Background: Patients receiving medical oncology care must weigh multiple factors when selecting a vascular access device, such as a peripherally inserted central catheter, implantable port, or midline catheter. Decision regret is an important patient-reported outcome that may adversely affect treatment adherence and quality of life. From the perspectives of shared decision-making and precision nursing, identifying subgroups of patients with distinct patterns of decision regret may help provide individualized decision support. Objective: To identify latent subgroups of decision regret among patients with cancer who underwent vascular access device placement, based on the three-dimensional structure of decision regret—process regret, option regret, and outcome regret—and to examine the associations of demographic characteristics, clinical factors, decisional conflict, and shared decision-making with subgroup membership. Methods: A cross-sectional survey was conducted using convenience sampling. A total of 309 patients who had undergone vascular access device placement and participated in treatment-related decision-making were recruited from the oncology department of a tertiary hospital in China between February and June 2026. Data were collected using a researcher-designed demographic and clinical characteristics questionnaire, the Three-Dimensional Decision Regret Scale, the Decisional Conflict Scale, and the Shared Decision-Making Questionnaire. Latent profile analysis was performed to identify subgroups of decision regret, and multinomial logistic regression was used to examine factors associated with subgroup membership. Results: A total of 309 patients were included in the final analysis. Based on model fit indices, LMR/BLRT results, entropy, class proportions, and clinical interpretability, the three-profile solution was selected and identified three latent profiles: low decision regret (77.35%), moderate decision regret (13.59%), and high decision regret (9.06%). Univariable analyses showed that place of residence, educational attainment, employment status, monthly household income, type of vascular access device, family involvement in decision-making, receipt of decision-related education, decisional conflict score, and shared decision-making score differed significantly across profiles (all p < 0.05). In the multinomial logistic regression model, place of residence, educational attainment, employment status, family involvement in decision-making, receipt of decision-related education, decisional conflict score, and shared decision-making score were associated with profile membership. After correcting for classification uncertainty using R3STEP, DCS and SDM-Q-9 remained significantly associated with profile membership, whereas the association with employment status was no longer significant. However, the high-regret group was small (n = 28), and the confidence intervals for several predictors were wide (e.g., unemployment: relative risk ratio (RRR) = 30.5, 95% CI 3.24–288). Monthly household income and type of vascular access device did not remain statistically significant. Conclusions: Substantial heterogeneity in decision regret was observed among patients with cancer who underwent vascular access device placement. Particular attention should be given to patients who experience high levels of decisional conflict or receive insufficient preprocedural education. Profile-based nursing interventions and enhanced shared decision-making before device placement are promising strategies, but their effects need to be evaluated in prospective studies.
For advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, targeted therapy is the standard first-line treatment, but acquired resistance and disease progression are inevitable. Identification of resistance mechanisms is crucial for guiding subsequent anti-tumor therapy. We report a 57-year-old female patient with advanced lung adenocarcinoma harboring an EGFR exon 21 L858R mutation. The patient experienced disease progression with rare gynecological metastasis after 16 months of first-line furmonertinib therapy. Next-generation sequencing (NGS) of the uterine metastatic lesion identified concurrence of EGFR mutation and ALK fusion, while fluorescence in situ hybridization (FISH) confirmed MET polysomy. The patient exhibited intolerance to the combination therapy of glumetinib plus furmonertinib. Subsequently, the patient received a combination of furmonertinib and the ALK-TKI ensartinib, which was assessed as a partial response (PR) at the first restaging evaluation (1 month after treatment initiation), with favorable safety and tolerability. Secondary ALK fusion may represent a rare but clinically meaningful resistance mechanism in EGFR-mutant NSCLC. Furthermore, while gynecological metastasis from lung cancer is uncommon, clinicians should be alert to this possibility in patients presenting with relevant symptoms, with pelvic examination conducted as needed.
