Search Results (953)

Background/Objectives: Long-term follow up of pediatric radiotherapy survivors referred to tertiary and quaternary centers is difficult, limiting outcome monitoring. We implemented an electronic Health Status Survey (HSS) to capture survivorship data. Methods: The Health Status Survey (HSS) was distributed to survivors aged 1 month–25 years treated with curative-intent radiotherapy at our institution. Eligibility required confirmed survival and valid email contact. Survey responses and demographics were summarized with descriptive statistics and comparative tests. Surveys were sent to 876 eligible participants, with 322 responses received (36.8%) between December 2023 and March 2024. Results: Survey completion extended follow up by a median of 18.3 months (about 1.5 years), improving monitoring beyond the last chart-documented visit. Respondents reported 12 recurrences, 5 s malignancies, and 7 deaths not captured in prior records, altering event-free survival statistics by as much as 7.5%. Most respondents (90.1%) reported a medical visit in the past year, and many provided updates on ongoing health issues, provider contact, and social outcomes. Conclusions: The HSS is a replicable method for extended follow up of tertiary and quaternary care center patients, capturing previously unreported clinical, social, and educational outcomes. By supplementing chart data with patient-reported information, this cost-effective tool supports targeted annual follow up and the identification of trends for long-term survivorship care. Full article

Background/Objectives: Adult survivors of childhood and young adult Hodgkin’s lymphoma (HL) are at a higher risk than the general population for moderate to life-threatening chronic health conditions (CHCs) including cardiac, vascular, endocrine and pulmonary impairments. Regular physical activity (PA) can improve physical fitness, reducing the risk of severity for CHCs. However, it is unclear whether adult survivors of HL experience the same benefits from PA as their peers. This scoping review aims to describe the associations between PA, physical fitness, perceived health, chronic disease and mortality in adult survivors of HL. In addition, body composition, autonomic dysfunction and associated treatment-related risk factors were included. Methods: MEDLINE (via PubMed), Web of Science, CINAHL and Cochrane databases were searched for potential studies that involved PA or physical fitness and outcomes such as body composition, autonomic dysfunction, associated treatment-related risk factors, associated chronic disease/mortality or perceived health. Results: A total of 2886 records were retrieved. After screening, 20 studies were included for review. In comparison to the general population, adult survivors of HL reported lower PA levels and had lower physical fitness. In addition, survivors were more likely to have abnormalities in body composition (i.e., reduced bone mineral density) and perceived health, autonomic dysfunctions and a higher risk of chronic disease and mortality than controls. An exposure to thoracic and neck radiotherapy seemed to be consistently associated with poor fitness (i.e., reduced muscle strength, lower cardiopulmonary fitness) and body composition, physical inactivity and autonomic dysfunctions. Conclusions: Interventional studies are needed to determine the maximum effective doses of PA regarding frequency, intensity, time, type, volume and progression (exercise prescription principles) that best optimize cardiovascular adaptations and health benefits in adult survivors of HL. Full article

Radiotherapy (RT) remains a cornerstone of cancer treatment, offering spatially precise cytotoxicity against malignant cells. However, emerging evidence reveals that ionizing radiation (IR) exerts biological effects beyond the targeted tumor volume, manifesting as radiation bystander effects (BEs) and other non-targeted effects (NTEs). These phenomena challenge the traditional paradigm of RT as a localized intervention, highlighting systemic and long-term consequences in non-irradiated tissues. This comprehensive review synthesizes molecular, cellular, and clinical insights about BEs, elucidating the complex intercellular signaling networks gap junctions, cytokines, extracellular vesicles, and oxidative stress that propagate damage, genomic instability, and inflammation. We explore the role of mitochondrial dysfunction, epigenetic reprogramming, immune modulation, and stem cell niche disruption in shaping BEs outcomes. Clinically, BEs contribute to neurocognitive decline, cardiovascular disease, pulmonary fibrosis, gastrointestinal toxicity, and secondary malignancies, particularly in pediatric and long-term cancer survivors. The review also evaluates countermeasures including antioxidants, COX-2 inhibitors, exosome blockers, and FLASH RT, alongside emerging strategies targeting cfCh, inflammasomes, and senescence-associated secretory phenotypes. We discuss the dual nature of BEs: their potential to both harm and heal, underscoring adaptive responses and immune priming in specific contexts. By integrating mechanistic depth with translational relevance, this work posits that radiation BEs are a modifiable axis of RT biology. Recognizing and mitigating BEs is imperative for optimizing therapeutic efficacy, minimizing collateral damage, and enhancing survivorship outcomes. This review advocates for a paradigm shift in RT planning and post-treatment care, emphasizing precision, personalization, and systemic awareness in modern oncology. Full article

