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BackgroundOral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown.ObjectivesTo explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT.Design and SettingA prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model.ParticipantsAdult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days.Main MeasuresThe Nijmegen Continuity Questionnaire was used to assess patients’ perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence.Key ResultsBetter personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006–0.17).ConclusionsIn a system where the PCP is the case manager, cancer patients’ perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.

IntroductionPre-malignant cervical disease and invasive cervical cancer present a significant global health burden with respect to morbidity and mortality, mostly in low- and middle-income countries. Human papillomavirus (HPV) infection typically manifests for the first time in adolescence. We aimed to identify adolescent sociodemographic and anthropometric characteristics associated with subsequent risk for pre-malignant cervical disease and cervical cancer, in a country that offers free screening and HPV vaccines.MethodsThis historical cohort study included 969 123 Israeli women examined and anthropometrically measured at age 17 years between January 1967 and December 2011. Data on pre-malignant disease and invasive cervical tumors were obtained from the national cancer registry by linkage. We excluded non-Jewish minorities (a total of 25 472 women) and orthodox/ultraorthodox Jewish women since these populations are not required by law to serve in the military, as well as women with a pre-examination diagnosis of cancer. Cox proportional hazards regression models were applied per each lesion type, adjusted for origin, measured body mass index, height, education, dwelling type, birth year, and age at examination.ResultsIn total, 5094 and 859 incident pre-malignant cervical disease and cervical cancer cases, respectively, were diagnosed during a median follow-up of 17.6 years. Risk for both lesions was origin-dependent, with higher incidence in women of North-African origin (HR (pre-malignant cervical disease) 1.22, 95% CI 1.04 to 1.42; HR (cervical cancer) 1.87, 95% CI 1.30 to 2.69) compared with European origin. Height, lower education, and later birth year were associated with higher pre-malignant cervical disease and cervical cancer risk also. Adolescent overweight (HR 0.81, 95% CI 0.74 to 0.90) and obesity (HR 0.56, 95% CI 0.43 to 0.71) status were associated with reduced pre-malignant cervical disease but not cervical cancer incidence, as did urban (vs rural) residence.DiscussionEthnic background, tall stature, and education were associated with pre-malignant cervical disease and cervical cancer incidence, while adolescent overweight and obesity were inversely associated with only pre-malignant cervical disease. Despite free screening and HPV vaccines, these findings suggest that there is still a need for appropriate safe sex and screening education in adolescence.

PurposeTo explore factors associated with necessity beliefs and concerns among patients receiving oral anticancer therapy (OACT) and, specifically, to examine the relationship between continuity of care (COC) and patients’ beliefs about OACT.MethodsA cross-sectional study was conducted among patients from four oncology centers receiving OACT (either targeted, hormonal, or chemotherapy). Two months after OACT initiation, patients were asked to participate in a face-to-face or telephone survey. The Beliefs about Medicines Questionnaire was used to examine patients’ perceptions of their personal necessity for OACT and concerns about potential adverse effects. The Nijmegen Continuity Questionnaire was used to assess patients’ perceived COC. Data on clinical characteristics were collected from medical records.ResultsParticipants’ beliefs about OACT necessity (n = 91) were found to be associated with COC within the oncology team, and with COC between the oncology specialist and the primary care physicians (β = 0.27, p = 0.003; β = 0.22, p = 0.02, respectively), beyond age, depression, and cancer type (ΔR2 = 0.14, p < 0.001). Additionally, the difference between participants’ beliefs about OACT necessity and their OACT-related concerns was associated with COC within the oncology team (β = 0.30, p = 0.001), beyond age, income, family status, and cancer type (ΔR2 = 0.09, p = 0.001).ConclusionsThis study shows that cancer patients’ perceptions about the COC between care providers are related to their beliefs about OACT necessity, thus providing evidence for the importance of health care delivery approaches that support COC within the oncology team and between the oncology specialist and the primary care physician.

