Current Oncology

15 pages, 592 KB

Open AccessArticle

Assessing Immune Fitness in Oncological Rehabilitation—Validity and Responsiveness of the Immune Status Questionnaire and Single-Item Scale

by Anne M. S. de Hoop, Johanna A. Eggink, Cindy Veenhof, Cyrille A. M. Krul, Jelle P. Ruurda, Raymond H. H. Pieters and Karin Valkenet

Curr. Oncol. 2026, 33(7), 415; https://doi.org/10.3390/curroncol33070415 - 10 Jul 2026

Abstract

Background: Immune fitness (IF) reflects the body’s ability to mount appropriate immune responses. Monitoring IF could improve tailored treatment in oncological rehabilitation. The Immune Status Questionnaire (ISQ) and the Single-Item Scale (SIS) were developed to assess IF, but their clinimetric properties in cancer [...] Read more.

Background: Immune fitness (IF) reflects the body’s ability to mount appropriate immune responses. Monitoring IF could improve tailored treatment in oncological rehabilitation. The Immune Status Questionnaire (ISQ) and the Single-Item Scale (SIS) were developed to assess IF, but their clinimetric properties in cancer rehabilitation remain unknown. Aims: To evaluate the construct validity, responsiveness, and correlation between the ISQ and the SIS in oncological rehabilitation. Methods: The study population included people participating in oncological rehabilitation during or within one year after medical treatment. Data were collected prospectively via questionnaires. Construct validity and responsiveness were assessed through predefined hypotheses, including correlations with fatigue, sleep problems, malnutrition risk, activity impairment, and physical functioning. Results: In total, 97 individuals were included in the analyses. Median ISQ and SIS scores were 8/10 and 7/10, respectively. Correlations ranged from r = −0.21 to r = −0.50. Only the SIS correlations with fatigue and physical functioning, and the ISQ correlation with fatigue, met the predefined thresholds. Responsiveness hypotheses were not confirmed. Conclusions: The ISQ and the SIS demonstrated low construct validity and responsiveness in this population. IF scores were higher than expected. Correlations showed links between fatigue, physical functioning, and IF. Future research should develop tools tailored to the complex immune disturbances experienced by cancer survivors. Full article

19 pages, 737 KB

Open AccessArticle

Parotid Metastases from Head–Neck Cutaneous Squamous Cell Carcinoma: A Prognostic Stratification

by Giulia Togo, Luca Calabrese, Giovanni dell’Aversana Orabona, Franco Ionna, Francesco Longo, Renato de Falco, Pietro Perotti, Ottavio Piccin and Luca Gazzini

Curr. Oncol. 2026, 33(7), 414; https://doi.org/10.3390/curroncol33070414 - 10 Jul 2026

Abstract

Background/Objectives: Cutaneous squamous cell carcinomas (cSCC) of the head and neck district are among the most common non melanocytic malignant skin carcinomas. The proposal to differentiate, within the N stage, parotid metastases from lateral cervical metastases, originates from the different prognostic value of [...] Read more.

Background/Objectives: Cutaneous squamous cell carcinomas (cSCC) of the head and neck district are among the most common non melanocytic malignant skin carcinomas. The proposal to differentiate, within the N stage, parotid metastases from lateral cervical metastases, originates from the different prognostic value of the metastatic region involved. Methods: We retrospectively evaluated 61 patients, surgically treated for parotid metastases from cSCC between January 2002 and June 2023, in four Departments of Surgery, to assess the geographic distribution of parotid metastases and to describe their recurrence patterns, to evaluate the prognostic value of the number of affected lateral cervical lymph nodes (LN) and the number of positive intra-glandular lymph nodes (IGLN) and to identify the main prognostic histopathological factors. Results: Our results did not show significant differences between participating centers in the distribution of parotid metastases, nor in their recurrence rates. However, our results highlight how adjuvant radiotherapy is deeply associated with the Overall Survival (OS), improving survival rates in patients with advanced-stage neoplasms (Odds Ratio 5.0), although causality cannot be inferred because of the retrospective study design. Moreover, a statistically significant correlation was found between the major inflammatory biomarkers and the OS. The presence of IGLN was identified as one of the main factors associated with recurrence and poor prognosis in patients with cSCC and in particular, in patients with N3b nodal stage. Conclusions: our findings suggest that both LN and IGLN could be used to propose an additional staging stratification for the N parameter, thereby guiding the treatment strategy and postoperative follow-up for patients with parotid metastases from cSCC of the head and neck district. Full article

(This article belongs to the Section Head and Neck Oncology)

14 pages, 235 KB

Open AccessArticle

Access to Guideline-Concordant Oncology Genomic Testing: A Qualitative Study of Black Cancer Patients and Oncology Providers

by Andrea Thoumi, Yadurshini Raveendran, Laura Fish, M. J. Gathings, Emily Rosario, Shaun R. Jones, Hayden B. Bosworth, Linda Sutton, John H. Strickler and Tomi Akinyemiju

Curr. Oncol. 2026, 33(7), 413; https://doi.org/10.3390/curroncol33070413 - 10 Jul 2026

Abstract

Genomic testing is a key component of precision oncology; however, Black patients receive genomic testing at lower rates. The purpose of this qualitative study was to identify individual and health system drivers of genomic testing disparities at a National Cancer Institute-designated comprehensive cancer [...] Read more.

