Introduction Tumour-associated macrophages (TAMs) are highly plastic immune cells that polarize into tumour killing M1-like or tumour promoting M2-like macrophages depending on signals in the tumour microenvironment (TME). Exercise training may induce TAMs towards M1-like phenotypes to slow cancer progression and metastasis. In this study, we explored the effects of wheel running in tumour-challenged mice by analysing immune cell expression in metastatic tissues. Methods Archival breast cancer lung metastases tissues of old BALB/c mice were subjected to multiplex immunofluorescence (mIHC) to quantify immune cell subsets. The immune cell expressions were then analysed against the primary mammary tumour mass, metastatic lung tissue area, as well as distance ran before and after tumour implant for the exercise mice. Results Based on the mIHC results from control (n=9) and exercise (n=10) mice tissues, wheel running did not significantly alter immune cell expressions relative to lung metastases or mammary tumour. Correlations between immune cell expression and the metastatic foci area revealed significant trends. Of note, F4/80 + CD163 + or M2-like macrophage expression is positively correlated for both control (r=0.835, p =0.005) and exercise (r=0.669, p =0.034). The F4/80 + cells or overall macrophage expression was only positively correlated in the control (r=0.764, p =0.017) group. Likewise, the mammary tumour mass was positively correlated in the control group (r=0.834, p =0.010) but not in the exercise group. Interestingly, F4/80 + CD86 + or M1-like macrophage cells (r=0.758, p =0.011) and M1/M2 ratio (r=0.642, p =0.045) were only significantly correlated with mean distances ran after tumour implant. Conclusion Voluntary wheel running may shift the expression of metastatic TAMs towards anti-tumour M1-like macrophages in a dose-dependent manner after tumour challenge. This study demonstrates the importance and potential of implementing exercise training in combination with immunotherapy to treat metastatic breast cancer.
Introduction In Europe, cervical cancer (CC) is the third most common gynaecologic cancer, and the second among women under the age of 45. CC screening uptake is highly variable across the region, and especially low among vulnerable groups. Current evidence suggests that HPV (Human Papilloma Virus) vaccination benefits women beyond traditional adolescent vaccination age groups, and so the HPV-FASTER approach has been proposed as a strategy to accelerate the elimination of CC in Europe. The HPV-FASTER-Implement implementation research project aims to evaluate strategies that integrate HPV-based screening with concomitant HPV vaccination (HPV-FASTER approach) for vulnerable groups aged 25–45 years, including migrants and sex workers in Spain and Sweden, women living with HIV and transgender men in Denmark, incarcerated women in Romania, and women living in deprived areas in France. Methods To assess the capacity of health systems to deliver combined HPV vaccination and HPV-based screening, we adapted the Cervical Cancer Screening Service Availability and Readiness Assessment (CervScreen-SARA) protocol and tools, considering also the WHO Effective Vaccine Management tool. This implementation research protocol includes three components: a desk review of CC screening and vaccination guidelines, and policies currently in place; screening, colposcopy, and vaccination services facility visits; and interviews with key meso- and macro-level stakeholders. Triangulation of the information allows the identification of strengths and areas of improvement in implementing the HPV-FASTER approach. Conclusions This implementation research protocol offers a structured approach to assess the readiness of health systems to deliver combined HPV vaccination and HPV-based CC screening to vulnerable populations, and will allow the tailoring of strategies to strengthen CC prevention services.
Introduction Use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for control of type 2 diabetes and cardiovascular disease (CVD) risk reduction is increasing. Given the established link between obesity and multiple cancers, there is growing interest in the potential effects of GLP-1RAs on cancer risk reduction. This systematic literature review and meta-analysis evaluated the association between GLP-1RA use and cancer incidence. Methods We conducted literature searches in MEDLINE and EMBASE databases, covering publications up to September 17th, 2025. Our review included studies among adults receiving GLP-1RAs for any indication that reported effects on cancer incidence of any type. Results Among 1,644 unique citations identified, 139 studies met the inclusion criteria for full-text review. After study exclusion, a total of 78 observational studies were included in the review and meta-analysis. GLP-1RA use was associated with statistically significant reductions in cancer risk for 10 of 13 obesity-associated cancers, specifically colorectal, endometrial, esophageal, gallbladder, liver, ovarian, pancreatic and stomach cancers along with meningioma and multiple myeloma. Compared to insulin specifically, GLP-1RAs provided protective effects against cancer of the colorectum (RR: 0.54, 95% CI: 0.44, 0.66), liver (RR: 0.35, 95% CI: 0.20, 0.62), and pancreas (RR: 0.41, 95% CI: 0.36, 0.48). The risk of developing thyroid cancer was slightly elevated, but not statistically significant, among GLP-1RA users (RR: 1.09, 95% CI: 0.98, 1.21). Conclusions Pooled estimates of observational studies suggest notable reductions in cancer incidence for several obesity-associated cancers. As GLP-1RA use increases, ongoing safety monitoring and long-term real-world data are essential. The potential role of GLP-1RAs in cancer risk reduction warrants further investigation through large-scale RCTs, alongside balanced risk-benefit discussions with patients.