Background/Objectives: With increasing survival rates in pediatric oncology, late effects, such as therapy-induced infertility, are becoming more relevant. This study evaluated the management of fertility preservation in children and adolescents with cancer at the Medical University Innsbruck between 2000 and 2018. Methods: In this retrospective monocentric study, 552 patients (0–17 years) receiving chemotherapy were analyzed. Data was extracted from the Clinical Information System and the cryopreservation database. The assessed main variables included pubertal status, sex hormone levels, and use of fertility preservation methods. Results: Fertility preservation was documented in 6.5% of patients, more frequently in males (8.9%) than females (3.2%). Sperm cryopreservation was performed in twenty-eight males, ovarian tissue cryopreservation in six females, and oocyte cryopreservation in three. Pubertal status at diagnosis was recorded in 4.9% of patients and hormone levels in 29.7%. Conclusions: The findings highlight significant gaps in systematic fertility preservation, particularly in female patients. Consistent assessment of pubertal and hormonal parameters at diagnosis is essential to inform decision-making. Standardized procedures and closer interdisciplinary collaboration are needed to ensure equitable access to fertility preservation and safeguard long-term quality of life. Full article

Background: The change over time of certain inflammatory markers, such as the neutrophil–lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI), is a prognostic factor in many cancers, including breast cancer. This study retrospectively evaluated how a 12-week intensive exercise program might have influenced both the NLR and SIRI in women with breast cancer. Methods: Two institutional review board-approved prospective clinical trials, EXERT-BC (NCT05747209, 2 November 2022) and EXERT-BCN (NCT05978960, 31 July 2023), were retrospectively assessed. Complete blood count (CBC) values performed before and after participation in a 12-week intensive resistance program were analyzed post hoc. Blood tests were ordered as part of routine clinical care and not pre-specified by either study protocol. Participants who had blood work more than four months from study intake or completion were excluded. Additionally, those undergoing active systemic therapy or with underlying inflammatory conditions were also excluded. The NLR and SIRI values were analyzed via the Mann–Whitney test, with pair-wise assessment of pre- and post-intervention values via the Wilcoxon signed-rank test. Results: Out of 84 participants, 21 people met the inclusion criteria. Roughly 70% had either ductal carcinoma in situ (DCIS) or early-stage breast cancer. The average blood draw was taken within two months of study intake and outtake. After the 12-week structured exercise program, there was an associated reduction in both the NLR (2.26 [IQR, 1.70–4.22] to 1.99 [1.44–2.62]; ΔNLR = −0.27, W = 47.0, p = 0.016) and SIRI (1.23 [0.82–1.64] to 0.80 [0.59–1.45]; ΔSIRI = −0.43, W = 48.0, p = 0.018). Of those who saw their inflammatory markers improve, roughly two thirds showed a clinically relevant improvement. Conclusions: Completion of a 12-week intensive resistance exercise program was associated with a statistically improved NLR and SIRI. The small sample size and retrospective nature limit the broader application of these findings. The results, however, provide a genesis for prospective validation examining the potential benefit exercise might have on the NLR and SIRI in women with breast cancer. Full article

