While nurses report challenges with the manual administration of large-volume subcutaneous drugs, these challenges and potential solutions are not captured in the literature. In this cross-sectional study, 45 nurses with experience administering large-volume subcutaneous biologics completed an 18-item survey about preferences for syringes vs. on-body delivery systems. 100% responded that an on-body delivery system seemed easy to learn and use and preferable to syringes. In a drug delivery scenario including comprehensive administration details and assuming equivalent safety and efficacy, 97.78% preferred the on-body delivery system to a daratumumab/hyaluronidase syringe. In the total sample, this preference was primarily attributed to (1) reduced nurse effort due to hands-free delivery, (2) decreased patient pain due to a thinner needle, (3) elimination of needlestick injuries due to a hidden needle, and (4) increased clinic efficiency due to hands-free delivery. 95.56% felt that the on-body delivery system would improve clinic throughput better than syringes. Nurses reported that an on-body delivery system would be easy to learn and use and would improve clinic efficiency and safety. They underscored the importance of decreasing nurse physical burden, needlestick injuries, and patient needle phobia. Contrary to the assumption that speed is paramount, nurses prioritized reducing effort, enhancing administration safety, and improving patient comfort over injection speed.

For papillary thyroid cancer (PTC) patients, no consensus has been reached for the impact of diagnosis-to-treatment interval (DTI) on patient survival outcomes. We evaluated the impact of DTI on prognosis among patients with PTC.

Patients diagnosed as PTC were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The initial treatment strategies include surgery, radiation therapy, chemotherapy, hormone, immunotherapy, and/or active surveillance according to the SEER. Patients were grouped as follows: (I) DTI 0 (interval < 1 month or immediate treatment), (II) DTI 1-3 months, (III) DTI 4-5 months, and (IV) DTI ≥6 months.

A total of 168,969 patients with PTC were included in this cohort study. Median follow-up time was 84.0 months. No significant overall survival (OS) difference was observed between patients with immediate treatment and DTI 1-3 months. However, DTI 4-5 months and ≥6 months were associated with poorer OS compared to patients with immediate treatment. Although Kaplan-Meier analysis suggested slight TCSS differences between the delayed and immediate treatment groups, these disappeared after adjusting for tumor characteristics and treatment factors.

A short-term delay (1-3 months) had no significant impact on OS, whereas more than 3 months of DTI resulted in poorer OS. Notably, delayed treatment had no impact on TCSS. These findings suggest that short-term delays are unlikely to affect survival, supporting decision-making flexibility for patients with low-risk PTC within three months of diagnosis.

Prolonged treatment delay often leads to adverse cancer prognosis. However, the demographic and clinical predictors of higher treatment delay burden in the Philippines have not been thoroughly evaluated.

We conducted a population-based retrospective cohort study on patients diagnosed with common cancers who received cancer treatment, to quantify the burden of prolonged treatment delay in the Philippines among this population. We analyzed 20,654 patients with common cancers from the Department of Health-Rizal Cancer Registry. The Poisson regression model with robust variance was used to identify demographic and clinical predictors of prolonged treatment delay. In addition, we examined the associations among those receiving different initial treatment types, including surgery, radiotherapy, and chemotherapy.

We found 35.1 % of the studied cancer patients experienced initial treatment delay of more than 30 days, as well as 25.2 % and 20.0 % experiencing treatment delays exceeding 60 and 90 days, respectively. We found higher risk of prolonged treatment delay of more than 90 days in those with 0-19 years of age at diagnosis, male gender, cancer treatment at non-private hospitals, diagnoses during the 1990s, more advanced cancer stages, and non-surgical initial treatments. For patients with surgery as the initial treatment, younger age at cancer diagnosis was not significantly associated with increased burden of prolonged treatment delay, unlike for those initially treated with radiotherapy or chemotherapy.

By identifying the characteristics of treated cancer patients with higher risk of protracted treatment delay, our findings will inform the national cancer control program to especially target those patients for treatment delay reduction.

Cancer is a major health issue, particularly in low- and middle-income countries where 70% of cancer deaths occur. Stigma and barriers to screening and treatment lead to poor outcomes. We conducted structured searches of PubMed, Embase, MEDLINE, CINAHL, and CABI Global Health databases according to PRISMA-ScR guidelines. Searches used keywords related to (1) Africa, (2) cancer, and (3) stigma. We then screened to finalize a list of research manuscripts, dissertations, theses, and conference abstracts using quantitative, qualitative, or mixed methods to explore cancer stigma in Africa. This review focused on non-cervical cancers. Breast and cervical cancers have distinct stigma-related experiences due to awareness, screening, and sociocultural perceptions. Including cervical cancer risks dilutes the specificity and depth of findings. The review included 53 studies that linked stigma and cancer in Africa to physical symptoms, appearance changes, misconceptions, and emotional challenges, hindering care and worsening treatment outcomes. Cancer-related stigma negatively impacts screening and treatment engagement in Africa. The lack of intervention studies underscores the need for evidence-based strategies to reduce stigma. Future efforts should reduce barriers to cancer care, enhance public awareness, and implement policy changes to improve outcomes.

