ABSTRACT Background Medical‐legal partnerships can address health‐harming legal needs (HHLNs) but caregiver‐inclusive models are understudied. Aims To evaluate the feasibility, acceptability, and preliminary efficacy in addressing HHLNs of proactive legal care for patient‐caregiver dyads. Methods This single‐arm pilot trial (NCT07153016) enrolled patients with advanced‐stage colorectal cancer and their self‐nominated caregiver. Cancer Legal Care (CLC) provided personalized legal checkups and 3‐month follow‐up at no cost. Feasibility was assessed by rates of initial checkup, 3‐month engagement, and receipt of legal service. Acceptability was assessed by likelihood of recommending the intervention to others. Participant‐reported outcomes, implementation measures, and interviews were summarized. Results We enrolled 9 of 10 planned dyads. Among the 9 enrolled, 8 completed baseline surveys, 7 completed initial legal checkups, and 7 completed 3‐month assessments. Initial legal checkups lasted a median of 45 minutes, and CLC provided median 4 hours of legal service per dyad. At baseline, 7 of 16 participants self‐identified HHLNs, while CLC identified 1.7 additional HHLNs per dyad. The study met predefined feasibility benchmarks [initial engagement (16/18, 89%), 3‐month questionnaire completion (14/18, 78%), and receipt of ≥ 1 legal service (14/18, 78%)] and acceptability (12/14, 86% recommended the intervention) benchmarks. Dyads noted improvements in financial control, support‐seeking, and maintaining daily activities; however, caregiver‐specific needs were not consistently identified or prioritized. Conclusions Proactive legal care for recently diagnosed patient‐caregiver dyads was feasible and acceptable, and identified and addressed HHLNs. However, caregiver‐inclusive medical‐legal partnership models may require caregiver‐specific intake, longitudinal follow‐up, and clearer distinction between patient, caregiver, and shared needs.
ABSTRACT Background Cancer survivors face persistent social, emotional, and practical challenges that can worsen health and quality of life. These unmet needs disproportionately affect Black cancer survivors and contribute to inequitable outcomes. Aims This qualitative study explores the experiences and preferences of Black cancer survivors participating in a community health worker (CHW) supported intervention to assess and address health‐related social needs (HRSNs). Methods Semi‐structured interviews were conducted with participants enrolled in a 6‐month CHW intervention in the United States to assess and address social needs. A mix of inductive and deductive coding was used within a constructivist framework to identify themes aligning with Patient‐Reported Outcomes Measurement Information System (PROMIS) social support and quality of life (QOL) domains. Results Thirty interviews were conducted. Most participants were female ( n = 22), had breast cancer ( n = 14), and experienced social needs ( n = 22). Participants described significant emotional, practical, and financial challenges during survivorship. Participants commonly cited that CHWs provided significant emotional support, as well as food and transportation referrals. Over half of participants reported increased awareness and self‐efficacy in navigating community resources. Most participants reported improvements in quality of life, particularly with enhanced emotional well‐being and instrumental support, that were vital to their daily functioning. Conclusion Consistent, monthly phone‐based CHW support improved emotional well‐being, self‐efficacy, and overall quality of life. Future research should explore the impact of interventions on psychometrically validated quality of life measures and receipt of appropriate survivorship care.
ABSTRACT Objective Postoperative complications following colorectal cancer resection remain common despite technical advances, yet associations of psychosocial and spiritual health with surgical risk are poorly characterized. Methods This prospective cohort study enrolled 985 patients undergoing colorectal cancer resection at a single tertiary center (2013–2021). Preoperative assessments included health behaviors (Smart Management Strategy for Health Assessment Tool), self‐rated health status (5 Health Status Questionnaire), and health‐related quality of life (EORTC QLQ‐C30). The primary outcome was any complication within 30 days; secondary outcomes were complication subtype (surgical vs. non‐surgical) and severity (minor vs. major). Multivariable stepwise logistic regression was performed per outcome. Results Overall, 305 patients (31.0%) experienced at least one complication: 235 surgical (23.9%), 106 non‐surgical (10.8%), and 32 major (3.3%). Lower positive‐thinking behavior was associated with overall (OR 1.52; 95% CI 1.11–2.07) and minor complications (OR 1.52; 95% CI 1.11–2.09); lower helping‐others behavior with surgical complications (OR 2.06; 95% CI 1.27–3.35); and poor spiritual health with non‐surgical complications (OR 2.11; 95% CI 1.37–3.26). Preoperative fatigue showed the strongest association with major complications (OR 4.04; 95% CI 1.60–10.21). Conclusions Distinct psychosocial and spiritual health domains were associated with distinct complication subtypes, with preoperative fatigue showing the strongest association with major complications. Whether these reflect modifiable contributors or markers of underlying vulnerability cannot be determined from an observational design; the findings identify patients who may benefit from additional supportive resources rather than a basis for risk stratification.
