Category: Nevin Manimala

JMIR Res Protoc. 2026 Aug 27;15:e92566. doi: 10.2196/92566.

ABSTRACT

BACKGROUND: Cancer-related pain remains highly prevalent and frequently undertreated despite advances in oncological therapies and analgesic strategies. Multidisciplinary approaches are recommended to optimize complex cancer pain management and integrate supportive care; however, robust real-world evidence evaluating their measurable clinical and patient-reported impact remains limited. Structured multidisciplinary cancer pain committees may be associated with changes in pain outcomes, quality of life, and patient experience, but prospective evaluations in routine clinical practice are scarce.

OBJECTIVE: The primary objective of this study is to describe changes in pain intensity following multidisciplinary evaluation in patients with cancer-related pain. Secondary objectives include describing changes in quality of life, pain interference, opioid consumption, treatment-related adverse effects, and patient-reported experience measures (PREMs) following multidisciplinary cancer pain committee assessment.

METHODS: This is a prospective, single-center, longitudinal, observational pre-post study conducted in a tertiary university hospital. A total of 68 adult patients with cancer-related pain referred to a multidisciplinary cancer pain management committee will be consecutively included in the study. Clinical variables and patient-reported outcomes will be collected at baseline (T0, before committee evaluation) and at 60 days following multidisciplinary committee assessment (T1). The primary outcome measure will be the change in pain intensity measured using the visual analog scale. Secondary outcomes include pain interference assessed with the Brief Pain Inventory-Short Form; health-related quality of life measured with the EQ-5D; and opioid consumption, treatment-related adverse effects, and PREMs, including patient satisfaction, assessed using the Likert scale. Pre-post comparisons will be performed using paired statistical tests (2-tailed paired t test or Wilcoxon signed rank test, depending on data distribution). Statistical significance will be set at P<.05.

RESULTS: Participant recruitment began in July 2026. At the time of submission of this revised manuscript, 3 participants had been enrolled. Recruitment and follow-up are ongoing. Data collection is expected to continue through late 2027, and the primary study results are expected to be available in early 2028, following completion of data collection and statistical analysis.

CONCLUSIONS: This study will describe changes in clinical and patient-reported outcomes following multidisciplinary cancer pain committee assessment in routine clinical practice. Although causal inference is not possible because of the observational pre-post design, the findings may inform future optimization and evaluation of multidisciplinary cancer pain management pathways.

TRIAL REGISTRATION: OSF Registries ty5m9; https://osf.io/ty5m9.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92566.

PMID:42659650 | DOI:10.2196/92566

PLoS One. 2026 Aug 27;21(8):e0337982. doi: 10.1371/journal.pone.0337982. eCollection 2026.

ABSTRACT

The coefficient of variation (CV) is a frequently used standardized measure of variability that allows meaningful comparison among datasets measured using different scales or units. Although widely applied in practice, formal statistical inference for the CV under non-normal distributions has received limited attention. This study focuses on estimating the CV for the weighted exponential distribution under an adaptive Type-II hybrid progressive censoring scheme, which enhances the efficiency of life-testing experiments by balancing test duration and the number of observed failures. Both Bayesian and non-Bayesian frameworks are considered. Point estimation in the non-Bayesian framework is carried out using the maximum likelihood method, whereas interval estimates are constructed through the parametric bootstrap approach. For the Bayesian approach, posterior inference is performed through Markov chain Monte Carlo sampling with under appropriate gamma prior assumptions. To illustrate the implementation of the proposed procedures, a simulated dataset is analyzed, and a comprehensive Monte Carlo simulation study is subsequently conducted to evaluate the accuracy and efficiency of the estimators. According to the analysis, Bayesian estimators based on informative prior distributions yield more precise estimates of the CV.

PMID:42659621 | DOI:10.1371/journal.pone.0337982

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2500376. doi: 10.1200/CCI-25-00376. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: The National Cancer Institute Comorbidity Index (NCI-CI) captures patient-level comorbidity burden using diagnosis codes found in administrative claims or electronic health record (EHR) data. However, it is less well understood how claims- and EHR-based comorbidity measures compare. We determined the concordance between the claims-based and EHR-based NCI-CI using a linked data source.

MATERIALS AND METHODS: This study used a linkage of tumor registry, EHR, and Medicare claims data. Eligible patients were 65 years and older and were diagnosed and/or received their first course of treatment in 2019-2020. We formed comparison pairs determined by the data source, period relative to the diagnosis date, length of interval for calculating the index, and type of comorbidity index. The primary pair was the 12-month prediagnosis NCI-CI calculated using claims (NCI-CI_claims) and EHR (NCI-CI_EHR) data. We compared pairs using descriptive statistics, correlation coefficients, and histograms. We also identified patient-level factors associated with claims/EHR comorbidity discordance using models of categorical outcomes.

