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Objective: Clinical notes contain unstructured representations of patient histories, including the relationships between medical problems and prescription drugs. To investigate the relationship between cancer drugs and their associated symptom burden, we extract structured, semantic representations of medical problem and drug information from the clinical narratives of oncology notes., Materials and Methods: We present Clinical concept Annotations for Cancer Events and Relations (CACER), a novel corpus with fine-grained annotations for over 48 000 medical problems and drug events and 10 000 drug-problem and problem-problem relations. Leveraging CACER, we develop and evaluate transformer-based information extraction models such as Bidirectional Encoder Representations from Transformers (BERT), Fine-tuned Language Net Text-To-Text Transfer Transformer (Flan-T5), Large Language Model Meta AI (Llama3), and Generative Pre-trained Transformers-4 (GPT-4) using fine-tuning and in-context learning (ICL)., Results: In event extraction, the fine-tuned BERT and Llama3 models achieved the highest performance at 88.2-88.0 F1, which is comparable to the inter-annotator agreement (IAA) of 88.4 F1. In relation extraction, the fine-tuned BERT, Flan-T5, and Llama3 achieved the highest performance at 61.8-65.3 F1. GPT-4 with ICL achieved the worst performance across both tasks., Discussion: The fine-tuned models significantly outperformed GPT-4 in ICL, highlighting the importance of annotated training data and model optimization. Furthermore, the BERT models performed similarly to Llama3. For our task, large language models offer no performance advantage over the smaller BERT models., Conclusions: We introduce CACER, a novel corpus with fine-grained annotations for medical problems, drugs, and their relationships in clinical narratives of oncology notes. State-of-the-art transformer models achieved performance comparable to IAA for several extraction tasks., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Importance: Medicare Advantage (MA) has grown significantly over the last decade; however, MA's performance for patients with serious conditions, such as cancer, remains unclear., Objective: To compare resource use and care quality between MA and traditional Medicare (TM) beneficiaries undergoing cancer chemotherapy., Design, Setting, and Participants: This cohort study used TM claims and MA encounter records from January 2015 to December 2019. Participants were MA and TM beneficiaries who initiated cancer chemotherapy between January 2016 and December 2019. Inverse probability of treatment weighting balanced characteristics between MA and TM beneficiaries, and regression estimation was used. The analysis was conducted between August 2023 and May 2024., Exposure: Chemotherapy initiation after a 1-year washout period., Main Outcomes and Measures: Resource use and care quality were measured during a 6-month period following chemotherapy initiation. Resource use was measured using standardized prices for services in both MA and TM, covering hospital inpatient services, outpatient care, Part D drugs, and hospice services. Chemotherapy utilization was examined for Part B chemotherapy, Part B supportive drugs, and Part D chemotherapy. Quality measures included chemotherapy-related emergency department (ED) visits and hospitalizations, avoidable ED visits, preventable hospitalizations during the 6-month episode, and survival days up to 18 months from chemotherapy initiation., Results: The study comprised 96 501 MA enrollees contributing to 98 872 episodes (mean [SD] age, 72.9 [7.6] years; 55 859 [56.5%] female; 7371 [7.5%] Hispanic, 14 778 [14.9%] non-Hispanic Black, and 75 130 [75.0%] non-Hispanic White participants) and 206 274 TM beneficiaries, contributing 212 969 episodes (mean [SD] age, 72.7 [8.3] years; 121 263 [56.9%] female; 8356 [3.9%] Hispanic, 16 693 [7.8%] non-Hispanic Black, and 182 228 [85.6%] non-Hispanic White participants). Adjusted total resource use per enrollee during the 6-month episode was $8718 (95% CI, $8343 to $9094) lower in MA than TM ($62 599 vs $71 317). Part B chemotherapy resource use accounted for most of the difference in total resource use, with MA enrollees having $5032 (95% CI, $4772 to $5293) lower use than TM beneficiaries. Lower resource use for Part B chemotherapy in MA was associated with both fewer chemotherapy visits (-1.06 visits; 95% CI, -1.10 to -1.02 visits) and less expensive chemotherapy per visit (-$277; 95% CI, -$275 to -$179). Findings on quality were mixed, but importantly, survival did not differ between MA and TM patients who initiated chemotherapy., Conclusions and Relevance: In this cohort study of Medicare beneficiaries with cancer undergoing chemotherapy, MA enrollment was associated with lower resource use but not shorter survival.

In situ cancer vaccination refers to any approach that exploits tumour antigens available at a tumour site to induce tumour-specific adaptive immune responses. These approaches hold great promise for the treatment of many solid tumours, with numerous candidate drugs under preclinical or clinical evaluation and several products already approved. However, there are challenges in the development of effective in situ cancer vaccines. For example, inadequate release of tumour antigens from tumour cells limits antigen uptake by immune cells; insufficient antigen processing by antigen-presenting cells restricts the generation of antigen-specific T cell responses; and the suppressive immune microenvironment of the tumour leads to exhaustion and death of effector cells. Rationally designed delivery technologies such as lipid nanoparticles, hydrogels, scaffolds and polymeric nanoparticles are uniquely suited to overcome these challenges through the targeted delivery of therapeutics to tumour cells, immune cells or the extracellular matrix. Here, we discuss delivery technologies that have the potential to reduce various clinical barriers for in situ cancer vaccines. We also provide our perspective on this emerging field that lies at the interface of cancer vaccine biology and delivery technologies., (© 2024. Springer Nature Limited.)

Trust is a major factor in effective public dissemination and use of relevant health information to guide important health decisions. To examine mass media as a communication channel for delivering cancer information among Japanese adults, we identified the level of trust in various types of mass media as sources of cancer information, and examined factors associated with trust, including exposure to mass media, sociodemographic factors, and cancer history. Data were analyzed for 3,109 Japanese adults who responded to a nationally representative cross-sectional mail survey. Data included trust in cancer information sources, sociodemographic variables, cancer history, and exposure to mass media. Logistic regression analysis was used. The prevalence of high trust in cancer information sources was highest for physicians (94.7%). Among mass media, Internet (47.2%) was the most trusted source of cancer-related information, followed by television (44.3%), newspapers/magazines (42.7%), and radio (32.7%). The high-exposure group for newspapers (AOR = 1.28, 95%CI = 1.07-1.54) was more likely to trust newspapers. Similarly, high-exposure groups for radio (1.22, 1.02-1.45), Internet (1.21, 1.01-1.45), and television (1.30, 1.10-1.53) were positively associated with trust in each media type. Although trust in mass media was lower than trust in physicians, the study found that a large group of respondents had high levels of trust in mass media sources. Trust in cancer information from each mass media type was mainly related to the level of exposure to each mass media type. Developing health communication strategies using mass media may be effective for disseminating relevant cancer information in Japan.

