Global cancer incidence in older adults, 2012 and 2035: A population-based study

Associations of human exposure to 6PPD and 6PPDQ with colorectal cancer: A mixture analysis

N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (6PPD) and its oxidation product, 6PPD-quinone (6PPDQ), are widely present in the environment. Toxicological studies have demonstrated that they can induce adverse health effects on the intestinal system. However, epidemiological studies examining the association between human 6PPD and 6PPDQ exposure and colorectal cancer (CRC) risk remain scarce. In this study, human urinary 6PPD and 6PPDQ concentrations were analyzed in 329 controls and 367 CRC cases from Quzhou, China. A combination of analyses, including unconditional logistic regression, Bayesian kernel machine regression (BKMR), and restricted cubic spline analysis, was employed to evaluate associations between urinary 6PPD and 6PPDQ levels and CRC risk, adjusting for demographic and lifestyle variables. The median concentration of 6PPDQ in CRC cases (0.94 vs 0.14 μg/g creatinine) was significantly higher than that in controls (Mann-Whitney U test, p = 0.001), while the median concentration of 6PPD showed no significant (p = 0.061) difference between the two groups (0.31 vs 0.38 μg/g creatinine). Higher urinary 6PPDQ concentrations were significantly associated with increased CRC risk, especially among participants with third (adjusted OR = 2.79, 95 % CI: 1.76-4.47; p for trend <0.001) and fourth (adjusted OR = 7.13, 95 % CI: 4.31-12.0; p for trend <0.001) quartiles of exposure. Additionally, the joint effects of 6PPD and 6PPDQ exposure, assessed using the BKMR model, indicated a positive association with CRC risk, suggesting a cumulative risk from co-exposure. This study provides the first epidemiological evidence linking human 6PPDQ exposure to CRC risk, highlighting its potential role in colorectal carcinogenesis.

Risk assessment of postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery based on a nomogram model

BACKGROUND

Lung cancer is a leading cause of death in the elderly. Thoracoscopic surgery, though minimally invasive, poses a greater risk of postoperative atelectasis in this group owing to age and comorbidities. The aim of this study was to identify risk factors for atelectasis in elderly lung cancer patients and develop a nomogram model for clinical prediction.

METHODS

Clinical data from 322 elderly patients with lung cancer were retrospectively analysed and split into a training set (n = 226) and a validation set (n = 96) at a 7:3 ratio. Independent risk factors for postoperative atelectasis were identified via univariate and multivariate logistic regression. A nomogram prediction model was constructed and evaluated for discrimination (ROC curves), calibration (Hosmer-Lemeshow test, calibration curves), and clinical utility (decision curve analysis, DCA).

RESULTS

The multivariate logistic regression analysis revealed that the independent risk factors for postoperative atelectasis (P < 0.05) were age ≥ 70 years, a smoking history, decreased preoperative forced expiratory volume in one second (FEV1), and lobectomy. The areas under the ROC curves of the nomogram model were 0.826 (95% CI: 0.767-0.885) and 0.918 (95% CI: 0.802-0.991) in the training and validation sets, respectively. The calibration curves demonstrated a strong consistency between the predicted and observed outcomes. The DCA curves revealed that the model provided a high net clinical benefit when the threshold probability ranged from 0.07 to 0.60, with a maximum net benefit of 73%.

CONCLUSION

The independent risk factors identified for postoperative atelectasis in elderly lung cancer patients undergoing thoracoscopic surgery are age ≥ 70 years, smoking history, reduced preoperative FEV1, and lobectomy.

Prevalence of pre-existing cognitive impairment in patients treated for cancer and the impact of cancer treatment on cognitive outcomes: A scoping review

INTRODUCTION

Pre-existing cognitive impairment (CI) is likely underreported in patients treated for cancer, and its prevalence remains unclear. Older adults with CI may have a greater risk of treatment failure and increased morbidity and mortality than patients with intact cognition. To our knowledge, there has not been a previous review summarizing data on the prevalence of pre-existing CI in patients with cancer. This review addresses: (1) What is the prevalence of pre-existing CI in patients treated for cancer and (2) What is the impact of cancer treatment on cognitive outcomes among patients exhibiting pre-existing CI before planned cancer treatment?

MATERIALS AND METHODS

We defined CI as a diagnosis of dementia or mild or unspecified CI before any cancer treatment, including surgery. This scoping review followed the Arksey and O'Malley framework and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Two reviewers independently screened titles, abstracts, and full-text articles, resolving disagreements with a third reviewer. The reviewers systematically searched MEDLINE, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception until July 15, 2023, including original research focused on participants aged 60 or older reporting the prevalence of pre-existing CI before any cancer treatment.

RESULTS

Among the 10,490 screened citations, 23 manuscripts reporting on 21 studies met the inclusion criteria for both review questions. Pre-existing CI was prevalent at a mean rate of 6 % in administrative database studies, while clinical studies employing pre-treatment cognitive screening tools, primarily the Mini-Mental State Examination and Mini-Cog, reported a higher mean prevalence of 26 % (range 2.6 to 52 %). Only one study reported postoperative delirium in 27.9 % of patients with CI following cancer surgery, suggesting a higher risk of delirium in this population. However, none of the reviewed studies provided data on other cognitive outcomes, such as chemotherapy-related CI or treatment toxicity, in these individuals.

DISCUSSION

Pre-existing CI is common but highly variable. The variability in reported prevalence rates can largely be attributed to significant differences in study inclusion criteria of participants and sample size, with some studies relying on regionally limited datasets.

Exploring the status of online social support for older adults with cancer: A scoping review

INTRODUCTION

The number of new cancer cases among older adults is rising, yet their social support needs remain unmet due to diminishing social networks with age. Since the COVID-19 pandemic, online technologies have provided increased opportunities for social support for this demographic via digital platforms such as online peer support groups, online communities, and chat rooms. This scoping review explores the current state of the use of online social support for older adults with cancer.

MATERIALS AND METHODS

This scoping review was based on the Arksey and O'Malley methodological framework with the extension proposed by Levac and colleagues. The protocol was registered on Open Science Framework (OSF). PubMed, Elsevier Embase (including Medline), and EBSCO CINAHL Complete were searched to identify eligible studies. The review findings were presented in a narrative synthesis.

RESULTS

Out of 6542 references, we included three studies. Two studies investigated older patients' preferences for different types of peer support through surveys and questionnaires, and the third examined the feasibility of an online platform for older women with breast cancer. Barriers identified include a lower interest and familiarity, sense of involvement, and emotional impact of a new diagnosis. However, factors such as socio-demographic characteristics and positive motivation for using online peer support act as facilitators.

DISCUSSION

This scoping review is the first to examine the literature on online social support specifically for older adults with cancer, revealing a paucity of research. Further research is required to understand the potential need and interest in online social support for this population, especially as technology becomes more integrated into daily life post-COVID.

What are the determinants of functional decline in older adults with cancer? Results from the INCAPAC study

INTRODUCTION

Older adults with cancer are exposed to greater difficulties in carrying out their daily activities due to cancer itself, its treatment, or both. The aim of this study was to describe functional decline after cancer diagnosis and to investigate the determinants of this decline among older individuals with cancer.

MATERIALS AND METHODS

Using the Gironde cancer registries, older subjects (≥65 years) with a diagnosis of cancer between 2005 and 2018 were identified in three prospective cohorts on aging. Functional decline was defined as an increase of 1 point for Activities of Daily Living (ADL), 2 points for Instrumental Activities of Daily Living (IADL), and 3 points for the overall score (ADL + IADL) between cancer pre- and post-diagnosis visits. Logistic regression models were used to identify determinants of functional decline among older subjects who underwent a post-diagnostic assessment. Additionally, multinomial logistic regression models were performed to account for individuals who had died prior to the post-diagnostic cancer visit.

RESULTS

A total of 306 individuals followed-up after the cancer diagnosis were included (median age at cancer diagnosis: 83; 44 % female). Older age at cancer, low educational level, impaired initial functional status, and poor five-year cancer-related prognosis were significantly associated with functional decline across all three scores. Multinomial logistic regression analyses (n = 489) yielded similar results, but only cancer-related factors, specifically unfavorable vital prognosis, were associated with higher risk of death.

