Category: Statistics

JMIR Public Health Surveill. 2026 Aug 19;12:e90734. doi: 10.2196/90734.

ABSTRACT

BACKGROUND: The range expansion of ticks transmitting zoonotic diseases in Canada poses challenges for public health surveillance. Active monitoring of where tick populations are emerging helps inform public health responses, but is resource intensive and logistically complex. Crowdsourced data may provide a cost-effective approach to augment surveillance. In this study, we assessed the value of crowdsourced data from eTick, a platform whereby the public submits tick photographs for expert identification.

OBJECTIVE: We aimed to (1) characterize spatial patterns of eTick submissions and identify socioecological factors associated with their occurrence and frequency, and (2) assess the ability of indicators derived from eTick to predict census subdivisions (CSDs) with established tick populations.

METHODS: We conducted a retrospective ecological assessment (2020-2023) for the effectiveness of crowdsourced data to detect established blacklegged tick (Ixodes scapularis) populations in Quebec, Canada. First, we applied a spatial scan approach to assess significantly high submission rates in human- and animal-origin data separately. Then, using zero-inflated regression models, we assessed socioecological factors associated with the occurrence and counts of tick submissions. Next, we used logistic regression models to assess the value of using eTick surveillance data to predict the presence of established tick populations, as documented by active surveillance. Finally, we calculated thresholds for eTick submissions to maximize sensitivity, specificity, or a balance of both metrics for detecting established tick populations, and developed scenarios to interpret linear predictors of submission counts across different socioecological contexts.

RESULTS: No clusters in submissions were detected for human and animal-origin data. However, high concentrations of ticks found on humans corresponded with areas reporting a high risk of Lyme disease. Tick submissions of animal origin extended beyond endemic areas, highlighting their complementary surveillance value. Zero-inflated models identified socioeconomic, climatic, and land cover factors significantly associated with submission rates. Logistic regression models, including significant socioecological factors, performed best to identify CSDs with established tick populations. Predictive performance was similar for ticks from humans (area under the curve [AUC] 0.86), animals (AUC 0.83), and all submissions combined (AUC 0.85). Using the best model adjusted for population size, median income, median age, and cumulative degree days above 0 °C, an optimal threshold of 3.32 crowdsourced tick submissions allowed the detection of CSDs with established tick populations while maximizing sensitivity and specificity (both 0.76).

CONCLUSIONS: This work introduces a framework for analyzing crowdsourced surveillance data by correcting for participation bias and benchmarking against active surveillance. Unlike approaches relying on traditional or unadjusted data, it incorporates socioecological factors associated with reporting. We show that crowdsourced data can yield reliable inferences about vector distributions and provide a methodological approach that could be applied across species and regions. Applied to eTick, it supports integration into surveillance systems to improve early detection, targeting interventions, and cost-effective monitoring of emerging risks by public health.

PMID:42617049 | DOI:10.2196/90734

JMIR Form Res. 2026 Aug 19;10:e86279. doi: 10.2196/86279.

ABSTRACT

BACKGROUND: Neighborhood disinvestment, characterized by built environment disrepair and deterioration, has been linked to health behaviors and outcomes, including cancer survival. However, disinvestment temporal dynamics, including time-lagged exposure estimates among colorectal cancer (CRC) cases, remain underexplored.

OBJECTIVE: This study aimed to describe and validate a spatiotemporal neighborhood audit protocol using Google Street View imagery, develop and compare predictive spatiotemporal models of neighborhood disinvestment, and examine time-lagged associations between disinvestment and CRC survival.

METHODS: We conducted 8256 virtual audits of Franklin County, Ohio, streetscapes sampled across locations and dates from 2009 to 2022 using 7 disinvestment indicators: garbage, graffiti, abandoned buildings, building conditions, yard conditions, road verge conditions, and large dumpsters. Of these, 5751 eligible location date audits were included. A neighborhood disinvestment score (NDS) was derived using item response theory. We fit spatiotemporal regression Kriging models with a simplified sum-metric covariance structure and compared two candidate models using out-of-sample root mean square prediction error (RMSPE): (1) a model incorporating major highways, waterways, and railways to define neighborhood boundaries, and (2) a traditional Kriging model allowing NDS to vary continuously across space and time. The best-fitting model was used to estimate NDS at the geocoded address and diagnosis date of 2727 CRC cases diagnosed from 2012 to 2019 and recorded within the Ohio Cancer Incidence Surveillance System. Covariates included age, sex, minoritized race-ethnicity, marital status, health insurance, and cancer stage at diagnosis (localized, regional, and distant). We built accelerated failure time models to estimate time ratios and 95% CIs for NDS averaged over 0-, 3-, 6-, 12-, 18-, and 24-month time lags. Models were adjusted for covariates. We tested stage by NDS interactions. Those alive through December 31, 2020, were right censored.