The PD-1/PD-L1 checkpoint pathway is important for regulating immune responses and can be targeted by immunomodulatory drugs to treat a variety of immune disorders. However, the precise protein-protein interactions required for the initiation of PD-1/PD-L1 signaling are currently unknown. Previously, we designed a series of first-generation PD-1 targeting peptides based on the native interface region of programmed death ligand 1 (PD-L1) that effectively reduced PD-1/PD-L1 binding. In this work, we further characterized the previously identified lead peptide, MN1.1, to identify key PD-1 binding residues and design an optimized peptide, MN1.4. We show MN1.4 is significantly more stable than MN1.1 in serum and retains the ability to block PD-1/PD-L1 complex formation. We further characterized the immunomodulatory effects of MN1.4 treatment by measuring markers of T cell activation in a co-culture model with ovarian cancer cells and peripheral blood mononuclear cells. We found MN1.4 treatment reduced cytokine secretion and suppressed T cell responses in a similar manner as recombinant PD-L1. Therefore, the PD-L1 interface region used to design MN1.4 appeared sufficient to initiate PD-1 signaling and likely represents the minimum necessary region of PD-L1 required for PD-1 recognition. We propose a peptide agonist for PD-1, such as MN1.4, could have several applications for treating autoimmune disorders caused by PD-1 deficiencies such as type 1 diabetes, inflammatory arthritis, or autoimmune side effects arising from monoclonal antibody-based cancer immunotherapies., Competing Interests: Conflict of interest R. C., A. H., A. B., A. S., M. P., L. L., and A. L. are inventors on patents related to protein painting and disclosed structures. Monet Pharmaceuticals licensed the rights of patents related to protein painting that are owned by George Mason University. A. H., L. L., and A. L. own shares of Monet Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background & Aims: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing globally. We assessed independent associations of NAFLD with all-cause and cause-specific mortality in older community-dwelling adults in the United States., Methods: Data from the Rancho Bernardo Study cohort, who participated in the research from 1992 to 1996 with mortality data (followed up to July 2019), were analyzed. NAFLD was determined by the improved Fatty Liver Index for the multiethnic US population in the absence of secondary causes of liver disease. Hazard ratios (HRs), 95% CIs, and population-attributable fractions of risk factors on mortality were calculated. Competing-risk analyses of cause-specific mortality were performed., Results: Of the 1523 eligible participants (mean age, 71.8 y; 39.9% male; 99.3% non-Hispanic White; and 10.7% obese), 404 (26.4%) had NAFLD. During 23,311 person-years of follow-up evaluation (mean, 15.22 y; SD, 8.41 y), among NAFLD and non-NAFLD, there were 296 and 717 deaths from all causes, 113 and 263 cardiac deaths, 62 and 112 cancer deaths, and 6 and 2 liver deaths, respectively. NAFLD had a 26% higher all-cause mortality (HR, 1.26; 95% CI, 1.08-1.47) and a 33% (HR, 1.33; 95% CI, 1.04-1.70) and 55% (HR, 1.55; 95% CI, 1.11-2.15) higher cardiac and cancer mortality, respectively, than non-NAFLD. Population-attributable fractions showed 13.9% of deaths, 6.2% of cardiac deaths, and 12.1% of cancer deaths were attributable to NAFLD after adjustments of risk factors (sedentary lifestyle, obesity, hypertension, hyperlipidemia, diabetes)., Conclusions: NAFLD is associated independently with all-cause, cardiac, and cancer mortality. Efforts must continue to raise awareness about NAFLD and develop care pathways and public health efforts to reduce NAFLD burden and associated mortality., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Introduction: Recent research has found widespread misperceptions about nicotine. This study tests perceptions among U.S. adults with respect to nicotine addictiveness and cancer harm, while distinguishing between nicotine misperceptions (ie an incorrect response) and "don't know" (DK) responses., Aims and Methods: Data from three cycles of the Health Information National Trends Survey, fielded in 2015, 2017, and 2019 were merged for analysis. Weighted multinominal logistic regression models were conducted where nicotine addictiveness and cancer harm beliefs (DK, incorrect, and correct responses) were regressed on survey year and demographic variables. We also tested for interactions between survey year and demographic variables to assess if previously identified disparities had evolved during these years., Results: Analyses showed lower odds of misperceptions about nicotine addictiveness, but higher odds of misperceptions about nicotine cancer harm in 2019 compared to 2015. There was no change in DK responses during these years. Disparities by sociodemographics and tobacco use status were observed, mostly for cancer harm. Survey year significantly interacted with age in the model for cancer harm, which was driven primarily by increased incorrect responses and decreased DK responses over time among the youngest age group (18-34 years). There were no significant interactions between survey year and race and ethnicity or level of educational attainment., Conclusions: Disparities in nicotine addictiveness and cancer harm perceptions reflect the uneven distribution of knowledge in the U.S. adult population. Nicotine cancer harm misperceptions are increasing and educational efforts to address this misperception are warranted., Implications: Future educational efforts targeting nicotine addictiveness beliefs may benefit by focusing on DK responders. The growing trend of misperceptions of nicotine's role in cancer harm may negatively impact perceptions about nicotine replacement therapy and low nicotine content cigarettes. Future efforts should focus on correcting nicotine cancer harm misperception, particularly among young adults., (Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2022.)

Background: Belatacept is employed alongside calcineurin inhibitor (CNI) therapy to prevent graft rejection in kidney transplant patients who are Epstein-Barr virus (EBV) seropositive. Preliminary data suggested that rates of post-transplant lymphoproliferative disorder (PTLD) were higher in individuals treated with belatacept compared to CNI therapy alone., Methods: The records of 354 adults who underwent kidney only transplantation from January 2015 through September 2021 at one medical center were evaluated. Patients underwent treatment with either low-doses of mycophenolate, tacrolimus and sirolimus (B 0 , n = 235) or low-doses of mycophenolate, tacrolimus and belatacept (B 1 , n = 119). All recipients underwent induction with antithymocyte globulin and a rapid glucocorticosteroid taper. Relevant donor and recipient information were analyzed and endpoints of PTLD were assessed., Results: There were no cases of PTLD in either cohort within the study period. Recipients in the belatacept cohort experienced lower estimated glomerular filtration rates at 12 months (B 0 : 67.48 vs. B 1 : 59.10, p = 0.0014). Graft failure at 12 (B 0 : 1.28% vs. B 1 : 0.84%, p = 1.0) and 24 months (B 0 :2.55% vs. B 1 : 0.84%, p = 0.431) were similar. There was no difference in rejection rates at 12 (B 0 : 1.27% vs. B 1 : 2.52%, p = 0.408) or 24 months (B 0 : 2.12% vs. B 1 : 2.52%, p = 1.000). Both groups had similar rates of malignancy, mortality and CMV/BK viremia., Conclusion: Non-belatacept (MMF, tacrolimus and sirolimus) and belatacept-based (MMF, tacrolimus and belatacept) regimens do not appear to pose any increased risk of early onset PTLD. Both cohorts benefited from low rates of rejection, malignancy, mortality and graft failure. Recipients will continue to be monitored as PTLD can manifest as a long-term complication., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest., (Published by Elsevier B.V.)

