IntroductionSurveillance of at-risk populations for pancreatic ductal adenocarcinoma (PDAC) is a potential strategy to reduce its incidence and improve its prognosis. However, there is considerable debate about who should participate and relatively little information about how people perceive different testing options.MethodsUsing the Health Belief Model as a framework, this qualitative, observational study including eleven focus groups and seven interviews, summarizes the knowledge, motivations, barriers and preferences for PDAC surveillance in underserved populations with low cancer screening rates and for high-risk individuals (HRI).ResultsHRIs have a high motivation to participate in PDAC screening and perceive few barriers to engage. Participants from underserved populations had little knowledge of PDAC and surveillance, but they were interested in surveillance for PDAC based on their perception of the benefits of cancer screenings. The main barriers for participation in PDAC surveillance programs were cost, distrust of the larger medical system, discomfort associated with the testing, lack of a provider's recommendation, and fear of a positive result. These barriers varied based on a person's race/ethnicity and geographic location (urban vs. rural). Preferences expressed by underserved populations suggest that tests for early PDAC detection will need to be accurate, no or low cost, minimally invasive, and convenient to access. There was a correlation between a person's self-perceived susceptibility for PDAC and their willingness to tolerate more invasive and less convenient methods. In addition, participants were motivated to participate in early detection programs with clear guidelines accompanied by their doctor's recommendations.ConclusionThere appears to be an association between actual and perceived risk of PDAC and patient willingness to participate in an early detection program. For populations lower along the risk spectrum, there is limited knowledge about pancreatic cancer or its risk factors, and potentially significant barriers to participate in an early detection program if deemed eligible.

Most squamous cell carcinomas of the anus, or anal cancers, are attributable to persistent infection with the human papillomavirus (HPV), analogous to cervical cancer. Although rare in the general population, rates of anal cancer are high among people with immune-compromising conditions or a history of HPV-related cancers. Recent evidence demonstrates that treatment of high-grade squamous intraepithelial lesions (HSIL), a precursor of anal cancer, prevents progression to anal cancer. This has motivated the international release of several guideline statements now recommending anal cancer screening. For a new practice of cancer screening to be integrated into routine care for at-risk populations, implementation strategies will need adaptation for local settings. Our aim is to illustrate the potential value of combining the methods of implementation science with the anal screening cascade framework to support evidence-informed adoption of the guidelines across the different clinical services points where patients might undergo anal cancer screening. We point out means by which research activity could be directed, with particular attention to identifying and addressing care gaps to inform the adoption and scale-up of anal cancer screening. These approaches may help to guide local decisions regarding first steps for anal cancer screening implementation, including determining which populations may need enhanced effort, and to identify where more preparation may be needed.

IntroductionMantle cell lymphoma (MCL) constitutes an aggressive subtype of B-cell lymphoma and demonstrates significant clinical and biological heterogeneity. B symptoms are important clinical indicators in tumors. In the present study, we investigated the frequency and prognostic significance of B symptoms among different primary sites of MCL.MethodWe conducted an observational study of 2,025 MCL patients from the SEER database. We analyzed the frequency of B symptoms at different primary sites and evaluated their impact on prognosis.ResultsThe highest incidence of B symptoms was observed in the small intestine (35.29%), and the lowest in the nasopharynx (6.67%). Among patients with primary lymph node involvement, the intrathoracic and abdominal lymph nodes showed the highest proportion of B symptoms (both 40%), while the head, face, and neck lymph nodes showed the lowest (9.3%). In patients with primary site involvement of lymph nodes or nasopharynx, those with B symptoms had a worse prognosis than those without B symptoms (P < 0.05). Similarly, patients with primary lesions involving multiple regional lymph nodes, lymph node not otherwise specified (NOS), or inguinal/leg lymph nodes exhibited worse prognosis when B symptoms were present (P < 0.05).ConclusionIn summary, our study highlights the heterogeneity in both the frequency and prognostic significance of B symptoms across different primary sites in MCL patients.