Treatment delay in breast cancer care represents a significant concern in oncology, potentially impacting patient survival outcomes. While various factors can contribute to delayed treatment initiation, the quantitative relationship between specific delay intervals and survival remains incompletely understood in breast cancer management. Our study aims to explore the impact of treatment delays on survival outcomes in breast cancer. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases, covering publications from 2000 to 2025. From an initial 6222 records, 18 eligible studies comprising 25 cohorts were included. Hazard ratios (HRs) for all-cause and breast cancer-specific mortality were extracted or calculated for treatment delays of 4, 8, and 12 weeks. Random-effects meta-analyses were performed, and heterogeneity and publication bias were assessed using I2 statistics, funnel plots, and Egger's test. This meta-analysis revealed progressively increasing mortality risks with longer treatment delays. For all-cause mortality, HRs increased from 1.12 (95% CI 1.08-1.15) at 4 weeks to 1.25 (95% CI 1.17-1.33) at 8 weeks, and 1.39 (95% CI 1.26-1.53) at 12 weeks. Breast cancer-specific mortality showed more pronounced effects, with HRs of 1.20 (95% CI 1.06-1.36), 1.43 (95% CI 1.11-1.84), and 1.71 (95% CI 1.18-2.49) for 4-, 8-, and 12-week delays, respectively. Analyses combining both survival outcomes demonstrated consistent risk elevation across all time intervals (4 weeks: HR = 1.12, 95% CI 1.09-1.16; 8 weeks: HR = 1.26, 95% CI 1.18-1.34; 12 weeks: HR = 1.41, 95% CI 1.29-1.55). While heterogeneity was significant (I2 = 54-92%), no substantial publication bias was detected. Delays in initiating breast cancer treatment are associated with significantly worse survival, particularly for cancer-specific mortality. Each additional 4-week delay increases the hazard of death by over 10%, underscoring the urgency of minimizing delays in diagnosis-to-treatment pathways. These findings have critical implications for healthcare systems, clinical decision-making, and public health policy.

The National Accreditation Program for Rectal Cancer (NAPRC) was established in 2017 to decrease rectal cancer treatment variation and improve oncologic outcomes. Initiating curative intent treatment <60 days of first evaluation is one NAPRC standard. We evaluated whether oncologic outcomes improved with timely treatment and factors associated with its receipt.

Using the NCDB, we identified stage I to III rectal cancer patients treated from 2004 to 2020 treated with curative-intent surgery. Patients were stratified into 2 cohorts (timely [<60 d], delayed [≥60 d]) for survival analysis and exploration of variables associated with timely treatment.

We included 117,459 patients with a median age of 61 years (interquartile range: 52 to 70 y). Most patients were male (61.1%), White (86.2%), Charlson 0 (77.1%) with stage II (33.5%) or III (44.3%) cancer treated with chemoradiation (58.1%), or surgery (27.0%) first. Timely treatment was associated with improved overall survival (OS; median OS: 153.26 vs. 128.59 m). Patients in the highest income bracket (odds ratio [OR] 1.30) with stage II (OR: 1.27) or III (OR: 1.50) cancer receiving neoadjuvant chemotherapy (OR: 2.24) or chemoradiation (OR: 1.73) as the first treatment received more timely treatment. Patients with Charlson ≥2 (OR: 0.83) of Black (OR: 0.56) or Hispanic (OR: 0.73) race received more delayed treatment (all P <0.01).

Timely rectal cancer treatment is associated with improved survival. Socioeconomic disparities limit timely treatment with attendant worse survival, supporting national homogenization of care. As multimodal care for rectal cancer becomes increasingly complex, timely treatment remains paramount.

Sociodemographic disparities in cancer care outcomes are often related to delayed or limited care access. However, it is unknown whether outcome differences persist after establishing high-level care. This study evaluated the relationship between rectal cancer outcomes and sociodemographic status at academic cancer centers.

A retrospective cohort study of patients with rectal cancer treated at academic cancer centers was conducted utilizing the National Cancer Database. Primary outcome was overall survival, while secondary outcomes included 30- and 90-day mortality, time from diagnosis to treatments, hospital readmission rates, and hospital length of stay.

Of the 127,023 patients, median age was 62.7 years (SD 11.92), 59.3% were male, 80.3% were white, and 39.4% presented with stage III disease. After adjustment, Black patients had the worst overall survival (HR 1.10, 95% CI 1.01-1.19, p = 0.016). Private insurance status conferred overall survival benefit (HR 0.66, 95% CI 0.58-0.75, p < 0.001) as well as the best protection against 30- and 90- day postoperative mortality (30-day OR 0.31, 95% CI 0.10-0.97, p = 0.044; 90-day OR 0.37, 95% CI 0.16-0.83, p = 0.015). Black patients experienced longer time to first treatment than their white counterparts, with a delay of 3.23 days (95% CI 1.87-4.58, p < 0.001).

This study demonstrated the existence of sociodemographic disparities even within the walls of academic institutions, where care should be evidence-based, standardized, comprehensive, and equitable. When analyzing causal pathways, delays in time to treatment initiation may be contributing to these outcomes, but may be modifiable.