RESULTS: The final sample included 1,616 individuals. The median values for NCI-CI_claims and NCI-CI_EHR were 0.6 (range: 0-4.11) and 0.29 (range: 0-3.06), respectively. We identified moderate correlation (0.49-0.52) between the claims-based and EHR-based comorbidity measures across all comparison pairs. Among individuals with claims-based comorbidities, 32 percent did not report any of those comorbidities based on the EHR data. Older age (eg, age 80+ years) was positively associated with the odds of having a discordant pair.

CONCLUSION: In this study, we found moderate correlations between claims-based and EHR-based approaches to NCI comorbidity measures. Mean comorbidity index values were consistently higher using claims data potentially because of more complete capture of health care utilization and diagnoses outside of the hospital system using claims data.

PMID:42659595 | DOI:10.1200/CCI-25-00376

Obstet Gynecol. 2026 Aug 27. doi: 10.1097/AOG.0000000000006415. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between the Affordable Care Act (ACA) Medicaid expansion and severe maternal morbidity (SMM) during delivery hospitalization.

METHODS: This was a retrospective, repeated cross-sectional study using data from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All delivery hospitalizations from 2010 to 2018 were analyzed; of the 26 U.S. states included, 16 expanded Medicaid in January 2014 and 10 did not. The primary outcome was the SMM rate, as defined by Centers for Disease Control and Prevention criteria, exclusive of blood transfusion. We used a quasi-experimental design to compare changes in the SMM rate from preexpansion (2010-2013) to postexpansion (2015-2018) in states that expanded Medicaid compared with those that did not. Generalized synthetic control models were used to estimate the adjusted average treatment effect on the treated.

RESULTS: The study sample included 11.98 million delivery hospitalizations; among those hospitalized, 82,903 (69.2/10,000) experienced SMM. The ACA Medicaid expansion was associated with a 5.2% (95% CI, 2.1-8.2) increase in the proportion of delivery hospitalizations paid for by Medicaid, but not with any statistically significant change in the SMM rate (0.02%; 95% CI, -0.01 to 0.04). Results were consistent in the subgroup analyses by maternal race and ethnicity and in sensitivity analyses.

CONCLUSION: Expanded access to public health insurance was not associated with a reduction in SMM during delivery hospitalizations. Additional clinical and policy interventions may be required to improve maternal health outcomes.

PMID:42659592 | DOI:10.1097/AOG.0000000000006415

Obstet Gynecol. 2026 Aug 27. doi: 10.1097/AOG.0000000000006407. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess associations among maternal geographic residence, access to obstetric care, and nonspontaneous delivery, including labor induction and prelabor cesarean delivery, in individuals with low-risk term pregnancies.

METHODS: We analyzed cross-sectional 2022 National Center for Health Statistics natality data, restricted to individuals with healthy, low-risk, term (37-40 weeks of gestation) singleton births. Maternal residence was classified along the rural-urban continuum and county-level maternity care access designations. Deliveries were categorized as spontaneous (reference) or nonspontaneous (ie, clinician initiated) and further classified as induction or prelabor cesarean. Cox proportional hazards models (with data augmentation as appropriate) were used to estimate hazard ratios (HRs) adjusted for maternal age, race and ethnicity, prepregnancy body mass index (BMI), and cigarette smoking status.

RESULTS: Among 1,157,422 low-risk term births, residents of rural and limited-access counties had a higher incidence of nonspontaneous delivery, particularly at 39-40 weeks of gestation, compared with residents of urban and full-access counties (adjusted HR 1.22 in suburban to 1.42 in the most rural counties, P trend<.01; adjusted HR 1.25 in moderate- to 1.43 in no-access counties, P trend<.01). This finding was driven by induction (observed in 34.4% of full-term deliveries; adjusted HR 1.31 in suburban to 1.56 in the most rural counties; P trend<.01; adjusted HR 1.33 in moderate- to 1.52 in no-access counties, P trend<.01). The opposite pattern was observed for prelabor cesarean delivery (4.8% of deliveries; adjusted HR 0.69 in suburban to 0.61 in the most rural counties, P trend<.01; adjusted HR 0.70 in moderate- to 0.79 in no-access counties, P trend<.01). Associations for the rural-urban continuum were driven largely by maternity care access: adjusted HR 1.05 for nonspontaneous delivery in rural/full-access counties and 1.39 in urban-suburban/no-access counties compared with urban-suburban/full-access counties. All associations were attenuated at 37-38 weeks of gestation compared with 39-40 weeks.

