Albert Schweitzer Hospital

BACKGROUND:Physical activity (PA) is associated with improved overall survival (OS) among colorectal cancer (CRC) patients, but research on PA changes after diagnosis remains limited. This study examines associations between OS and changes in PA from CRC diagnosis onward, across stage- and treatment-related subgroups. METHODS:Data were analyzed from patients in two large CRC cohorts (PLCRC and COLON) enrolled between August 2010 and December 2022 (follow-up until February 1st, 2024). This included 3395 stage I-IIA patients who underwent surgery only, 2406 stage IIB/C-III patients who received (neo-)adjuvant therapy, and 669 metastatic CRC (mCRC) patients. PA was assessed via the validated SQUASH questionnaire at diagnosis (T0), and at 6, 12, and 24 months post-diagnosis (T6 to T24). Moderate-to-vigorous-intensity recreational activity was quantified by calculating Metabolic Equivalent of Task (MET) hours per week. Associations with OS were examined for change (active [tertile 2 and 3] vs inactive [tertile 1]) between timepoints using multivariable Cox proportional hazards models. RESULTS:Among surgery-only patients, change from inactivity to activity between T0 and T6 was significantly associated with OS (HR = 0.58, 95% CI = 0.35 to 0.96). For (neo-)adjuvantly treated patients, significant associations were observed between T6 and T12 (HR = 0.53, 95% CI = 0.31 to 0.90). Among mCRC patients, a significant association was observed between T6 and T12 (HR = 0.53, 95% CI = 0.29 to 0.99). CONCLUSION:Changing from inactivity to activity is significantly associated with prolonged survival during the early months post-diagnosis for surgery-only CRC patients, and later for those undergoing (neo-)adjuvant therapy or with metastatic disease. Validation is warranted in interventional studies.

Ulcerative proctitis (UP) is associated with bowel urgency, rectal bleeding and fecal incontinence.1 However, data regarding the impact of these symptoms on quality of life (QoL) is scarce.2 Patients with active UP (endoscopic MAYO score ≥1 up to 15 cm beyond the anal verge) were prospectively enrolled in 7 Dutch (non-)academic hospitals from March to November 2025. Baseline clinical and demographical data were collected. Digital questionnaires were used to assess QoL (EQ-5D-5L), patient-reported disease activity (MIAH-UC), bowel urgency (uNRS), fecal incontinence (CCFIS), constipation (PAC-SYM) and sexual distress (FSDS). The QoL (EQ-5D-5L utility score) was compared to a cohort of healthy Dutch adults (n = 979)3 and patients with active more extensive ulcerative colitis (fecal calprotectin ≥150μg/g or CRP ≥5mg/L) from the same region (n = 155)4. Multivariable linear regression was used to identify risk factors for impaired QoL. A total of 108 patients were included (56% female, median age 45 years [IQR 30-58]). Fifty-four had newly diagnosed UP and 54 were previously diagnosed (median disease duration 8 years [IQR 3-12]) with UP (n = 24) or extensive colitis (n = 30). Endoscopic MAYO score was mild in 42 (41%), moderate in 52 (50%) and severe in 9 (8.7%) patients; median fecal calprotectin was 367 ug/g (IQR 180-1089). Questionnaire response rate was 82% and demonstrated a mean EQ-5D-5L VAS and utility scores of 70 (SD 17.3, maximum score 100) and 0.79 (SD 0.19, maximum score 1.00), respectively. QoL (EQ-5D-5L utility score) of UP patients was significantly lower compared to healthy Dutch adults (p = 0.001), and similar to patients with active left-sided or pancolitis (p = 0.84) (Figure 1a). Clinical symptoms were frequent, with 71% (n = 63) reporting significant bowel urgency (uNRS ≥5), 25% (n = 22) fecal incontinence affecting daily life at least weekly (Figure 1b) and 24% (n = 20) sexually related personal distress (FSDS ≥15). In addition, 13% (n = 12) reported moderate to severe constipation symptoms (≥2 on PAC-SYM item 9). Multivariable analyses demonstrated that both increased fecal incontinence (β -0.014, p = 0.023) and sexual distress scores (β -0.008, p < 0.001) were significantly associated with a reduced QoL (Table 1). Patients with UP experience a significant symptom burden and report a reduced QoL that is comparable to patients with more extensive UC. Fecal incontinence and sexual distress are key contributors to QoL impairment and should be routinely assessed in clinical practice. Structured symptom screening and targeted interventions such as pelvic floor therapy or psychological support may promote holistic, patient-centered care and improve QoL outcomes. References: 1. Kyriacou M, Radford S, Moran GW; Focus group collaborators group. Delphi consensus survey: the opinions of patients living with refractory ulcerative proctitis and the health care professionals who care for them. BMJ Open Gastroenterol. 2023;10(1):e001139. 2. Caron B, Abreu MT, Siegel CA, et al. IOIBD Recommendations for Clinical Trials in Ulcerative Proctitis: The PROCTRIAL Consensus. Clin Gastroenterol Hepatol. 2022;20(11):2619-2627.e1. 3. Versteegh MM, Vermeulen KM, Evers SMAA, de Wit GA, Prenger R, Stolk EA. Dutch Tariff for the Five-Level Version of EQ-5D. Value Health. 2016;19(4):343-352. 4. van Linschoten RCA, van der Woude CJ, Visser E, et al. Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study. Inflamm Bowel Dis. 2025;31(2):332-343. Conflict of interest: Mr. Pierik, Robert-Jan: None. Bodelier, Alexander: Participation in advisory boards of: Johnson&Johnson, Eli Lilly, Sanofi. Received unrestricted grant from Amphia research fund. West, Rachel: Has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring, Pfizer, Galapagos, AbbVie and Janssen. Hoekstra, Jildou: None De Jonge, Vincent: None van der Wiel, Sanne: None Verweij, Karen: None Ter Borg, P.: None Visser, Elyke: Received a speaker fee from Lilly Versteegh, Matthijs: None Derikx, Lauranne: Lauranne Derikx has served on advisory boards as a speaker for Abbvie, Johnson & Johnson, Alfasigma, Takeda, and Pfizer. She has received independent research funding from Pfizer. De Vries, Annemarie C.: Has served on advisory boards for Takeda, Janssen, Bristol Myers Squibb, Abbvie, Pfizer, and Galapagos and has received unrestricted research grants from Takeda, Janssen, and Pfizer.

