CA: A Cancer Journal for Clinicians最新文献

{"title":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019","authors":"Farhad Islami MD, PhD,&nbsp;Emily C. Marlow PhD,&nbsp;Blake Thomson DPhil, MPhil,&nbsp;Marjorie L. McCullough ScD, RD,&nbsp;Harriet Rumgay PhD,&nbsp;Susan M. Gapstur PhD, MPH,&nbsp;Alpa V. Patel PhD,&nbsp;Isabelle Soerjomataram MD, PhD, MSc,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21858","DOIUrl":"10.3322/caac.21858","url":null,"abstract":"<p>In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating for and informing cancer prevention and control. Herein, based on up-to-date relative risk and cancer occurrence data, the authors estimated the proportion and number of invasive cancer cases (excluding nonmelanoma skin cancers) and deaths, overall and for 30 cancer types among adults who were aged 30 years and older in 2019 in the United States, that were attributable to potentially modifiable risk factors. These included cigarette smoking; second-hand smoke; excess body weight; alcohol consumption; consumption of red and processed meat; low consumption of fruits and vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and seven carcinogenic infections. Numbers of cancer cases and deaths were obtained from data sources with complete national coverage, risk factor prevalence estimates from nationally representative surveys, and associated relative risks of cancer from published large-scale pooled or meta-analyses. In 2019, an estimated 40.0% (713,340 of 1,781,649) of all incident cancers (excluding nonmelanoma skin cancers) and 44.0% (262,120 of 595,737) of all cancer deaths in adults aged 30 years and older in the United States were attributable to the evaluated risk factors. Cigarette smoking was the leading risk factor contributing to cancer cases and deaths overall (19.3% and 28.5%, respectively), followed by excess body weight (7.6% and 7.3%, respectively), and alcohol consumption (5.4% and 4.1%, respectively). For 19 of 30 evaluated cancer types, more than one half of the cancer cases and deaths were attributable to the potentially modifiable risk factors considered in this study. Lung cancer had the highest number of cancer cases (201,660) and deaths (122,740) attributable to evaluated risk factors, followed by female breast cancer (83,840 cases), skin melanoma (82,710), and colorectal cancer (78,440) for attributable cases and by colorectal (25,800 deaths), liver (14,720), and esophageal (13,600) cancer for attributable deaths. Large numbers of cancer cases and deaths in the United States are attributable to potentially modifiable risk factors, underscoring the potential to substantially reduce the cancer burden through broad and equitable implementation of preventive initiatives.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"405-432"},"PeriodicalIF":503.1,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key issues face AI deployment in cancer care","authors":"Mike Fillon","doi":"10.3322/caac.21860","DOIUrl":"10.3322/caac.21860","url":null,"abstract":"&lt;p&gt;With artificial intelligence (AI) erupting across all aspects of life, including health care, oncology is a logical field ripe for new applications. AI is already used in cancer care and diagnosis, such as tumor identification on x-rays and pathology slides. Beyond that, emerging technology is using AI to forecast the prognosis of patients and to assess their treatment options. One unknown is how oncologists feel about this trend, which includes possibly relinquishing some control over their profession and patients.&lt;/p&gt;&lt;p&gt;A new study asked 204 oncologists for their views on the rapidly developing AI tools. Specifically, they were asked about ethical issues that they face regarding the deployment of AI (e.g., whether they believed that AI could be used effectively in patient-care decisions). The main issue that the researchers investigated was to what degree patients should provide explicit informed consent for the use of AI during treatment decision-making. The study appears in &lt;i&gt;JAMA Network Open&lt;/i&gt; (doi:10.1001/jamanetworkopen.2024.4077).&lt;/p&gt;&lt;p&gt;In the study, which was conducted from November 15, 2022 to July 31, 2023, a random sample of oncologists from across the country were asked 24 questions via traditional mail (which included a $25 gift card) about their views on the use of AI in clinical practice. Follow-ups with nonresponders were conducted via email and phone calls.