Search Results (3,102)

Background/Objectives: Anorexia–Cachexia Syndrome (ACS) is a multifactorial condition common in advanced chronic illnesses, leading to significant impacts on prognosis and quality of life. This retrospective cohort study aimed to evaluate the prevalence, management strategies, and clinical and patient-centered outcomes of ACS in a home-based palliative care team. Methods: Clinical records of 128 adult patients followed between 2021 and 2024 were analyzed. Data collected included sociodemographic variables, clinical diagnosis, nutritional parameters (Palliative Performance Scale (PPS), Mini Nutritional Assessment (MNA)), symptoms (anorexia, fatigue), interventions (enteral nutrition, psychological and rehabilitative support), and relevant medications. Statistical analysis included descriptive, inferential, and multivariable proportional hazard regression analysis to identify independent predictors of weight loss and anorexia. Results: Manifestations of ACS were observed across both oncologic and non-oncologic conditions. The prevalence of weight loss and anorexia were interrelated and were not different between diagnostic groups. Using multivariable analysis, higher baseline MNA scores (HR = 3.797, p = 0.006) and the use of enteral nutrition (HR = 7.418, p = 0.014) were independently associated with an increased risk of significant weight loss. Lower baseline PPS scores (HR = 0.069), use of enteral nutrition (HR = −0.890), and the presence of psychological support were protective for subsequent anorexia. Dexamethasone use was associated with greater nutritional decline in univariate models. Conclusions: The management of ACS in home palliative care requires the early identification of symptoms, multidisciplinary intervention, and personalized strategies beyond disease etiology. Risk of weight loss is associated with higher MNA scores, and these are best managed in the first week. In anorexia cases, psychological support is protective. Full article

Digital twin is a mathematical model that virtually represents a physical object or process and predicts its behavior at future time points. These simulation models enable a deeper understanding of tumorigenic processes and improve biomarker discovery in cancer research. Tumor microenvironment is marked by dysregulated signaling pathways, where kinases and phosphatases serve as critical regulators and promising sources for biomarker discovery. These enzymes operate within multiscale and context-dependent processes where spatial and temporal coordination determine cellular outcomes. Digital Twin technology provides a platform for multimodal and multiscale modeling of kinase and phosphatase processes at the patient-specific level. These models have the potential to transform biomarker validation processes, enhance the prediction of therapeutic responses, and support precision decision-making. In this review, we present the major alterations affecting kinases and phosphatase functions within the tumor microenvironment and their clinical relevance as biomarkers, and we address how digital twins in oncology can augment and refine each stage of the biomarker discovery pipeline. Introducing this emerging technology for cancer biomarker discovery will assist in accelerating its adoption and translation into precision diagnostics and targeted therapies. Full article

Background: Social determinants of health (SDOH) are critical contributors to cancer disparities, influencing prevention, early detection, treatment access, and survival outcomes. Addressing these disparities is essential in achieving equitable oncology care. Artificial intelligence (AI) is revolutionizing oncology by leveraging advanced computational methods to address SDOH-driven disparities through predictive analytics, data integration, and precision medicine. Methods: This review synthesizes findings from systematic reviews and original research on AI applications in cancer-focused SDOH research. Key methodologies include machine learning (ML), natural language processing (NLP), deep learning-based medical imaging, and explainable AI (XAI). Special emphasis is placed on AI’s ability to analyze large-scale oncology datasets, including electronic health records (EHRs), geographic information systems (GIS), and real-world clinical trial data, to enhance cancer risk stratification, optimize screening programs, and improve resource allocation. Results: AI has demonstrated significant advancements in cancer diagnostics, treatment planning, and survival prediction by integrating SDOH data. AI-driven radiomics and histopathology have enhanced early detection, particularly in underserved populations. Predictive modeling has improved personalized oncology care, enabling stratification based on socioeconomic and environmental factors. However, challenges remain, including AI bias in screening, trial underrepresentation, and treatment recommendation disparities. Conclusions: AI holds substantial potential to reduce cancer disparities by integrating SDOH into risk prediction, screening, and treatment personalization. Ethical deployment, bias mitigation, and robust regulatory frameworks are essential in ensuring fairness in AI-driven oncology. Integrating AI into precision oncology and public health strategies can bridge cancer care gaps, enhance early detection, and improve treatment outcomes for vulnerable populations. Full article

