Nevin Manimala

Clin Transl Oncol. 2025 Nov 23. doi: 10.1007/s12094-025-04127-1. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary objective of this study is to identify opportunities to improve clinical and comprehensive support of patients diagnosed with gynaecological cancers in Spain. Secondary objectives included identifying the unmet needs regarding awareness and access to screening strategies of gynaecological cancers in Spain.

METHODS: A mixed-methods design was used, combining qualitative and quantitative research in 235 participants. The qualitative component comprised semi-structured interviews and focus groups with 12 patients with gynaecological cancer, 6 caregivers, and 11 healthcare professionals. The quantitative component included anonymous surveys from 44 women with gynaecological cancer and 162 women from the general population. Descriptive statistics were applied.

RESULTS: The qualitative study revealed needs in prevention, early diagnosis, emotional support, nutrition, physical activity, and sexual health. Among surveyed patients, the mean knowledge of gynaecological cancer before diagnosis was low (2.3/6). Substantial limitations were reported after diagnosis in physical activity (59%), diet (43%), and sexual life (70%), and 55% experienced psychological consequences. Fifty-six percent reported insufficient non-pharmacological information from their healthcare team, and 59% sought support from patient associations. In the general population, 40% of women had never received information on gynaecological cancer.

CONCLUSIONS: Improving care for women with gynaecological cancers in Spain requires action at two levels: (1) strengthened early detection through awareness and screening strategies, and (2) expanded supportive services including nutrition, psycho-oncology, physical activity programmes, and sexual health interventions. Addressing taboos around women’s sexuality and leveraging patient associations and preferred communication channels should be priorities.

PMID:41275447 | DOI:10.1007/s12094-025-04127-1

Aesthetic Plast Surg. 2025 Nov 23. doi: 10.1007/s00266-025-05465-9. Online ahead of print.

ABSTRACT

BACKGROUND: The supraclavicular lateral incision approach offers a promising alternative to the conventional median incision in thyroid surgery, prioritizing cosmetic outcomes and quality of life (QoL) without compromising safety. This study evaluated its efficacy and impact on thyroid-specific QoL in patients undergoing thyroid lobectomy for unilateral papillary thyroid carcinoma (PTC).

METHODS: A prospective, nonrandomized study was conducted on 197 PTC patients, including 98 treated with the supraclavicular approach and 99 with the conventional approach. Demographic, clinicopathologic, operative, and postoperative data were collected. Cosmetic satisfaction was assessed at six months post-surgery using visual analog scales, while thyroid-specific QoL was evaluated with the validated T-QoL questionnaire. Statistical analyses compared outcomes between the two groups.

RESULTS: Both approaches achieved comparable surgical outcomes, with no significant differences in operation time, blood loss, or complication rates. The supraclavicular approach demonstrated superior cosmetic satisfaction scores for incision scars (median 9 vs. 6, P = 0.001). Although overall T-QoL scores were similar, psychological well-being was significantly better in the supraclavicular group (P = 0.036), with a trend toward improved social well-being (P = 0.066). No recurrences were observed during a median follow-up of 28 months.

CONCLUSIONS: The supraclavicular lateral incision approach offers enhanced cosmetic outcomes and mitigates QoL decline without increasing surgical risks. It serves as a feasible, cost-effective alternative to conventional and remote-access techniques, aligning with contemporary trends in minimally invasive thyroid surgery.

LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:41275446 | DOI:10.1007/s00266-025-05465-9

J Cancer Surviv. 2025 Nov 23. doi: 10.1007/s11764-025-01940-z. Online ahead of print.

ABSTRACT

PURPOSE: To examine labor force participation and employment income during early adulthood among childhood cancer survivors and matched cancer-free individuals in Canada.

METHODS: Children aged 0-14 diagnosed with cancer from 2000 to 2017 in Canada were identified from the Canadian Cancer Registry and matched to cancer-free individuals by birth year, sex, and region of Canada at age 18. Matched cohorts were generated for all cancers combined, by cancer type (hematologic/central nervous system [CNS]/solid), and age at cancer diagnosis (0-4, 5-9, 10-14 years). Using linked national tax records, we examined labor force participation (declared employment income of > $0) and employment income (2017 CAD) annually during adulthood (≥ 18 years) until 2017. Absolute and relative differences in outcomes between groups were investigated using generalized estimating equations.