Genomic testing is a key component of precision oncology; however, Black patients receive genomic testing at lower rates. The purpose of this qualitative study was to identify individual and health system drivers of genomic testing disparities at a National Cancer Institute-designated comprehensive cancer center. We conducted interviews with 15 oncology providers and 11 Black cancer patients between September 2023 and October 2024. These patients were eligible for genomic testing based on National Comprehensive Cancer Network (NCCN) guidelines, being diagnosed within last 10 years (2014–2023), at least 18 years old, and English-speaking. Providers included oncologists and oncology patient navigators. Topics included motivators, barriers, and knowledge of genomic testing and factors influencing decision-making. The Penchansky and Thomas theoretical framework of healthcare access (e.g., availability, accessibility, accommodation, affordability, and acceptability) guided thematic analysis. Among patients eligible for genomic testing, most participants (n = 7) received genomic testing as part of their cancer treatment based on EMRs, however many patients (n = 7) could not recall discussing genomic testing with their oncologist. Most patients and all providers highlighted affordability as a challenge: patients were concerned about unexpected costs associated with testing, while providers were concerned about costs of matched molecular targeted therapy. Both patients and providers highlighted patient-centered communication to mitigate mistrust and promote patient engagement in care. Despite limited awareness, Black patients view genomic testing positively. Addressing multiple dimensions of access is key to improving system-level processes and ensuring that more patients benefit from lifesaving targeted therapy. Full article

(This article belongs to the Special Issue Advances in Health Equity to Reduce Cancer Health Disparities)

17 pages, 621 KB

Open AccessArticle

Exploring Key Unmet Supportive Care Needs of Adolescent and Young Adult Cancer Patients: A Qualitative Study to Inform Regional Program Development

by Sitara Sharma, Sarah Cleyn, Haydn Bechthold, Alicia Hilderley and Amirrtha Srikanthan

Curr. Oncol. 2026, 33(7), 412; https://doi.org/10.3390/curroncol33070412 - 10 Jul 2026

Abstract

Background: Adolescents and young adults (AYAs; aged 15–39) diagnosed with cancer face distinct challenges that are poorly addressed within traditional cancer care models. This qualitative study explored AYAs’ unmet supportive cancer care needs in Eastern Ontario (Canada) to inform the development of a [...] Read more.

Background: Adolescents and young adults (AYAs; aged 15–39) diagnosed with cancer face distinct challenges that are poorly addressed within traditional cancer care models. This qualitative study explored AYAs’ unmet supportive cancer care needs in Eastern Ontario (Canada) to inform the development of a tailored multidisciplinary program. Methods: As part of a larger mixed-methods study, AYAs receiving/post-cancer treatment in the Champlain region of Eastern Ontario were purposively recruited to complete a survey and a semi-structured interview. Demographic and interview data were analyzed descriptively and via thematic analysis, respectively. Results: Sixteen AYAs (M_age = 32.2 years [range: 19–42]; 56.3% female) were interviewed virtually using a co-designed, semi-structured guide between October 2024 and February 2025. Analysis revealed five themes (i.e., major care gaps) and 12 sub-themes, including: (1) lack of standardized fertility counselling, (2) neglected psycho-emotional impact, (3) limited sexual health education and support, (4) difficulty navigating the healthcare system, and (5) financial toxicity and the cost of being sick young. Conclusions: AYAs in Eastern Ontario face persistent gaps in supportive cancer care that undermine their quality of life. Our findings underscore the need for targeted system-level improvements and offer a foundation for co-designing an evidence-based regional AYA care model that better addresses the holistic needs of this growing population. Full article

(This article belongs to the Section Psychosocial Oncology)

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26 pages, 1117 KB

Open AccessReview

Crosstalk Between Opioids and the Anti-Tumour Immune Checkpoint Axis

by Parsa Alan and Marie-Odile Parat

Curr. Oncol. 2026, 33(7), 411; https://doi.org/10.3390/curroncol33070411 - 9 Jul 2026

Abstract

Opioids are frequently prescribed for cancer pain management, yet accumulating evidence suggests that opioid exposure may be associated with inferior outcomes in patients also undergoing treatment with immune checkpoint inhibitors (ICIs). To synthesize mechanistic and clinical evidence linking opioids to the PD-1/PD-L1 axis, [...] Read more.

Opioids are frequently prescribed for cancer pain management, yet accumulating evidence suggests that opioid exposure may be associated with inferior outcomes in patients also undergoing treatment with immune checkpoint inhibitors (ICIs). To synthesize mechanistic and clinical evidence linking opioids to the PD-1/PD-L1 axis, the literature was searched up to 18 January 2026, with study selection and data extraction focused on (i) cancer-cell and immune-cell effects of opioid agonism or antagonism on PD-1/PD-L1 biology, and (ii) clinical studies reporting ICI outcomes (progression-free survival, overall survival, or treatment duration) with concomitant opioid exposure. Preclinical studies support multiple, non-mutually exclusive mechanisms: opioids can induce PD-L1 in tumour cells, modulate innate-inflammatory pathways (including TLR4-linked cascades), promote dysfunctional T-cell phenotypes that reduce responsiveness to PD-1 blockade, and show context- and opioid-dependent effects. Clinical cohorts and meta-analytic datasets in non-small cell lung cancer and other tumour types report associations between opioid exposure (including higher morphine-equivalent dosing) and worse ICI outcomes. The intersection of opioid signaling with PD-1/PD-L1 biology likely operates across cancer cell-intrinsic and immune cell-intrinsic pathways, providing a mechanistic rationale for prospective evaluation of opioid-sparing strategies and/or peripheral opioid antagonism as adjuncts to checkpoint blockade. Full article