Background/Objectives: The incidence of early onset colorectal cancer (EOCRC) is increasing globally, particularly among underrepresented populations such as Hispanic/Latino individuals. TP53 is among the most frequently mutated pathways in CRC; however, its role in EOCRC, especially in relation to disparities and treatment outcomes, remains poorly defined. We developed AI-HOPE-TP53, a novel conversational AI agent, to enable a real-time, disparity-aware analysis of TP53 pathway alterations in EOCRC. Methods: AI-HOPE-TP53 integrates a fine-tuned biomedical large language model (LLaMA 3) with harmonized datasets from cBioPortal (TCGA, MSK-IMPACT, AACR Project GENIE). Natural language queries are translated into workflows for mutation profiling, Kaplan–Meier survival analysis, and odds ratio estimation across clinical and demographic subgroups. Results: The platform replicated known genotype–phenotype associations, including elevated TP53 mutation frequency in EOCRC and poorer prognosis in TP53-mutated tumors. Significant findings included a survival benefit for patients with early-onset TP53-mutant CRC treated with FOLFOX (p = 0.0149). Additional exploratory analyses showed a trend toward higher prevalence of TP53 pathway alterations in Hispanic/Latino EOCRC patients (OR = 2.13, p = 0.084) and identified sex-based disparities in treatment, with women being less likely than men to receive FOLFOX (OR = 0.845, p = 0.0138). Conclusions: AI-HOPE-TP53, developed in this study and made publicly available, is the first conversational AI platform tailored for pathway-specific and disparity-aware EOCRC research. By integrating clinical, genomic, and demographic data through natural language interaction, hypothesis generation and equity-focused analyses are enabled, with significant potential to advance precision oncology. Full article

Background/Objectives: Psychosocial factors are not routinely screened for during the perioperative period, even though they significantly influence overall health. This study aimed to inventory the psychosocial vulnerabilities among patients undergoing cancer surgery. Methods: We conducted a cross-sectional analysis of a researcher-administered psychosocial screener implemented within a statewide health system between July 2023 and August 2025. A 45 min screener was offered to consecutive adult patients within two weeks before their major elective cancer surgery. Residential addresses were geocoded to assign neighborhood deprivation percentiles for the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). Elevated psychosocial vulnerability was determined based on a model-based clustering approach, and a high deprivation index was defined as ≥75th percentile. Results: A total of 383 patients (37% response rate) completed the screener, including colorectal (40%), thoracic (36%), and surgical oncology (24%) patients, with a median age of 66 years (IQR, 57–73). Over half (52.0%, n = 199) reported ≥2 psychological and ≥2 social vulnerabilities. Younger patients (p = 0.021), non-white patients (p < 0.001), patients identifying as non-heterosexual (p = 0.014), without a partner (p < 0.001) or private insurance (p = 0.040), and those with lower household income (p < 0.001) were more likely to report elevated psychosocial vulnerability. Patients with elevated psychosocial vulnerability were more likely to reside in deprived neighborhoods (ADI: 34.0 vs. 29.0, p = 0.035; SVI: 0.35 vs. 0.27, p = 0.005). Conclusions: Patients undergoing major cancer surgery experience substantial psychosocial vulnerabilities, particularly those from socioeconomically disadvantaged neighborhoods. Future work should identify the psychosocial factors most predictive of poor surgical outcomes to guide targeted preoperative interventions. Full article

Early palliative care improves quality of life for patients with life-limiting illnesses, but access is often inequitable. The goal of this study was to assess disparities in early specialist palliative care (SPC) consultation among newly diagnosed stage IV lung cancer patients. All newly diagnosed stage IV lung cancer patients in southern Alberta, Canada (June 2021–March 2022) were offered SPC consultations from a multidisciplinary team, post-oncology visit. A retrospective chart review analyzed demographic factors and consultation outcomes (accepted, ineligible, declined/unreachable), using the Pampalon Deprivation Index and NamSor surname analysis as proxies for equity-related variables. Of 113 patients, 76.2% were eligible for consultation, and 67.4% of those accepted consultation. Older age (>65 years), male sex, and high deprivation were linked to declining SPC (p < 0.05–0.01). Conversely, living alone or with a non-partner increased acceptance (p < 0.05). Age, sex, deprivation, and living situation influenced SPC acceptance. Identifying disparities can guide interventions to improve equitable access. Full article