BACKGROUND:Few studies examined treatment-specific long-term risks of cardiovascular diseases (CVD) in diffuse large B-cell lymphoma survivors treated with potentially cardiotoxic radiotherapy and/or chemotherapy with or without rituximab after the 1990s. METHODS:Long-term CVD risk was examined in a multicenter cohort comprising 2356 diffuse large B-cell lymphoma survivors who survived at least 5 years and who were treated at ages 15-61 years in 1989-2012. CVD data were acquired from medical records, general practitioners, and disease registries. Observed CVD numbers were compared with expected CVD incidence in the Dutch population to estimate standardized incidence ratios (SIRs) and absolute excess risks (10 000 person-years). Treatment-specific CVD risks were assessed using multivariable Cox regression. RESULTS:During a median follow-up of 14.2 years (IQR = 10.1-18.9 years), 312 survivors were diagnosed with a first CVD at least 5 years after treatment. Compared with the general population, diffuse large B-cell lymphoma survivors had increased risks of heart failure ([HF]; SIR = 3.9, 95% confidence interval [CI] = 3.4 to 4.6; absolute excess risk = 62.8) and cerebrovascular accident (SIR = 1.3, 95% CI = 1.0 to 1.7; absolute excess risk = 9.8), while risk of coronary artery disease was decreased (SIR = 0.7, 95% CI = 0.5 to 0.9; absolute excess risk = -30.9). HF risk was higher among females (SIR = 5.3, 95% CI = 4.2 to 6.5) than males (SIR = 3.2, 95% CI = 2.6 to 4.0, P for heterogeneity < .001), and among survivors aged 40 years and younger at diffuse large B-cell lymphoma treatment (SIR = 10.5, 95% CI = 7.2 to 14.8; P for trend < .001). Exposure to more than 300 mg/m2 doxorubicin was associated with a 2.8-fold (95% CI = 1.7 to 4.5) increased risk of cardiomyopathy or HF, while radiotherapy involving the heart was associated with a 1.9-fold (95% CI = 1.1 to 3.1) increased risk of valvular heart disease. CONCLUSION:Those surviving at least 5 years after diffuse large B-cell lymphoma have increased risks of developing CVDs, especially HF. Physicians and patients should recognize this risk, and individualized cardiac screening should be considered.

Global health research continues to rely heavily on knowledge generated outside the regions that bear the greatest disease burden, reinforcing structural inequities in scientific leadership and innovation. The GlaxoSmithKline (GSK) Africa Open Lab (AOL) was established to address this imbalance by investing directly in African-led research capacity. This reflective analysis examined how participation in the inaugural GSL-AOL cohort influenced research capacity, scientific independence, and career development among early-career African researchers. The reflection was guided by the question: How has your participation as part of the inaugural cohort of the GSK AOL programme influenced your research capacity, scientific independence, and career trajectories as an early-career African researchers? A structured collaborative reflection approach was undertaken involving all 11 members of the inaugural cohort. Reflections were analyzed using Ritchie and Spencer's Framework Method, with responses independently reviewed, coded, and synthesized into consensus themes. Drawing on our collective experiences and potential outputs, we reveal how catalytic funding, structured mentorship, and intentional network-building can accelerate research independence, strengthen institutional capacity, and expand professional opportunities. The cohort's achievements provide evidence that African-led, researcher-centered investment models can contribute meaningfully to equitable global health research. Sustained impact, however, will require continued support from African governments, institutions, and international partners.