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16 pages, 609 KB

Open AccessSystematic Review

Laparoscopically Harvested Pedicled Omental Flap in Immediate Unilateral Breast Reconstruction: A Systematic Review of Surgical Techniques and Clinical Outcomes

by Annie M. Wu, Surabi Thirugnanasampanthar and Muriel Brackstone

Curr. Oncol. 2026, 33(7), 410; https://doi.org/10.3390/curroncol33070410 - 9 Jul 2026

Abstract

Laparoscopically harvested pedicled omental flap (LHPOF) reconstruction is a minimally invasive autologous option for immediate breast reconstruction, but prior reviews have largely examined omental flaps broadly, combining open and laparoscopic harvests, free and pedicled transfers, and mixed reconstructive indications. This systematic review evaluated [...] Read more.

Laparoscopically harvested pedicled omental flap (LHPOF) reconstruction is a minimally invasive autologous option for immediate breast reconstruction, but prior reviews have largely examined omental flaps broadly, combining open and laparoscopic harvests, free and pedicled transfers, and mixed reconstructive indications. This systematic review evaluated operative characteristics, peri-operative complications, and esthetic outcomes following LHPOF after oncologic breast surgery. MEDLINE, Cochrane and Embase were searched without language or date restrictions, with backward citation searching of included studies. Eligible studies included female patients undergoing immediate unilateral breast reconstruction with LHPOF after mastectomy or BCS. Twenty-two studies published between 2001 and 2025 were included, representing 1869 patients. Operative techniques were broadly consistent, most commonly involving transverse-colon-first omental harvest, preservation of the right gastroepiploic vessels, and tunnelling from the inframammary fold toward the xiphoid. Reported complications included omental fat necrosis, partial flap loss, hematoma, infection, epigastric bulging, and incisional or tunnel-site hernia. Esthetic outcomes were generally favourable but assessed using heterogeneous methods. Current evidence suggests this technique is feasible in selected patients and may offer favourable esthetic outcomes with limited donor-site morbidity. However, prospective comparative studies with standardized reporting are needed to define optimal patient selection, long-term safety, and esthetic durability. Full article

(This article belongs to the Special Issue Recent Advances in Breast Reconstruction Following Cancer)

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16 pages, 499 KB

Open AccessSystematic Review

The Role of Tumor Debulking Surgery in Improving Survival of Patients with Head and Neck Cancer: A Systematic Review

by Aris I. Giotakis, Evangelos Tagkalos, Matthias Santer, Daniel Dejaco and Benedikt Hofauer

Curr. Oncol. 2026, 33(7), 409; https://doi.org/10.3390/curroncol33070409 - 9 Jul 2026

Abstract

Background/Objectives: Data on the value of tumor debulking surgery are scarce. We aimed to examine whether tumor debulking surgery followed by non-surgical treatment (cases) improves survival compared to non-surgical treatment alone (controls) in patients with head and neck cancer (HNC). Methods: [...] Read more.

Background/Objectives: Data on the value of tumor debulking surgery are scarce. We aimed to examine whether tumor debulking surgery followed by non-surgical treatment (cases) improves survival compared to non-surgical treatment alone (controls) in patients with head and neck cancer (HNC). Methods: We performed a systematic review of studies published in the databases PubMed, Scopus and Cochrane Central Register of Controlled Trials up to 10 December 2024. Studies evaluating tumor debulking surgery followed by non-surgical treatment and reporting survival (local recurrence, disease-free survival or overall survival) in subjects with HNC were included; case reports were excluded. We assessed the quality of observational studies with the Newcastle–Ottawa Scale. Results: Among 11 retrospective small studies, three case–control studies (one of high quality, i.e., 7/9, and two of moderate quality, i.e., 6/9 and 5/9) suggested longer survival in 72 cases with predominantly squamous cell carcinoma (SCC) than in 40 controls with predominantly SCC. However, these survival benefits cannot be attributed solely to tumor debulking surgery, as confounding by indication is the most likely explanation. In supraglottic laryngeal SCC, one study reported a local recurrence-free survival rate and overall survival of 80% and 88%, respectively, in 25 cases compared with 86% and 77%, respectively, in 24 controls. In sarcomas, local recurrence-free survival was 25%, 65% and 100% for unknown resection margins, wide local excision and radical excision, respectively. Conclusions: The heterogeneous data indicate the need for higher-quality research. It would be interesting to investigate whether an attempt to surgically debulk paranasal sinus tumors while preserving adjacent vital organs (e.g., the orbit and/or brain) should be incorporated into the treatment strategy for patients with extended paranasal sinus squamous cell carcinoma. Tumor debulking surgery did not improve survival in supraglottic laryngeal SCC or head and neck soft tissue sarcomas. Full article

(This article belongs to the Section Head and Neck Oncology)

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24 pages, 1178 KB

Open AccessSystematic Review

Tobacco Use, Stigma, and Coping in Lung Cancer: A Systematic Review of Their Psychosocial Interactions and Clinical Implications

by Anais Sánchez-Ros, Francisco Tomás-Aguirre, Marcelino Pérez-Bermejo, María Teresa Murillo-Llorente, María Ester Legidos-García, Ignacio Ventura and Teresa Mayordomo-Rodriguez

Curr. Oncol. 2026, 33(7), 408; https://doi.org/10.3390/curroncol33070408 - 9 Jul 2026

Abstract

Background: Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the [...] Read more.

