CA: A Cancer Journal for Clinicians最新文献

{"title":"Becoming the new editor for CA: The future is now","authors":"Don S. Dizon MD","doi":"10.3322/caac.21828","DOIUrl":"10.3322/caac.21828","url":null,"abstract":"<p><i>CA: A Cancer Journal for Clinicians (CA)</i> was not a journal I ever saw myself publishing in let alone leading; its impact factor and prestige seemed out of reach for me—such is the Imposter Syndrome. Still, I came across the opportunity to become its editor and I applied, thinking I would regret it if I did not at least try. To my delight, I was chosen to succeed Ted Gansler, who had led <i>CA</i> as its editor for 23 years. Unbeknownst to me, I would also be the first to lead the journal from outside of the American Cancer Society (ACS).</p><p><i>CA</i> holds a special place in medicine, and specifically in oncology. Best known for the annual publication of Cancer Statistics, it is also the reference for a diverse readership, from primary care providers to advanced practice practitioners, both within the United States and globally. Therefore, it remains important that what we publish is accessible to all—regardless of whether they are specialized in cancer medicine. With that in mind, we have instituted new instructions for our potential authors, and they are based in intentionality. Articles submitted need to be understandable to our audience, and this is an opportunity to translate technical concepts into much more accessible language. I’ve asked the authors to be cognizant that our readership includes not only diverse health professionals but also people who themselves have experienced cancer, their caregivers, and advocates. As such, patient-centric language should be used. As examples, cancer should not be used as an adjective (e.g., breast cancer patients) nor should progression on treatment be referred to as a failure. The patient experience is also one that it is important to acknowledge, and I have challenged those who intend to submit to <i>CA</i> to incorporate patients’ points of view in the construction and the writing of articles and to include them as authors wherever it makes sense.</p><p>As we move into the future, I hope to make use of <i>CA</i> to democratize the access to important information; and, in 2024, <i>CA</i> will begin considering publication of high-impact clinical trial results. I intend the process to be a collaboration from the start, from gaging the appropriateness of phase 3 research for <i>CA</i> to timely peer review and publication, while maintaining the standards set above. Although this is a major shift in the past content <i>CA</i> has accepted, our editorial group at ACS believe this is an important step for <i>CA</i>, not only because of its eminence in medical publishing but because it represents an opportunity for everyone to access information that may change the standards of care. These articles will not be restricted—they will be free and downloadable at our journal’s website, just as <i>CA</i> content has always been.</p><p>Most of all, I want to ensure all who read and contribute to <i>CA</i> that the rigorous care that Dr. Gansler provided will continue. Articles are personally reviewe","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"132"},"PeriodicalIF":254.7,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139568387","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":"Most patients with cancer are not undergoing germline genetic testing","authors":"Mike Fillon","doi":"10.3322/caac.21827","DOIUrl":"10.3322/caac.21827","url":null,"abstract":"<p>Science editor Amy H from Santa Clarita, California, was aware of her immediate family’s heavy cancer history so it came as no surprise to her when she was diagnosed with cancer—a stage 1 tumor in the transverse colon. However, nagging questions remained: Did lifestyle, environment, or other factors play a role in her diagnosis, or could her cancer possibly have been tied to a genetic history?</p><p>A new study has found that her uncertainty and anxiety are not uncommon: Most patients with cancer do not undergo germline testing to learn if their cancer may have been associated with an inherited gene mutation. The study appears in the <i>Journal of the American Medical Association</i> (doi:10.1001/jama.2023.9526).</p><p>For the study, researchers included patients from California and Georgia in the Surveillance, Epidemiology, and End Results (SEER) registries, who were at least age 20 years, and diagnosed with any cancer between January 1, 2013, and March 31, 2019. Genes were grouped by cancer types and recommended for testing according to the National Comprehensive Cancer Network’s practice guidelines. Four laboratories submitted gene-level interpretations while also checking nationwide for patients who may have moved to other states.