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Needs assessment tools may guide optimization of clinical services to be more patient-centered. As needs of patients living with and beyond colorectal cancer (CRC) may also be influenced by socio-cultural backgrounds and healthcare ecosystems, we developed and validated a needs assessment questionnaire for CRC in a multi-ethnic, low-and middle-income setting. The study methodology was guided by the COSMIN checklist. Items generation was based on findings from independent qualitative inquiries with patients, input from cancer stakeholders, and literature review. Following translation into Malay language, content and face validation were undertaken. The tool was administered to 300 individuals living with and beyond CRC. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Criterion validity was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires. The 48-item bilingual needs assessment tool for colorectal cancer (NeAT-CC) encompassed six domains of needs, namely (i) diagnosis, (ii) psychosocial and information, (iii) healthcare, (iv) practical and living with cancer, (v) financial and (vi) employment. Cronbach's alpha was above 0.70 for all domains, indicating good internal consistency. CFA also demonstrated acceptable convergent and divergent validity with composite reliability >0.70 and Heterotrait-Monotrait index <0.90 for all constructs. Criterion validity was established given the significant correlation with quality of life. The NeAT-CC was easily understandable, took 15-20 minutes for completion and may be self-administered. Utilization of NeAT-CC may facilitate optimization of supportive and survivorship care services following CRC in local settings. The tool has wider potential for adaptation in other multi-ethnic and/or low and middle-income settings.

As one of the major threats to women's health worldwide, breast cancer requires early diagnosis and accurate classification, since they are key to optimizing therapeutic interventions and ensuring precise prognosis. Recently, deep learning has demonstrated notable advantages in breast cancer image classification. However, their performance heavily relies on the proper configuration of hyperparameters. To overcome the inefficiencies and weaknesses of conventional hyperparameter optimization methods, like limited effectiveness and vulnerability to premature convergence, this research proposes a Multi-Strategy Parrot Optimizer (MSPO) and applies it to breast cancer image classification tasks. Based on the original Parrot Optimizer, MSPO integrates several strategies, including Sobol sequence initialization, nonlinear decreasing inertia weight, and a chaotic parameter to enhance global exploration ability and convergence steadiness. Tests using the CEC 2022 benchmark functions reveal that MSPO surpasses leading algorithms regarding optimization precision and convergence rate. An ablation study was conducted on three variants of MSPO through CEC 2022 to further validate the effectiveness of each key strategy. Furthermore, MSPO is combined with the ResNet18 model and applied to the BreaKHis breast cancer image dataset. Results indicate that the model optimized by MSPO notably surpasses both the non-optimized version and other alternative optimization algorithms using four assessment indicators: accuracy, precision, recall, and F1-score. This validates the promising application potential and practical significance of MSPO in medical image classification tasks.

Breast cancer remains a leading cause of mortality among women globally. Early diagnosis and precise classification are essential for treatment and improving survival rates. This research introduces a novel algorithm: the Parallel Enzyme Action Optimizer (PEAO). PEAO introduces three key innovations: a parallel strategy to enhance global exploration, a multi-strategy communication mechanism (optimal replacement, optimal mean replacement, and circular optimal replacement) to improve information exchange, and the Lévy flight strategy to avoid local optima. The proposed algorithm was applied to optimize the hyperparameters of a BiLSTM network for breast cancer diagnosis. Experimental results on the Breast Cancer Wisconsin Diagnostic (BCWD) and Wisconsin Breast Cancer (WBC) datasets demonstrate that the PEAO-BiLSTM model significantly improves classification accuracy, precision, recall, and F1-score compared with recent meta-heuristic algorithms and other hyperparameter optimization methods. These results confirm that the proposed approach provides a robust and reliable diagnostic framework, contributing to the development of intelligent, data-driven systems for clinical decision support in breast cancer diagnosis.

The Chinese Society for Therapeutic Radiology Oncology, the Chinese Anti-Cancer Association, the Chinese Society of Clinical Oncology, the Head and Neck Cancer International Group, the European Society for Radiotherapy and Oncology, and the American Society for Radiation Oncology collaboratively developed evidence-based guidelines and a comprehensive contouring atlas for neck target volume delineation in nasopharyngeal carcinoma. These guidelines address five key challenges in modern radiotherapy practice: margin design of clinical target volume; nodal target volume delineation after induction chemotherapy; delineation of equivocal nodes evident on imaging; low-risk clinical target volume delineation based on regional stepwise extension patterns; and modifications for anatomical boundaries of lymphatic areas. Developed through a rigorous systematic review and expert appraisal process by a panel of 50 international, multidisciplinary members from 17 countries and regions, these guidelines incorporate the latest advances in nasopharyngeal carcinoma diagnosis and treatment. They reflect contemporary therapeutic concepts and elaborate on current practice variations. These guidelines aim to standardise global practice, substantially improving consistency and reducing variability in nasopharyngeal carcinoma radiotherapy target delineation.

