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Objectives: To update and extend the examination of cancer incidence in a cohort of Danish firefighters, now adding 7 years of follow‐up and 2766 additional firefighters. The primary focus was directed toward cancer sites that recently contributed to the hazard evaluation conducted by the International Agency for Research on Cancer (IARC). Methods: The updated cohort consisted of 11,827 male Danish firefighters who were followed up for cancer from 1968 to 2021. Cohort cancer morbidity was compared with a working population reference group, and standardized incidence ratios (SIR) were used for estimation of relative risks, along with 95% confidence intervals (95% CI). Results: Among full‐time firefighters, SIR of skin melanoma was 1.30 (95% CI: 1.02–1.66), and SIR = 1.37 (95% CI: 1.02–1.85) for over 5 years of employment. Slightly positive associations were also observed for cancer of the urinary bladder (SIR = 1.16; 95% CI: 0.93–1.45), prostate (SIR = 1.11; 95% CI: 0.97–1.28), and testis (SIR = 1.11; 95% CI: 0.75–1.63). Conclusions: This updated study provides evidence indicating an elevated risk of skin melanoma in firefighters. Consistent with IARC's evaluation, we also identified positive associations for urinary bladder, prostate, and testis cancer. In contrast, our findings did not suggest an increased risk of colon cancer, non‐Hodgkin lymphoma, and mesothelioma. The latter may be due to small numbers in our still relatively young cohort. Continuous follow‐up for cancer in firefighters is warranted, including assessment of influence from surveillance bias. [ABSTRACT FROM AUTHOR]

This article presents a case study of a patient with diabetes who developed a fungal infection in the urinary tract while taking a specific medication. The medication, called an SGLT-2 inhibitor, has been linked to an increased risk of urinary tract infections and genital yeast infections. The article emphasizes the need for more research to understand the connection between fungal infections and the use of SGLT-2 inhibitors in diabetic patients. The text is a correspondence from a researcher at Copenhagen University Hospital and is published by BJU International. [Extracted from the article]

Purpose: Since the 1980's, diversity management (DM) has been regarded as a relevant scholarly and practical endeavour laden with different and often contrasting rationales and conceptualisations. In this regard, the current literature on DM largely differentiates between two overarching approaches – the instrumental and the critical approach with varying conceptualisations and underlying understandings of DM. The purpose of this paper is to discuss how a paradox lens can be utilised to bridge existing understandings of diversity management. Design/methodology/approach: The authors aim to discuss the current state of DM literature and reconceptualise DM from a paradox lens. Findings: The authors argue that the use of a paradox lens on DM allows for challenges to be brought forward instead of ignored or hidden away by illuminating and actively acknowledging both the liberating but also the challenging and oftentimes constraining experiences for the actors involved. Thus, a Paradox lens offers space for embracing and utilising paradoxes when working with diversity. Originality/value: Diversity management is no new concept in the field of human resource management and several scholars argue that the longstanding divide between the instrumental and critical approach remains problematic and limiting for the practice of DM. Hence, the value of reconceptualising DM from a paradox lens lies in bridging the two approaches in order to give way to viewing DM as a nuanced, dynamic and multifaceted practice that can accommodate complexity and contradictions in new and potentially beneficial manners. [ABSTRACT FROM AUTHOR]

