Journal of Cancer Policy最新文献

{"title":"Inequalities in the utilisation of curative-intent treatments for early-stage non-small cell lung cancer across urban and rural areas: A population-based study in England","authors":"Eva Kagenaar ,&nbsp;David G. Lugo-Palacios ,&nbsp;Ajay Aggarwal ,&nbsp;Andrew Hutchings ,&nbsp;Lu Han ,&nbsp;Stephen O’Neill ,&nbsp;Bernard Rachet ,&nbsp;John Edwards ,&nbsp;Corinne Faivre-Finn ,&nbsp;Richard Grieve","doi":"10.1016/j.jcpo.2025.100662","DOIUrl":"10.1016/j.jcpo.2025.100662","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess sociodemographic inequalities in anticancer treatments including curative-intent surgery and curative-intent radiotherapy for people with early-stage non-small cell lung cancer (NSCLC), across urban and rural areas.</div></div><div><h3>Methods</h3><div>A total of 38,229 eligible patients with early-stage NSCLC were identified from the English cancer registry and information on anti-cancer treatment (curative-intent surgery, curative-intent radiotherapy, palliative treatment, no anticancer treatment) was extracted from linked data. Multinomial logistic regression models estimated the association of sociodemographic measures with receipt of anticancer treatments, adjusting for case-mix and travel time.</div></div><div><h3>Results</h3><div>Those living in more deprived areas were less likely to receive curative-intent surgery with a mean change in the estimated probability of −11.1 %age points (95 % CI −12.5;-9.6), but more likely to receive curative radiotherapy with a mean change of + 4.3 %age points (95 % CI 3.0;5.6), than those living in the least deprived areas. Compared to those living in the five largest cities, the estimated probability of receiving curative-intent surgery was lower for those living in other urban areas with a mean change of −2.7 %age points (95 % CI −3.7;-0.2), and those living in rural areas, with a mean change of −2.2 %age points (95 % CI −3.7;-0.6). The probability of receiving curative-intent radiotherapy was lower by on average −2.3 %age points (95 % CI −3.2;-1.3) for those living in other urban areas versus the largest cities, but the corresponding reduction for those living in rural areas was small (-0.5 %age points, 95 % CI −1.9;0.1).</div></div><div><h3>Conclusion</h3><div>There are major inequalities in receipt of curative-intent surgery for early-stage NSCLC according to deprivation, and urban versus rural residence with smaller inequalities for receipt of curative-intent radiotherapy.</div></div><div><h3>Policy Implications</h3><div>The further expansion of radiotherapy services could reduce inequalities in uptake of curative-intent treatment for NSCLC, but the impact on patient outcomes must be assessed.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100662"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizing the opportunity to leverage home-based palliative care for cancer education and screening in high-burden and resource-limited settings in India","authors":"Laxman Kumar Mahaseth ,&nbsp;Subhadra Goala ,&nbsp;Vidhubala Elangovan ,&nbsp;Kathirvel Soundappan ,&nbsp;Krishnakumar Rathnam ,&nbsp;Bibha Thapa ,&nbsp;Kanan Singha ,&nbsp;Ravi Kannan","doi":"10.1016/j.jcpo.2025.100646","DOIUrl":"10.1016/j.jcpo.2025.100646","url":null,"abstract":"<div><h3>Background</h3><div>Despite national screening efforts and a high cancer burden, the cancer screening rate is low in the northeast region of India. Seizing every opportunity for early detection is crucial in reducing cancer-related morbidity and mortality. This study assessed the outcomes of cancer education and symptom screening (CESS) among family members and neighbours of cancer patients on home-based palliative care (Home-PC) in Barak Valley of Assam, India.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study based on record review. Trained lay health workers (TLHW) attached to a tertiary cancer hospital conducted CESS sessions (self-administered or facilitated questionnaire) during routine Home-PC visits.</div></div><div><h3>Results</h3><div>Of 916 individuals, 75 (8.2 %) reported cancer-related symptoms and 33 (44 %) attended the screening OPD of a tertiary hospital for assessment. Of them, 17 (51.5 %) were diagnosed with cancer, predominantly oral, breast, and other cancers. The median (interquartile range) days from symptom screening to screening OPD visit was 10 (2.5, 49.5) days, while from screening OPD visit to diagnosis was 1 (0, 8) day.</div></div><div><h3>Conclusion</h3><div>Integrating CESS into Home-PC is feasible and aids in prompt diagnosis in resource-limited settings. This strategy could be used as an opportunity for early cancer detection and management, especially in high-burden regions like Northeast India.