Rhododendron huadingense is a nationally protected wild plant species in China with a small population and narrow natural distribution, which is experiencing severe anthropogenic threats. The demographic structure and trends of R. huadingense on Mount Dapan in Zhejiang Province were analyzed to help researchers understand its population dynamics by using static life tables, quantitative dynamic indices, survivorship curves, and survival analysis based on three censuses of a 1 ha plot in 2012, 2017, and 2022. Over this decade, the population of R. huadingense declined by 9.58% from 668 to 604 individuals. From 2012 to 2022, the diameter class structure of the population consistently exhibited a pyramidal pattern, with the number of individuals initially increasing and then decreasing as diameter classes advanced. Over this decade, the diameter class structure of the population consistently showed a declining trend. Dynamic indices showed that the quantitative dynamic index of the population without external interferences was greater than with external interferences, and that both were greater than zero, suggesting growth potential. The maximum risk probability in response to random disturbance from 2012 to 2022 (2017 > 2022 > 2012) was greater than zero but relatively small, indicating underlying demographic instability. Life tables showed Deevey Type II survivorship with mortality rates decreasing in larger diameter classes. These demographic patterns indicate that R. huadingense is transitioning from recruitment-driven growth to senescence-dominated population dynamics. Urgent conservation interventions are needed, including (1) enhancing seedling establishment, (2) improving habitat quality, (3) promoting natural regeneration processes. Full article

Background: Total knee arthroplasty (TKA) is a widely performed and highly successful procedure, with cemented fixation historically considered the standard. Advances in implant design have renewed interest in cementless fixation, which shows comparable survivorship and increasing use, particularly in younger patients. Evidence on perioperative outcomes remains mixed, prompting this study to compare hemoglobin decline and operative time between cemented and cementless TKA of the same design. Methods: This monocentric retrospective cohort study included consecutive patients undergoing primary TKA between 2019 and 2021, divided into cemented and cementless groups. Inclusion criteria were primary osteoarthritis, age > 45 years, hemoglobin > 13 g/dL, ferritin > 100 ng/mL, and complete perioperative hemoglobin data (preoperative, PostOperativeDay (POD)1, 3, 5). Primary outcomes were operative time and hemoglobin trajectory, analyzed using multivariable regression and mixed-effects models adjusted for age, sex, and implant design. Propensity score matching was performed as a sensitivity analysis. Results: A total of 123 TKAs were analyzed (63 cementless, 60 cemented). Cementless TKA had a shorter operative time than cemented (72.0 ± 12.0 vs. 79.8 ± 15.1 min; 95% CI −12.2 to −2.8; p < 0.01). Cementless fixation was associated with significantly shorter operative time (72.0 ± 11.8 vs. 79.8 ± 15.1 min, p < 0.01), a difference that remained significant after multivariable adjustment and propensity score matching. Postoperative hemoglobin declined in both groups, with no significant unadjusted between-group differences at any timepoint. In adjusted mixed-effects models, cementless TKA was associated with a slightly greater hemoglobin decline compared with cemented TKA, with mean adjusted differences of −0.56 g/dL on POD1 (95% CI [−0.95, −0.17]), −0.53 g/dL on POD3 (95% CI [−0.91, −0.14]), and −0.34 g/dL on POD5 (95% CI [−0.64, −0.04]). However, this was not clinically relevant, as no transfusions or anemia-related complications occurred. Conclusions: Cementless TKA was associated with reduced operative time compared with cemented fixation, an effect robust to adjustment and propensity score matching. These conclusions apply to a selected, relatively non-anemic cohort. Although hemoglobin decline was slightly greater with cementless fixation, the difference was small and not clinically meaningful. Full article