The evolution of robotic surgery in urologic oncology has led to the emergence of single-port (SP) robotic systems as a potential alternative to the widely adopted multi-port (MP) platforms. This narrative review provides a comprehensive comparison between SP and MP robotic systems, the former of which received FDA approval in 2018 and CE marking in 2024, focusing on their application across radical prostatectomy, partial and radical nephrectomy, and radical cystectomy. Drawing from the most current literature, we examine perioperative outcomes, oncologic efficacy, postoperative recovery, and complication rates. The review highlights the technical challenges unique to SP surgery, including restricted triangulation, limited instrumentation, and a defined learning curve, while also emphasizing innovations such as transvesical prostatectomy and the Supine Anterior Retroperitoneal Access (SARA) approach. Additionally, we explore the potential impact of emerging technologies—such as artificial intelligence, augmented reality, and telesurgery—on the future of SP platforms. Despite early limitations, SP systems have demonstrated comparable safety and effectiveness in selected cases and may offer unique advantages in specific anatomical scenarios. Continued innovation, structured training, and robust long-term outcome data will be essential for the broader adoption and integration of SP robotic surgery in clinical practice. Full article

Artemisinin and its derivatives are widely recognized for their exceptional antimalarial efficacy. Recently, accumulating evidence indicates therapeutic potential beyond malaria. Despite these advances, detailed mechanisms and pharmacological limitations remain incompletely defined. This review summarizes their pharmacological activities and molecular mechanisms associated with oncology, immunoregulation, and metabolic disorders. Mechanistically, these compounds exert potent antitumor effects by inducing oxidative stress, arresting the cell cycle, triggering apoptosis, and inhibiting angiogenesis. They likewise modulate immune responses, re-establishing immune homeostasis and enhancing the effectiveness of immunotherapeutic strategies. Preliminary evidence also suggests involvement in metabolic regulation, pointing to promising avenues for treating metabolic disorders. Given alternative mechanisms of artemisinin and its derivatives, we also discuss the trinity modulation network among antitumor activity, immunoregulation, and metabolic homeostasis. We anticipate that future research will address these knowledge gaps, thereby enhancing the clinical utility of artemisinin and its derivatives and improving patient outcomes across diverse pathologies. Full article

Cancer, a leading global cause of death responsible for nearly 10 million deaths annually, demands innovative therapeutic strategies. Intrinsic cytotoxicity and biocompatibility of zinc oxide nanoparticles (ZnO-NPs) have rendered them promising nanoplatforms in oncology. We herein systematically review their applications for targeted cancer chemotherapy, with a focus on physicochemical properties, drug delivery mechanisms, and interactions with the tumor microenvironment (TME). We searched PubMed, SCOPUS, and Web of Science from inception through December 2024 for peer-reviewed preclinical studies on cancer models. Results were qualitatively synthesized. Quality was assessed with the SYRCLE risk of bias tool. Among 20 eligible studies, ZnO-NPs were frequently functionalized with ligands to enhance tumor targeting and minimize systemic toxicity. Chemotherapeutic agents (doxorubicin, 5-fluorouracil, docetaxel, cisplatin, gemcitabine, and tirapazamine) were loaded into ZnO-based carriers, with improved anticancer efficacy compared to free drug formulations, particularly in multidrug-resistant cell lines and in vivo murine xenografts. The mildly acidic TME was exploited for pH-responsive drug release, premature leakage reduction, and improvement of intratumoral accumulation. Enhanced therapeutic outcomes were attributed to reactive oxygen species generation, zinc ion-mediated cytotoxicity, mitochondrial dysfunction, and efflux pump inhibition. Deep tumor penetration, apoptosis induction, and tumor growth suppression were also reported, with minimal toxicity to healthy tissues. ZnO-NPs might constitute a versatile and promising strategy for targeted cancer chemotherapy, offering synergistic anticancer effects and improved safety profiles. Future studies emphasizing long-term toxicity, immune responses, and scalable production could lead to clinical translation of ZnO-based nanomedicine in oncology. Full article