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100646"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to ‘beyond virtual learning: Leveraging project ECHO to sustain and localize national cancer control plan implementation in LMICs’","authors":"Linsey Eldridge,&nbsp;Kalina Duncan,&nbsp;Mishka Kohli Cira","doi":"10.1016/j.jcpo.2025.100639","DOIUrl":"10.1016/j.jcpo.2025.100639","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100639"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival as a safety guardrail in cancer drug trials","authors":"Rashidul Alam Mahumud","doi":"10.1016/j.jcpo.2025.100666","DOIUrl":"10.1016/j.jcpo.2025.100666","url":null,"abstract":"<div><div>Surrogate endpoints have accelerated access to oncology drugs but often leave uncertainty about net patient benefit. We propose a pragmatic framework that recentres overall survival (OS) as both the definitive patient-centred efficacy endpoint and a safety guardrail capable of detecting net harm that intermediate measures may miss. The framework comprises four pillars. First, designing for harm exclusion: protocols should prespecify a clinically meaningful OS harm margin, power event-driven follow-up to exclude or detect that margin with precision, and mandate independent data monitoring committee oversight. Analyses should match explicit estimands and pair hazard ratios with restricted mean survival time to accommodate non-proportional hazards. Second, handling crossover and post-progression therapy: when crossover is ethical or unavoidable, trials should adopt treatment-policy estimands for the primary question and prespecified causal sensitivity analyses. Protocols must map access to guideline-concordant post-progression care, record uptake and timing, and distinguish biological dilution from health-system scarcity. Third, using surrogates with discipline: when OS cannot feasibly be primary, sponsors should submit a disease-specific surrogate dossier summarising trial- and patient-level validation and quantifying expected translation to OS, while continuing to collect OS and assess it against the prespecified harm boundary. Fourth, preventing missingness-driven bias: continue outcome collection after treatment discontinuation, set triggers for asymmetric loss to follow-up, and perform structured tipping-point analyses. We recommend a regulatory traffic-light aligned to OS maturity, green (traditional approval), amber (time-limited with confirmatory obligations), red (standards unmet), and conditioning economic conclusions (QALYs, net monetary benefit) on OS harm exclusion. Operationalising OS as a safety guardrail protects patients and strengthens the credibility and value of cancer trials.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100666"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global emerging trends and correlation of financial toxicity in cancer care: A bibliographic review (2013–2024)","authors":"Xiaojun Zhang ,&nbsp;Shixiang Chen ,&nbsp;Yuting Feng ,&nbsp;Hailing Ren ,&nbsp;Yanwen Zhang ,&nbsp;Ying Chen ,&nbsp;Bingxin Ma ,&nbsp;Jin Yang ,&nbsp;Yaogang Wang ,&nbsp;Qi Lu ,&nbsp;Yue Zhao","doi":"10.1016/j.jcpo.2025.100658","DOIUrl":"10.1016/j.jcpo.2025.100658","url":null,"abstract":"<div><h3>Purpose</h3><div>Financial toxicity has garnered increasing attention due to the financial “toxic effect” of cancer therapy. This study was conducted to provide an overall research landscape on financial toxicity from chronological, geographical, socioeconomic and epidemiological perspectives.</div></div><div><h3>Designs</h3><div>Publications on financial toxicity were retrieved from the Web of Science Core Collection. IBM SPSS 26.0 was used to analyze the correlation between the number of publications and socioeconomic and epidemiological factors. VOSviewer, CiteSpace, Scimago Graphica and Pajek were used for country/region collaboration, reference cocitation, keyword cooccurrence, and keyword burst analysis.</div></div><div><h3>Results</h3><div>Between 2013 and 2024, 501 publications were identified, with the number of publications increasing annually. The annual number of publications was highly positively correlated with the annual cancer incidence rate, prevalence rate, death rate, and disability-adjusted life years (R² = 0.907, 0.820, 0.836, 0.808, respectively). The number of publications in different countries was highly positively correlated with total health spending, government health spending, and out-of-pocket health spending (R² = 0.955, 0.906, 0.746, respectively). The top journal was Supportive Care in Cancer (79 publications). Research hotspots focus on the impact of financial toxicity on quality of life and psychological distress, the measurement and cost burden of financial toxicity, its impact on health outcomes, and the employment and health impact of financial toxicity. Research frontiers focused on the financial stress and young adult.</div></div><div><h3>Conclusions</h3><div>The increasing number of publications on financial toxicity highlights its growing recognition as an important issue in healthcare. Health professionals and governments should address the high costs of cancer care and explore interventions to reduce its impact on patients and healthcare spending.