JRC recent publications

A healthy mind in a healthy ecosystem

Good mental health is essential for people to live healthy and happy lives. Across the EU, close to one in two people (46%) experienced an emotional or psychosocial problem in 2023. The total costs of mental health problems have been estimated at more than 4% of the GDP (or more than €600 billion) in 2015.

Environmental quality is known to affect mental health. Presence of nearby green areas can benefit mental health, while air pollution, noise and high temperatures can have a negative impact.

The COVID-19 pandemic has had a detrimental impact on European’s well-being. People were less able to visit parks during strict lockdowns, but green space exposure through private gardens might have had a protective effect on mental health.

Before the COVID-19 pandemic, environmental stressors, such as air pollution, and socio-economic deprivation were associated with increased utilisation of mental health services. On the other hand, presence and amount of trees, as well as sunlight, were associated with less mental health service utilisation, suggesting a possible protective role for these factors. Lockdown measures enforced during the pandemic modified such relationships.

Engaging citizens in research on the effect of the living environment on mental health demonstrated the importance of not only the physical attributes of the environment (e.g. amount of nearby green space) for well-being, but also their functional characteristics (e.g. opportunity for socialising) and its political dimension (e.g. urban planning).

Van Rijn, E. et al. European Commission, 2024, JRC136908

Non-Animal Methods in Science and Regulation

The 2023 EURL ECVAM Status Report outlines research and development activities, along with initiatives that foster the implementation and utilisation of non-animal methods and approaches in scientific research and regulation. The Three Rs principle, which advocates for Replacement, Reduction, and Refinement of animal use in basic, applied, and translational research, as well as for regulatory purposes, is firmly established in EU legislation, with the ultimate goal of fully replacing animal testing.

New approach methodologies encompassing a range of innovative technologies, including in vitro methods employing 3D tissues and cells, organ-on-chip technologies, computational models (including machine learning and artificial intelligence), and 'omics (transcriptomics and metabolomics), are developed, evaluated, and integrated into assessment frameworks in order to enhance the efficiency and effectiveness of hazard and risk assessment of chemicals and products across various regulatory contexts. Furthermore, substantial efforts are directed at promoting the development and utilisation of non-animal approaches in fundamental and applied research, where the majority of animal testing occurs, as well as for educational purposes. The achievements and accomplishments documented in this report are the culmination of collaborative efforts with EURL ECVAM's dedicated partners and stakeholders.

Zuang, V. et al. Publications Office of the European Union, Luxembourg, 2024, doi:10.2760/05390, JRC136460

Updated EUROCAT guidelines for classification of cases with congenital anomalies

Within the European Platform on Rare Diseases Registration, the JRC is operating the Central Registry of EUROCAT, a European network for surveillance of congenital anomalies. The network performs epidemiological surveillance of congenital anomalies to facilitate the identification of teratogenic exposures and to assess the impact of primary prevention and prenatal screening policies. The results of surveillance, including prevalence, prenatal detection rates and the evaluation of clusters and pan-European trends in major congenital anomalies across Europe, are publicly available on the EUROCAT website.

Precise and correct classification of congenital anomalies is important in epidemiological studies, not only to classify according to etiology, but also to group similar congenital anomalies together to create homogeneous subgroups for surveillance and research. The EUROCAT subgroups were defined grouping anomalies together because of shared etiological mechanisms or clinical characteristics. The EUROCAT multiple congenital anomaly (MCA) algorithm identifies cases with potential MCA, which is important for surveillance of new teratogenic exposures. Both are based on International Classification of Diseases (ICD10/ICD9) codes. They provide a standardized and clear methodology for congenital anomaly research that we hope will be adopted by other researchers in an international context.

Bergman, J.E. et al. Birth Defects Research, ISSN 2472-1727, 116 (2), 2024, p. e2314, JRC134429, DOI 10.1002/bdr2.2314 (online)

Uncovering inequalities: Colorectal cancer screening in Europe (pdf)

A new factsheet published in the European Cancer Inequalities Registry identifies inequalities related to colorectal cancer screening. There are differences between Member States in the implementation of screening schemes, their coverage, participation rates and programmes methods applied.

Milcamps A., et al., European Cancer Inequalities Registry (ECIR), European Commission, JRC137531

Cancer prevention

Lung cancer mortality trends among women across Spain: the role of birth cohorts in diverging regional patterns

Smoking among Spanish women has increased during the last 50 years and is considered by some authors a modern epidemic. However, mortality risk by cohorts may differ at a regional level, given that health inequalities (and the determinants of smoking and its consequences) are regionally patterned. We applied an Age-Period-Cohort model to identify birth cohort effects on female lung cancer mortality in Spain. We found a strong linear increase in lung cancer mortality during the 1980–2019 period in all regions. Cohorts born between 1935 and 1955 presented a higher relative risk of death at a national and subnational level. However, we found diverging cohort patterns across regions afterward, with some regions presenting a slight mortality improvement (or stagnation) in their youngest cohorts, while in other regions mortality kept increasing. This suggests that inequalities in lung cancer mortality in Spain among women are not only generationally based, but that generational risks also vary across space. Some of the regions that presented improvements in mortality among its younger cohorts are Madrid, Navarra, and the Basque Country, which are some of the wealthiest in the Country. While speculative, this could imply that improvements at a regional level might be associated with factors related to structural conditions that result in the adoption of healthy behaviors. © 2023, The Author(s).

Bramajo O., Journal of Population Research, 2024, Volume 41, Issue 1, Article number 2

Excess pancreatic cancer risk due to smoking and modifying effect of quitting smoking: The Multiethnic Cohort Study

Purpose: Risk factors for pancreatic cancer include racial/ethnic disparities and smoking. However, risk trajectories by smoking history and race/ethnicity are unknown. We examined the association of smoking with pancreatic cancer by race/ethnicity to generate age-specific incidence estimates by smoking history. Methods: We modeled pancreatic cancer incidence by race/ethnicity, age, pack-years, and years-quit using an excess relative risk model for 182,011 Multiethnic Cohort participants. We tested heterogeneity of smoking variables and pancreatic cancer by race/ethnicity and predicted incidence by smoking history. Results: We identified 1,831 incident pancreatic cancer cases over an average 19.3 years of follow-up. Associations of pack-years (p interaction by race/ethnicity = 0.41) and years-quit (p interaction = 0.83) with pancreatic cancer did not differ by race/ethnicity. Fifty pack-years smoked was associated with 91% increased risk (95% CI 54%, 127%) relative to never smokers in the combined sample. Every year quit corresponded to 9% decreased excess risk (95% CI 2%, 15%) from pack-years smoked. Differences in baseline pancreatic cancer risk across racial/ethnic groups (p < 0.001) translated to large differences in risk for smokers at older ages across racial/ethnic groups (65–122 cases per 100,000 at age 70). Conclusion: Smoking pack-years were positively associated with elevated pancreatic cancer risk. Predicted risk trajectories showed a high impact of smoking cessation at < 65 years. Although we did not identify significant heterogeneity in the association of pack-years or years quit with pancreatic cancer risk, current smoker risk varied greatly by race/ethnicity in later life due to large differences in baseline risk. © The Author(s) 2023.

