JNCI Journal of the National Cancer Institute最新文献

{"title":"Early palliative care for African American and rural-dwelling advanced cancer family caregivers: long-term outcomes.","authors":"J Nicholas Odom, Andres Azuero, Richard A Taylor, Jennifer Young Pierce, Chelsea L McGowen, Maria Pisu, Gabrielle Rocque, Rhiannon D Reed, Rachel Wells, Shena Gazaway, Sarah Mollman, Rushil V Patel, Macy L Stockdill, Sylvia Huang, Sally Engler, Marie A Bakitas","doi":"10.1093/jnci/djag339","DOIUrl":"https://doi.org/10.1093/jnci/djag339","url":null,"abstract":"<p><strong>Background: </strong>African American and rural-dwelling family caregivers of patients with advanced cancer may face structural, geographic, transportation, and access barriers to supportive care. Evidence is limited regarding the long-term effects of early palliative care interventions designed for these populations.</p><p><strong>Methods: </strong>We examined 36 and 48 week outcome data from 222 caregivers and 165 patients who participated in a single-blind, multi-site randomized clinical trial (intervention vs. usual care) of a lay-coach-led, caregiver-focused early palliative care intervention ENABLE Cornerstone (January 2020-November 2025). Caregiver and patient anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), quality of life (QOL) (PROMIS Global Health 10), and caregiver burden (Montgomery-Borgatta Caregiver Burden scales [MBCB]) at 36 and 48 weeks were examined using baseline-constrained linear mixed effects models with participant and intervention-coach random effects.</p><p><strong>Results: </strong>Intervention caregivers reported lower demand burden compared with usual care at 36 weeks (mean [SE] difference = -1.54 [0.52]; Cohen's d = -0.41 [95% CI, -0.68, -0.13]; adjusted p=.03). Intervention patients demonstrated significantly lower depressive symptoms at 36 weeks (mean [SE] difference = -1.53 [0.61]; Cohen's d = -0.38 [95% CI, -0.67, -0.08]; adjusted p=.048) and better physical quality of life at 48 weeks (mean [SE] difference=3.93 [1.38]; Cohen's d = 0.46 [95% CI, 0.14, 0.78]; adjusted p=.02).</p><p><strong>Conclusions: </strong>This caregiver-focused early palliative care intervention produced significant long-term patient benefits in a trial enrolling African American and rural-dwelling caregivers, including lower patient depressive symptoms and better physical QOL. Caregiver effects were more limited, although demand burden improved. These findings support scalable caregiver-focused palliative care strategies for populations facing barriers to specialty supportive care.</p><p><strong>Clinicaltrials.gov identifier: </strong>NCT04318886.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Per- and polyfluoroalkyl substances levels other than PFOS, PFOA, or PFHxS and liver cancer risk: a nested case-control analysis.","authors":"Cody Z Watling, Jessica L Petrick, Barry I Graubard, Hyokyoung G Hong, Xuehong Zhang, Matthew J Barnett, Mollie E Barnard, Yu Chen, A Heather Eliassen, J Michael Gaziano, Wen-Yi Huang, Jae H Kang, Jill Koshiol, I-Min Lee, Erikka Loftfield, Steven C Moore, Lorelei A Mucci, Marian L Neuhouser, Christina C Newton, Howard D Sesso, Martha Shrubsole, Rashmi Sinha, Lesley Tinker, Matthew Triplette, Caroline Y Um, Kala Visvanathan, Jean Wactawski-Wende, Eleanor L Watts, Walter C Willett, Fen Wu, Wei Zheng, Peter T Campbell, Jonathan N Hofmann, Mark P Purdue, Dinesh Barupal, Katherine A McGlynn","doi":"10.1093/jnci/djag325","DOIUrl":"https://doi.org/10.1093/jnci/djag325","url":null,"abstract":"<p><p>Epidemiologic studies of PFAS and liver cancer risk have produced conflicting results with no strong or clear associations for pre-diagnostic perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorohexanesulfonate (PFHxS). We now report analyses of nine additional PFAS in a nested case-control study within 12 prospective cohorts (853 cases, 853 matched controls) in the United States. Using multivariable-adjusted conditional logistic regression, we estimated odds ratios per 90th vs. 10th percentile increase in PFAS levels. Perfluoroheptanoic acid (PFHpA) was positively associated with liver cancer risk (OR: 1.78, 95% CI: 1.26-2.52); no associations were observed for other PFAS. Significant heterogeneity was observed by sex, cancer subtype, and time from blood collection. Associations were stronger among males (OR: 3.72, 95% CI: 2.10-6.59), for hepatocellular carcinoma (4.53, 2.59-7.94), and for those diagnosed ≤10 years after blood collection (3.17, 1.80-5.57). Given continued use of short-chain PFAS in consumer products, further research on their effects on liver health is warranted.