The NCCN Guidelines for Survivorship offer guidance for health care providers who care for survivors of adult-onset cancer. These guidelines include screening, evaluation, and treatment recommendations for common physical and psychosocial problems resulting from cancer and its treatment and provide a framework for care coordination. They also present guidance for helping cancer survivors to enhance their wellness and maintain a healthy lifestyle. This article summarizes the panel’s current recommendations and recent updates regarding anxiety, depression, distress, and trauma in cancer survivors.
This review summarizes the current NCCN recommendations for the surgical management of pleural mesothelioma, highlighting the clinical trials and retrospective analyses that have shaped current practice and informed guideline recommendations. Advances in systemic therapy, surgical technique, and radiation therapy have shifted management toward multidisciplinary care. Contemporary treatment paradigms emphasize the importance of histology, stage, performance status, and institutional expertise when considering surgical intervention. Surgery can still be considered part of the multimodality treatment strategy in carefully selected patients, despite recent evidence suggesting its possible lack of benefit. Further investigation is required to improve patient stratification, refine multimodal regimens, and develop novel therapeutic approaches. This review aims to provide a contemporary framework for understanding the current role of surgery within the broader management of pleural mesothelioma.
Mesothelioma is a rare cancer that originates from the mesothelial surfaces of certain sites within the body. Pleural mesothelioma is the most common type and represents approximately 85% of mesotheliomas. The NCCN Guidelines for Mesothelioma: Pleural provide recommendations for evaluation and treatment in patients with pleural mesothelioma. The NCCN Guidelines will continue to be updated annually based on available clinical evidence and panel consensus.
BACKGROUND:Prophylactic cranial irradiation (PCI) reduces the incidence of brain metastases (BMs) in patients with limited-stage small cell lung cancer (LS-SCLC). However, predictive biomarkers that identify patients most likely to benefit from PCI have not been established. This study investigates the potential of 18F-fluoro-2-deoxyglucose (18F-FDG) PET as a predictor of PCI benefit in patients with LS-SCLC. PATIENTS AND METHODS:This multicenter study analyzed patients with LS-SCLC who underwent brain MRI and 18F-FDG PET/CT at baseline, followed by treatment with concurrent chemoradiotherapy. To evaluate whether the benefit of PCI varies according to BM risk, we compared outcomes between PCI-treated and untreated patients stratified by risk group. RESULTS:Of 261 patients overall, 171 received PCI and 90 did not. In patients not receiving PCI, high metabolic tumor volume (MTV; >45.201 cm3) was associated with inferior intracranial time to progression (iTTP; hazard ratio [HR], 5.62; 95% CI, 1.69-18.77; P=.005), progression-free survival (PFS; HR, 2.35; 95% CI, 1.38-4.02; P=.002), and overall survival (OS; HR, 2.23; 95% CI, 1.27-3.91; P=.005). Conversely, MTV demonstrated no significant association with survival outcomes among PCI recipients. Subgroup analysis revealed that PCI conferred no survival advantage in the low-MTV group, whereas in the high-MTV group, PCI was associated with improved iTTP (HR, 0.27; 95% CI, 0.15-0.51; P<.001), PFS (HR, 0.49; 95% CI, 0.35-0.69; P<.001), and OS (HR, 0.56; 95% CI, 0.40-0.80; P=.001). Interaction analysis confirmed a significant effect modification between MTV status and PCI benefit for iTTP, PFS, and OS, supporting MTV as an independent predictive biomarker for PCI benefit. CONCLUSIONS:Baseline PET-derived MTV serves as a clinically relevant predictor of PCI benefit in LS-SCLC, supporting a risk-adapted PCI strategy guided by metabolic imaging biomarkers. This approach may reduce unnecessary neurotoxicity and optimize treatment outcomes and should be prospectively validated.
Monitoring and detection of relapse are key components of the current treatment paradigm for relapsed or refractory (R/R) multiple myeloma. The degree of clinical disease and biochemical disease progression, as well as the drug classes patients have been exposed or are refractory to, guides the sequencing and timing of therapies for patients with R/R disease. Supportive care focusing on bone health, infection, and thrombosis remains important for these patients. The cornerstones of management of R/R multiple myeloma are a multidisciplinary approach and early referral to tertiary cancer centers.