Since its adoption into public health programmes in 2006, the Human Papillomavirus (HPV) vaccine has proven its powerful effect in preventing cervical cancer, the most prevalent HPV-associated cancer. Nevertheless, a considerable burden of HPV infection is associated with non-cervical cancers and conditions that, due to a historically gendered narrative around HPV vaccination, are still partially neglected in most preventive agendas. Gender-neutral vaccination (GNV) programmes have been steadily adopted in an increasing number of countries, but global endorsement of this strategy is still being delayed, especially in low- and middle-income countries (LMICs). In this perspective paper, we advocate for an accelerated global shift from female-only to universal, gender-neutral HPV vaccination. This perspective analyses how a GNV strategy addresses the rising burden of non-cervical cancers, promotes gender justice for vulnerabilised groups, and strengthens population-wide herd immunity amidst shifting global funding and healthcare disparities, particularly in LMICs. Further, a gender-neutral approach could also strengthen programme resilience in settings where female vaccination coverage remains far below the elimination targets. The case of HPV vaccination shows that women-only public health interventions can further exacerbate the stigmatisation of women in society and, rather than improving women's health, amplify inequity. We believe that the experience with the HPV vaccine can play a significant role in demonstrating that women-specific vaccination programmes can have unintended consequences: whilst they may improve specific health outcomes, they simultaneously cause social harm to the sex groups they intend to protect, thereby failing to address broader health outcomes across the global society as a whole.

IntroductionIn 2013, the United States (U.S.) Preventive Services Task Force recommended low-dose computed tomography (LDCT) for lung-cancer screening. We assessed temporal, population-level changes in incidence, stage at diagnosis, and mortality before and after this recommendation among adults aged 55-79 years.MethodsUsing the US Centers for Disease Control and Prevention Wide-ranging Online Data WONDER (CDC WONDER), Global Burden of Disease (GBD), and SEER data, we examined age-adjusted incidence (AAIR) and mortality (AAMR) trends. Joinpoint regression and interrupted time-series (ITS) models evaluated pre- and post-2014 changes in population-level trends; counterfactual analyses estimated differences between observed outcomes and projections based on pre-2014 trends. SEER was used to characterize stage distributions (localized, regional, distant).ResultsPost-2014 declines accelerated across data systems. Annual AAMR decreased by 3.03% in CDC WONDER and 2.58% in GBD; AAIR declined by 1.85% and 2.37%, respectively. SEER showed a higher proportion of localized disease and fewer distant-stage diagnoses after 2014; joinpoint analyses identified a 2013 inflection with steeper declines in distant-stage incidence thereafter. In models extrapolating pre-2014 trends to subsequent years, observed deaths were lower than counterfactual projections by 28,168 in CDC WONDER and 6,906 in GBD. As an exploratory indicator, mortality-to-incidence ratios declined nationally and in both sexes.ConclusionsDuring the USPSTF LDCT guideline era, independent national datasets showed accelerated mortality declines and a shift toward localized-stage diagnoses. These convergent findings are temporally consistent with real-world benefits of LDCT screening, but they should be interpreted within a broader context that includes continued reductions in smoking, gradual screening uptake, and major therapeutic advances. The findings are hypothesis-generating and do not estimate the isolated causal effect of LDCT screening.