Objective: To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains., Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019., Study Selection: Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion., Data Extraction: Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV)., Data Synthesis: Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome., Conclusions: These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types., (Copyright © 2022. Published by Elsevier Inc.)

Background: Measuring function with valid and responsive tools in patients with cancer is essential for driving clinical decision-making and for the end points of clinical trials. Current patient-reported outcome measurements of function fall short for many reasons. This study evaluates the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile, a novel measure of function across multiple domains., Methods: Two hundred nine participants across five geographically distinct tertiary care centers completed the assessment and pain rating at two outpatient cancer rehabilitation clinic visits. Patients and providers completed a global rating of change measure at the second visit to indicate whether the patient was improving or worsening in function. Multiple response indices and linear models measured whether the measure was responsive to self-reported and clinician-rated changes over time. Correlations between changes in function and changes in anchors (pain rating and performance status) were also calculated., Results: Function as measured by the PROMIS Cancer Function Brief 3D Profile changed appropriately as both patients and clinicians rated change. Small to moderate effect sizes supported the tool's responsiveness. Function was moderately correlated with pain and more strongly correlated with performance status, and changes in function corresponded with changes in anchor variables. No floor/ceiling effect was found., Conclusions: The PROMIS Cancer Function Brief 3D Profile is sensitive to changes over time in patients with cancer. The measure may be useful in clinical practice and as an end point in clinical trials., Lay Summary: We gave patients a questionnaire by which they told their physicians how well they were functioning, including how fatigued they were. This study tested that questionnaire to see whether the scores would change if patients got better or worse., (© 2022 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Importance: According to National Health and Nutrition Examination Survey data, 52% of surveyed US adults reported using at least 1 dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement. The most commonly cited reason for using supplements is for overall health and wellness and to fill nutrient gaps in the diet. Cardiovascular disease and cancer are the 2 leading causes of death and combined account for approximately half of all deaths in the US annually. Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects., Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation., Population: Community-dwelling, nonpregnant adults., Evidence Assessment: The USPSTF concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined., Recommendation: The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement).

Objective: To develop an item response theory (IRT)-calibrated, patient-reported outcome measure (the PROMIS Cancer Function Brief 3D Profile) of physical function, including associations with fatigue and social participation, in cancer rehabilitation patients., Design: Large-scale field testing, graded response model IRT analyses, and multivariate regression analysis., Setting: Six cancer rehabilitation clinics associated with cancer centers across the United States., Participants: Adults (N=616) treated in outpatient cancer rehabilitation medicine clinics., Intervention: Not applicable., Main Outcome Measures: The PROMIS(r) Cancer Function 3D Profile (including existing items from PROMIS(r) item banks)., Results: A total of 616 patients completed 21 items in the initial item pool. Nine items were removed because of comparatively lower information that they provide according to the IRT item calibrations, low item-total correlations, or bimodal distributions. The remaining items generated a 12-item short form. Regression analyses determined that the items were responsive to and representative of the patient population across trait ranges and multiple domains and subdomains of function., Conclusions: This psychometric investigation supports the use of the PROMIS Cancer Function Brief 3D Profile for evaluating function in outpatient cancer rehabilitation patients., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The established findings of lower representation of minority population in clinical trials are skewed by the national representation of the US population by race where they account only for 30%, making it difficult to compare the participation rate by race. We report the direct age-adjusted demographic and socioeconomic disparities in clinical trial participation among cancer survivors using the most recent national survey data. In 2018, 7.1% of cancer survivors reported participating in the clinical trial as a part of their cancer treatment. The participation rate was significantly higher among younger adults (age 18-24, 19.1%), male (8.5%), black (19.8%), and Hispanic (14.4%) cancer survivors, while rate was lower among female (4.2%), and white (5.4%). By marital status, 8.5% of unmarried and 3.5% of married cancer survivors reported clinical trial participation. These results help explain the demographic disparities in cancer survivors and drawing attention to targeted education and awareness intervention for ideal cancer care., (© 2020. American Association for Cancer Education.)

This study aimed to elucidate whether gynecologic cancer patients and their support persons have certain expectancies for emotion and whether these expectancies, if they exist, affect cancer-related communication. Semi-structured interviews ( N  = 34) were conducted separately with 18 patients and one of their support persons ( n  = 16). Thematic analysis revealed a subset of patients and support persons expected patients to not have any negative emotions, which patients also reported they perceived from support persons, and that these expectancies could affect cancer-related communication. These results have implications and can facilitate appropriate recommendations for how cancer patients and support persons co-manage patients' emotions.

The application of nanostructured materials in medicine is a rapidly evolving area of research that includes both the diagnosis and treatment of various diseases. Metals, metal oxides and carbon-based nanomaterials have shown much promise in medical technological advancements due to their tunable physical, chemical and biological properties. The nanoscale properties, especially the size, shape, surface chemistry and stability makes them highly desirable for diagnosing and treating various diseases, including cancers. Major applications of nanomaterials in cancer diagnosis include in vivo bioimaging and molecular marker detection, mainly as image contrast agents using modalities such as radio, magnetic resonance, and ultrasound imaging. When a suitable targeting ligand is attached on the nanomaterial surface, it can help pinpoint the disease site during imaging. The application of nanostructured materials in cancer diagnosis can help in the early detection, treatment and patient follow-up . This review aims to gather and present the information regarding the application of nanotechnology in cancer diagnosis. We also discuss the challenges and prospects regarding the application of nanomaterials as cancer diagnostic tools., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: Little is known about cancer survivors' self-perception of their dietary quality compared with their measured diet quality and how those perceptions may influence their actual diet. This study aimed to fill this gap using national large datasets., Methods: National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2014 were used. The healthy eating index (HEI) based on 24-h dietary recall was used to measure diet quality. Logistic regression models were fit to examine the influence of the misperception of eating healthiness on diet quality., Results: The agreement between self-perceived and actual diet quality was low (Kappa = 0.06, 95% CI: 0.02, 0.09) among cancer survivors. Over-rating diet quality was associated with a 5.39 lower total HEI score (P < 0.0001), 1.00 lower HEI score for empty calorie intake (P = 0.0028), 0.15 lower score for vegetable intake (P = 0.108), and 0.29 lower score for fruit intake; under-rating one's diet quality was associated with a 7.12 higher total HEI score (P < 0.0001), 2.57 higher HEI score for empty calorie intake (P < 0.0001), 0.02 higher score for vegetable intake (P = 0.904), and 0.84 higher score for fruit intake (P = 0.001). Our multinomial regression estimates suggested that each 10-year increase in age was associated with an increase in the odds of being an over-rater vs. a correct-rater (OR: 11.4, 95% CI: 10.01, 10.2). Hispanics were more likely than non-Hispanic whites to over-rate their diet quality (OR: 1.792, 95% CI: 1.062, 3.024)., Conclusions: Tailored nutrition interventions and guidance aimed at reducing the divergence between self-assessed and actual diet quality have the potential to improve cancer survivorship and narrow racial/ethnic and socioeconomic disparities.