Background: Obesity and chronic kidney disease (CKD) often coexist and compound the risk of adverse health outcomes including dysglycemia and accelerated CKD progression. Obesity also limits access to kidney transplantation. The objectives of this study were to (1) understand current weight-management practices in CKD centres across Canada and (2) describe the availability of weight-management services nationwide. Methods: We conducted a cross-sectional, quantitative, online survey of English-speaking nephrologists practicing in Canada in 2025. The 23-question survey was developed based on a literature review and the content expertise of investigators. It was reviewed by nephrologists to ensure clarity, appropriateness, and ease of completion. Survey questions focused on the availability of dietitian services, exercise supports, behavioural counselling, weight-management consultations, and use of weight-loss medications in kidney outpatient clinics and dialysis units (including hemodialysis and peritoneal dialysis). The survey was administered via Qualtrics and distributed through the Canadian Society of Nephrology to nephrologists who care for patients with advanced CKD. Results: Between April 7 and June 12, 2025, 56 valid and complete responses were received, an estimated 15% response rate. Respondents primarily practised in Ontario (36%), Quebec (20%), British Columbia (18%), and Alberta (14%), with fewer respondents from the Territories and Atlantic provinces. Clinicians reported initiating weight-management discussions with patients when they felt obesity was contributing to poor health or impacting eligibility for transplant. While almost all nephrologists reported having access to a dietitian, over 60% were uncertain about the specific role of the dietitian in weight management. Gaps in the availability and coordination of behavioural coaching, physiotherapy, and exercise services were frequently cited. Over 60% of nephrologists reported prescribing weight-loss medications despite limited evidence supporting their efficacy and safety in patients with advanced CKD. Conclusions: Weight management is a recognized health priority in patients with advanced CKD, yet there are gaps in management. The nephrology community would benefit from weight-management services that reduce morbidity and improve transplant access for patients with CKD.
Introduction We aimed to develop and validate a clinically interpretable multimodal deep learning framework integrating multi-sequence MRI and clinical variables for predicting overall survival (OS) in locally advanced cervical squamous cell carcinoma (LACSCC). Methods This retrospective cohort study included 247 patients with pathologically confirmed LACSCC. Pretreatment MRI sequences, including contrast-enhanced T1-weighted imaging (T1CE), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), were analyzed. Tumor regions of interest were manually delineated, and slice-level deep features were extracted using a fine-tuned ResNet-50 network. A graph neural network was then constructed to model spatial relationships among MRI slices, aggregate slice-level features into patient-level representations, and integrate imaging features with clinical variables to generate a Deep Learning Prognostic Score (DLPS). Model performance was assessed using time-dependent receiver operating characteristic (ROC) curves, Kaplan-Meier survival analysis, Cox regression analysis, and nomogram calibration. Results In the validation cohort, the model achieved area under the ROC curve values of 0.747, 0.749, and 0.706 for predicting 1-year, 3-year, and 5-year OS, respectively. Kaplan-Meier survival analysis showed significantly better OS in the high-DLPS group than in the low-DLPS group. Multivariable Cox regression analysis identified DLPS as an independent predictor of OS. The nomogram integrating DLPS and significant clinical variables showed good calibration in both the training and validation cohorts. Conclusion We developed and validated a multimodal MRI-based GNN framework for individualized OS prediction in LACSCC. By integrating spatially structured imaging features with clinical variables, the model provided effective prognostic stratification and may support personalized risk assessment and treatment decision-making.