Background: Medial-compartment knee osteoarthritis with varus alignment is treated surgically by realignment (high tibial osteotomy, HTO), resurfacing (unicompartmental knee arthroplasty, UKA), or proximal fibular osteotomy (PFO), which aims to indirectly unload the medial tibial plateau. Methods: We conducted a structured narrative review (PubMed/MEDLINE, Google Scholar; 2000–2025; last search 30 August 2025) of comparative clinical, biomechanical and safety data for HTO, UKA and PFO, including prior meta-analyses and mechanistic reports. One hundred fourteen studies met prespecified criteria. Results: HTO reliably corrects coronal alignment and unloads the medial compartment; long-term survivorship varies by selection and technique, and complications include hinge fracture, delayed/nonunion and hardware problems. UKA typically yields faster early pain relief and recovery in pooled analyses, with implant-specific failure risks and mid-term revision dependent on design and surgical experience. PFO cohorts consistently report early pain and function gains with plausible biomechanical rationale, but evidence is dominated by small, heterogeneous series with short follow-up and limited comparative data. Adjusted head-to-head comparisons generally favor UKA for early pain yet show HTO and UKA can achieve similar patient-reported improvements in selected younger cohorts; robust comparative trials including PFO are lacking. Conclusions: HTO and UKA are established, mechanistically distinct options best matched to patient age, alignment, activity goals, and comorbidity. PFO is a low-burden, promising alternative with uncertain durability; longer-term, controlled evaluation and registry surveillance are required before broad adoption. Findings should inform shared decision-making while acknowledging differences in evidence maturity. Full article

Background/Objectives: Pancreatic cancer remains highly fatal, often diagnosed late with poor prognoses and worse psychological quality of life compared to other cancers. Globally, it is the twelfth most common cancer but the sixth leading cause of cancer-related deaths, with actual 5-year survival rates below 5%. Northern Ireland’s outcomes are among the worst, yet research on people’s experiences across the illness trajectory is scarce. Consequently, the unique needs of people with pancreatic cancer are poorly understood. It is crucial we develop deeper understanding of the entire pancreatic cancer journey to address this. This study aims to explore the lived experiences of people diagnosed with pancreatic cancer in Northern Ireland and generate a theory that explains their journeys, from pre-diagnosis through to survivorship or end of life. Methods: This study will adopt a grounded theory approach, incorporating multiple qualitative data generation methods: semi-structured interviews with patients and care partners, and focus groups with professionals. An optional photovoice (participatory photography) method will be offered to participants. Theoretical sampling principles and constant comparative analysis will guide recruitment, data collection, and analysis to ensure the explanatory theory is rooted in participants’ lived experiences. Conclusions: Establishing a holistic, in-depth understanding of people’s pancreatic cancer journeys will enable us to better comprehend, anticipate, and meet their needs. A theory grounded in empirical data about lived experiences can inform priorities for future care, support services, policy, and research, and contribute to the development of support interventions that help people to maintain the best possible quality of life, whether during a short-term, terminal illness; treatment journey; long-term symptom management; or survivorship. Full article

Background/Objectives: Artificial Intelligence (AI) is rapidly advancing in medicine, facilitating personalized care by leveraging complex clinical data, imaging, and patient monitoring. This study characterizes current practices in AI use within oncology clinical trials by analyzing completed U.S. trials within the Cancer Control Continuum (CCC), a framework that spans the stages of cancer etiology, prevention, detection, diagnosis, treatment, and survivorship. Methods: This cross-sectional study analyzed U.S.-based oncology trials registered on ClinicalTrials.gov between January 2015 and April 2025. Using AI-related MeSH terms, we identified trials addressing stages of the CCC. Results: Fifty completed oncology trials involving AI were identified; 66% were interventional and 34% observational. Machine Learning was the most common AI application, though specific algorithm details were often lacking. Other AI domains included Natural Language Processing, Computer Vision, and Integrated Systems. Most trials were single-center with limited participant enrollment. Few published results or reported outcomes, indicating notable reporting gaps. Conclusions: This analysis of ClinicalTrials.gov reveals a dynamic and innovative landscape of AI applications transforming oncology care, from cutting-edge Machine Learning models enhancing early cancer detection to intelligent chatbots supporting treatment adherence and personalized survivorship interventions. These trials highlight AI’s growing role in improving outcomes across the CCC in advancing personalized cancer care. Standardized reporting and enhanced data sharing will be important for facilitating the broader application of trial findings, accelerating the development and clinical integration of reliable AI tools to advance cancer care. Full article

