Tag: pubmed

JMIR Res Protoc. 2025 Jun 4;14:e67875. doi: 10.2196/67875.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) after radiotherapy (RT) in patients with breast cancer (BC) is a relatively new and understudied topic. AF can increase the risk of stroke and other serious cardiovascular complications, compromising patients’ quality of life and survival. Screening of AF, both asymptomatic and symptomatic forms, is therefore essential for optimal management.

OBJECTIVE: The aim of the Watch Your Heart After Radiotherapy for Breast Cancer (WATCH) study is to assess the incidence of AF (symptomatic or asymptomatic) occurring throughout a 5-year follow-up after RT and to investigate whether cardiac radiation exposure is associated with the occurrence of such events.

METHODS: WATCH is a cohort study that will include 200 patients over 65 years old, treated with RT for BC 5 years before inclusion and without a history of AF. Cross-sectional screening for AF at the time of the scheduled 5-year post-RT visit will be conducted by recording data from a Withings ScanWatch smartwatch for 1 month, confirmed by an electrocardiogram (ECG), and validated by a physician. In addition, a transthoracic echocardiography (TTE) will be performed, providing a comprehensive assessment of cardiac structures, and allowing us to investigate the underlying etiology and assess the risk of complications. Patients’ medical records will provide retrospective information about the timing and risk factors for the occurrence of AF and other arrhythmias and cardiac diseases during the 5 years following RT. The development of deep learning algorithms for autosegmentation analysis of potentially critical substructures for the occurrence of AF, including cardiac chambers, the sinoatrial node, the atrioventricular node, coronary arteries, and pulmonary veins (PVs), will produce dosimetry linked to previous RT treatment for all contoured structures.

RESULTS: Enrollment started in October 2023 and will continue until mid-2026 to include 200 patients, which will ensure an 80% statistical power to detect a significant difference in AF incidence around 15% for the group of patients moderately exposed (<75th percentile of the mean heart radiation dose) and 25% for the group of patients highly exposed (>75th percentile of the mean heart radiation dose). The results are expected by the end of 2026.

CONCLUSIONS: This study will contribute to generating new knowledge on AF after RT for BC and help considering the inclusion of AF screening into routine clinical practice for these patients. Identifying the dose-risk associations would improve RT delivery protocols to limit the occurrence of different forms of AF and, if necessary, initiate appropriate treatment.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06073509; clinicaltrials.gov/study/NCT06073509?id=NCT06073509&rank=1.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67875.

PMID:40466092 | DOI:10.2196/67875

N Engl J Med. 2025 Jun 5;392(21):2113-2124. doi: 10.1056/NEJMoa2414859.

ABSTRACT

BACKGROUND: The benefit of regional nodal irradiation in the treatment of breast cancer is well established for patients with pathologically positive axillary nodes, but whether it is also beneficial for patients whose nodes become pathologically tumor free (ypN0) after neoadjuvant chemotherapy remains unclear.

METHODS: We evaluated whether regional nodal irradiation improves outcomes in patients with biopsy-proven, node-positive breast cancer who reach ypN0 status after neoadjuvant chemotherapy. Patients with breast cancer with a clinical stage of T1 to T3 (tumor size, ≤2 cm to >5 cm), N1, and M0 (indicating spread to one to three axillary lymph nodes but no distant metastasis) who had ypN0 status after neoadjuvant chemotherapy were randomly assigned to receive regional nodal irradiation or no regional nodal irradiation. The primary end point was the interval of freedom from invasive breast cancer recurrence or death from breast cancer (invasive breast cancer recurrence-free interval). Secondary end points included the locoregional recurrence-free interval, the distant recurrence-free interval, disease-free survival, and overall survival. Safety was also assessed.