&lt;/p&gt;&lt;p&gt;Issues covered bias, responsibilities, and whether they would be able to explain to patients how the technology was deployed in determining their care. There were 387 surveys sent to oncologists; 52.7% (&lt;i&gt;n&lt;/i&gt; = 204) were completed. Those responding came from 37 states; 63.7% (&lt;i&gt;n&lt;/i&gt; = 120) were male, and 62.7% (&lt;i&gt;n&lt;/i&gt; = 128) identified as non-Hispanic White.&lt;/p&gt;&lt;p&gt;Very few respondents said that AI prognostic and clinical decision models could be used clinically when only researchers could explain them (13.2% of respondents [&lt;i&gt;n&lt;/i&gt; = 27] for prognosis and 7.8% [&lt;i&gt;n&lt;/i&gt; = 16] for clinical decisions).&lt;/p&gt;&lt;p&gt;For AI prognostic and clinical decision models that oncologists could explain, the percentages were much higher: 81.3% (&lt;i&gt;n&lt;/i&gt; = 165) and 84.8% (&lt;i&gt;n&lt;/i&gt; = 173), respectively. Fewer respondents—13.8% (&lt;i&gt;n&lt;/i&gt; = 28) and 23.0% (&lt;i&gt;n&lt;/i&gt; = 47), respectively—reported that the models also needed to be explainable by patients.&lt;/p&gt;&lt;p&gt;The survey also found that 36.8% of oncologists (&lt;i&gt;n&lt;/i&gt; = 75) believed that if an AI system selected a treatment regimen different from what they would recommend, they would present both options and let the patient decide. Although that represented less than half of the respondents, it was the most common answer.&lt;/p&gt;&lt;p&gt;Regarding responsibility for medical or legal problems arising from AI use, 90.7% of respondents (&lt;i&gt;n&lt;/i&gt; = 185) indicated that AI developers should be held accountable. This was considerably higher than the 47.1% (&lt;i&gt;n&lt;/i&gt; = 96) who felt that the responsibility should be shared with physicians and the 43.1% (","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"320-322"},"PeriodicalIF":503.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colon cancer blood test effective for average-risk population","authors":"Mike Fillon","doi":"10.3322/caac.21859","DOIUrl":"10.3322/caac.21859","url":null,"abstract":"&lt;p&gt;A new study appearing in The &lt;i&gt;New England Journal of Medicine&lt;/i&gt; (&lt;i&gt;NEJM&lt;/i&gt;) investigated the effectiveness of an emerging colon cancer screening option—a cell-free DNA (cfDNA) blood-based test known as Shield—that researchers and clinicians hope will encourage more people to be screened for colorectal cancer (CRC) (doi:10.1056/NEJMoa2304714).&lt;/p&gt;&lt;p&gt;Allison Rosen, MS, from Houston, Texas, is a 12-year CRC survivor who says that she is alive today because of timely colon cancer screening. “Unfortunately,” says Ms Rosen, “after talking with the community about the importance of screening and even with the knowledge that screening can save their life, people tell me every day that they refuse to get screened because both stool-based tests and colonoscopies have very negative stigmas.”&lt;/p&gt;&lt;p&gt;Ms Rosen points to American Cancer Society (ACS) data showing that one third of the screening-eligible population is not getting screened even though 90% of CRC deaths can be prevented with timely screening. Ms Rosen is the director of the ACS’s Project ECHO (Extension for Community Healthcare Outcomes) in Houston, Texas.&lt;/p&gt;&lt;p&gt;The Shield test is a blood-based CRC screening test meant for average-risk people with no family history of CRC and no personal history of CRC or advanced polyps (large polyps). Targeted patients are also CRC symptom–free.&lt;/p&gt;&lt;p&gt;The researchers who conducted the &lt;i&gt;NEJM&lt;/i&gt; study believe that this screening test option could be key to improving screening rates, leading to fewer colon cancer deaths.&lt;/p&gt;&lt;p&gt;According to study author William M. Grady, MD, medical director of the Gastrointestinal Cancer Prevention Program at the Fred Hutchinson Cancer Center in Seattle, Washington, the test is on par with stool-based CRC screening tests, such as the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test, for the detection of CRC.&lt;/p&gt;&lt;p&gt;The results of the &lt;i&gt;NEJM&lt;/i&gt; study were derived from the ECLIPSE (Evaluation of the ctDNA LUNAR Test in an Average Patient Screening Episode) study, a multisite clinical trial of nearly 8000 people aged 45–84 years. The study was underwritten and led by Guardant Health (based in Palo Alto, California). The focus of the study was the comparison of the effectiveness of the blood test and colonoscopies for CRC sensitivity and for advanced neoplasia, including CRC and advanced precancerous lesions. Also investigated was the sensitivity for discovering if advanced precancerous lesions had a negative cfDNA blood-based test.