RESULTS: Overall, 3635 childhood cancer survivors and 1,032,090 cancer-free individuals were included (median age by maximum follow-up: 22 years). During follow-up, survivors were 5% less likely to be employed (risk ratio [RR], 0.95; 95% CI 0.94, 0.96) and earned 6% lower income annually (ratio of income, 0.94; 95% CI 0.89, 0.98), after adjusting for age and period effects. The largest effect sizes were observed among CNS survivors (RR for, 0.89; 95% CI 0.87, 0.92; ratio of income, 0.77; 95% CI 0.67, 0.89).

CONCLUSIONS: In this pan-Canadian longitudinal matched cohort study, we observed differences in socioeconomic outcomes between adult-aged childhood cancer survivors and cancer-free individuals. Given the cohort’s young age, additional studies incorporating education data are warranted.

IMPLICATIONS FOR CANCER SURVIVORS: Childhood cancer can impact a survivor’s career path. This study provides insight into the financial trajectory of survivors in Canada.

PMID:41275443 | DOI:10.1007/s11764-025-01940-z

Ophthalmol Ther. 2025 Nov 23. doi: 10.1007/s40123-025-01275-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric patients with noninfectious uveitis refractory to standard therapies have limited options. Efficacy and safety of systemic tacrolimus, a calcineurin inhibitor used successfully in adult noninfectious uveitis as an adjuvant immunomodulatory treatment, was investigated in the pediatric population at our institution.

METHODS: This was a retrospective chart review of patients ≤ 18 years old diagnosed with noninfectious uveitis who were intolerant to or failed conventional systemic immunosuppressants between January 2014 and June 2025 at a tertiary referral center. The primary outcome was treatment success, defined as two or more of the following: ≤ 0.5+ anterior chamber cell, ≤ 2 drops of topical steroids per day per eye, improvement or resolution of vitritis, macular edema, papillitis, and angiographic leakage without addition of systemic therapy at 6 and 12 months after tacrolimus initiation. Secondary outcomes included need for dose reduction or discontinuation owing to adverse effects. Descriptive statistics were used to analyze the data.

RESULTS: Data from 11 patients, with median age of 10 years, were analyzed. Treatment success was achieved in 88.9% and 63.6% of patients at 6 and 12 months, respectively. Although seven patients experienced laboratory abnormalities, tacrolimus was not discontinued. An average tacrolimus dose of 0.16 mg/kg/day divided every 12 h achieved therapeutic tacrolimus levels. Median duration (range) of tacrolimus therapy was 24 months (4-93 months).

CONCLUSIONS: Tacrolimus may potentially be a well-tolerated, safe, and effective option for refractory cases of pediatric noninfectious uveitis.

PMID:41275437 | DOI:10.1007/s40123-025-01275-z

Eur J Pediatr. 2025 Nov 23;184(12):782. doi: 10.1007/s00431-025-06639-y.

ABSTRACT

The aim of this study was to assess the socio-economic burden on families of children diagnosed with inflammatory bowel diseases (IBD), particularly ulcerative colitis (UC), and Crohn’s disease (CD). The study was conducted at the 2nd Clinic of Paediatrics, Gastroenterology and Nutrition of Wroclaw Medical University. Anonymous questionnaires were completed by parents of paediatric IBD patients. The survey collected demographic, socio-economic, and treatment-related data. The study identified both material and non-material costs associated with IBD care. These included frequent private medical visits, medication, diet modifications, and transportation. Average monthly travel expenses were PLN 215.9 for UC and PLN 302.3 for CD (PLN = Polish zloty, 1 PLN = 0.25 euro). Limited access to paediatric gastroenterologists, especially in remote areas, led many families to seek private care, with associated monthly costs averaging PLN 312.3 for UC and PLN 513.3 for CD. Additionally, parents reported frequent work absences due to caregiving responsibilities, further impacting income and quality of life.

CONCLUSION: Childhood IBD imposes a considerable financial and psychosocial burden on families. The findings underscore the need for improved access to public healthcare services and financial support mechanisms to reduce the strain on affected families.

WHAT IS KNOWN: • Families of children with IBD (ulcerative colitis, Crohn’s disease) face significant costs related to medical care and lifestyle changes. • Limited access to specialised paediatric gastroenterologists and frequent absences from work add to the overall family burden.