</p><p>There were 1,369,602 patients selected for the study. Patient variables included sex, cancer stage at diagnosis, age at diagnosis, ethnicity, and race. They also included companion genetic testing resulted comprising 107 genes of interest. The results were classified as pathogenic, benign, or uncertain.</p><p>The patients who underwent testing varied by the following cancer types: 50% had male breast cancer, 38.6% had ovarian cancer, 26% had female breast cancer, 7.5 had more than one cancer type, 6.4% had endometrial cancer, 5.6% had pancreatic cancer, 5.6% had colorectal cancer, 1.1% had prostate cancer, and 0.3% had lung cancer.</p><p>The researchers also found that testing overall increased during the time of the study. Of particular note, they found that testing in patients with pancreatic cancer increased from 1.2% in 2013 to 18.6% in 2019. This increase was not even, however; testing for patients with lung cancer remained low, increasing only from 0.1% in 2013 to 0.8% in 2019. They also found lower rates of genetic testing in older patients; although 18% of patients age 40 years were tested, only 2% of patients at age 80 years were tested.</p><p>The study authors noted that of all the pathogenic results, 67.5% to 94.9% of gene variants were in those genes that practice guidelines recommend testing. They also found that 68.3% to 83.8% of variants identified were in genes that have been linked to cancer type. “Gastrointestinal cancer–associated genes represented 68.3% of pathogenic results in colorectal cancer and 71.8% of pathogenic results in endometrial cancer,” they wrote. “Breast and ovarian cancer–associated genes represented 79.5% of pathogenic results in female breast cancer, 83.8% in male brea","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"6-7"},"PeriodicalIF":254.7,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490190","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":"More care needed for cancer caregivers","authors":"Mike Fillon","doi":"10.3322/caac.21826","DOIUrl":"10.3322/caac.21826","url":null,"abstract":"<p>W then ophthalmologist and co-founder of Glaucomflecken LLC, William Flanary, MD, suffered two separate, unrelated bouts of cancer and then cardiac arrest, his wife served as his primary caregiver. While Dr Flanary received the medical attention he needed, Kristin Flanary, also known as Lady Glaucomflecken, co-founder and marketing director of Glaucomflecken LLC in Portland, Oregon, was left frazzled and worn down. “We discovered there’s a big discrepancy between how closely we look at how patients are doing in terms of distress versus how closely we look at how caregivers are doing.”</p><p>She is not alone in her view. It is well-accepted that cancer causes many physical, emotional, and financial burdens not only for patients, but for their caregivers as well. A new observational study has confirmed that caregivers’ needs are often overlooked, making them vulnerable.</p><p>The study by researchers at Wake Forest School of Medicine in Winston-Salem, North Carolina, appears in the <i>Journal of the National Cancer Institute</i> (doi:10.1093/jnci/djad198).</p><p>According to study authors, what prompted the creation of this study was the growing recognition that there was a need for better integration of caregivers into patient-centered cancer care, but to do so research was needed to evaluate the most pressing caregiving burdens and to develop strategies to ease these burdens. They noted that caregivers’ experience symptoms of at least moderate depression, anxiety, worry, and stress that can hinder their ability to help with the patient’s coping and functioning. “The practice of clinic-level distress screening may be one opportunity to improve the assessment and management of caregiver concerns,” they wrote.</p><p>For the study, the researchers worked with Wake Forest University’s NCI Community Oncology Research Program (WF NCORP) Research Base in Winston-Salem, North Carolina. NCORPs are part of a network for clinical trials and cancer care delivery research in community oncology clinics nationwide. “There are approximately 1,000 distinct sub-affiliates within 46 NCORP affiliates, many of which cluster together in organizational units or practice groups with common resources, providers, and operations,” they wrote. Data collection took place between January 2019 and June 2020.</p><p>The surveys were given to the staff member identified as the most knowledgeable about supportive care services, distress screening, and management for oncology patients at their institution. For this study, the researchers referred to them as supportive care leaders (SCLs.)</p><p>Key factors the researchers collected included the number of oncology providers, academic affiliations, the practice setting (in-patient, outpatient, freestanding outpatient, or private clinic) whether it was single or multi-specialty group, hospital affiliations, patient demographics (including age, sex, race, and ethnicity), and whether patients were enrolled in Medicaid and/or Medicare.