&lt;/p&gt;&lt;p&gt;Of the 7861 patients who met the study criteria, 83.1% with colonoscopy-detected CRC registered a positive cfDNA test; 16.9% had a negative test (i.e., a colonoscopy detected CRC, but a circulating tumor DNA [ctDNA] test did not). Overall, the researchers found that the blood test was most sensitive for CRCs, including early-stage cancers. They also found that it was less sensitive for advanced precancerous lesions, which may become cancerous later.&lt;/p&gt;&lt;p&gt;Furthe","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"317-319"},"PeriodicalIF":503.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer misinformation on social media","authors":"Stacy Loeb MD, MSc, PhD (Hon),&nbsp;Aisha T. Langford PhD, MPH,&nbsp;Marie A. Bragg PhD,&nbsp;Robert Sherman BA,&nbsp;June M. Chan ScD","doi":"10.3322/caac.21857","DOIUrl":"10.3322/caac.21857","url":null,"abstract":"<p>Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks—such as their extensive use and the relative ease it allows to share information quickly—facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give <i>information prescriptions</i> to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"453-464"},"PeriodicalIF":503.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141425293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving landscape of tissue-agnostic therapies in precision oncology","authors":"Vivek Subbiah MD,&nbsp;Mohamed A. Gouda MD,&nbsp;Bettina Ryll MD, PhD,&nbsp;Howard A. Burris III MD,&nbsp;Razelle Kurzrock MD","doi":"10.3322/caac.21844","DOIUrl":"10.3322/caac.21844","url":null,"abstract":"<p>Tumor-agnostic therapies represent a paradigm shift in oncology by altering the traditional means of characterizing tumors based on their origin or location. Instead, they zero in on specific genetic anomalies responsible for fueling malignant growth. The watershed moment for tumor-agnostic therapies arrived in 2017, with the US Food and Drug Administration's historic approval of pembrolizumab, an immune checkpoint inhibitor. This milestone marked the <i>marriage</i> of genomics and immunology fields, as an immunotherapeutic agent gained approval based on genomic biomarkers, specifically, microsatellite instability-high or mismatch repair deficiency (dMMR). Subsequently, the approval of NTRK inhibitors, designed to combat <i>NTRK</i> gene fusions prevalent in various tumor types, including pediatric cancers and adult solid tumors, further underscored the potential of tumor-agnostic therapies. The US Food and Drug Administration approvals of targeted therapies (<i>BRAF</i> V600E, <i>RET</i> fusion), immunotherapies (tumor mutational burden ≥10 mutations per megabase, dMMR) and an antibody-drug conjugate (Her2-positive–immunohistochemistry 3+ expression) with pan-cancer efficacy have continued, offering newfound hope to patients grappling with advanced solid tumors that harbor particular biomarkers. In this comprehensive review, the authors delve into the expansive landscape of tissue-agnostic targets and drugs, shedding light on the rationale underpinning this approach, the hurdles it faces, presently approved therapies, voices from the patient advocacy perspective, and the tantalizing prospects on the horizon. This is a welcome advance in oncology that transcends the boundaries of histology and location to provide personalized options.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"433-452"},"PeriodicalIF":503.1,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better communication is key for quality-of-life improvement in low-income and minority patients","authors":"Mike Fillon","doi":"10.3322/caac.21842","DOIUrl":"10.3322/caac.21842","url":null,"abstract":"&lt;p&gt;Although approximately half of patients with cancer receive symptom management and advance care planning (ACP), a new study reports that the percentage is much worse—only approximately 20%—for low-income and minority patients. The researchers note that this disparity results in not just reduced quality of life for the patients but also increased costs of care for individuals and overall.&lt;/p&gt;&lt;p&gt;The study found a slew of obstacles behind this imbalance, including inadequate time with clinicians, a lack of sufficient reimbursement, and social biases such as racism. “Yet few interventions address such disparate care,” wrote the researchers. The study appears in the &lt;i&gt;Journal of Clinical Oncology&lt;/i&gt; (doi:10.1200/JCO.23.00309).