Search Results (3,179)

(1) Background: Early palliative care (EPC) is increasingly recognized as a key component of comprehensive cancer management, with evidence supporting improvements in quality of life, symptom control, and clinical outcomes in advanced malignancies. (2) Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024623219). We searched PubMed, Embase, and the Cochrane CENTRAL Library for randomized controlled trials (RCTs) evaluating EPC in adults with advanced, incurable, or metastatic cancer. Eligible studies reported on at least one of the following: overall quality of life, symptom burden, or disease progression indicators. (3) Results: Forty-one RCTs met inclusion criteria. Despite heterogeneity in timing and structure, EPC consistently improved quality of life and reduced symptom burden in advanced cancer patients, with 32 trials demonstrating significant clinical benefit. Some studies also reported slowed disease progression. However, several RCTs showed no significant effects, highlighting variation in outcomes, possible subgroup effects, and challenges in implementation. Definitions and delivery of EPC varied widely, particularly in timing, frequency, and integration into oncology care. (4) Conclusions: These findings support the integration of EPC alongside disease-directed treatments, challenging the misconception that palliative care is only appropriate at the end of life and reinforcing its role early in the cancer care continuum. Full article

Background/Objectives: Melanoma is an aggressive skin cancer with increasing incidence worldwide. Dermoscopy has revolutionized early melanoma detection, but most studies have focused on the general adult population. This study aims to analyze dermoscopic and histological differences in melanoma across age groups, evaluating whether specific patterns vary between younger and older patients. Methods: This retrospective study included 285 histopathological confirmed melanomas diagnosed at the Dermatology Clinic of the University of Turin between November 2021 and April 2024. Patients were stratified by age (<40 vs. ≥40 years), and statistical analyses (Chi-square, logistic regression) assessed differences in dermoscopic, histopathological, and anatomical parameters. Results: Younger patients showed a higher prevalence of growth-related features (e.g., pseudopods, OR = 5.43; asymmetric globules, OR = 2.33) and a thicker Breslow index (mean = 1.05 mm). Older patients exhibited more regression-associated signs (scar-like depigmentation, OR = 0.15; peppering, OR = 0.39), greater lesion size, and solar elastosis. Dermoscopic regression significantly predicted histological regression, with age-stratified analysis revealing peppering as a predictor in younger patients (p = 0.015) and scar-like depigmentation in older ones (p = 0.012). Conclusions: Melanoma exhibits distinct dermoscopic features depending on patient age, with growth-associated patterns being more common in younger individuals and regressive patterns predominating in older patients. These findings highlight the importance of age-specific diagnostic considerations in melanoma detection, potentially improving early diagnosis and patient outcomes. Full article

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

Background/Objectives: Adult-type diffuse gliomas, including astrocytoma and glioblastoma multiforme (GBM), are brain tumors with a very poor prognosis. While current treatment options for glioma patients are not providing satisfactory outcomes, research indicates that natural compounds could serve as alternative treatments. However, their low bioavailability requires nanotechnology solutions, such as liposomes. Methods: In this study, we propose the co-encapsulation of acteoside (ACT) with other natural compounds, cannabidiol (CBD) or naringenin (NG), in a cationic liposomal nanoformulation consisting of DOTAP and POPC lipids, which were prepared using the dry lipid film method. The liposomes were characterized by their physicochemical properties, including particle size, zeta potential, and polydispersity index (PDI), with additional analyses performed using ¹H Nuclear Magnetic Resonance (NMR). Furthermore, biological experiments were performed with U-87 MG astrocytoma and U-138 MG GBM cell lines and non-cancerous MRC-5 lung fibroblasts using the MTT assay and evaluating the expression of Bax and Bcl-xL to evaluate their potential as anticancer agents. Conclusions: The IC₅₀ values for the nanoformulations in U-138 MG cells at 48 h were 6 µM for ACT + CBD and 5 µM for ACT + NG. ACT and CBD or NG demonstrated a potential synergistic effect against GBM in a liposomal formulation. Notably, treatment with ACT + CBD (5 µM) and ACT + NG (5 µM) liposomal formulations significantly upregulated Bax protein level in U-138 cells at both 24 and 48 h. In parallel, ACT + CBD (5 µM) also modulated Bcl-xL protein level in both U-138 MG and U-87 MG cell lines at the same time points. The obtained nanoformulations were homogeneous and stable for 21 days, evidenced by a narrow particle size distribution, a low polydispersity index (PDI) < 0.3, and a positive zeta potential. Full article