BACKGROUND:The AJCC staging system has assigned variable prognostic weight to multifocal disease across versions for intrahepatic cholangiocarcinoma (iCCA). We aimed to better delineate how multifocality influences survival in patients with resectable iCCA to refine clinical staging and better inform treatment sequencing. PATIENTS AND METHODS:We retrospectively identified patients undergoing curative-intent hepatectomy for iCCA between 2000 and 2024 from 6 international, high-volume hepatobiliary centers. Patients were stratified by multifocality, T classification, and N classification. Overall survival (OS) was evaluated using Kaplan-Meier and Cox regression analyses, and a novel modified system was proposed based on current AJCC groupings. RESULTS:A total of 731 patients met the study inclusion criteria. Multifocal disease was present in 36% of patients with T2-T4 tumors and was independently associated with worse OS (hazard ratio, 1.64; 95% CI, 1.21-2.22; P=.002) compared with solitary tumors on multivariable analysis. This survival disadvantage persisted across T2 classification (28.8 vs 44.8 months; P=.001) and T3 classification (21.2 vs 36.5 months; P=.003), and remained significant after adjustment for nodal status (P=.003 and P=.017, respectively). Compared with solitary disease, multifocality also conferred worse OS in patients with node-negative (36.0 vs 58.9 months; P=.003) and regionally node-positive disease (19.2 vs 23.8 months; P=.016). Current AJCC staging failed to distinguish prognostic differences between stage II and stage IIIA disease (48.3 vs 46.9 months; P=.190). However, our proposed modifications, which classify multifocal tumors as T3 and upstage multifocality from stage II to stage IIIA in node-negative disease and from stage IIIB to a newly defined stage IIIC in node-positive disease, better stratified overall risk (P<.001). CONCLUSIONS:Multifocality independently predicts poor prognosis in resectable iCCA. Refining the current staging system by reclassifying multifocal tumors as T3 may improve prognostic stratification and better inform treatment sequencing.
BACKGROUND:Combination amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy are the current standard first-line therapies for treatment-naïve patients with EGFR-mutated advanced lung cancer. We aim to compare the cost-effectiveness of all 3 regimens. METHODS:This economic evaluation with a 20-year time horizon and annual 3% discount was conducted from the perspective of the health care sectors in Taiwan and the Unites States (US). Simulated patients were entered into partitioned survival models upon initiation of amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy. Model inputs were derived from trials and network meta-analyses (progression-free/overall survival, adverse events, and subsequent therapies), insurance payments or retail prices (costs of drug administration, physician visits, monitoring, and end-of-life care), and hospital cohorts (health utility). Subgroup, one-way deterministic, and probabilistic analyses were performed. RESULTS:The incremental cost-effectiveness ratios (ICERs) of osimertinib + chemotherapy versus osimertinib monotherapy (Taiwan: $231,234 per quality-adjusted life-year [QALY]; US: $442,506/QALY) and amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $412,332/QALY; US: $2,623,132/QALY) exceeded willingness-to-pay (WTP) thresholds (Taiwan: $70,000/QALY; US: $150,000/QALY). Cost of drugs and adverse event management accounted for the main cost differences among the 3 strategies. ICERs remained higher than WTP thresholds across patient subgroups. The lowest ICER for amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $232,192/QALY; US: $1,319,408/QALY) was noted among patients aged ≥65 years. Osimertinib + chemotherapy had a 2.0% (Taiwan) and 0.4% (US) probability of being cost-effective at the respective WTP thresholds, with amivantamab-lazertinib showing an even lower probability. CONCLUSIONS:Our analysis suggests that despite the superior efficacy of amivantamab-lazertinib and osimertinib + chemotherapy, neither is cost-effective compared with osimertinib as first-line treatment for EGFR-mutated advanced lung cancer.
BACKGROUND:The Health Equity Report Card (HERC) was developed to establish best practice recommendations and promote accountability among health systems in addressing care inequities. Recognizing the growing importance of health equity, particularly in cancer care, this study aims to evaluate the feasibility of implementing the HERC within academic cancer centers and to gather insights on its benefits and challenges during implementation to improve its usability. METHODS:This quality improvement study used a mixed-methods approach, collecting both quantitative and qualitative data over an 18-month period from April 2022 to October 2024 from 5 NCCN Member Institutions. Participants completed self- and third-party scores, as well as survey evaluations providing feedback on the process of using the HERC. Feedback from stakeholders was systematically collected to assess usability and identify areas for improvement. RESULTS:All participating sites successfully achieved the feasibility objectives by completing the self- and third-party scoring processes using the HERC, with unanimous agreement among the sites regarding the feasibility of the HERC for implementation. Site feedback indicated areas for enhancement, particularly in improving question clarity and simplifying the scoring process. Continuous feedback loops facilitated iterative improvements to the HERC, ultimately enhancing user experience and the scoring process. CONCLUSIONS:The HERC demonstrates strong potential as a viable framework for prioritizing and assessing equity in care delivery within academic cancer centers. The successful implementation across multiple sites, along with positive stakeholder feedback, underscores its utility in enhancing accountability and promoting best practices in addressing health inequities. Future studies should explore the long-term impacts of HERC implementation on patient outcomes and equity in care delivery. A study testing the HERC for applicability in community oncology settings is ongoing.