DISCUSSION

Functional decline in older individuals with cancer is both multifactorial and multidimensional. Further studies are needed to disentangle the effects of cancer and aging.

Factors Associated With Falls Among Community-Dwelling Older Adults With Osteoarthritis: A Sex Subgroup Analysis

Osteoarthritis elevates the risk of falling among older adults due to joint pain and stiffness, especially among women, yet sex influences in these associations remain understudied. This study investigated factors associated with falls by sex. A sample of community-dwelling older adults with osteoarthritis from the 2016 Health and Retirement Study (2624 females; 1271 males) was analyzed using survey-weighted logistic regression, controlling for sociodemographic characteristics such as geographic residence and health-related issues. For women with osteoarthritis, higher risk of falling was associated with being White compared to Black, living in rural areas compared to urban areas, in addition to opioid use. Among men with osteoarthritis, having heart problems and better distal vision increased the risk of falling. Sex-specific fall prevention strategies, such as rural programs, opioid education for women, and increasing awareness and fall education for men with heart problems, are encouraged to promote active living among older adults with osteoarthritis.

Profiles and disparities of the global cancer and subtypes burden among adults aged 65 years and older: changing patterns in incidence and mortality, 1990-2021

This study aimed to elucidate the global temporal and geographic characteristics of 29 cancers in older people aged ≥ 65 years, based on data from the Global Burden of Disease Study 2021. The average annual percentage changes (AAPCs) were calculated to estimate temporal trends of age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs). Globally, there was an increase of 8.52 million cancer cases and 3.16 million cancer deaths among older people from 1990 to 2021. The ASIR of cancers combined presented an annually increased trend (AAPC: 0.49%), and regions with high sociodemographic index (SDI) experienced the highest increase (AAPC: 0.94%). Over the same period, the ASMR of cancers combined annually decreased (AAPC: -0.40%) globally, whereas regions with low SDI (AAPC: 0.32%) and low-middle SDI (AAPC: 0.48%) exhibited significantly increased ASMRs. Prostate cancer, lung cancer, and colorectal cancer were the three most common cancers for older people globally, and decreased relative inequalities were observed in higher-SDI countries from 1990 to 2021. For these three cancers, concentration index of ASMR respectively decreased from 0.26 to 0.06, from 0.20 to 0.17, and from 0.24 to 0.18. In contrast, the ASIR and ASMR of these cancers exhibited significant upward trends in lower-SDI regions. Our findings revealed that cancer burden for older people presented disparities globally, where higher-SDI countries faced a greater burden of cancer incidence and lower-SDI countries experienced an upward trend in cancer mortality. More attention should be given to prostate cancer, lung cancer, female breast cancer, and gastrointestinal cancers, especially in lower-SDI regions.

Experiences With an Intervention Based on Geriatric Assessment With Management: A Qualitative Study

AIMS

To describe: (i) Experiences of older patients with cancer after receiving an intervention based on geriatric assessment with management. (ii) Experiences of cancer nurses in municipal health care from implementing an intervention based on geriatric assessment with management and their perspectives on the intervention.

DESIGN

A qualitative, descriptive interview study reported according to COREQ.

METHODS

The sample comprises five men and three women with cancer, mean age 75 years, and 11 female cancer nurses. Data collection was performed as individual patient interviews, and individual and small group interviews with cancer nurses. Inductive, thematic analysis was performed.

RESULTS

Three main themes were generated: Systematic approach, Patient-centeredness and Regular and professional contact.

PATIENT OR PUBLIC CONTRIBUTION

Participants did not review transcripts, participate in analysis, or review results. This was not deemed appropriate, as all interviews were analysed as a whole. User representatives participated in the planning and conducting of the intervention study and implementation procedures.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03881137.

The role of healthcare professionals' attitudes in treatment decision-making for older adults with cancer: A scoping review

INTRODUCTION

The global population of older adults with cancer is increasing, presenting care challenges caused by comorbidity, polypharmacy, and frailty. In response to these complexities, healthcare professionals (HCPs) rely on their own attitudes to a larger extent due to limitations in the treatment evidence for this population. This scoping review aims to explore and describe the attitudes of HCPs in the context of treatment decision-making for older adults with cancer.

MATERIALS AND METHODS

We conducted a scoping review on HCP attitudes or subjective inclinations in the treatment decision-making process for older adults with cancer. PubMed, Embase, Medline, and EBSCO CINAHL Complete were searched using predefined inclusion criteria. A two-step screening process was implemented, conducted by two-reviewer teams.

RESULTS

From 5161 de-duplicated references, 21 studies were retained for analysis (nine qualitative, six quantitative, five mixed methods). Five patterns were observed, highlighting how HCP attitudes can shape consultation dynamics, influence the interpretation of patient factors such as age and comorbidities, and impact communication with older patients. Additionally, HCP background profession and practice environment emerged as influential in shaping both attitudes and decision-making processes.

DISCUSSION

This scoping review describes the role of HCP attitudes in communicating treatment options with older adults with cancer. It suggests the importance of considering the role of attitudes in decision-making when developing educational resources for geriatric-centred communication skills to support shared decision-making practices in the cancer treatment of older adults.

Long-term exposure to ambient NO2 increase oral cancer prevalence in Southern China: a 3-year time-series analysis

Background

While the correlation between cancer and air pollutants is well-established, research on the delayed effects of NO2 on oral cancer remains limited.

Methods

We collected data on nitrogen dioxide (NO2) along with diagnosed cases of oral cancer in Guangxi, China, and analyzed the correlation between exposure to NO2 and the prevalence of oral cancer.

Results

The study included 1,841 participants diagnosed with oral malignancies, consisting of 1,179 males (64.0%) and 662 females (36.0%), with a mean age of 55.9 ± 14.0 years. The NO2 concentration is 20.2 ± 10.4 μg/m3. The highest cumulative effects of NO2 exposure were observed at a 3-year cumulative lag, with a relative risk (RR) of 1.115 (95% CI: 1.102-1.128). For males, the most pronounced effect of NO2 also occurred at a 3-year lag (RR = 1.110, 95% CI: 1.094-1.127). Similarly, among females, the significant cumulative impact of NO2 was found at a 3-year lag (RR = 1.123, 95% CI: 1.101-1.145). For individuals under 60 years of age, the cumulative impact of NO2 peaked at the same 3-year lag (RR = 1.102, 95% CI: 1.085-1.120). For individuals aged 60 and above, the highest cumulative impact of NO2 was also detected at a 3-year lag (RR = 1.132, 95% CI: 1.112-1.152). For the group with normal BMI, the highest cumulative effect of NO2 exposure was also observed at the 3-year lag period (RR = 1.289, 95% CI: 1.217-1.365), consistent with the findings for other groups.

Conclusion

These findings suggest a significant lagged effect of long-term NO2 exposure on oral cancer, with varying associations between NO2 and oral cancer across different ages and genders.

Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis

BACKGROUND

The global cancer burden is rising, with early-onset cancers becoming more prevalent. We aimed to investigate the burden, trend and population disparity in 33 early-onset cancers from 2012 to 2021.

METHODS

Annual incidence, death, and disability-adjusted life years (DALY) numbers and rates for early-onset (15-49 years) cancer groups were calculated from Global Burden of Diseases (GBD) 2021 dataset, covering 2012-2021 across global, five SDI groupings, and 204 countries and territories. Estimated annual percentage change (EAPC) in the incidence, mortality and DALY rates was calculated to quantify temporal trends, while spearman correlation analysis was used to examine the correlation between rates, EAPC and SDI.