Background: Biological aging influences cancer outcomes, but its changes during chemotherapy and impact on chemotoxicity in colorectal cancer (CRC) remain underinvestigated. We examined (1) trajectories of biological aging (using Levine Phenotypic Age) during six months of chemotherapy, (2) sociodemographic and clinical risk factors for biological aging, and (3) links between biological aging and chemotoxicity. Methods: Using data from electronic health records (2013–2019) from 1129 adult CRC patients, we computed biological aging (raw Levine Phenotypic Age and its age acceleration [Levine Phenotypic Age–chronological age]) from routine blood tests (e.g., complete blood counts, hepatorenal/inflammatory markers). Chemotoxicity was identified primarily via International Classification of Diseases (ICD-9 and -10) codes. Results: Chemotherapy accelerated biological aging over time. Biological aging at baseline and changes over time predicted chemotoxicity. However, changes in biological aging over time showed stronger associations than baseline biological aging. Advanced cancer stages, higher comorbidity burden, and socioeconomic disadvantage (especially area-level deprivation) were associated with accelerated biological aging at baseline and over time. Biological aging occurred across both young and older adults. Conclusions: Levine Phenotypic Age, computed from routine blood tests in EHRs, offers a feasible clinical tool for aging-related chemotoxicity risk stratification. Validation in diverse cohorts and the development of predictive models are needed. Full article

Seafood contamination by heavy metals is a growing public health concern, particularly in regions like Tunisia where seafood is a major dietary component. This study assessed concentrations of cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn) in the muscle tissue of the red shrimp Parapenaeus longirostris, collected in 2023 from four coastal regions: Bizerte, Monastir, Kerkennah, and Gabes. Metal analysis was conducted using flame atomic absorption spectroscopy. This species was chosen due to its ecological and economic importance. The study sites were chosen based on their differing levels of industrial, urban, and agricultural influence, providing a representative overview of regional contamination patterns. Mean concentrations were 1.04 µg/g for Zn, 0.59 µg/g for Cu, 1.56 µg/g for Pb, and 0.21 µg/g for Cd (dry weight). Pb was the most prevalent metal across sites. Statistically significant variation was observed only for Cu (p = 0.0334). All metal concentrations were below international safety limits set by FAO/WHO and the European Union. Compared to similar studies, the levels reported were similar or slightly lower. Human health risk was evaluated using target hazard quotient (THQ), hazard index (HI), and cancer risk (CR) values. For adults, THQ ranged from 5.44 × 10⁻⁶ to 8.43 × 10⁻⁴, while for children it ranged from 2.40 × 10⁻⁵ to 3.72 × 10⁻³. HI values were also well below 1, indicating negligible non-carcinogenic risk. CR values for Cd and Pb in both adults and children fell within the acceptable risk range (10⁻⁶ to <10⁻⁴), suggesting no significant carcinogenic concern. This study provides the first field-based dataset on metal contamination in P. longirostris from Tunisia, contributing valuable insights for seafood safety monitoring and public health protection. Full article

