The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals

Annals of Surgical Oncology

AUTHOR CONTRIBUTIONS Conceptualization: SP, GM, CB, RS. Data curation: SP, AC, FC, MDP, GL, ES. Formal Analysis: SP, FC, MDP, GL, ES. Funding acquisition: CB, FC. Investigation: SP, GM. Methodology: SP, GM. Project administration: SP, RS, CB. Resources: SP, GM, RS. Supervision: RS, CB. Validation: SP, GM, CB, RS. Visualization: SP, GM, ES. Writing–original draft: All authors Writing–review & editing: All Authors.

Objective:To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance.Background:Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRIs) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well quantified.Materials and Methods:A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the Cancer of the Pancreas Screening (CAPS) goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals …

Scientific Reports

Acute kidney injury (AKI) following hyperthermic intraperitoneal chemotherapy (HIPEC) is common. Identifying patients at risk could have implications for surgical and anesthetic management. We aimed to develop a predictive model that could predict AKI based on patients’ preoperative characteristics and intraperitoneal chemotherapy regimen. We retrospectively gathered data of adult patients undergoing HIPEC at our health system between November 2013 and April 2022. Next, we developed a model predicting postoperative AKI using multivariable logistic regression and calculated the performance of the model (area under the receiver operating characteristics curve [AUC]) via tenfold cross-validation. A total of 412 patients were included, of which 36 (8.7%) developed postoperative AKI. Based on our multivariable logistic regression model, multiple preoperative and intraoperative characteristics were …

Cancer Research

Regulatory T cells (Tregs) contribute to the immunosuppressive nature of pancreatic ductal adenocarcinoma (PDAC). Systemic depletion of Tregs can enhance anti-tumor T cell immunity, but can also cause unwanted autoimmune complications. A tumor-specific Treg-targeted therapy that effectively and safely enhances anti-tumor immunity for PDAC treatment remains an unmet need. We have recently found that αvβ5 integrin is expressed on Tregs that reside in the PDAC, but not those in the spleen, suggesting that the integrin can serve as a targetable marker for tumor-resident Tregs. Indeed, long-term treatment with the iRGD tumor-penetrating peptide, which effectively targets αvβ5+ cells in PDAC tissue, depleted Tregs in a tumor-specific manner leading to a significant expansion of CD8+ T cells in transgenic and syngeneic PDAC mouse models. αvβ5+ Tregs were induced from both naïve CD4+ T cells and …

Annals of Surgical Oncology

Any good prognosis of patients with pancreatic cancer (PC) passes through a combination of surgery and chemotherapy. For nonresectable, nonmetastatic patients, the therapeutic journey has historically been represented by chemotherapy, and hopefully, surgery. However, for resectable PC, this sequential approach has been challenged by neoadjuvant therapy in recent years. 1 Since the European Study Group of Pancreatic Cancer (ESPAC) trials, adjuvant chemotherapy (AT) has become the gold standard after upfront resection of resectable PC. These trials focused on the type, schedule, and survival advantages of the different types of chemotherapy. These clinical trials are based on the obviousness that patients access AT. However, clinical trials may not correspond to the real world and the percentage of patients accessing AT has been reported to range from 30% to 50%. 2 This ultimately results in half of …

645Background: Pancreas cancer (PC) is the third leading cause of cancer death in the United States. Canopy Cancer Collective (CCC) was founded in 2019 given the urgent need for improvements in survival and patient experience. Through interdisciplinary teams inclusive of patients, 14 care centers formed a learning health network (LHN) to share data and best practices to accelerate improvements in PC care delivery and outcomes. Methods: In October 2022, LHN representatives gathered to establish aims for the year. Through a consensus process, the LHN arrived at four aims to achieve by December 31, 2023. The aims are: Patients screened for 1) clinical trials will increase from 39% to 100%, 2) palliative care will increase from 30% to 100%, 3) enzyme need will increase from 37% to 100%, and 4) goals of care assessed will increase from 57% to 100% . CCC established measures to guide improvement …