Bogumil D. et al., Cancer Causes and Control, 2024, Volume 35, Issue 3, Pages 541-548

Walking pace and the time between the onset of noncommunicable diseases and mortality: a UK Biobank prospective cohort study

Purpose: To estimate time spent in various cardiovascular disease (CVD) and cancer states, according to self-reported walking pace. Methods: In total, 391,744 UK Biobank participants were included (median age = 57 years; 54.7% women). Data were collected 2006–2010, with follow-up collected in 2021. Usual walking pace was self-defined as slow, steady, average, or brisk. Multistate modeling determined the transition rate and mean sojourn time in and across three different states (healthy, CVD or cancer, and death) upon a time horizon of 10 years. Results: The mean sojourn time in the healthy state was longer, while that in the CVD or cancer state was shorter in individuals reporting an average or brisk walking pace (vs. slow). A 75-year-old woman reporting a brisk walking pace spent, on average, 8.4 years of the next 10 years in a healthy state; an additional 8.0 (95% CI: 7.3, 8.7) months longer than a 75-year-old woman reporting a slow walking pace. This corresponded to 4.3 (3.7, 4.9) fewer months living with CVD or cancer. Similar results were seen in men. Conclusions: Adults reporting an average or brisk walking pace at baseline displayed a lower transition to disease development and a greater proportion of life lived without CVD or cancer. Availability of data and materials: Research was conducted using the UK Biobank resource under Application #33266. The UK Biobank resource can be accessed by researchers on application. Variables derived for this study have been returned to the UK Biobank for future applicants to request. No additional data are available. © 2024 The Authors

Henson J. et al., Annals of Epidemiology, 2024, Volume 90, Pages 21 - 27

Impact of weight loss on cancer-related proteins in serum: results from a cluster randomised controlled trial of individuals with type 2 diabetes

Background: Type 2 diabetes is associated with higher risk of several cancer types. However, the biological intermediates driving this relationship are not fully understood. As novel interventions for treating and managing type 2 diabetes become increasingly available, whether they also disrupt the pathways leading to increased cancer risk is currently unknown. We investigated the effect of a type 2 diabetes intervention, in the form of intentional weight loss, on circulating proteins associated with cancer risk to gain insight into potential mechanisms linking type 2 diabetes and adiposity with cancer development. Methods: Fasting serum samples from participants with diabetes enrolled in the Diabetes Remission Clinical Trial (DiRECT) receiving the Counterweight-Plus weight-loss programme (intervention, N = 117, mean weight-loss 10 kg, 46% diabetes remission) or best-practice care by guidelines (control, N = 143, mean weight-loss 1 kg, 4% diabetes remission) were subject to proteomic analysis using the Olink Oncology-II platform (48% of participants were female; 52% male). To identify proteins which may be altered by the weight-loss intervention, the difference in protein levels between groups at baseline and 1 year was examined using linear regression. 

Mendelian randomization (MR) was performed to extend these results to evaluate cancer risk and elucidate possible biological mechanisms linking type 2 diabetes and cancer development. MR analyses were conducted using independent datasets, including large cancer meta-analyses, UK Biobank, and FinnGen, to estimate potential causal relationships between proteins modified during intentional weight loss and the risk of colorectal, breast, endometrial, gallbladder, liver, and pancreatic cancers. Findings: Nine proteins were modified by the intervention: glycoprotein Nmb; furin; Wnt inhibitory factor 1; toll-like receptor 3; pancreatic prohormone; erb-b2 receptor tyrosine kinase 2; hepatocyte growth factor; endothelial cell specific molecule 1 and Ret proto-oncogene (Holm corrected P-value <0.05). Mendelian randomization analyses indicated a causal relationship between predicted circulating furin and glycoprotein Nmb on breast cancer risk (odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.67–0.99, P-value = 0.03; and OR = 0.88, 95% CI = 0.78–0.99, P-value = 0.04 respectively), though these results were not supported in sensitivity analyses examining violations of MR assumptions. Interpretation: Intentional weight loss among individuals with recently diagnosed diabetes may modify levels of cancer-related proteins in serum. Further evaluation of the proteins identified in this analysis could reveal molecular pathways that mediate the effect of adiposity and type 2 diabetes on cancer risk. Funding: The main sources of funding for this work were Diabetes UK, Cancer Research UK, World Cancer Research Fund, and Wellcome. © 2024 The Author(s)

Bull C.J. et al., eBioMedicine, 2024, Volume 100, Article number 104977

Every tenth malignant solid tumor attributed to overweight and alcohol consumption: A population-based cohort study   

Background: Recent studies have shown that some four in ten cancers are attributable to a few key risk factors. The aim of this study was to estimate cohort-based population attributable fractions (PAFs) in Finland for potentially modifiable cancer risk factors. Methods: Data from eight health studies including 253,953 subjects with 29,802 incident malignant solid tumors were analysed using Bayesian multivariate regression model with multiplicative risk factor effects. We estimated the effects of smoking, excess body weight, alcohol consumption, physical activity, parity and education on cancer incidence and related PAFs by cancer site, accounting for competing mortality. Results: PAF for all cancer sites and exposures combined was 34% (95% credible interval 29%−39%) in men and 24% (19%−28%) in women. In men, 23% (21%−27%) and in women 8% (6%−9%) of all cancers were attributed to smoking. PAF related to excess body weight was 4% (2%−6%) in men and 5% (2%−7%) in women, to alcohol 7% (3%−10%) in men and 4% (0%−7%) in women, and to excess body weight and alcohol combined 10% (6%−15%) in men and 9% (4%−13%) in women. Conclusion: Smoking was the most important factor contributing to cancer burden in Finnish men and women over the last 40 years. The contribution of excess body weight and alcohol consumption together outweighed the role of smoking in women. As the prevalence of overweight is expected to increase, more efficient public health measures supporting adherence to healthy weight are essential to reduce cancer burden. © 2024 The Authors

Seppä K. et al., European Journal of Cancer, 2024, Volume 198, Article number 113502

Toxicological Aspects Associated with Consumption from Electronic Nicotine Delivery System (ENDS): Focus on Heavy Metals Exposure and Cancer Risk

Tobacco smoking remains one of the leading causes of premature death worldwide. Electronic Nicotine Delivery Systems (ENDSs) are proposed as a tool for smoking cessation. In the last few years, a growing number of different types of ENDSs were launched onto the market. Despite the manufacturing differences, ENDSs can be classified as “liquid e-cigarettes” (e-cigs) equipped with an atomizer that vaporizes a liquid composed of vegetable glycerin (VG), polypropylene glycol (PG), and nicotine, with the possible addition of flavorings; otherwise, the “heated tobacco products” (HTPs) heat tobacco sticks through contact with an electronic heating metal element. The presence of some metals in the heating systems, as well as in solder joints, involves the possibility that heavy metal ions can move from these components to the liquid, or they can be adsorbed into the tobacco stick from the heating blade in the case of HTPs. Recent evidence has indicated the presence of heavy metals in the refill liquids and in the mainstream such as arsenic (As), cadmium (Cd), chromium (Cr), nickel (Ni), copper (Cu), and lead (Pb). The present review discusses the toxicological aspects associated with the exposition of heavy metals by consumption from ENDSs, focusing on metal carcinogenesis risk. © 2024 by the authors.