Purpose To investigate the relationship between time to treatment initiation (TTI) of definitive radiotherapy and survival outcomes in locally advanced head and neck cancers (LAHNC). Methods We retrospectively included patients diagnosed between 2005 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate regression analysis, recursive partition analysis, penalized spline function, chi-square test, Kaplan-Meier method, and multivariate Cox proportional-hazards models were used for statistical analyses. Results A total of 18657 patients were included. Patients were stratified into 3 groups: no delay (<36 days), at risk of delay (36-61 days), and delay (>61 days). Compared to patients who initiated radiotherapy within 61 days, patients who initiated radiotherapy after 61 days had a higher risk of death in 5-year cancer-specific survival (CSS) (no delay vs. at risk of delay vs. delay: 58.7% vs. 60.5% vs. 50.5%) (P<0.001) and overall survival (OS) (no delay vs. at risk of delay vs. delay: 47.7% vs. 49.5% vs. 39.4%) (P<0.001). Patients in the delay group had worse outcomes in CSS (hazard ratio [HR], 1.209; 95% confidence interval [CI], 1.143-1.278; P<0.001) and OS (HR, 1.199; 95% CI, 1.146-1.256; P<0.001). In patients with oral cavity, oropharyngeal, and laryngeal cancers, the risk of death progressively rose as the treatment was delayed. However, there was no significant difference in the risk among patients with hypopharyngeal cancer. Conclusions For patients with LAHNC, delay of definitive radiotherapy leads to inferior survival. Our study highlights that the threshold of 36 and 61 days significantly affects survival and identifies patients experiencing these delays.
Introduction Inadequate and conflicting reporting exists regarding the intricate association between positive lymph node (PLN) number and papillary thyroid cancer (PTC) survival. Our aim was to elucidate the relationships between PLN and overall survival in PTC patients using a large population-based study. Methods Data on PTC patients diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Proportional hazards regression models with restricted cubic splines (RCS) were employed to examine the associations between them. Multivariable adjusted Cox regression models and sensitivity analyses were conducted to validate the association. Results In total, 44,181 patients with PTC were included (18,148 with and 26,033 without lymph node metastases). After adjusting for covariate effects, patients with node metastases exhibited compromised survival compared to those without (hazard ratio[HR], 1.58; 95% confidence interval [CI], 1.44 to 1.74). In the RCS model, all-cause mortality risk increased rapidly until seven PLN, with a HR of 1.14 (95% CI, 1.11 to 1.17) per increase of one metastatic node but stabilized afterwards (HR, 1.01; 95% CI, 0.98 to 1.05) ( P for non-linearity <0.001). Furthermore, multivariate Cox models and sensitivity analyses confirmed similar correlations between the PLN count and overall survival. Conclusions Our study suggests an evident non-linear association between PLN number and overall survival in PTC patients, suggesting a potential threshold of seven or fewer PLN to have better survival outcome.
Background Hyperkalemia affects more than one in five patients receiving maintenance hemodialysis and remains a major contributor to arrhythmias and sudden cardiac death. Traditional potassium restriction has centered on limiting fruits and vegetables, even as emerging evidence challenges the assumption that all high-potassium foods pose equal risk. Meanwhile, awareness of potassium additives has grown, and recommendations to avoid additive-containing processed foods have been layered onto existing restrictions. Together, the uncertainties around long-standing to newer recommendations create guidance that is difficult for many patients to navigate. Objective To describe the protocol for EvoKe-HD, a pilot randomised controlled trial evaluating the feasibility, acceptability and safety of a targeted dietary counselling strategy for potassium management in hemodialysis. Design Two-arm, 1:1 randomised, parallel-group feasibility trial. Setting Two dialysis units at the CIUSSS du Nord-de-l’Île-de-Montréal, Canada. Patients Adults receiving thrice-weekly maintenance hemodialysis with elevated pre-dialysis serum potassium levels or receiving regular potassium binder therapy. Measurements The primary feasibility outcome is the proportion of eligible patients who enrol and complete the 3-month assessment. The main exploratory clinical outcome is mean mid-week pre-dialysis serum potassium during follow-up. Secondary and exploratory outcomes include hyperkalemia events, potassium binder use, dialysate potassium adjustments, biochemical measures, dietary outcomes, patient-reported outcomes, and process evaluation measures. Methods Participants are randomised to monthly targeted dietary counselling focused on reducing potassium additives and selected high-impact foods, or to monthly standard potassium-restriction counselling based primarily on total potassium content. Feasibility outcomes will be summarized with 95% confidence intervals. Mean follow-up serum potassium will be analysed using linear mixed-effects model adjusted for baseline potassium and sex, with a random intercept for participant. Results Recruitment began in June 2025 and was completed in January 2026. The last study visit was completed in March 2026. Process evaluation interviews are expected to be completed in July 2026. Limitations As a single-centre pilot feasibility trial, EvoKe-HD is not powered to evaluate definitive effects on serum potassium, hyperkalemia events, or other clinical outcomes. Conclusions EvoKe-HD will assess whether a targeted potassium counselling strategy can be implemented in routine hemodialysis care and will provide feasibility and process evaluation data to inform the design of a larger trial.