RESULTS

In 2021, there were 2.65 million new early-onset cancer cases excluding non-melanoma skin cancer (NMSC), resulting in 0.99 million deaths and 50.7 million DALYs. Breast, tracheal, bronchus and lung (TBL), cervical, colon and stomach cancers were the leading causes of DALYs. The DALY rate for early-onset cancer excluding NMSC changed from 65.7 million in 2012 to 67.0 million in 2021, with an estimated annual percentage change (EAPC) of -0.49%. While the DALY rate plateaued for females, it decreased by -0.95% for males. Ten of 33 cancer groups exhibited an EAPC > 0. The high SDI quintile had 1,100 DALYs per 100,000 caused by early-onset cancers excluding NMSC, with the highest declining trend in DALY and mortality rates, while the high-middle SDI quintile had the highest early-onset mortality rates. Rising trends in cancer incidence and mortality were especially notable among females in the middle, low-middle, and low SDI quintiles.

CONCLUSION

The global burden of early-onset cancer differs significantly by SDI quintile and gender. The increasing burden across multiple cancer groups poses a significant public health challenge. The rising burden of multiple cancer types is alarming, highlighting the need for increased policy support and targeted medical assistance to address the disparities in their impact.

Curious Dichotomies of Apolipoprotein E Function in Alzheimer's Disease and Cancer-One Explanatory Mechanism of Inverse Disease Associations?

An apparent "inverse" relationship exists between two seemingly unconnected conditions, Alzheimer's disease (AD) and cancer, despite sharing similar risk factors, like increased age and obesity. AD is associated with amyloid beta (Aβ) plaques and neurofibrillary tau tangles that cause neural degeneration; cancer, in contrast, is characterized by enhanced cell survival and proliferation. Apolipoprotein E (ApoE) is the main lipoprotein found in the central nervous system and via its high affinity with lipoprotein receptors plays a critical role in cholesterol transport and uptake. ApoE has 3 protein isoforms, ApoE E2, ApoE E3, and ApoE E4, respectively encoded for by 3 allelic variants of APOE (ε2, ε3, and ε4). This review examines the characteristics and function of ApoE described in both AD and cancer to assimilate evidence for its potential contribution to mechanisms that may underly the reported inverse association between the two conditions. Of the genetic risk factors relevant to most cases of AD, the most well-known with the strongest contribution to risk is APOE, specifically the ε4 variant, whereas for cancer risk, APOE has not featured as a significant genetic contributor to risk. However, at the protein level in both conditions, ApoE contributes to disease pathology via affecting lipid physiology and transport. In AD, Aβ-dependent and -independent interactions have been suggested, whereas in cancer, ApoE plays a role in immunoregulation. Understanding the mechanism of action of ApoE in these diametrically opposed diseases may enable differential targeting of therapeutics to provide a beneficial outcome for both.

Immune Checkpoint Inhibitors and Cognition in Adults with Cancer: A Scoping Review

Cancer-related cognitive decline refers to a deterioration in cognitive function affecting adults with cancer at any stage of their cancer journey. Older adults are at increased risk of cognitive decline. As the indications for immune checkpoint inhibitors expand in the treatment of cancer, understanding the potential complicating cognitive issues experienced by those receiving this therapy will be important. The aim of this scoping review is to identify the literature regarding immune checkpoint inhibitors and subjective/objective decline, to identify evidence in older adults, differences between older and younger adults, and outline areas for further research. Four large electronic databases were searched. Records were screened using standardised methodology. Ten studies were identified that met the inclusion criteria for review. Six studies objectively evaluated cognitive function in adults receiving ICI treatment; eight studies performed subjective cognitive assessments. There were differences identified in the cognitive assessment tools used and the methodology between studies. Few studies reported on age-dependent findings. The results of this scoping review highlight the need for further research in this area using standardised methodology and testing, with a particular focus on the cognitive outcomes of older adults who may be at increased risk of developing cognitive decline while on treatment.

Dead-End protein expression, function, and mutation in cancer: a systematic review

Cancer incidence is rising globally, particularly in aging populations. Understanding the genetic, cellular, and molecular mechanisms underlying cancer is crucial for developing effective interventions. Dead-end protein 1 (DND1), an RNA-binding protein, plays a pivotal role in germ cell regulation and tumorigenesis. This systematic review investigates DND1's multifaceted roles in cancer progression and evaluates its interactions and potential as a therapeutic target. A systematic search of four databases (Web of Science, MEDLINE via PubMed, Scopus, and Embase) yielded 436 unique records. After screening, 38 studies were included for data extraction. STRING-based network analysis identified key interactors-including NANOS1-3, TDRD7, DAZL, and EIF2S2- and pathways associated with RNA binding, translational regulation, and apoptosis. DND1 demonstrates dual, context-dependent roles as both a tumor suppressor and promoter. Its regulation of miRNAs and interaction with germ cell-specific proteins emerged as critical mechanisms in tumor suppression and progression. This study highlights DND1's central role in cancer biology, with significant implications for diagnostics and therapeutics. The findings provide a robust foundation for experimental validation of key interactions and further exploration of DND1's molecular mechanisms. The dual functionality of DND1 as a tumor suppressor and promoter underscores its potential as a target for novel cancer therapies, particularly for germ cell tumors and other cancers.

Real-world implementation of geriatric assessment in cancer care among older adults: the role of implementation science frameworks

PURPOSE OF REVIEW

The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.

RECENT FINDINGS

Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.

SUMMARY

Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.

Allies not enemies-creating a more empathetic and uplifting patient experience through technology and art

OBJECTIVE

To understand whether art and technology (mainly conversational agents) may help oncology patients to experience a more humanized journey.

METHODS

This narrative review encompasses a comprehensive examination of the existing literature in this field by a multicenter, multidisciplinary, and multiprofessional team aiming to analyze the current developments and potential future directions of using art and technology for patient engagement.

RESULTS

We identified three major themes of patient engagement with art and three major themes of patient engagement with technologies. Two real-case scenarios are reported from our experience to practically envision how findings from the literature can be implemented in different contexts.

CONCLUSION

Art therapy and technologies can be ancillary supports for healthcare professionals but are not substitutive of their expertise and responsibilities. Such tools may help to convey a more empathetic and uplifting patient journey if properly integrated within clinical practice, whereby the humanistic touch of medicine remains pivotal.

Epidemiology of cancer in older adults: a systematic review of age-related differences in solid malignancies treatment

PURPOSE OF REVIEW

We examined the latest epidemiological research on age-related differences in cancer treatment and selected outcomes, among patients with cancer aged 60 and above in comparison to younger patients.

RECENT FINDINGS

Colorectal, pancreatic and lung cancers were studied most often. Most studies were conducted in Europe or the United States of America (USA) within single centers. For unselected patients, older patients receive less treatment, and their survival, regardless of the metric used (cancer-specific survival or overall survival), was poorer than that of middle-aged patients. Age-related differences in treatment and outcomes were more pronounced in patients aged over 80 years. However, among patients selected for treatment, complications, adverse events rates and survival probabilities were comparable between older and younger patients. Treatment differences, especially the omission of therapy, were often smaller for good prognosis cancer types. The likelihood of receiving treatment decreased as age increases, regardless of the cancer types, treatment, countries and setting. More research on treatment in older patients with cancer, especially the frailest and the oldest, is urgently needed as there is still a lack of data to tailor treatment.

Multimorbidity characteristics in older adults and their associated factors in complex networks: a cross-sectional study

Background

Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the older adults in Jiangsu, China is relatively lacking.

Methods

We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patterns in old adults.

Results

The mean age of these patients was 72.0 ± 8.7 years, and the male-to-female ratio was 1: 1.53. These patients during the COVID-19 period (from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases (I10-I15)," "Other forms of heart disease (I30-I52)," "Diabetes mellitus (E10-E14)," "ischaemic heart diseases (I20-I25)" and "Cerebrovascular diseases (I60-I69)." The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by diabetes mellitus, other forms of heart disease, and ischaemic heart diseases (I20-I25).

Conclusion

In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in most periods. However, during the pandemic period, we should pay more attention to diseases that require urgent treatment, such as malignant tumors. For different periods, the spectrum of diseases we focus on should change accordingly.

