Search Results (352)

Cyclin-dependent kinase (CDK)4/6 inhibitors have become a key component of adjuvant treatment for patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer who are at high risk of recurrence. The addition of abemaciclib and ribociclib to standard endocrine therapy has demonstrated clinically meaningful improvements in invasive disease-free survival, supported by the monarchE and NATALEE trials, respectively. With expansion of patient eligibility for CDK4/6 inhibitors, multidisciplinary coordination among medical oncologists, surgeons, nurses, pharmacists, and other health care providers is critical to optimizing patient identification, monitoring, and management of adverse events. This expert guidance document provides practical recommendations for implementing adjuvant CDK4/6 inhibitor therapy in routine clinical practice, incorporating insights from multiple specialties and with patient advocacy representation. Key considerations include patient selection based on clinical trial data, treatment duration, dosing schedules, adverse event profiles, monitoring requirements, drug–drug interactions, and patient-specific factors such as tolerability, cost, and quality of life. This guidance aims to support Canadian clinicians in effectively integrating CDK4/6 inhibitors into clinical practice, ensuring optimal patient outcomes through a multidisciplinary and patient-centric approach. Full article

Background: Pleural mesothelioma (PM) is a type of cancer that is difficult to diagnose and treat. Patients may have vastly varying prognoses, and prognostic factors may help guide the clinical approach. As a recently identified biomarker, the pan-Immune-Inflammation-Value (PIV) is a simple, comprehensive, and peripheral blood cell-based biomarker. Methods: The present study represents a retrospective observational analysis carried out within a single-center setting. Ninety-five patients with PM stages I–IV were enrolled in the study. We analyzed the correlation between patients’ demographic characteristics, clinicopathological factors such as histological subtypes, surgery status, tumor thickness, blood-based parameters, and treatment options with their prognoses. PIV was calculated by the following formula: (neutrophil count × monocyte count × platelet count)/lymphocyte count. Additionally, blood-based parameters were used to calculate the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII). Results: We categorized the patients into two groups, low PIV group (PIV ≤ 732.3) and high PIV group (PIV > 732.3) according to the determined cut-off value, which was defined as the median. It was revealed that high PIV was associated with poor survival outcomes. The median follow-up period was 15.8 months (interquartile range, IQR, 7.1 to 29.8 months). The median overall survival (OS) was significantly longer in patients in the low PIV group (median 29.8 months, 95% confidence interval (CI), 15.6 to 44) than the high PIV group (median 14.7 months, 95% CI, 10.8 to 18.6 p < 0.001). Furthermore, the study revealed that patients with low PIV, NLR, and SII values were more likely to be eligible for surgery and were diagnosed at earlier stages. Additionally, these markers were identified as potential predictors of disease-free survival (DFS) in the surgical cohort and of treatment response across the entire patient population. Conclusions: In addition to well-established clinical factors such as stage, histologic subtype, resectability, and Eastern Cooperative Oncology Group (ECOG) performance status (PS), PIV emerged as an independent and significant prognostic factor of overall survival (OS) in patients with PM. Moreover, PIV also demonstrated a remarkable independent prognostic value for disease-free survival (DFS) in this patient population. Additionally, some clues are provided for conditions such as treatment responses, staging, and suitability for surgery. As such, in this cohort, it has outperformed the other blood-based markers based on our findings. Given its ease of calculation and cost-effectiveness, PIV represents a promising and practical prognostic tool in the clinical management of pleural mesothelioma. It can be easily calculated using routinely available laboratory parameters for every cancer patient, requiring no additional cost or complex procedures, thus facilitating its integration into everyday clinical practice. Full article