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of an eHealth intervention to improve quality of life in long-term breast cancer survivors: a 9-month randomized controlled trial.","authors":"Gustavo Adolfo Pimentel-Parra, Paula Escalada-Hernández, Leticia San Martín-Rodríguez, Cristina García-Vivar, Nelia Soto-Ruiz","doi":"10.1093/jnci/djag328","DOIUrl":"https://doi.org/10.1093/jnci/djag328","url":null,"abstract":"<p><strong>Background: </strong>Quality of life may deteriorate in long-term breast cancer survivors after treatment. Evidence on the long-term effectiveness of eHealth interventions remains limited. This study aimed to evaluate the longer-term effect of CUMACA-M on overall quality of life over a 9-month follow-up period among long-term breast cancer survivors, compared with usual care.</p><p><strong>Methods: </strong>A parallel-group randomized clinical trial was conducted in Spain from November 2023 to January 2025. A total of 201 disease-free long-term breast cancer survivors (≥5 years post-diagnosis) were randomly assigned to a 9-month eHealth intervention (n = 102) or usual care (n = 99). Quality of life was assessed using the Quality of Life-Cancer Survivors scale at baseline and 3, 6, and 9 months. Intention-to-treat analyses used mixed linear models and nonparametric tests as appropriate.</p><p><strong>Results: </strong>Retention exceeded 90%. Group-by-time interactions were significant for overall quality of life (P=.006) and psychological well-being (P= .034). Quality of life declined in the control group from 5.83 at baseline to 5.57 at 9 months (change=-0.26, 95% CI=-0.46 to -0.07) but remained stable in the intervention group (5.70 to 5.69). At 9 months, adjusted quality of life favored CUMACA-M (mean difference=0.24, 95% CI = 0.03 to 0.44; P=.024; Cohen d = 0.32). Small significant effects also favored CUMACA-M for physical (P<.001, r = 0.28), social (P=.004, r = 0.23), and psychological well-being (P=.034, Cohen d = 0.40), but not spiritual well-being.</p><p><strong>Conclusions: </strong>The eHealth intervention prevented deterioration in quality of life over 9 months among long-term breast cancer survivors. Digital interventions may provide a scalable strategy to support survivorship care.</p><p><strong>Registration: </strong>ClinicalTrials.gov NCT05322460;  https://clinicaltrials.gov/study/NCT05322460.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant and antipsychotic prescriptions among 21 605 English survivors of childhood cancer: a population-based cohort.","authors":"Emma J Heymer, Chloe J Bright, Michael M Hawkins, David L Winter, Ceren Sunguc, Thomas Round, G Martin, Helen Jenkinson, Roderick Skinner, Katherine E Thackray, Raoul C Reulen","doi":"10.1093/jnci/djag323","DOIUrl":"https://doi.org/10.1093/jnci/djag323","url":null,"abstract":"<p><strong>Background: </strong>Mental health is an important aspect of wellbeing among childhood cancer survivors. Examining antidepressants and antipsychotics prescription patterns could provide insights into mental health needs, but comprehensive data on community prescribing remains limited. We investigated rates of antidepressant and antipsychotic prescriptions among childhood cancer survivors.</p><p><strong>Methods: </strong>Using English national prescription data (April 2015-December 2021), we investigated antidepressant and antipsychotic prescription patterns in a population-based cohort of 21,605 five-year survivors of childhood cancer (diagnosed ages 0-14 years, 1971-2006). Prescription rates were compared with the general population using standardised incidence ratios (SIRs) and absolute excess risks (AERs), per 100 person-years.</p><p><strong>Results: </strong>31% of survivors received at least one antidepressant prescription (expected 21%) with prescription rates 50% greater than the general population (SIR=1.5, 95%CI: 1.5-1.5). Annually, 6% were prescribed antidepressants versus 4% expected, i.e. 2% in excess (AER=2.0, 95%CI: 1.8-2.1).Female survivors had higher prescription rates than males (38.8% versus 24.2%; AER=2.7% versus 1.4%). Bone cancer survivors had the greatest antidepressant prescribing (SIR=2.0, 95%C 1.8-2.3), with 42% receiving prescriptions. Overall, 24% of survivors received SSRIs and 10% tricyclics. CNS tumour survivors had the highest antipsychotic prescription rate (SIR=2.4, 95%CI: 2.1-2.7).