RESULTS: NDS exhibited substantial spatial but modest temporal variation, with spatial correlation measurable within 2.8 kilometers and temporal correlation up to 270 days. Traditional spatiotemporal Kriging outperformed the boundary-based model (RMSPE_traditional=0.651 vs RMSPE_boundary=0.662). NDS varied by season, with lower disinvestment scores in spring and summer compared with fall. The accelerated failure time CRC survival model indicates an interaction between NDS and stage at diagnosis for all NDS time lags tested; higher prediagnosis NDS was significantly associated with shorter survival only among those with regional and not among those with localized or distant stage at diagnosis. For example, with a 6-month prediagnosis averaged time lag, each standard deviation increase in NDS was associated with a time ratio of 0.628 (95% CI 0.436-0.904). Associations were largely identical across time lags.

CONCLUSIONS: The spatiotemporal neighborhood audit approach is feasible and efficient. NDS varies appreciably across season, was accurately estimated using regression Kriging, and time-lagged exposures from 0 to 24 months produced negligible change in the NDS-CRC survival association.

PMID:42617043 | DOI:10.2196/86279

J Cancer Res Ther. 2026 Apr 1;22(3):582-589. doi: 10.4103/jcrt.jcrt_1656_25. Epub 2026 Aug 14.

ABSTRACT

INTRODUCTION: Tumor-infiltrating lymphocytes (TILs) are emerging as key biomarkers in invasive breast carcinoma (IBC), reflecting the host immune response and influencing prognosis. While TILs are well-studied globally, data from the Indian subcontinent remains scarce. This study assesses stromal TILs (sTILs) and intratumoral TILs (iTILs) in an Indian cohort, investigating their associations with pathological features, clinical stage, and molecular subtypes.

METHODS: A retrospective observational study of consecutive IBC patients at a single Indian cancer center was conducted over two years and included. Demographic, pathological, and immunohistochemical (IHC) data (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 [HER2], Ki67 proliferation index) were collected. TILs were evaluated on Hematoxylin and eosin (H and E) slides using International TILs Working Group (ITILWG) guidelines: sTILs expressed as a percentage of stromal area and iTILs semi-quantitatively (0-300). Correlations and group comparisons were analyzed using Spearman’s rank correlation, Kruskal-Wallis tests, and multivariable linear regression.

RESULTS: A total of 326 patients were included. The median sTIL percentage was 7% (interquartile range [IQR] 5-38), and the median iTIL score was 60 (IQR 20-130). Higher median sTIL and iTIL levels were observed in triple-negative and HER2-enriched tumors, high-grade cancers, and hormone receptor-negative disease. Median sTIL percentages increased with tumor grade (grade 1: 5% [IQR 5-5]; grade 3: 35% [IQR 9-60]). Similar patterns were observed for iTILs. After Holm adjustment, associations with nuclear pleomorphism, mitotic activity, tumor grade, molecular subtype, Ki-67 category, and hormone receptor status remained statistically significant. In multivariable analyses using log-transformed TILs, molecular subtype and tumor grade were independently associated with higher sTIL and iTIL levels, while stage IV disease was associated with lower TIL levels compared with stage II.

CONCLUSIONS: This study confirms a strong correlation between sTILs and iTILs, suggesting sTIL assessment alone may suffice for routine practice. Higher TIL levels were significantly linked to more aggressive pathological features, such as higher tumor grade and triple-negative/HER2-enriched subtypes. While TIL levels varied with clinical stage, no consistent monotonic relationship was observed. Future research should integrate other biomarkers predictive of immunotherapy response and establish clinically actionable TIL cut-off values.