Obesity is a growing global health concern with widespread impacts on physical, psychological, and social well-being. Clinically, it is a major driver of type 2 diabetes (T2D), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), and cancer, reducing life expectancy by 5–20 years and imposing a staggering economic burden of USD 2 trillion annually (2.8% of global GDP). Despite its significant health and socioeconomic impact, earlier obesity medications, such as fenfluramine, sibutramine, and orlistat, fell short of expectations due to limited effectiveness, serious side effects including valvular heart disease and gastrointestinal issues, and high rates of treatment discontinuation. The advent of glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, tirzepatide) has revolutionized obesity management. These agents demonstrate unprecedented efficacy, achieving 15–25% mean weight loss in clinical trials, alongside reducing major adverse cardiovascular events by 20% and T2D incidence by 72%. Emerging therapies, including oral GLP-1 agonists and triple-receptor agonists (e.g., retatrutide), promise enhanced tolerability and muscle preservation, potentially bridging the efficacy gap with bariatric surgery. However, challenges persist. High costs, supply shortages, and unequal access pose significant barriers to the widespread implementation of obesity treatment, particularly in low-resource settings. Gastrointestinal side effects and long-term safety concerns require close monitoring, while weight regain after medication discontinuation emphasizes the need for ongoing adherence and lifestyle support. This review highlights the transformative potential of incretin-based therapies while advocating for policy reforms to address cost barriers, equitable access, and preventive strategies. Future research must prioritize long-term cardiovascular outcome trials and mitigate emerging risks, such as sarcopenia and joint degeneration. A multidisciplinary approach combining pharmacotherapy, behavioral interventions, and systemic policy changes is critical to curbing the obesity epidemic and its downstream consequences. Full article

(1) Background: Patient-centered care for individuals with breast cancer requires multidisciplinary cooperation to ensure the appropriate use of medication and prevent medication-related problems. Pharmaceutical care has been associated with improved adherence in breast cancer management, a factor linked to patient outcomes and mortality. This study aims to summarize and explore the provision and utilization of pharmaceutical services for breast cancer patients by pharmacists. (2) Methods: A scoping review was performed to assess the pharmacist’s role in providing pharmaceutical services for patients with breast cancer. A comprehensive review of four databases (PubMed, Ovid Embase, Ovid International Pharmaceutical Abstracts, and Scopus) was completed between 1 January 2012 and 8 April 2025 according to PRISMA-ScR framework. (3) Results: A total of 46 articles met the inclusion criteria, which included RCTs, observatory studies, cohort studies, and reviews. Findings suggest that both clinical and community pharmacists play an important role in prevention, management, and education for breast cancer patients. (4) Conclusions: Pharmacists can improve health outcomes by providing pharmaceutical service in breast cancer care. Optimizing interventions, expanding services, and evaluating long-term cost-effectiveness is needed in the future. Full article

Background: Semaglutide and Liraglutide are medications in the Glucagon-like peptide-1 agonists (GLP-1 RAs) class used to manage type 2 diabetes mellitus and obesity in Saudi Arabia. Although the 1.0 mg once weekly dosage of Semaglutide does not have a labeled indication for the management of obesity, many believe that this dosage is more effective than the 3.0 mg once daily Liraglutide dosage for the management of both diabetes and obesity. Objective: To compare the effectiveness of the dosage of 1.0 mg of Semaglutide administered once weekly versus 3.0 mg of Liraglutide administered once daily in controlling HbA1c levels, promoting weight loss, and evaluating their financial implications among obese patients in Saudi Arabia using real-world data. Methods: A retrospective review of Electronic Medical Records (EMRs) from January 2021 to June 2024 was conducted on patients prescribed Semaglutide or Liraglutide for at least 12 months. Exclusion criteria included pre-existing severe conditions (e.g., cardiovascular disease, stroke, or cancer) and missing baseline data. The primary outcomes assessed were changes in HbA1c, weight, and direct medical costs. Results: Two hundred patients (100 patients on the 1.0 mg once weekly dose of Semaglutide and 100 patients on the 3.0 mg once daily dose of Liraglutide) of those randomly selected from the EMRs met the inclusion criteria and were included in the analysis. Of the 200 eligible patients (65.5% female, mean age 48.54 years), weight loss was greater with Semaglutide (−8.09 kg) than Liraglutide (−5.884 kg). HbA1c reduction was also greater with Semaglutide (−1.073%) than Liraglutide (−0.298%). The use of Semaglutide resulted in lower costs of USD −1264.76 (95% CI: −1826.82 to 33.76) and greater reductions in weight of −2.22 KG (95% CI: −7.68 to −2.784), as well as lower costs of USD −1264.76 (95% CI: (−2368.16 to −239.686) and greater reductions in HbA1c of −0.77% (95% CI: −0.923 to −0.0971) in more than 95% of the cost effectiveness bootstrap distributions. Conclusions: Semaglutide 1.0 mg weekly seems to be more effective and cost-saving in managing prediabetes, diabetes, and obesity compared to Liraglutide 3.0 mg daily. Future studies should examine these findings using a more representative sample and a robust study design. Full article