RESULTS: A total of 1641 patients were enrolled in the trial; 1556 were included in the primary-event analysis: 772 in the irradiation group and 784 in the no-irradiation group. After a median follow-up of 59.5 months, 109 primary end-point events (50 in the irradiation group and 59 in the no-irradiation group) had occurred. Regional nodal irradiation did not significantly increase the invasive breast cancer recurrence-free interval (hazard ratio, 0.88; 95% confidence interval, 0.60 to 1.28; P = 0.51). Point estimates of survival free from the primary end-point events were 92.7% in the irradiation group and 91.8% in the no-irradiation group. Regional nodal irradiation did not increase the locoregional recurrence-free interval, the distant recurrence-free interval, disease-free survival, or overall survival. No deaths related to the protocol-specified therapy were reported, and no unexpected adverse events were observed. Grade 4 adverse events occurred in 0.5% of patients in the irradiation group and 0.1% of those in the no-irradiation group.

CONCLUSIONS: The addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy. (Funded by the National Institutes of Health; NSABP B-51-Radiation Therapy Oncology Group 1304 ClinicalTrials.gov number, NCT01872975.).

PMID:40466065 | DOI:10.1056/NEJMoa2414859

JMIR Cancer. 2025 Jun 4;11:e67131. doi: 10.2196/67131.

ABSTRACT

BACKGROUND: Cancer imposes significant physical and emotional distress not only on patients, but also on their caregivers. In recent years, there has been a growing focus on the mental and physical well-being of caregivers. Among various psychological interventions, cognitive behavioral therapy (CBT) is widely recognized as one of the most effective approaches. However, traditional CBT is often limited by time and geographical constraints, resulting in delayed or inefficient support for caregivers. Internet-based cognitive behavioral therapy (ICBT) presents a valuable alternative for alleviating the caregiving burden and the negative emotions experienced by caregivers.

OBJECTIVES: This study aimed to provide a scoping review of ICBT interventions for caregivers of patients with cancer, examining intervention content, outcome measures, and effectiveness and to offer insights and references for the development and clinical applications of ICBT programs tailored to caregivers of patients with cancer in China.

METHODS: Relevant literature was systematically searched in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Journal Database. The search timeframe was from database inception to June 6, 2024. Inclusion criteria encompassed intervention studies that implemented cognitive behavioral therapy for caregivers of patients with cancer via the internet, WeChat (Tencent), or mobile electronic devices. This category includes both randomized and nonrandomized controlled trials.

RESULTS: A total of 12 studies met the criteria and were included in the review. The intervention content included the following components: treatment initiation and brief introduction (5/12, 41%), cognitive education and restructuring (7/12, 58%), emotional expression and coping (6/12, 50%), cognitive restructuring and reinforcement (4/12, 33%), behavioral training and activation (9/12, 75%), problem-solving techniques (4/12, 33%), communication (5/12, 41%), and completion of treatment with follow-up consolidation (3/12, 25%). The intervention duration typically ranged from 6 to 8 weeks. Outcome indicators encompassed feasibility and acceptability, anxiety, depression, caregiver burden, and quality of life. ICBT demonstrated positive effects for caregivers of patients with cancer. Most intervention programs were feasible and acceptable, with 2 out of 5 feasibility studies reporting recruitment rates below 50%. Attrition rates across studies ranged from 3% to 16%, and caregivers expressed satisfaction with the information, quality, and skills provided. ICBT exhibits a moderate effect in diminishing negative emotions among caregivers and alleviating caregiver stress. However, its impact on improving quality of life is not statistically significant, underscoring the need for long-term follow-up.

CONCLUSIONS: The implementation of ICBT for caregivers of patients with cancer has demonstrated beneficial outcomes, attributed to its practicality and flexibility, which contribute to its greater acceptance among caregivers. Nevertheless, there is significant heterogeneity in intervention format, duration, and outcome indicators. It is necessary to develop optimal intervention strategies and secure online platforms based on the cultural background in China to improve the quality of life of caregivers.

PMID:40466058 | DOI:10.2196/67131

JMIR Cancer. 2025 Jun 4;11:e67650. doi: 10.2196/67650.

ABSTRACT

BACKGROUND: Despite its potential to predict and detect early cancer risks, genetic testing remains underused by the public. This study, guided by the health belief model (HBM), examined key factors influencing an individual’s willingness to undergo genetic testing for cancer, with a particular focus on gender, caregiver status, and participation in online social support groups.

OBJECTIVE: This study aimed to explore the factors that can influence the individual’s decision to undergo preventative genetic testing for cancer so that more informed action can be taken to encourage the individuals to engage in preventative health behavior.