PMID:42617026 | DOI:10.4103/jcrt.jcrt_1656_25

J Cancer Res Ther. 2026 Apr 1;22(3):577-581. doi: 10.4103/jcrt.jcrt_296_26. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: Cancer-associated anorexia is common in patients with locally advanced head and neck cancer undergoing radiotherapy and contributes to nutritional decline, reduced treatment tolerance, and psychosocial distress. While megestrol acetate (MA) has been shown to improve appetite in various cancer populations, limited data exist on its impact on caregiver-related outcomes. This study evaluated the short-term effect of low-dose MA on patients’ appetite and caregivers’ eating-related distress.

METHODS: This prospective, single-arm observational study included 50 adult patients with histologically confirmed locally advanced head and neck squamous cell carcinoma experiencing treatment-related anorexia. Patients received oral MA 160 mg during radiotherapy for 10 days. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ; range 4-20), and caregiver distress was evaluated using the Eating Distress Scale (EDS). Baseline and 10-day follow-up scores were compared using paired statistical tests.

RESULTS: Mean SNAQ score increased significantly from 9.76 ± 1.59 at baseline to 14.32 ± 1.47 at follow-up [mean difference 4.56; 95% confidence interval (CI) 3.97-5.14; P = 0.001]. EDS scores decreased significantly from 30.32 ± 2.31 to 18.28 ± 4.59 (mean reduction 12.04; 95% CI 10.77-13.30; P = 0.001). Appetite improvement was observed despite advanced disease stage and compromised performance status.

CONCLUSIONS: Low-dose MA was associated with significant improvement in appetite and reduction in caregiver eating-related distress over a 10-day follow-up period. These findings suggest short-term symptomatic benefit and support the inclusion of caregiver-centered outcomes in supportive oncology research. Larger controlled studies with longer follow-up are warranted to validate these observations.

PMID:42617025 | DOI:10.4103/jcrt.jcrt_296_26

J Cancer Res Ther. 2026 Apr 1;22(3):571-576. doi: 10.4103/jcrt.jcrt_232_26. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: Deep inspiration breath-hold (DIBH) is widely used in left-sided breast cancer radiotherapy to reduce cardiac exposure. While its dosimetric benefits are well established, patient experience and radiotherapy technologist (RTT) perspectives remain less explored. This study aimed to evaluate patient-reported experiences and RTT perceptions of DIBH implementation in routine clinical practice.

METHODS: A prospective observational study was conducted involving 20 female patients with left-sided breast cancer treated using DIBH and six RTTs with 6-8 years of experience. Patient experience was assessed using a structured 15-item questionnaire covering understanding, comfort, breath-hold performance, and overall satisfaction. RTT perspectives were evaluated using a 12-item questionnaire addressing patient coaching, technical challenges, and satisfaction with DIBH implementation. Responses were recorded on a 5-point Likert scale and analyzed using descriptive statistics.

RESULTS: All patients reported a clear understanding of DIBH instructions and adequate staff guidance, with 100% agreement for both. Overall satisfaction was high (mean score 4.5 ± 0.5), and most patients reported that DIBH became easier with successive treatment sessions. However, variability was observed in physical comfort and breath-hold tolerance, with only 40% reporting complete comfort during breath-hold. Psychological stress prior to breath-hold was reported by 60% of patients. RTTs unanimously agreed that DIBH improved setup reproducibility and cone-beam computed tomography matching accuracy, though additional coaching requirements and occasional technical interruptions were reported.

CONCLUSION: DIBH is well accepted by patients and perceived by RTTs as beneficial for treatment accuracy. Its routine implementation requires ongoing patient coaching and workflow optimization to balance clinical benefit with operational efficiency.

PMID:42617024 | DOI:10.4103/jcrt.jcrt_232_26

J Cancer Res Ther. 2026 Apr 1;22(3):553-561. doi: 10.4103/jcrt.jcrt_1157_24. Epub 2026 Aug 14.

ABSTRACT

INTRODUCTION: A wide array of therapeutic options for the treatment of oral cancer induces stress, consequently exacerbating the condition.

AIM: The study aimed to assess the efficacy of a holistic approach to the survival of oral cancer patients and assess prognostic indicators.

MATERIAL AND METHODS: A retrospective study was conducted on 60 medical records of clinically and histopathologically confirmed cases of oral squamous cell carcinoma (OSCC) from January 2015 to December 2016. Out of 60 patients, 30 were participating in the 2-year Cancer Care program (group 1) and 30 were not participating (group 2). Data about prognostic indicators for survival were subjected to thorough statistical analysis.