Antimicrobial peptides (AMPs) represent a powerful support to conventional antibiotics in addressing the global challenge of antimicrobial resistance (AMR). Their broad-spectrum antimicrobial activity and unique mechanisms of action enable diverse potential applications, including combating multidrug-resistant pathogens, immune modulation, and cancer therapy. Their clinical implementation is hindered by challenges such as toxicity, instability, and high production costs. Recent advances in AMP design, optimization, and delivery mechanisms such as nanoparticle conjugation and rational engineering have enhanced their efficacy, stability, and specificity. Integrating AMPs into precision medicine and combining them with existing therapies promises to overcome current limitations. With ongoing advancements, AMPs have the potential to redefine infection management and possibly other medical problems. Full article

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management. Full article

Background/Objectives: Prostate cancer (PCa) remains a major contributor to cancer-related morbidity and mortality worldwide. Current diagnostic strategies, largely based on PSA screening, lack specificity and sensitivity, leading to unnecessary invasive procedures and elevated healthcare costs. This real-world study evaluated the EpiSwitch^® PSE assay, a blood-based test analyzing 3D genome conformation signatures, ability to avoid unnecessary biopsies and the resulting clinical and economical benefits. Methods: 187 patients undergoing evaluation for PCa were tested with the EpiSwitch^® PSE assay. Biopsy confirmation was available for 53 patients, while predictive modeling assessed 134 patients using EpiSwitch PSE results and clinical variables. Results: Among the 187 patients evaluated, predictive modeling showed that up to 79.1% (106/134) of patients could safely defer biopsy based on a low-likelihood EpiSwitch PSE result, while an alternative model showed a 66.4% (89/134) biopsy avoidance rate. The PSE result demonstrated strong concordance with biopsy-confirmed diagnoses and was the most influential predictor in multivariate analysis, followed by PI-RADS score. The test achieved a 100% technical success rate, with an average turnaround time of 4.4 days. Conclusions: Incorporating the EpiSwitch PSE assay into clinical workflows enhances decision-making efficiency, reduces unnecessary biopsies, and improves healthcare resource utilization. These findings support the assay’s strong clinical utility and economic value, highlighting its potential for broader adoption as a minimally invasive reflex test and a pre-biopsy triage tool for the early and accurate detection of prostate cancer. Future studies should include prospective, multicenter trials to confirm these results across broader populations and evaluate longitudinal outcomes of patients managed with PSE-guided care. Full article

Immunotherapy has a defined role in the treatment of both early- and late-stage triple-negative breast cancer (TNBC) and is under active exploration in human epidermal receptor 2-positive as well as high-risk hormone-receptor-positive subtypes. It is critical to balance the efficacy and toxicity of immunotherapy while keeping the cost and duration of treatment in check. In addition to the immunohistochemistry testing of PD-L1 expression, which only predicts the efficacy of immunotherapy in metastatic TNBC, there is a lack of biomarkers that are better standardized to predict efficacy and treatment response, detect early relapse, and guide prognosis in breast cancer patients treated with immunotherapy. Circulating tumor DNA (ctDNA) is a minimally invasive, dynamic, real-time, blood-based biomarker that has shown promising value in the management of solid tumors, including breast cancer. This review discusses the emerging evidence for the potential application of ctDNA to further refine patient-centered care and personalize treatment based on a molecularly defined risk assessment for breast cancer patients treated with immunotherapy-based approaches. We further discuss the challenges and barriers to widespread adoption of this promising tool in the management of breast cancer patients requiring immunotherapy. Full article

Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was based on the hospital discharge records from the National Health System between 2016 and 2022. The variables analyzed were sex, age, comorbidities, discharge diagnoses and procedures, overall severity, whether empyema was a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay (LOS), in-hospital mortality, and healthcare costs. Results: Between 2016 and 2022, 19864 PE cases were diagnosed in Spain, revealing an overall rate of 0.64 per 1000 hospitalizations, with the exception of a slight decline in 2021. The mean age of the patients with PE was 61 years, and 73.85% were men. Most patients had low comorbidities, with a median Charlson comorbidity index (CCI) of 1.7. Most cases (63%) involved secondary diagnoses (pneumonia, pneumococcal pneumonia, sepsis, COVID, or lung cancer). The in-hospital mortality rate was higher in the secondary diagnosis group than in the primary diagnosis group (13.4% vs. 6.2%, respectively, p < 0.001). The factors associated with increased mortality included older age (≥66 years), higher CCI scores, ICU admission, and shorter LOS (<10 days). Conversely, pleural drainage and pneumonia as secondary diagnoses were protective factors. Conclusions: PE is an increasingly common pathology in clinical practice, especially in older and frail patients. It is associated with high morbidity and mortality, and its prognosis worsens with age and comorbidities. Therefore, early and appropriate diagnosis and standardized management strategies are required to mitigate the mortality and healthcare costs. Full article