Background: Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the relationship between tobacco use, lung cancer stigma, and coping, and how these factors interact and influence patients’ psychological outcomes. Methods: Following the PRISMA 2020 guideline, PubMed/MEDLINE and Dialnet were searched (window 2014–April 2026) for empirical studies conducted in adults with lung cancer that addressed stigma, coping, or relevant psychological outcomes (e.g., anxiety, depression, distress, or quality of life). Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus and, where needed, by a third reviewer. Methodological quality was appraised with design-specific tools (JBI for cross-sectional and cohort studies, CASP for qualitative studies, and COSMIN-oriented criteria for the psychometric study). Given the clinical and methodological heterogeneity, a structured narrative synthesis was conducted following the SWiM guideline. The protocol was registered in the Open Science Framework. Results: Twenty-four studies were included. Stigma was prevalent and consistently associated with depression, anxiety, distress, and poorer quality of life, with longitudinal evidence indicating that stigma precedes and predicts distress. Internalised stigma (guilt, shame, self-blame) was the facet most strongly linked to depression and anxiety. Smoking history graded stigma intensity (current > former > never smokers) but did not determine it, since clinically significant stigma also affected never-smokers. Adaptive coping (e.g., fighting spirit, positive reappraisal) and social support were consistently associated with better psychological adjustment and quality of life, while maladaptive coping (e.g., helplessness, avoidance, anxious preoccupation) was associated with worse outcomes; cross-sectional evidence further indicated that coping modes mediated the relationship between stigma and quality of life and that social support and self-compassion attenuated the impact of stigma on distress. Conclusions: Internalised stigma is a central, modifiable psychosocial stressor in lung cancer that affects smokers and never-smokers alike. Systematic screening for stigma, coping, and social support, together with non-stigmatising care, is warranted. Full article

(This article belongs to the Section Psychosocial Oncology)

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13 pages, 842 KB

Open AccessArticle

Prognostic Impact of the Systemic Immune-Inflammation Index According to Concurrent Chemotherapy Backbone in Stage III Non-Small Cell Lung Cancer

by Aykut Demirkıran, Murat Araz, Melek Karakurt Eryılmaz, Mustafa Karaağaç, Muhammed Muhiddin Er, Berrin Benli Yavuz and Mehmet Artaç

Curr. Oncol. 2026, 33(7), 407; https://doi.org/10.3390/curroncol33070407 - 9 Jul 2026

Abstract

Clinical outcomes remain heterogeneous among patients with unresectable stage III non-small cell lung cancer treated with definitive chemoradiotherapy. We evaluated the prognostic value of the systemic immune-inflammation index (SII) and explored survival outcomes according to the concurrent chemotherapy backbone in this setting. This [...] Read more.

Clinical outcomes remain heterogeneous among patients with unresectable stage III non-small cell lung cancer treated with definitive chemoradiotherapy. We evaluated the prognostic value of the systemic immune-inflammation index (SII) and explored survival outcomes according to the concurrent chemotherapy backbone in this setting. This retrospective study included 101 patients treated with definitive chemoradiotherapy before consolidation durvalumab became standard practice. Baseline SII was calculated using routine blood counts. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan–Meier method and Cox proportional hazards models. With a median follow-up of 40.6 months, patients with low SII had significantly longer OS (26.1 vs. 10.9 months, p = 0.004) and PFS (15.6 vs. 7.2 months, p = 0.018) than those with high SII. Elevated SII remained independently associated with inferior OS in multivariable analysis (HR 1.99, 95% CI 1.21–3.27, p = 0.007). Although survival was numerically longer with cisplatin/etoposide than with carboplatin/paclitaxel, the difference was not statistically significant. Subgroup analysis according to SII level and chemotherapy regimen showed the poorest outcomes among patients with high SII receiving carboplatin/paclitaxel. These findings support the prognostic value of SII and suggest a potential role for risk stratification in patients with unresectable stage III NSCLC undergoing definitive chemoradiotherapy in the pre-durvalumab era. Full article

(This article belongs to the Section Thoracic Oncology)

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15 pages, 484 KB

Open AccessArticle

Patterns of Hope and Loneliness Among Patients and Caregivers Affected by Biliary Tract Cancers

by Samar Attieh, Leonard Angka, Christine Lafontaine, Melinda Bachini, Rebecca C. Auer and Carmen G. Loiselle

Curr. Oncol. 2026, 33(7), 406; https://doi.org/10.3390/curroncol33070406 - 8 Jul 2026

Abstract

Biliary tract cancers (BTCs), including cholangiocarcinoma and gallbladder cancers, are characterized by their rarity, poor prognosis, limited treatment options, and significant psychosocial burden among affected individuals. Hope and loneliness are known to play significant roles in shaping cancer-related experiences and outcomes; however, their [...] Read more.