RESULTS: The patients in group 1 had a younger mean age of 44.33 ± 8.66 years compared to group 2 with 51.20 ± 9.99 years. The mean survival time for group 1 was 81.60 ± 5.02 months and 66.00 ± 20.29 months in group 2 with a statistically significant difference. Group 2 had a higher risk of mortality, with a 1.31 relative risk and a 1.39 times higher probability of death than group 1. Cox regression analysis revealed that group 2 was significantly associated with the risk of OSCC.

CONCLUSION: The current study indicated that employing a holistic strategy is a successful approach for increasing the OS of patients with OSCC.

PMID:42617022 | DOI:10.4103/jcrt.jcrt_1157_24

J Cancer Res Ther. 2026 Apr 1;22(3):548-552. doi: 10.4103/jcrt.jcrt_2409_25. Epub 2026 Aug 14.

ABSTRACT

INTRODUCTION: Climate change is predominantly driven by human activity. The plethora of machines, gadgets, and devices in a radiation oncology department and the personnel can leave a significant carbon footprint. This article presents the details of the carbon footprint generated by a single tertiary care radiation oncology center with state-of-the-art equipment.

METHODS: We meticulously tabulated all the existing equipment at our center, including major treatment machines (Linac, simulator and brachytherapy machines) and units such as treatment planning system (TPS) and other associated computers, printers, and other electronic gadgets. We also recorded the to and from traveled time and distance of each department staff person from their residence to the hospital. Subsequently, Online tools/links and existing literature was used to convert the acquired parameters into CO 2 emission.

RESULTS: The total CO 2 emission in the year (related to electrical equipment being used) was 200.91 tCO 2 . In all, there are 15 departmental personnel working in our department. CO 2 emission from their daily commute to the hospital annually was 5.06 tCO 2 . The Carbon dioxide footprint generated by the patients and their attendants reporting to our center for daily radiotherapy treatment annually was 66.44 tCO 2 . In all, the total departmental cumulative CO2 emission of our department was 272.41 tCO 2 per year.

CONCLUSION: This article provides insight into the likely emission load from a radiation oncology setup. The radiation oncology community must take cognizance of these findings and work further toward reducing carbon emissions in their departmental workflow. This shall be our small but significant contribution towards making the world safer for future generations.

PMID:42617021 | DOI:10.4103/jcrt.jcrt_2409_25

J Cancer Res Ther. 2026 Apr 1;22(3):540-547. doi: 10.4103/jcrt.jcrt_1652_25. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: Gynecological malignancies, particularly ovarian and endometrial cancers, primarily contribute to cancer-related morbidity and mortality across the world and in India. Debulking surgery is still the cornerstone of treatment for advanced cases, but these procedures are associated with significant perioperative risks that can impact recovery and delay adjuvant therapy.

OBJECTIVE: This study intends to identify predictors of 30-day postoperative morbidity and 90-day mortality following debulking surgeries for gynecological malignancies in an Indian tertiary care setting.

METHODS: A retrospective observational study was conducted at the National Cancer Institute, AIIMS Jhajjar, including 100 patients who underwent debulking surgery for ovarian, endometrial, or cervical malignancies between January 2022 and June 2023. Data on demographics, disease stage, surgical details, intraoperative events, and postoperative outcomes were collected. Univariate and multivariable logistic regression analyses were performed to identify significant predictors of morbidity and mortality.

RESULTS: Major 30-day morbidity occurred in 42% of patients, while no 90-day mortality was noted. On univariate analysis, surgical duration >300 min (odds ratio (OR) 2.72[95% confidence interval {CI} 1.15 to 6.44]; P = 0.021), sustained hypotension (OR 2.67[95% CI 1.05 to 6.75]; P = 0.035), blood loss ≥500 ml (OR 2.56[95% CI 1.11 to 5.89]; P = 0.025), and intraoperative blood transfusion (OR 3.70[95% CI 1.60 to 8.53]; P = 0.002) were significantly associated with increased morbidity. Multivariable analysis revealed that intermediate or high surgical complexity was protective against 30-day morbidity (OR 0.163 [95% CI 0.034 to 0.792]; P = 0.025), which can be attributed to careful patient selection and better perioperative optimization of high-risk patients.

CONCLUSION: Prolonged surgery, increased blood loss, and hemodynamic instability are decisive predictors of postoperative morbidity. Selection and perioperative optimization enable safe performance of complex debulking procedures in appropriate patients. Employing structured risk stratification and targeted perioperative interventions is essential for improving postoperative outcomes in this population. Prospective validation and assessment of these strategies should be emphasized.

