Purpose Electronic patient-reported outcome (ePRO) systems are increasingly used in oncology practice to capture patient-reported symptoms, including psychological distress. However, it remains unclear to what extent anxiety reported via ePRO is reflected in pharmacist documentation. Methods This retrospective single-center study included patients receiving outpatient chemotherapy who were registered in an ePRO system. We characterized how anxiety reported via ePRO was reflected in routine pharmacist documentation at the patient level within a 28-day observation window. The primary definition of ePRO-reported anxiety was moderate or greater severity (Grade ≥2) reported at least once. The relationship between the two information sources was descriptively characterized using Cohen’s kappa coefficient, McNemar’s test, matched-pairs odds ratios, and overall, positive, and negative agreement. Sensitivity analyses varied the anxiety severity thresholds and number of reporting days required to define ePRO-positive anxiety. Results Among 115 registered patients, 108 submitted at least one ePRO report and were included in the paired analyses. In the primary analysis, Grade ≥2 anxiety was reported via ePRO in 19, whereas anxiety-related pharmacist documentation was identified in 11 patients. Four patients had both Grade ≥2 ePRO-reported anxiety and anxiety-related pharmacist documentation, 15 had Grade ≥2 ePRO-reported anxiety without corresponding pharmacist documentation, and seven had pharmacist documentation without Grade ≥2 ePRO-reported anxiety. The matched-pairs odds ratio was 2.14 (95% CI, 0.82–6.21), with no statistically significant asymmetry (McNemar p = 0.134). Agreement estimates varied according to the severity threshold and number of reporting days used to define ePRO-positive anxiety. Conclusions Patient-reported anxiety captured through ePRO monitoring was not always reflected in routine pharmacist documentation during outpatient chemotherapy care. Because pharmacists directly reviewed ePRO data and pharmacist documentation was neither an independent nor a standardized assessment of anxiety, differences between the two information sources should not be interpreted as failure by pharmacists to recognize anxiety. Rather, ePRO and routine pharmacist documentation captured anxiety-related information within different clinical contexts and may provide complementary information for multidisciplinary care.
Background Many patients experience cognitive decline after hematopoietic stem cell transplant (HCT). This retrospective analysis evaluated trajectories of cognitive function in HCT patients. The study purpose was to identify the most common predictors of post-HCT cognitive change and inform earlier identification and pursuit of interventions to improve the impact on healthcare compliance, quality of life, and survivorship. Materials & methods Duke Adult Bone Marrow Transplant clinic Clinical Pre-, Peri, and Post-HCT Optimization Program (C-POP) assessments data collected between 2018 and 2023 were analyzed (n = 282). Cognitive function was measured with the Montreal Cognitive Assessment (MoCA). Results Fifty-six (19.9%) participants’ MoCA scores were <26 (mild cognitive impairment cutpoint) at pre-treatment sign-off (SO). Pre/post-HCT comparisons from SO to year-1 (Y1) (n = 103) indicated 57 (55.3%) unchanged scores. At Y1, 15 participants’ scores (14.56%) decreased ≥2 points, 31 (30.1%) improved ≥2 points, and only eighteen (17.4%) scored <26. Predictors for decreased scores included older age, female sex, decreased grip strength and frailty at Y1. Scores decreased for the cognitive domains of abstraction, delayed recall, and orientation. Changes were significant across timepoints. Those aged 40-59 showed the most decline for delayed recall and orientation. Conclusions Prospective assessment of grip strength, frailty, and cognitive function (MoCA) may inform tailored interventions and rehabilitation interventions. Future research to investigate prehabilitation to maximize nutritional, cognitive, and fitness status is warranted.