Biliary tract cancers (BTCs), including cholangiocarcinoma and gallbladder cancers, are characterized by their rarity, poor prognosis, limited treatment options, and significant psychosocial burden among affected individuals. Hope and loneliness are known to play significant roles in shaping cancer-related experiences and outcomes; however, their trajectories in the context of rare cancers remain unexplored. The Canadian Cholangiocarcinoma Collaborative (C3) was founded to enhance access to treatment, research, and support for individuals affected by BTC in Canada. This mixed-methods study aimed to measure hope and loneliness among patients and caregivers over time and to gain a deeper understanding of their experiences. A total of 92 patients and 44 informal caregivers, self-, peer-, or physician-referred, consented to participate in this study. Participants completed electronic self-reported measures of hope (Hope Herth Index (HHI), 12 items) and loneliness (UCLA Loneliness scale, 20 items) upon joining C3 (baseline, T0), following the first informational session with a C3 research navigator (T1), and after two to three months (T2). A subsample (n = 14) also participated in two online focus groups. At baseline, participants reported relatively high levels of hope (patients: M = 39.8, SD = 4.9; caregivers: M = 38.9, SD = 4.68), with the HHI ranging from 12 to 48, where higher scores indicate higher hope. They also reported low-to-moderate levels of loneliness (patients: M = 32.13, SD = 9.63; caregivers: M = 36.69, SD = 12.37), with the scale ranging from 20 to 80, where low loneliness: 20–34; moderate: 35–49; moderately high: 50–64; and high: 65–80. At T1, a significant decrease in hope (mean difference [MD] = −1.38, 95% CI [−2.64, −0.11], p = 0.029) and a significant increase in loneliness (MD = 1.75, 95% CI [0.27, 3.23], p = 0.016) were found among patients, with no further significant changes from T1 to T2. Among caregivers, no significant changes were observed from baseline to T1; however, at T2, there was a significant decrease in hope (MD = −2.01, 95% CI [−3.61, −0.40], p = 0.010) and a significant increase in loneliness (MD = 4.54, 95% CI [1.31, 7.77], p = 0.004). No significant differences in hope or loneliness were found between participants who engaged in C3 activities and those who did not. Dyadic analysis revealed significant correlations between patients’ and caregivers’ hope and loneliness at baseline and at T2. Despite the significant changes, findings indicate consistently high levels of hope and low-to-moderate levels of loneliness over time. Focus group analyses further contextualize quantitative findings by highlighting patients’ and caregivers’ experiences in greater depth. The results serve to inform current and future initiatives aimed at providing timely, personalized psychosocial support to patients and caregivers affected by BTC. Full article

(This article belongs to the Section Psychosocial Oncology)

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19 pages, 971 KB

Open AccessArticle

Major Postoperative Complications and Survival After Lung Cancer Resection in Patients Aged ≥80 Years: Risk Factor Analysis

by Fuad Damirov, Junli Ke, Javad Karimbayli, Mircea G. Stoleriu, Sascha Dreher, Enole Boedeker, Sibylle Gerz, Rudolf A. Hatz and Gerhard Preissler

Curr. Oncol. 2026, 33(7), 405; https://doi.org/10.3390/curroncol33070405 - 7 Jul 2026

Abstract

This study aimed to identify risk factors for major postoperative complications (TMM) and their impact on overall survival in patients aged ≥80 years undergoing lung cancer surgery, a group at increased risk of morbidity. A total of 88 patients aged ≥80 years who [...] Read more.

This study aimed to identify risk factors for major postoperative complications (TMM) and their impact on overall survival in patients aged ≥80 years undergoing lung cancer surgery, a group at increased risk of morbidity. A total of 88 patients aged ≥80 years who underwent anatomical lung resections were retrospectively analyzed. Postoperative complications were classified into minor or no complications (TMM 0–2) and major (TMM ≥ 3) complications. Logistic regression analysis was performed to identify independent predictors of major complications. Kaplan–Meier estimates were used to measure overall survival. Major complications occurred in 24 patients (27.3%). Multivariable regression analysis identified perioperative blood transfusion as an independent risk factor for major complications (p = 0.0009). Patients with major complications exhibited significantly reduced overall survival (p = 0.0009). Subgroup analysis revealed that patients who underwent minimally invasive surgery had significantly better survival (p = 0.01). Moreover, perioperative transfusion correlated with diminished overall survival (p = 0.0027). In patients aged ≥80 years undergoing lung resections, the occurrence of major postoperative complications is associated with significantly impaired survival. Minimally invasive surgical approaches and blood conservation strategies may mitigate complications and enhance long-term outcomes in this high-risk group. Full article

(This article belongs to the Special Issue Advances in Geriatric Oncology: Toward Optimized Cancer Care)

18 pages, 2030 KB

Open AccessReview

Real-World Management of HMA-Related Myelosuppression During MDS Treatment in the Canadian Landscape

by Michelle Geddes, Brett L. Houston, Lalit Saini, Ismail Sharif, Rena Buckstein and Ryan J. Stubbins

Curr. Oncol. 2026, 33(7), 404; https://doi.org/10.3390/curroncol33070404 - 7 Jul 2026

Abstract

Hypomethylating agents (HMAs) are the cornerstone in the treatment of higher-risk myelodysplastic syndromes (MDSs), particularly for patients who are not candidates for allogeneic hematopoietic cell transplant (allo-HCT). Despite demonstrated efficacy in improving hematologic outcomes, the clinical management of HMA-associated myelosuppression remains a challenge. [...] Read more.