Hepatocellular carcinoma (HCC) is the most prevalent subtype of liver cancer with an increasing incidence worldwide. Single nucleotide polymorphisms (SNPs) may influence disease risk and serve as predictive markers. This study aimed to evaluate the association of PNPLA3 (rs738409 and rs2294918), GCKR (rs780094), MBOAT7 (rs641738), NCAN (rs2228603), and TM6SF2 (rs58542926) SNPs with the risk of developing HCC in a Mexican population. A case-control study was conducted in unrelated Mexican individuals. Cases were 173 adults with biopsy-confirmed HCC and 346 were healthy controls. Genotyping was performed using TaqMan allelic discrimination assay. Logistic regression was applied to evaluate associations under codominant, dominant, and recessive inheritance models. p-values were corrected using the Bonferroni test (pC). Haplotype and gene–gene interaction were also analyzed. The GG homozygous of rs738409 and rs2294918 of PNPLA3, TT, and TC genotypes of GCKR, as well as the TT genotype of MBOAT7, were associated with a significant increased risk to HCC under different inheritance models (~Two folds in all cases). The genotypes of NCAN and TM6SF2 did not show differences. The haplotype G-G of rs738409 and rs2294918 of PNPLA3 was associated with an increased risk of HCC [OR (95% CI) = 2.2 (1.7–2.9)]. There was a significant gene–gene interaction between PNPLA3 (rs738409), GCKR (rs780094), and MBOAT7 (rs641738) (Cross-validation consistency (CVC): 10/10; Testing accuracy = 0.6084). This study demonstrates for the first time that PNPLA3 (rs738409 and rs2294918), GCKR (rs780094), and MBOAT7 (rs641738) are associated with an increased risk of developing HCC from multiple etiologies in Mexican patients. Full article

Background: Chemotherapy-induced peripheral neuropathy is a common and debilitating side effect of cancer treatment. While exercise has shown promise in alleviating this burden, it remains underutilised in clinical practice due to the lack of accessible, clinician-friendly guidance. Aim: This review aimed to synthesise current evidence on exercise interventions for managing chemotherapy-induced peripheral neuropathy and provide practical insights to support clinicians in integrating these approaches into patient care. Methods: A search was conducted across MEDLINE, CINAHL, and SPORTDiscus using keywords related to exercise and CIPN. Studies were included if they involved adults receiving neurotoxic chemotherapy and exercise-based interventions. Two authors independently screened studies and resolved conflicts with a third author. Study quality was assessed using the JBI Critical Appraisal Tools, and only studies meeting a minimum quality standard were included. A balanced sampling approach was employed. Data on study design, participant characteristics, interventions, and outcomes were extracted. Results: Eleven studies were included, covering various exercise modalities: multimodal (n = 5), yoga (n = 2), aerobic (n = 1), resistance (n = 1), balance (n = 1), and sensorimotor (n = 1). Exercise interventions, particularly multimodal exercise, significantly improved symptom severity, functionality, and quality of life (p < 0.05). The studies had high methodological quality, with randomised controlled trials scoring between 9/13 and 11/13, and quasi-experimental studies scoring 8/9 on JBI tools. Conclusions: This review highlights the significant benefits of exercise, especially multimodal exercise, for managing CIPN and provides guidance for integrating these strategies into clinical practice. Future research is needed to refine exercise prescriptions and develop standardised guidelines. Full article

Although evidence suggests adiposity as a modifiable risk factor for postmenopausal breast cancer (BC), its association with premenopausal BC remains uncertain. This potential differential relationship for menopausal status has been insufficiently investigated in the Moroccan population due to limited data. This study aims to assess the relationship between various indicators of adiposity and the risk of BC among Moroccan women by menopausal status. A multicenter case-control study was conducted in Morocco between December 2019 and August 2023, including 1400 incident BC cases and 1400 matched controls. Detailed measures of adiposity and self-reported measures from different life stages were collected. Unconditional logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between body size indicators and the risk of BC, adjusting for a range of known risk factors for BC. Higher waist circumference (WC) and hip circumference (HC) were associated with an increased risk of BC in both pre- (p-trend < 0.001 for both WC and HC) and post-menopausal women (p-trend < 0.001 for WC, 0.002 for HC). Current body mass index (BMI) ≥30 kg/m² increased the risk of postmenopausal BC (p-trend = 0.012). Among postmenopausal women, higher weight at age 20 was positively associated with BC risk (p-trend < 0.001), while, weight at age 30 was significantly associated with increased BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend = 0.028). Interestingly, weight gain since age 20 was inversely associated with BC risk in postmenopausal women in the adjusted model (p-trend = 0.006). Young-adult BMI observed a significant increased trend with BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend < 0.001). In premenopausal women, larger body shape during childhood and early adulthood was positively associated with BC risk (p-trend = 0.01 and = 0.011, respectively). In postmenopausal women, larger childhood and adolescent body silhouettes were also associated with increased BC risk (p-trend = 0.045 and 0.047, respectively). These results suggest that anthropometric factors may have different associations with pre- and post-menopausal BC among Moroccan women. This underscores the importance of conducting large prospective studies to better understand these findings and explore their links to different molecular subtypes of BC. Full article