WHAT IS NEW: • This study quantifies the monthly out-of-pocket travel and private care costs for paediatric IBD in Poland (PLN 215.9-513.3), previously rarely documented. • The findings highlight significant non-material impacts, such as caregiver work absences, further reducing family quality of life.

PMID:41275433 | DOI:10.1007/s00431-025-06639-y

Cancer Med. 2025 Nov;14(22):e71400. doi: 10.1002/cam4.71400.

ABSTRACT

OBJECTIVE: To examine the association between adverse childhood events (ACEs) and cannabis use among adult cancer survivors in the United States.

METHODS: We conducted a cross-sectional study of cancer survivors ≥ 18 years old using 2020 Behavioral Risk Factor Surveillance System data. ACEs were categorized as 0, 1, 2-3, and ≥ 4. Weighted multivariable logistic regression estimated the odds of cannabis use by ACE category.

RESULTS: Among 7896 cancer survivors, cannabis use prevalence was 6.0%. ACE distribution was 44.1% (0), 22.7% (1), 20.2% (2-3), and 13.0% (≥ 4). Cannabis use was more common among younger adults, Hispanics, never-married individuals, smokers, and those reporting fair/poor health. Compared to those with 0 ACEs, cancer survivors with 2-3 ACEs (aOR: 2.56, 95% CI: 1.57-4.27) and ≥ 4 ACEs (aOR: 4.10, 95% CI: 2.54-6.64) had significantly higher odds of cannabis use.

CONCLUSIONS: Cancer survivors with a higher number of ACEs reported increased odds of cannabis use. These findings support further study of ACEs and substance use in cancer survivors and may inform trauma-informed survivorship care.

PMID:41275428 | DOI:10.1002/cam4.71400

Cancer Med. 2025 Nov;14(22):e71380. doi: 10.1002/cam4.71380.

ABSTRACT

OBJECTIVE: This study examined all-cause and cause-specific cancer mortality among older migrants and non-migrants in Finland and the role of socioeconomic status in mortality differences.

METHODS: We used the Finnish Causes of Death Register on all deaths (2002-2020) among individuals aged ≥ 70 (N = 718,717) and the corresponding population-at-risk data (N = 13,241,620 person years). Poisson regression was used with two sequential models adjusting for age at death, calendar year, and region of residence in Finland (M1), and personal annual disposable income (M2).

RESULTS: We found an overall cancer mortality advantage for both migrant men (IRR in the full model 0.83, 95% CI: 0.78-0.89) and migrant women (IRR: 0.89, 95% CI: 0.83-0.95) and lung cancer mortality advantage for migrant men (IRR: 0.77, 95% CI: 0.67-0.89) and women (IRR: 0.67, 95% CI: 0.53-0.85). For migrant men, advantage was found in pancreatic cancer (IRR: 0.76, 95% CI: 0.58-0.99), prostate cancer (IRR: 0.78, 95% CI: 0.66-0.93), and leukaemia and lymphoma (IRR: 0.73, 95% CI: 0.58-0.93), and for women in genital cancers (IRR: 0.69, 95% CI: 0.55-0.86). Notable variations were observed by region of origin and in certain cases, migrants’ lower income obscured the full extent of their cancer mortality advantage. A mortality disadvantage was observed in stomach cancer among men (IRR: 2.76, 95% CI: 2.08-3.65) and women (IRR: 2.32, 95% CI: 1.79-3.00) born in the former USSR. Liver cancer mortality disadvantage was found for men from the Global South and East (IRR: 2.00, 95% CI: 1.10-3.61), and this association was attenuated after adjustment for personal disposable income. In cancers of the urinary tract, men born in Sweden had elevated mortality (IRR: 2.09, 95% CI: 1.14-3.81).

CONCLUSION: Finings underscore the need for targeted cancer prevention and screening programmes that account for the diverse backgrounds, sex, socioeconomic status, and health risks of migrant populations, particularly those from higher-risk regions.

PMID:41275426 | DOI:10.1002/cam4.71380

Ann Saudi Med. 2025 Nov-Dec;45(6):381-387. doi: 10.5144/0256-4947.2025.381. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Errors in clinical laboratory tests can have a detrimental effect on healthcare delivery. The pre-analytical phase accounts for most laboratory errors, known as pre-analytical errors (PAEs).

OBJECTIVE: This study investigated the causes and frequencies of PAEs occurring within a laboratory of a tertiary care hospital.

DESIGN: A single-center, retrospective, observational study.