Closed incision negative pressure therapy (ciNPT) with foam dressings has received broad recognition for its ability to support incision healing for a variety of surgical procedures. Over time, these dressings have evolved to include linear and 'area' shapes to better conform to different incision types and surface geometries. To address new studies on these configurations and provide guidance for dressing selection, an international, multidisciplinary panel of experts was convened. The panel reviewed recent publications on ciNPT with reticulated open cell foam (ROCF) dressings, shared their cases and experiences and engaged in roundtable discussions on benefits, drawbacks and technical challenges. Topics were ranked by importance and refined into potential consensus statements. These were shared for anonymous feedback, requiring 80% agreement for consensus. This manuscript establishes 12 consensus statements regarding risk factors supporting the use of ciNPT, conditions supporting preference of linear or area ciNPT dressings and tips for practical application of ciNPT with ROCF dressings. While this consensus panel expands on previous publications to aid clinicians' decision-making, further research is needed to refine recommendations and identify the strengths and limitations of ciNPT. Continued multidisciplinary collaboration will ensure ciNPT remains vital for improving surgical outcomes and patient care.

SARS-CoV-2 continues to spread across the world as a highly transmissible endemic disease. For many cancer patients, SARS-CoV-2 infection is unavoidable. It continues to disrupt cancer care, causing treatment delays and major psycho-socio-medical issues. At present, there is limited evidence on safe prescribing of anti-cancer therapy, and safe treatment restart following SARS-CoV-2 infection. We conducted a prospective cohort study involving 406 COVID-19-positive cancer patients across five UK cancer centres and collected data on delay durations, COVID-19 symptoms and mortality, to ascertain the effect of treatment interruptions. Patients were studied between May 2022 and March 2023, during which Omicron variants of SARS-CoV-2 were predominant. Mean treatment interruption was 12.7 days (standard deviation 47.3 days). Upon resuming anti-cancer therapy, 8.5% experienced COVID-19 symptom progression, and 1.2% succumbed to COVID-19-related mortality. Patients with haematological cancers had a 3.4-fold increased risk of severe symptoms at 4 weeks compared to solid tumour patients. Higher symptom burden at COVID-19 diagnosis was associated with a 3.0-fold increase in symptom severity at 4 weeks following treatment restart. At 8 weeks following restart, 2.1% had increased morbidity or mortality. We highlight the ongoing impact of COVID-19 on patients and cancer care, and the risk of resuming cancer treatments in patients with symptomatic COVID-19. Although the risk of mortality is relatively low upon treatment resumption, personalised approaches assessing cancer diagnosis and SARS-CoV-2 status are crucial. Treatments are also stopped due to other infectious conditions and our results could be reviewed in the context of yearly influenza pandemics.

Cancer patients with a pre-existing mental disorder or substance use disorder (SUD) have a poorer prognosis compared to other cancer patients, with suboptimal routes to diagnosis and treatment as possible contributing factors. Shorter intervals from suspicion of cancer to start of cancer treatment have been observed following the implementation of Cancer Patient Pathways (CPP) in the Nordic countries, which may have led to a better prognosis. We aimed to investigate whether incident cancer patients with and without pre-existing mental disorder or SUD were equally likely to be included in a CPP. We also investigated the associations between pre-existing mental disorder or SUD and low primary care utilization, and cancers diagnosed post-emergency or close to death in non-CPP enrolees.

This population-based registry study included incident cancer patients aged 21-79 between 2015 and 2018 (n = 65,328). Information on pre-existing mental disorders or SUD was gathered from national registries of primary and specialised health care, prescriptions, and disability diagnosis. Propensity score analyses using inverse probability weighting along with the McNemar test were performed to evaluate the risk of non-inclusion in any CPP for all cancers combined, lifestyle-related cancers combined, and the most common cancers individually.

Cancer patients with pre-existing mental disorder or SUD had an 8% (RR = 1.08; 95% Confidence Interval (CI) 1.03-1.13) higher risk of non-enrolment in a CPP. Patients with prior hospitalisation for mental disorder or SUD, and patients with pre-existing psychosis or depression were at particular risk of non-inclusion in a CPP compared to controls, especially for cancers that often present with symptoms late in the course of the disease, such as lung cancer. In line with this, patients with pre-existing mental disorder or SUD who were not referred to a CPP faced a 34% (RR = 1.34; 95% CI 1.18-1.53%) increased risk of unrecognised cancer close to death.

Cancer patients with pre-existing mental disorder or SUD have an increased risk of non-inclusion in a CPP. If not included in a CPP, they have an increased risk of having unrecognised cancer close to death. By addressing barriers to CPP-inclusion, and enhancing the quality of diagnostic and treatment services, healthcare systems could achieve better cancer outcomes for vulnerable patient groups.

Cancer inequalities are wide and enduring, within countries between socio-demographic groups and between countries. These are generated and sustained throughout the key phases of the cancer pathway, from investigation, clinical assessment, decision and access to treatment, and follow-up care. We aimed to describe the characteristics of implemented interventions, evaluated in published controlled experiments in the medical literature, specifically designed to target reductions in inequalities along the cancer pathway. We searched the Ovid Medline and Embase databases from January 2005 to April 2024 for controlled experiments reporting on interventions tackling inequalities. We extracted information on the publication, the aim and type of intervention, its setting, the characteristics of the sample and of the interventions, and summarised their results and limitations. We identified 56 articles reporting on 57 interventions. Of these, 51 (89.5%) focused on access to screening; 56 (98.2%) focused on colorectal, breast, and cervical cancers; 37 (64.9%) concentrated on ethnic inequalities and 48 (84.2%) were based in the USA. In addition, the majority of interventions sought to change individual knowledge, beliefs, and behaviour rather than issues at the system-level. The importance of addressing how healthcare is delivered equitably to all individuals is widely recognised, and there is evidence that individual factors account for only a small part of cancer pathway inequalities. Yet, this scoping review reports a lack of diversity in the implementation of interventions addressing cancer inequalities, and a minority of them target health system issues.