BACKGROUND:Patients undergoing bone marrow transplantation (BMT) experience significant physical and psychological symptoms. Scalable psychosocial interventions to reduce distress and improve quality of life (QoL) are limited. Virtual reality (VR), with its 3-dimensional capabilities, offers a novel, scalable, patient-centered modality to address these needs. METHODS:We randomized adult patients with hematologic malignancies undergoing autologous or allogeneic BMT to receive either a VR supportive care intervention (BMT-VR) or usual care during hospitalization. BMT-VR consists of 6 modules focused on: (1) psychoeducation and managing expectations; (2) psychosocial skill-building to promote coping; and (3) strategies to facilitate acceptance while facing uncertainty. The primary endpoint was feasibility (≥60% enrollment and ≥60% completion of ≥4 of 6 modules). Secondary outcomes included QoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant), depression and anxiety (Hospital Anxiety and Depression Scale), and posttraumatic stress disorder symptoms (Post-Traumatic Stress Disorder Checklist-Civilian Version) at baseline and at weeks 2, 4, 12, and 24 post-BMT. The System Usability Scale (≥80 indicates excellent usability) was administered at 4 weeks post-BMT. RESULTS:Of eligible patients, 62.5% (85/136) consented and 59.6% (81/136) enrolled in the study (mean [SD] age, 57.9 [14.7] years; 51.9% female; 70.4% underwent allogeneic BMT). Among those assigned to BMT-VR, 64.1% completed ≥4 of 6 modules, exceeding feasibility benchmarks, and 69.2% (27/39) rated usability as excellent. After 4 weeks, patients assigned to BMT-VR reported improved QoL (108.2 vs 96.8; P=.014) and anxiety symptoms (3.6 vs 5.3; P=.016) versus usual care. No differences in depression or PTSD symptoms emerged at 4 weeks. Longitudinally, BMT-VR participants showed greater improvements in QoL (β = 3.8; P=.002), depression (β = -0.8; P<.001), and PTSD (β = -1.7; P=.006), but not in anxiety, compared with usual care. CONCLUSIONS:A VR-delivered psychosocial intervention is feasible during hospitalization for autologous or allogeneic BMT and shows promising preliminary effects on QoL and psychological outcomes. A future multisite trial is needed to assess efficacy for improving QoL and psychological distress in BMT recipients.
Background: Although studies have reported on the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening, data on long-term changes remain limited, particularly during the later phases of the pandemic (post 2021) and among racial and ethnic subgroups. Patients and Methods: We analyzed data from the 2019, 2021, and 2023 National Health Interview Survey to assess clinician recommendations for CRC screening, past 2-year screening rates, and screening modalities used. Trends were compared across racial/ethnic groups and social determinants of health, including insurance status and income. Results: Our sample represented 95 million individuals in 2019, 97 million in 2021, and 98 million in 2023. Compared with 2019, CRC screening recommendations dropped by 20% in 2021 ( P <.0001), with larger decreases among Hispanics (28%) and uninsured individuals (41%). Recommendations remained 11% lower in 2023 ( P =.03). In 2021, past 2-year colonoscopy use declined by 8% ( P =.001), whereas multitarget stool DNA testing (mt-sDNA) increased by 18% ( P =.03) and fecal immunochemical test/fecal occult blood test (FIT/FOBT) use increased by 55% ( P <.001). Colonoscopy declines were greatest among Asian individuals (32%), whereas increases in FIT/FOBT use were highest among Hispanic (78%) and Black (92%) individuals. By 2023, colonoscopy use had returned to prepandemic levels (28%), and mt-sDNA use increased by an additional 40%, resulting in an overall 8% increase in past 2-year screening compared with 2019 ( P <.001). Conclusions: Early in the pandemic, increased stool-based testing offset reduced colonoscopy uptake. Colonoscopy rates have since recovered, whereas stool-based testing continues to increase, with notable differences across ethnic groups. This sustained shift toward stool-based testing offers an opportunity to improve screening, especially where colonoscopy access is limited.