IntroductionTreatment combination of pembrolizumab plus platinum and 5-fluorouracil (PF) has increased the survival of recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). The combination of platinum and gemcitabine (PG) has been shown to be superior to PF in the treatment of R/M nasopharyngeal carcinoma patients. Therefore, we hypothesise that the combination of pembrolizumab with PG would be comparable to pembrolizumab with PF as a first-line treatment in R/M HNSCC.Methods and analysisThis is an open-label, multicentre, single-arm, phase 2 study of pembrolizumab plus PG for first-line treatment in subjects with R/M HNSCC in Malaysia. The study is conducted using the Optional Simon optimal 2-stage design. At the initial stage, 26 subjects will be enrolled and if seven or more patients achieve an objective response rate (ORR), then 63 patients will be enrolled. Subjects will be given pembrolizumab 200 mg3 every 3 weeks up to 35 cycles in combination with chemotherapy for up to six cycles of platinum (either cisplatin at 35 mg/m2 intravenous on day 1 and day 8 or carboplatin at area under the curve 5 intravenous on day 1 of each 3-week cycle) and gemcitabine at 1250 mg/m2 intravenous on days 1 and 8 of a 3-week cycle. The primary end point is the ORR as per Response Evaluation Criteria in Solid Tumors 1.1. Secondary end points include the overall survival, progression free survival, response duration and safety. The exploratory objectives include relationships of microbiome profiles, prognostic and predictive biomarkers with the clinical responses.Ethics and disseminationThe study was approved by the ethics committee of the University Malaya Medical Centre (202213–10884). Findings will be disseminated through conference presentations and peer review publications.Trial registration numberClinicalTrials.gov (www.clinicaltrial.gov); NCT05286619.

The Chinese Society for Therapeutic Radiology Oncology, the Chinese Anti-Cancer Association, the Chinese Society of Clinical Oncology, Head and Neck Cancer International Group, the European Society for Radiotherapy and Oncology, and the American Society for Radiation Oncology jointly developed evidence-based guidelines and a contouring atlas for primary target volume delineation for radiotherapy in nasopharyngeal carcinoma. The guidelines systematically address three crucial challenges: margin design of clinical target volumes; target volume delineation after induction chemotherapy; and low-risk clinical target volume delineation based on local stepwise extension patterns. Based on a comprehensive systematic review and critical appraisal by an international multidisciplinary panel of 50 nasopharyngeal carcinoma specialists from 17 countries and regions, these guidelines are in keeping with advances in nasopharyngeal carcinoma diagnosis and treatment, embodying contemporary treatment concepts, and elaborating on the differences in practice. These guidelines aim to support global clinical practice in radiotherapy target volume delineation, substantially enhancing homogeneity and reducing variability in nasopharyngeal carcinoma target delineation.