All-trans retinoic acid (ATRA) combined with arsenic trioxide (ATO) is the standard of care for acute promyelocytic leukemia (APL), including high-risk disease. Secondary intracranial hypertension (SIH), historically termed pseudotumor cerebri (PTC), is a recognized but uncommon and potentially therapy-limiting complication of retinoid exposure, reported predominantly in pediatric and young-adult patients and most frequently during induction. We report a 31-year-old man with high-risk microgranular APL in whom SIH was diagnosed during the first ATRA/ATO consolidation cycle. The clinical course included progressive headache, ocular pain, pulsatile tinnitus, focusing difficulties, visual deterioration, and diplopia. Ophthalmological assessment demonstrated bilateral papilledema with marked peripapillary retinal nerve fiber layer thickening despite preserved central visual acuity. Magnetic resonance imaging showed bilateral optic nerve sheath distension, prominent optic nerve heads, mild pituitary flattening, and bilateral transverse sinus stenosis. Lumbar puncture demonstrated an opening pressure of 32 cm H2O with otherwise unremarkable cerebrospinal fluid; removal of approximately 30 mL resulted in immediate symptomatic improvement. Management consisted of temporary ATRA interruption, therapeutic lumbar punctures, acetazolamide, and individualized ATRA rechallenge and dose titration. Repeated attempts at dose escalation reproduced symptoms, and ATRA was ultimately maintained at a maximally tolerated dose of 30 mg/m2/day while full-dose ATO was continued. Molecular remission was achieved after the first consolidation cycle and remains sustained at 18-month follow-up. This case highlights the importance of recognizing ATRA-associated SIH throughout the treatment course and illustrates a pragmatic strategy for preserving ATRA exposure when standard-dose treatment is limited by neurological toxicity. However, the oncological equivalence of reduced-dose ATRA cannot be inferred from a single case.
Individuals living with metastatic cancer frequently experience high symptom burden and reduced quality of life, leading many to seek integrative therapies alongside standard care. This study utilized the Theoretical Framework of Acceptability to systematically examine patient perspectives and the acceptability of integrative naturopathic oncology. Qualitative, semi-structured virtual interviews were conducted with 12 adult metastatic cancer patients who had received at least three months of care at a specialized Canadian clinic. The hybrid inductive-deductive analysis revealed high overall intervention acceptability. Patients reported positive emotional attitudes, strong alignment with personal values, improved treatment understanding, and increased confidence in managing their care. They particularly valued relational support, whole-person care, and an enhanced sense of agency. However, key implementation barriers included significant out-of-pocket expenses, social and family trade-offs, and navigating disconnected, uncoordinated healthcare systems. Integrative naturopathic oncology is highly acceptable to metastatic cancer patients as a valued complement to conventional regimens. To optimize equitable and safe care delivery, future health systems must reduce financial barriers and introduce structured communication channels between conventional and integrative health providers.
Background/Objectives: We compared the prognostic performance of preoperative prognostic nutritional index (PNI) and Gustave Roussy Immune Score (GRIm-s) after curative-intent gastrectomy. Methods: This retrospective cohort included 168 patients, including five postoperative in-hospital deaths. Continuous PNI and ordinal GRIm-s were compared using censoring-adjusted time-dependent AUC and concordance, with paired bootstrap confidence intervals. Preoperative prediction models underwent bootstrap internal validation; restricted mean survival time and time-varying Cox analyses addressed non-proportional hazards. Results: There were 92 deaths and 107 disease-free survival (DFS) events. At 36 months, overall survival (OS) AUC was 0.659 for PNI and 0.527 for GRIm-s (difference 0.132, 95% CI 0.039–0.226); corresponding DFS values were 0.650 and 0.516 (difference 0.134, 95% CI 0.035–0.228). After optimism correction, preoperative PNI-model AUCs were 0.610 for OS and 0.595 for DFS. PNI associations weakened over time. The cohort-derived 49.6 threshold was used only in secondary exploratory analyses. Conclusions: PNI showed better unadjusted discrimination than GRIm-s at three years, but modest internally validated model performance limits clinical interpretation. These findings do not establish clinical utility, a validated cutoff, or a substitute for pathological assessment. External validation is required.