PMID:42617020 | DOI:10.4103/jcrt.jcrt_1652_25

J Cancer Res Ther. 2026 Apr 1;22(3):525-530. doi: 10.4103/jcrt.jcrt_1710_25. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: Non-Small Cell Lung Carcinoma (NSCLC) is frequently associated with driver mutations in the epidermal growth factor receptor (EGFR) gene. Activating EGFR mutations occur in approximately 14-38% of NSCLC cases, with common mutations-exon 19 deletions and exon 21 L858R-accounting for nearly 90%. Uncommon mutations, including G719X, S768I, L861Q, and exon 20 insertions (Ins20), excluding T790M, comprise about 10-15% and are increasingly recognized for their therapeutic implications.

METHODS: This retrospective study profiled uncommon EGFR mutations in NSCLC patients at a tertiary cancer care center. EGFR mutation testing was performed on 4463 samples using a commercial detection kit. Statistical analyses were conducted using Python 3, with P < 0.05 considered significant.

RESULTS: EGFR mutations were identified in 32.2% (1441/4463) of cases, of which 85.37% were common and 9.92% were uncommon (excluding T790M). Among uncommon mutations, 77.7% were single and 22.2% were compound. The most frequent single mutation was Ins20 (27%), followed by L861Q (25.7%) and G719X (20.8%). These mutations were most common in patients aged 51-70 years, predominantly with adenocarcinoma histology. Nodal staging was available for 118 patients, while both nodal and treatment data were available for 112. No significant association was observed between mutation subtype and nodal staging (P = 0.918). However, a significant correlation was found between mutation subtype, distant metastasis, and treatment modality (P < 0.001).

CONCLUSIONS: Uncommon EGFR mutations in NSCLC are associated with advanced-stage presentation. While nodal staging is independent of mutation subtype, treatment strategies are strongly genotype-driven, underscoring the importance of precise molecular characterization.

PMID:42617018 | DOI:10.4103/jcrt.jcrt_1710_25

J Cancer Res Ther. 2026 Apr 1;22(3):516-524. doi: 10.4103/jcrt.jcrt_1936_25. Epub 2026 Aug 14.

ABSTRACT

INTRODUCTION: Carcinoma breast is now one of the leading causes of cancer-related deaths in women. It is categorized into various subtypes based on molecular typing and immunohistochemistry. It is crucial to study these subtypes to ensure early diagnosis and treatment. Therefore, our study aims to assess the histopathological and molecular subtypes of invasive breast cancers and their association with E-Cadherin expression.

MATERIALS AND METHODS: A cross-sectional study was conducted on 90 cases of invasive breast carcinoma. Immunohistochemistry was performed for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, Ki-67, and E-Cadherin. Molecular subtypes were classified as Luminal A, Luminal B, HER2/neu enriched, and Triple-negative. E-Cadherin expression was categorized as positive (2+/3+) or negative (0/1+). Associations were analyzed using Chi-square test, one-way analysis of variance, and independent t-test. A P < 0.05 was considered statistically significant.

RESULTS: ER positivity was observed in 57.8%, PR in 44.4%, HER2/neu in 21.1%, E-Cadherin positivity in 66.7%, and high Ki-67 (>15%) in 52.2% of cases. Molecular subtypes included Luminal A (44.4%), Luminal B (16.7%), HER2/neu enriched (14.4%), and Triple-negative (24.4%). Molecular subtype was significantly associated with lymph node involvement (P < 0.001), lymphatic invasion (P < 0.001), vascular invasion (P = 0.043), and perineural invasion (P < 0.001). E-Cadherin expression showed strong association with molecular subtype (P < 0.001). Loss of E-Cadherin was most frequent in Triple-negative tumors (81.8%) and HER2/neu enriched tumors. E-Cadherin loss was significantly associated with larger tumor size (P = 0.029), higher Nottingham grade (P = 0.026), and ER negativity (P = 0.024).

CONCLUSION: E-Cadherin loss is significantly associated with aggressive molecular subtypes and adverse histopathological features in invasive breast carcinoma, suggesting its potential relevance as a marker of tumor.

PMID:42617017 | DOI:10.4103/jcrt.jcrt_1936_25