Objective: Patient-provider communication is a critical component of cancer care. Digital tools have been applied to facilitate cancer care and patient-provider communication. However, to date, there is no systematic review on this growing body of literature. The objective of this study is to identify the existing digital interventions to improve patient-provider communication among cancer patients and survivors, summarize their characteristics, and synthesize the outcomes of these interventions., Methods: We searched the databases of PubMed, CINAHL, and PsycINFO using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with the following criteria: (a) empirical studies focusing on digital interventions to facilitate communication between cancer patients or survivors and their health care providers, (b) reporting qualitative or quantitative health outcomes of the cancer patients or survivors after the digital intervention, and (c) English articles published after 2000., Results: The initial literature search generated 1006 articles; only 13 met the inclusion criteria. Most of the studies were conducted among breast, prostate, and lung cancer patients. Ten out of 13 studies used randomized controlled trials to evaluate intervention efficacy. The outcomes assessed included symptoms reporting and management, decision making, distress and quality of life, and utilization of health care. Most studies reported positive outcomes following the interventions., Conclusions: The existing evidence on the number, characteristics, and outcomes of digital interventions to improve patient-provider communication suggests the preliminary efficacy of such interventions. It is essential to develop and implement more evidence-based digital interventions to engage patients, enhance patient-provider communication, and facilitate patient-centered decision making to improve patient-centered health outcomes, especially in underserved communities of cancer patients and survivors., (© 2019 John Wiley & Sons, Ltd.)

Introduction: The American College of Sports Medicine convened an International Multidisciplinary Roundtable on Exercise and Cancer in March 2018 to evaluate and translate the evidence linking physical activity and cancer prevention, treatment, and control. This article discusses findings from the Roundtable in relation to the biologic and epidemiologic evidence for the role of physical activity in cancer prevention and survival., Results: The evidence supports that there are a number of biologically plausible mechanisms, whereby physical activity can influence cancer risk, and that physical activity is beneficial for the prevention of several types of cancer including breast, colon, endometrial, kidney, bladder, esophageal, and stomach. Minimizing time spent in sedentary behavior may also lower risk of endometrial, colon and lung cancers. Conversely, physical activity is associated with higher risk of melanoma, a serious form of skin cancer. Further, physical activity before and after a cancer diagnosis is also likely to be relevant for improved survival for those diagnosed with breast and colon cancer; with data suggesting that postdiagnosis physical activity provides greater mortality benefits than prediagnosis physical activity., Conclusions: Collectively, there is consistent, compelling evidence that physical activity plays a role in preventing many types of cancer and for improving longevity among cancer survivors, although the evidence related to higher risk of melanoma demonstrates the importance of sun safe practices while being physically active. Together, these findings underscore the importance of physical activity in cancer prevention and control. Fitness and public health professionals and health care providers worldwide are encouraged to spread the message to the general population and cancer survivors to be physically active as their age, abilities, and cancer status will allow.

Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them., (© 2019 American Cancer Society.)

Over the last few decades, there have been significant developments in theoretical, experimental, and clinical approaches to understand the dynamics of cancer cells and their interactions with the immune system. These have led to the development of important methods for cancer therapy including virotherapy, immunotherapy, chemotherapy, targeted drug therapy, and many others. Along with this, there have also been some developments on analytical and computational models to help provide insights into clinical observations. This work develops a new mathematical model that combines important interactions between tumor cells and cells in the immune systems including natural killer cells, dendritic cells, and cytotoxic CD8 + T cells combined with drug delivery to these cell sites. These interactions are described via a system of ordinary differential equations that are solved numerically. A stability analysis of this model is also performed to determine conditions for tumor-free equilibrium to be stable. We also study the influence of proliferation rates and drug interventions in the dynamics of all the cells involved. Another contribution is the development of a novel parameter estimation methodology to determine optimal parameters in the model that can reproduce a given dataset. Our results seem to suggest that the model employed is a robust candidate for studying the dynamics of tumor cells and it helps to provide the dynamic interactions between the tumor cells, immune system, and drug-response systems., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Pranav Unni and Padmanabhan Seshaiyer.)

There is growing evidence that older adults exposed to natural disasters are at disproportionate risk for adverse health events such as all-cause mortality, injury, hospital admissions, stroke, displacement, cardiopulmonary distress, stress-related mental health problems, and exacerbation of chronic illnesses. Typically, analyses of the health consequences of natural disasters focus only on the populations impacted for the duration and immediate aftermath of the disaster. With few exceptions, the long-term effects of natural disasters on older adult health have not been examined. This article describes the potential consequences of exposure to natural disasters that contribute to cancer and disruption of cancer care treatment systems for older adults. It is argued that exposures to floods and wildfires in particular present an underestimated threat to the onset and/or progression of cancer and cancer care management in older adults. We propose that these impacts should be examined not only from an emergency preparedness perspective during the event but also from a public health focus that prospectively assesses risks for cancer and other health disparities. Recommendations for comprehensive longitudinal risk assessment and emergency preparedness models that address the full impact of natural disasters on the health and well-being of vulnerable, at risk, older adults are offered., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