The PD-1 inhibitor, nivolumab, was introduced to Danish PD-L1 positive patients as second-line treatment for recurrent/metastatic head and neck squamous cell carcinoma (rmHNSCC) in 2017. In 2020 pembrolizumab was introduced as first-line treatment for PD-L1 positive disease. Aim of the present study was to determine the real-life efficacy of single drug treatment with pembrolizumab compared to nivolumab. Patients were eligible if they were treated between 2017 and end of 2022, had histologically confirmed PD-L1 positive rmHNSCC, and had received either pembrolizumab or nivolumab. Patient, tumor and treatment related data were collected prospectively from patient files at the five Danish head and neck cancer centers and from the DAHANCA database. iRECIST was used for treatment response evaluation, and PD-L1 expression was determined using tumor proportion score (TPS) for nivolumab and combined proportion score (CPS) for pembrolizumab according to international recommendations. Only patients treated with single agent PD-1 inhibition were eligible for the present study. Descriptive statistics were used to describe patient, tumor and treatment. Endpoints were response rate (RR), overall survival (OS) and progression-free survival (PFS), calculated from start of treatment to date of event or censoring. Survival was estimated by the Kaplan-Meier method. Analyses were two-sided and p<0.05 were considered significant. In total 375 patients were identified out of which 229 (61%) received pembrolizumab and 146 (39%) nivolumab. At baseline, the median age was 68 years for pembrolizumab and 63 years for nivolumab (p<0.001). The two groups did not differ significantly in terms of gender with 74% being male and 26% female or in terms of type of recurrence, where metastatic disease was present in 74% of patients while the remaining 26% had locally advanced cancers. The median number of treatment cycles administered was 5 (range: 1-54) for nivolumab and 5 (range: 1-31) for pembrolizumab. In patients treated with pembrolizumab, 2% [95% CI: 1-6%] experienced complete remission and 19% [95% CI: 14-26%] had partial response. In the nivolumab group 7% [95% CI: 4-13%] achieved complete remission and 9% [95% CI: 5-15%] had partial response. A median OS of 10 months [95% CI: 10-13 Mo.] and a median PFS of 5 months [95% CI: 4-6 Mo.] was observed for pembrolizumab. For nivolumab median OS was 10 months [95% CI: 9-12 Mo.] and median PFS 3 months [95% CI: 3-4 Mo.]. No significant difference in efficacy was observed between the two PD-1 inhibitors using OS or PFS as endpoints (figure 1+2). [Display omitted] WHO performance status (PS) showed an impact on treatment outcome. In the pembrolizumab group, patients with WHO PS=1 had a significant worse outcome (compared to WHO PS=0), HR=1.8 [95% CI: 1.1-3.0] (p=0.01), using OS as endpoint and HR=3.4 [95% CI: 2.0-5.9] (p<0.001) for patients with WHO PS≥2 (compared to WHO PS=0). Using PFS as endpoint, the WHO PS=1 group did worse compared to the WHO PS=0 group, HR=1.6 [95% CI: 1.1-2.4] (p=0.03) while HR=1.7 [95% CI: 1.1-2.7] (p=0.03) was observed for patients with WHO PS≤2 (compared to WHO PS=0). In the nivolumab group, patients with WHO PS=1 had a significant worse outcome (compared to WHO PS=0), HR=2.9 [95% CI: 1.6-5.2] (p=0.001) using OS as endpoint and HR=10.1 [95% CI: 4.8-21.5] (p<0.001) for WHO PS≤2 (compared to WHO PS=0). For the endpoint PFS patients with WHO PS=1 had a HR=2.3 [95% CI: 1.4-3.7] (p=0.001) while HR=5.3 [95% CI: 2.7-10.4] (p<0.001) for WHO PS≤2 (both endpoints compared to WHO PS=0). PD-L1 expression did not overall seem to bear any impact on treatment outcome. For patients with TPS ≥ 20% or CPS ≥ 20, HR=0.9 [95% CI: 0.6-1.2] (p=0.4) and HR=0.8 [0.6-1.1] (p=0.2) was obtained for the endpoints OS and PFS respectively. For patients treated with nivolumab using OS as endpoint HR=1.0 [95% CI: 1.0-1.0] (p=0.4) was seen, whereas PD-L1 expression ≥ 20% using PFS as endpoint showed a reduced risk of progression, HR=0.6 [95% CI: 0.4-0.8] (p=0.003). Overall, this national phase IV multicenter study comparing pembrolizumab with nivolumab showed no significant difference in efficacy in terms of either OS or PFS despite one of the drugs being used as first line therapy and the other as second line therapy. The study suggest that PD-1 inhibitors can have a relevant place as either first- or second-line treatment, and that patient performance affects outcome of the treatment. [ABSTRACT FROM AUTHOR]