Pembrolizumab is active in head and neck squamous cell carcinoma (HNSCC), with programmed cell death ligand 1 (PD-L1) expression associated with improved response. KEYNOTE-048 was a randomised, phase 3 study of participants with untreated locally incurable recurrent or metastatic HNSCC done at 200 sites in 37 countries. Participants were stratified by PD-L1 expression, p16 status, and performance status and randomly allocated (1:1:1) to pembrolizumab alone, pembrolizumab plus a platinum and 5-fluorouracil (pembrolizumab with chemotherapy), or cetuximab plus a platinum and 5-fluorouracil (cetuximab with chemotherapy). Investigators and participants were aware of treatment assignment. Investigators, participants, and representatives of the sponsor were masked to the PD-L1 combined positive score (CPS) results; PD-L1 positivity was not required for study entry. The primary endpoints were overall survival (time from randomisation to death from any cause) and progression-free survival (time from randomisation to radiographically confirmed disease progression or death from any cause, whichever came first) in the intention-to-treat population (all participants randomly allocated to a treatment group). There were 14 primary hypotheses: superiority of pembrolizumab alone and of pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival and progression-free survival in the PD-L1 CPS of 20 or more, CPS of 1 or more, and total populations and non-inferiority (non-inferiority margin: 1·2) of pembrolizumab alone and pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival in the total population. The definitive findings for each hypothesis were obtained when statistical testing was completed for that hypothesis; this occurred at the second interim analysis for 11 hypotheses and at final analysis for three hypotheses. Safety was assessed in the as-treated population (all participants who received at least one dose of allocated treatment). This study is registered at ClinicalTrials.gov, number NCT02358031. Between April 20, 2015, and Jan 17, 2017, 882 participants were allocated to receive pembrolizumab alone (n=301), pembrolizumab with chemotherapy (n=281), or cetuximab with chemotherapy (n=300); of these, 754 (85%) had CPS of 1 or more and 381 (43%) had CPS of 20 or more. At the second interim analysis, pembrolizumab alone improved overall survival versus cetuximab with chemotherapy in the CPS of 20 or more population (median 14·9 months vs 10·7 months, hazard ratio [HR] 0·61 [95% CI 0·45–0·83], p=0·0007) and CPS of 1 or more population (12·3 vs 10·3, 0·78 [0·64–0·96], p=0·0086) and was non-inferior in the total population (11·6 vs 10·7, 0·85 [0·71–1·03]). Pembrolizumab with chemotherapy improved overall survival versus cetuximab with chemotherapy in the total population (13·0 months vs 10·7 months, HR 0·77 [95% CI 0·63–0·93], p=0·0034) at the second interim analysis and in the CPS of 20 or more population (14·7 vs 11·0, 0·60 [0·45–0·82], p=0·0004) and CPS of 1 or more population (13·6 vs 10·4, 0·65 [0·53–0·80], p<0·0001) at final analysis. Neither pembrolizumab alone nor pembrolizumab with chemotherapy improved progression-free survival at the second interim analysis. At final analysis, grade 3 or worse all-cause adverse events occurred in 164 (55%) of 300 treated participants in the pembrolizumab alone group, 235 (85%) of 276 in the pembrolizumab with chemotherapy group, and 239 (83%) of 287 in the cetuximab with chemotherapy group. Adverse events led to death in 25 (8%) participants in the pembrolizumab alone group, 32 (12%) in the pembrolizumab with chemotherapy group, and 28 (10%) in the cetuximab with chemotherapy group. Based on the observed efficacy and safety, pembrolizumab plus platinum and 5-fluorouracil is an appropriate first-line treatment for recurrent or metastatic HNSCC and pembrolizumab monotherapy is an appropriate first-line treatment for PD-L1-positive recurrent or metastatic HNSCC. Merck Sharp & Dohme.

The incidence of colorectal cancer (CRC) is rapidly rising in several Asian countries, including Malaysia, but there is little data on health care provider costs in this region. The aim of this study was to estimate the cost of CRC management from the perspective of the health care provider, based on standard operating procedures. A combination of top-down approach and activity-based costing was applied. The standard operating procedure (SOP) for CRC was developed for each stage according to national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost was calculated and incorporated into the treatment pathway in order to obtain the total cost of managing a single CRC patient according to the stage of illness. The cost data were represented by means and standard deviation and the results were demonstrated by tabulation. All cost data are presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late stage (Stage II-IV) was analysed using independent -test. The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30) for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant lower cost compared to late stage (2) = -4.729, = 0.042. The highest fraction of the cost was related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II-IV. CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV. The early stages conserved more resources than did the advanced stages of cancer. Early diagnosis and management of CRC, therefore, not only affects oncologic prognosis, but has implications for health care costs. This adds further justification to develop and implement CRC screening programmes in Malaysia.

Evidence remains mixed on the benefits of oral cryotherapy in the prevention of oral mucositis and pain associated with fluorouracil-based chemotherapy. The intent of this article is to evaluate the effect of oral cryotherapy on the prevention of oral mucositis and pain among patients with colorectal cancer undergoing fluorouracil-based chemotherapy. Using an experimental study design, the authors randomly assigned 80 patients to either the intervention (n = 40) or usual care group (n = 40). Intervention group participants received oral cryotherapy in the form of ice chips held in their mouths during chemotherapy infusion. Both groups used sodium bicarbonate mouthwash postchemotherapy until the next cycle. In the usual care group, most participants reported grade 2 (moderate to life-threatening) or greater mucositis. Pain associated with mucositis was lower using oral cryotherapy, with the majority of participants in the intervention group reporting no pain.