IntroductionAdvance Care Planning (ACP) is a patient-centered process that enables individuals to consider their goals and priorities and make plans with their healthcare team for future care. Oncology clinicians care for critically ill patients and are central to facilitating and documenting ACP. While Australian and international guidelines strongly support ACP in oncology, clinician engagement and documentation of ACP remain suboptimal. This study aimed to explore oncology clinicians' ACP knowledge, decision-making, and practice, including factors influencing engagement in ACP.MethodsA qualitative study was conducted using semi-structured interviews with oncology clinicians from three metropolitan hospitals in New South Wales, Australia. Participants were purposefully sampled and interviewed between November 2021 and March 2022. Interviews were audio-recorded, transcribed, and analyzed using deductive thematic analysis guided by the Theoretical Domains Framework (TDF). An inductive approach was subsequently applied to develop explanatory subthemes within identified domains.ResultsEleven clinicians participated, including Medical/Radiation Oncology Consultants (54.5%) and Advanced Trainees (45.5%). Interview length ranged from 17.5 to 35.5 minutes. A total of 380 quotes were coded across all 14 TDF domains, generating 33 explanatory subthemes. Four domains were most influential: Knowledge and Skills, Social/Professional Role and Identity, Environmental Context and Resources, and Social Influences. Although all participants recognized ACP as best-practice care, engagement was influenced by limited formal training and legal literacy, uncertainty regarding responsibility for initiating and documenting ACP, variable inconsistent interdisciplinary communication, workload and time constraints, electronic medical record functionality, and patient characteristics (i.e.,psychological state, health literacy, cultural complexity).ConclusionACP in oncology is shaped by complex, interdependent socio-cultural and organizational factors. Applying the TDF identified key behavioral and contextual determinants. Improving ACP requires multilevel strategies targeting clinician capability, role clarity, and system-level supports, including structured education, clearer documentation processes, improved electronic medical record functionality, and integration of ACP into routine multidisciplinary care.

IntroductionFrailty is a known predictor of poor outcomes in older patients with cancer; however, its recognition in non-older populations remains limited. In this prospective multicenter observational study, we compared the Taiwan Cancer Frailty Tool (TCFT) with the Flemish version of the Triage Risk Screening Tool (fTRST) and comprehensive geriatric assessment (CGA) in screening for frailty among non-older Taiwanese patients with cancer.MethodsWe prospectively enrolled 1,162 patients with cancer aged <65 years from multiple Taiwanese centers (2022-2024). Frailty was assessed using CGA (reference standard), TCFT, and fTRST, with frailty defined as ≥2 abnormal CGA domains. Both TCFT and fTRST were tested at two thresholds (>0 and >1). Diagnostic performance metrics and Kaplan-Meier survival analyses were performed.ResultsThe median patient age was 54 years (range, 20-64 years), and 74.6% were male. The predominant cancer types were head and neck, esophageal, and gastric/small bowel cancers. The prevalence of frailty was 44.0% (CGA), 65.0% (TCFT >0), and 73.4% (fTRST >0). TCFT >0 demonstrated a higher sensitivity (88.8%) and negative predictive value (86.0%) than fTRST >0 (88.5% and 80.9%, respectively). TCFT >1 provided superior specificity (93.1%) and positive predictive value (83.5%). The area under the curve for TCFT was significantly higher than that for fTRST (0.788 vs. 0.748; p = 0.012). All tools predicted poor survival, with TCFT exhibiting a more consistent prognostic performance across thresholds than fTRST.ConclusionFrailty is prevalent and prognostically significant in non-older patients with cancer. TCFT demonstrated superior diagnostic and prognostic utility compared with fTRST, supporting its integration into routine frailty screening for this population.