Background/Objectives: Operating rooms represent valuable and pivotal units of any hospital. Therefore, their management affects healthcare service delivery through rescheduling, staff shortage/overtime, cost inefficiency, and patient dissatisfaction, among others. To optimize scheduling, we aim to assess preoperative evaluation criteria that influence the prediction of surgery duration for gastric cancer (GC) patients. In GC, radical surgery with curative intent is the ideal treatment. Nevertheless, the intervention sometimes must be palliative if the patient’s status and tumor staging prove too advanced. Methods: A 6-year retrospective cohort study was performed in a tertiary care hospital, including all cases diagnosed with GC (ICD-10 code C16), confirmed through histopathology, and undergoing surgical treatment (N = 108). Results: The results of our study confirm male predominance (63.89%) among GC surgery candidates while bringing new perspectives on patient evaluation criteria and choice of surgical intervention (curative—Group 1, palliative—Group 2). Surgery duration, including anesthesiology (175.19 [95% CI (157.60–192.77)] min), shows a direct correlation with the number of lymph nodes dissected (Surgical duration [min] = 10.67 × No. of lymph nodes removed − 32.25). Interestingly, the aggressiveness of the tumor based on histological grade (highly differentiated being generally less aggressive than poorly differentiated) shows differential correlation with surgery duration among curative and palliative surgery candidates. Similarly, TNM staging indicates the need for a longer surgical duration (pTNM stage IIA, IIB, and IIIA) for curative interventions in patients with less advanced stages, as opposed to shorter surgery duration for palliative interventions (pTNM stage IIIC and IV). Conclusions: The study quantitatively presents the resources needed for the optimal surgical treatment of different groups of GC patients, as the disease coding systems in use regard the treatment of each pathology as “standard” in terms of patient management. The results obtained are anchored in the global perspectives of surgical outcomes and aim to improve the management of operating room scheduling, staff, and resources. Full article

Background: Despite clinical utility in managing hereditary cancers, genetic testing (GT) remains underutilized. While barriers include knowledge gaps and cost, clinician recommendation is a major driver of GT uptake, with rates varying by cancer type and family cancer history documentation. Methods: Adult participants (≥18 years) were recruited through multiple sources to complete a cancer family history survey for a larger intervention trial. Participants with personal or family history indicating increased hereditary cancer risk who had not undergone GT (N = 3001) were invited to complete a baseline survey. Multivariable logistic regression was used to analyze associations between demographics and cancer history by receipt of a clinician recommendation for GT. Results: Among 784 respondents, most were White (84.6%), female (58.4%), and over age 51 (75.3%), with 58.2% reporting a diagnosis of cancer. Only 14.0% reported receiving a clinician recommendation for GT, with lower recommendation rates among younger adults (20.1%), those reporting no financial stress (10.7%), and those with higher education (12.0%). Multivariate analysis showed participants who did not report financial stress (p = 0.049) were less likely to receive a recommendation. Discussion: These findings highlight disparities in GT recommendation by clinicians. Increased clinician education about indications for GT, the implementation of electronic medical record tools to facilitate the identification of patients with guideline-concordant personal and/or biological-relative cancer history, and patient-facing interventions could standardize the dissemination of recommendations for GT. Conclusions: Future efforts that focus on increasing clinician education and electronic decision support should identify individuals with personal and/or biological-relative cancer history meeting criteria for GT. Full article