Granata S. et al., International Journal of Molecular Sciences, 2024, Volume 25, Issue 5, Article number 2737

Elucidating the link between thyroid cancer and mercury exposure: a review and meta-analysis

Mercury (Hg) is a widely distributed and bioavailable metal of public health concern, with many known human toxicities, but data regarding mercury's influence on thyroid cancer (TC) is scarce. Mercury is known to impact several molecular pathways implicated in carcinogenesis, and its proclivity for bioaccumulation in the thyroid suggests a potential modulatory effect. We conducted a literature/systematic review of studies between 1995–2022 intending to define better and establish relationships between these two entities, congregate the evidence for mercury's potential role in thyroid carcinogenesis, and identify populations of interest for further study. Insufficient evidence precludes definitive conclusions on dietary mercury as a TC risk factor; however, several common mechanisms affected by mercury are crucial for TC development, including biochemical, endocrine, and reactive oxygen species effects. Quantitative analysis revealed associations between TC risk and mercury exposure. In three mercury studies, average urine levels were higher in TC patients, with a mean difference of 1.86 µg/g creatinine (95% CI = 0.32–3.41). In two studies investigating exposure to elevated mercury levels, the exposed group exhibited a higher risk of developing TC, with a relative risk of 1.90 (95% CI = 1.76–2.06). In three thyroid tissue studies, mercury levels (ppm) were higher in TC patients, averaging 0.14 (0.06–0.22) in cancerous cases (N = 178) and 0.08 (0.04–0.11) in normal thyroids (N = 257). Our findings suggest an association between mercury exposure and TC risk, implying a possible predisposing factor. Further research is necessary to reveal the clinical relevance of dietary and environmental mercury exposures in TC pathogenesis. © The Author(s) 2024.

Webster A.M. et al., Environmental Science and Pollution Research, 2024, Volume 31, Issue 9, Pages 12841- 12855

The obesity-autophagy-cancer axis: Mechanistic insights and therapeutic perspectives

Autophagy, a self-degradative process vital for cellular homeostasis, plays a significant role in adipose tissue metabolism and tumorigenesis. This review aims to elucidate the complex interplay between autophagy, obesity, and cancer development, with a specific emphasis on how obesity-driven changes affect the regulation of autophagy and subsequent implications for cancer risk. The burgeoning epidemic of obesity underscores the relevance of this research, particularly given the established links between obesity, autophagy, and various cancers. Our exploration delves into hormonal influence, notably INS (insulin) and LEP (leptin), on obesity and autophagy interactions. Further, we draw attention to the latest findings on molecular factors linking obesity to cancer, including hormonal changes, altered metabolism, and secretory autophagy. We posit that targeting autophagy modulation may offer a potent therapeutic approach for obesity-associated cancer, pointing to promising advancements in nanocarrier-based targeted therapies for autophagy modulation. However, we also recognize the challenges inherent to these approaches, particularly concerning their precision, control, and the dual roles autophagy can play in cancer. Future research directions include identifying novel biomarkers, refining targeted therapies, and harmonizing these approaches with precision medicine principles, thereby contributing to a more personalized, effective treatment paradigm for obesity-mediated cancer. © 2024 The Authors.

Behrooz A.B. et al., Seminars in Cancer Biology, 2024, Volume 99, Pages 24-44

Physical Activity, Insulin Resistance and Cancer: A Systematic Review

Introduction: Insulin resistance (IR), a key aspect of type 2 diabetes and a defining characteristic of obesity and its associated conditions, emerges as a mechanistic pathway potentially implicated in cancer pathophysiology. This presents an appealing intervention target for cancer patients. The objective of this study is to conduct a systematic review, examining the scientific evidence regarding the impact of physical activity on modifying insulin resistance in individuals with cancer. Methods: The selection criteria were specific: only randomized controlled clinical trials published in the last 13 years and written in English or Spanish were included. The databases utilized for the search included PubMed, Scopus, Cochrane Library, EBSCO, and WEB OF SCIENCE. The protocol for this review was duly registered in the International Register of Systematic Reviews (CRD42023435002). 

The final search was conducted on 14 May 2023. Results: The outcomes were assessed using the tool proposed by the Cochrane Handbook to evaluate the risk of bias in the included studies. Among the 12 studies incorporated, 8 demonstrated a low risk of bias, two had an unclear risk of bias, and the remaining two showed a high risk of bias. The variety of exercise types used across all studies was extensive, making definitive conclusions challenging. Physical activity was linked to enhanced insulin sensitivity in seven studies, while five studies showed no significant changes in insulin resistance between the intervention and control groups. Importantly, none of the interventions employed in the included studies exhibited adverse effects on the study participants. Conclusions: The role of exercise as a medicine against insulin resistance has been evidenced in many different studies, mostly related to obesity and cardiovascular diseases. Engaging in physical activity could be a healthy option to combat the effects of insulin resistance in cancer patients, although evidence is weak and limited, according to the results of our systemic review. We further found that literature is lacking at the level of optimal doses, timing, and type of exercise. More studies are needed with more defined PA programs in type and length. © 2024 by the authors.

Navarro-Ledesma S. et al., Cancers, 2024, Volume 16, Issue 3, Article number 656

Screening / Early detection

Prediction of cancer driver genes and mutations: the potential of integrative computational frameworks

The vast amount of available sequencing data allows the scientific community to explore different genetic alterations that may drive cancer or favor cancer progression. Software developers have proposed a myriad of predictive tools, allowing researchers and clinicians to compare and prioritize driver genes and mutations and their relative pathogenicity. However, there is little consensus on the computational approach or a golden standard for comparison. Hence, benchmarking the different tools depends highly on the input data, indicating that overfitting is still a massive problem. One of the solutions is to limit the scope and usage of specific tools. However, such limitations force researchers to walk on a tightrope between creating and using high-quality tools for a specific purpose and describing the complex alterations driving cancer. While the knowledge of cancer development increases daily, many bioinformatic pipelines rely on single nucleotide variants or alterations in a vacuum without accounting for cellular compartments, mutational burden or disease progression. Even within bioinformatics and computational cancer biology, the research fields work in silos, risking overlooking potential synergies or breakthroughs. Here, we provide an overview of databases and datasets for building or testing predictive cancer driver tools. Furthermore, we introduce predictive tools for driver genes, driver mutations, and the impact of these based on structural analysis. Additionally, we suggest and recommend directions in the field to avoid silo-research, moving towards integrative frameworks. © The Author(s) 2024. Published by Oxford University Press.