Official journal of the American College of Gastroenterology| ACG

METHODS:HRI (subjects with a family history or mutation carriers with/without a family history were enrolled in 18 centers). They underwent annual magnetic resonance with cholangiopancreatography or endoscopic ultrasound (NCT04095195).RESULTS:During the study period (June 2015–September 2022), 679 individuals were enrolled. Of these, 524 (77.2%) underwent at least baseline imaging, and 156 (29.8%) with at least a 3-year follow-up or pancreatic malignancy/premalignancy-related events, and represented the study population. The median age was 51 (interquartile range 16) years. Familial PC cases accounted for 81.4% of HRI and individuals with pathogenic variant for 18.6%. Malignant (n= 8) and premalignant (1 PanIN3) lesions were found in 9 individuals. Five of these 8 cases occurred in pathogenic variant carriers, 4 in familial PC cases (2 tested negative at germline testing and 2 others were …

arXiv preprint arXiv:2402.15030

Multi-gene panel testing allows efficient detection of pathogenic variants in cancer susceptibility genes including moderate-risk genes such as ATM and PALB2. A growing number of studies examine the risk of breast cancer (BC) conferred by pathogenic variants of such genes. A meta-analysis combining the reported risk estimates can provide an overall age-specific risk of developing BC, i.e., penetrance for a gene. However, estimates reported by case-control studies often suffer from ascertainment bias. Currently there are no methods available to adjust for such ascertainment bias in this setting. We consider a Bayesian random-effects meta-analysis method that can synthesize different types of risk measures and extend it to incorporate studies with ascertainment bias. This is achieved by introducing a bias term in the model and assigning appropriate priors. We validate the method through a simulation study and apply it to estimate BC penetrance for carriers of pathogenic variants of ATM and PALB2 genes. Our simulations show that the proposed method results in more accurate and precise penetrance estimates compared to when no adjustment is made for ascertainment bias or when such biased studies are discarded from the analysis. The estimated overall BC risk for individuals with pathogenic variants in (1) ATM is 5.77% (3.22%-9.67%) by age 50 and 26.13% (20.31%-32.94%) by age 80; (2) PALB2 is 12.99% (6.48%-22.23%) by age 50 and 44.69% (34.40%-55.80%) by age 80. The proposed method allows for meta-analyses to include studies with ascertainment bias resulting in a larger number of studies included and thereby more …

Cancer Research

Introduction: Pancreatic cancer is characterized by desmoplastic, fibroinflammatory stroma. The crosstalk between cancer cells and their surrounding tumor microenvironment (TME) promotes disease progression, metastasis, and chemoresistance. We identified MICAL2 as a super-enhancer-associated gene in pancreatic cancer. MICAL2 (molecule interacting with Cas-L) proteins are flavin monooxygenases that promote actin depolymerization and indirectly regulate SRF transcription. In other work, we have found that MICAL2 promotes pancreatic cancer growth and progression. This study evaluated how MICAL2 pancreatic cancer cell expression modulates the PDAC tumor microenvironment. Methods: RNA-Seq analysis performed on human pancreas cancer cells (AsPC-1) before and after MICAL2 KD revealed differential regulation of IL-1α. We validated the expression of IL-1α in multiple human and mouse …

Journal of Gastrointestinal Surgery

BackgroundSarcopenic obesity and muscle attenuation have been associated with survival in patients with borderline resectable and advanced pancreatic ductal adenocarcinoma (PDA); however, these relationships are unknown for patients with resectable PDA. This study examined the associations between skeletal muscle and adipose tissue as measured on baseline computed tomography (CT) and the overall survival (OS) of participants with resectable PDA in a secondary analysis of the Southwest Oncology Group S1505 clinical trial (identifier: NCT02562716).MethodsThe S1505 phase II clinical trial enrolled patients with resectable PDA who were randomized to receive modified FOLFIRINOX or gemcitabine and nab-paclitaxel as perioperative chemotherapy, followed by surgical resection. Baseline axial CT images at the L3 level were analyzed with externally validated software, and measurements were …

Annals of Surgical Oncology

BackgroundPreoperative nutritional status and body structure affect short-term prognosis in patients undergoing major oncologic surgery. Bioimpedance vectorial analysis (BIVA) is a reliable tool to assess body composition. Low BIVA-derived phase angle (PA) indicates a decline of cell membrane integrity and function. The aim was to study the association between perioperative PA variations and postoperative morbidity following major oncologic upper-GI surgery.Patients and MethodsBetween 2019 and 2022 we prospectively performed BIVA in patients undergoing surgical resection for pancreatic, hepatic, and gastric malignancies on the day before surgery and on postoperative day (POD) 1. Malnutrition was defined as per the Global Leadership Initiative on Malnutrition criteria. The PA variation (ΔPA) between POD1 and preoperatively was considered as a marker for morbidity. Uni and multivariable logistic …