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"3-5"},"PeriodicalIF":254.7,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490179","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 statistics 2024: All hands on deck","authors":"Don S. Dizon MD, Arif H. Kamal MD, MBA, MHS","doi":"10.3322/caac.21824","DOIUrl":"10.3322/caac.21824","url":null,"abstract":"<p>The 2024 update to Cancer Statistics from the American Cancer Society estimates that over 2,000,000 people this year will hear the words, “you have cancer.”<span><sup>1</sup></span> This amounts to nearly 5500 people each day, or the equivalent to one person experiencing this every 15 seconds. This marks the first time incidence has eclipsed 2 million Americans, with more people being diagnosed at earlier stages of these diseases, when cure rates are the highest. Consequently, cancer mortality continues to decline, with an estimated 4.1 million lives saved since 1991, because of significant investments in research and screening by the National Institutes of Health, the Centers for Disease Control and Prevention, the American Cancer Society, and others. To us, four parts of the report particularly stand out.</p><p>First, historically, cancer has been a disease that disproportionally affects men. However, this report demonstrates that, whereas the cancer incidence in men has been stable since the 2013, the incidence in women has ticked up since the late 1990s, attributed to higher rates of breast and uterine corpus cancers and melanoma. Thus cancer is becoming more gender-indiscriminate, with a male-to-female incidence ratio of 1.14 (95% CI, 1.136–1.143) in all ages. Many have hypothesized that differential lifestyle and risk-taking behaviors, alongside environmental exposures, resulted in higher cancer rates in men. However, as the incidence gap between genders closes, signs may point to risk factors (e.g., obesity, sedentary lifestyle) that are similarly affecting both groups, highlighting the need for a better understanding of this phenomenon.</p><p>Second, although the overall cancer incidence is increasing, there are particular cancers and populations disproportionately affected. For example, whereas the rise in uterine corpus cancers in White women has increased by about 1% per year since the mid-2000s, the increase is in excess of 2% in Black, Hispanic, Asian American, and Pacific Islander people. Colorectal cancer (CRC) too shows a variability when age is considered; the declines noted in CRC are largely because of a lower rate in people older than 65 years; among those younger than 55 years, the rate continues to increase by 1% to 2% per year. Finally, men saw their rates stabilize for liver cancer and, potentially, for melanoma between 2015 and 2019, yet women saw their rates increase by 2% per year. Taken together, the report highlights how cancer cannot be over-simplified to one diagnosis, nor can we generalize these trends in a short bullet.</p><p>Third, although the report highlights the tremendous advances in the treatment of hematologic and advanced solid tumor malignancies, the impact of disparities cannot be overstated. Compared with White women, for example, more Black women are diagnosed at a more advanced stage (44% vs. 23%) and have a poorer prognosis (5-year survival rate estimates of 63% vs. 84%, respectively). As the aut","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"8-9"},"PeriodicalIF":254.7,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477590","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 statistics, 2024","authors":"Rebecca L. Siegel MPH,&nbsp;Angela N. Giaquinto MSPH,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21820","DOIUrl":"10.3322/caac.21820","url":null,"abstract":"<p>Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2020) and mortality data collected by the National Center for Health Statistics (through 2021). In 2024, 2,001,140 new cancer cases and 611,720 cancer deaths are projected to occur in the United States. Cancer mortality continued to decline through 2021, averting over 4 million deaths since 1991 because of reductions in smoking, earlier detection for some cancers, and improved treatment options in both the adjuvant and metastatic settings. However, these gains are threatened by increasing incidence for 6 of the top 10 cancers. Incidence rates increased during 2015–2019 by 0.6%–1% annually for breast, pancreas, and uterine corpus cancers and by 2%–3% annually for prostate, liver (female), kidney, and human papillomavirus-associated oral cancers and for melanoma. Incidence rates also increased by 1%–2% annually for cervical (ages 30–44 years) and colorectal cancers (ages &lt;55 years) in young adults. Colorectal cancer was the fourth-leading cause of cancer death in both men and women younger than 50 years in the late-1990s but is now first in men and second in women. Progress is also hampered by wide persistent cancer disparities; compared to White people, mortality rates are two-fold higher for prostate, stomach and uterine corpus cancers in Black people and for liver, stomach, and kidney cancers in Native American people. Continued national progress will require increased investment in cancer prevention and access to equitable treatment, especially among American Indian and Alaska Native and Black individuals.