Journal of the National Comprehensive Cancer Network : JNCCN最新文献

{"title":"County-Level Medical Debt and Its Associations With Cancer Stage and Survival in the United States.","authors":"Xuesong Han, Nuo Nova Yang, Xin Hu, Qinjin Fan, Jingxuan Zhao, Zhiyuan Zheng, Kewei Sylvia Shi, Breno Braga, Changchuan Jiang, K Robin Yabroff","doi":"10.6004/jnccn.2026.7036","DOIUrl":"10.6004/jnccn.2026.7036","url":null,"abstract":"<p><strong>Background: </strong>Medical debt is recognized as a social determinant of health. This study examines associations of county-level medical debt in collections with diagnosis stage and survival among individuals newly diagnosed with cancer in the United States.</p><p><strong>Patients and methods: </strong>A cohort of individuals aged ≥18 years newly diagnosed with cancer in 2011-2019 was identified from the National Cancer Database and followed through December 31, 2019. The county-level share of adults with medical debt in collections was combined with patient-level data. Hierarchical multivariable logistic and Cox proportional hazard models estimated associations of county-level medical debt with cancer diagnosis stage and overall survival, respectively, for all patients and by cancer type, clinical, and socioeconomic subgroups.</p><p><strong>Results: </strong>A total of 7,558,658 individuals with cancer were identified, with median county-level medical debt of 18%, ranging from 0% to 56%. Patients in the highest medical debt quartile had the highest proportion with stage IV disease and lowest 5-year survival rate. After adjusting for other patient- and county-level characteristics, patients living in counties in the highest quartile of medical debt were more likely to be diagnosed with stage IV disease (odds ratio, 1.079; 95% CI, 1.064-1.094) and had poorer survival (hazard ratio, 1.072; 95% CI, 1.061-1.082) than those living in counties in the lowest quartile of medical debt, with a statistically significant dose-response relationship (P for trend <.001). Patterns were observed across major cancer types and were consistent across socioeconomic and clinical subgroups.</p><p><strong>Conclusions: </strong>County-level medical debt was associated with advanced-stage diagnosis and worse survival among individuals newly diagnosed with cancer. Future research is warranted to evaluate the recent and ongoing US policy changes on medical debt prevalence and their effects on cancer care and outcomes.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805311","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":"Metabolic Tumor Volume as a Predictor of Benefit From Prophylactic Cranial Irradiation in Limited-Stage Small Cell Lung Cancer.","authors":"Taejun Lee, Chang Gon Kim, Kyung Hwan Kim, Seoyoung Lee, Moonki Hong, Jae-Hoon Lee, Hyo Sup Shim, Sangwoo Kim, Su Kyoung Park, Min Hee Hong, Ja Hyun Yeo, Hong In Yoon, Arthur Cho, Hye Ryun Kim","doi":"10.6004/jnccn.2026.7029","DOIUrl":"10.6004/jnccn.2026.7029","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic cranial irradiation (PCI) reduces the incidence of brain metastases (BMs) in patients with limited-stage small cell lung cancer (LS-SCLC). However, predictive biomarkers that identify patients most likely to benefit from PCI have not been established. This study investigates the potential of 18F-fluoro-2-deoxyglucose (18F-FDG) PET as a predictor of PCI benefit in patients with LS-SCLC.</p><p><strong>Patients and methods: </strong>This multicenter study analyzed patients with LS-SCLC who underwent brain MRI and 18F-FDG PET/CT at baseline, followed by treatment with concurrent chemoradiotherapy. To evaluate whether the benefit of PCI varies according to BM risk, we compared outcomes between PCI-treated and untreated patients stratified by risk group.</p><p><strong>Results: </strong>Of 261 patients overall, 171 received PCI and 90 did not. In patients not receiving PCI, high metabolic tumor volume (MTV; >45.201 cm3) was associated with inferior intracranial time to progression (iTTP; hazard ratio [HR], 5.62; 95% CI, 1.69-18.77; P=.005), progression-free survival (PFS; HR, 2.35; 95% CI, 1.38-4.02; P=.002), and overall survival (OS; HR, 2.23; 95% CI, 1.27-3.91; P=.005). Conversely, MTV demonstrated no significant association with survival outcomes among PCI recipients. Subgroup analysis revealed that PCI conferred no survival advantage in the low-MTV group, whereas in the high-MTV group, PCI was associated with improved iTTP (HR, 0.27; 95% CI, 0.15-0.51; P<.001), PFS (HR, 0.49; 95% CI, 0.35-0.69; P<.001), and OS (HR, 0.56; 95% CI, 0.40-0.80; P=.001). Interaction analysis confirmed a significant effect modification between MTV status and PCI benefit for iTTP, PFS, and OS, supporting MTV as an independent predictive biomarker for PCI benefit.