IntroductionVariations in short-term breast cancer survival call for promotion of primary prevention, screening, risk awareness and earlier symptomatic presentation.MethodsWe conducted an umbrella review of published systematic reviews on promotion of screening participation or awareness of and help-seeking behaviours for symptoms with a focus on breast cancer and transferable lessons from the other top five male and female adult cancers in the UK (or other high-income countries with universal healthcare). We searched Ovid MEDLINE, EMBASE and Cochrane Database of Systematic Reviews (up until 31.12.25). Two reviewers independently screened 20% of titles and abstracts and all full-texts, as well as carried out all AMSTAR 2 assessments to exclude less informative and 'critically low' quality reviews. We extracted information within included reviews on relevant primary studies to conduct random effects meta-analyses.ResultsForty-three reviews were included, reporting on 168 relevant randomised controlled trials showing significant increases in screening uptake for scheduled versus open appointments (Odds ratio(OR);95% Confidence Intervals(CI)=1.88;1.63,2.17, k=6), advance notification letters versus standard invitation only (OR;95% CI=1.13;1.07,1.20, k=6), letters signed by General Practitioners (OR;95% CI=1.35;1.19,1.53, k=14), educational information (in paper-format) versus no such information (OR;95% CI=1.33;1.05,1.69, k=18), follow-up by calls (OR;95% CI=1.49;1.04,2.14, k=11) or text messages (OR;95% CI=1.28;1.05,1.56, k=7), phone counselling (OR;95% CI=2.63;1.47,4.70, k=4), multi-lingual approaches (OR;95% CI=1.35;1.11,1.63, k=13). Screening uptake was higher in most versus least socially disadvantaged areas for multi-lingual approaches by phone (p=<0.01), follow-up calls (p=<0.01), reminder letters (p=0.03) and 'implementation intentions' (goal-directed plans promoting screening) (p=<0.01). Meta-analyses also showed significant improvements for decision aids (paper-format) on knowledge (OR;95% CI=3.88;1.52,9.93, k=7) and informed choice (OR;95% CI=4.97;1.72,14.35, k=4). Statistical heterogeneity was prevalent, potential publication bias and most studies had high or unclear risks of bias.ConclusionSome effective interventions were identified; however, information on inequalities across outcomes and interventions targeting awareness and help-seeking behaviours were limited.

IntroductionFemale sexual dysfunction (FSD) in any gynaecological cancer survivor is one aspect of female functioning that is neglected in survivorship care. Therefore, their actual prevalence is far from known to the treating physician. This study aimed to evaluate the prevalence of sexual dysfunction in gynaecological cancer survivors, determine its risk factors, and correlate sexual dysfunction with serum neurotropic factors.MethodsThis was a cross-sectional, observational study among 200 gynaecological cancer survivors who are sexually active, conducted in the gynaecological cancer clinic at a tertiary care centre. Sexual function was assessed using the Hindi-validated Female Sexual Function Index (FSFI), and serum brain-derived neurotrophic factor (BDNF), substance P, and neuropeptide Y (NPY) were measured by ELISA. The correlation between these biomarkers, with domains and subdomains of the female sexual function index, was explored.ResultsIn this cohort of 200 gynaecological cancer survivors, 189 (94.5%) women had FSD (FSFI <26.55). Age was the only independent clinical predictor of FSD in multivariable analysis (p = 0.02), while cancer site, stage, treatment modality, and menopausal status were not significant in this cohort. Overall biomarker levels did not differ between women with and without FSD. However, subdomain analysis showed high dysfunction rates in lubrication, orgasm, pain, and arousal, with significant biomarker differences for substance P and NPY in several dysfunctional subdomains.ConclusionsFSD was highly prevalent in gynaecological cancer survivors. While overall biomarker differences were not significant, subdomain-specific associations suggest that substance P and NPY may have a role in domain-level sexual dysfunction and merit further study.