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"12-49"},"PeriodicalIF":254.7,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21820","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477593","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":"Interpreting and integrating genomic tests results in clinical cancer care: Overview and practical guidance","authors":"Raffaella Casolino MD, PhD,&nbsp;Philip A. Beer MD, PhD,&nbsp;Debyani Chakravarty PhD,&nbsp;Melissa B. Davis PhD,&nbsp;Umberto Malapelle PhD,&nbsp;Luca Mazzarella MD, PhD,&nbsp;Nicola Normanno MD,&nbsp;Chantal Pauli MD,&nbsp;Vivek Subbiah MD,&nbsp;Clare Turnbull MD PhD,&nbsp;C. Benedikt Westphalen MD,&nbsp;Andrew V. Biankin FRCS, PhD","doi":"10.3322/caac.21825","DOIUrl":"10.3322/caac.21825","url":null,"abstract":"<p>The last decade has seen rapid progress in the use of genomic tests, including gene panels, whole-exome sequencing, and whole-genome sequencing, in research and clinical cancer care. These advances have created expansive opportunities to characterize the molecular attributes of cancer, revealing a subset of cancer-associated aberrations called <i>driver mutations</i>. The identification of these driver mutations can unearth vulnerabilities of cancer cells to targeted therapeutics, which has led to the development and approval of novel diagnostics and personalized interventions in various malignancies. The applications of this modern approach, often referred to as <i>precision oncology</i> or <i>precision cancer medicine</i>, are already becoming a staple in cancer care and will expand exponentially over the coming years. Although genomic tests can lead to better outcomes by informing cancer risk, prognosis, and therapeutic selection, they remain underutilized in routine cancer care. A contributing factor is a lack of understanding of their clinical utility and the difficulty of results interpretation by the broad oncology community. Practical guidelines on how to interpret and integrate genomic information in the clinical setting, addressed to clinicians without expertise in cancer genomics, are currently limited. Building upon the genomic foundations of cancer and the concept of precision oncology, the authors have developed practical guidance to aid the interpretation of genomic test results that help inform clinical decision making for patients with cancer. They also discuss the challenges that prevent the wider implementation of precision oncology.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"264-285"},"PeriodicalIF":254.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085127","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":"Opioid analgesics for nociceptive cancer pain: A comprehensive review","authors":"Christina Abdel Shaheed PhD,&nbsp;Christopher Hayes MMed,&nbsp;Christopher G. Maher DMedSc,&nbsp;Jane C. Ballantyne MD,&nbsp;Martin Underwood MD,&nbsp;Andrew J. McLachlan PhD,&nbsp;Jennifer H. Martin PhD,&nbsp;Sujita W. Narayan PhD,&nbsp;Mark A. Sidhom MBBS","doi":"10.3322/caac.21823","DOIUrl":"10.3322/caac.21823","url":null,"abstract":"<p>Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite <i>stable and adequately controlled background pain</i>). They found a paucity of placebo-controlled trials for background cancer pain, although tapentadol or codeine may be more efficacious than placebo (moderate-certainty to low-certainty evidence). Nonsteroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac, ketorolac, and the antidepressant medicine imipramine, may be at least as efficacious as opioids for moderate-to-severe background cancer pain. For breakthrough cancer pain, oral transmucosal, buccal, sublingual, or intranasal fentanyl preparations were identified as more efficacious than placebo but were more commonly associated with toxicities, including constipation and nausea. Despite being recommended worldwide for the treatment of cancer pain, morphine was generally not superior to other opioids, nor did it have a more favorable toxicity profile. The interpretation of study results, however, was complicated by the heterogeneity in the study populations evaluated. Given the limited quality and quantity of research, there is a need to reappraise the clinical utility of opioids in people with cancer pain, particularly those who are not at the end of life, and to further explore the effects of opioids on immune system function and quality of life in these individuals.