This study aimed to develop and validate machine learning models to predict pathological complete response (pCR) after neoadjuvant therapy in patients with breast cancer patients.

Clinical and pathological data from 1143 patients were analyzed, encompassing variables such as age, gender, marital status, histologic grade, T stage, N stage, months from diagnosis to treatment, molecular subtype, and response to neoadjuvant therapy. Seven machine learning models were trained and validated using both internal and external datasets. Model performance was evaluated using multiple metrics, and interpretability analysis was conducted to assess feature importance.

Key variables influencing pCR included grade, N stage, months from diagnosis to treatment, and molecular subtype. The Naive Bayes model emerged as the most effective, with accuracy (0.746), sensitivity (0.699), specificity (0.808), and F1 score (0.759) surpassing other models. Both internal and external validation confirmed the model's robust predictive power. A web tool was developed for clinical use, aiding in personalized treatment planning. Interpretability analysis further elucidated the contribution of features to pCR prediction, enhancing clinical applicability.

The Naive Bayes model provides a robust tool for personalized treatment decisions in patients with breast cancer undergoing neoadjuvant therapy. By accurately predicting pCR rates, it enables clinicians to tailor treatment strategies, potentially improving outcomes.

The diagnosis-to-first-treatment interval (DFTI) is an important prognostic factor and a major concern for patients with breast cancer as well as their clinicians. It may be particularly important for patients with early-stage breast cancer. The aim of this study was to investigate the association between DFTI and risk of mortality in patients with new-onset early-stage breast cancer.

This nationwide, retrospective cohort study utilized data from the Korean National Health Insurance database and the Korea National Cancer Incidence Database (2006-2017). By using 1:5 propensity score matching, 3,625 participants with a DFTI < 60 days and 725 with a DFTI ≥ 60 days were included in the analysis. Cox proportional hazard regression models were used to examine the association between the DFTI and 5-year all-cause mortality risk.

Compared with patients with breast cancer with a DFTI < 60 days, patients with a DFTI ≥ 60 days had a higher 5-year mortality risk (hazard ratio [95% confidence interval], 2.09 [1.43-3.06]). Similarly, sensitivity analysis with a 45-day threshold revealed higher mortality in patients with a DFTI ≥ 45 days (HR [95% CI], 1.49 [1.14-1.96]) than their counterparts with a DFTI < 45 days. This association was greater for patients with low household income, those who lived in rural areas, and those with a high Charlson comorbidity index.

A DFTI ≥ 60 days was associated with mortality risk in patients with early-stage breast cancer. These results emphasize the importance of closely monitoring the waiting times of this patients population and ensuring timely treatment.

As the complexity and need for cancer care services continue to grow, time to treatment initiation (TTI) has been increasing across cancer types. Presently there are no comprehensive analyses identifying the recent changes in TTI and the important variables causing variation in TTI for all the most prevalent cancer types.

This is a retrospective, observational study using data from the National Cancer Database from 2004 to 2015. The database was queried for newly diagnosed patients with cancer stages I-IV who had TTI within 0-180 days. Stepwise linear regression models were used as a variable selection technique to identify the most significant independent variables to evaluate as predictor variables.

The study sample included 5,615,193 patients (median age, 65; 51.5% female; 86.1% White) across 30 different cancer types (most prevalent: breast [22.1%], lung [18.8%], prostate [16.6%]). The median [IQR] TTI across all 30 cancer types was 26 [6-47] days, with an increase of 7 days from 2004 (21 [4-44]) to 2015 (28 [9-49]; P < .001). No individual cancer type decreased in TTI from 2004 to 2015. The proportion of patients diagnosed with new stage I disease increased by 52.2% from 2004 (28.4%, n = 78,732) to 2015 (43.2%, n = 256,150). All other stages decreased in percent incidence. There was a 100.0% increase in median TTI for stage I patients from 2004 to 2015 (14-28 days). Cancer stage was the most important predictor of change in TTI for 16 cancer types (P < .001 for all 16).

TTI is increasing for patients with cancer, and the recent increase in stage I diagnoses is highly associated with this change.