Nourbakhsh M. et al., Briefings in Bioinformatics, 2024, Volume 25, Issue 2

Toward ovarian cancer screening with protein biomarkers using dried, self-sampled cervico-vaginal fluid

Early detection is key for increased survival in ovarian cancer, but no general screening program exists today due to lack of biomarkers and overall cost versus benefit over traditional clinical methods. Here, we used dried cervico-vaginal fluid (CVF) as sampling matrix coupled with mass spectrometry for detection of protein biomarkers. We find that self-collected CVF on paper cards yields robust results and is suitable for high-throughput proteomics. Artificial intelligence–based methods were used to identify an 11-protein panel that separates cases from controls. In validation data, the panel achieved a sensitivity of 0.97 (95% CI 0.91–1.00) at a specificity of 0.67 (0.40–0.87). Analyses of samples collected prior to development of symptoms indicate that the panel is informative also of future risk of disease. Dried CVF is used in cervical cancer screening, and our results opens the possibility for a screening program also for ovarian cancer, based on self-collected CVF samples. © 2024 The Author(s).

Hedlund Lindberg J. et al., iScience, 2024, Volume 27, Issue 2, Article number 109001

Association between circulating inflammatory markers and adult cancer risk: a Mendelian randomization analysis

Background: Tumour-promoting inflammation is a “hallmark” of cancer and conventional epidemiological studies have reported links between various inflammatory markers and cancer risk. The causal nature of these relationships and, thus, the suitability of these markers as intervention targets for cancer prevention is unclear. Methods: We meta-analysed 6 genome-wide association studies of circulating inflammatory markers comprising 59,969 participants of European ancestry. We then used combined cis-Mendelian randomization and colocalisation analysis to evaluate the causal role of 66 circulating inflammatory markers in risk of 30 adult cancers in 338,294 cancer cases and up to 1,238,345 controls. Genetic instruments for inflammatory markers were constructed using genome-wide significant (P < 5.0 × 10−8) cis-acting SNPs (i.e., in or ±250 kb from the gene encoding the relevant protein) in weak linkage disequilibrium (LD, r2 < 0.10). Effect estimates were generated using inverse-variance weighted random-effects models and standard errors were inflated to account for weak LD between variants with reference to the 1000 Genomes Phase 3 CEU panel. 

A false discovery rate (FDR)-corrected P-value (“q-value”) <0.05 was used as a threshold to define “strong evidence” to support associations and 0.05 ≤ q-value < 0.20 to define “suggestive evidence”. A colocalisation posterior probability (PPH4) >70% was employed to indicate support for shared causal variants across inflammatory markers and cancer outcomes. 

Findings were replicated in the FinnGen study and then pooled using meta-analysis. Findings: We found strong evidence to support an association of genetically-proxied circulating pro-adrenomedullin concentrations with increased breast cancer risk (OR: 1.19, 95% CI: 1.10–1.29, q-value = 0.033, PPH4 = 84.3%) and suggestive evidence to support associations of interleukin-23 receptor concentrations with increased pancreatic cancer risk (OR: 1.42, 95% CI: 1.20–1.69, q-value = 0.055, PPH4 = 73.9%), prothrombin concentrations with decreased basal cell carcinoma risk (OR: 0.66, 95% CI: 0.53–0.81, q-value = 0.067, PPH4 = 81.8%), and interleukin-1 receptor-like 1 concentrations with decreased triple-negative breast cancer risk (OR: 0.92, 95% CI: 0.88–0.97, q-value = 0.15, PPH4 = 85.6%). These findings were replicated in pooled analyses with the FinnGen study. Though suggestive evidence was found to support an association of macrophage migration inhibitory factor concentrations with increased bladder cancer risk (OR: 2.46, 95% CI: 1.48–4.10, q-value = 0.072, PPH4 = 76.1%), this finding was not replicated when pooled with the FinnGen study. For 22 of 30 cancer outcomes examined, there was little evidence (q-value ≥0.20) that any of the 66 circulating inflammatory markers examined were associated with cancer risk.

Interpretation: Our comprehensive joint Mendelian randomization and colocalisation analysis of the role of circulating inflammatory markers in cancer risk identified potential roles for 4 circulating inflammatory markers in risk of 4 site-specific cancers. Contrary to reports from some prior conventional epidemiological studies, we found little evidence of association of circulating inflammatory markers with the majority of site-specific cancers evaluated. Funding: Cancer Research UK (C68933/A28534, C18281/A29019, PPRCPJT∖100005), World Cancer Research Fund (IIG_FULL_2020_022), National Institute for Health Research (NIHR202411, BRC-1215-20011), Medical Research Council (MC_UU_00011/1, MC_UU_00011/3, MC_UU_00011/6, and MC_UU_00011/4), Academy of Finland Project 326291, European Union's Horizon 2020 grant agreement no. 848158 (EarlyCause), French National Cancer Institute (INCa SHSESP20, 2020-076), Versus Arthritis (21173, 21754, 21755), National Institutes of Health (U19 CA203654), National Cancer Institute (U19CA203654). © 2024 The Author(s).

Yarmolinsky J. et al., eBioMedicine, 2024, Volume 100, Article number 104991

Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression

Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. 

Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I–IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms, p < 0.0001), SDNNs (22.8 to 27.7 ms, p < 0.0001), and pNN50s (6.2 to 8.1%, p < 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (−11.8 to −14.0 bpm, p < 0.0001) and higher rMSSDs (+31.7 to +32.8 ms, p < 0.0001), SDNNs (+45.2 to +45.8 ms), p < 0.0001, and pNN50s (19.2 to 21.6%, p < 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p = 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients’ co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups. © 2024 by the authors.

Ben-David K. et al., Cancers, 2024, Volume 16, Issue 5, Article number 962

Biomarkers for Early Cancer Detection: A Landscape View of Recent Advancements, Spotlighting Pancreatic and Liver Cancers

Cancer is one of the leading causes of death worldwide. Early cancer detection is critical because it can significantly improve treatment outcomes, thus saving lives, reducing suffering, and lessening psychological and economic burdens. Cancer biomarkers provide varied information about cancer, from early detection of malignancy to decisions on treatment and subsequent monitoring. A large variety of molecular, histologic, radiographic, or physiological entities or features are among the common types of cancer biomarkers. Sizeable recent methodological progress and insights have promoted significant developments in the field of early cancer detection biomarkers. Here we provide an overview of recent advances in the knowledge related to biomolecules and cellular entities used for early cancer detection. We examine data from the CAS Content Collection, the largest human-curated collection of published scientific information, as well as from the biomarker datasets at Excelra, and analyze the publication landscape of recent research. We also discuss the evolution of key concepts and cancer biomarkers development pipelines, with a particular focus on pancreatic and liver cancers, which are known to be remarkably difficult to detect early and to have particularly high morbidity and mortality. The objective of the paper is to provide a broad overview of the evolving landscape of current knowledge on cancer biomarkers and to outline challenges and evaluate growth opportunities, in order to further efforts in solving the problems that remain. The merit of this review stems from the extensive, wide-ranging coverage of the most up-to-date scientific information, allowing unique, unmatched breadth of landscape analysis and in-depth insights. © 2024 The Authors. Published by American Chemical Society.