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"286-313"},"PeriodicalIF":254.7,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138713998","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":"American Cancer Society’s report on the status of cancer disparities in the United States, 2023","authors":"Farhad Islami MD, PhD,&nbsp;Jordan Baeker Bispo PhD,&nbsp;Hyunjung Lee PhD, MS, MPP, MBA,&nbsp;Daniel Wiese PhD,&nbsp;K. Robin Yabroff PhD,&nbsp;Priti Bandi PhD,&nbsp;Kirsten Sloan BA,&nbsp;Alpa V. Patel PhD,&nbsp;Elvan C. Daniels MD, MPH,&nbsp;Arif H. Kamal MD, MBA, MHS,&nbsp;Carmen E. Guerra MD, MSCE,&nbsp;William L. Dahut MD,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21812","DOIUrl":"10.3322/caac.21812","url":null,"abstract":"<p>In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"136-166"},"PeriodicalIF":254.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152005","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":"Disparities in cancer care: A long way to go","authors":"Shail Maingi MD,&nbsp;Don S. Dizon MD","doi":"10.3322/caac.21822","DOIUrl":"10.3322/caac.21822","url":null,"abstract":"&lt;p&gt;The 2023 American Cancer Society (ACS) report on cancer disparities highlights the persistent issues related to inequities in cancer incidences and outcomes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Black individuals continue to be diagnosed at higher incidence rates than White individuals with multiple cancers, including colorectal, pancreatic, lung, prostate, and cervical cancers. The report also reveals that Black patients with the same cancers as White patients have a 16%–20% higher mortality rate.&lt;/p&gt;&lt;p&gt;These findings highlight that disparities persist and how difficult the challenges are to address them, particularly when they cannot be attributed easily to any one factor. In the 2023 ACS report, for example, the authors looked at the impact of education on cancer mortality rates and found that those with ≤12 years of education had a 2.5 times higher rate of mortality than those with ≥16 years of education. The protective effect of years of education, however, had less effect on mortality among Black individuals with cancer, who continued to have a higher mortality rate compared with White individuals across all educational thresholds. Therefore, the higher cancer incidence rates are multiplicative for Black individuals who have multiple identities associated with worse outcomes.&lt;/p&gt;&lt;p&gt;The finding that Black individuals who are highly educated and still have higher cancer mortality rates brings up two important issues. The first is the devastating and pervasive impact of structural racism and minority status on the health of Black individuals regardless of socioeconomic strides and success. The authors note that these manifest as a lack of access to high-quality services, financial burdens that limit treatment, or biases that prevent screening and preventative efforts, among others.&lt;/p&gt;&lt;p&gt;Implicit bias on a provider and staff level can also contribute to differences in the quality of cancer care being delivered and exacerbate medical mistrust. For example, Enzinger and colleagues evaluated access to opioids among people on Medicare who were dying of cancer (&lt;i&gt;n&lt;/i&gt; = 318,549) in the 30 days before death or hospice enrollment.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Compared with White patients, Black and Hispanic patients were less likely to receive any opioid, and, if given, they were more likely to receive a lower daily and a lower total dose. Black men also reportedly were more likely to undergo urine drug screening. According to this report, the disparities were not attenuated by adjustments for socioeconomic factors (e.g., rurality, community-level factors). The second important issue regarding access to opioids is that it emphasizes the importance of applying an intersectional lens to disparities work in order to make progress, which is something that is missing from the current analyses.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Intersectionality&lt;/i&gt; was originally used by Kimberlé Crenshaw in Black feminist theory as a critical framework to understand power and oppression that takes into acc","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"133-135"},"PeriodicalIF":254.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152006","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":"Testicular cancer in 2023: Current status and recent progress","authors":"Deaglan J. McHugh MD,&nbsp;Jack P. Gleeson MB BCh BAO, MRCPI,&nbsp;Darren R. Feldman MD","doi":"10.3322/caac.21819","DOIUrl":"10.3322/caac.21819","url":null,"abstract":"<p>Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"167-186"},"PeriodicalIF":254.7,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72012741","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}