</p><p><strong>Conclusions: </strong>Baseline PET-derived MTV serves as a clinically relevant predictor of PCI benefit in LS-SCLC, supporting a risk-adapted PCI strategy guided by metabolic imaging biomarkers. This approach may reduce unnecessary neurotoxicity and optimize treatment outcomes and should be prospectively validated.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761656","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":"Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT: A Randomized Controlled Trial.","authors":"Saro H Armenian, Xinyi Du, Alysia Bosworth, Stephanie Rodarte, Elina Balasian, Samhitha Boyapalli, Claudia Herrera, Meagan Echevarria, Lanie Lindenfeld, Monzr Al Malki, Ryotaro Nakamura, Badri Modi, Kevin C Oeffinger, Karen M Emmons, Ashfaq A Marghoob, Stephen J Forman, F Lennie Wong, Alan C Geller","doi":"10.6004/jnccn.2026.7030","DOIUrl":"10.6004/jnccn.2026.7030","url":null,"abstract":"<p><strong>Background: </strong>Survivors of hematopoietic cell transplantation (HCT) have an increased risk of skin cancer, yet adherence to recommended skin self-examination (SSE) and annual physician skin examinations is low. Scalable strategies to improve screening in this high-risk population are needed.</p><p><strong>Patients and methods: </strong>We conducted a randomized controlled trial of 720 adult survivors of HCT enrolled between October 30, 2020, and December 13, 2023. Participants received remotely delivered print materials and 12 educational text messages over 9 months (patient activation and education [PAE]). In the PAE plus physician activation group (PAE + Phys), providers also received educational materials and guidance on performing skin examinations. Primary outcomes were participant-reported SSE within the prior 2 months and physician skin examination within the prior 12 months, assessed at baseline and 12 months. Secondary outcomes included the number of body regions examined and skin cancer knowledge.</p><p><strong>Results: </strong>Median age at enrollment was 61 years (range, 18-81), and the median time from HCT until enrollment was 3.1 years (range, 1.7-5.3). The proportion of participants reporting both physician skin examination and SSE increased in both groups, from 15.8% to 47.5% in the PAE group (odds ratio [OR], 4.98; 95% CI, 3.54-7.02) and from 18.0% to 52.1% in the PAE + Phys group (OR, 5.49; 95% CI, 4.03-7.50), with no significant between-group difference. SSE increased significantly in both groups, from 34.7% to 81.5% in the PAE group and from 31.5% to 79.0% in the PAE + Phys group, without no significant between-group difference. Physician skin examinations increased from 32.1% to 55.3% in the PAE group and from 33.2% to 64.8% in the PAE + Phys group, with a significantly greater increase in the PAE + Phys group (P=.01). The mean number of body regions examined more than doubled in both groups, and skin cancer knowledge and self-efficacy improved significantly.</p><p><strong>Conclusions: </strong>Remotely delivered interventions improved skin cancer screening among HCT survivors. Patient activation substantially increased SSE, whereas physician activation provided additional benefit for physician-performed skin examinations. These findings suggest that physician activation enhances clinician-performed screening and supports scalable survivorship care models for high-risk populations.</p><p><strong>Clinicaltrials: </strong>gov identifier: NCT04358276.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687598","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":"Authors' Reply to the Letter to the Editor by Batalini et al: Observational Data on Vitamin D Do Not Justify Routine Screening or Supplementation to Improve Breast Cancer Outcomes.","authors":"Song Yao, Alfredo V Chua, Heather Greenlee, Marilyn L Kwan, Lawrence H Kushi","doi":"10.6004/jnccn.2026.7063","DOIUrl":"10.6004/jnccn.2026.7063","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805342","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":"Mesothelioma: Pleural, Version 3.2026, NCCN Clinical Practice Guidelines In Oncology.","authors":"James Stevenson, Gregory J Riely, Douglas E Wood, Dara L Aisner, Andrea L Axtell, Jessica R Bauman, Ankit Bharat, Joe Y Chang, Aakash Desai, Thomas J Dilling, Jonathan Dowell, Gregory A Durm, Scott Gettinger, Travis E Grotz, Matthew A Gubens, Aditya Juloori, Rudy P Lackner, Michael Lanuti, Benjamin Levy, Jules Lin, Billy W Loo, Christine M Lovly, Fabien Maldonado, Daniel Morgensztern, Trey C Mullikin, Thomas Ng, Dawn Owen, Dwight H Owen, Tejas Patil, Patricio M Polanco, Jonathan Riess, Ana Lucia Ruano Mendez, Theresa A Shapiro, Aditi P Singh, Alda Tam, Tawee Tanvetyanon, Jane Yanagawa, Edwin Yau, Karen Yun, Kristina Gregory, Lisa Hang","doi":"10.6004/jnccn.2026.0038","DOIUrl":"10.6004/jnccn.2026.0038","url":null,"abstract":"<p><p>Mesothelioma is a rare cancer that originates from the mesothelial surfaces of certain sites within the body. Pleural mesothelioma is the most common type and represents approximately 85% of mesotheliomas. The NCCN Guidelines for Mesothelioma: Pleural provide recommendations for evaluation and treatment in patients with pleural mesothelioma. The NCCN Guidelines will continue to be updated annually based on available clinical evidence and panel consensus.