Introduction Globally, ovarian cancer is the third most common gynecological malignancy, following cervical and uterine cancers. The protective effect of combined oral contraceptive (COC) use against the development of primary ovarian cancer is well-established. However, little is known about the potential prognostic benefit of COC use among patients already diagnosed with ovarian cancer. Therefore, this study aimed to evaluate the association of COC use on ovarian cancer survival in oncology centers in Addis Ababa, Ethiopia. Methods A hospital-based, retrospective cohort study was conducted among a total of 436 ovarian cancer patients, comprising 109 COC users and 327 non-users. Kaplan–Meier survival curves and the log-rank test were used to assess differences in overall survival. The incidence density rate of mortality was calculated for each group. The effect of COC use on time to death following an ovarian cancer diagnosis was estimated using Cox proportional hazards regression, with a significance level of 5%. Results The mortality incidence density rate among ovarian cancer patients with prior COC use was 5.55 per 1,000 person-years (95% CI: 3.69–8.35), compared with 13.95 per 1,000 person-years (95% CI: 11.89–16.35) among non-users. The 5-year overall survival rate was higher among COC users (66.18%; 95% CI: 53.07–76.41) than among non-users (37.65%; 95% CI: 31.26–44.01). The median overall survival time for the cohort was 49.80 months. After adjustment for potential confounders, prior COC use was associated with a lower hazard of mortality compared with non-use (adjusted hazard ratio [AHR] = 0.37; 95% CI: 0.24–0.59). Conclusions In the present study, prior COC use was associated with improved overall survival among women diagnosed with ovarian cancer. These findings provide preliminary evidence of a possible prognostic association; however, further studies are needed to confirm these findings and clarify the underlying mechanisms.
Background Accurate prognostic classification in autosomal dominant polycystic kidney disease is important for risk stratification and treatment decisions, including tolvaptan eligibility. Although the ellipsoid method has shown good performance for kidney volume measurement in magnetic resonance imaging cohorts, data from cohorts imaged predominantly with computed tomography remains limited. Objective To evaluate the agreement between the ellipsoid and manual segmentation methods for kidney volume measurement in a computed tomography-heavy cohort of patients with autosomal dominant polycystic kidney disease, with a focus on prognostic classification and identification of high-risk disease. Design Retrospective observational cohort study. Setting The Ottawa Hospital Cystic Kidney Disease Clinic, a tertiary academic center in Ottawa, Ontario, Canada. Patients One hundred fifty-one patients with autosomal dominant polycystic kidney disease who underwent cross-sectional abdominal imaging suitable for volumetric assessment between January 2018 and February 2022, including 107 computed tomography studies and 44 magnetic resonance imaging studies. Measurements Height-adjusted total kidney volume, Mayo Clinic Imaging Classification, and classification of high-risk disease (classes 1C-1E). Methods Height-adjusted total kidney volume was measured using both manual segmentation, the reference standard, and the ellipsoid method. Agreement in kidney volume measurement was assessed using intraclass correlation coefficients, Bland-Altman analysis, and mean percent difference. Agreement in Mayo Clinic Imaging Classification was assessed using weighted Cohen kappa. Diagnostic performance of the ellipsoid method for identifying high-risk disease was evaluated using sensitivity, specificity, positive predictive value, and McNemar testing. Results The ellipsoid method showed good concordance with manual segmentation height-adjusted total kidney volume measurement, with an intraclass correlation coefficient of 0.93 overall, 0.92 in the computed tomography subgroup, and 0.96 in the magnetic resonance imaging subgroup. The ellipsoid method underestimated kidney volume by a mean of 12.7%. Agreement in Mayo Clinic Imaging Classification was high, with a weighted Cohen kappa of 0.87, although 25.8% of cases were misclassified, most often to a lower risk class. For identification of high-risk disease, the ellipsoid method had a sensitivity of 83.0% and a specificity of 98.0% overall; in the computed tomography subgroup, sensitivity was 85.5% and specificity was 97.4%. Limitations Single-center design, use of a single reader, and cross-sectional analysis without longitudinal follow-up. Discussion In this computed tomography-heavy cohort, the ellipsoid method showed good concordance with manual segmentation for kidney volume measurement and high specificity for identifying high-risk disease. However, systematic underestimation may lead to downward misclassification, particularly in borderline cases.