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100658"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigational sites requirements according to trial complexity and intervention level under EU Regulation No. 536/2014","authors":"Celeste Cagnazzo ,&nbsp;Evaristo Maiello ,&nbsp;Roberto Labianca ,&nbsp;Valeria Facciolo ,&nbsp;Francesco Perrone ,&nbsp;Gennaro Daniele ,&nbsp;Massimo Di Maio ,&nbsp;Carmine Pinto","doi":"10.1016/j.jcpo.2025.100655","DOIUrl":"10.1016/j.jcpo.2025.100655","url":null,"abstract":"<div><div>The full implementation of Regulation (EU) No. 536/2014 has transformed the European clinical research landscape, introducing a harmonised, risk-based framework for trial approval and conduct. In Italy, however, the lack of nationally standardised site suitability criteria beyond phase I trials remains a critical regulatory gap, leading to procedural inconsistencies, delayed activations, and unequal patient access. This paper examines the shortcomings in European and Italian regulations and operations and suggests a tiered framework of minimum requirements for investigational centres. The model adjusts requirements based on trial complexity and associated risk, while ensuring compliance with EU legislation. This approach supports wider participation in pragmatic and late-phase oncology trials and prevents excessive centralisation in a few key hubs. It also emphasizes the need for formal recognition of essential research roles, such as study coordinators, data managers, and research pharmacists, critical to high-quality trials. By adopting this risk-adapted, scalable approach, national authorities could improve site qualification, streamline trial timelines, and enhance Italy’s competitiveness in international oncology research. From a policy standpoint, establishing proportionate national standards is urgent to ensure equitable patient access, strengthen the resilience of the research system, and align with the inclusive and risk-oriented spirit of Regulation (EU) No. 536/2014.</div></div><div><h3>Policy summary</h3><div>Italy lacks nationally standardised site suitability criteria beyond phase I clinical trials, causing delays and inequities. This paper proposes a risk-based, proportionate framework of minimum requirements for investigational sites, aligned with Regulation (EU) No. 536/2014. Adoption by AIFA would provide consistent benchmarks for Ethics Committees and sponsors, improve trial activation, and expand equitable access to innovative therapies, while reinforcing Italy’s role in multinational oncology research.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100655"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the equity gap in colorectal cancer screening: A comparative analysis across high-income countries","authors":"Yasmin Jahan ,&nbsp;Atiqur SM-Rahman","doi":"10.1016/j.jcpo.2025.100657","DOIUrl":"10.1016/j.jcpo.2025.100657","url":null,"abstract":"<div><h3>Background</h3><div>Despite the availability of colorectal cancer (CRC) screening programs in high-income countries (HICs), disparities in access and outcomes persist. Equity-focused policies are essential to ensure that CRC prevention reaches all population groups, particularly those underserved or marginalized.</div></div><div><h3>Methods</h3><div>We conducted a comparative policy analysis of CRC screening systems across ten HICs using peer-reviewed literature, national cancer agency reports, and updated screening data. Two summary tables were developed: one detailing screening modalities, coverage rates, and intervals; the other outlining equity-focused policies, gaps, and country-specific recommendations.</div></div><div><h3>Results</h3><div>The analysis revealed substantial variation in screening modalities and coverage rates, with organized, population-based programs generally achieving higher uptake. Equity-focused policies varied widely, with common gaps including limited outreach in rural areas, under-screening among minority populations, and insufficient equity data collection. Recommendations included expanding culturally tailored education, improving data systems, and embedding equity metrics into national strategies.</div></div><div><h3>Conclusion</h3><div>This study contributes to the growing evidence base on health equity in cancer prevention by offering a replicable framework for cross-country policy benchmarking. The findings underscore the importance of integrating equity into CRC screening programs to reduce disparities and improve outcomes across diverse health systems.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100657"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Areca nut-related oral cancer awareness in adults: A meta-analysis","authors":"Nathaniel Wu ,&nbsp;Thomas J. Roberts ,&nbsp;Nikki Apana ,&nbsp;Sanjena Venkatesh ,&nbsp;Nicole Deville ,&nbsp;Eric Pineda ,&nbsp;Song Zhang ,&nbsp;Mona Pathak ,&nbsp;Kekoa Taparra ,&nbsp;William J. Moss","doi":"10.1016/j.jcpo.2025.100649","DOIUrl":"10.1016/j.jcpo.2025.100649","url":null,"abstract":"<div><h3>Background</h3><div>Areca nut is classified as a Group I carcinogen for oral cavity malignancies by the International Agency for Research on Cancer. Cultivation of the substance and oral cancer incidences have risen considerably in recent years. The assessment of areca nut-related health risk awareness is an increasingly imperative global health topic.