Tenchov R. et al., ACS Pharmacology and Translational Science, 2024, Volume 7, Issue 3, Pages 586-613

Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity

Background: Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. Methods: This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. Results: Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. Conclusions: This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC. © 2024 by the authors.

Glaser K.M. et al., International Journal of Environmental Research and Public Health, 2024, Volume 21, Issue 2, Article number 126

Cancer diagnosis and treatment

European cancer mortality predictions for the year 2024 with focus on colorectal cancer

Background: We predicted cancer mortality figures for 2024 for the European Union (EU), its five most populous countries, and the UK. We focused on mortality from colorectal cancer (CRC). Materials and methods: Based on cancer death certification and population data from the World Health Organization and Eurostat databases from 1970 until the most available year, we predicted deaths and age-standardized rates (ASRs) for 2024 for all cancers and the 10 most common cancer sites. We fitted a linear regression to the most recent trend segment identified by the joinpoint model. The number of avoided deaths since the peak in 1988-2024 was estimated for all cancers and CRC. Results: We predicted 1 270 800 cancer deaths for 2024 in the EU, corresponding to ASRs of 123.2/100 000 men (−6.5% versus 2018) and 79.0/100 000 women (−4.3%). Since 1988, about 6.2 million cancer deaths have been avoided in the EU and 1.3 million in the UK. Pancreatic cancer displayed unfavorable predicted rates for both sexes (+1.6% in men and +4.0% in women) and lung cancer for women (+0.3%). The focus on CRC showed falls in mortality at all ages in the EU, by 4.8% for men and 9.5% for women since 2018. The largest declines in CRC mortality are predicted among those 70+ years old. In the UK, projected ASRs for CRC at all ages are favorable for men (−3.4% versus 2018) but not for women (+0.3%). Below age 50 years, CRC mortality showed unfavorable trends in Italy and the UK, in Poland and Spain for men, and in Germany for women. Conclusions: Predicted cancer mortality rates remain favorable in the EU and the UK, mainly in males due to earlier smoking cessation compared to females, underlining the persisting major role of tobacco on cancer mortality in Europe. Attention should be paid to the predicted increases in CRC mortality in young adults. © 2023 The Author(s).

Santucci C. et al., Annals of Oncology, 2024, Volume 35, Issue 3, Pages 308-316

Comparison of the prognostic value of eight nutrition-related tools in older patients with cancer: A prospective study

Objectives: The primary objective of the present study was to evaluate and compare the ability of eight nutrition-related tools to predict 1-year mortality in older patients with cancer. Design, setting and participants: We studied older patients with cancer from the ELCAPA cohort and who had been referred for a geriatric assessment at one of 14 participating geriatric oncology clinics in the greater Paris area of France between 2007 and 2018. Measurements: The studied nutrition-related tools/markers were the body mass index (BMI), weight loss (WL) in the previous 6 months, the Mini Nutritional Assessment, the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index, the Glasgow Prognostic Score (GPS), the modified GPS, and the C-reactive protein/albumin ratio. Results: A total of 1361 patients (median age: 81; males: 51%; metastatic cancer: 49%) were included in the analysis. Most of the tools showed a progressively increase in the mortality risk as the nutrition-related risk category worsened (overall p-values <0.02 for all) after adjustment for age, outpatient status, functional status, severe comorbidities, cognition, mood, cancer treatment strategy, tumour site, and tumour metastasis. All the models were discriminant, with a C-index ranging from 0.748 (for the BMI) to 0.762 (for the GPS). The concordance probability estimate ranged from 0.764 (WL) to 0.773 (GNRI and GPS)). Conclusion: After adjustment for relevant prognostic factors, all eight nutrition-related tools/markers were independently associated with 1-year mortality in older patients with cancer. Depending on the time or context of the GA, physicians do not always have the time or means to perform and assess all the tools/markers compared here. However, even when some information is missing, each nutritional tool/marker has prognostic value and can be used in the evaluation. © 2024 The Authors.

Valter, R. et al., Journal of Nutrition, Health and Aging, 2024, Volume 28, Issue 4, Article number 100188

Cancer care pathways across seven countries in Europe: What are the current obstacles? And how can artificial intelligence help?

Background: Cancer poses significant challenges for healthcare professionals across the disease pathway including cancer imaging. This study constitutes part of the user requirement definition of INCISIVE EU project. The project has been designed to explore the full potential of artificial intelligence (AI)-based technologies in cancer imaging to streamline diagnosis and management. The study aimed to map cancer care pathways (breast, prostate, colorectal and lung cancers) across INCISIVE partner countries, and identify bottle necks within these pathways. Methods: Email interviews were conducted with ten oncology specialised healthcare professionals representing INCISIVE partner countries: Greece, Cyprus, Spain, Italy, Finland, the United Kingdom (UK) and Serbia. A purposive sampling strategy was employed for recruitment and data was collected between December 2020 and April 2021. Data was entered into Microsoft Excel spreadsheet to allow content examination and comparative analysis. Results: The analysed pathways all shared a common characteristic: inequalities in relation to delays in cancer diagnosis and treatment. All the studied countries, except the UK, lacked official national data about diagnostic and therapeutic delays. Furthermore, a considerable variation was noted regarding the availability of imaging and diagnostic services across the seven countries. Several concerns were also noted for inefficiencies/inequalities with regards to national screening for the four investigated cancer types. 

Conclusions: Delays in cancer diagnosis and treatment are an ongoing challenge and a source for inequalities. It is important to have systematic reporting of diagnostic and therapeutic delays in all countries to allow the proper estimation of its magnitude and support needed to address it. Our findings also support the orientation of the current policies towards early detection and wide scale adoption and implementation of cancer screening, through research, innovation, and technology. Technologies involving AI can have a great potential to revolutionise cancer care delivery. Policy summary: This study highlights the widespread delay in cancer diagnosis across Europe and supports the need for, systematic reporting of delays, improved availability of imaging services, and optimised national screening programs. The goal is to enhance cancer care delivery, encourage early detection, and implement research, innovation, and AI-based technologies for improved cancer imaging. © 2023 The Authors.