Background: Childhood cancer survivors (CCSs) are at heightened risk of long-term neurocognitive and emotional difficulties that can affect educational attainment, social participation, and overall quality of life. These outcomes vary across developmental stages and are influenced by treatment modality, age at diagnosis, and central nervous system (CNS) involvement. Methods: A comprehensive literature search was conducted in PubMed, Scopus, PsycINFO, and Web of Science for articles published between January 2000 and June 2024. Search terms included combinations of “childhood cancer survivors,” “neurocognitive outcomes,” “executive function,” “emotional regulation,” and related MeSH terms. Inclusion criteria required peer-reviewed studies assessing CCS using standardized neuropsychological or emotional measures. Results: Evidence indicates persistent deficits in processing speed, working memory, and higher-order executive functions, with additional challenges in attention and memory. Emotional difficulties, including anxiety, depression, and social withdrawal, were prevalent and often co-occurred with cognitive impairments. Developmental timing of cancer and treatment was a key determinant of outcome. Family functioning, school reintegration support, and broader social environments emerged as important moderators of resilience. Conclusions: CCSs face complex, interrelated cognitive and emotional challenges that warrant early identification and ongoing, developmentally tailored intervention. Integrated approaches combining cognitive remediation and psychosocial support appear most effective. Future research should prioritize longitudinal designs, multi-informant assessments, and culturally sensitive frameworks to inform targeted prevention and rehabilitation strategies. Our synthesis highlights that deficits in processing speed and working memory are most pronounced following CNS-directed therapies during early developmental stages, whereas emotional vulnerabilities such as anxiety and social withdrawal often emerge later in adolescence. Interventions combining cognitive remediation, targeted psychosocial support, and structured school reintegration show the strongest evidence for improving adaptive outcomes. Coordinated survivorship care across healthcare, educational, and family systems is essential to sustain developmental recovery. Full article

Background: Quality of life (QoL) is a crucial outcome measure in cancer care. This study aimed to identify the association of health-related quality of life (HRQoL) among colorectal cancer (CRC) patients in Malaysia. Methods: The study was conducted from January 2021 to July 2022, recruiting CRC patients from two teaching hospitals in Malaysia. The validated Malay versions of EORTC QLQ-C30 and QLQ-CR29 questionnaires assessed physical, psychological, and social functioning. Patients were evaluated 6 months after diagnosis to determine QoL associations. Anthropometric measurements were recorded at baseline (diagnosis, 0 months) and at follow-up (6 months). Results: Among 87 CRC patients (55.2% male, mean age 59.8 ± 11.8 years), 37.9% had stage III disease and 13.8% had stage IV. Most patients (93%) underwent surgery and 78% received chemotherapy. The mean global health status score was 66.57 ± 20.75. Multiple linear regression analysis revealed that older age (p = 0.03), advanced cancer stage (p = 0.017), lower body weight (p = 0.017), and reduced hip circumference (p = 0.040) are significantly associated with poorer global health status quality of life (GHS QoL). Nutritional parameters specifically predicted functional domains: lower body weight and BMI predicted role and cognitive function, while lower hip circumference predicted emotional function. Conclusions: Advanced age, disease stage, and nutritional status are significant associations of QoL in Malaysian CRC patients. These findings highlight the importance of nutritional assessment and intervention in CRC survivorship care to optimize patient outcomes. Full article