Annals of Surgical Oncology

BackgroundLittle is known about adjuvant therapy (AT) omission and use outside of randomized trials. We aimed to assess the patterns of AT omission and use in a cohort of upfront resected pancreatic cancer patients in a real-life scenario.MethodsFrom January 2019 to July 2022, 317 patients with resected pancreatic cancer and operated upfront were prospectively enrolled in this prospective observational trial according to the previously calculated sample size. The association between perioperative variables and the risk of AT omission and AT delay was analyzed using multivariable logistic regression.ResultsEighty patients (25.2%) did not receive AT. The main reasons for AT omission were postoperative complications (38.8%), oncologist’s choice (21.2%), baseline comorbidities (20%), patient’s choice (10%), and early recurrence (10%). At the multivariable analysis, the odds of not receiving AT increased …

Journal of Medical Genetics

BackgroundSurveillance for pancreatic ductal adenocarcinoma (PDAC) is recommended for high-risk individuals with genetic variants in PDAC-associated genes and/or family history. Surveillance uptake and adherence may depend on the perception of PDAC risk and cancer worry. We aimed to determine PDAC risk perception in at-risk individuals and assess factors associated with PDAC surveillance uptake.MethodsAt-risk individuals identified from a prospective academic registry were sent a survey electronically. PDAC risk perception, cancer worry and surveillance uptake were surveyed. Factors associated with increased risk perception and surveillance were assessed. Five-year PDAC risk was calculated using the PancPRO risk assessment model, and correlation with subjective risk assessment was assessed.ResultsThe overall survey response rate was 34% (279/816). The median perceived PDAC risk …

Statistics in Medicine

It is increasingly common to encounter prediction tasks in the biomedical sciences for which multiple datasets are available for model training. Common approaches such as pooling datasets before model fitting can produce poor out‐of‐study prediction performance when datasets are heterogeneous. Theoretical and applied work has shown multistudy ensembling to be a viable alternative that leverages the variability across datasets in a manner that promotes model generalizability. Multistudy ensembling uses a two‐stage stacking strategy which fits study‐specific models and estimates ensemble weights separately. This approach ignores, however, the ensemble properties at the model‐fitting stage, potentially resulting in performance losses. Motivated by challenges in the estimation of COVID‐attributable mortality, we propose optimal ensemble construction, an approach to multistudy stacking whereby we jointly …

Cancer Research

Immunotherapy has had very limited success in pancreatic cancer, due to its low mutational burden and immunosuppressive microenvironment. Our approach consists in redirecting pre-existing antiviral immunity against pancreatic tumors by delivering viral antigens using the tumor penetrating peptide iRGD .This peptide, targets the tumor vasculature through αv integrins and neuropilin-1, delivering conjugated or co-administered cargo to tumors. Here we used mouse cytomegalovirus (CMV) as an infection model. CMV is a β-herpesvirus that induces a strong T-cell response in mice and humans, comprising >10% of all circulating CD4 and CD8 T cells mostly with effector-memory phenotype. Importantly, human CMV infects over 60% of the world’s population rendering it a suitable candidate for translation. Mice latently infected with CMV were orthotopically implanted with KPC pancreatic tumor cells and treated …

Journal of the National Comprehensive Cancer Network

Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome resulting from a reciprocal translocation between chromosomes 9 and 22 [t9;22] that gives rise to a BCR::ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase in developed countries. Tyrosine kinase inhibitor (TKI) therapy is a highly effective treatment option for patients with chronic phase–CML. The primary goal of TKI therapy in patients with chronic phase–CML is to prevent disease progression to accelerated phase–CML or blast phase–CML. Discontinuation of TKI therapy with careful monitoring is feasible in selected patients. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase–CML.