Hesso I. et al., Journal of Cancer Policy, 2024, Volume 39, Article number 100457

Safe optimal control of cancer using a Control Barrier Function technique

This paper addresses the problem of designing a safe and optimal control strategy for typical cancer using the Control Barrier Function (CBF) technique. Cancer is a complex and highly dynamic disease characterized by uncontrolled cell growth and proliferation. By formulating the cancer dynamics as a control system, this study introduces a CBF-based controller that guides the cancerous tissue towards safe and controlled behaviors. The controller is designed to simultaneously optimize treatment efficacy and patient safety. The methodology involves modeling the cancer growth dynamics, incorporating relevant biological constraints, and designing the CBF-based controller to regulate the tumor's evolution within acceptable bounds. Simulation results demonstrate the effectiveness of the CBF-based strategy in achieving safe and optimal cancer control. The controller showcases the ability to drive the cancerous tissue towards desired states while respecting predefined safety constraints. © 2024 The Author(s).

Ahmadi Z. et al., Mathematical Biosciences, 2024, Volume 369, Article number 109142

Quality of life

Geriatric evaluation methods in oncology and their use in clinical studies: A systematic literature review

Introduction: Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of “frailty” is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research. Materials and Methods: We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth. Results: In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation. Discussion: The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process. © 2023 The Authors.

Stueger, A. et al., Journal of Geriatric Oncology, 2024, Volume 15, Issue 3, Article number 101684

Comparing the use of aggressive end-of life care among frail and non-frail patients with cancer using a claims-based frailty index

Introduction: Despite mounting consensus that end-of-life (EOL) care for patients with cancer should focus on improving quality of life, many patients continue to receive aggressive, disease-oriented treatment until death. Within this group, patients with increased frailty may be at higher risk of adverse treatment-related outcomes. We therefore examined the relationship between degree of frailty and receipt of aggressive EOL care among Medicare-insured patients with cancer in Ohio. Materials and Methods: From the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare claims, we identified patients diagnosed with breast, colorectal, lung, or prostate cancer who died between 2012 and 2016. Frailty was operationalized using a validated claims-based frailty index. Six quality indicators reflecting receipt of aggressive EOL care were identified from claims: (1) any cancer-directed treatment, (2) >1 emergency department (ED) visit, (3) >1 hospital admission, (4) any intensive care unit (ICU) admission in the last 30 days of life, (5) entry to hospice in the last three days of life, and (6) in-hospital mortality. Multivariable logistic regression analysis was performed to control for demographic factors, Medicare and Medicaid dual enrollment, and cancer type and stage in the relationship between frailty and aggressive EOL care. Results: Overall, 31,465 patients met selection criteria. Patients with moderate/severe frailty were less likely than non−/pre-frail patients to receive any aggressive EOL care (adjusted odds ratio [aOR] 0.92 [95% confidence interval 0.86–0.99]). This group was also less likely to undergo cancer-directed treatment in their last 30 days or to enter hospice in their last three days. Increasing frailty was associated with lower odds of admission to the ICU in the last 30 days of life (mild frailty: aOR 0.88 [0.83–0.94]; moderate/severe frailty: aOR 0.85 [0.78–0.92]) or of dying in-hospital (mild frailty: 0.85 [0.79–0.91]; moderate/severe frailty: aOR 0.74 [0.67–0.82]), but higher odds of having >1 ED visit in the last 30 days of life (mild frailty: aOR 1.43 [1.32–1.53]; moderate/severe frailty: aOR 1.61 [1.47–1.77]). Discussion: These findings suggest the need for more explicit discussion of emergency care seeking for patients with cancer at the end of life. © 2023

Sachdev R. et al., Journal of Geriatric Oncology, 2024, Volume 15, Issue 2, Article number 101706

The Role of Rehabilitation for the Dying Cancer Patient

Purpose of Review: This article aims to expand on the role of rehabilitation clinicians in providing whole-person care to the dying cancer patient. We identify symptoms common at the end of life in patients with cancer and demonstrate how rehabilitation specialists can use medications and interventions to ease the dying process. Recent Findings: Achieving adequate pain and symptom control can be done through a collaborative, multidisciplinary model with physiatrists, nurses, and therapists in all disciplines. Addressing anxiety, depression, and existential distress can and must be part of the whole-person rehabilitation care. Summary: Achieving a “good death” is a collaborative process and one that is unique to each individual. Research has revealed that people want to be as symptom-free as possible, remain as functional and clear-thinking as possible, and contribute to those around them. The rehabilitation team is well-poised to help individuals meet these goals. © The Author(s) 2024.

Arora A. et al., Current Physical Medicine and Rehabilitation Reports, 2024, Volume 12, Issue 1, Pages 119-125

Effects of cancer severity on the relationship between emotional intelligence, perceived social support, and psychological distress in Italian women

Purpose: This study aims to understand the association between emotional intelligence, perceived social support, and psychological distress (i.e., anxiety, depression, stress) in women with cancer at different stages. Specifically, the aims of this study were to investigate: i) the links between emotional intelligence and psychological distress (i.e., symptoms of anxiety, stress and depression); ii) the mediating role of perceived social support provided by family members, friends, and significant others in the relationship between emotional intelligence and psychological distress; iii) the impact of cancer type and cancer stage (I-II vs III-IV) in moderating these relationships, among Italian women. Methods: The research sample consisted of 206 Italian women (mean age = 49.30 ± 10.98 years; 55% breast cancer patients) who were administered a questionnaire to assess emotional intelligence, perceived social support, and psychological distress. Structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model. Results: Emotional intelligence had a positive association with perceived social support, which in turn prevented psychological distress only in women with early-stages cancers. The type of cancer has no effect on these relationships. Conclusions: The findings of this study indicate a pressing need to screen and recognize women with lower emotional intelligence and perceived social support, as they may be more prone to experiencing psychological distress. For such individuals, our results recommend the implementation of psychological interventions aimed at enhancing emotional intelligence and fortifying their social support networks, with consideration for the stage of cancer they are facing. © The Author(s) 2024.

Bruno F. et al., Supportive Care in Cancer, 2024, Volume 32, Issue 2

Applying Digital Health in Cancer and Palliative Care in Europe: Policy Recommendations from an International Expert Workshop (MyPal Project)

Background: Digital health interventions are becoming increasingly important for adults, children, and young people with cancer and palliative care needs, but there is little research to guide policy and practice. Objectives: To identify recommendations for policy development of digital health interventions in cancer and palliative care. Design: Expert elicitation workshop. Setting: European clinical (cancer and palliative care, adult and pediatric), policy, technical, and research experts attended a one-day workshop in London, England, in October 2022, along with MyPal research consortium members. Methods: As part of the European Commission-funded MyPal project, we elicited experts’ views on global, national, and institutional policies within structured facilitated groups, and conducted qualitative analysis on these discussions. Results/Implementation: Thirty-two experts from eight countries attended. Key policy drivers and levers in digital health were highlighted. Global level: global technology regulation, definitions, access to information technology, standardizing citizens’ rights and data safety, digital infrastructure and implementation guidance, and incorporation of technology into existing health systems. National level: country-specific policy, compatibility of health apps, access to digital infrastructure including vulnerable groups and settings, development of guidelines, and promoting digital literacy. Institutional level: undertaking a needs assessment of service users and clinicians, identifying best practice guidelines, providing education and training for clinicians on digital health and safe digital data sharing, implementing plans to minimize barriers to accessing digital health care, minimizing bureaucracy, and providing technical support. Conclusions: Developers and regulators of digital health interventions may find the identified recommendations useful in guiding policy making and future research initiatives. MyPal child study Clinical Trial Registration NCT04381221; MyPal adult study Clinical Trial Registration NCT04370457 © 2024 Mary Ann Liebert Inc. All rights reserved.