Background Accurate staging is critical in pediatric rhabdomyosarcoma (RMS), as bone marrow (BM) and nodal involvement strongly influence risk stratification and treatment. Current guidelines recommend invasive procedures, including bone marrow aspirate/biopsy (BMAB) for all patients, and nodal histology in selected patients, despite their burden in children. This study evaluates the diagnostic performance of 18F-FDG PET/CT for BM and nodal staging in pediatric RMS.Methods A retrospective, multicenter study was conducted including patients less than 25 years with newly diagnosed RMS from Paris Kids Cancer centers who underwent baseline 18F-FDG PET/CT. PET/CT accuracy was assessed using BMAB as the reference standard. For nodal staging, histological confirmation was used when available; otherwise, an exploratory real-world clinical assessment of lymph node status based on imaging and follow-up was applied. Discordant cases underwent multidisciplinary review including MRI.Results Among 147 patients, 129 had both 18F-FDG PET/CT and BMAB. PET/CT correctly classified BM status in more than 99% of cases, with a negative predictive value of 99.1%. Nine PET-positive/BMAB-negative cases were confirmed as true BM involvement on MRI, reflecting possible BMAB sampling bias. For nodal staging, 18F-FDG PET/CT sensitivity and specificity were 85.2% and 85.7% versus histology (48 cases). Using real-world clinical assessment (146 cases), sensitivity and specificity increased to 86.5% and 96.8%, respectively.Conclusions 18F-FDG PET/CT demonstrates excellent accuracy for BM staging and strong performance for nodal assessment in pediatric RMS. These findings support selective omission of invasive staging procedures in patients with negative 18F-FDG PET/CT while reinforcing the complementary role of sentinel node biopsy in specific subgroups.
Background Allogeneic hematopoietic stem cell transplantation (alloHSCT) is an essential therapy for several malignant and nonmalignant diseases, but relapse and graft loss remain the principal threats to its success. Routine monitoring of chimerism and minimal residual disease (MRD) enables early detection of imminent recurrence and guides pre-emptive donor lymphocyte infusion (preDLI), which aims to improve or stabilize mixed chimerism (MC) in nonmalignant indications and to exert a graft-versus-leukemia (GvL) effect in malignancies. Pediatric data remain limited and protocols heterogeneous, particularly for nonmalignant disorders.Procedure This retrospective single-center study analyzed 56 pediatric patients who received preDLI at T & uuml;bingen Children's Hospital between 1998 and 2022 after HLA-matched or single-mismatched alloHSCT. Two primary endpoints were prespecified: the rate of MC stabilization or improvement after preDLI, and the cumulative incidence of de novo graft-versus-host disease (GvHD) attributable to preDLI. Competing risks methodology was applied for graft loss or relapse, non-relapse mortality, and GvHD. Analyses used R version 4.5.1 (alpha = 0.05).Results Cumulated doses ranged from 25 & times; 103 to 71 & times; 106 cells/kg, depending on HLA disparity and indication. PreDLI stabilized or improved MC in 65% of nonmalignant (20/31) and 60% of malignant (15/25) indications, averting graft loss without re-transplantation in most responders. Treatment was well tolerated; three patients (5.4%) developed de novo GvHD, all Grade I.Conclusions PreDLI is a safe and effective intervention in pediatric transplantation, particularly as repeated, escalating doses. We provide practical recommendations, while acknowledging that standardization remains challenging and outcome depends on center experience and indication.