METHODS: This study uses data collected from the 2020 Health Information National Trends Survey (HINTS 5 Cycle 4), which included 2947 respondents representing 199,510,996 US adults aged 18 years and older. Multivariable logistic regression and survey-weighted generalized linear models were applied to examine the relationship between cancer genetic testing and caregiver status, participation in online support groups, gender, and constructs associated with the HBM, while controlling for sociodemographic and health-related characteristics.

RESULTS: Our findings show that women are more likely to undergo cancer genetic testing, with gender moderating the influence of perceived susceptibility (β=2.54, P=.03) and severity (β=0.94, P<.050) on testing decisions. In line with the HBM, perceived benefits (β=0.19, P=.03) and cues to action (β=2.86, P<.001) increase the likelihood of testing. Results also show that caregivers of patients with cancer (β=1.25, P=.04) and those actively participating in online health support groups (β=0.47, P=.04) are also more likely to engage in cancer genetic testing.

CONCLUSIONS: Cancer remains a significant health challenge in the United States, with 1.8 million new cases and 606,520 deaths annually. Early detection is vital for treatment success. This study investigates factors influencing the decision to undergo genetic testing for cancer. The examination of caregiver status and online support groups as influencing factors, along with the HBM, provided a significant theoretical contribution to the health care research domain. Results indicated that caregivers and men should be directly targeted with messaging on genetic cancer screening as a proactive health behavior. Additionally, online support groups can promote early detection and encourage participation in genetic testing. Future research should further explore implementing proactive outreach strategies to encourage wider adoption of genetic testing for cancer.

PMID:40466055 | DOI:10.2196/67650

Crit Care Explor. 2025 Jun 4;7(6):e1270. doi: 10.1097/CCE.0000000000001270. eCollection 2025 Jun 1.

ABSTRACT

IMPORTANCE: Epidemiological studies have highlighted disparities in illnesses and outcomes for critically unwell children.

OBJECTIVES: We aimed to describe social characteristics and explore links with the outcome of postoperative complications with children’s heart surgery.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a multicenter observational dataset including those under 17 years old undergoing heart surgery from October 2015 to June 2017 at five U.K. children’s cardiac centers.

MAIN OUTCOMES AND MEASURES: Univariate and multivariable multinomial regression analyses were undertaken for the outcome of predefined postoperative complications.

RESULTS: Of 2898 cases meeting criteria, 2708 had complete data. Two thousand one hundred three (77.66%) had no complications, 369 (13.62%) had a single complication, 56 (2.06%) received Extracorporeal Life Support, and 179 (6.61%) had multiple complications. Children residing in low deprivation neighborhoods were under-represented: lowest quintile 361 (13.33%). Minoritized ethnic group was strongly linked to indices of deprivation: residence in neighborhoods with highest deprivation occurred with Bangladeshi, Black African, and Pakistani ethnicity and lowest deprivation with White ethnicities. Adjusted for clinical risk factors compared with the reference group (White), patients from Asian background had a significantly higher risk of developing single vs. no complications (odds ratio [OR], 1.53; 95% CI, 1.00-2.32) and Black patients had a higher risk of developing multiple vs. no complications (OR, 2.19; 95% CI, 1.09-4.41). Among single complications, Asian children had a higher risk of developing feeding issues (OR, 2.07; 95% CI, 1.13-3.28).

CONCLUSIONS AND RELEVANCE: Ethnicity and socioeconomic deprivation may be linked to greater risk of certain complications after pediatric cardiac surgery. Further exploration of inequities is needed in this population.

PMID:40466039 | DOI:10.1097/CCE.0000000000001270

Crit Care Explor. 2025 Jun 4;7(6):e1271. doi: 10.1097/CCE.0000000000001271. eCollection 2025 Jun 1.

ABSTRACT

OBJECTIVES: To evaluate the safety and efficacy of an early chest tube removal protocol in reducing tube duration without increasing complications following pediatric cardiac surgery.

DESIGN: A single-center, randomized controlled trial.

SETTING: Pediatric cardiac ICU.