Screening tools for malignancy in patients with cryptogenic stroke: Systematic review

Up to 20% of patients with cryptogenic ischemic stroke have an occult malignancy at the time of stroke presentation, providing an opportunity for early cancer detection. Despite this significant association, there is currently no consensus in international guidelines on how to systematically screen for malignancy in ischemic stroke patients. This review aims to summarize recent evidence on clinical features and scores, and predictive laboratory tests, that can guide malignancy screening in ischemic stroke patients. Our systemic search included PubMed, MEDLINE and Cochrane databases and yielded a total of 12 studies meeting the inclusion criteria for review. Elevated D-dimer levels and multiple infarcts in different cerebral circulations emerged as key markers. Based on the summarized data, we propose a flowchart for clinical decision-making regarding malignancy screening in patients with ischemic stroke. As the initial steps, we recommend using D-dimers cut-offs and stroke pattern on brain imaging to classify patients according to their risk profile. Based on the identified risk, we recommend a subsequent diagnostic workup addressing the most prevalent cancer types, including gastrointestinal tract, lung adenocarcinoma and gender-related cancer. The clinical implications of early malignancy screening and the need for evidence-based guidelines in cryptogenic stroke are discussed.

Liposome-encapsulated lambda exonuclease-based amplification system for enhanced detection of miRNA in platelet-derived microvesicles of non-small cell lung cancer

Platelet-derived microvesicles (PMVs) and their encapsulated microRNAs (miRNAs) hold immense potential as biomarkers for early non-small cell lung cancer (NSCLC) diagnosis. This study presents a pioneering liposome-based approach for enhanced miRNA detection within PMVs, employing a lambda exonuclease (λ EXO)-based amplification system encapsulated in immunoliposomes. The platform exploits the novel catalytic functionality of λ EXO, demonstrating its unprecedented capability to catalyze RNA-DNA hybrid substrates. The λ EXO-based amplification system exhibited high sensitivity and specificity in detecting miRNA-21, a key miRNA associated with NSCLC, demonstrating a limit of detection (LOD) of 33.11 fg mL-1. The system was successfully encapsulated within liposomes, which were then functionalized with CD41 antibody to facilitate targeted delivery and fusion with PMVs. The results reveal a significant difference in miRNA-21 levels between PMVs from NSCLC patients and healthy individuals, with a 2.06-fold higher abundance observed in NSCLC patients. This research presents a significant technological advancement in miRNA detection, paving the way for improved early diagnosis and personalized medicine approaches.

Epidemiologic trends and characteristics of cancer-related emergency department visits of older patients living with cancer in South Korea

We aimed to investigate the demographic characteristics, common chief complaints, and diagnosis of geriatric cancer-related emergency department (ED) visits and trends of ED outcomes. This retrospective observational study included all ED visits in South Korea between 2016 and 2020. The study population was older people ≥ 65 years living with cancer who visited ED with cancer-related problems. The demographics, common diagnoses, and ED outcomes were investigated. A multivariate logistic regression analysis was conducted to investigate factors associated with mortality. Geriatric cancer-related ED (GCED) visits were 746,416 cases over 5 years. The proportion of older adults among cancer-related ED visits increased from 50.1% in 2016 to 55.3% in 2020. The proportion of the "oldest old" (≥ 85 years) increased from 9.6 to 12.1%. For GCED, the ward admission rate after ED treatment was 60.2% and in-hospital mortality rate was 11.8%. Both of these increased with age group ("young old" (65-74), "middle old" (75-84), and "oldest old" (≥ 85 years) groups admission rates: 56.1%, 62.8%, and 68.0%; and mortality rates: 10.0%, 12.7%, and 15.7%, respectively). The most common diagnosis was pneumonia (4.9%). Old age and ambulance use were also associated with mortality. Older adults account for more than half of cancer-related ED visits, and their number is increasing every year. GCED visits are associated with high hospitalization and mortality, especially among the oldest old. It is important to prepare for a rise in GCED visits is necessary.

Exploring nurses' experiences of caring for older adults with cancer: a meta-synthesis of qualitative evidence

Nurses' important role in cancer treatment shows the need to explore their experiences caring for older adults with cancer, an area where previous research has identified a research gap.

This review aimed to synthesize the existing qualitative findings on nurses' experiences of caring for older adults with cancer.

Meta-synthesis.

A systematic search of four electronic databases was conducted using relevant keywords, from January 2000 to April 2024, with an update in July 2024.

A meta-synthesis using thematic analysis was employed to integrate the primary qualitative findings. The reporting of this review adhered to the ENTREQ guidelines.

Four analytical themes emerged: (1) unpacking the emotional and psychological toll, (2) facilitating effective connections with patients, (3) addressing practical and logistical challenges, and (4) navigating role dynamics in cancer care.

This meta-synthesis identified the need of prioritizing nurses' emotional, psychological, and practical well-being in cancer care, particularly when caring for older adults. By acknowledging and addressing the emotional and psychological strain, fostering meaningful patient connections, managing practical challenges, and navigating role dynamics, healthcare systems can enhance the quality of care for older cancer patients and support the well-being of nurses in this critical role.

Investigating the Uptake of Hypofractionation for Breast and Prostate Cancer in Sub-Saharan Africa: A Qualitative Study of Physician and Medical Physicist Perspectives

Purpose

In prostate and breast cancer, moderate hypofractionation (HF) has demonstrated comparable, if not greater, efficacy than conventional fractionation. There is a stark disparity in the uptake of HF between North America and Africa. Using the Consolidative Framework for Implementation Research, we evaluated barriers and facilitators for implementing HF in Sub-Saharan Africa (SSA).

Methods and Materials

Radiation oncologists and medical physicists working in SSA were recruited via the AORTIC Radiation Oncology Special Interest Group and subsequent snowball sampling. Interviews were conducted virtually between November 2022 and January 2023. Transcripts were analyzed using directed content analysis guided by a Consolidative Framework for Implementation of research interview domains and constructs.

Results

In total, 19 interviewees (17 radiation oncologists and 2 medical physicists) from 11 SSA countries participated, of which 94% noted the use of HF (40.05 Gy/15fx or 42.67 Gy/16fx) in breast cancer clinics and 38% in prostate cancer clinics (60-66 Gy/20fx). While nearly all participants identified the benefits of HF for both clinics and patients, many also noted that the lack of long-term data within an African population created discomfort in using HF. Many participants believed in the utility of HF but expressed a lack of confidence in its use caused by uncertainty about the safety of the technique, especially in centers with cobalt or 3-dimensional conformal radiation therapy-only capabilities. In breast HF, participants expressed concern regarding breast size and ideal eligibility criteria for patients. In prostate HF, on-treatment imaging and lack of fiducials were identified as barriers. Key facilitators in adopting HF included hands-on training, partnerships with disease-site-specific individuals with HF experience, and consensus on patient eligibility and technique requirements.

Conclusions

HF is regarded as a valuable tool for breast and prostate cancer in SSA, and breast HF is widely used. Attention to the use of 3-dimensional conformal radiation therapy with HF, long-term toxicity data in African populations, and training sessions may facilitate further use of HF for prostate cancer.

Sexual Satisfaction and Associated Factors Among Older Cancer Survivors

As little is known about sexual satisfaction among older (≥ 65 years) cancer survivors, this study examined sexual satisfaction defined as physical pleasure and emotional satisfaction in sexual relationships, including associated factors. This secondary analysis of the National Social Life, Health, and Aging Project round 3 data set included 173 partnered older cancer survivors. The data included ratings of physical pleasure, emotional satisfaction, importance of sexual activity, mental and physical health, and scores of sexual function (the presence of problems; if any, the extent of related bother) and social support and strain from partners. The sample's mean age was 74.30 years (SD = 6.36). Most were male (n = 120, 69.36%) and White (n = 139, 80.35%). Older adults reported they were "very" satisfied with sexual relationships both physically and emotionally: mean (SD) = 2.88 (1.01) and 3.18 (0.77), respectively. Seventy (40.46%) had problems with sexual function that were bothersome. Adjusted linear regression models showed physical pleasure was associated with perceived physical health (β = 0.22) and social support (β = 0.19); and emotional satisfaction was associated with social support (β = 0.39) and strain from partners (β = -0.23). Sexual function was not associated with sexual satisfaction. In conclusion, perceived health and social factors may be more influential than sexual function in older cancer survivors' sexual satisfaction, but future research is warranted to confirm these relationships. A focus on relational aspects of sexual health may provide a broader array of options to improve older cancer survivors' sexual satisfaction.