MCL-1, a member of the antiapoptotic BCL-2 family, is a prosurvival protein with an essential DNA repair function. This study aims to test whether inhibition of protein synthesis by mTOR complex (mTORC) inhibitors depletes MCL-1, suppresses homologous recombination (HR) repair, and sensitizes cancer cells to PARP inhibitors. Treatment with everolimus decreases MCL-1 in colorectal carcinomas and small cell lung cancer (SCLC) cells but not glioblastoma multiforme (GBM) cells with a PTEN mutational background. However, AZD2014, a dual mTORC inhibitor, depletes MCL-1 in GBMs. Further, we show that everolimus decreases 4EBP1 phosphorylation only in colorectal carcinoma, whereas AZD2014 decreases 4EBP1 phosphorylation in both colorectal carcinoma and GBM cells. Combination therapy using everolimus or AZD2014 with olaparib inhibits the growth of clone A and U87-MG xenografts in in vivo and decreases clonogenic survival in in vitro compared with monotherapy. Reintroduction of MCL-1 rescues the survival of cancer cells in response to combination of everolimus or AZD2014 with olaparib. Treatment of cells with mTORC inhibitors and olaparib increases γ-H2AX and 53BP1 foci, decreases BRCA1, RPA, and Rad51 foci, impairs phosphorylation of ATR/Chk1 kinases, and induces necroptosis. In summary, mTORC inhibitors deplete MCL-1 to suppress HR repair and increase sensitivity to olaparib both in in vitro and in xenografts. IMPLICATIONS: Targeting the DNA repair activity of MCL-1 in in vivo for cancer therapy has not been tested. This study demonstrates that depleting MCL-1 sensitizes cancer cells to PARP inhibitors besides eliciting necroptosis, which could stimulate antitumor immunity to improve the therapeutic intervention of cancers., (©2018 American Association for Cancer Research.)

Social media are often heralded as offering cancer campaigns new opportunities to reach the public. However, these campaigns may not be equally successful, depending on the nature of the campaign itself, the type of cancer being addressed, and the social media platform being examined. This study is the first to compare social media activity on Twitter and Instagram across three time periods: #WorldCancerDay in February, the annual month-long campaigns of National Breast Cancer Awareness Month (NBCAM) in October and Movember in November, and during the full year outside of these campaigns. Our results suggest that women's reproductive cancers - especially breast cancer - tend to outperform men's reproductive cancer - especially prostate cancer - across campaigns and social media platforms. Twitter overall generates substantially more activity than Instagram for both cancer campaigns, suggesting Instagram may be an untapped resource. However, the messaging for both campaigns tends to focus on awareness and support rather than on concrete actions and behaviors. We suggest health communication efforts need to focus on effective messaging and building engaged communities for cancer communication across social media platforms.

Due to the importance of precision medicine, it is essential to identify the right patients for the right treatment. Biomarkers, which have been commonly used in clinical research as well as in clinical practice, can facilitate selection of patients with a good response to the treatment. In this paper, we describe a biomarker threshold adaptive design with survival endpoints. In the first stage, we determine subgroups for one or more biomarkers such that patients in these subgroups benefit the most from the new treatment. The analysis in this stage can be based on historical or pilot studies. In the second stage, we sample subjects from the subgroups determined in the first stage and randomly allocate them to the treatment or control group. Extensive simulation studies are conducted to examine the performance of the proposed design. Application to a real data example is provided for implementation of the first-stage algorithms.

People who have cancer diagnoses often need care throughout their lives through all stages of their illness. These stages include diagnosis, primary treatment, survivorship, and end of life. The management of people with cancer, now a common and chronic illness with long-term survival improving, is complex, challenging, and rapidly changing. Rehabilitation for people with cancer diagnoses is a new specialty and is charged with providing care throughout the trajectory of illness and wellness to maximize potential for function and mitigate disability. Rehabilitation interventions include the application of physical and occupational therapeutics, speech and language interventions, and physical medicine in order to help patients reach their individual goals and to promote life satisfaction. The Department of Rehabilitation in the Clinical Center of the National Institutes of Health has pioneered this field through research and clinical care models over the past 40 years. Staff of this department has supported clinical research investigators at the National Institutes of Health in their exploration of new treatments using chemotherapies, surgery, radiation, and psychosocial interventions. They have also engaged in research specific to rehabilitation to devise and improve functional outcome measures, design exercise interventions, devise orthotics, and prosthetic devices for adaptation to functional loss. Collectively, the staff has published widely in oncology textbooks and professional journals in order to share findings and improve the quality of cancer rehabilitation treatment across the continuum of care., (Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Although symptoms during cancer treatments are prevalent and are important clinical outcomes of childhood cancer, the symptom experiences of Puerto Rican children along with the symptom alleviation/care practices that parents provide during cancer treatments have received limited attention. To examine the occurrence/severity of symptoms on the Therapy-Related Symptom Checklist-Children (TRSC-C), reported by mothers of Puerto Rican children undergoing cancer treatments and identifying mothers' symptom alleviation/management strategies. Descriptive study conducted between January and May 2012. Mothers of 65 Puerto Rican children/adolescents undergoing cancer treatments responded to the Spanish versions of the TRSC-C, Symptom Alleviation: Self-Care Methods, and a Demographic and Health form. The children/adolescents' mean age was 9.2 (1-17) years; 62% were boys; 56 had chemotherapy; 9 had chemoradiotherapy. Children diagnoses were 35.4% leukemia, 24.6% solid tumors, 24.6% nervous system tumors, and 15.4% other. On the TRSC-C, the symptoms experienced by 70% or more of the children were: irritability (77%), nausea (75%), and hair loss (72%). On the Symptom Alleviation: Self-Care Methods, the most commonly reported symptom alleviation category was "taking prescribed medicines." Puerto Rican mothers reported the use of alleviation practices to treat their children experiencing symptoms during pediatric cancer treatments. Patients and caregivers need to be educated about treatment-induced side effects, and the life-threatening consequences of underreporting and undermanagement. Symptoms should always be addressed at the time of initiation of primary or adjuvant cancer therapy because pretreatment symptoms may persist or get worse across the trajectory of treatment. A continuous assessment and management of symptoms during the childhood cancer trajectory can optimize clinical care and improve quality of life of patients and families., (© 2016 John Wiley & Sons Australia, Ltd.)