PATIENTS: Two hundred fifteen pediatric patients with chest tubes after cardiac surgery.

INTERVENTIONS: Patients were randomized to early removal (drainage threshold < 6 mL/kg over 8 hr) or late removal (24-hr assessment) groups. Primary outcomes included chest tube duration, whereas secondary outcomes encompassed ICU stay, ventilation time, hospital stay, and complication rates.

MEASUREMENTS AND MAIN RESULTS: Median chest tube duration was significantly shorter in the early removal group (3 d) compared with the late removal group (4.9 d; p < 0.0001). Rates of fluid reaccumulation and pneumothorax were low and comparable between groups. Notably, no patients in either group required tube reinsertion. ICU and total hospital stay durations were similar across groups.

CONCLUSIONS: An early chest tube removal protocol following pediatric cardiac surgery suggests a reduction in chest tube duration without increasing the risk of complications. These findings support the adoption of an evidence-based early removal approach to enhance patient comfort and optimize ICU resource utilization in pediatric cardiac surgery patients.

PMID:40466038 | DOI:10.1097/CCE.0000000000001271

J Gerontol A Biol Sci Med Sci. 2025 Jun 4:glaf102. doi: 10.1093/gerona/glaf102. Online ahead of print.

ABSTRACT

BACKGROUND: The relationships of joint exposure to various outdoor and indoor environmental factors with the risk of frailty and mortality remain unclear.

METHODS: Based on the China Health and Retirement Longitudinal Study, we enrolled 13745 participants in the final analysis. The living environmental score incorporated seven factors: ambient fine particulate matter, residential greenness, household fuel use, indoor temperature, water sources, building types, and household cleanliness (ranged from 0 to 8). Frailty was assessed by a 40-item deficit-accumulation frailty index. Cox proportional hazards regressions were used to assess the longitudinal associations of individual and joint exposure to living environmental factors with risk of frailty and mortality.

RESULTS: In this prospective study, 3389 participants developed frailty and 815 died during a 7-year follow-up. A higher living environmental score was linked to reduced risks of frailty (hazard ratio (HR): 0.872, 95% CI: 0.854-0.890) and mortality (HR: 0.893, 95% CI: 0.856-0.932). Population-attributable fraction analyses revealed that 23.5% of frailty and 17.2% of deaths could be attributed to lower living environmental scores. For single factors, solid fuel use and PM2.5 exposure had the greatest attribution to incident frailty and all-cause mortality, respectively. The effects of low living environmental score on all-cause mortality were mediated via frailty.

CONCLUSION: Multiple living environmental risk factors were separately and jointly associated with increased risks of frailty and mortality in an additive manner, emphasizing the importance of comprehensively assessing various environmental factors to promote healthy aging.

PMID:40466023 | DOI:10.1093/gerona/glaf102

JCO Glob Oncol. 2025 Jun;11:e2400535. doi: 10.1200/GO-24-00535. Epub 2025 Jun 4.

ABSTRACT

PURPOSE: Cancer patient navigation (CPN) training programs in the United States do not address the unique challenges of limited-resource settings. This study evaluates knowledge acquisition, utilization, and participant feedback from the Caribbean Cancer Research Institute’s (CCRI) CPN training program, which trained participants from the Caribbean, Botswana, and Kenya between 2018 and 2023.

METHODS: The CCRI conducted in-person CPN training in 2018 and 2019, paused in 2020 because of the COVID-19 pandemic, and transitioned to a virtual format in 2021. The program, delivered annually, expanded its curriculum and included participants from Kenya and Botswana. Knowledge acquisition was assessed through a 60-question pretest and post-test, and a 23-question program evaluation survey measured participant satisfaction. A follow-up eight-question survey assessed knowledge utilization. Summary statistics were used to describe participant demographics and survey responses, whereas paired t-tests were used to compare pretest and post-test scores.