IntroductionLow cancer health literacy undermines patients' ability to interpret complex information and participate in shared decision making, and is associated with worse outcomes. Evidence for effective health literacy interventions in metastatic breast cancer (MBC) remains limited. We evaluated a patient-led, virtual health literacy program designed to strengthen MBC-specific knowledge and self-efficacy.MethodsWe conducted a mixed-methods, pre-post evaluation across two program iterations (Fall 2023; Spring 2024) delivered by a national, patient-led-MBC organization, Project Life. The five-week synchronous course called Spinning Science covered breast cancer subtyping, genetic/genomic testing, clinical trials, circulating tumor DNA, and information literacy, with small-group activities and polling. Program participants were adults living with MBC. De-identified pre/post surveys assessed (1) self-efficacy for engaging in health decisions, and (2) knowledge using items adapted from the Cancer Health Literacy Test aligned to course content. Paired two-sample t-tests examined pre-post changes (α=0.05). Open-ended responses were analyzed thematically.ResultsFifty-four people with MBC were enrolled (cohort 1, n=17; cohort 2, n=37); 46 provided matched pre- and post-surveys (14 and 32, respectively). Agreement with "I don't know enough to make my own medical decisions" declined from 43% pre to 13% post (p<0.05), indicating improved self-efficacy. Baseline knowledge scores were high, and knowledge item gains were not statistically significant, consistent with ceiling effects. Post-program items showed >80% agreement for increased confidence in self-advocacy, improved health literacy, and sense of community. Qualitative feedback highlighted strengths like digestible content, approachable patient facilitators and flexible scheduling, as well as priorities for refinement such as continued access to materials, and more MBC-specific and numeracy content.ConclusionsA patient-developed, virtual health literacy program for people living with MBC showed meaningful improvements in self-efficacy, with actionable, participant-driven refinements between cohorts. This model offers a practical, scalable pathway for advancing self-efficacy within and beyond MBC.

IntroductionAutomated colorectal cancer (CRC) screening programs often invite all age-eligible patients for fecal immunochemical testing (FIT), but providers may defer screening in clinically complex patients. However, such nuanced decisions are not captured by most automated systems. We evaluated whether International Classification of Diseases, Tenth Revision (ICD-10) codes are associated with variations in FIT ordering patterns beyond age-based outreach criteria.MethodsIn a retrospective observational study of 15,020 screening-eligible patients aged 50-75, we compared the frequency of ICD-10 codes between patients with and without a FIT order. We repeated the analysis restricted to those with a Charlson Comorbidity Index (CCI)<5.ResultsOverall, 4,833 (32.2%) patients did not have a FIT order. Of the 1,215 ICD-10 codes examined, 96 were significantly associated with the absence of a FIT order (p<0.05). These codes frequently indicated digestive diseases (e.g., colonic neoplasm, diverticular disease), advanced comorbidities (e.g., frailty, paralysis), and acute conditions (e.g., fractures, severe infections). Among the patients with CCI<5, 41 codes were associated with the absence of a FIT order (p<0.05), such as heart failure and chronic kidney disease.ConclusionScreening-eligible patients without a FIT order were more likely to have ICD-10 codes reflecting digestive diseases, chronic comorbidities, and acute conditions. These findings demonstrate that specific diagnostic profiles are associated with real-world FIT ordering patterns, highlighting the need for further investigation into how comorbidities and competing clinical priorities relate to CRC screening decisions.

In low- and middle-income countries (LMICs), leadership in cancer prevention and control is often concentrated among a small number of key individuals across the cancer continuum. While these leaders are crucial to system development, insufficient succession planning and mentorship mean that over-reliance on individuals places cancer prevention and control at risk of disruption during leadership transitions. Grounded in a critical synthesis of the field, this Perspective examines succession planning and mentorship in cancer prevention and control, highlighting how fragile leadership pipelines, the "missing middle" of mid-career professionals, and informal mentorship cultures and structural inequities, weaken system continuity and resilience. The article further examines barriers to effective mentorship in LMICs and proposes strategies centered on institutionalized mentorship, inclusive approaches, and distributed leadership to strengthen continuity and sustainable development of cancer prevention and control systems. A stable leadership structure requires collaboration across career stages, with senior leaders contributing institutional memory and strategic judgement, mid-career professionals anchoring operational delivery and governance, and early-career professionals contributing innovation and fresh perspectives. Importantly, we advocate for succession planning and mentorship to be institutionalized as core functions of cancer systems, rather than left to individual goodwill, to enable this collaborative structure to sustain leadership continuity and resilience.