IntroductionThis study assesses the impact of the Affordable Care Act (ACA) on lung cancer stage at diagnosis and cancer-specific survival, focusing on whether increased access to care for minorities and low-income individuals improves detection and outcomes.MethodologyA retrospective analysis of SEER database data (2007-2020) compared lung cancer cases in pre-ACA (2007-2013) and post-ACA (2014-2020) periods. California, a Medicaid expansion state, and Texas, a non-expansion state, were analyzed. Patients aged 18-64 years were followed for up to 6 years. Difference-in-differences and multinomial logistic regression were used to evaluate the ACA Medicaid expansion impact on disease stage and cancer-specific mortality.ResultsAmong 104,415 lung cancer patients, 59,825 (57.3%) were diagnosed pre-ACA, and 44,590 (42.7%) post-ACA. The cohort was predominantly White (63.7%) and male (52.9%), with an average age of 56.8 years. In California, ACA implementation led to a 1.2 percentage point increase in localized disease (95% CI: 0.2%-2.2%, P < 0.001) and a 2.8 percentage point reduction in metastatic disease (95% CI: -4.1% to -1.4%, P < 0.001) compared to Texas. Cancer-specific mortality in California decreased by 15.9% (95% CI: -23.9% to -7.8%, P < 0.001) vs Texas.ConclusionACA Medicaid expansion in California resulted in earlier lung cancer detection, reduced metastatic disease, and lower cancer-specific mortality compared to Texas. These improvements spanned all racial and ethnic groups, underscoring the benefits of Medicaid expansion in improving cancer outcomes.

Treatment of impending pathologic fractures and insufficiency fractures of the sacrum due to metastatic disease and radiation is challenging. The use of traditional hardware is limited by poor bone quality and presence of non-contained defects. The role of minimally invasive photodynamic nails (PDN) for treatment of these fractures remains poorly understood.

Patients with symptomatic impending pathologic fractures of the sacrum due to metastatic bone disease, multiple myeloma, or insufficiency fractures from radiation osteitis who underwent PDN stabilization were identified. Primary outcomes included post-operative complications, pain relief, opioid consumption, and function. Pain was assessed using Visual Analog Scale (VAS), and function was measured using the Combined Pain and Ambulatory Function (CPAF) score. Outcomes were assessed preoperatively at 6 weeks, 3 months, 6 months, 1 year and 2 years.

Fourteen patients (median age 70, 50% female) underwent sacral PDN stabilization between 2020 and 2023, with a median 1.4-year follow-up. Overall complication rate was 7% (1/14 patients), with one case of venous thromboembolism. Median pain VAS decreased from 7 preoperatively to 6 at 6 weeks (p = 0.02), and to 4 at 2 years (p = 0.002). Median CPAF score improved from 6 preoperatively to 7 at 3 months and remained at this level through the 2-year follow-up. Chronic opioid use decreased from 85.7% preoperatively to 60% at 2 years.

PDN stabilization sacral insufficiency fractures in oncologic patients is a safe surgical technique that effectively restores patient ambulatory function and provides rapid pain relief. Further research with larger cohorts is warranted to confirm these promising results.

III.

Not applicable.

Delays in time to treatment (TTT) have been shown to affect cancer survival, yet this has not been investigated in adolescent and young adult (AYA) Hodgkin lymphoma (HL) patients. This retrospective analysis included 508 patients with TTT defined as the time between diagnosis and chemotherapy start. The median TTT for the population was 28 days (IQR: 12-44). Patients who reported fevers and night sweats had shorter TTT than those who did not (p = 0.016 and p = 0.017, respectively). TTT varied significantly by age group (p < 0.01), with adolescents (15-18 years) having nearly a 10-day shorter TTT (21.3 days) compared to a TTT of 30.2 and 31.2 days for emerging adults (19-25 years) and young adults (26-39 years), respectively. Delayed TTT was not associated with risk of death. The lack of association with survival may reflect the overall favorable survival experienced by AYA HL patients and is in line with that reported for HL across all age populations.

Surgery remains the primary treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, it can lead to postoperative complications and reduced functionality. Prehabilitation aims to improve functional reserves before surgery. We aimed to evaluate the implementation of a multimodal prehabilitation program in "real-world" patients undergoing gastrointestinal cancer surgery.

An implementation study evaluating prehabilitation in patients undergoing gastrointestinal (colorectal or UGI) cancer surgery at Concord Hospital. The prehabilitation program included supervised exercise, nutrition and nursing support delivered face-to-face or by telehealth (COVID-19 adaptations).

baseline, pre-surgery and 30 days after surgery.

implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework.

functional, nutritional and surgical outcomes, with comparisons to historical controls.

Between January 2020 and December 2021, 181 patients were screened; 91 (50%) were eligible. Reach: 77/91 recruited (63 colorectal, 14 UGI). Median age, 70 years (IQR, 59-79); 60% were males. Median intervention duration, 16 days (IQR, 12.25-19.75).

quality of life, anxiety and functional capacity improved from baseline to pre-surgery (6-min walk test (+16.1 m, p=0.038) and 2-min step test (+10.0 steps, p<0.001)). Compared to historical controls, hospital length of stay was reduced by 2.1 days (p=0.010), with no differences in complications. Adoption: 91% of referrals came directly from surgeons.

94% completed the intervention, with high adherence and satisfaction levels. Maintenance: after study completion, the program was incorporated into standard care with some modifications.

Prehabilitation can be implemented in a real-world setting, with a trend towards improving functional and surgical outcomes, but dedicated resources are necessary to implement and maintain the program.