&lt;/p&gt;&lt;p&gt;The randomized clinical trial was a collaboration between Unite Here Health (UHH) centers in Atlantic City, New Jersey, and Chicago, Illinois. UHH is an employer–union health fund that serves low-income and minority workers and their families.&lt;/p&gt;&lt;p&gt;The researchers developed a community advisory board and recruited 160 patients newly diagnosed with solid tumors and hematologic malignancies from the UHH membership who were considered to have poor health-related quality of life (HRQOL) and inadequate care. They called the program LEAPS (Lay Health Workers Educate, Engage, and Activate Patients to Share). They also included a study component that added patients with unaddressed health-related social needs (HRSNs).&lt;/p&gt;&lt;p&gt;The goal of the study was to evaluate the effectiveness of LEAPS in improving HRQOL outcomes. Patients self-reported their age, gender, race, ethnicity, education, and household income.&lt;/p&gt;&lt;p&gt;The median age of the patients was 58 years, and there were 83 females (51.8%). The study group included 82 Whites (51.3%), 47 Hispanics (29.4%), and 44 African Americans and other Blacks (27.5%). There were also two American Indians or Alaska Natives (1.3%), 31 Asians (19.4%), and one Native Hawaiian (0.6%). The annual household income for 127 of the patients (79.4%) was less than $35,000. Thirty-seven of the patients (23.1%) had breast cancer, and 64 of the patients (40.0%) had stage IV disease.&lt;/p&gt;&lt;p&gt;The patients were randomly assigned equally to a usual-care control group, which included outpatient oncology services and case management by a union-affiliated nurse, and to an intervention group, which comprised usual care plus access to a trained community health worker (CHW) for 12 months. The researchers ensured that the groups were similar in demographic and clinical variables.&lt;/p&gt;&lt;p&gt;The CHWs, who were bilingual and covered multiple languages, assisted participants with ACP, screened them for symptoms, and referred them to community-based resources for their individual HRSNs. Patients in the intervention group received weekly telephone calls for 4 months and then monthly calls for 1 year. ACP education in the preferred language of each patient was included.&lt;/p&gt;&lt;p&gt;The main end point evaluation was each patient’s ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"207-209"},"PeriodicalIF":254.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21842","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between menopausal hormone therapy and breast cancer remains unsettled","authors":"Mike Fillon","doi":"10.3322/caac.21843","DOIUrl":"10.3322/caac.21843","url":null,"abstract":"&lt;p&gt;It has been more than 2 decades since the Women’s Health Initiative (WHI; https://www.whi.org/) alarmed clinicians with a report that found that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA), when administered to postmenopausal women, increased breast cancer risk as well as the risks for coronary heart disease, stroke, and total mortality without improving quality of life. Since then, several researchers have questioned the findings, and the overarching conclusions have been revisited by WHI investigators themselves. Despite this, clinicians and their patients continue to take on a “safer rather than sorry” stance and often decide against taking the menopausal hormone therapy (HT), regardless of what symptoms may be present.&lt;/p&gt;&lt;p&gt;For example, in a study appearing in the journal Menopause: The Journal of The Menopause Society in April 2023 (doi:10.1097/GME.0000000000002154), WHI investigators conceded that HT yielded considerable benefits. However, they continued to assert that the associated increase in the risk of breast cancer with combined HT (CEE and MPA) remained a valid concern.&lt;/p&gt;&lt;p&gt;In response, a review published in the journal sought to rectify the association between breast cancer and HT—both CEE alone and CEE in combination with MPA, a large source of the misinterpretation (doi:10.1097/GME.0000000000002267). One of the authors, Avrum Z. Bluming, MD, an oncologist at the Keck School of Medicine at the University of Southern California in Los Angeles, explains it this way: “According to WHI’s own data, estrogen alone significantly decreases the risk of breast cancer development (by 23%) and the risk of breast cancer death (by 40%)—crucial information for women who have had hysterectomies.” In addition, “when started within 10 years of a woman’s final period (the ‘window of opportunity’), the WHI now agrees,” says Dr Bluming, that “it significantly decreases the risk for coronary heart disease, improves longevity, is the best and safest treatment for menopausal symptoms, and does not increase the risk of stroke. Further, it decreases the risk of osteoporotic hip fracture, colon cancer, and diabetes mellitus.” The sole issue at play is the association between combined HT (CEE plus MPA) and the risk of breast cancer.