Journal of the National Comprehensive Cancer Network

The NCCN Guidelines for Kidney Cancer provide multidisciplinary recommendations for diagnostic workup, staging, and treatment of patients with renal cell carcinoma (RCC). These NCCN Guidelines Insights focus on the systemic therapy options for patients with advanced RCC and summarize the new clinical data evaluated by the NCCN panel for the recommended therapies in Version 2.2024 of the NCCN Guidelines for Kidney Cancer.

Journal of the National Comprehensive Cancer Network

Background Pathologist-initiated genomic test ordering, or reflex testing, could speed cancer care delivery and improve patient outcomes. We developed the Multi-TEAMSystems Framework Precision Oncology Reflex Testing (TEAMSPORT) toolkit to support implementation of reflex testing. The toolkit promotes use of: a facilitator, relational coordination diagnostics, genomic testing champions, team meeting redesign, and audit and feedback of NCCN guideline-recommended testing. Few established measures of NCCN guideline-recommended testing exist to support feedback to teams. We sought to create and test measures that could be derived from institutional data. Methods We identified existing measures of adherence to guideline-recommended genomic testing from the National Quality Forum database and modeled new measures after them. We scanned NCCN guidelines and the biomarker compendia to …

Journal of the National Comprehensive Cancer Network

Background Patients with acute promyelocytic leukemia (APML) frequently present with complications secondary to disseminated intravascular coagulopathy, including hemorrhage. Thrombotic events at presentation, including stroke, remain less common, with leukocytosis described as the predominant risk factor. Few cases in the literature have been reported in patients with APML and leukopenia generally and no cases in the microgranular variant specifically. Here, we describe a case of a patient with microgranular variant APML with leukopenia without thrombocytopenia or anemia presenting as recurrent strokes. Case Report A 61-year-old woman with breast cancer (microinvasive ductal carcinoma) s/p mastectomy and adjuvant radiation 3 years prior (on adjuvant letrozole) and epilepsy (on lamotrigine for 10 years) presented with right-sided weakness and numbness initially thought to be recurrence of a …

Journal of the National Comprehensive Cancer Network

Screening for diagnosis and treatment of histological high-grade squamous intraepithelial lesions (hHSIL) using anal cytology (aCyt) or HPV testing tests, alone or in pairs, can improve screening to prevent cancer. We analyzed data for 201 men who have sex with men with complete data for high-risk (hr) HPV testing (APTIMA and Hybrid Capture 2 (HC2)), Dacron aCyt (HRA-day aCyt), and High-Resolution Anoscopy (HRA) and biopsy. Also, each had> 1 historical aCyt performed by other providers 6 to 30 months before the HRA. Multivariable fully-adjusted logistic regression models estimated odds ratios (ORs) and 95% CI, and area under receiver operating characteristic curves (AUC) assessed the discriminative accuracy of single and paired-test strategies to predict hHSIL and ASC-US to no intraepithelial lesions (NIL) for HRA-day aCyt and> ASC-US to NIL for historical aCyt. Single and two-test strategies using …

Journal of the National Comprehensive Cancer Network

The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.

Journal of the National Comprehensive Cancer Network

The treatment of Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) has evolved to include several new options. The NCCN Guidelines for WM/LPL provide a framework on which to base decisions regarding diagnosis, treatment, assessment of response to treatment, and follow-up of both newly diagnosed and previously treated WM/LPL.

Journal of the National Comprehensive Cancer Network

Background Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population. Patients and Methods This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion …

Journal of the National Comprehensive Cancer Network

Background Radiation therapy (RT) can improve survival in oligometastatic prostate cancer (OMPC) patients (pts). Reports implicate immune system contribution to both local tumor control and systemic regression of metastases. Understanding molecular and immune drivers of clinical responses in irradiated OMPC pts may elucidate mechanisms of RT-driven antitumor immune activity. Methods Prospective samples from consented pts with OMPC (de novo/oligorecurrent) receiving RT included baseline (pre-RT) and 3 post-RT blood samples (RT end, 3-, 6-months). Peripheral blood mononuclear cells (PBMC) were obtained at each timepoint. PBMC sample barcoding and antibody labeling was performed prior to analysis by mass cytometry by time of flight (CyTOF). Data were debarcoded/analyzed using standard deconvolution/gating/clustering algorithms. Wilcoxon signed-rank tests identified longitudinal …