Objectives: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. Methods: This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate/MASCC), MASCC-C (CRP/MASCC) and MASCC-LC models (CRP × lactate/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. Results: A total of 269 patients (mean age: 67.6 ± 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. Conclusions: Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings. Full article

Background: Preimplantation genetic testing for polygenic diseases (PGT-P) is a reproductive technology that has made it possible to assign risk scores to embryos for various complex polygenic conditions such as diabetes, hypertension, breast cancer, and schizophrenia. Whether there is public interest in utilizing PGT-P and what public opinions are regarding this technology is unknown. Therefore, the objective of our study was to evaluate the opinion of the general United States (US) public regarding PGT-P. Methods: A web-based questionnaire consisting of 25 questions was administered to a nationally representative sample of adult US residents according to age and sex. The survey contained a description of PGT-P, followed by questions with Likert-scale responses ranging from strongly agree to strongly disagree. Results: Of the 715 respondents recruited, 673 (94%) completed the survey. Most respondents agreed that use of PGT-P is ethical (54%), and another 37% were neutral; however, approximately 9% of respondents disagreed and were opposed to the use of PGT-P. Those that opposed PGT-P cited that it was “unethical” (46%) or “not natural” (39%), believed children could be negatively affected (31%), or stated that it went against their religion (15%). The majority of respondents did not know whether PGT-P was safe for embryos (68%) or children (67%) and felt that anyone should be able to utilize it (53%). Conclusions: Participants who were younger, were Atheist, or were Democrats were more likely to agree that “PGT-P is ethical”. This study identified that more than half of respondents supported the use of PGT-P. However, concerns regarding its safety and ethical implications persist. Full article

Background and Objectives: Patients with hip fractures have a high mortality rate, highlighting the need for a reliable prognostic tool. Although the prognostic nutritional index (PNI) is a well-established predictor in patients with cancer, its utility has not been thoroughly investigated in patients with hip fractures. Therefore, this study aims to evaluate the association between PNI and mortality in patients undergoing hip fracture surgery. Materials and Methods: A retrospective review was conducted on all patients aged ≥65 years who underwent surgery for hip fracture between January 2014 and February 2018. Quartile stratification was chosen because no universally accepted clinical cut-off exists for PNI; this approach enables comparison of equally sized groups and exploration of potential non-linear risk patterns. The primary endpoints were 1-year and overall mortality in older adults undergoing hip fracture surgery. Multivariable Cox proportional-hazards models adjusted for age, sex, ASA class and comorbidities. Results: A total of 815 patients were analyzed. One-year and overall mortality rates were highest in the Q1 group (26.6%, 14.2%, 6.9%, 6.4% [p < 0.001] and 56.7%, 36.3%, 27.0%, 15.2% [p < 0.001], respectively). In Cox regression analysis, a lower preoperative PNI was significantly associated with an increased risk of overall mortality (Q1: HR 3.25, 95% confidence interval [CI] 2.11–5.01, p < 0.001; Q2: HR 1.85, 95% CI 1.19–2.86, p = 0.006; Q3: HR 1.52, 95% CI 0.97–2.38, p = 0.065; Q4 as reference), indicating a stepwise, dose–response increase in mortality risk as PNI decreases. Conclusions: The findings demonstrate that a lower preoperative PNI is significantly associated with higher 1-year and overall mortality in older adults undergoing hip fracture surgery. Although further prospective validation is needed, preoperative PNI may help predict mortality in frail patients undergoing hip fracture surgery and identify those who could benefit from nutritional assessment and optimization before surgery. Full article