&lt;/p&gt;&lt;p&gt;In their review, Dr Bluming and his colleagues write that “the association between combined HT and an ‘increased breast cancer risk’ is actually not statistically significant. Further, even if one were to accept that the WHI’s claims of an increased risk were accurate, that increase would amount to one additional case of breast cancer for every 1,000 women treated per year but no increase in the risk of dying from breast cancer.” In addition, they argue that the assertion from WHI investigators that there is an association between the declining incidence of breast cancer and the reduction in HT prescriptions is not supported by several lines of data, including the fact that","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"210-212"},"PeriodicalIF":254.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey","authors":"Sarah A. Pohl MPH,&nbsp;Barry A. Nelson BS,&nbsp;Tanjeena R. Patwary MPH,&nbsp;Salina Amanuel BS,&nbsp;Edward J. Benz Jr MD,&nbsp;Christopher S. Lathan MD, MS, MPH","doi":"10.3322/caac.21841","DOIUrl":"10.3322/caac.21841","url":null,"abstract":"<p>Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"383-396"},"PeriodicalIF":503.1,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140826497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical updates in neuroendocrine tumors: Version 9 American Joint Committee on Cancer staging system for gastroenteropancreatic neuroendocrine tumors","authors":"Aman Chauhan MD,&nbsp;Kelley Chan MD,&nbsp;Thorvardur R. Halfdanarson MD,&nbsp;Andrew M. Bellizzi MD,&nbsp;Guido Rindi MD, PhD,&nbsp;Dermot O’Toole MD,&nbsp;Phillip S. Ge MD,&nbsp;Dhanpat Jain MD,&nbsp;Arvind Dasari MD,&nbsp;Daniel A. Anaya MD, MSHCT,&nbsp;Emily Bergsland MD,&nbsp;Erik Mittra MD, PhD,&nbsp;Alice C. Wei MD,&nbsp;Thomas A. Hope MD,&nbsp;Ayse T. Kendi MD,&nbsp;Samantha M. Thomas MS,&nbsp;Sherlonda Flem BS, CTR,&nbsp;James Brierley MB,&nbsp;Elliot A. Asare MD, MS,&nbsp;Kay Washington MD, PhD,&nbsp;Chanjuan Shi MD, PhD","doi":"10.3322/caac.21840","DOIUrl":"10.3322/caac.21840","url":null,"abstract":"<p>The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including gastroenteropancreatic neuroendocrine tumors (GEP-NETs), is meant to be dynamic, requiring periodic updates to optimize AJCC staging definitions. This entails the collaboration of experts charged with evaluating new evidence that supports changes to each staging system. GEP-NETs are the second most prevalent neoplasm of gastrointestinal origin after colorectal cancer. Since publication of the AJCC eighth edition, the World Health Organization has updated the classification and separates grade 3 GEP-NETs from poorly differentiated neuroendocrine carcinoma. In addition, because of major advancements in diagnostic and therapeutic technologies for GEP-NETs, AJCC version 9 advocates against the use of serum chromogranin A for the diagnosis and monitoring of GEP-NETs. Furthermore, AJCC version 9 recognizes the increasing role of endoscopy and endoscopic resection in the diagnosis and management of NETs, particularly in the stomach, duodenum, and colorectum. Finally, T1NXM0 has been added to stage I in these disease sites as well as in the appendix.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"359-367"},"PeriodicalIF":503.1,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140815053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States","authors":"K. Robin Yabroff PhD,&nbsp;Joanna F. Doran JD,&nbsp;Jingxuan Zhao MPH,&nbsp;Fumiko Chino MD,&nbsp;Ya-Chen Tina Shih PhD,&nbsp;Xuesong Han PhD,&nbsp;Zhiyuan Zheng PhD,&nbsp;Cathy J. Bradley PhD,&nbsp;Monica F. Bryant JD","doi":"10.3322/caac.21837","DOIUrl":"10.3322/caac.21837","url":null,"abstract":"<p>The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019–2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"341-358"},"PeriodicalIF":503.1,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140651450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}