The aim in radiotherapy treatment planning is to have sufficient target coverage and as low a dose to the Organs at Risk (OARs) as possible, adhering to the relevant guidelines. A high and consistent radiotherapy plan quality is vital when treatment plans are used as the foundation for patient selection in clinical trials. Proton therapy, being a substantially newer treatment modality than conventional photon therapy, is at risk of having a steeper learning curve in treatment planning. This inequality is important to investigate in a clinical study comparing the two, as this could influence the trial results. This study aims to evaluate the development of radiotherapy treatment plan quality for head and neck cancer patients receiving photon and proton therapy over time in the context of the DAHANCA 35 trial. From May 2019 to June 2023,189 patients were included in the ongoing DAHANCA 35 trial, with 63 patients in the pilot phase and 126 in the subsequent randomisation phase. In the pilot phase, all included patients were offered proton treatment, and in the randomisation phase, patients were randomised 1:2 (photon:proton). Patients were first seen at a local treatment centre, where a photon and comparative proton plan were prepared. If patients were offered proton treatment, a new clinical proton plan was made at the proton treatment centre and subsequently used for treatment. This study analysed 189 photon plans, 189 comparative proton plans, and 140 clinical proton plans. The treatment plans were prepared conforming to the DAHANCA guidelines [1] to ensure the clinical relevance of all treatment plans The plan quality was assessed separately for photon plans, comparative proton plans, and clinical proton plans in three time intervals. The mean dose was investigated individually for 13 OARs relevant for head and neck cancer: oesophagus, glottic larynx, supraglottic larynx, mandible, extended oral cavity, left and right parotid glands, upper-, middle-, and lower pharyngeal constrictor muscles, left and right submandibular glands, and thyroid gland. Furthermore, treatment plan quality was analysed using a new metric called Normalised Toxicity Index (NTI), calculated as a normalised average of the mean dose to the OARs compared to the threshold mean dose recommended by the DAHANCA guidelines. An NTI > 1 indicated that the OARs, on average, received a dose higher than the recommended thresholds, and an NTI < 1 indicated that the OARs received a dose below the thresholds. Hence, a lower NTI indicated better plan quality concerning OAR doses. The Kruskal-Wallis test was used to investigate a potential difference in the intervals for mean dose and NTI for each treatment type. The significance level was Bonferroni adjusted to account for multiple testing. The three time intervals were defined with 63 patients in the pilot phase constituting one interval (Pilot phase), the subsequent 64 patients from the randomisation phase in the next interval (Randomisation 1), and the remaining 62 patients from the randomisation phase in the third interval (Randomisation 2). The periods were 22 months for the Pilot phase, 19 months for Randomisation 1, and 14 months for Randomisation 2. Across the 13 OARs, the mean dose to individual OARs did not show a general time-dependent change, except for the right parotid gland in the clinical proton plans. Figure 1 shows a box plot with samples overlaid for the mean dose to the extended oral cavity as an example of the OARs. [Display omitted] The NTI was not significantly different for the photon plans, comparative proton plans, and clinical proton plans in the three consecutive intervals, as shown in Figure 2. The median NTI for the clinical proton plans was 0.88 (interquartile range [0.70,1.00]) for the Pilot phase, 0.83 [0.75,0.89] for Randomization 1, and 0.79 [0.67,0.98] for Randomization 2. The plan quality of the clinical proton plans appears stable from this new NTI metric. [Display omitted] The analyses conducted in this study did not show a general time-dependent change in plan quality in any of the three types of plans. This could be caused by the nationally developed proton treatment planning template. A stable treatment plan quality can help ensure a consistent selection for clinical trials, thus providing transparency for analysis of the outcome of the trials. The plan quality will continuously be followed to ensure consistency. [ABSTRACT FROM AUTHOR]