CONCLUSION: Maternal residence and access to obstetric care were associated with the timing and method of delivery among individuals with low-risk pregnancies, possibly reflecting differences in health care system capacity and local practice norms. Declining local access to maternity care may contribute to increased reliance on labor induction in rural and limited-access settings.

PMID:42659590 | DOI:10.1097/AOG.0000000000006407

JCO Glob Oncol. 2026 Aug;12(8):e2600130. doi: 10.1200/GO-26-00130. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: Cancer imposes substantial economic burden through indirect costs associated with labor outcomes and productivity loss. This systematic review and meta-analysis quantifies labor and productivity outcomes among patients with cancer and survivors to inform economic evaluations and policy development.

METHODS: We systematically searched PubMed, EconLit, and Web of Science databases in June 2025 using cancer, productivity loss, and labor outcomes terminology. Peer-reviewed studies reporting eight outcomes were included. Following screening of 6,239 abstracts and full-text review of 358 articles, 144 studies from 27 countries met inclusion criteria for meta-analysis.

RESULTS: The available evidence skews strongly toward formal employment situations in high-income, Western countries. We estimate a 25% productivity loss due to absenteeism (95% CI, 18 to 32) and a 23% productivity loss due to presenteeism (95% CI, 21 to 26); working hours are reduced by 19% (95% CI, 14 to 24); the return-to-work rate is 47% (95% CI, 39 to 54) with a median time of 239 days for full return; the overall job loss rate is 9% (95% CI, 8 to 11; 35% for advanced cancer; 95% CI, 22 to 48); the unemployment rate is 29% (95% CI, 22 to 36); the long-term disability/pension use is 11% (95% CI, 0 to 22); and the early retirement rate is 14% (95% CI, 8 to 20). For each reported outcome, cancer’s productivity costs are observed to be more severe among women than men.

CONCLUSION: This represents the largest comprehensive meta-analysis of cancer-related labor outcomes to date. Estimated labor and productivity consequences are in line with previous research, but outcomes varied significantly by gender, cancer stage, geographic region, and time since diagnosis. Subgroup analysis provides nuanced insight into how these factors influence labor and productivity outcomes. These evidence-based estimates provide critical inputs for economic evaluations and support development of policies to maintain professional productivity among patients with cancer and survivors.

PMID:42659587 | DOI:10.1200/GO-26-00130

JCO Glob Oncol. 2026 Aug;12(8):e2600060. doi: 10.1200/GO-26-00060. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: Timely discussion of goals of care (GoC) between oncologists and patients with advanced cancer can improve end-of-life (EoL) decision making, ensuring that care aligns with individual preferences. However, barriers at multiple levels could limit timely EoL communication. This cross-sectional study examined oncologists’ perceptions of barriers to GoC discussions regarding EoL processes among patients in Puerto Rico.

METHODS: A 26-item questionnaire was distributed to oncologists in Puerto Rico, assessing three barrier domains (patient and family; physician; and systemic or external factors) and oncologists’ willingness to engage in GoC discussions. Data were collected between April 2024 and January 2025. Descriptive statistics were used to summarize oncologists’ characteristics. Differences in oncologists’ characteristics and willingness to engage in the decision-making process were assessed with the Mann-Whitney test (non-normally distributed data). Associations between barriers and oncologists’ characteristics, such as age and training, were explored.

RESULTS: A total of 60 oncologists across Puerto Rico (approximately 50% participation rate) completed the questionnaire. Over 65% identified patient- and family-related factors as the primary barriers to EoL discussions. Although 58.3% of oncologists had not received formal training in EoL, they did not perceive this as a significant barrier. Yet, those without formal training faced greater barriers.

CONCLUSION: Family and patient factors emerged as the predominant barriers. Despite oncologists’ willingness to engage in EoL discussions, the absence of formal training may hinder these conversations. Further research should focus on communication training and initiatives to provide oncologists, patients, and families with valuable resources for EoL decision making.

PMID:42659585 | DOI:10.1200/GO-26-00060

Am J Public Health. 2026 Aug 27:e1-e7. doi: 10.2105/AJPH.2026.308640. Online ahead of print.

ABSTRACT

Politicians and advocates across the political spectrum have called for health policy to follow the data. But the political implications of this claim depend on the data that are collected, the analysis methods used, and the standards for evidence that are applied or ignored. As the political nature of public health has come to the forefront of public policy, so has the political aspect of the statistics that underpin public health research and practice. Power and political economy have always shaped data, even when data are portrayed as technocratic and apolitical. Statistical methods are built on assumptions about the world, as they have been since their inception. And the demand for a specific type of causal or cost‒benefit evidence for some policies, or what counts as evidence, is a political, not technical, claim. Rather than attempting to claim legitimacy by retreating from the political aspects of public health, biostatisticians need to confront this role head-on, acknowledge the political and social structures that shape our work, and engage fully at the intersection of the political and the statistical. (Am J Public Health. Published online ahead of print August 27, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308640).