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805352","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":"Letter to the Editor: Observational Data on Vitamin D Do Not Justify Routine Screening or Supplementation to Improve Breast Cancer Outcomes.","authors":"Felipe Batalini, Rodolfo Garza-Morales, Wallace Klein Schwengber, Brenda Ernst","doi":"10.6004/jnccn.2026.7064","DOIUrl":"10.6004/jnccn.2026.7064","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805323","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":"NCCN Guidelines® Insights: Survivorship, Version 3.2026.","authors":"Lindsay L Peterson, Allison L McDonough, Shannon M Ansbaugh, Ella J Ariza-Heredia, Saro Armenian, K Scott Baker, Tarah J Ballinger, Elizabeth J Cathcart-Rake, Stuart H Cohen, Andrew T Day, Evgenios Evgeniou, Nathan Paul Fairman, Josephine Feliciano, Tessa Faye Flores, Debra L Friedman, Nicolette M Gabel, Christine E Hill-Kayser, Karen Hock, Cristina Kline-Quiroz, Nita K Lee, Kathi Mooney, Halle C F Moore, Natalie Moryl, Heather Neuman, Linda Overholser, Chirayu G Patel, Andrea Porpiglia, Laura Q Rogers, Ava Saidain, Lidia Schapira, Sophia K Smith, Laura Tenner, Diane Von Ah, Eric H Yang, Phyllis Zee, Deborah Freedman-Cass, Nicole McMillian","doi":"10.6004/jnccn.2026.0039","DOIUrl":"10.6004/jnccn.2026.0039","url":null,"abstract":"<p><p>The NCCN Guidelines for Survivorship offer guidance for health care providers who care for survivors of adult-onset cancer. These guidelines include screening, evaluation, and treatment recommendations for common physical and psychosocial problems resulting from cancer and its treatment and provide a framework for care coordination. They also present guidance for helping cancer survivors to enhance their wellness and maintain a healthy lifestyle. This article summarizes the panel's current recommendations and recent updates regarding anxiety, depression, distress, and trauma in cancer survivors.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805320","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":"When Patients Read First.","authors":"Daniel M Geynisman","doi":"10.6004/jnccn.2026.0040","DOIUrl":"https://doi.org/10.6004/jnccn.2026.0040","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805401","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":"A New Window in the Transplant Room: The Tangible Future of Virtual Reality in Supportive Oncology.","authors":"Kanishka Uttam Chandani, Nandita Khera","doi":"10.6004/jnccn.2026.7072","DOIUrl":"10.6004/jnccn.2026.7072","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805219","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":"Current Surgical Perspectives for Pleural Mesothelioma.","authors":"Simon Esteva, Fereidoun Abtin, Gregory A Fishbein, Robert B Cameron, Bryan M Burt, Jane Yanagawa","doi":"10.6004/jnccn.2026.7059","DOIUrl":"10.6004/jnccn.2026.7059","url":null,"abstract":"<p><p>This review summarizes the current NCCN recommendations for the surgical management of pleural mesothelioma, highlighting the clinical trials and retrospective analyses that have shaped current practice and informed guideline recommendations. Advances in systemic therapy, surgical technique, and radiation therapy have shifted management toward multidisciplinary care. Contemporary treatment paradigms emphasize the importance of histology, stage, performance status, and institutional expertise when considering surgical intervention. Surgery can still be considered part of the multimodality treatment strategy in carefully selected patients, despite recent evidence suggesting its possible lack of benefit. Further investigation is required to improve patient stratification, refine multimodal regimens, and develop novel therapeutic approaches. This review aims to provide a contemporary framework for understanding the current role of surgery within the broader management of pleural mesothelioma.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 8","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805347","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}