RESULTS: The virtual, self-paced CCRI CPN Training Program covered 11 topics over 12 hours. Between 2018 and 2023, 55 participants enrolled: 80% (n = 44) passed, 18% (n = 10) failed, and 2% (n = 1) did not complete the course. Most participants (95%, n = 52) were from the Caribbean, with 80% (n = 44) from Trinidad and Tobago. Three participants were from Botswana and Kenya. The majority were female (98%, n = 54) and nurses (36%, n = 20), and did not have a personal history of cancer (89%, n = 49). Significant knowledge gains (P < .001) were observed across all years except 2023. Participants expressed high satisfaction and suggested improvements. Twenty-two percent (n = 6 of 27) secured employment as patient navigators in oncology settings.

CONCLUSION: The CCRI CPN training program trained participants across the Caribbean and showed preliminary acceptability in Kenya and Botswana. Strengths include its low-cost, virtual, self-paced format, adaptability to limited-resource settings, and region-specific content. Future efforts will focus on updating training materials and expanding recruitment.

PMID:40466015 | DOI:10.1200/GO-24-00535

Rev Assoc Med Bras (1992). 2025 Jun 2;71(4):e20241894. doi: 10.1590/1806-9282.20241894. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Eating Pathology Symptoms Inventory within the Brazilian context. Specifically, it assessed the scale’s efficacy in measuring disordered eating behaviors, with an emphasis on binge eating, and investigated its relationship with food cravings.

METHODS: This cross-sectional study utilized data from a non-probabilistic convenience sample of 1,374 Brazilians. Confirmatory factor analysis and multiple-group confirmatory factor analysis were employed to examine the factor structure and assess invariance across groups with and without binge-eating symptoms. Reliability was evaluated using Cronbach’s alpha and McDonald’s omega, while external validity was assessed through Pearson’s correlations between Eating Pathology Symptoms Inventory and Food Cravings Questionnaire-Trait-reduced scores. Discriminant validity was analyzed using Welch’s t-test.

RESULTS: The confirmatory factor analysis supported the eight-factor model, demonstrating a good fit across the overall sample (Comparative Fit Index=0.936, root mean square error of approximation=0.057). Reliability analysis indicated high internal consistency, with Cronbach’s alpha and McDonald’s omega values ranging from 0.745 to 0.917. Multiple-group confirmatory factor analysis confirmed measurement invariance across groups with and without binge-eating symptoms. The Welch two-sample t-test showed significantly higher Eating Pathology Symptoms Inventory scores in the binge-eating group. Furthermore, Eating Pathology Symptoms Inventory subscales related to binge-eating behaviors exhibited strong correlations with food craving scores, supporting the scale’s external validity.

CONCLUSION: The Eating Pathology Symptoms Inventory demonstrates strong reliability and validity as a tool for assessing eating disorder symptoms in Brazil, with effectiveness in distinguishing binge-eating behaviors.

PMID:40466001 | DOI:10.1590/1806-9282.20241894

Rev Assoc Med Bras (1992). 2025 Jun 2;71(4):e20241760. doi: 10.1590/1806-9282.20241760. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this cross-sectional study was to identify genital hygiene behaviors and the influencing factors in a sample of women from the Turkish population.

METHODS: Data collection was conducted through an online survey distributed via WhatsApp and social media groups (n=357). The data were collected using the “Genital Hygiene Behaviors Scale.” Analyses were conducted using the Mann-Whitney U test, Kruskal-Wallis test, Spearman’s correlation, and robust analysis of variance.

RESULTS: The mean age of the women was 31.94±9.7 years; 66.1% were university graduates and 49.6% were married. The mean Genital Hygiene Behaviors Scale total score was 94.93±9.8. genital hygiene behaviors were found to be better among women who were older, who had a higher level of education, were employed, were married, who had received genital hygiene education, and who had a history of genital infections in the past year. Additionally, 38.7% of the women reported abnormal vaginal discharge, and those with abnormal discharge exhibited lower genital hygiene behavior scores. Women who practiced vaginal douching were found to exhibit less adequate genital hygiene behaviors. It was determined that the majority of women with a history of genital infections had not received genital hygiene education and obtained the lowest genital hygiene scores (p<0.05).

CONCLUSION: The findings obtained in the present study indicate that women in socioeconomically disadvantaged groups require more education on this subject and that healthcare professionals should seize every opportunity to provide education.

PMID:40465997 | DOI:10.1590/1806-9282.20241760