Quality of Decision Making in Radiation Oncology

High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.

Measuring healthy life expectancy and determinants of poor perceived health: A population-based study among a subset of rare and common cancer survivors

BACKGROUND

As the survival proportions for rare cancers are on average worse than for common cancers, assessing the expected remaining life years in good health becomes highly relevant. This study aimed to estimate the healthy life expectancy (HLE) of a subset of rare and common cancer survivors, and to assess the determinants of poor perceived health in rare cancer survivors.

METHODS

To calculate HLE, survival data from the population-based Netherlands Cancer Registry of survivors of a rare cancer (i.e., ovarian cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma) (n=21,376) and a common cancer (i.e., colorectal cancer (CRC)) (n=76,949) were combined with quality of life (QoL) data from the PROFILES registry on a random sample of the rare (n=1025) and common cancer (n=2400) survivors. A flexible parametric relative survival model was used to estimate life expectancy (LE) and years of life lost, and multivariate logistic regression was applied to determine factors related to reported poor perceived health.

RESULTS

Patients previously diagnosed with a rare cancer had an average LE of 8-36 years and were expected to spend ≥67 % of their remaining life in good health. CRC survivors had an average LE of 10 years with approximately 65 % of their remaining life expected to spend in good health. For all cancer types, those aged ≥65 years or with stage IV had the lowest HLE. Low socioeconomic status, advanced stage, and having received radiotherapy only were important predictors of poor perceived health among rare cancer survivors.

CONCLUSION

HLE can provide meaningful perspective for patients and practitioners for all cancer types, including rare cancers. Yet, data on QoL for rare cancers should be routinely collected, as such will serve as an indicator for monitoring and improving cancer care, and for enabling HLE measurements in cancer survivors.

The effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, and health-related quality of life in adults with malignant lymphoma undergoing chemotherapy: a systematic review of randomized controlled trials

PURPOSE

This study aims to identify and summarize evidence on the effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, health-related quality of life (HRQoL), feasibility of the interventions, in patients with malignant lymphoma undergoing chemotherapy.

METHODS

A systematic search was conducted in six electronic databases and trials registers on November 15, 2023. Peer-reviewed randomized controlled trials (RCTs) comparing exercise intervention with controls/usual care in adults (≥18 years) diagnosed with Hodgkin's lymphoma and non-Hodgkin's lymphoma undergoing chemotherapy were considered for inclusion. All study authors were contacted to obtain unpublished subgroup data. Two reviewers independently screened and extracted data and assessed the quality of evidence using the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Six RCTs published between 2009 and 2021, with 838 participants, were included. Due to clinical heterogeneity, a meta-analysis was not feasible, therefore the results were synthesized narratively. Exercise interventions during treatment were found to be feasible with few adverse events reported. The included studies indicate positive effects of exercise during chemotherapy on muscle mass, muscle strength, functional performance, aerobic capacity, and HRQoL compared to usual care.

INTERPRETATION

Despite extensive search criteria, a limited number of heterogenous studies were eligible, which may explain the very low certainty of evidence for all outcomes. Nonetheless, exercise-based interventions conducted during treatment were feasible, safe and potentially effective. Further studies are needed to guide future exercise recommendations for these patients.

Age-dependent differences in breast tumor microenvironment: challenges and opportunities for efficacy studies in preclinical models

Immunity suffers a function deficit during aging, and the incidence of cancer is increased in the elderly. However, most cancer models employ young mice, which are poorly representative of adult cancer patients. We have previously reported that Triple-Therapy (TT), involving antigen-presenting-cell activation by vinorelbine and generation of TCF1+-stem-cell-like T cells (scTs) by cyclophosphamide significantly improved anti-PD-1 efficacy in anti-PD1-resistant models like Triple-Negative Breast Cancer (TNBC) and Non-Hodgkin's Lymphoma (NHL), due to T-cell-mediated tumor killing. Here, we describe the effect of TT on TNBC growth and on tumor-microenvironment (TME) of young (6-8w, representative of human puberty) versus adult (12 m, representative of 40y-humans) mice. TT-efficacy was similar in young and adults, as CD8+ scTs were only marginally reduced in adults. However, single-cell analyses revealed major differences in the TME: adults had fewer CD4+ scTs, B-naïve and NK-cells, and more memory-B-cells. Cancer-associated-fibroblasts (CAF) with an Extracellular Matrix (ECM) deposition-signature (Matrix-CAFs) were more common in young mice, while pro-inflammatory stromal populations and myofibroblasts were more represented in adults. Matrix-CAFs in adult mice displayed decreased ECM-remodeling abilities, reduced collagen deposition, and a different pattern of interactions with the other cells of the TME. Taken together, our results suggest that age-dependent differences in the TME should be considered when designing preclinical studies.

The Relevance of Sex and Age as Non-Modifiable Risk Factors in Relation to Clinical-Pathological Parameters in Colorectal Cancer

BACKGROUND AND OBJECTIVES

We aimed to assess the significance of sex and age compared to other clinical-pathological parameters in colorectal cancer (CRC).

MATERIALS AND METHODS

Our study included a retrospective approach to CRC patients who underwent surgery at the 'Pius Brinzeu' County Clinical Emergency Hospital in Timisoara (PBECCHT), Romania. The analyzed parameters were: patient age and sex, tumor location, histological type, differentiation grade (G), extent of tumor (pT), lymph-node status (pN), distant metastasis status (pM), and lymphovascular invasion (LVI). The population was divided into three groups based on age, with those under 49 years old, 50 to 69 years old, and elderly (>70).

RESULTS

The study's inclusion criteria were met by 1885 patients, with a male-to-female ratio of 1.39:1. There were significant differences between the sexes in the anatomical location of tumors (p < 0.0001). Younger patients were more likely to have deeply invasive tumors (p = 0.0096), LVI (p = 0.0332), lymph-node metastases (p = 0.0158), and metastatic disease (p = 0.0017).

CONCLUSIONS

Over the ten-year period reviewed, the frequency of CRC cases has progressively increased, with males being diagnosed more often. In terms of patient age, the young population exhibits clinical features of aggressive evolution. Patient sex did not influence the analyzed parameters, except for tumor location, where right colon tumors are slightly more common in females.

Analyzing the cancer mortality-to-incidence ratios and health expenditures in the aging population: a 20-year comparative study across high-income countries

Background

The global burden of cancer is expected to increase by 60% over the next two decades, largely due to population aging. The study aims to examine the association between cancer mortality-to-incidence ratios (MIR) with healthcare expenditures (HE), and human development index score for individuals 70 years old or older.

Method

This is an epidemiological study using publicly available data from the Global Burden of Disease (GBD) for six over the years 1990-2019. A generalized linear model was employed to examine the association between MIR, and health expenditures and health development index score.

Results

Included countries showed a statistically significant negative association between MIR and both HE, and HE, indicating that higher HDI and HE are associated with decreased MIR with the highest decrease was for China, the coefficient for HDI is -1.29 (95% CI: -1.35 to -1.24, p < 0.0001), the coefficient for HE is -0.103 (95% CI: -0.17 to -0.03, p < 0.0001). There are variations exist in MIRs between high and low health expenditure countries for each cancer type.

Conclusion

The study reveals a significant impact of HE and HDI on cancer outcomes in older adults. Variations between high and low HE nations highlight potentially improved cancer outcomes in high HE countries. Considering the anticipated growth in the aging population worldwide, a rise in cancer cases is expected among older individuals. The implications are profound, suggesting an impending strain on healthcare systems, particularly in nations with a high proportion of elderly and low health expenditures.