Timely initiation of treatment is a core principle of oncologic care, especially for aggressive cancers such as lung cancer. However, the real-world impact of short-term delays in treatment initiation on survival outcomes in lung cancer remains unclear. This meta-analysis evaluates the association between treatment delays of 4, 8, and 12 weeks and all-cause mortality in lung cancer patients. A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. Of 5360 screened records, 15 studies were included, comprising 16 cohorts for overall survival of lung cancer patients. Hazard ratios (HRs) for 4-, 8-, and 12-week treatment delays were estimated using random-effects meta-analyses. Heterogeneity was measured with the I2 statistic, and publication bias was assessed using funnel plots and Egger's test. No significant association was found between treatment delay and survival at any of the time points. Pooled HRs were 1.00 (95% CI, 0.99-1.02) for a 4-week delay, 1.01 (95% CI, 0.99-1.03) for an 8-week delay, and 1.01 (95% CI, 0.98-1.05) for a 12-week delay. Despite high heterogeneity (I2 = 97%), no evidence of publication bias was detected. This meta-analysis found no significant impact of short-term treatment delays (up to 12 weeks) on mortality in lung cancer patients. These findings challenge the assumption that brief delays universally worsen outcomes and underscore the importance of individualized treatment planning and prioritization.

Patients who undergo noncardiac surgery shortly after percutaneous coronary intervention (PCI) experience higher rates of perioperative ischemic events, but delaying surgery may affect disease staging and influence cancer recurrence. We aimed to evaluate the association between time from PCI to cancer surgery and cardiovascular and oncologic outcomes in patients with early-stage cancer.

We included patients with early-stage cancer with a history of PCI who underwent cancer surgery (N=3621). The patients were divided into 2 groups based on the time between the dates of PCI and cancer surgery (<12 and ≥12 months). We also grouped patients who underwent early surgery and late surgery, defined as patients who underwent surgery ≥1 and <1 month after cancer diagnosis. Outcomes included bleeding, spontaneous myocardial infarction, repeat revascularization, cancer recurrence, and death. The time from PCI to cancer surgery <12 months group had higher bleeding (hazard ratio [HR], 1.30 [95% CI, 1.18-1.32]), spontaneous myocardial infarction (HR,1.96 [95% CI, 1.32-2.92]), cancer recurrence (HR, 1.26 [95% CI, 1.01-1.56]), and mortality (HR, 1.23 [95% CI, 1.04-1.44]) compared with the ≥12 months group. Among the time from PCI to cancer surgery <12 months group, the early-surgery group had lower cancer recurrence risk than those who underwent late surgery (HR, 0.70 [95% CI, 0.49-0.99]) without differences in bleeding and cardiac outcome.

Although patients who undergo surgery within 12 months of PCI have higher risks of bleeding and cardiovascular events, delaying surgery may increase the risk of cancer recurrence. Therefore, the timing of surgery should be a personalized decision, weighing the risks of cardiovascular complications against the potential oncologic outcomes.

URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06357000.

To determine the prevalence and incidence of falls and fall-related injuries in community-dwelling older adults with a diagnosis of cancer and examine whether falls prevalence varies with specific cancer characteristics.

A systematic search of five databases was conducted. Studies that included community-dwelling adults with a mean age ≥ 60 years with a current or past diagnosis of cancer and that reported data on the prevalence and/or incidence of falls and/or fall-related injuries were included. Prevalence and incidence rates of falls were pooled for meta-analysis, and meta-regression was used to investigate associations between cancer characteristics (e.g. cancer type and cancer treatment received) and prevalence of falls.

Fifty-seven studies with sample sizes ranging from 51-146,959 participants were included. The pooled prevalence of older adults with cancer who fell in the last 6 months (25%; 95% CI 19%, 32%) and 12 months (29%; 95% CI 24%, 34%) was similar. Subgroup analysis showed that the pooled prevalence of falls for older adults with breast cancer was higher (26%; 95% CI 22%, 30%) compared to those with prostate (14%; 95% CI 9%, 20%) or colorectal cancer (13%; 95% CI 11%, 16%).

The overall prevalence of falls amongst community-dwelling older adults with cancer is relatively similar compared to the general older adult population, noting that fall events may have been under-reported.

Falls are common amongst older adults with cancer, but the link between cancer characteristics and exposure to falls risk requires further investigation to better understand the risk factors specific to cancer survivors.

To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).

A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.

Studies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.

Of the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio [aHR]: 1.04 [1.03-1.06]; I2 = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 [1.01-1.20]; I2 = 39%; N = 52,003; 5 studies).

Initiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).

NA Laryngoscope, 135:1563-1570, 2025.

Although the majority of cervical cancer cases are in sub-Saharan Africa, little is known regarding how the COVID-19 pandemic affected cancer care in this context. Drawing from robust longitudinal data, this study aimed to assess cervical cancer treatment patterns in Botswana before and during the pandemic.

Longitudinal clinical and patient-reported data from a cohort of over 1,000 patients seen at a gynecologic oncology multidisciplinary team clinic in Botswana were used to evaluate treatment initiation patterns before (April 2018-December 2019) and during (April 2020-December 2021) the pandemic. The primary outcome was timeliness of treatment, defined as the number of days between the patient's first clinic visit and treatment initiation date, and categorized as timely (≤30 days), delayed (>30 days), or no treatment. The primary exposure was time of visit (pre-COVID-19 v COVID-19), defined by the month of the clinic visit.