Analysis of gene co-expression networks is a powerful "data-driven" tool, invaluable for understanding cancer biology and mechanisms of tumor development. Yet, despite of completion of thousands of studies on cancer gene expression, there were few attempts to normalize and integrate co-expression data from scattered sources in a concise "meta-analysis" framework. Here we describe an integrated approach to cancer expression meta-analysis, which combines generation of "data-driven" co-expression networks with detailed statistical detection of promoter sequence motifs within the co-expression clusters. First, we applied Weighted Gene Co-Expression Network Analysis (WGCNA) workflow and Pearson's correlation to generate a comprehensive set of over 3000 co-expression clusters in 82 normalized microarray datasets from nine cancers of different origin. Next, we designed a genome-wide statistical approach to the detection of specific DNA sequence motifs based on similarities between the promoters of similarly expressed genes. The approach, realized as cisExpress software module, was specifically designed for analysis of very large data sets such as those generated by publicly accessible whole genome and transcriptome projects. cisExpress uses a task farming algorithm to exploit all available computational cores within a shared memory node.We discovered that although co-expression modules are populated with different sets of genes, they share distinct stable patterns of co-regulation based on promoter sequence analysis. The number of motifs per co-expression cluster varies widely in accordance with cancer tissue of origin, with the largest number in colon (68 motifs) and the lowest in ovary (18 motifs). The top scored motifs are typically shared between several tissues; they define sets of target genes responsible for certain functionality of cancerogenesis. Both the co-expression modules and a database of precalculated motifs are publically available and accessible for further studies.

Gene coexpression network analysis is a powerful "data-driven" approach essential for understanding cancer biology and mechanisms of tumor development. Yet, despite the completion of thousands of studies on cancer gene expression, there have been few attempts to normalize and integrate co-expression data from scattered sources in a concise "meta-analysis" framework. We generated such a resource by exploring gene coexpression networks in 82 microarray datasets from 9 major human cancer types. The analysis was conducted using an elaborate weighted gene coexpression network (WGCNA) methodology and identified over 3,000 robust gene coexpression modules. The modules covered a range of known tumor features, such as proliferation, extracellular matrix remodeling, hypoxia, inflammation, angiogenesis, tumor differentiation programs, specific signaling pathways, genomic alterations, and biomarkers of individual tumor subtypes. To prioritize genes with respect to those tumor features, we ranked genes within each module by connectivity, leading to identification of module-specific functionally prominent hub genes. To showcase the utility of this network information, we positioned known cancer drug targets within the coexpression networks and predicted that Anakinra, an anti-rheumatoid therapeutic agent, may be promising for development in colorectal cancer. We offer a comprehensive, normalized and well documented collection of >3000 gene coexpression modules in a variety of cancers as a rich data resource to facilitate further progress in cancer research., Competing Interests: The authors have declared that no competing interests exist.

The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability affect most patients during and after disease treatment. Rehabilitation health care providers can diagnose and treat patients' physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population. However, few care delivery models integrate comprehensive cancer rehabilitation services into the oncology care continuum. The Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health with support from the National Cancer Institute and the National Center for Medical Rehabilitation Research convened a subject matter expert group to review current literature and practice patterns, identify opportunities and gaps regarding cancer rehabilitation and its support of oncology care, and make recommendations for future efforts that promote quality cancer rehabilitation care. The recommendations suggest stronger efforts toward integrating cancer rehabilitation care models into oncology care from the point of diagnosis, incorporating evidence-based rehabilitation clinical assessment tools, and including rehabilitation professionals in shared decision-making in order to provide comprehensive cancer care and maximize the functional capabilities of cancer survivors. These recommendations aim to enable future collaborations among a variety of stakeholders to improve the delivery of high-quality cancer care., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Novel, "outside of the box" approaches are needed for evaluating candidate molecules, especially in oncology. Throughout the years of 2000-2010, the efficiency of drug development fell to barely acceptable levels, and in the second decade of this century, levels have improved only marginally. This dismal condition continues despite unprecedented progress in the development of a variety of high-throughput tools, computational methods, aggregated databases, drug repurposing programs and innovative chemistries. Here we tested a hypothesis that the economic impact of targeting a particular gene product is predictable a priori by employing a combination of transcriptome profiles and quantitative metrics reflecting existing literature., Methods: To extract classification features, the gene expression patterns of a posteriori high-impact and low-impact anti-cancer target sets were compared. To minimize the possible bias of text-mining, the number of manuscripts published prior to the first clinical trial or relevant review paper, as well as its first derivative in this interval, were collected and used as quantitative metrics of public interest., Results: By combining the gene expression and literature mining features, a 4-fold enrichment in high-impact targets was produced, resulting in a favourable ROC curve analysis for the top impact targets. The dataset was enriched by the highest impact anti-cancer targets, while demonstrating drastic differences in economic value between high and low-impact targets. Known anti-cancer products of EGFR, ERBB2, CYP19A1/aromatase, MTOR, PTGS2, tubulin, VEGFA, BRAF, PGR, PDGFRA, SRC, REN, CSF1R, CTLA4 and HSP90AA1 genes received the highest scores for predicted impact, while microsomal steroid sulfatase, anticoagulant protein C, p53, CDKN2A, c-Jun, and TNSFS11 were highlighted as most promising research-stage targets., Conclusions: A significant cost reduction may be achieved by a priori impact assessment of targets and ligands before their development or repurposing. Expanding a suite of combinational treatments could also decrease the costs, while achieving a higher impact per developed ligand. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Importance: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies., Objective: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013., Evidence Review: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs., Findings: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries., Conclusions and Relevance: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

Objective: Standards terminologies may be large and complex, making their quality assurance challenging. Some terminology quality assurance (TQA) methodologies are based on abstraction networks (AbNs), compact terminology summaries. We have tested AbNs and the performance of related TQA methodologies on small terminology hierarchies. However, some standards terminologies, for example, SNOMED, are composed of very large hierarchies. Scaling AbN TQA techniques to such hierarchies poses a significant challenge. We present a scalable subject-based approach for AbN TQA., Methods: An innovative technique is presented for scaling TQA by creating a new kind of subject-based AbN called a subtaxonomy for large hierarchies. New hypotheses about concentrations of erroneous concepts within the AbN are introduced to guide scalable TQA., Results: We test the TQA methodology for a subject-based subtaxonomy for the Bleeding subhierarchy in SNOMED's large Clinical finding hierarchy. To test the error concentration hypotheses, three domain experts reviewed a sample of 300 concepts. A consensus-based evaluation identified 87 erroneous concepts. The subtaxonomy-based TQA methodology was shown to uncover statistically significantly more erroneous concepts when compared to a control sample., Discussion: The scalability of TQA methodologies is a challenge for large standards systems like SNOMED. We demonstrated innovative subject-based TQA techniques by identifying groups of concepts with a higher likelihood of having errors within the subtaxonomy. Scalability is achieved by reviewing a large hierarchy by subject., Conclusions: An innovative methodology for scaling the derivation of AbNs and a TQA methodology was shown to perform successfully for the largest hierarchy of SNOMED., (© The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