Hypomethylating agents (HMAs) are the cornerstone in the treatment of higher-risk myelodysplastic syndromes (MDSs), particularly for patients who are not candidates for allogeneic hematopoietic cell transplant (allo-HCT). Despite demonstrated efficacy in improving hematologic outcomes, the clinical management of HMA-associated myelosuppression remains a challenge. This review discusses the use of azacitidine and oral decitabine-cedazuridine (DEC-C) for MDS management in the Canadian context, with a focus on optimizing therapy to mitigate myelosuppression and prevent early HMA discontinuation due to toxicity. Close monitoring of complete blood counts is critical to early detection of myelosuppression and management of treatment-related cytopenias. In the real-world setting, specific HMA dose adjustments are used based on patient risk factors for myelosuppression or treatment-related complications. Supportive care strategies, including the use of growth factors and antimicrobials, can complement monitoring and dose modifications for HMA-related myelosuppression management, although their use is variable. This review summarizes current evidence and real-world management approaches for HMA-induced myelosuppression, with the aim of improving outcomes for patients undergoing treatment for MDS. Full article

(This article belongs to the Section Hematology)

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13 pages, 716 KB

Open AccessArticle

Body Composition and Melanoma Outcomes in Patients on Immunotherapy or Targeted Therapy: An Analysis from Canadian Melanoma Research Network

by Mohammad Biglari, Sanji Ali, Thiago Muniz, Marcus Butler, Marguerite Ennis, Scott Ernst and Ana Elisa Lohmann

Curr. Oncol. 2026, 33(7), 403; https://doi.org/10.3390/curroncol33070403 (registering DOI) - 6 Jul 2026

Abstract

Melanoma remains a major global health burden, though immunotherapy and targeted therapy have markedly improved survival. Obesity has paradoxically been associated with favorable outcomes in melanoma, yet body mass index (BMI) alone fails to capture its influence on treatment response. To address this [...] Read more.

Melanoma remains a major global health burden, though immunotherapy and targeted therapy have markedly improved survival. Obesity has paradoxically been associated with favorable outcomes in melanoma, yet body mass index (BMI) alone fails to capture its influence on treatment response. To address this gap, we conducted a multi-site cohort study within the Canadian Melanoma Research Network, including patients with advanced melanoma treated with immunotherapy or targeted therapy. Body composition was quantified using computerized tomography (CT) imaging to assess visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle (SM) mass and intermuscular adipose tissue (IMAT), and associations with progression-free survival (PFS) and overall survival (OS) were evaluated. No overall association was seen for BMI, SAT, VAT, IMAT or SM with PFS or OS. In the targeted therapy subset, higher BMI, SAT, VAT and SM were associated with better OS (hazard ratios 0.56 to 0.65), while no effect was seen in the immunotherapy group. IMAT emerged as a novel prognostic marker, with elevated levels associated with lower OS in males and better OS in females. Our findings show that CT-based body composition is not associated with survival outcomes in patients with advanced melanoma receiving immunotherapy. Full article

(This article belongs to the Section Dermato-Oncology)

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16 pages, 3664 KB

Open AccessArticle

Incremental Value of Iodine-125 Seed Implantation After Bronchial Artery Chemoembolization in Immunotherapy-Treated Advanced Lung Squamous Cell Carcinoma with Hemoptysis: A Retrospective Cohort Study Using Inverse Probability of Treatment Weighting

by Linhao Ran, Jiangwei Chen, Huan Liang, Jiajian Xie, Weichen Fu, Dichun Yang, Fan Li, Ying Liu and Li Jiang

Curr. Oncol. 2026, 33(7), 402; https://doi.org/10.3390/curroncol33070402 (registering DOI) - 5 Jul 2026

Abstract

Background: The incremental value of iodine-125 (I-125) seed implantation in advanced refractory lung squamous cell carcinoma (LUSC) with hemoptysis treated with bronchial artery chemoembolization (BACE) and immunotherapy remains unclear. Methods: This retrospective cohort study included 90 patients treated between June 2023 and June [...] Read more.

Background: The incremental value of iodine-125 (I-125) seed implantation in advanced refractory lung squamous cell carcinoma (LUSC) with hemoptysis treated with bronchial artery chemoembolization (BACE) and immunotherapy remains unclear. Methods: This retrospective cohort study included 90 patients treated between June 2023 and June 2025. Patients receiving BACE plus immunotherapy were classified according to whether I-125 seed implantation was performed within 7 days after BACE: G1, BACE plus immunotherapy (n = 42), and G2, BACE, I-125 seed implantation, and immunotherapy (n = 48). Inverse probability of treatment weighting (IPTW) served as the primary adjustment method. Results: After IPTW, baseline covariates were well balanced; propensity score matching yielded 26 patients per group. Compared with G1, G2 was associated with longer hemoptysis-free survival (not reached vs. 11 months; HR = 0.34, 95% CI 0.18–0.64, p < 0.05), overall survival (19 vs. 14 months; HR = 0.26, 95% CI 0.15–0.44, p < 0.05), and progression-free survival (12 vs. 9 months; HR = 0.34, 95% CI 0.21–0.56, p < 0.05). The 6-month objective response rate (ORR) and disease control rate (DCR) were higher in G2, whereas no significant difference in 24-h hemostasis or recorded grade 3 or higher adverse events was observed. Conclusions: Adding I-125 seed implantation to BACE plus immunotherapy was associated with improved outcomes in selected patients, and prospective validation is warranted. Full article

(This article belongs to the Special Issue Advances in Interventional Radiology for Oncological Management)

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25 pages, 3863 KB

Open AccessSystematic Review

Predictors and Risk Assessment Models for Venous Thromboembolism in Patients Diagnosed with Lymphoma: A Systematic Review

by Anca Maria Pop and Markus Rütti

Curr. Oncol. 2026, 33(7), 401; https://doi.org/10.3390/curroncol33070401 (registering DOI) - 4 Jul 2026

Abstract

Among hematological malignancies, lymphoma is associated with an increased incidence of venous thromboembolism (VTE) ranging between 4 and 12%. Although Khorana score was validated for stratifying VTE risk in cancer, its discrimination reliability in lymphoma is reduced by the lack of specific predictors. [...] Read more.