Decreased risk of cardiovascular disease mortality associated with occasional positive screens following cancer screenings

Positive results from cancer screenings, like a cancer diagnosis, can increase the risk of cardiovascular disease (CVD) mortality due to heightened psychological stress. However, positive screening results may also serve as a teachable moment to encourage the adoption of a healthier lifestyle. Consequently, the overall association between positive screenings and CVD mortality risk remains unclear. Based on PLCO data, the risk of CVD mortality associated with the number and types of positive screens was evaluated using Cox regression models among 149,258 eligible participants enrolled between 1993 and 2001. Additional analyses explored these associations stratified by prior CVD history. Exploratory analyses were also conducted to investigate whether positive screens were linked to the potential adoption of a healthier lifestyle. After a median follow-up of 19 years, significantly decreased risk of CVD mortality was observed for individuals with occasional positive screening (≤ 2 positive screens) [adjusted hazard ratio (HR, 95%CIs): 0.931 (0.897-0.968), P < 0.001] compared to the control arm. This effect was particularly notable for flexible sigmoidoscopy [0.842 (0.802-0.884), P < 0.001] and transvaginal ultrasound [0.855 (0.776-0.942), P = 0.002]. However, when the number of positive screens increased to more than two, the reduced risk of CVD mortality became non-significant [0.977 (0.941-1.014), P = 0.220]. Subgroup analyses revealed a greater reduction in CVD mortality risk among participants without a history of CVD [0.917 (0.864-0.973)] compared to those with a history of CVD [0.944 (0.898-0.993)]. Sensitivity analyses excluding screening-detected cancers showed similar association in the overall population [0.933 (0.897-0.970)], as well as in both subgroups with [0.945 (0.898-0.995)] and without previous CVD [0.919 (0.865-0.976)]. Exploratory analyses indicated a significantly higher proportion of any body mass index (BMI) reduction among those with a baseline BMI ≥ 25 kg/m2 who had positive screens compared to the control arm, particularly for individuals with occasional positive screens (48.07% vs. 47.04%, P value = 0.037). Occasional positive cancer screening are associated with reduced risk of CVD mortality, regardless of prior CVD history, cancer diagnosis, and other competitive risks.

The care of older patients with cancer across the United Kingdom in 2024: A narrative review by the International Society of Geriatric Oncology UK Country Group

The worldwide population is ageing, alongside an increase in cancer incidence rates. Over the past 10 years, there has been huge progress in the field of oncology with earlier diagnosis and an expansion of treatment options, leading to a growing number of older people living with cancer. That has meant that caring for older patients with cancer is now part of day-to-day oncology practices. This cohort often has geriatric syndromes and a higher prevalence of frailty and complex needs and preparing our clinical services to optimise care for these patients is essential. Whilst it is widely accepted that comprehensive geriatric assessments are of benefit to patients, only a small proportion of patients can access these through specialised teams during their cancer care. In the past few years there has been significant progress in this field throughout the United Kingdom (UK). The goal of this review is to inform other health care systems how to learn from what has been done in the UK. This paper provides an update from our previous review in 2020, detailing the new services being implemented and made available to patients and an expansion in the number of new pilot teams and research projects/trials throughout the four nations of the UK.

Nutritional support via feeding jejunostomy in esophago-gastric cancers: proposal of a common working strategy based on the available evidence

Malnutrition is common in patients affected by esophago-gastric cancers and has a negative impact on both clinical and economic outcomes. Yet not all patients at risk of malnutrition are routinely assessed and receive appropriate support. Further, available research does not provide a mean for standardization of timing, route, and dosage for nutritional support, and this is particularly true for enteral nutrition via feeding jejunostomy. Herein, we provide an overview of the current evidence and use the gathered knowledge as a starting point for a consensus proposal. As a result, we aim to facilitate the development of appropriate and uniformed interventions, thus fulfilling the need for a multimodal therapeutic approach in these set of cancer patients.

Analysis of pharmaceutical interventions in chemotherapy prescriptions of adult and pediatric patients at an oncology reference institute

Chemotherapy, one of the primary cancer treatments, has a high risk of causing significant harm in cases of its misuse. Pharmaceutical intervention is one of the strategies used to prevent medication errors from reaching the patient by identifying drug-related problems or other discrepancies related to patient data or medical progress. The primary objective of this study was to analyze the profile of the pharmaceutical intervention made in chemotherapy prescriptions for adult and pediatric patients in order to measure its impact on patient safety. A retrospective cross-sectional and observational study was conducted at a reference center for cancer treatment in Rio de Janeiro, Brazil. Pharmaceutical interventions performed in chemotherapy prescriptions from January to October 2022 were quantified, classified, and analyzed by their type, most common medicine, and acceptability. From the patients treated in the period, 220 (14.8%) adults and 64 (23.4%) children and teenagers received at least one pharmaceutical intervention. The most common types for adults were dose adjustments: overdose (22.5%) and underdose (22.5%). However, in pediatry, incompleteness of supporting drug protocol (22.1%) was the most registered. The most common medicines involved in pharmaceutical intervention were carboplatin (for adults) and electrolytes/hydration (for pediatric patients). Pharmaceutical intervention acceptability by prescriptors was very similar, reaching 80.4% for adults and 77.9% for pediatrics. The pharmaceutical intervention profile was quite distinct by virtue of the singularities of each population. The pharmacists' role was shown to be paramount in intercepting medication errors in the prescription of chemotherapy protocols, contributing to patient safety.

Preclinical Effects of Melatonin on the Development of Ehrlich's Tumor: A Biochemical, Cognitive, and Molecular Approach

BACKGROUND

It has already been shown that melatonin is an antitumoral molecule that affects malignant cells via some mechanisms. The benefit played by this hormone on cancer is due to its antioxidant effects.

OBJECTIVE

This study aimed to evaluate the preclinical effects of melatonin in mice with the Ehrlich ascites tumor.

METHODS

Twenty Balb/c male mice with Ehrlich tumor were treated with different melatonin doses. Their inflammatory and oxidative stress were accessed by gene expression. Hepatotoxicity and hematological parameters were also evaluated through biochemical analyses. Animal welfare was analysed weekly from the categories guided by the NC3Rs.

RESULTS

Gene expression analyses have shown that only Tnfα and Sod1 were expressed in all groups studied. Only the M-3 group showed increased Tnfα expression compared to the control. All groups treated with melatonin showed decreased Sod1 expression compared to the control. No signs of hepatotoxicity were caused by any of the melatonin doses used in the treatment.

CONCLUSION

In animals with Ehrlich´s tumor treated with melatonin, a decrease in oxidative stress, an amelioration in welfare and in cognitive tasks could be observed, even if the treatment has not reduced the size of the tumor itself. In parallel with the already patented use of melatonin in the treatment of sleep disorders or chronic kidney disease, our results propose its use to improve the general well-being of breast cancer patients.

Quantitative immunohistochemistry analysis of breast Ki67 based on artificial intelligence

Breast cancer is a common malignant tumor of women. Ki67 is an important biomarker of cell proliferation. With the quantitative analysis, it is an important indicator of malignancy for breast cancer diagnosis. However, it is difficult to accurately and quantitatively evaluate the count of positive nucleus during the diagnosis process of pathologists, and the process is time-consuming and labor-intensive. In this work, we employed a quantitative analysis method of Ki67 in breast cancer based on deep learning approach. For the diagnosis of breast cancer, according to breast cancer diagnosis guideline, we first identified the tumor region of Ki67 pathological image, neglecting the non-tumor region in the image. Then, we detect the nucleus in the tumor region to determine the nucleus location information. After that, we classify the detected nucleuses as positive and negative according to the expression level of Ki67. According to the results of quantitative analysis, the proportion of positive cells is counted. Combining the above process, we design a breast Ki67 quantitative analysis pipeline. The Ki67 quantitative analysis system was assessed on the validation set. The Dice coefficient of the tumor region segmentation model was 0.848, the Average Precision index of the nucleus detection model was 0.817, and the accuracy of the nucleus classification model was 96.66%. Besides, in clinical independent sample experiment, the results show that the proposed breast Ki67 quantitative analysis system achieve excellent correlation with the diagnosis efficiency of doctors improved more than ten times and the overall consistency of diagnosis is intra-group correlation coefficient: 0.964. The research indicates that our quantitative analysis method of Ki67 in breast cancer has high clinical application value.