PurposeTo investigate prevalence and risk factors associated with self-reported chronic pain, and other symptoms related to breast cancer or its treatment among breast cancer survivors (BCS).MethodsA cross-sectional study of a random sample of 410 female BCS, members of “Leumit” healthcare fund, diagnosed with primary nonmetastatic invasive breast cancer in the years 2002–2012. The study questionnaire included questions on health-related quality of life, pain symptoms, and was completed by all women contacted.ResultsA total of 305 BCS (74%), with a median of 7.4 years since diagnosis reported chronic pain, of whom 84% had moderate pain, and 97% experienced pain at least 1–3 days/week. Other symptoms were paresthesia (63%), allodynia (48%), and phantom sensations (15%). Report of pain symptoms, alone or combined, was significantly associated with poorer quality of life. In multivariable analyses, chronic pain was positively associated with mastectomy compared to breast-conserving surgery [Odds ratio (OR), 3.54; 95% confidence interval (CI) 1.46–8.59; P = 0.005], radiotherapy compared to non-radiotherapy (OR 2.96; 95% CI 1.43–6.12; P = 0.003), breast cancer stage at diagnosis—regional versus localized (OR 3.63; 95% CI 2.00–6.57; P < 0.001), and inversely with age (OR per one-year increment, 0.96; 95% CI 0.94–0.99; P = 0.002), and with time since diagnosis (OR per one-year increment, 0.82; 95% CI 0.75–0.90; P < 0.001).ConclusionsWith the increasing incidence of detected breast cancer and the improvements in treatment and consequently survival, knowledge about prevalence, and factors related to treatment late effects of chronic pain is highly relevant for potential prevention or management without negatively impacting quality of life.

Objectives: The emergence of SARS-CoV-2 variants with enhanced immune evasion capabilities poses ongoing challenges for maintaining population-level immunity. This study aim to evaluate neutralizing antibody responses to the wild-type (WT) strain and the Omicron sublineage XBB.1.9 in the Israeli population using serum samples collected between August 2022 and January 2023, prior to widespread circulation of XBB.1.9. Methods: Pseudovirus-based microneutralization assays incorporating variant-specific spike proteins were employed to measure neutralizing geometric mean titers (GMTs) across subgroups categorized by age, gender, socioeconomic status, and geographic region. Results: Neutralizing titers against XBB.1.9 were significantly lower than those against WT across all demographic groups, with a 29-fold reduction in neutralization activity against XBB.1.9, underscoring the immune escape potential of XBB.1.9. For WT, older adults (≥65 years) exhibited higher titers than younger individuals (p < 0.01), whereas no significant age-related differences were observed for XBB.1.9 (p > 0.05). Regional disparities in WT immunity were identified, with higher titers in Northern Israel compared to Jerusalem and Southern regions. By contrast, XBB.1.9 neutralization showed no significant regional variation. Conclusions: These findings demonstrate substantially reduced neutralization of XBB.1.9 compared to WT and reveal disparities in WT immunity by age and region. The results emphasize the need for updated vaccines targeting immune-evasive variants and for tailored vaccination strategies to address regional and demographic gaps in protection.

In an Israeli Ministry of Health database, 136 definite or probable cases of myocarditis were detected among 5 million vaccinated persons. The rate ratio after two doses as compared with unvaccinated persons was 2.35, with the highest risk among male recipients between the ages of 16 and 19 years.

In Israel, the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 was approved for use in adolescents in June 2021, shortly before an outbreak of B.1.617.2 (Delta) variant–dominant infection. We evaluated short-term vaccine effectiveness and found the vaccine to be highly effective among this population in this setting.

Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperative anxiety. This study examined the relative effectiveness of various individual and generic CAM methods combined with standard treatment (ST) in relieving preoperative anxiety, in comparison with ST alone. Randomized controlled trial. Holding room area Three hundred sixty patients. Patients were randomly divided into 6 equal-sized groups. Group 1 received the standard treatment (ST) for anxiety alleviation with anxiolytics. The five other groups received the following, together with ST (anxiolytics): Compact Disk Recording of Guided Imagery (CDRGI); acupuncture; individual guided imagery; reflexology; and individual guided imagery combined with reflexology, based on medical staff availability. Assessment of anxiety was taken upon entering the holding room area (surgery preparation room) (‘pre-treatment assessment’), and following the treatment, shortly before transfer to the operating room (‘post-treatment assessment’), based on the Visual Analogue Scale (VAS) questionnaire. Data processing included comparison of VAS averages in the ‘pre’ and ‘post’ stages among the various groups. Preoperatively, CAM treatments were associated with significant reduction of anxiety level (5.54-2.32, p<0.0001). In contrast, no significant change was noted in the standard treatment group (4.92-5.44, p=0.15). Individualized CAM treatments did not differ significantly in outcomes. However, CDRGI was less effective than individualized CAM (P<0.001), but better than ST (p=0.005). Individual CAM treatments integrated within ST reduce preoperative anxiety significantly, compared to standard treatment alone, and are more effective than generic CDRGI. In light of the scope of preoperative anxiety and its implications for public health, integration of CAM therapies with ST should be considered for reducing preoperative anxiety. •Study focused on preoperative anxiety reduction using CM additional to anxiolytics.•Individualized CM interventions were superior to generic CDRGI, and ST.•No significant differences were found between the individual CM treatments.•Differences between CDRGI and individual GI were statistically but not clinically significant.

Preoperative anxiety is common. To date, no randomized controlled trial has examined the effectiveness of reflexology in reducing preoperative anxiety in patients undergoing elective laparoscopic cholecystectomy. A randomized, single blinded, interventional trial was conducted with 300 patients undergoing elective laparoscopic cholecystectomy, comparing the following three groups: controls receiving standard-of-care (SoC) only (group 1); intervention group receiving reflexology and SoC (group 2); and a group receiving sham reflexology and SoC (group 3). The primary outcome was the mean difference between the three groups in visual analog scale for anxiety (VAS-A). The secondary outcome was a similar analysis confined to patients experiencing baseline moderate-to-high anxiety. In all groups, level of preoperative anxiety was evaluated at entry and exit from the holding room area (HRA). The evaluation was carried out using the VAS-A questionnaire. The study was registered at clinicaltrials.gov (NCT01733771). 101 patients were randomly assigned to the reflexology group, 99 to the sham reflexology arm, and 100 received SoC alone. In all groups, SoC included anxiolytics in 25% of patients received about 2 h before the operation. Baseline anxiety (at entry to HRA) was similar in all groups, averaging 5.3. Between-group analysis comparing the reflexology and sham groups detected 0.8 point difference on 0-10 VAS scale in favor of the reflexology group ( = 0.022). Subgroup analysis of patients with moderate to high level of anxiety (VAS-A>4) at baseline (consisting of 75% of study participants), indicated 1.3 points difference ( = 0.023). The study findings suggest that reflexology treatments have a small, yet significant advantage over sham reflexology and over standard-of-care in reducing preoperative anxiety, in patients with moderate-to-high levels of anxiety. https://clinicaltrials.gov/study/NCT01733771?tab=results, Identifier: NCT01733771.

Cancer risks and tumor types in male BRCA1 and BRCA2 mutation carriers are still unsettled. Cancer risks in men who were found to harbor a BRCA1 ( n  = 150) or a BRCA2 ( n  = 88) mutation or both ( n  = 2) were assessed by cross referencing with data on cancer occurrence in the Israeli National Cancer Registry. Incidence rates in mutation carriers were compared with men who were counseled, genotyped, and found not to harbor the familial mutation (true negative n  = 122), and with standardized incidence rates (SIRs). Of 210 cancer-free individuals at initial counseling, 11 cancers were diagnosed after a mean follow-up of 5.06 ± 4.1 years (1064 person/years) compared with 1/122 in a BRCA true-negative man. The SIR for all BRCA1/2 mutation carriers compared with the rates in the general population were elevated for pancreatic cancer [2.97 (95 % CI 1.83–4.29)] and breast cancer [16.44 (95 % CI 9.65–26.24)]. For prostate cancer these rates were 0.59 (95 % CI 0.4–0.84). Jewish BRCA1/2 mutation carriers are at an increased risk for breast and pancreatic, but not prostate cancer. These cancer risks and the consequent recommendations, if validated, should be transmitted to carriers at test result disclosure.