IntroductionIncreasing demand for colonoscopy continues to strain healthcare systems worldwide. Colon capsule endoscopy (CCE) offers a minimally invasive alternative, but its adoption is limited by high re-investigation rates. The aim of this study is to develop and evaluate clinical prediction models for selecting faecal immunochemical test (FIT) positive patients most suitable for CCE versus colonoscopy.MethodsWe conducted a secondary analysis of data from CareForColon2015 randomized controlled trial (2020-2022), including individuals aged 50-74 years with a positive FIT. Logistic regression models were developed to predict CCE transit, bowel cleansing, completeness, and colonoscopy indication. Sixty candidate predictors were assessed, including demographics, lifestyle factors, FIT values, medications, perceived stress, and health literacy. Models were validated using repeated random subsampling and evaluated on a 10% hold-out set using the area under the receiver-operating-characteristic curve (AUC), Cohen's K, and accuracy. Decision curve analysis (DCA) was performed to assess clinical utility.ResultsCCE achieved complete transit in 92.1% and acceptable bowel cleansing in 71.3% of participants, with 69.6% of investigations deemed complete. Colonoscopy was indicated in 68.0% of cases, based on broad inclusion criteria, and 55.9%, based on more stringent criteria. Models predicting colonoscopy indication showed moderate performance (AUC 0.69-0.71; accuracy 65-67%; Cohen's K 0.28-0.30). DCA indicated positive net benefit for both models within threshold probabilities of 0.5-0.75, supporting their potential to identify FIT-positive patients unlikely to benefit from immediate colonoscopy.ConclusionsClinical prediction models may assist in post-FIT triage between CCE and colonoscopy. DCA suggests potential to reduce unnecessary colonoscopies by identifying low-risk patients suitable for initial CCE. External validation is needed before clinical implementation.

IntroductionLymphomas are a heterogeneous group of haematological malignancies commonly treated with chemotherapy. Hodgkin lymphoma predominantly affects younger adults, while Non-Hodgkin lymphoma is more prevalent among older adults. Although survival outcomes have improved, treatment-related cardiovascular, musculoskeletal, and functional adverse effects contributing to fatigue, reduced cardiorespiratory fitness (CRF), diminished quality of life (QoL), and increased frailty risk, remain, particularly among older adults. Reduced CRF, measured by peak oxygen uptake (VO2peak), is an independent predictor of all-cause and cancer-specific mortality, and chemotherapy tolerance, making its preservation a clinically meaningful target. Evidence supporting exercise during active chemotherapy remains limited. This study aims to evaluate the effect of a 20-week combined exercise (EX) intervention on CRF in people with lymphoma receiving chemotherapy, compared with a treatment-as-usual (TAU) group.MethodsEDONOLA is a randomised (1:1), multicentre, parallel-group, open-label controlled clinical trial involving adults aged >18 years (n=180, EX, n=90; TAU, n=90). The exercise intervention comprises supervised sessions (two days/week) of low-to high-intensity resistance and aerobic interval training, plus two days/week of unsupervised exercise. The TAU group will receive standard clinical care and physical activity advice. Assessments will be conducted at baseline, 10 weeks, and 20 weeks. The primary outcome will be CRF, measured as VO2peak. Secondary outcomes will include muscular strength, frailty, body composition, physical activity, sedentary behaviour, QoL, fatigue, sleep, and biochemical profile, including immune biomarkers. Older participants (≥70 years) will additionally undergo a comprehensive geriatric assessment, and EX participants will be invited to a voluntary semi-structured qualitative interview.DiscussionThis multidisciplinary project integrates structured exercise into standard oncology care, aligned with Sustainable Development Goal 3. The intervention aims to mitigate treatment-related side effects, preserve CRF and muscular strength, improve QoL, and reduce frailty risk in people with lymphoma undergoing chemotherapy, while potentially decreasing long-term healthcare burden.