SETTING: King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.

MATERIALS AND METHODS: All laboratory test orders and repeated or rejected specimens in the Laboratory Information System (LIS) during 2021. The data consisted of the types of PAEs, their distribution across laboratory sections, the patient source among hospital departments, and the working shift during which PAEs were recorded.

MAIN OUTCOME MEASURES: The causes and frequencies of PAEs across laboratory sections, hospital departments, and work shifts were analyzed.

SAMPLE SIZE: 2104 PAEs from a total of 3 346 199 test orders.

RESULTS: Of the 3 346 199 test orders, 3137 were recorded as either repeated or rejected. Of these, 2104 (67.1%) were attributed to PAEs, representing a rate of 0.063% (95% CI: 0.060-0.066%) of the total test orders. ‘Clotted specimens’ (32%) and ‘insufficient quantity’ (31%) were the most frequent PAEs. Significant differences were identified in the error rate and type of PAEs across laboratory sections, hospital departments, and working shifts (P<.001 for each). The highest error rate was in the blood bank (0.4%). The hematology section accounted for the largest proportion of errors (48.4%). Most PAEs were test orders from the inpatient department (47.3%), with a majority occurring in the morning shift (58.2%).

CONCLUSION: Our study revealed a low overall PAE rate of 0.063%. ‘Clotted specimens’ and ‘insufficient quantity’ were the most frequent errors. Importantly, we identified significant differences in the types of PAEs across laboratory sections, hospital departments, and working shifts, indicating their multifaceted and context-dependent nature.

LIMITATIONS: A retrospective, single-center study.

PMID:41275351 | DOI:10.5144/0256-4947.2025.381

Ann Saudi Med. 2025 Nov-Dec;45(6):388-394. doi: 10.5144/0256-4947.2025.388. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted cancer care, resulting in significant diagnostic delays.

OBJECTIVES: While prior studies have examined shifts in clinical stage, limited data exist on the pandemic’s effect on histopathological features and long-term survival in gastric cancer (GC). We aimed to address this gap through a comprehensive comparative analysis.

DESIGN: Retrospective cohort study.

SETTING: Tertiary-care center.

PATIENTS AND METHODS: This single-center study included 317 participants newly diagnosed with GC, divided into pre-pandemic (March 2018-March 2020) and pandemic (March 2020-March 2022) groups. Demographic, clinical, and detailed histopathological characteristics and 1- and 3-year overall survival (OS) rates were compared between groups.

MAIN OUTCOME MEASURES: Comparison of clinical stage, treatment modality, histopathological features, and 1- and 3-year overall survival between GC patients diagnosed before and during the COVID-19 pandemic.

SAMPLE SIZE: 317 patients.

RESULTS: The pandemic group exhibited a significantly higher rate of metastasis at diagnosis (38.0% vs. 26.9%; P=.035), lower rate of surgical resection (54.0% vs. 65.3%; P=.041), and higher rate of palliative therapy (44.0% vs. 31.1%; P=.018). Histopathologically, this cohort had a greater proportion of high-grade (G3) tumors (P=.014), lower median number of dissected lymph nodes (P=.002), and poorer response to neoadjuvant therapy (P=.025). Both 1- and 3-year OS were significantly lower in the pandemic group (P=.009 and .045, respectively).

CONCLUSIONS: The COVID-19 pandemic was associated with more advanced disease at diagnosis and significantly worse long-term survival for patients with GC. These outcomes appear to result from diagnostic and treatment delays rather than substantial changes in tumor biology. These findings underscore the need to establish resilient cancer care systems to reduce vulnerability during health crises.

LIMITATIONS: Single-center retrospective design and selection bias due to histopathological analyses being limited to surgically treated patients.

PMID:41275347 | DOI:10.5144/0256-4947.2025.388

Ann Saudi Med. 2025 Nov-Dec;45(6):421-434. doi: 10.5144/0256-4947.2025.421. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.

OBJECTIVES AND DESIGN: This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.

METHODS: A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.

MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.

SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).

RESULTS: ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.

QUALITY OF EVIDENCE: Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger’s regression test indicated a low risk of publication bias for LVEF.

HETEROGENEITY: High (I²=97%) for LVEF at 6 months.

CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.

LIMITATIONS: The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.

REGISTRATION: PROSPERO CRD42024555546.

PMID:41275346 | DOI:10.5144/0256-4947.2025.421