</p><p><strong>Conclusion: </strong>This largest-to-date study shows higher antidepressant prescribing among childhood cancer survivors than previously recognised, particularly among women. Rather than indicating overtreatment, this likely reflects engagement with primary care and recognition of survivors' mental health needs. These findings highlight the importance of comprehensive mental health assessment during long-term follow-up and clear pathways for specialist mental health referral, as advocated by survivorship care guidelines.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advancements in gynecologic cancer research: a SPORE investigators meeting report.","authors":"Doris Mangiaracina Benbrook, Kimberly Levinson, Nagarajan Kannan, Bethany N Hannafon, Danuta Kozbor, Arun Kanakkanthara, Vishal Chandra, Marion Curtis, Nadine Hempel, Kimberly K Leslie, Han Liang, Mathew Powell, Rajani Rai, Mara Steinkamp, Xiang Xue","doi":"10.1093/jnci/djag319","DOIUrl":"10.1093/jnci/djag319","url":null,"abstract":"<p><p>Global incidence and mortality rates for endometrial and cervical cancers have been steadily rising, while these rates for ovarian cancer have decreased. Although these cancers represent unique diseases and challenges, overlapping biology and responses to targeted and immunotherapies create opportunities to advance research through shared knowledge and resources. In 2025, investigators funded by National Cancer Institute (NCI) Specialized Programs of Research Excellence (SPORE) and other NCI-supported grants convened a hybrid meeting to identify challenges and knowledge gaps in translational research, highlight advances, define shareable resources and technologies, and foster collaboration among the Gynecologic Cancer SPORE sites, patient advocates, and NCI staff. Special sessions were arranged for presentations by Patient Advocates, Early-stage Investigators, Investigators Transitioning to Gynecologic Cancer Research. Meeting-wide workshops on Sharing Resources and Reducing Time to Activation of Clinical Trials and networking events were included. Collectively, the presentations converged on three overarching themes: (i) interception and early disease biology, (ii) development of innovative targeted and immune-based therapies, (iii) critical role of shared resources and collaborative infrastructure in accelerating translational progress. The unifying theme across disease sites was molecular advances to improve early detection/prevention and to drive therapeutic advancements. Novel findings discussed included: candidate precursor cells and mechanisms of high grade serous ovarian cancer development; therapeutic vaccines and their delivery methods for cervical dysplasia; identification of immune-targetable ovarian cancer antigens; various novel molecularly targeted drugs and immune-based agents for endometrial and ovarian cancers; and approaches to bypass drug resistance. Workshops delineated actionable strategies to further advance gynecologic cancer translational research.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer overdiagnosis in mammography trials-separating signal from noise: a meta-analysis.","authors":"Sisse Helle Njor, Casper Urth Pedersen, Elsebeth Lynge, Robert A Smith, Matejka Rebolj","doi":"10.1093/jnci/djag302","DOIUrl":"https://doi.org/10.1093/jnci/djag302","url":null,"abstract":"<p><strong>Background: </strong>Estimates of breast cancer overdiagnosis from randomized mammography trials range from ∼0 to ∼50%, reflecting methodological inconsistencies including handling of exit screening and post-screening compensatory drops. A coherent framework for interpreting trial results is needed to aid clinical counselling and guideline development.</p><p><strong>Methods: </strong>We conducted a unified reanalysis of randomized mammography trials using a reference-based approach. As reference, we used observations from the population-based service screening program in Funen, Denmark, where the temporal pattern of relative proportions (RPs) was used to describe the excess cumulative breast cancer incidence in birth cohorts invited vs not invited to screening. Trial reports identified via PubMed and prior reviews provided cumulative incidence estimates by arm and follow-up period. Control arms with exit screening were reanalyzed as screened. Observed RPs were compared with those expected under the Funen pattern at corresponding timepoints. The hypothesis was that close agreement between observed and expected RPs would indicate compatibility with low overall overdiagnosis.