The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions on select 2026 updates to the guidelines regarding nonmetastatic disease: the elimination of the very-low-risk group, updates to the Principles of Active Surveillance, and caution in the use of focal therapy in newly diagnosed patients.
The NCCN Guidelines for Bladder Cancer provide strategies for the diagnosis, treatment, and follow-up of patients with bladder cancer, which is the sixth most common cancer in the United States. Bladder cancer can be divided into 3 categories along a clinical spectrum: (1) non-muscle-invasive bladder cancer; (2) muscle-invasive bladder cancer; and (3) metastatic bladder cancer, with most patients falling into the category of non-muscle-invasive disease. Thus, the selected content featured in this issue specifically covers the clinical presentation and workup of and subsequent management recommendations for non-muscle-invasive bladder cancer.
Based on recent estimates from the American Cancer Society, over the next 30 years, the number of people newly diagnosed with cancer annually will more than double in countries with low or medium Human Development Index rankings. Furthermore, a majority of cancer deaths occur each year in Asia, where close to 60% of the world’s population live. During a plenary session at the NCCN 2026 Annual Conference, an array of professionals discussed the current scope of cancer worldwide and the clinical implications for both oncology practices and health systems. Strategies for facilitating access to cancer care globally were explored, as were opportunities for collaboration among oncology stakeholders worldwide—such as that between the sub-Saharan Africa and MENA (Middle Eastern and North Africa) regions and NCCN.
Adoption of artificial intelligence (AI) in medicine has been an area of great interest due to its potential gains but also the potential challenges of its use, including hallucinations, bias, and privacy concerns. Different AI tools and technologies may provide solutions to many of oncology’s greatest issues across the entire cancer care continuum—provided the solutions are approached with oversight and regulatory guardrails and answer the right questions in the right way for the best possible results.
The Operational Excellence in Cancer Care Program at the NCCN 2026 Annual Conference highlighted the increasing complexity of oncology care delivery and the critical need for system-level strategies to address it. Discussions underscored how this complexity has outpaced existing care delivery models, contributing to gaps in guideline-concordant care, and emphasized that quality depends on both people and systems. Strategies to expand community access reinforced the importance of coordination across care settings. The potential and limitations of artificial intelligence were explored, along with key considerations for implementation and governance. Policy-focused discussions framed advocacy as a tool to align legislation with guideline-concordant care, advance equitable access, and enhance care quality. Practical strategies for redesigning care delivery included role delineation, proactive workforce planning, financial benchmarking, and evolving methods for measuring productivity—all aimed at supporting more sustainable, high-quality oncology care models.
Molecular profiling has fundamentally reshaped the classification and treatment of endometrial cancer, moving the field well beyond the traditional histologic framework. At the NCCN 2026 Annual Conference, Ritu Salani, MD, MBA, reviewed the 4 established molecular subtypes-POLE-ultramutated, mismatch repair-deficient (dMMR), no specific molecular profile (NSMP), and TP53-mutan-and their distinct prognostic and therapeutic implications. Key themes included the established role of checkpoint inhibitors in dMMR disease and the emerging question of whether chemotherapy remains necessary in that subgroup; treatment de-escalation strategies for POLE-mutated tumors; the growing importance of HER2 testing and HER2-directed therapy in selected tumors; the heterogeneity of the NSMP category and novel maintenance strategies under investigation; and the expanding pipeline of molecularly targeted agents and antibody-drug conjugates.
Updates presented at the NCCN 2026 Annual Conference underscored how ovarian cancer care is increasingly being shaped by the full treatment pathway rather than any single intervention. In a presentation on evolving ovarian cancer care, Shitanshu Uppal, MBBS, MBA, revisited the long-standing debate over primary debulking surgery compared with neoadjuvant chemotherapy, highlighting new data that continue to favor a more selective, outcome-focused approach to upfront surgery. The session also focused on newer systemic developments, including antibody-drug conjugates, the ROSELLA trial, the narrowing role of PARP inhibitors in biomarker-unselected disease, and the first meaningful immunotherapy signal in ovarian cancer with KEYNOTE-B96. Together, these updates suggest that optimal ovarian cancer care increasingly depends on integrating surgical judgment, tumor biology, maintenance strategies, and treatment options for recurrent disease across the full continuum of care.