Background/Objectives: Neuroendocrine neoplasms (NENs) of the rectum (rNEN) are a rare and heterogeneous group of tumors that can vary greatly in their biological behavior, from benign to highly aggressive. While small and well-differentiated tumors can often be handled endoscopically and still face a very good prognosis, tumor size, and grade, as well as lymph node and distant metastasis, are known risk factors for impaired prognosis. This study aimed at the identification of further prognostic factors in rNEN. Methods: A retrospective analysis of patients treated for rNEN at the ENTES Center of Excellence at Charité—Universitätsmedizin, including n = 121 patients, was performed to identify risk factors for recurrence, progression, and impaired outcome. Results: Progression-free survival (PFS) and overall survival (OS) differed significantly according to tumor grade (p < 0.001). In rNET patients undergoing surgery, the Ki-67 index and distant metastases were independent risk factors for shorter PFS. Among stage I rNETs, 10 patients developed disease recurrence, associated with lymphatic invasion (1.9% vs. 30.0%, p = 0.008) and higher Ki-67 values (2 (1–6) vs. 2 (1–16), p = 0.054). Conclusions: Tumor grade and presence of metastases represent important predictive factors in rNEN. Notably, even small, early-stage rNETs can harbor a risk of recurrence when unfavorable pathological features are present, highlighting the importance of tailored, risk-adapted surveillance strategies to optimize patient outcomes. Full article

Background/Objectives: Cancer immunotherapy has revolutionized the field of oncology by harnessing the immune system to attack cancer cells, increasing survival in a broad spectrum of malignancies. However, despite its positive therapeutic benefit, immunotherapy is also associated with a spectrum of adverse events affecting various vital organs, including the cardiovascular system. Methods: We conducted a comprehensive review of the available literature on the epidemiology, pathophysiological mechanisms, and current management approaches for cardiovascular adverse events associated with cancer immunotherapy. In addition, we evaluated emerging personalized strategies and interventions aimed at mitigating these risks and improving patient outcomes. Results: Immunotherapy is associated with a broad spectrum of potentially serious cardiovascular adverse events, including immune-mediated myocarditis, heart failure, arrhythmias, pericarditis, and accelerated atherosclerosis. Among these, immune checkpoint inhibitor-associated myocarditis is the most well characterized and potentially fatal form of cardiotoxicity, with reported mortality rates approaching 50%. Similarly, chimeric antigen receptor T-cell therapy, despite its powerful antitumor efficacy, is frequently associated with cytokine release syndrome—a profound immune activation that can lead to significant systemic and cardiovascular complications. In response to these challenges, several personalized strategies are currently under development, including artificial intelligence and machine learning approaches, genetic and transcriptomic profiling, novel biomarker discovery, and integrated risk scoring systems, all aimed at enhancing risk stratification and improving patient care. Conclusions: Cancer immunotherapy has been associated with a range of immune-related cardiac adverse events, both non-severe and severe. As such, it is critically important to adopt a personalized approach to patient management before, during, and after the administration of immunotherapy. Early recognition through heightened clinical vigilance, along with the implementation of individualized risk assessment tools, is essential for identifying patients at high risk of immunotherapy-induced cardiotoxicity. These strategies are imperative for optimizing patient outcomes and ensuring safe and effective cancer treatment. Full article