</p><p><strong>Results: </strong>Across 52 timepoints, 73 observed RPs closely matched those expected under the Funen reference pattern for invasive cancer with and without ductal carcinoma in situ. Deviations were plausibly related to incomplete reporting in early trial phases. Most 95% confidence intervals for the observed RPs overlapped expected RP values.</p><p><strong>Conclusions: </strong>When analyzed within a consistent framework accounting for exit screening and follow-up timing, mammography trials yield consistent excess-incidence patterns compatible with very low overdiagnosis (<5%). This supports balanced clinical and policy discussions without relying on unadjusted excess diagnoses as stand-alone overdiagnosis estimates.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RE: Benefit of adjuvant chemotherapy for resected pancreatic cancer following neoadjuvant FOLFIRINOX or Gemcitabine-Nab-paclitaxel: a multinational analysis.","authors":"Jiayong Ning, Zhijian Ren, Peng Yao","doi":"10.1093/jnci/djag312","DOIUrl":"https://doi.org/10.1093/jnci/djag312","url":null,"abstract":"","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RE: Benefit of adjuvant chemotherapy for resected pancreatic cancer following neoadjuvant FOLFIRINOX or gemcitabine-nab-paclitaxel: a multinational analysis.","authors":"Jia Liu","doi":"10.1093/jnci/djag311","DOIUrl":"https://doi.org/10.1093/jnci/djag311","url":null,"abstract":"","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Liu and to Ning, Ren, and Yao.","authors":"Victor Lopez-Lopez, Tanja Hasse, Ralph Fritsch, Ricardo Robles-Campos, Changhoon Yoo, Jose Oberholzer, Dilmurodjon Eshmuminov","doi":"10.1093/jnci/djag317","DOIUrl":"https://doi.org/10.1093/jnci/djag317","url":null,"abstract":"","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Biomarker Changes in a Randomised Low-Dose Tamoxifen Trial for Breast Cancer Prevention.","authors":"Stephen Nash, Mattias Hammarström, John-Olof Thörngen, Ola Winqvist, Erik Eliasson, Magnus Bäcklund, Mikael Eriksson, Sara Margolin, Linda Thorén, Signe Borgquist, Kamila Czene, Per Hall, Marike Gabrielson","doi":"10.1093/jnci/djag321","DOIUrl":"https://doi.org/10.1093/jnci/djag321","url":null,"abstract":"<p><strong>Background: </strong>Tamoxifen reduces breast cancer incidence and recurrence, but uptake for primary prevention remains limited, largely because of concerns regarding adverse effects at the standard 20 mg dose. Understanding systemic endocrine effects of lower tamoxifen doses may help improve future prevention strategies.</p><p><strong>Methods: </strong>We analysed data from 1,055 healthy women enrolled in the randomised, double-blind, placebo-controlled KARISMA trial, assigned to placebo or tamoxifen 1, 2.5, 5, 10, or 20 mg daily for 6 months. Plasma concentrations of endocrine biomarkers and tamoxifen metabolites were measured at study end. Associations between randomised tamoxifen dose, circulating metabolite concentrations, and endocrine biomarker plasma concentration (estrogens, androgens, progestogens, cortisol, prolactin, and sex hormone-binding globulin (SHBG)), were evaluated.</p><p><strong>Results: </strong>Tamoxifen dose was associated with measurable endocrine changes after six months, most consistently increased SHBG levels, with additional associations observed for cortisol and hydroxyprogesterone. SHBG demonstrated the clearest dose-response relationship, with increasing levels across tamoxifen dose groups and evidence of attenuated increase at intermediate doses. Large relative differences between placebo and 20 mg tamoxifen were additionally observed for estrone, estrone sulphate and estradiol. Unadjusted analyses of circulating endoxifen showed broadly similar endocrine patterns; however, these associations were substantially attenuated after adjustment for randomised tamoxifen dose. Circulating tamoxifen metabolites were strongly correlated with administered dose and with one another.</p><p><strong>Conclusions: </strong>Low-dose tamoxifen was associated with measurable endocrine changes, particularly in SHBG, cortisol, and hydroxyprogesterone. These findings show endocrine pharmacodynamic responses during low-dose tamoxifen therapy warrants further investigation as a potential component of future individualised prevention and adjuvant endocrine therapy strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID: NCT03346200.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}