Exploring the status of online social support for older adults with cancer: a scoping review protocol

INTRODUCTION

The estimated number of new cases among older adults with cancer has been increasing. Considering the decrease in social networks as adults age, their need for social support is often unmet. Notably, an increasing number of older adults with cancer have access to social support through online technologies, especially since the COVID-19 pandemic, which heightened the need for online social support. Little is known, however, about the extent to which online social support for older people with cancer has developed. This scoping review aims to explore the developments in online social support for older adults with cancer.

METHODS AND ANALYSIS

We will search PubMed, Elsevier Embase (including Medline) and EBSCO CINAHL Complete to identify eligible studies based on predefined criteria. Screening of articles and data extraction will be carried out independently by two reviewers, with conflicts resolved by a third reviewer. This scoping review will be based on the Arksey and O'Malley methodological framework with the extension proposed by Levac and colleagues. The review findings will be presented in a narrative analysis using tables. This protocol is registered on Open Science Framework at https://doi.org/10.17605/OSF.IO/Z9XJ7.

ETHICS AND DISSEMINATION

No ethical approval is needed. The findings will be published in a peer-reviewed journal and presented at conferences.

The value and effectiveness of geriatric assessments for older adults with cancer: an umbrella review

PURPOSE

This umbrella review aimed to summarise and synthesize the evidence on the outcomes reported and used to assess the value and or efficacy of geriatric assessments (GAs) for older adults with cancer.

METHODS

Six electronic databases, PsycINFO, MEDLINE, Embase, CINAHL, Cochrane Library and Web of Science databases, were searched to identify systematic reviews with or without meta-analyses that described the value or outcomes of GAs for older adults with cancer.

RESULTS

Twenty-six systematic reviews were included, of which six included a meta-analysis of the data. Thirteen associations and or outcomes were identified. Overall geriatric impairments predicted or were associated with majority of identified outcomes. However, the type of domains associated with outcomes differed within and across reviews. Only treatment toxicity was statistically significantly lower for patients allocated to the GA intervention group compared to standard care. Systematic reviews without meta-analyses demonstrated a positive impact of GA with management on treatment completion, communication and care planning and patient satisfaction with care.

CONCLUSION

There is evidence demonstrating the predictive value of GAs for older adults with cancer. GAs seems to be beneficial for older adults with cancer across some outcomes, with strong evidence demonstrating the impact of GA with management for treatment toxicity. However, there is mixed or limited evidence demonstrating the effect of GA in other treatment modalities, and on quality of life and economic outcomes.

L-Cystine-Based Polyurethane as a Drug-Delivery Vehicle in Targeted Cancer Therapy and Biomedical Applications

Controlled and sustained drug release is a critical aspect of drug-delivery systems (DDSs) that can be used in chemotherapy while ensuring therapy effectiveness and biosafety. Hence, polyurethane (PU) is modified using a biomolecule Cystine (CYS) for protracted drug release, aiming to enhance cancer treatment efficacy while minimizing adverse side effects in tumor patients. To confirm the formation of a polymer structure, characterization techniques such as NMR and FTIR are used, and the morphology is determined using SEM. Biocompatibility of the synthesized polymers is evaluated through cellular assessments, including MTT assay, cell adhesion, and antibacterial assay along with drug release using an anticancer drug, Paclitaxel (PTX). Notably, the incorporation of PTX in the polymer matrix results in minimal mortality (85% viable cells) rates in healthy cells (3T3), in contrast to a 56% mortality rate observed with the pure drug. While PTX shows a burst release and kills cancer cells only for the first 24 h, PU loaded with the drug shows sustained release and kills the cancer cells for 3 days. This vehicle selectively kills 59% of SiHA cells after a consecutive study of 3 days, which highlights the potential of this newly designed vehicle for effective drug delivery, particularly in anticancer treatments. Moreover, cystine's antibacterial property adds up with PU; hence, PU shows antibacterial activity against Staphylococcus aureus (MIC, 20 μg/mL) and also acts as a reductive oxygen species scavenger. Therefore, modifying PU with CYS has shown sustained release of PTX along with a selective effect on cells, underscoring its significance as a superior delivery agent and supported by a shred of convincing evidence.

Sister partnership to overcome the global burden of cancer

Emerging countries are currently facing an increasing burden of cancer while they do not have adequate prevention, monitoring, and research capabilities to tackle the disease. Cancer outcomes are influenced by several factors, including different cancer patterns, national cancer screening guidelines, current stage of disease, and access to quality care and treatments. Discrepancies in cancer care between emerging and developed countries require actions to achieve global health equity. The process of pioneering a sister relationship in the oncology field can thwart the global burden of cancer. The objective of such cooperation programs should include research and training programs, evidence-based oncology practice, and quality cancer. Building global connections will therefore be the novel approach to addressing the global burden of cancer.

Home-based care models for patients with terminal illnesses in low and middle-income countries: A systematic review of randomized and quasi-experimental studies

BACKGROUND

With the increasing lifespan of people and the transition from communicable to non-communicable diseases across the globe, there is an increasing number of people with terminal illnesses requiring home-based care in Low- and Middle-Income Countries (LMICs).

AIM

This systematic review evaluated home-based care models for patients with terminal illnesses in LMICs. The primary outcomes measured are quality of life (QoL), adherence to treatment, fatigue, bimanual and related activities.

METHODS

This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Four databases; Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE (Ovid), Cochrane Library and Scopus, were systematically searched for potentially relevant studies. Screening of records (titles/abstracts from and full-texts) was done and a total of seven studies (four Randomized Control Trials [RCTs] and three quasi-experimental studies) were included in this review.

RESULTS

Even though the included studies reported significant increase in the QoL of the studied patients, the studies have quality concerns.

CONCLUSION

Noting the general paucity of existing studies coupled with quality concerns across geographies in LMICs. More studies on home-based care for patients with terminal illness are needed with improved qualities and spread in these regions.

Temporal trends in age and stage-specific incidence of colorectal cancer in Saudi Arabia: A registry-based cohort study between 1997 and 2017

BACKGROUND

In Saudi Arabia, colorectal cancer (CRC) is the most common cancer in men and the third in women, posing a significant health burden. A comprehensive report of CRC incidence rates and trends in Saudi Arabia is lacking. This study aims to examine trends in CRC incidence among the Saudi population.

METHODS

We used data from the Saudi Cancer Registry to examine CRC age-specific incidence rates (ASIR) and age-standardized incidence rates (ASR) between 1997 and 2017. Joinpoint regression analysis was used to determine the magnitude and direction of observed trends stratified by age, sex, and CRC stage at diagnosis. Trends were measured using the annual percentage change (APC) and the average annual percentage change (AAPC) in CRC incidence rates.

RESULTS

In total, 19,463 new CRC cases were identified during the study period. Since 1997, ASR for CRC has steadily increased in men and women overall, irrespective of disease stages. The ASIR increased across all age groups and was more pronounced in older patients. Women aged 40-49 had a higher increase in incidence than men (AAPC= 5.3 % vs.4.7 %). Males aged 70-79 had an AAPC of 10.2 %, twice that of females (AAPC= 4.9 %). A consistent rise in ASIR was observed across all CRC stages and age groups in males and females. In recent years, males under 50 had a higher APC for distant CRC than females, while females aged 50-74 experienced a steeper increase in distant CRC than males.

CONCLUSION

We report a marked increase in the incidence of CRC over time in Saudi Arabia, affecting men and women across all age groups and disease stages at diagnosis. Our findings underscore the need to identify underlying risk factors and to develop and implement effective prevention policies and strategies, including screening programs to facilitate early detection and treatment.