An increase in the levels of oxidation is a universal feature of genomic DNA of irradiated or aged or even malignant cells. In case of apoptotic death of stressed cells, oxidized DNA can be released in circulation (cfDNA). According to the results of the studies performed in vitro by our group and other researchers, the oxidized cfDNA serves as a biomarker for a stress and a stress signal that is transmitted from the "stressed" area i.e. irradiated cells or cells with deficient anti-oxidant defenses to distant (bystander) cells. In recipient cells, oxidized DNA stimulates biosynthesis of ROS that is followed up by an increase in the number of single strand and double strand breaks (SSBs and DSBs), and activation of DNA Damage Response (DDR) pathway. Effects of oxidized DNA are considered similar to that of irradiation. It seems that downstream effects of irradiation, in part, depend on the release of oxidized DNA fragments that mediate the effects in distant cells. The responses of normal and tumor cell to oxidized DNA may differ. It seems that tumor cells are more sensitive to oxidized DNA-dependent DNA damage, while developing pronounced adaptive response. This may suggest that in chemotherapy or irradiation-treated human body, the release of oxidized DNA from dying cancer cells may give a boost to remaining malignant cells by augmenting their survival and stress resistance. Further studies of the effects of oxidized DNA in both in vitro and in vivo systems are warranted., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Despite the high risk of cancer to the population, Korean Americans are known to have lower knowledge about cancer related information and a lower level of adherence to cancer prevention guidelines. This indicates the necessity of cancer interventions targeting the Korean American population. To reach this population effectively, it is imperative to understand Korean Americans' cancer information seeking behaviors. This study (a) identified cancer information sources that are trusted and used by Korean American women and (b) examined how general media exposure and trust in cancer information sources are related to the use of these sources. It also (c) explored perceived usefulness and limitations of cancer information sources. A mixed methods study using seven focus group interviews with 34 Korean American women and surveys with 152 Korean American women was conducted in the Washington, DC, metropolitan area from 2011 to 2012. The results indicate that Korean American women viewed health care professionals as the most trusted cancer information source but used the Internet and Korean ethnic media more often for cancer information seeking because of language, cultural, and economic barriers. Korean American women were most likely to obtain cancer information from media they used frequently for general purposes. Correlations between usage frequency and trust in doctor/health providers and the Internet as cancer information sources were negligible. When seeking cancer information, important factors for Korean American women were accessibility, affordability, and language proficiency, cultural sensitivity, meeting immediate needs, understandability, convenience, and reliability of cancer information sources. Findings from this study support developing interventions using Korean language media, including print, television and the Internet for health promotion and cancer prevention targeting Korean American women.

Cancer is now the leading cause of death in China. Effective communication about cancer risk and prevention is an important component of cancer control. Yet, research in this area is very limited in China. This study used probability sample survey data from 2 Chinese cities (Beijing and Hefei, Anhui Province) to investigate potential predictors of self-initiated cancer information seeking. Analysis showed that cancer information seekers in China were likely to be married, relatively educated, earning modest incomes, living in rural areas, smoking occasionally, having a family cancer history, relatively trusting of the media for health information, somewhat knowledgeable about cancer, having nonfatalistic attitudes about cancer, and seeing a personal need for more cancer information. The pattern of results, particularly the lack of influence of personal health and risk perception factors, highlights the possibility that seeking for others might be more prevalent than seeking for self in China. Overall, findings suggest that emphasizing family need and mobilizing family support might be a productive approach to cancer communication interventions in China.

Aim: Although obesity is an established risk factor for cancer mortality among women, little is known about how body mass index (BMI) is interacting with certain lifestyle behaviors and sociodemographic characteristics to increase the risk of cancer mortality. The purpose of this study was to use classification trees to examine possible interactions between BMI, smoking, age, poverty level and marital status in identifying high-risk subgroups for all-cause cancer mortality in women., Material and Methods: Data from the US National Health Interview Survey linked with the National Death Index from 1990-2004 were used in this study. The data were restricted to women with complete information on all risk factors considered in the analyses. The data were analyzed using descriptive statistics and classification trees., Results: Findings revealed that younger women (41-50 years old) who smoked had higher cancer mortality if they were underweight. Even among 51-60-year-old never smokers, we observed an inverse relationship between BMI and mortality. High BMI, however, was not a protective factor in 51-60-year-old women who were not married and did not smoke., Conclusion: Classification tree analysis confirms and extends current knowledge about the role of BMI and smoking on cancer mortality by providing preliminary risk profiles. The findings indicate that it is imperative for cancer-related studies to examine BMI and smoking within age-specific groups and in the context of several sociodemographic factors that are known to independently affect cancer mortality., (© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.)

Psychological distress has been recognized as having a significant effect upon cognitive and emotional functioning, quality of life, and in some populations increased costs of care. Screening for distress and provision of psychosocial care in oncology treatment settings has been identified as a future accreditation standard by the American College of Surgeons Commission on Cancer (CoC). Because there are few available models of programs of distress screening and referral to inform oncology social workers and other members of the psychosocial support team with planning their own programs, this article seeks to provide exemplars of best practices that are currently in place in four different settings where psychosocial support is provided to people living with cancer and their families. Each program will provide an overview of how it was successfully established and its contribution toward evolving evidence-informed best practices.

Objective: Although several large distress studies have been conducted in outpatient oncology treatment settings, there are few, if any, studies that describe the incidence of psychological and physical distress in the inpatient oncology treatment setting. This pilot study hypothesized that inpatients experience levels of psychological distress that are equivalent to or greater than those reported in large outpatient studies. The study also sought to contribute to physical and psychological symptom distress incidence data., Methods: Using two measures designed to screen for psychological and physical distress, the Brief Symptom Inventory-18 and the M.D. Anderson Symptom Inventory, 52 oncology patients were screened within 24 h of admission to a hospital oncology unit., Results: Nearly two-thirds of the inpatient respondents reported levels of psychological distress that were not only within the clinically significant range but also at a rate that was nearly double that found in the outpatient distress screening studies that have been conducted to date. The physical symptoms most often rated at the severe level included fatigue (34.6%), pain (27.4%), and dry mouth (25.5%)., Conclusions: Failure to screen for psychological and physical symptom distress has lead to under recognition of a population that may have higher levels of distress than their outpatient counterparts and could potentially lead to uneven access to biopsychosocial support. Results support the notion that routinely screening for psychological and physical distress should become a first step in the assessment of the biopsychosocial needs of people receiving inpatient treatment for cancer., (Copyright © 2011 John Wiley & Sons, Ltd.)