Introduction Genetic alterations and the tumor microenvironment (TME) influence treatment response in anaplastic lymphoma kinase-rearranged non-small cell lung cancer (ALK+ NSCLC). This study maps site-specific TME adaptations and exploratory risk-associated signatures in lymph node metastases (LNT) to investigate metastatic evolution. Method We applied spatial transcriptomics to profile tumor (PanCK+) and stromal (PanCK-) compartments in a pilot cohort of 16 cases: primary lung tumors (LT, n = 3), LNT (n = 10), and brain metastases (BT, n = 3), with three site-matched non-tumor controls. LNT-derived prognostic signatures were evaluated using The Cancer Genome Atlas-Lung Adenocarcinoma (TCGA LUAD) cohorts. Results Distinct, site-specific TME features were observed. LNT stroma was enriched in fibroblasts and macrophages, while tumor segments showed increased neutrophils. BT exhibited a macrophage-associated immunosuppressive TME. Tumor cells evolved divergently: LT retained pulmonary identity and showed trend towards translation-associated programs, LNT cells shifted toward senescence and epigenetic remodeling, and BT cells showed activation of Class A/1 (Rhodopsin-like) receptor, GPCR and drug metabolism pathways. In LNT, exploratory risk-associated differences were observed. Low-risk cases (n = 6) showed adaptive immune signatures, whereas high-risk cases (n = 4) showed enrichment for stromal MET signaling and stress-response pathways. Because treatment exposure differed markedly between the risk groups, these observations should be interpreted as hypothesis-generating. TCGA LUAD analysis suggested the broader biological relevance of immune-associated markers, but reflected general LUAD rather than ALK+ specific biology. Discordant associations for GCLC and TIMP1 underscored the importance of spatial context. Conclusion Site-specific microenvironments may influence tumor adaptation across metastatic niches in ALK+ NSCLC. The exploratory risk-associated findings require validation in larger, uniformly treated cohorts.
BACKGROUND:Thymomas, though rare, are the most common anterior mediastinal neoplasms in adults, with incidence of 0.13 per 100,000 person-years. Due to indolent nature and lack of randomized trials, treatment relies on retrospective data. Literature on outcomes of unresectable thymomas in India is limited. METHODS:This retrospective study was conducted at a tertiary cancer centre in north India, analysing records of patients with advanced/unresectable thymic malignancies (stage III-IV) treated between January 2012 and December 2023. Clinicopathological features, response rates, progression-free survival (PFS), and overall survival (OS) were assessed. RESULTS:A total of 43 patients (median age 40 years [range 22-72]; 76.7% male) were included. Histology revealed thymoma in 36 (83.7%), thymic carcinoma in 4 (9.3%), and thymic neuroendocrine tumours in 3 (7%). Common symptoms were cough (60.5%), dyspnoea (60.5%), and chest pain (55.8%). Stage distribution was - III (20.9%), IVA (46.5%), and IVB (32.6%). Liver (14%) was the most common site of distant metastasis. Myasthenia gravis and pure red cell aplasia occurred in 7% each. Forty (93%) patients received systemic therapy, primarily Cyclophosphamide-Adriamycin-Cisplatin (75%). The objective response rate for first-line systemic therapy was 37.5% (all partial responses) with a clinical benefit rate of 87.5%. Twelve (30%) underwent surgery, with R0 resection in 6 (15%). Median PFS was 16.4 months, and OS was 56 months. CONCLUSION:Systemic therapy and surgery in selected cases provide meaningful outcomes in unresectable thymomas, emphasizing the need for prospective studies to refine treatment strategies.
BACKGROUND:B-cell acute lymphoblastic leukemia (B-ALL) is the most common pediatric cancer, comprising almost 25 % of childhood malignancies. Despite advances in chemotherapy, relapse remains a major cause of treatment failure, particularly in high-risk patients. Blinatumomab, a CD19-directed bispecific T-cell engager, approved for relapsed/refractory and measurable residual disease (MRD)-positive B-ALL, but its benefit in pediatric patients at increased risk of relapse remains uncertain. OBJECTIVE:To evaluate whether adding blinatumomab to chemotherapy improves survival and MRD outcomes in pediatric patients with relapsed/refractory or high-risk frontline B-ALL. METHODS:We searched PubMed, EMBASE, and Cochrane Library through March 2025, following PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating blinatumomab versus chemotherapy in pediatric B-ALL patients at increased risk of relapse. Primary outcomes were disease-free survival (DFS). Overall survival (OS), MRD, and adverse effects were also assessed. Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled using random-effects models. RESULTS:Four RCTs involving 2,011 patients were included. Blinatumomab significantly improved DFS (RR: 0.63, 95 % CI: 0.47-0.83; P = 0.001) and OS (RR: 0.62, 95 % CI: 0.47-0.84; P = 0.002). No statistically significant improvement was observed in MRD clearance (RR: 1.21, 95 % CI: 0.56-2.62; P = 0.62). Adverse event rates were similar between groups (RR: 1.00, 95 % CI: 0.57-1.75; P = 0.99), although heterogeneity was high. CONCLUSION:This meta-analysis suggests that adding Blinatumomab to chemotherapy improves survival in pediatric relapsed/refractory B-ALL and selected high risk frontline populations. However, limited frontline evidence and variability in MRD and toxicity reporting warrant further standardized pediatric studies.