Among hematological malignancies, lymphoma is associated with an increased incidence of venous thromboembolism (VTE) ranging between 4 and 12%. Although Khorana score was validated for stratifying VTE risk in cancer, its discrimination reliability in lymphoma is reduced by the lack of specific predictors. The aim of this systematic review was to summarize the evidence regarding predictors and available risk assessment models (RAMs) for VTE in patients with lymphoma. A systematic search was conducted on PubMed, Embase and Scopus in order to identify papers published until February 2026, which evaluated predictors and RAMs for VTE in patients diagnosed with lymphoma. Out of 592 evaluated papers, 44 met the inclusion criteria. The widely used Khorana score failed to appropriately identify patients with lymphoma at high risk for VTE, while the Thrombosis Lymphoma predictive score (ThroLy) showed modest improvement. Strong predictors for VTE were a poor performance status, older age, previous history of VTE, the use of central venous catheters, and bulky disease. However, the lack of external validation, the small sample size and bias due to confounding factors limit the generalizability of the results. Therefore, larger studies with external validation cohorts are needed to design lymphoma-specific RAMs and to identify predictors with high discrimination power. Full article

(This article belongs to the Section Hematology)

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13 pages, 1404 KB

Open AccessArticle

Analysing Emotional Well-Being in Cancer Patients: A Natural Language Processing Approach to Correlating Text with Hospital Anxiety and Depression Scale Scores

by Mustafa Serkan Alemdar and Hakan Şat Bozcuk

Curr. Oncol. 2026, 33(7), 400; https://doi.org/10.3390/curroncol33070400 (registering DOI) - 4 Jul 2026

Abstract

Background: Psychological distress, particularly anxiety and depression, is highly prevalent among cancer patients, and is associated with impaired quality of life, reduced treatment adherence, and increased mortality risk. Standardized screening instruments, such as the Hospital Anxiety and Depression Scale (HADS), are effective, but [...] Read more.

Background: Psychological distress, particularly anxiety and depression, is highly prevalent among cancer patients, and is associated with impaired quality of life, reduced treatment adherence, and increased mortality risk. Standardized screening instruments, such as the Hospital Anxiety and Depression Scale (HADS), are effective, but face implementation barriers in busy oncology outpatient settings. This cross-sectional study investigated whether BERT-based Natural Language Processing (NLP) analysis of brief patient-generated free texts would correlate with HADS scores in a consecutive cohort of cancer outpatients. Material and Methods: A total of 165 consecutive adult cancer outpatients were enrolled at a tertiary oncology center in Turkey. All participants completed the HADS questionnaire and were asked to write freely about their current emotional state in Turkish. Patient-generated texts were analyzed using a pre-trained Turkish BERT model to derive a continuous BERT Sentiment Score (BSS) and a categorical BERT Sentiment Cluster (BSC) via unsupervised hierarchical clustering. Univariate and multivariate linear regression analyses were performed to examine associations between clinical, demographic, and NLP-derived variables and the logarithmically transformed HADS score. Results: The mean total HADS score was 10.46 (range, 0–33), consistent with a moderate level of psychological distress. In multivariate analysis, two variables were independently associated with HADS scores: female sex (β = 0.20, t = 2.14, p = 0.034), associated with higher HADS scores, and BERT Sentiment Score (BSS) (β = −0.18, t = −2.43, p = 0.016), with higher values corresponding to lower HADS scores. Hierarchical clustering identified two distinct thematic groups: ‘Coping and Fighting Spirit’ (74%), and ‘Hope and Negative Feelings’ (26%); however, cluster membership (BSC) was not independently associated with HADS scores (β = −0.02, p = 0.789). Clinical variables, including cancer stage, diagnosis type, treatment status, and time since diagnosis, also were not independently associated with HADS scores. Conclusions: BERT-based sentiment analysis of brief patient-generated free texts yielded a continuous measure that independently correlated with HADS scores in cancer outpatients, alongside female sex. These findings provide proof-of-concept evidence that NLP-derived sentiment scoring may offer a practical, scalable, and complementary approach to standardized psychological screening in routine oncology care. Full article

(This article belongs to the Section Psychosocial Oncology)

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25 pages, 3138 KB

Open AccessArticle

Assessing the Clinical Relevance of BRCA1 RING Domain Variants of Uncertain Significance

by Matthew D. Martin, Gabriella C. Torretto, Kaamraan Islam, Nicole E. Archer, Harriet E. Feilotter and Scott K. Davey

Curr. Oncol. 2026, 33(7), 399; https://doi.org/10.3390/curroncol33070399 - 3 Jul 2026

Abstract

The BRCA1 protein serves an essential function in maintaining genomic integrity, to the extent that up to 80% of women carrying a pathogenic BRCA1 variant develop breast cancer (BC). Most of these carriers would benefit from prophylactic care, but genetic screens that uncover [...] Read more.