PMID:42659582 | DOI:10.2105/AJPH.2026.308640

J Clin Oncol. 2026 Aug 27:JCO2600161. doi: 10.1200/JCO-26-00161. Online ahead of print.

ABSTRACT

PURPOSE: Measurable residual disease (MRD) status after limited-duration treatment for chronic lymphocytic leukemia (CLL) strongly predicts survival times and is considered a surrogate end point. However, most prognostic indices, including the International Prognostic Index (CLL-IPI), rely solely on pretreatment features. To incorporate dynamic MRD data in prognostic models, the continuous individualized risk index (CIRI) was proposed in 2019. Since developed in the context of chemoimmunotherapy, we here propose a refined version of CIRI, in the context of fixed-duration targeted therapy, which includes MRD status at interim, end-of-treatment (EoT) and, in addition, 12-month post-EoT (CIRI2-CLL).

METHODS: After developing model parameters from the CLL8/10/11 and MURANO trials, we applied CIRI2-CLL to independent validation sets from the CLL14 (venetoclax-obinutuzumab v chlorambucil-obinutuzumab) and CLL13 (venetoclax-obinutuzumab with or without ibrutinib v chemoimmunotherapy) trials and assessed model calibration, stratification, and performance.

RESULTS: We compared CIRI2-CLL with individual indices and found good calibration with an approximately 5% difference between observed and predicted event probabilities for progression-free survival (PFS). CIRI2-CLL demonstrated superior performance compared with individual indices as measured by C-statistics between 0.82 and 0.98 at all time points, including MRD and CLL-IPI, improving PFS prediction by 14%-37% from 2 to 5 years. When stratifying patients by CIRI2-CLL into low-, intermediate-, and high-risk groups, the corresponding 3-year PFS rates were 100.0%, 70.2%, and 10.8%. Performance was maintained for overall survival.

CONCLUSION: These results validate CIRI2-CLL in the context of limited-duration CLL therapy. Our approach suggests the models’ adaptability to emerging additional longitudinal MRD and/or outcome data. By introducing CIRI2-CLL, we offer a dynamic tool for investigators to reliably identify patients with increased risk of disease relapse after limited-duration therapy with venetoclax and obinutuzumab, freely accessible at CIRI2 (Stanford University), with important implications for informed decision making and for future risk-adapted CLL trial design.

PMID:42659576 | DOI:10.1200/JCO-26-00161

Knee Surg Sports Traumatol Arthrosc. 2026 Aug 27. doi: 10.1002/ksa.70573. Online ahead of print.

ABSTRACT

PURPOSE: This study assessed the association between (1) annual and (2) cumulative surgeon volume and patient-reported outcome measures (PROMS) after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) using data from the UK Nonarthroplasty hip registry (NAHR).

METHODS: All hip arthroscopies (HAs) recorded in the UK NAHR between January 2012 and May 2023 were identified. Annual and cumulative consultant HA volume were derived for each case. International Hip Outcome Tool (iHOT)-12 and EuroQol-5 Dimensions (EQ-5D) index scores were captured preoperatively and at 6 and 12 months postoperatively. Multivariable linear regression models with restricted cubic splines were used to define associations between consultant annual and cumulative volume and outcome. The null hypothesis was that neither annual nor cumulative volume would be significantly associated with postoperative iHOT-12 or EQ-5D score change.

RESULTS: A total of 3531 HAs were identified (median age 36 years [IQR: 28-44], 62.4% female) from 76 contributing consultant surgeons. Median annual consultant HA volume was 51 (IQR: 22-102), and median cumulative volume was 163 (IQR: 57-404). Cumulative consultant volume of 170 HA cases demonstrated the lowest 12-month postoperative iHOT-12 score gain (29.6 [95%CI: 27.0-32.1]) compared to a cumulative consultant HA volume of 972 cases (35.2 [95%CI 32.1-38.3]), where the score difference became significant but remained below the minimal clinically important difference (MCID). No statistically significant relationship between consultant volume and EQ-5D Index were observed. Cases where the consultant had the highest cumulative volumes were younger (35.7 vs. 37.0 years, p = 0.03) and a greater proportion underwent excision of isolated cam impingement lesions (62.2% vs. 49.3% p = 0.001), compared to cases performed by the lowest volume consultants.

CONCLUSION: This study found a small but statistically significant association (below the MCID) between higher cumulative case volume and improved early functional outcome following HA. Highest-volume surgeons consistently treated younger patients with less-severe chondral damage.

LEVEL OF EVIDENCE: Level III.

PMID:42659574 | DOI:10.1002/ksa.70573