Of the 559 patients with cervical cancer diagnosed during the study period, 336 were seen pre-COVID-19, and 223 were seen during the COVID-19 period. During the pandemic, a higher proportion of patients experienced treatment delays (66.4%) or received no treatment (24.2%), compared with the pre-COVID-19 period (35.7% and 9.8%, respectively; P < .001). Multivariable regression models indicated that patients seen during the pandemic were 10 times more likely to experience treatment delays (adjusted odds ratio [aOR], 10.01 [95% CI, 5.69 to 17.62]) and 14 times more likely to receive no treatment (aOR, 14.16 [95% CI, 7.14 to 28.10]).

The pandemic exacerbated treatment delays for patients with cervical cancer in Botswana. There is a need for evidence-based strategies to address these treatment delays, considering the disproportionate burden of disease and persistent disparities in access to care in Botswana and other low- and middle-income countries.

Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice.

We implemented an algorithm to define a claims-based index as the date of the earliest International Classification of Diseases code for the cancer in Medicare and estimated agreement with the date of diagnosis from a North Carolina registry for patients diagnosed aged 66 or older with 16 cancer types from 2008 to 2017 (n = 92,056). We then classified whether each cancer was initially diagnosed through care originating in the ED using each date.

The index date was identical to the cancer registry date for 47% of patients and preceded the registry date for 28%, with extent of agreement varying by cancer- and patient-specific characteristics. Agreement in ED-involved diagnosis classification using each date varied by cancer site, with sensitivity of classifications using the registry date relative to the index having a minimum of 86% for prostate and kidney cancer.

Studies assessing healthcare utilization proximal to cancer diagnosis should carefully consider the relevant assessment window and be aware that the use of cancer registry versus claims-based dates may impact variable classification.

Growing breast cancer is associated with an inherent risk of metastasis. If surgical treatment of breast cancer is delayed, the prognosis worsens with increasing tumor size. This justifies the search for a safe time interval between diagnosis and surgery.

The 2022 population-based data on incidence and the time interval to initial surgery for the United States (U.S.) and Germany are used. Tumor growth and initiation of metastases can be calculated using public data on hormone receptor status, volume doubling time, and tumor size-dependent relative survival. Our assumptions are based on an initial 19.8 mm mean tumor size. 15-year BC-specific mortality in both countries is assumed to be 19.6% without surgical delay. Volume doubling time stratified by hormone receptor status, assumed to be continuous may differ by a factor of 2.4.

The U.S. and Germany report 287,850/71,375 new breast cancers for the year 2022 and 2019. If tumor removal is delayed by 8 weeks, mortality rate increases by 2.25/4.79% (HR + /HR-) as estimated by our model. The currently reported mean delay in the U.S. and Germany of 33.7/26.0 days or 4.8/3.7 weeks, respectively, would lead to an estimated 4,676/918 additional BC deaths or a 1.6/1.2% rise in the 15-year BC-specific mortality rate.

This study offers reasonable evidence that confirmed cases of breast cancer should be prioritized and treated according to hormone receptor status and tumor size as soon as possible. Effective screening measures should be followed by timely treatment.

The majority of esophageal and gastric cancers are diagnosed at an advanced stage with poor overall survival (OS). Whether the pre-diagnostic interval from symptom onset has any impact on OS is unclear. We investigated this question in the peri-COVID19 pandemic era.

We retrospectively analyzed a cohort of 308 patients with esophageal, gastroesophageal junction, or gastric carcinoma treated with curative intent at the Princess Margaret Cancer Centre from January 2017 to December 2021. Clinical details pertaining to the initial presentation were determined through a retrospective chart review. Cox proportional hazards regression models were used to assess the association between pre-diagnostic intervals and OS, adjusting for baseline patient characteristics.

The median interval from symptom onset to diagnosis was 98 days (IQR 47-169 days). Using a cox proportional hazard model, prolonged pre-diagnostic interval was not associated with worse OS (HR 1.00, p = 0.62). Comparing patients diagnosed before and during the COVID19 pandemic, there was a notable increase in diagnostic delay with median pre-diagnostic interval increasing from 92 to 126 days (p = 0.007). Median age at time of diagnosis was 69.6 during the pandemic vs. 64.7 before the pandemic. Linear regression showed squamous cell histology was significantly associated with increasing time to initial diagnosis (p = 0.04), but this did not hold true in a multivariable model. Looking at other delay metrics, there were no changes in time interval from diagnosis to treatment during versus before the pandemic (median = 1.7 weeks for both), and there was no change in time from diagnosis to resection in those patients who underwent surgery.

The COVID19 pandemic caused significant diagnostic delay for patients presenting with curative gastroesophageal and gastric cancer. The lack of correlation of pre-diagnostic interval with OS may reflect underlying tumor biology as the driving force that determines prognosis.

Monitoring trends of cancer incidence, mortality and survival is vital for the planning and delivery of health services, and the evaluation of diagnostics and treatment at the population level. Furthermore, comparisons are often made between population subgroups to explore inequalities in outcomes. During the COVID-19 pandemic routine delivery of health services were severely disrupted. Resources were redeployed to COVID-19 services and patient risk of COVID-19 infection required serious consideration. Cancer screening services were paused, the availability of healthcare providers was reduced and, in some cases, patients faced difficulty in accessing optimal treatment in a timely manner. Given these major disruptions, much care should be taken when interpreting changes in cancer survival estimates during this period. The impact on cancer incidence and mortality statistics that have already been reported in some jurisdictions should drive further thought on the corresponding impact on cancer survival, and whether any differences observed are real, artificial or a combination of the two. We discuss the likely impact on key cancer metrics, the likely implications for the analysis of cancer registration data impacted by the pandemic and the implications for comparative analyses between population groups and other risk factor groups when using data spanning the pandemic period.