The BRCA1 protein serves an essential function in maintaining genomic integrity, to the extent that up to 80% of women carrying a pathogenic BRCA1 variant develop breast cancer (BC). Most of these carriers would benefit from prophylactic care, but genetic screens that uncover variants of uncertain significance (VUSs) do not provide insight on disease risk or clinical decision-making. In accordance with guidelines established by The American College of Molecular Genetics (ACMG) and Association for Molecular Pathology (AMP), this study produced computational and functional evidence to inform the reclassification of BRCA1 VUSs as pathogenic or benign, with a specific focus on the abundant subset of missense variants within the RING domain. A six-feature linear support vector machine (LSVM) specifically trained on BRCA1 RING variants performed well (84% accurate in predicting in vitro binding loss) and provided supporting classification evidence for 322 VUS. A mammalian cell co-immunoprecipitation (co-IP) assay that quantified the binding between variant BRCA RING constructs and endogenous BARD1 provided corroborating strong evidence for nine VUSs and correlated with a homology-directed repair (HDR) assay by Starita et al. (p = 0.04). The combined evidence warrants the reclassification of three VUSs as likely benign (N16S, A17D, and E100D) and one as likely pathogenic (H41P), and underscores the promise of domain-specific approaches for missense VUS reclassification. Full article

(This article belongs to the Topic Artificial Intelligence in Computational Pathology for Cancer Diagnosis)

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13 pages, 1553 KB

Open AccessArticle

Transition from Oncologist- to Therapist-Led MRI-Guided Ultra-Hypofractionated Adaptive Prostate Radiation Therapy: Evaluation of Early Clinical Outcomes

by Amanda Moreira, Tara Rosewall, Jennifer Dang, Aran Kim, Anna T. Santiago, Aruz Mesci, Enrique Gutierrez, Andrew Bayley, Andrew McPartlin, Rachel M. Glicksman, Alejandro Berlin, Jeff Winter, Winnie Li and Peter Chung

Curr. Oncol. 2026, 33(7), 398; https://doi.org/10.3390/curroncol33070398 - 3 Jul 2026

Abstract

MR-guided adaptive radiotherapy (ART) enables daily plan optimization for prostate cancer but is resource-intensive. This study evaluated dosimetric and clinical outcomes following transition from radiation oncologist (RO)-led to radiation therapist (RTT)-led MR-guided ART. All prostate cancer patients treated with MR-guided ART on a [...] Read more.

MR-guided adaptive radiotherapy (ART) enables daily plan optimization for prostate cancer but is resource-intensive. This study evaluated dosimetric and clinical outcomes following transition from radiation oncologist (RO)-led to radiation therapist (RTT)-led MR-guided ART. All prostate cancer patients treated with MR-guided ART on a 1.5T MR-linac were retrospectively reviewed. Consecutive RO-led (September 2019–November 2021) and RTT-led (April 2022–October 2023) cohorts were compared, excluding the actual transition period. Toxicities (CTCAE v5.0), dose–volume metrics from daily adapted plans, target volume variation, and biochemical recurrence-free survival (BRFS) were analyzed. A total of 166 patients were included (78 RO-led, 88 RTT-led; median follow-up 40 and 35 months). Dosimetric differences between the cohorts were statistically small (<1%). Rates of G2+ GI adverse events were similar across all timepoints. An increase in on-treatment GU events was observed in the RTT-led cohort (G2+ 27% vs. 9%, G3 incidence n = 2 vs. n = 0), likely reflecting higher baseline urinary dysfunction; no post-treatment differences persisted. Early biochemical outcomes were comparable, with 36-month BRFS of 93.5% (RO-led) and 95.0% (RTT-led). RTT-led MR-guided ART achieved comparable dosimetric quality and early biochemical outcomes to RO-led workflows with adverse advents that resolved in the long term. With structured training and a mature practice setting, RTT-led ART represents a scalable model to support future adaptive radiotherapy practice. Full article

(This article belongs to the Special Issue Hypofractionated Radiotherapy for Prostate Cancer: Emerging Evidence and Clinical Practice)

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12 pages, 266 KB

Open AccessArticle

Mental Distress, Fatigue and Executive Function in Adult Survivors of Childhood Leukemia and Non-Hodgkin Lymphoma

by Anna R. Franzén, Jan Stubberud, Torstein B. Rø, Stian Lydersen, Kaja S. Egset, Ellen Ruud, Siri Weider, Mary-Elizabeth Eilertsen, Anne Mari Sund, Trude Reinfjell and Magnus A. Hjort

Curr. Oncol. 2026, 33(7), 397; https://doi.org/10.3390/curroncol33070397 - 1 Jul 2026

Abstract

Survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) are at risk of developing long-term adverse effects after survival. This study examined observed proportions of perceived mental distress, fatigue, and executive function (EF) impairment in adult childhood [...] Read more.

Survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) are at risk of developing long-term adverse effects after survival. This study examined observed proportions of perceived mental distress, fatigue, and executive function (EF) impairment in adult childhood cancer survivors (CCSs) of ALL, AML, and NHL. Secondly, it examined the association between perceived EF impairment and mental distress or fatigue. Participants (n = 132; 57% female) were recruited from two major Norwegian hospitals. Self-report questionnaires included the Behavior Rating Inventory of Executive Function, Adult Version, the Hopkins Symptom Checklist-25, and the Fatigue Severity Scale. Proportions exceeding established clinical thresholds were calculated, and groups were compared using Pearson’s chi-squared test and Newcombe confidence intervals. Overall, 49% and 41% of participants met the clinical thresholds for depression and anxiety; 43% for fatigue; and 28% for EF impairment. Perceived EF impairment was significantly associated with mental distress and fatigue. Mental distress, fatigue, and EF impairment are commonly reported and distressing late effects among CCSs of ALL, AML, and NHL. Follow-up care focusing on neurocognitive and psychological outcomes is important for the long-term functioning and well-being of this survivor group. Targeted neurocognitive rehabilitation may represent a key component of follow-up care. Full article

(This article belongs to the Section Childhood, Adolescent and Young Adult Oncology)

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