Gastric cancer traditionally affects older adults, and its precursor lesions and risk factors are well-documented in this population. Helicobacter pylori (H. pylori) infection remains highly prevalent in Saudi Arabia and contributes to gastric pathology. However, early-onset gastric cancer (EOGC), diagnosed in individuals aged ≤ 45 years, presents unique challenges and remains poorly understood in young populations. Therefore, we conducted an observational cohort study using a prospective longitudinal design (2021–2024) involving 1823 Saudi nationals aged 18–45 years who underwent zoom high-definition chromoendoscopy to evaluate the prevalence of premalignant gastric lesions (PGLs) and EOGC. We found a high H. pylori prevalence (78.0%) with PGLs in 1.9% of participants and EOGC-adenocarcinoma in 0.7% of patients. All EOGC cases arose from dysplasia, with most PGLs being classified as OLGA/OLGIM stage II/III. Multiple risk factorswere significantly associated with PGLs and EOGC, including H. pylori infection (p = 0.022), increasing age (p < 0.001), a family history of gastric cancer (p < 0.001), poor dietary habits (p < 0.001), obesity (p < 0.001), and smoking (p < 0.001). Additional EOGC risk factors include dage of 36–45 years (p = 0.018), EBV infection (p = 0.016), and diabetes mellitus (p = 0.001). These findings demonstrate the notable presence of PGLs and EOGC in young Saudi adults and emphasize the importance of early detection and risk factor management in this vulnerable population. Full article

Survivors of pediatric cancer are at risk for late effects and require risk-adapted long-term follow-up (LTFU) care. Yet less than 50% of survivors attend LTFU care. This study aimed to identify barriers and enablers of engaging with LTFU care as perceived by Canadian survivors of pediatric cancer and healthcare providers (HCPs). Survivors (n = 108) and HCPs (n = 20) completed surveys assessing barriers and enablers to attending LTFU care, summarized using descriptive statistics. Participants were invited to participate in survivor focus groups (n = 22) or HCP semi-structured interviews (n = 7). These were analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation for Behaviour Change (COM-B) model, which explores how an individual’s capability, opportunity, and motivation influence a target behaviour. Structural barriers, transitioning from pediatric to adult care, and time constraints were highlighted as barriers that affect survivors’ physical opportunity to engage in LTFU care. Accessibility, financial support, HCPs and family support, and community resources were highlighted as enablers that better survivors’ physical and social opportunity to engage in LTFU care. In conclusion, Canadian survivors of pediatric cancer highlighted barriers that limited their physical opportunity to attend LTFU care, while factors that enhanced their physical and social opportunities facilitated greater engagement with LTFU care. Full article

Background/Objectives: After diagnosis, it is common for women with breast cancer to gain weight, which is associated with worse clinical outcomes. However, traditional measures such as body weight, BMI, and waist circumference do not detect key changes in body composition, such as fat redistribution or muscle loss. The objective of this exploratory study was to assess the evolution of body composition and muscle strength after one year of treatment, and their relationship with metabolic biomarkers. Methods: Prospective observational study in newly diagnosed breast cancer patients. Body composition was assessed using bioelectrical impedance analysis (BIA) and ultrasound (US); muscle strength was measured by handgrip dynamometry. Biomarkers analyzed included glucose, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), glycosylated hemoglobin (HbA1c), total cholesterol (and its fractions), triglycerides, C-reactive protein (CRP), 6-interleukin (IL-6), vitamin D, myostatin, and fibroblast growth factor 21 (FGF-21). Results: Sixty-one women (mean age 58 years) were included. After one year, fat mass and related parameters significantly increased, while skeletal muscle mass and muscle strength decreased. Sarcopenic obesity prevalence rose from 1.16% to 4.9%. No significant changes were found in biomarkers, but positive correlations were observed between fat parameters and insulin, HOMA-IR, and triglycerides, and negative correlations with HDL-cholesterol. Conclusions: BIA and US can detect unfavorable changes in body composition that are not reflected in conventional measurements. At one year post-diagnosis, women showed increased fat accumulation, muscle loss, and reduced strength, even without significant metabolic biomarker changes. Further research is warranted to elucidate the long-term clinical implications of these findings and the external validity in larger cohorts. Full article