</div></div><div><h3>Methods</h3><div>A systematic review of the Medline, Web of Science, Embase and Cochrane databases was undertaken in search of prospective survey studies evaluating areca nut-related health literacy in adults. The primary outcome of interest was the percentage of respondents that were unaware that areca nut products cause oral cancer. A random effects meta-analysis was used to calculate pooled weighted averages. Subgroup analyses stratifying by healthcare education level, geography and publication year were performed using a Chi-square test.</div></div><div><h3>Results</h3><div>Twenty-eight articles with a total of 13,440 respondents were included in the analysis. Collectively, 50 % (95 % CI: 40 %-60 %, I² 99·5 %) of respondents did not identify areca nut products in general as a risk factor for oral cancer. Only five studies specifically inquired about the carcinogenicity of areca nut without additives. Collectively, 80 % (95 % CI: 63 %-96 %, I² 99·3 %) of these respondents did not know that pure areca nut is a carcinogen. There were no significant discrepancies on subgroup analyses by healthcare education level, geography or date of publication.</div></div><div><h3>Conclusion</h3><div>An international collection of evidence substantiates drastic areca nut-related health literacy deficiencies internationally.</div></div><div><h3>Policy Summary</h3><div>There is an urgent need for healthcare professionals in areca nut regions to launch formalized educational campaigns. Medically-accurate, culturally-sensitive warning labels are strongly indicated.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100649"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Bridging the equity gap in colorectal cancer screening: A comparative analysis across high-income countries” [J. Cancer Policy 46 (2025) 100657]","authors":"Yasmin Jahan ,&nbsp;Atiqur SM-Rahman","doi":"10.1016/j.jcpo.2025.100667","DOIUrl":"10.1016/j.jcpo.2025.100667","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100667"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing and comparing patient engagement in clinical cancer research: A cross-regional analysis between Europe and Japan using a structured evaluation tool","authors":"Laureline Gatellier ,&nbsp;Beatrice Serckx ,&nbsp;Lode Dewulf ,&nbsp;Nicholas Brooke ,&nbsp;Bertrand Tombal ,&nbsp;Hadrien Charvat ,&nbsp;Keiko Katsui ,&nbsp;Yoshiyuki Majima ,&nbsp;Jin Higashijima ,&nbsp;Kazuyuki Suzuki ,&nbsp;Ingrid Klingmann ,&nbsp;Beata Juzyna ,&nbsp;Iryna Shakhnenko ,&nbsp;Kenichi Nakamura ,&nbsp;Tomohiro Matsuda","doi":"10.1016/j.jcpo.2025.100634","DOIUrl":"10.1016/j.jcpo.2025.100634","url":null,"abstract":"<div><h3>Background</h3><div>Meaningful patient engagement (PE) is increasingly recognized as a critical element of clinical cancer research. Policy frameworks in Europe and Japan reflect growing support for involving patients in research and policymaking. However, tools to assess the actual implementation of PE in clinical trials remain limited. This study introduces a structured, self-evaluation tool for principal investigators (PIs) to assess PE and compares its application to academic trials across Europe and Japan.</div></div><div><h3>Methods</h3><div>A two-dimensional matrix was developed to evaluate PE across eight key research steps—research priorities, fundraising, protocol development, informed consent, ethical review, investigator meetings, reporting, and regulatory submission—against five engagement levels (0: none to 4: co-creation). The tool was refined to ensure linguistic and contextual applicability in both regions. A structured questionnaire incorporating the matrix was distributed to PIs identified from public databases. Statistical analyses were conducted to compare PE practices between both regions.</div></div><div><h3>Results</h3><div>Among 178 European and 123 Japanese trials, PI response rate were 24.2 % (n = 43) and 52.0 % (n = 64), respectively. Across all research steps, 60.7 % of European and 80.6 % of Japan trials contained no PE. However, PE was reported in at least one step in 86.0 % of European and 39.1 % of Japanese trials. When engaging, European trials showed higher levels in protocol development, informed consent, ethical review, and reporting steps than Japan (<em>p</em> &lt; 0.001 for all).</div></div><div><h3>Conclusion</h3><div>This study developed a simple, structured tool to assess PE and applied it to trials in Europe and Japan. It revealed regional differences across culturally and structurally distinct systems, demonstrating its value for cross-context comparison and broader application.</div></div><div><h3>Policy summary</h3><div>By enabling structured assessment and monitoring of PE, this tool supports the implementation of engagement policies across regions. Its adaptability may foster shared learning and cross-border collaboration, especially in regions where engagement frameworks are still emerging.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100634"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}