Background/Objectives: Neck-specific pain and disability are common and burdensome for survivors of oropharyngeal squamous cell carcinoma (OPSCC), yet the biological mechanisms underlying these symptoms remain poorly understood. While patient-reported outcomes (PROs) offer valuable insight into pain and function, their limited integration with molecular data restricts the development of targeted interventions. The purpose of this study was to explore transcriptomic differences associated with neck pain and disability in OPSCC survivors. Methods: Bulk RNA sequencing was performed on blood samples collected from OPSCC survivors either pre-radiation or more than one year post treatment. DESeq2 was used to determine differentially expressed genes between survivors reporting no versus any neck-related pain, as measured by the validated Neck Disability Index. Ingenuity Pathway Analysis was used to explore interaction among the genes. Results: We identified 24 significantly differentially expressed genes (adjusted p < 0.05) linked to hematopoietic, immune, and neuronal functions. Pathway analysis of the top 50 differentially expressed genes revealed overlap in interferon signaling, iron homeostasis, and blood cell development, suggesting molecular connectivity in hematologic and immunologic disease, cellular movement, and connective tissue disorders. Conclusions: These findings suggest the existence of molecular phenotypes associated with patient-reported neck pain and disability in OPSCC survivors and highlight the importance of integrating PROs with molecular profiling to better understand survivorship burden. Full article

Background and Objectives: The pineal gland is a neuroendocrine structure whose function can be disrupted in patients with malignancies. This study examines the differences in pineal gland volume between oncology patients and healthy controls, as well as the relationship between volume and the duration of chemotherapy. Materials and Methods: A retrospective study included 400 participants, divided into two groups: 200 oncology patients and 200 healthy controls. The pineal gland volume was measured using MRI scans, utilizing T1-sagittal, T2-coronal/axial sections, and post-contrast 3D T1W MPRAGE tomograms. The volume was calculated based on the ellipse approximation formula: V = (L × H × W)/2. The study analyzed the relationships between pineal gland volume and factors such as age, sex, primary tumor origin, and the duration of chemotherapy. Results: The pineal gland volume was significantly smaller in oncology patients in comparison with the healthy controls (p < 0.001). The average volume in oncology patients was 32.41 ± 16.79 mm³, whereas in healthy controls, it was 59.26 ± 29.99 mm³. A significantly smaller pineal gland volume was observed in patients with malignancies, regardless of sex, with no notable differences between groups. Age also did not significantly influence gland volume (p > 0.05). The primary tumor site did not significantly influence gland volume (p > 0.05). A moderate positive correlation was observed between the duration of chemotherapy and pineal gland volume (ρ = 0.322; p = 0.007). Conclusions: The pineal gland showed reduced volume in oncology patients compared to controls. The observed positive correlation with chemotherapy duration should be interpreted cautiously and may reflect survivorship bias rather than direct treatment effects. Full article

Background. Cancer treatment-related cognitive impairment (CTRCI) is a frequent and persistent consequence of systemic cancer therapy, adversely affecting quality of life and independence among cancer survivors. Methods. To clarify the relative effectiveness of available treatments, we conducted a systematic review and network meta-analyses of randomized controlled trials evaluating psychological, pharmacological, and other interventions for established CTRCI in adult survivors of non-central nervous system cancers. Eligible trials reported objective outcomes in one or more of eight cognitive domains, including learning, memory, processing speed, word generation, cognitive flexibility, attention, working memory, and abstraction. Results. Eighteen studies met inclusion criteria, with 14 trials (n = 1100) contributing to network meta-analyses of immediate post-intervention effects across seven domains. A therapist-guided group intervention combining patient education and cognitive rehabilitation consistently ranked highest and was associated with significantly improved learning, memory, processing speed, attention, and working memory compared with a waitlist control, although the certainty of evidence (CoE) was low to very low and largely based on a single trial. Mindfulness-based interventions were also associated with improved processing speed (low CoE). Donepezil was associated with no benefit versus placebo for any domain. Conclusions. While findings suggest that structured multimodal group interventions may represent the most promising strategy for CTRCI, CoE was low, and additional rigorous, standardized trials are required. Full article