Payne S. et al., Journal of Palliative Medicine, 2024, Volume 27, Issue 2

Increased Stress Is Associated With Severe Pain and Decrements in Cognitive Function in Patients Receiving Chemotherapy

Objectives: Purposes were to identify subgroups of adult oncology patients (n = 1342) with distinct joint profiles of worst pain and cognitive function (CF) and evaluate for differences in demographic and clinical characteristics, as well as the severity of three distinct types of stress, resilience, and coping. Data sources: Measures of pain and CF were evaluated six times over two cycles of chemotherapy. The other measures of demographic and clinical characteristics, stress, resilience, and coping were completed at enrollment (ie, prior to the second or third cycle of chemotherapy). Results: Using latent profile analysis, four distinct profiles were identified (ie, no pain + moderate CF [27.6%], moderate pain + high CF [22.4%] moderate pain and moderate CF [32.4%, both moderate], severe pain and low CF [17.5%, both severe]). Both moderate and both severe classes reported higher global, cancer-specific, and cumulative life stress, lower levels of resilience, and greater use of disengagement coping strategies. The Both severe class had higher occurrence rates for a number of adverse childhood experiences (ie, family violence in childhood, physical abuse at <16 years, forced sex at <16 years). Risk factors associated with membership in the two worst profiles included: being female, having a lower annual income, having a higher comorbidity burden, and having a poorer functional status. Conclusion: Findings suggest that 72.4% of the patients reported pain scores in the moderate to severe range and 77.6% reported low to moderate levels of CF. Clinicians need to assess for both symptoms and various types of stress on a routine basis. © 2023 The Authors.

Chen J. et al., Seminars in Oncology Nursing, 2024, Volume 40, Issue 1, Article number 151577

Physical Activity, Sedentary Time, and Psychosocial Functioning among Adults with Cancer: A Scoping Review

The post-treatment period (after the completion of primary cancer treatment) is a phase during which adults with cancer are particularly vulnerable to the physical and psychological side effects of treatment. Adopting healthy lifestyle habits during this time is essential to mitigate these effects. This scoping review investigated the associations of physical activity (PA) and sedentary time (ST) with two post-treatment psychosocial indicators among adults with cancer: psychological functioning and quality of life (QoL). An exhaustive search was performed in January 2023 across five databases, namely APA PsycInfo, MedLine, SPORTDiscuss, SCOPUS, and CINAHL, adhering to PRISMA guidelines for scoping reviews. Twenty articles met the inclusion criteria; 16 used a cross-sectional design, while 4 used a longitudinal one. PA and ST were assessed mainly with accelerometers (n = 17), and psychosocial indicators with self-reported questionnaires (n = 20). Most studies linked higher PA levels to reduced anxiety (n = 3) and depression (n = 4) symptoms, and elevated ST to higher psychological symptoms (n = 3). Opposite associations were observed for QoL (n = 5). Altogether, PA appeared to be more strongly related to psychological functioning and QoL than ST. This scoping review highlights associations of PA and ST with psychological functioning and QoL among adults with cancer in the post-treatment period. However, future studies must prioritize longitudinal designs to establish directionality. © 2024 by the authors.

Côté A. et al., International Journal of Environmental Research and Public Health, 2024, Volume 21, Issue 2, Article number 225

Other

From the creation of the European research area in 2000 to a Mission on cancer in Europe in 2021-lessons learned and implications

In the year 2000, cancer research in Europe had the potential to make a difference as it had several unique strengths, such as a strong foundation in biomedical science, good patient registries, infrastructures that spanned from biological repositories to bioinformatic hubs as well as thriving Comprehensive Cancer Centers (CCCs) and basic/preclinical cancer research institutions of high international standing. Research, however, was fragmented and lacked coordination. As a result, Europe could not harness its potential for translating basic research discoveries into a clinical setting for the patients' benefit. What was needed was a paradigm shift in cancer research that addressed the translational research continuum. Along these lines, in 2000, European Union (EU) Commissioner Philippe Busquin established the European Research Area (ERA) and in 2002 the European Cancer Research Area (ECRA), and their political approval was a powerful catalyst for the increased involvement of scientists in science policy in the EU. In this report, we briefly describe the actions embraced by the cancer community and cancer organizations in response to Busquin's proposals that led to the creation of the EU Mission on Cancer (MoC) in Horizon 2020 in 2021. © 2024 The Authors. Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.

Celis, J. et al., Molecular Oncology, 2024, Volume 18, Issue 4, Pages 785-792

Mediators of Black–White inequities in cardiovascular mortality among survivors of 18 cancers in the USA

Background: This study aims to quantify Black–White inequities in cardiovascular disease (CVD) mortality among US survivors of 18 adult-onset cancers and the extent to which these inequities are explained by differences in socio-economic and clinical factors. Methods: Survivors of cancers diagnosed at ages 20–64 years during 2007–16 were identified from 17 Surveillance, Epidemiology and End Results registries. Associations between race and CVD mortality were examined using proportional hazards models. Mediation analyses were performed to quantify the contributions of potential mediators, including socio-economic [health insurance, neighbourhood socio-economic status (nSES), rurality] and clinical (stage, surgery, chemotherapy, radiotherapy) factors. Results: Among 904 995 survivors, 10 701 CVD deaths occurred (median follow-up, 43 months). Black survivors were more likely than White survivors to die from CVD for all 18 cancers with hazard ratios ranging from 1.30 (95% CI ¼ 1.15–1.47) for lung cancer to 4.04 for brain cancer (95% CI ¼ 2.79–5.83). The total percentage mediations (indirect effects) ranged from 24.8% for brain (95% CI¼–5.2–59.6%) to 99.8% for lung (95% CI ¼ 61.0–167%) cancers. Neighbourhood SES was identified as the strongest mediator for 14 cancers with percentage mediations varying from 25.0% for kidney cancer (95% CI ¼ 14.1–36.3%) to 63.5% for lung cancer (95% CI ¼ 36.5–108.7%). Insurance ranked second for 12 cancers with percentage mediations ranging from 12.3% for leukaemia (95% CI ¼ 0.7–46.7%) to 31.3% for thyroid cancer (95% CI ¼ 10.4–82.7%). Conclusions: Insurance and nSES explained substantial proportions of the excess CVD mortality among Black survivors. Mitigating the effects of unequal access to care and differing opportunities for healthy living among neighbourhoods could substantially reduce racial inequities in CVD mortality among cancer survivors. © The Author(s) 2023; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Sung H. et al., International Journal of Epidemiology, 2024, Volume 53, Issue 1