Background: Rural patients, including those with rectal cancer, continue to be underrepresented in research and medically underserved with unique challenges to accessing care. Like the rest of America, rural patients are experiencing rising rates of rectal cancer; however, unlike the rest of the country, they also have rising rectal cancer-related mortality. This study aims to review the literature regarding care for patients with rectal cancer in rural settings, from presentation and diagnosis to treatment algorithms, oncologic outcomes, their unique preferences, and the goals of care. Methods: A literature search was performed on PubMed, on 31 October 2024, using synonyms of “rural” and “rectal cancer” to identify relevant articles. Articles from outside the USA and Canada and those offering only commentary were eliminated during the initial screening/retrieval. A full-text review was performed on the remaining articles; all the studies that did not address the identified primary or secondary outcomes in rural rectal cancer patients were then excluded. All the primary and secondary outcomes are briefly summarized in narrative form, with more detail on the primary outcomes provided in tables. The variability in the key criteria between the studies is also summarized in the tables and appendices provided. Results: Thirty studies were identified that addressed the outcomes of interest in rural rectal cancer patient populations. The total number of participants could not be assessed given the use of overlapping databases. Of the articles, 21 addressed treatment modalities (surgery, chemotherapy, radiation), 13 addressed oncologic outcomes, and a mix of additional studies addressed the diagnostic work up, costs, and patient preferences. The studies addressing treatment demonstrated similar practices in regard to chemotherapy and surgical management, aside from lower rates of minimally invasive surgery, along with decreased neoadjuvant radiotherapy use and increased under-dosing in rural patients. The oncologic outcomes were overall similar to worse for rural patients as compared to urban patients, even for those receiving treatment at high-volume urban centers. Additionally, rural patients have higher healthcare costs for rectal cancer care. Discussion/Conclusions: Rural patients are an at-risk group, with a rising disease burden and worsening rectal cancer outcomes, despite advances in rectal cancer care and improving oncologic outcomes in the general population. Analysis of the situation is complicated due to the underrepresentation of rural patients in research and the lack of uniformity in the definition of “rural”. Moreover, significant gaps in the literature remain, such that the evaluation of guideline-concordant care is incomplete, including an absence of literature about watch-and-wait approaches in rural populations. While regionalization of rectal cancer care has shown promise, the improvements in outcomes may not be commensurate for rural patients. Thus, a specific focus on the impact of this shift for rural patients is necessary to mitigate unintended consequences. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with the Asia-Pacific (APAC) region bearing a disproportionate burden. This paper examines HCC challenges within seven APAC health systems, identifies key barriers at each stage of the patient journey, and proposes tailored, actionable solutions. To effectively address HCC challenges, a stepwise approach should prioritise high-impact solutions, focusing on prevention, early diagnosis, and expanding surveillance to maximise health outcomes and economic benefits, while tailoring strategies to each health system’s unique resources and constraints. Methods: A mixed-methods approach was used, including expert consultations from the 2024 HCC APAC Policy Forum, a literature review, and a review of Japan’s HCC management model. Data were collected through workshops and stakeholder feedback from healthcare professionals, policymakers, researchers and patient advocates across Australia, India, Malaysia, South Korea, Taiwan, Thailand, and Vietnam. Results: Key findings include significant disparities in HCC awareness, prevention, early detection, diagnosis, and access to treatment. Common challenges across APAC include limited public awareness, suboptimal surveillance infrastructure, and financial barriers to care. The integration of novel biomarkers and advanced surveillance modalities were identified as crucial priorities for improving early detection. Japan’s multi-faceted approach to HCC management serves as a successful model for the region. Conclusions: A customised and targeted approach is essential for reducing the HCC burden across APAC. The proposed recommendations, tailored to each health system’s needs, can significantly improve patient outcomes and reduce healthcare costs. Effective collaboration among stakeholders is necessary to drive these changes. Full article

Background and Objectives: As a leading European country in terms of cervical cancer incidence and mortality, there has been a pressing need for Romania to upgrade its cervical cancer management. The criteria set by the International Federation of Gynecology and Obstetrics indicate that different treatments should have a similar trend concerning progression-free survival and overall survival at all the various stages of cervical cancer. This study aimed to assess the cost-effectiveness (CE) of the primary treatment plans related to the survival rate for cervical cancer screening in the western part of Romania and provide some recommendations. Materials and Methods: Descriptive statistics and a correlation model were used to examine costs. AI models have been developed to forecast the CE of different treatments using the above-mentioned studies on overall survival rates and treatment-related toxicity rates for five years. The costs of cervical cancer treatment were sourced from the public health department, the oncology clinic in the western region of Romania, and the County Hospital available for each stage. Results: Treatment expenses vary by cancer stage, with a significant increase from stages IA/IB to IIA, stabilizing between IIA and IIIC (about €7800–€8300), followed by a steep decline in IVA and a more pronounced decrease in IVB and in situ. The results highlight certain treatment combinations and their costs, indicating that the highest costs (exceeding €8000) are linked to multimodal treatments, which encompass surgery, chemotherapy, radiotherapy, and brachytherapy. Conclusions: Advanced cancer stages (IIA–IIIC) entail the highest treatment costs due to intricate, multimodal therapy, whereas early stages (IA, IB, in situ) and late terminal stages (IVB) are linked to considerably reduced treatment costs. Full article