Background/Objectives: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is rising rapidly and disproportionately affects Hispanic/Latino (H/L) populations. While FOLFOX is a standard first-line chemotherapy, its impact on tumor genomics in EOCRC remains poorly understood. Given the central role of WNT signaling in colorectal cancer (CRC), we aimed to characterize WNT pathway alterations in EOCRC across diverse populations and assess their associations with FOLFOX treatment and clinical outcomes. Methods: Somatic mutation data from 2515 CRC patients (266 H/L, 2249 Non-Hispanic White [NHW]) were analyzed. Patients were stratified by age (EOCRC vs. late-onset colorectal cancer), ancestry (H/L vs. NHW), and FOLFOX treatment status. Mutation frequencies in WNT pathway genes were compared, and Kaplan–Meier analysis evaluated overall survival. Results: WNT pathway alterations were pervasive across groups, with APC mutations dominating. Notably, non-canonical WNT mutations (e.g., CTNNB1, RNF43) were significantly less frequent in FOLFOX-treated H/L EOCRC patients compared to untreated individuals, suggesting potential chemotherapy-driven selection. In NHW patients, FOLFOX treatment was associated with reduced mutation frequencies across multiple WNT regulators, which correlated with improved overall survival. Conclusions: Our findings reveal that WNT pathway dysregulation in EOCRC is shaped by ancestry, treatment status, and age. FOLFOX appears to reduce specific WNT alterations in H/L patients and broader WNT disruptions in NHW patients, with survival benefits observed primarily in the latter. These results underscore ancestry-specific molecular responses to chemotherapy and the need for precision oncology strategies tailored to high-risk populations. Full article

Perfusion assessment is critical in clinical oncology, particularly in tumor characterization, intraoperative decision making, and postoperative outcome predictions. Hyperspectral imaging (HSI) has emerged as a promising, non-contact, non-invasive, and contrast-free modality capable of capturing spatial and spectral information related to tissue oxygenation and hemoglobin distribution. This study provides an up-to-date review of recent advances in the use of HSI for perfusion monitoring in clinical oncological applications, with a special focus on its adoption in laparoscopic surgeries, brain tumor delineation, and head and neck cancer interventions. The integration of HSI into surgical workflows and its potential to reduce complications are discussed. Overall, while HSI is emerging as an appealing, real-time, quantitative perfusion imaging modality, a lack of standardized protocols and interpretation guidelines pose the most significant challenges. Addressing these gaps through multicenter clinical trials is essential for advancing the routine use of HSI in oncological surgery. Full article

Rectal cancer remains a significant clinical challenge due to its complex anatomy and the critical need to balance oncological radicality with functional preservation. Multimodal treatment strategies, including neoadjuvant therapy, advanced endoscopic techniques, and precise surgical approaches, have evolved to optimize patient outcomes. Neoadjuvant chemoradiotherapy improves resectability and local control in locally advanced tumors, while endoscopic treatment offers organ-preserving options for carefully selected early-stage cancers. Surgical resection, primarily through total mesorectal excision (TME), remains the cornerstone of curative therapy, with minimally invasive and transanal approaches enhancing precision and recovery. In advanced and recurrent cases, extended procedures such as pelvic exenteration provide potential for cure despite substantial morbidity. This review summarizes current evidence on the indications, techniques, and outcomes of neoadjuvant, endoscopic, and surgical treatments for rectal cancer, emphasizing individualized treatment planning to achieve optimal oncological and functional results. Full article

Cancer remains a leading global health challenge, with conventional diagnostic and treatment methods often lacking precision and adaptability. This review explores transformative advancements that are reshaping oncology by addressing these limitations. It begins with an overview of cancer’s complexity, emphasizing the shortcomings of conventional tools such as imaging and chemotherapy, which frequently fail to deliver targeted care. The discussion then shifts to biomarkers, which represent a groundbreaking frontier in early detection, enabling the identification of unique biological signatures that signal the presence of cancer with heightened sensitivity. Building on this foundation, the review examines personalized molecular therapies, which target the specific genetic and molecular vulnerabilities of tumors. These therapies not only enhance treatment efficacy but also minimize adverse effects, offering patients improved outcomes and quality of life. By integrating biomarker-driven diagnostics with tailored therapeutic strategies, a new paradigm of precision oncology emerges, bridging the gap between early detection and effective intervention. Real-world case studies highlight both successes, such as significantly improved survival rates, and persistent challenges, including accessibility and cost barriers. Looking ahead, the review outlines pathways by which to scale these innovations, emphasizing the critical need for robust infrastructure, sustained research investment, and equitable healthcare policies. It concludes by envisioning a future where biomarkers and personalized therapies converge to redefine cancer care, offering earlier detection, precise interventions, and better patient experiences. This work underscores the urgency of adopting cutting-edge approaches to overcome cancer’s persistent threats, paving the way for a more effective and humane era in oncology. Full article