Many Korean Americans (KAs) suffer high cancer incidence levels and have low cancer screening rates. A significant number of KAs lack adequate information about cancer screening tests. However, little is known about the health information seeking behaviors of KAs. This study examines the types of cancer information searched for, the cancer information seeking experiences, and the awareness of major cancer information sources, such as the National Cancer Institutes (NCI) and the NCI's Cancer Information Service, among KAs. It also examines associations with demographic characteristics and media use influencing variations in the awareness of cancer information sources. Data for this study were gathered with a cross-sectional, community-based survey (254 KAs). The survey results indicated that KA's involvement in cancer information seeking is relatively low, and they have somewhat negative experiences in seeking cancer information. In addition, their awareness of cancer information sources was limited. Despite of the heavy use of Korean ethnic media, it did not connect to cancer information source awareness. Rather, use of US mainstream media was significantly related with awareness. Campaigns using the Korean language through partnerships with Korean ethnic media to inform KAs about credible sources of health information appear to be warranted by our findings.

Tumor markers are the molecules that indicate the presence or prognosis of malignancy. Most often, tumor markers are produced by the cancer tissue itself. Many of them could be secreted into the body fluids in small quantities. Thus, tumor markers could be useful for early diagnostics of primary tumors and relapsed disease, as well as for determining tumor prognosis and predicting likely response of the tumor to therapy. Tumor markers are part of the clinical routine. Nevertheless, lack of sensitivity and specificity precludes routine usage of single tumor markers in population-based screening. Shortcomings of single tumor markers could be solved by parallel evaluation of multiple tumor markers that can perform with required certainty. Genome and proteome-wide approaches currently lead to identification and initial characterization of hundreds new tumor marker candidates. Most prominent of such methods are serological analyses of recombinant cDNA expression libraries (SEREX), 2-dimensional polyacrylamide gel electrophoresis, mass spectrometry, as well as protein and DNA microarrays. Last but not the least is a computational approach allowing high-throughput detection of tumor marker candidate genes in publicly available datasets. Listed approaches are critically discussed in this review as well as the most crucial tumor-related findings. Finally, a perspective on the future of tumor markers in the tailored medicine is given.

While the incidence of psychological distress among people receiving treatment for cancer in outpatient treatment settings has received attention by researchers, few studies have investigated the incidence of psychological distress in inpatient settings. Similarly, efficacy or effectiveness studies describing psychosocial interventions with cancer patients in inpatient settings are all but absent from the research literature. The purpose of this study was to screen for psychological distress among persons receiving inpatient treatment for cancer and to then test the efficacy of a communications model known as FLEX Care®, used to enhance routine psychosocial care, in an effort to reduce measurable levels of psychological distress. Following the vetting of more than 400 potential participants, 35 met rigorous screening criteria and also consented to participate in this randomized pre-post control group study. The intervention group received the FLEX Care®-enhanced routine psychosocial intervention, while the control group received the routine psychosocial intervention alone. Mean scores for psychological distress were found to be nearly twice as high in the study sample as those levels reported in outpatient studies. Additionally, participants who received the FLEX Care®-enhanced psychosocial intervention experienced a significant reduction in psychological distress in contrast to participants in the control setting. The findings from this study underscore the need to screen for symptoms of psychological distress in inpatient settings and lend preliminary support to the use of personalized psychosocial intervention strategies that can be used as adjuvant to routine psychosocial care in the inpatient setting to reduce psychological distress.

Immigrant health is an important component of American public health. But relatively little is known about immigrants' cancer information use. Using the 2005 Health Information National Trends Survey (HINTS) data, this study examined potential disparities between foreign-born (n = 563) and U.S.-born (n = 4,830) populations in their access to and experience with cancer information. Logistic regressions showed that foreign-born Hispanics were less likely than the U.S.-born to have ever sought cancer information (adjusted odds ratio [OR] = .51). Foreign-born individuals overall were also less likely to have had somebody else look for cancer information for them (OR = .66). Compared with the U.S.-born, foreign-born individuals in general faced greater obstacles during the process of cancer information seeking (ORs = 1.98-2.27). They were also less trusting of some important sources of health information (ORs = .50-.64), a pattern that was particularly pronounced among Hispanics (ORs = .20-.43). Implications of these disparities were explored through multiple linear regressions that revealed negative associations between cancer information use and undesirable cancer beliefs.

The purpose of this interdisciplinary descriptive study was to examine the perceptions of nurses, school personnel, and parents about school reentry for children with cancer and to determine whether activities and services performed supported school reentry. The study also investigated parents' perception of the impact of cancer on their child's academic performance, cognitive ability, and school attendance. Results of the study showed that few activities and services were performed to facilitate children's school reentry by either nurses or school personnel. Parents reported no significant differences in their children's cognitive ability or academic performance. School attendance was significantly lower after diagnosis and therapy. Conclusions were that communication among nurses, school personnel, and parents was a major barrier to providing effective services to students and their parents. Nurses were unsure of how to help parents navigate the school bureaucracy, school personnel felt they needed more information, and parents felt that their children were not receiving all the school reentry services needed. Individuals in this study recommended that a liaison position be created to coordinate services.

There are significant challenges to communicating relevant cancer prevention and control information to health care consumers due both to the complexities of the health information to be communicated and the complexities of health communication, especially with vulnerable populations. The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute, yet also tremendously complex, for reaching vulnerable populations, those groups of people who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the population. These vulnerable populations, typically the poorest, lowest educated, and most disenfranchised members of modern society, are heir to serious cancer-related health disparities. Vulnerable populations often have health literacy difficulties, cultural barriers, and economic challenges to accessing and making sense of relevant health information. This paper examines these challenges to communicating relevant information to vulnerable populations and suggests strategies for effectively using different communication media for marketing cancer prevention and control to reduce health disparities and promote public health.

From its beginnings in the 1970s, the National Cancer Institute's (NCI's) Cancer Information Service (CIS) has developed as a vibrant program for providing health care professionals and the public with relevant cancer-related information through telephone, mail, and online communication. The CIS has become an important contributor to health communication and health education research. Through its network of community partnerships, it has disseminated relevant cancer information and health promotion programs to vulnerable and hard-to-reach populations. It has become a model for the development of health information and education programs around the world. However, the CIS is still growing; it is continually innovating and refining its programs and services. This concluding article examines the potential for increasing CIS contributions to cancer education and cancer control in the future.

The National Cancer Institute (NCI) supported four innovative demonstration research projects, "The Digital Divide Pilot Projects," to test new strategies for disseminating health information via computer to vulnerable consumers. These projects involved active research collaborations between the NCI's Cancer Information Service (CIS) and regional cancer control researchers to field test new approaches for enhancing cancer communication in vulnerable communities. The projects were able to use computers to successfully disseminate relevant cancer information to vulnerable populations. These demonstration research projects suggested effective new strategies for using communication technologies to educate underserved populations about cancer prevention, control, and care.