Citations

Background: NCCN publishes evidence-based guidelines across the cancer care continuum that are commonly used as the standard for clinical management and policy in cancer care. Our study aimed to assess the content of survivorship recommendations within disease-based NCCN Guidelines. Methods: In January 2024, we downloaded 64 disease-based guidelines from the NCCN website; 10 were excluded. The remaining 54 guidelines were reviewed for survivorship-focused content. Content of the guidelines was systematically categorized across domains of the Quality of Cancer Survivorship Care Framework, and the level of detail was rated as not addressed, briefly addressed, mostly addressed, or fully addressed. Guidelines were re-reviewed for updates in April 2025. Results: Of 54 guidelines reviewed in 2025, 16 (30%) included a dedicated survivorship section with focused content, although sections, titles, and formats varied. Other guidelines included survivorship recommendations in algorithms and/or discussion sections. A total of 18 guidelines (33%) had neither a dedicated section nor reference to the NCCN Survivorship Guidelines. Guidelines with a dedicated section, as well as those referencing the NCCN Survivorship Guidelines (65%), generally provided more detailed survivorship content. Across all guidelines, the surveillance for recurrences/new cancers domain was most commonly included (96%) and typically the most detailed. Information on physical (81%) and psychosocial (72%) effects and health promotion (65%) was often included, but the level of detail varied. Chronic disease management (31%) was seldomly included. Information on care coordination/communication and patient education was present in 50% of the guidelines. Compared with the guidelines reviewed in 2024, the 2025 updates had limited expansion of survivorship content. Conclusions: Cancer survivorship content is inconsistently presented across disease-specific NCCN Guidelines. As these guidelines evolve, there is an opportunity to tailor, expand, and standardize the recommendations, making them easier to find by clearly labeling and integrating them within each guideline to improve accessibility and better support clinicians in delivering patient-centered care.

ABSTRACT Background A randomized phase II screening trial of gemcitabine, nab‐paclitaxel, and cisplatin with a medically supervised ketogenic diet (MSKD) versus usual diet (non‐MSKD) was conducted in patients with treatment‐naive metastatic pancreatic ductal adenocarcinoma (PDAC). Methods Patients with untreated metastatic PDAC were randomized 1:1 to MSKD or non‐MSKD while receiving gemcitabine, nab‐paclitaxel, and cisplatin on days 1 and 8 of a 21‐day cycle. The MSKD was guided by a remote health care team and daily ketone (beta‐hydroxybutyrate) levels, with goal beta‐hydroxybutyrate of 0.5 to 3.0 mM. The primary endpoint was progression‐free survival (PFS) using a one‐sided alpha level of 0.20. Secondary endpoints included overall survival (OS), safety, and quality of life (QOL). Changes in microbiome were an exploratory endpoint. Findings Overall, there were 32 evaluable patients. In the MSKD arm, 15 of 16 patients achieved nutritional ketosis; the median proportion of days in ketosis was 39.4%. The median PFS was 8.5 months in MSKD patients and 6.2 months in non‐MSKD patients: hazard ratio, 0.53 (95% CI, 0.21–1.37); one‐sided p = .096. The median OS was 13.7 months with MSKD and 10.2 months in the non‐MSKD arm: hazard ratio, 0.58 (95% CI, 0.25–1.37); one‐sided p = .107). All MSKD‐related adverse events were grade 1‐2. There were no significant differences in grade ≥3 chemotherapy‐related adverse events between the arms. MSKD patients had no decline in QOL and had significant enrichment of beneficial taxa in the microbiome ( p < .05, log‐fold change ≥2). Conclusions The MSKD is feasible in patients with PDAC and, although not powered for definitive outcomes, shows trends in improved PFS and OS when combined with gemcitabine, nab‐paclitaxel, and cisplatin, without added toxicity or detriment to QOL. Larger studies are required to confirm these findings and establish the value of the MSKD in pancreatic cancer treatment.

Abstract Advances in biomarker technology, digital cognitive assessments, and amyloid‐targeting therapies have redefined the opportunities for accurate and early diagnosis and care of Alzheimer's disease (AD). These advances also create new possibilities for intervention before the onset of cognitive impairment. This paradigm shift has increased the focus on Stages 1 and 2 of AD, in which individuals are cognitively unimpaired but exhibit biological evidence of disease. While early identification of AD offers an opportunity to intervene early to delay progression and preserve quality of life, it also presents complex challenges related to communicating diagnostic results to patients and their families, contextualizing the cost effectiveness of early diagnosis and treatment, and implementation of and equitable access to treatments. Recent, successfully enrolled, preclinical AD trials highlight the complex strategies required to identify asymptomatic, biomarker‐positive individuals on a large scale, and demonstrate critical knowledge gaps in inclusion, follow‐up, and long‐term outcome measurement. The Spring 2025 Alzheimer's Association Research Roundtable (AARR) meeting brought together academics, clinicians, industry, and regulatory leaders to exchange perspectives on current challenges, key learnings, and potential strategies for identifying and treating individuals in very early stages of AD, effectively and safely. This paper presents key takeaways from the Spring 2025 AARR meeting. Highlights New criteria for Alzheimer's disease (AD) enable early identification of AD pathology. Blood tests and digital cognitive assessment tools may facilitate early and personalized care. Plasma biomarkers may be scalable in clinical settings but need confirmation or follow‐up assessments in those individuals with equivocal results. Early therapy shows best results in people with lower initial amyloid and tau burden.