Preoperative geriatric assessment to predict functional outcome after major urologic operations: Results from a multicenter study

INTRODUCTION

Major urological tumor surgery entails a severe risk of unexpected adverse events, persistent functional deterioration, and death in older patients. The Erlangen Index (EI) geriatric assessment tool has previously been shown to predict incomplete functional recovery following major urological tumor surgery in an elderly patient collective. We prospectively evaluated assessment tools including EI in a multicenter setting.

MATERIALS AND METHODS

A total of 340 patients over the age of 65 were assessed prospectively before and after cystectomy, prostatectomy, or renal tumor surgery at three academic centers in Germany and Austria. Endpoints were long-term functional deterioration (Activities of daily living (ADL) measured by Barthel-Index) at day 30 and day 180, and mortality at day 180.

RESULTS

In this study 58 (17.0 %) patients underwent cystectomy, 140 (41.2 %) prostatectomy and 142 (41.8 %) a kidney tumor operation. Mean age was 74.8 years. ADL impairment as a measure of incomplete recovery at day 30 and 180 after surgery were recorded in 47.6 % and 37.4 % of cases, respectively. The EI showed good sensitivity for mortality at day 180 (reference cohort: 85 %, validation center 1: 100 %, validation center 2: 50 %) and for ADL impairment at day 180 (reference cohort 75.4 %, validation center 1 72.3 %, validation center 2 83.3 %).

CONCLUSION

Elderly patients with a poor performance status have a high risk of persistent functional deterioration. Data from this multicenter external validation trial confirms the EI as an accurate and reliable tool to identify patients with high risk of mortality or persistent postoperative functional impairment.

Single-drug Chemotherapy Plus Immunotherapy as First-line Treatment for Stage Ⅳ Non-small Cell Lung Cancer Elderly Patients: A Phase II Clinical Trial UNICORN Study

INTRODUCTION

Lung cancer remains the most common malignancy and the leading cancer-related death among the elderly in China, which deserves more research attention. Immunotherapy combined with platinum-based doublet chemotherapy has been approved as the standard treatment for advanced non-small cell lung cancer (NSCLC) patients who are devoid of specific gene mutations or fusions. Given that patients with NSCLC over the age of 65 typically exhibit declining organ function and physical condition, they often showed reduced tolerance for this rigorous treatment regimen. However, the KEYNOTE-042 study illuminated a promising pathway: in patients testing positive for programmed death-ligand 1 (PD-L1), immunotherapy alone has demonstrated a superior overall survival (OS) compared to platinum-based doublet chemotherapy. This suggests that moderating the intensity of chemotherapy and prioritizing immunotherapy may be a gentler alternative in elderly demographic.

PATIENTS AND METHODS

This multicenter phase II clinical trial named UNICORN aimed to enroll 49 patients aged 65 and older, utilizing paclitaxel or nab-paclitaxel for those with squamous NSCLC, and pemetrexed for those diagnosed with lung adenocarcinoma. The treatment protocol entails 4 cycles of serplulimab plus chemotherapy followed by an extended regimen of serplulimab maintenance, spanning a total of 35 cycles. Primary endpoints of this study are progression-free survival (PFS), disease control rate (DCR) and the secondary endpoints are OS, objective control rate (ORR) and safety metrics.

CONCLUSION

This is the first study to evaluate the efficacy and safety of serplulimab combined with either paclitaxel or pemetrexed in elderly treatment-naïve patients with stage IV NSCLC whose PD-L1 are positive.

Integrated approach to reducing polypharmacy in older people: exploring the role of oxidative stress and antioxidant potential therapy

Increased life expectancy, attributed to improved access to healthcare and drug development, has led to an increase in multimorbidity, a key contributor to polypharmacy. Polypharmacy is characterised by its association with a variety of adverse events in the older persons. The mechanisms involved in the development of age-related chronic diseases are largely unknown; however, altered redox homeostasis due to ageing is one of the main theories. In this context, the present review explores the development and interaction between different age-related diseases, mainly linked by oxidative stress. In addition, drug interactions in the treatment of various diseases are described, emphasising that the holistic management of older people and their pathologies should prevail over the individual treatment of each condition.

Colorectal cancer in older adults after the USPSTF's 2008 updated screening recommendation

BACKGROUND

Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.

METHODS

We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65-74).

RESULTS

There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = -4.0, -2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = -13.9 cases/100,000 population; C.I. = -22.6, -5.1) and mortality rates (Est. = -5.6 deaths/100,000 population; C.I. = -10.1, -1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.

DISCUSSION

The USPSTF's 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

Explainable Machine Learning Models Using Robust Cancer Biomarkers Identification from Paired Differential Gene Expression

In oncology, there is a critical need for robust biomarkers that can be easily translated into the clinic. We introduce a novel approach using paired differential gene expression analysis for biological feature selection in machine learning models, enhancing robustness and interpretability while accounting for patient variability. This method compares primary tumor tissue with the same patient's healthy tissue, improving gene selection by eliminating individual-specific artifacts. A focus on carcinoma was selected due to its prevalence and the availability of the data; we aim to identify biomarkers involved in general carcinoma progression, including less-researched types. Our findings identified 27 pivotal genes that can distinguish between healthy and carcinoma tissue, even in unseen carcinoma types. Additionally, the panel could precisely identify the tissue-of-origin in the eight carcinoma types used in the discovery phase. Notably, in a proof of concept, the model accurately identified the primary tissue origin in metastatic samples despite limited sample availability. Functional annotation reveals these genes' involvement in cancer hallmarks, detecting subtle variations across carcinoma types. We propose paired differential gene expression analysis as a reference method for the discovering of robust biomarkers.

Progress in Precision Medicine for Head and Neck Cancer

This paper presents a comprehensive comparative analysis of biomarkers for head and neck cancer (HNC), a prevalent but molecularly diverse malignancy. We detail the roles of key proteins and genes in tumourigenesis and progression, emphasizing their diagnostic, prognostic, and therapeutic relevance. Our bioinformatic validation reveals crucial genes such as AURKA, HMGA2, MMP1, PLAU, and SERPINE1, along with microRNAs (miRNA), linked to HNC progression. OncomiRs, including hsa-miR-21-5p, hsa-miR-31-5p, hsa-miR-221-3p, hsa-miR-222-3p, hsa-miR-196a-5p, and hsa-miR-200c-3p, drive tumourigenesis, while tumour-suppressive miRNAs like hsa-miR-375 and hsa-miR-145-5p inhibit it. Notably, hsa-miR-155-3p correlates with survival outcomes in addition to the genes RAI14, S1PR5, OSBPL10, and METTL6, highlighting its prognostic potential. Future directions should focus on leveraging precision medicine, novel therapeutics, and AI integration to advance personalized treatment strategies to optimize patient outcomes in HNC care.

Interdisciplinary provider visits attenuate relationship between patient concerns and distress in older adults with cancer

PURPOSE

This study examined the relationship between multidimensional patient concerns and anxiety and depression in a national sample of older adults with cancer (OACs ≥ 65 years) and the buffering effect of visiting providers across disciplines (e.g., oncology, allied health, primary care, mental health) on these relationships.

METHODS

Participants completed a cross-sectional survey through the Cancer Support Community's Cancer Experience Registry (CER), an online community-based research initiative. Eligible participants were 65 years and older and diagnosed with cancer in the past five years. Participants completed self-report measures of (1) the severity of their concerns across multiple domains, (2) anxiety and depression, and (3) whether they received care for "symptoms and side effects" from various providers.

RESULTS

The sample consisted of 277 OACs; 45% endorsed elevated anxiety and 31% endorsed elevated depression. The most severe concerns were in the domains of body image and healthy lifestyle and symptom burden and impact. More severe concerns were associated with higher levels of anxiety and depression. The relationship between concern severity and distress was weaker in OACs who saw a palliative care, mental health, physical or occupational therapy provider, pharmacist, or primary care provider relative to OACs who did not. A visit with an oncology provider did not moderate most relationships between concerns and distress.

CONCLUSIONS

The relationship between OACs' concerns and distress was attenuated by treatment with a specialty provider. Interdisciplinary team care may be a vital component of comprehensive patient-centered care for OACs.