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), which encompass well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs), are a clinically and pathologically heterogeneous group of diseases with an increasing incidence, presenting significant challenges in diagnosis and treatment. This Special Collection brings together studies examining GEP-NEN management from four distinct perspectives: clinicopathological prognostic factors, sex-related survival differences, comparative real-world use and outcomes of long-acting somatostatin analogs, and tumor burden assessment using somatostatin receptor-based imaging. This editorial connects the studies in the collection, discussing the evolving field toward risk-adapted and personalized management of GEP-NENs, ie., a prognostic approach that integrates tumor biology with patient characteristics.
Diabetes is a leading cause of chronic kidney disease, yet gaps in the use of guideline-directed therapies persist in primary care. In 2025, our group developed and validated community pharmacist-led prescribing algorithms for individuals with an estimated glomerular filtration rate ≥30 mL/min/1.73 m 2 , targeting angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, sodium-glucose cotransporter-2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists. To address the evolving therapeutic landscape, we developed and validated a semaglutide-specific algorithm to complement this approach. Algorithm development and validation followed Lynn’s method. A two-part questionnaire per algorithm item assessed content and face validity, with nephrology clinicians (nephrologists and kidney pharmacists) and community pharmacists rating items using Likert scales. Content validity was measured using item-level (I-CVI) and scale-level (S-CVI/Ave) indices, while face validity was assessed by level of agreement to five statements per round. The algorithm was iteratively revised between rounds. Ten nephrology clinicians (five per round for three rounds) and 12 community pharmacists (six per round for two rounds) participated. For clinicians, the I-CVI ranged from 0.6 to 1.0, with an overall S-CVI/Ave of 0.89 across three rounds. Among pharmacists, all items met the prespecified content validity threshold for both rounds (I-CVI ≥0.83; P < 0.05). Face validity exceeded the 70% consensus threshold for both validator groups. This study adds a validated semaglutide-specific algorithm to our existing pharmacist-led care model, expanding a suite of algorithms to support uptake of disease-modifying therapies for individuals with type 2 diabetes and chronic kidney disease in primary care. Implementation and evaluation in Nova Scotia community pharmacy clinics are underway.
Background Despite advances in cervical cancer screening, cervical cancer rates have been increasing in the last decade. Hispanic women have higher cervical cancer incidence and mortality rates compared to non-Hispanic women in the United States. These disparities are primarily due to language barriers experienced in this Spanish-preferred population. Our study aims to improve cervical cancer screening rates among Spanish-preferred patients through a Spanish-language multimedia presentation on cervical cancer screening. Methods In patients not adherent to U.S. cervical cancer screening guidelines, we conducted a non-randomized study comparing standard care in Family Medicine (FM) to standard care plus a multimedia presentation with Spanish voiceover intervention in Internal Medicine (IM). We evaluated whether baseline characteristics differed between the two study arms using the Wilcoxon rank sum test and either the Chi-Square test or Fisher’s exact test. For the primary goal, we examined whether there was a difference in screening scheduling rates between the intervention and standard care groups using the Chi-Square test. Using descriptive statistics, we investigated whether there was a difference in characteristics for those who scheduled screening and those who did not. Results We had 52 patients in IM and 58 in FM, differing in age and insurance status, with median ages of 45.5 and 40.0, and percent insured of 65.4% and 82.8%. Post-study, 25.0% (13/52) in IM and 15.5% (9/58) in FM scheduled cervical screening appointments, which was not significantly different, p=0.21. Patients who scheduled screening had higher rates of insurance coverage, at 95.5% compared to 69.3%. Conclusion No statistically significant difference in scheduling rates among Spanish-preferred patients was observed in this study. Further efforts should include larger samples and randomization.