Journal of the National Comprehensive Cancer Network

Background A pancreatic cancer (PC) diagnosis can lead to emotional distress and overwhelm patients, making it difficult to understand and manage treatment journeys. Patients have different preferences for receiving education and communication, hence personalizing this can alleviate barriers to patient engagement. We hypothesize that utilizing digital tools to evaluate learning preferences and emotional states will provide the opportunity to improve the patient experience and personalize education at the point of care. Methods This IRB-exempt study included 50 non-metastatic PC patients who received multidisciplinary care and was performed as part of an adult learning health network (Canopy) project. Phase 1 utilized the CANCER101 Learning Preference Barometer (LPB) and Emotional Journey Barometer (EJB) to assess patient learning preferences and emotional state at baseline and follow-up (Figure 1 …

Journal of the National Comprehensive Cancer Network

Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of patients with advanced melanoma. Circulating tumor cells (CTCs) can provide prognostic information in cancer patients including response to therapies, risk of progression, and overall survival. CTC biomarkers such as Human Leukocyte Antigen Class–I (HLA-I) and Programmed Death Ligand–1 (PD-L1) may give insight into how a patient’s disease evolves throughout ICI treatment. Methods In our study, we utilize microfluidic exclusion-based sample processing (ESP) technology to isolate and characterize CTCs from patients with advanced-stage melanoma. Capture efficiency and specificity of antibodies against melanoma associated proteins, NG2 (MCSP) and CD146 (MCAM), on two different melanoma cell lines (Mel624, SK-Mel28, and M21) was confirmed using our fully automated technology. Serial CTC samples from …

Journal of the National Comprehensive Cancer Network

Vulvar cancer is annually diagnosed in an estimated 6,470 individuals and the vast majority are histologically squamous cell carcinomas. Vulvar cancer accounts for 5% to 8% of gynecologic malignancies. Known risk factors for vulvar cancer include increasing age, infection with human papillomavirus, cigarette smoking, inflammatory conditions affecting the vulva, and immunodeficiency. Most vulvar neoplasias are diagnosed at early stages. Rarer histologies exist and include melanoma, extramammary Paget’s disease, Bartholin gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma, and sarcoma. This manuscript discusses recommendations outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treatments, surveillance, systemic therapy options, and gynecologic survivorship.

Journal of the National Comprehensive Cancer Network

Mesothelioma is a rare cancer that originates from the mesothelial surfaces of the pleura and other sites, and is estimated to occur in approximately 3,500 people in the United States annually. Pleural mesothelioma is the most common type and represents approximately 85% of these cases. The NCCN Guidelines for Mesothelioma: Pleural provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with pleural mesothelioma. These NCCN Guidelines Insights highlight significant updates to the NCCN Guidelines for Mesothelioma: Pleural, including revised guidance on disease classification and systemic therapy options.

Journal of the National Comprehensive Cancer Network

Background Pancreatic adenocarcinoma (PC) is a highly lethal malignancy with a survival rate of only 12%. Surveillance is recommended for high-risk individuals (HRIs), but it is not widely adopted. To address this unmet clinical need and drive early diagnosis research, we established the Pancreatic Cancer Early Detection (PRECEDE) Consortium. Methods PRECEDE is a multi-institutional international collaboration that has undertaken an observational prospective cohort study. Individuals (aged 18–90 years) are enrolled into 1 of 7 cohorts based on family history and pathogenic germline variant (PGV) status. From April 1, 2020, to November 21, 2022, a total of 3,402 participants were enrolled in 1 of 7 study cohorts, with 1,759 (51.7%) meeting criteria for the highest-risk cohort (Cohort 1). Cohort 1 HRIs underwent germline testing and pancreas imaging by MRI/MR …

Journal of the National Comprehensive Cancer Network

Background: There has been a significant increase in early-onset cancers, defined as cancer in adults under age 50, especially gastrointestinal (GI) cancers. Individual risk factors contributing to early-onset cancer diagnoses are mainly unknown. An initiative of the Cancer Moonshot, improved access to genetic testing is needed to improve patient outcomes. We examined potential risk factors (eg, social determinants of health, germline multigene panel testing, BMI, alcohol use, insurance) in patients with early-onset GI cancers (colon, rectal, appendix, pancreas) in SC Methods: The electronic medical record (EMR) was retrospectively reviewed (1/1/2020–8/30/2023) to identify patients with newly diagnosed early-onset GI cancer at a community oncology clinic in SC We determined cases using an electronic report (ie, age, new patients, diagnosis). Eligibility criteria was confirmed by EMR review, and data was …