Smartphone-based augmented reality patient education in radiation oncology

We built an augmented reality (AR) patient education application for portable iOS and Android devices that allows patients to view a virtual simulation of themselves receiving radiation treatment. We created software that reads data from the clinical treatment planning system and renders the patient's actual radiotherapy plan in AR on a tablet or smartphone. The patient's CT simulation data are converted into a 3D translucent virtual human shown being treated with visible radiation beams from a virtual linear accelerator. We conducted a patient study to determine if showing patients this AR simulation improves patient understanding of radiotherapy and/or reduces anxiety about treatment. A total of 75 patients completed this study. The most common plans were 3D breast tangents and intensity modulated radiotherapy lung plans. Patients were administered questionnaires both before and after their AR viewing experience. After their AR viewing, 95% of patients indicated that they had a better understanding of how radiotherapy will be used to treat their cancer. Of the 35 patients who expressed anxiety about radiotherapy beforehand, 21 (60%) indicated that they had decreased anxiety after the AR session. In our single-arm prospective patient study, we found that this simplified low-cost tablet-based personalized AR simulation can be a helpful educational tool for cancer patients undergoing radiotherapy. © 2023 The Author(s).

Wang L.J. et al., Technical Innovations and Patient Support in Radiation Oncology, 2024, Volume 29, Article number 100229

The effect of neighborhood socioeconomic disadvantage on smoking status, quit attempts, and receipt of cessation support among adults with cancer: Results from nine ECOG-ACRIN Cancer Research Group trials

Background: Tobacco use is associated with adverse outcomes among patients diagnosed with cancer. Socioeconomic determinants influence access and utilization of tobacco treatment; little is known about the relationship between neighborhood socioeconomic disadvantage (NSD) and tobacco assessment, assistance, and cessation among patients diagnosed with cancer. Methods: A modified Cancer Patient Tobacco Use Questionnaire (C-TUQ) was administered to patients enrolled in nine ECOG-ACRIN clinical trials. We examined associations of NSD with (1) smoking status, (2) receiving tobacco cessation assessment and support, and (3) cessation behaviors. NSD was classified by tertiles of the Area Deprivation Index. Associations between NSD and tobacco variables were evaluated using logistic regression. Results: A total of 740 patients completing the C-TUQ were 70% male, 94% White, 3% Hispanic, mean age 58.8 years. Cancer diagnoses included leukemia 263 (36%), lymphoma 141 (19%), prostate 131 (18%), breast 79 (11%), melanoma 69 (9%), myeloma 53 (7%), and head and neck 4 (0.5%). A total of 402 (54%) never smoked, 257 (35%) had formerly smoked, and 81 (11%) were currently smoking. Patients in high disadvantaged neighborhoods were approximately four times more likely to report current smoking (odds ratio [OR], 3.57; 95% CI, 1.69–7.54; p =.0009), and more likely to report being asked about smoking (OR, 4.24; 95% CI, 1.64–10.98; p =.0029), but less likely to report receiving counseling (OR, 0.11; 95% CI, 0.02–0.58; p =.0086) versus those in the least disadvantaged neighborhoods. Conclusions: Greater neighborhood socioeconomic disadvantage was associated with smoking but less cessation support. Increased cessation support in cancer care is needed, particularly for patients from disadvantaged neighborhoods. © 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

Walter A.W. et al., Cancer, 2024, Volume 130, Issue 3, Pages 439-452

A randomized controlled trial of a distress screening, consultation, and targeted referral system for family caregivers in oncologic care

Objective: Distress screening is standard practice among oncology patients, yet few routine distress screening programs exist for cancer caregivers. The objective of this study was to demonstrate the feasibility, acceptability, and preliminary efficacy of Cancer Support Source-CaregiverTM (CSS-CG, 33-item), an electronic distress screening and automated referral program with a consultation (S + C) to improve caregiver unmet needs, quality of life, anxiety, depression, and distress relative to Enhanced Usual Care (EUC; access to educational materials). Method: 150 caregivers of patients with varying sites/stages of cancer were randomized to S + C or EUC and completed assessments at baseline, 3-months post-baseline, and 6-months post-baseline. A subset of participants (n = 10) completed in-depth qualitative interviews. Results: S + C was feasible: among 75 caregivers randomized to S + C, 66 (88%) completed CSS-CG and consultation. Top concerns reported were: (1) patient's pain and/or physical discomfort; (2) patient's cancer progressing/recurring; and (3) feeling nervous or afraid. Differences between groups in improvements on outcomes by T2 and T3 were modest (ds < 0.53) in favor of S + C. Qualitative data underscored the helpfulness of S + C in connecting caregivers to support and helping them feel cared for and integrated into cancer care. Conclusions: S + C is feasible, acceptable, and yields more positive impact on emotional well-being than usual care. Future studies will examine programmatic impact among caregivers experiencing higher acuity of needs, and benefits of earlier integration of S + C on caregiver, patient, and healthcare system outcomes. © 2024 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Applebaum A.J. et al., Psycho-Oncology, 2024, Volume 33, Issue 2, Article number e6301

Causal relationships between risk of venous thromboembolism and 18 cancers: a bidirectional Mendelian randomization analysis

Background: People with cancer experience high rates of venous thromboembolism (VTE). Risk of subsequent cancer is also increased in people experiencing their first VTE. The causal mechanisms underlying this association are not completely understood, and it is unknown whether VTE is itself a risk factor for cancer. Methods: We used data from large genome-wide association study meta-analyses to perform bidirectional Mendelian randomization analyses to estimate causal associations between genetic liability to VTE and risk of 18 different cancers. Results: We found no conclusive evidence that genetic liability to VTE was causally associated with an increased incidence of cancer, or vice versa. We observed an association between liability to VTE and pancreatic cancer risk [odds ratio for pancreatic cancer: 1.23 (95% confidence interval: 1.08–1.40) per log-odds increase in VTE risk, P ¼ 0.002]. However, sensitivity analyses revealed this association was predominantly driven by a variant proxying non-O blood group, with inadequate evidence to suggest a causal relationship. Conclusions: These findings do not support the hypothesis that genetic liability to VTE is a cause of cancer. Existing observational epidemiological associations between VTE and cancer are therefore more likely to be driven by pathophysiological changes which occur in the setting of active cancer and anti-cancer treatments. Further work is required to explore and synthesize evidence for these mechanisms. © The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.

Cornish N. et al., International Journal of Epidemiology, 2024, Volume 53, Issue 1

Disclaimer: the views expressed are purely those of the writer and do not under any circumstances reflect the official position of the European Commission. The articles contained in this news report are not selected according to strict criteria but following an editorial choice, which can by no means be exhaustive or comprehensive. The News Report presents original abstracts of the articles.