Introduction An understanding of perspectives toward kidney transplant amongst individuals with kidney failure is integral to supporting treatment-related decision-making and preparing for life post-transplant, yet this has not been studied in a Canadian context. Therefore, the objective of this study was to examine the perspectives of individuals with kidney failure in Canada regarding kidney transplant. Methods Adults (18-75y) from four Canadian provinces who either had initiated dialysis within the prior 6 months or were preemptively referred for kidney transplantation within the prior 3 months were recruited to participate in focus group discussions (FGDs) or individual interviews. Data were analyzed using inductive thematic analysis. Results Fifteen individuals participated in one of four FGDs (n=13) or a semi-structured interview (n=2). Seven were on dialysis and eight were pre-dialysis (four and six of whom had been referred for transplant, respectively). Overall, participants expressed a clear preference for transplant compared to dialysis. Participants’ willingness to consider transplant was influenced by their (1) relationship with the healthcare team , recognition of (2) the necessity of treatment , the (3) potential to live a “normal” life , and knowledge of (4) others’ experiences with transplant . Despite a preference for transplant, participants expressed (5) concerns regarding securing a living donor and a sense of having (6) a lack of control over the transplant referral process. Conclusion In this study, we evaluated perceptions towards kidney transplantation amongst individuals with kidney failure in Canada. Understanding potential concerns regarding future transplant may lead to improved patient-centered education, communication and psychosocial support strategies to empower patients to confidently make treatment-related decisions.
Introduction The incidence of melanoma among younger patients is increasing. This demographic often turns to social media for information and connection. This observational study aims to quantify the prevalence of anti-sunscreen sentiments on TikTok and analyze their content and communication style. Methods Videos tagged #nosunscreen on TikTok were collected in July 2024. Reviewers gathered video characteristics such as username, user profile (individual or organisation), date posted, captions, length, number of followers, likes, views, shares, and comments, presence of sponsorship, and filming location. User demographics were noted. Reviewers also noted communication styles and other video characteristics such as the use of audio memes or music. Users’ opinions about not wanting to wear sunscreen were collected and analysed. Spearman’s correlation coefficient, Chi-squared test, and Phi coefficient were calculated between variables. Results 321 English language TikToks were selected. The majority (38%) were posted in 2023. Average video length was 25 seconds. Mean number of followers was 90,053 (SD 324,640). Mean number of views, likes, and comments was 73,121 (SD 408,245), 5,250 (SD 31,772), and 51 (SD 203), respectively. Only 12 videos included product sponsorship. Female (78%) predominance was observed and 19% showed a person belonging to a visible ethnic minority. 45% of videos used music and 30% used audio memes. 32% were filmed outdoors, mostly the backyard or the beach. In 44% of videos, a sunburn was shown. Almost half of the videos (41%) provided explicit sunscreen sentiments. Common reasons for not wearing sunscreen included personal preferences, trends, perceived natural sun exposure benefits, sunscreen being viewed as unnecessary and/or harmful, alternative forms of sun precaution, and the desire to tan. 42% of videos conveyed sarcasm and/or irony. Anti-sunscreen stances were strongly associated with a lack of regret for not wearing sunscreen (p<0.001). Conclusion TikTok videos tagged with #nosunscreen highlight the alarming prevalence of anti-sunscreen sentiments.
IntroductionLimited research has examined whether genetic testing awareness and uptake differ for individuals with varying levels of health literacy. We examined the association between health literacy and genetic testing and 1) awareness, 2) uptake, and 3) desire for genetic risk information, while controlling for socio-demographic factors.MethodsWe conducted secondary analyses using cross-sectional data from a Community Health Needs Assessment (CHNA) survey conducted between January and March 2022. Multivariable binary logistic regression models were used to examine the relationship between health literacy and genetic testing awareness and uptake, and an ordinal logistic regression model examined the association between health literacy and desire for genetic risk information. All models were adjusted for demographic characteristics.ResultsThe sample was predominantly female (67.8%), White (75.7%), non-Hispanic (77.1%), employed (52%), had a high school education or vocational training (44.8%), had health insurance coverage (85.6%), and preferred to speak English at home (79.4%). After controlling for socio-demographic characteristics, higher health literacy was associated with greater odds of genetic testing awareness (aOR = 1.27, 95% CI: 1.10 - 1.47), and inversely associated with genetic testing uptake (aOR = 0.78, 95% CI: 0.69 - 0.88). The association between health literacy and desire for genetic risk information was not statistically significant after controlling for demographics.ConclusionsOur findings suggest that health literacy is associated with genetic testing awareness, but more research is needed to fully understand the relationship between health literacy and genetic testing engagement. Our findings could help inform future community-based, health literacy-sensitive interventions.