Journal of the National Comprehensive Cancer Network

Introduction Head and neck squamous cell carcinoma (HNSCC) is an aggressive and genetically complex group of tumors affecting nearly 600,000 people worldwide each year. Moreover, HNSCC treatment is multimodal and often requires both surgical resection and adjuvant radiation therapy (RT) or chemoradiation therapy (CRT). Currently, the National Cancer Center Network recommends initiating postoperative radiation therapy (PORT) within 6 weeks after surgery to improve survival outcomes and decrease rates of recurrence. 1 However, recent trends suggest a decreasing national compliance to this guideline, as most patients with HNSCC initiate PORT beyond this time frame. 2 Given the increasing delay to adjuvant therapy, this study seeks to identify what specific factors prevent timely PORT initiation for HNSCC patients at Froedtert Hospitals and the Medical College of Wisconsin, as well as potential …

Journal of the National Comprehensive Cancer Network

Background: Parallel panel germline and somatic genetic testing of all patients with ovarian cancer (OC) can identify more pathogenic variants (PVs) that would benefit from PARP inhibitor (PARPi) therapy, and allow for precision prevention in unaffected relatives with PVs. In this study, we estimate the cost-effectiveness and population impact of parallel panel germline and somatic BRCA testing of all patients with OC incorporating PARPi therapy in the United Kingdom and the United States compared with clinical criteria/family history (FH)–based germline BRCA testing. We also evaluate the cost-effectiveness of multigene panel germline testing alone. Methods: Microsimulation cost-effectiveness modeling using data from 2,391 (UK: n= 1,483; US: n= 908) unselected, population-based patients with OC was used to compare lifetime costs and effects of panel germline and somatic BRCA testing of all OC cases (with …

Journal of the National Comprehensive Cancer Network

Background Loneliness, a subjective feeling of being isolated, is a prevalent concern for elderly people and more so among cancer survivors because a cancer diagnosis and its subsequent treatment may result in long-term adverse health effects. This study aimed to examine the association of loneliness and mortality risk among cancer survivors in the United States. Methods We identified a longitudinal cohort of cancer survivors aged ≥50 years from the nationally representative panel surveys of the 2008–2018 Health and Retirement Study. Follow-up for vital status was through 2020. Loneliness was measured using an 11-item abbreviated version of the UCLA Loneliness Scale (Version 3), including questions about lacking companionship and feeling isolated from others. A score was assigned according to the responses to each question, with 1 for least lonely, 2 for moderately lonely …

Journal of the National Comprehensive Cancer Network

Background Metastatic triple-negative breast cancer (TNBC) is aggressive with a poor median overall survival (OS), ranging from 8 to 13 months. There exists considerable heterogeneity in the survival at the individual patient level. To better understand the survival heterogeneity and improve risk stratification, our study aims to identify the factors influencing survival utilizing a large patient sample in the National Cancer Database (NCDB). Methods Women diagnosed with metastatic TNBC from 2010 to 2020 in the NCDB were included. Demographic, clinic-pathological, treatment data, and overall survival outcomes were collected. Kaplan-Meier curves were used to estimate OS and the log-rank test to identify OS differences between groups for each variable in the univariate analysis. The Cox proportional hazard model with backward elimination was used to identify factors affecting OS in the multivariate analysis …

Journal of the National Comprehensive Cancer Network

The NCCN Guidelines for Merkel Cell Carcinoma (MCC) provide recommendations for diagnostic workup, clinical stage, and treatment options for patients. The panel meets annually to discuss updates to the guidelines based on comments from expert review from panel members, institutional review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new page for locally advanced disease in the setting of clinical node negative status, entitled “Clinical N0 Disease, Locally Advanced MCC.” This new algorithm page addresses locally advanced disease, and the panel clarifies the meaning behind the term “nonsurgical” by further defining locally advanced disease. In addition, the guideline includes the management of in-transit disease and updates to the systemic therapy options.