surveys to assess changes in financial toxicity (three domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions and coping behaviors), health related quality of life (PROMIS Physical and Mental Health, Anxiety, Depression and Parent Proxy scales), and perceived feasibility, acceptability, and appropriateness...

Stromal tumor-infiltrating lymphocyte (sTIL) enrichment in pre-treatment breast tumors has been associated with superior response to neoadjuvant treatment and survival. In a population-based cohort, we studied sTIL-survival associations by race and ethnicity. We assessed associations of continuous sTIL scores and sTIL-enriched breast cancers (defined as percent lymphocytic infiltration of tumor stroma or cell nests at cutoffs of 30%, 50%, and 70%) with clinical and epidemiologic characteristics and conducted multivariable survival analyses...

The COVID-19 pandemic caused widespread disruptions in cancer care. We hypothesized that the greatest disruptions in diagnosis occurred in screen-detected cancers. We identified patients (≥18 years) newly diagnosed with cancer from 2019 to 2020 in the United States National Cancer Database and calculated the change in proportion of early to late-stage cancers using a weighted linear regression. Disruptions in early-stage diagnosis were greater than late-stage diagnosis (17% vs 12.5%). Melanoma demonstrated the greatest relative decrease in early- vs late-stage diagnosis (22...

BACKGROUND: Surrogate endpoints for overall survival (OS) in patients with resectable non-small cell lung cancer (NSCLC) receiving neoadjuvant therapy are needed to provide earlier treatment outcomes indicators and accelerate drug approval. This study's main objectives were to investigate the association between pathologic complete response (pCR), major pathologic response (MPR), event-free survival (EFS) and OS, and to determine whether treatment effects on pCR and EFS correlate with treatment effects on OS...

PURPOSE: Cancer Genetic Risk Assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a Tailored Counseling and Navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with Targeted Print (TP) and Usual Care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months...

BACKGROUND: Opioid safety initiatives may secondarily impact opioid prescribing and pain outcomes for cancer care. METHODS: We reviewed electronic health record data at a tertiary Veterans Affairs system (VA Palo Alto) for all patients from 2015-2021. We collected outpatient Schedule II opioid prescriptions data and calculated morphine milligram equivalents (MMEs) using CDC conversion formulas. To determine the clinical impact of changes in opioid prescription, we used the highest level of pain reported by each patient on the 0 to 10 Numeric Rating Scale (NRS) in each year, categorized into mild (0-3), moderate (4-6), and severe (7 and above)...

Multi-parametric magnetic resonance imaging (mpMRI) has emerged as an important tool for identifying clinically-significant prostate cancer. We examined if the addition of a 400-variant multi-ancestry polygenic risk score (PRS) to mpMRI has the potential to improve identification. Based on data from 24,617 men from the Mass General Brigham Biobank, we identified 1,243 men who underwent mpMRI. Men in the top PRS quartile were more likely to have clinically-significant prostate cancer (47.1% vs 28.6% in the bottom PRS quartile, adjusted relative proportion 1...

INTRODUCTION: Studies suggest that many emergency department (ED) visits and hospitalizations for cancer patients may be preventable. CMS has implemented changes to the hospital outpatient reporting program that targets acute care in treatment patients for preventable conditions. Oncology urgent care centers aim to streamline patient care. Our cancer center developed an urgent care center called the direct referral unit (DRU) in 2011. METHODS AND MATERIALS: We abstracted visits to our adjacent hospital ED and DRU from January 2014-June 2018...

Unaffordable housing has been associated with poor health. We investigated the relationship between severe housing cost burden(SHCB) and premature cancer mortality (death <65 years) overall and by Medicaid expansion status. County-level SHCB was measured by percentage of households that spend ≥50% of their income on housing. States were classified based on Medicaid expansion status (expanded, late-expanded, non-expanded). Adjusted-mortality rate ratios (aRRs) were estimated by cancer type across SHCB quintiles...

BACKGROUND: Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. METHODS: Childhood cancer survivors (≥5 years from diagnosis; n = 12,340; 51.5% female; mean[SD] age = 39...

BACKGROUND: Models with polygenic risk scores (PRSs) and clinical factors to predict risk for different cancers have been developed. However, these models have been limited by the PRS-derivation methods and the incomplete selection of clinical variables. METHODS: We used UK Biobank (UKBB) to train the best PRSs for eight cancers (bladder, breast, colorectal, kidney, lung, ovarian, pancreas, and prostate) and select relevant clinical variables from 733 baseline traits through extreme gradient boosting (XGBoost)...

BACKGROUND: Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties experienced by young adult cancer survivors in the United States in the post Affordable Care Act (ACA) period. METHOD: We identified 1,009 cancer survivors aged 18-39 years from the National Health Interview Survey 2015-2022 and matched 963 (95%) cancer survivors to 2,733 controls using nearest neighbor matching...

BACKGROUND: Breast cancer treatment and survivorship entails a complex and expensive continuum of subspecialty care. Our objectives were to assess catastrophic health expenditures, insurance churn, and non-employment among women younger than 65 years who reported a diagnosis of breast cancer. We also evaluated changes in these outcomes related to implementation of the Affordable Care Act. METHODS: The data source for this study was the Medical Expenditure Panel Survey (2005-2019), which is a national annual cross-sectional survey of families, providers, and insurers in the United States...

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