Japan has developed one of the world’s most established population-based gastric cancer screening systems through more than six decades of continuous refinement in public health policy, technological innovation, and quality assurance. This review summarizes the historical development, technological evolution, quality assurance framework, and future perspectives of gastric cancer screening in Japan, while providing comparisons with major gastric cancer screening programs and prevention initiatives worldwide. Japanese gastric cancer screening can be traced to the postwar adaptation of mass tuberculosis radiographic screening systems, followed by the nationwide implementation of double-contrast upper gastrointestinal radiography. Subsequent advances in gastrointestinal endoscopy, including high-resolution imaging, magnifying endoscopy, and image-enhanced endoscopy, have facilitated the transition toward endoscopic screening and improved early gastric cancer detection. Japan has also established highly standardized quality assurance systems, including structured training, credentialing, standardized examination protocols, defined quality indicators, and continuous program monitoring of screening performance. These efforts have supported the standardization and continuous quality improvement of population-based gastric cancer screening programs. The incidence and risk-factor profile of gastric cancer are changing rapidly because of declining Helicobacter pylori prevalence, population aging, and increasing recognition of Helicobacter pylori -naïve gastric cancer. Consequently, future screening systems will likely require greater incorporation of personalized risk stratification, optimized allocation of endoscopic resources, and emerging technologies such as artificial intelligence-assisted endoscopy and structured digital quality assurance systems. Japan’s experience provides a valuable case study illustrating how quality assurance, technological innovation, and public health infrastructure can be integrated to support population-based gastric cancer screening.
Introduction Patients with colorectal cancer and other intestinal cancers often experience a high symptom burden and frequently require healthcare services near the end of life (EOL). Early involvement of specialist palliative care (SPC) has been shown to improve quality of life and reduce aggressive EOL care, but data on its timing in this population is limited. This study examined the association between timing of SPC contact and healthcare utilization at the EOL. Patients and Methods This nationwide retrospective cohort study included all patients who died from colorectal cancer and other intestinal cancers in Finland in 2019. Data on healthcare use were obtained from national registers. Patients were categorized based on the timing of their first SPC contact into early (>30 days before death) and late or no SPC contact (≤30 days or none). Healthcare utilization in the last month of life was compared between groups, and multivariable logistic regression was used to identify factors associated with acute care. Results A total of 1445 patients were included, of whom 339 (23%) received early SPC contact, with a median of 142 days before death. Early SPC contact was associated with fewer emergency department (ED) contacts (43% vs. 54%, p<0.001) and secondary care hospitalizations (21% vs. 49%, p<0.001) and with a lower likelihood of death in hospital (59% vs. 80%, p<0.001). In multivariable analyses, late or no SPC contact was associated with higher odds of ED contacts (odds ratio (OR) 1.613, 95% confidence interval (CI) 1.255–2.074) and hospitalizations (OR 4.029, 95% CI 2.998–5.415). Conclusions SPC contact occurring more than 30 days before death was associated with lower acute care use and fewer hospital deaths among patients with colorectal cancer and other intestinal cancer. These findings support consideration of earlier integration of SPC in the disease trajectory and warrant further prospective studies evaluating its impact on EOL care and healthcare utilization.
Introduction Relapsed or refractory B-cell acute lymphoblastic leukaemia (B-ALL) carries a poor prognosis in adults. Although immunotherapies have expanded treatment options, access to these life-extending therapies remains a challenge in many resource-constrained healthcare systems. This study explored healthcare professionals’ perspectives on the immunotherapy landscape for adult B-ALL in Malaysia’s public sector. Methods A qualitative study was conducted using in-depth, semi-structured interviews with 11 healthcare professionals from two tertiary centres in Malaysia. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results Six themes characterised the current implementation landscape. While the clinical benefits of immunotherapy were widely recognised, its use remained largely restricted to salvage or bridging therapy. Financial constraints, fragmented funding mechanisms, administrative burden, infrastructure constraints, limited clinical expertise or experience, and the absence of standardised treatment pathways hindered wider integration into routine care. These collectively contributed to inequitable access and delayed treatment initiation in a setting of a rapidly progressive disease. Conclusions Healthcare professionals recognise the therapeutic value of immunotherapy for adult B-ALL, but its implementation in Malaysia’s public sector remains selective and constrained. Systemic reforms across funding, formulary policy, workforce development, and clinical governance may be needed to close the gap between therapeutic potential and patient outcomes.