With the increasing use of CT, it may help detecting incidental breast cancers. Our study analysed the relationship between breast cancer detection on CT and features of the cancer, factors related to the scan and report, the treatment offered, and cancer prognostics, in NHS settings.

56 scans in 42 patients were retrospectively included.

38 reports (67.9%) missed the breast cancers. Missed cancers were found to be smaller (P = .0042), progressed more by the time they were diagnosed (P = .0011), and their initial treatment was delayed by a median of 3.4 years (P < .0001). Cancers were more likely to be missed out of hours (P = .0485), in an outpatient reporting session (P = .0397), when the cancer presented as a circumscribed mass (P = .0196), and when the breasts were dense (P = .0250).

A significant percentage of breast cancer is missed on CT, with subsequent delay in starting treatment. Systematic approach when reporting, awareness of atypical cancer presentations, and minimizing distractions while reporting, may improve the detection of breast cancer on CT.

This study identified opportunities to detect, and the factors associated with missing and delayed treatment of, incidental breast cancer on CT, specifically in NHS settings. By increasing radiologists' awareness of those factors, it is hoped to prevent delay in treatment of this cohort of cancer patients.

Heart failure (HF), a chronic and progressive disease, is increasing in prevalence worldwide and is associated with increased hospitalizations and death. Despite notable improvements in medical therapy for HF, patients are still at risk of future negative outcomes. Current guidelines recommend four classes of medication for treating patients with HF, deemed guideline-directed medical therapy (GDMT). The use and adherence of these GDMTs serve as a major predictor of outcomes in those with chronic HF; however, implementation of therapy remains poor, despite substantial evidence of benefit. The acute hospitalization for HF and the subsequent vulnerable period serve as important milestones for adequate disease modification, and implementing a strategy for aggressive medical therapy can improve HF outcomes. Current guidelines also recommend that follow-up with multidisciplinary chronic disease management specific to HF be provided to those living with heart failure, which is essential for improving readmissions and mortality. This follow-up, although important by itself, serves as an important avenue for disease modification through medication titration, and implementing such structured follow-up is essential for further population-wide improvements in HF mortality. In this context, the STRONG-HF trial investigators developed an implementation trial providing evidence for the rapid inpatient initiation and subsequent titration of HF GDMT, demonstrating the importance of implementation strategies in the care of HF patients. In this narrative review, we review the evidence base for treating patients with HF, highlight deficits in our current real-world experience, and provide support for trial evidence like STRONG-HF in the global fight to reduce the burden of HF.

Prostate cancer (PCa) is the second most common cancer in men worldwide, with significant incidence and mortality, particularly in Mexico, where diagnosis at advanced stages is common. Early detection through screening methods such as digital rectal examination and prostate-specific antigen testing is essential to improve outcomes. Despite current efforts, compliance with prostate screening (PS) remains low due to several barriers. This study aims to develop and validate a predictive model for PCa screening compliance in Mexican men.

Retrospective observational design with data from the Mexican Health and Aging Study (MHAS). Participants were men aged 50-69 from three cohorts: development/internal validation, temporal validation, and external validation. Key predictors were identified using relaxed Least Absolute Shrinkage and Selection Operator (LASSO) regression, and model performance was assessed using the area under the curve (AUC) from receiver operating characteristic (ROC) analyses, along with calibration and decision curve analysis (DCA). A web nomogram was also developed.

The final model included seven key predictors. AUC values indicated good predictive performance: 0.783 for the training subgroup, 0.722 for the test subgroup, 0.748 for the time cohort, and 0.756 for the external cohort, with sensitivities of 73.5%. The DCA demonstrated the superior clinical utility of the model compared to the reference strategies.

The predictive model developed for performance to PCa screening is robust across different cohorts and highlights critical factors influencing performance. The accompanying web-based nomogram enhances clinical applicability and supports interventions aimed at improving PCa screening rates among Mexican men.

The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock.

The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated. Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.

Seeking a second opinion (SO) is a patient's right that is essential to appropriate decision-making for their care and treatment. In Japan, however, no previous studies have provided objective data on the nationwide practice of SO among cancer patients. In this study, we investigated SO referrals, including delays in initiating care, using data from nationwide hospital-based cancer registries and 2018-2020 the Diagnosis Procedure Combination (DPC) survey. Among the more than 2.6 million patients diagnosed with cancer, 1.6% received SO referral letters as reimbursement. The referral rates varied based on sex, age, and geographic regions. A total of 52.1% of SO were sought before active treatment of the tumor. Approximately 60% of the patients who sought SO prior to the initial treatment returned to their original provider for treatment. The average period from diagnosis to the start of treatment among those who sought SO was 18 days and 22 days longer for non-small lung cancer and breast cancer, respectively, than among those who did not seek SO. In the future, the risk-benefit of SO referral should be examined, considering both the prognostic impact of treatment delay due to SO and the psychological benefits for the patient gained from SO.