Citations

SummaryThe goal of this study was to ascertain the effect of patient body size on clinic‐ or patient‐delayed health care during the COVID‐19 pandemic and factors predicting delay. Primary survey data were collected in August 2021 from 3593 individuals living within the communities near Mayo Clinic facilities in Minnesota, Wisconsin, Arizona, and Florida. More people who identified with the higher‐weight BMI categories reported having their care appointments cancelled (62.3%) compared to those who identified with normative weight (38.0%) or underweight (47.7%; p < .001) and reported more frequently delaying their own care (67.9%) relative to those who identified with normative weight (47.0%) or underweight (62.3%; p < .001). Higher‐weight people were more likely than others to report delay was due to not knowing where to get care (UW: 5.6%, NW: 3.5%, HW: 7.0%, pchi‐square < .001), worrying about weight‐based judgement (UW: 2.1%, NW: 2.1%, HW: 4.5%, pchi‐square < .001), and fearing discrimination (UW: 2.9%, NW: 2.4%, HW: 5.5%, pchi‐square < .001). There was no difference across groups in delay due to fear of COVID‐19 exposure. Weight gain was associated with care delay in higher‐weight and normative weight groups. Having experienced more patient‐centred care pre‐COVID was associated with less care delay in the normative weight group, but more care delay in other groups. Higher‐weight people were more likely to have their care delayed by health care providers and to delay care themselves. Patient weight gain and concerns about discrimination and judgement about weight gain may have driven the delay of needed care during COVID‐19.

Abstract Apathy is a prevalent and persistent neuropsychiatric syndrome across many neurological disorders, significantly impacting both patients and caregivers. We systematically quantified discrepancies between self- and caregiver-reported apathy in 335 patients with a variety of diagnoses, such as frontotemporal dementia (behavioural variant and semantic dementia subtypes), Parkinson’s disease, Parkinson’s disease dementia, dementia with Lewy bodies, Alzheimer’s disease dementia, mild cognitive impairment, small vessel cerebrovascular disease, subjective cognitive decline and autoimmune encephalitis. Using the Apathy Motivation Index (AMI) and its analogous caregiver version (AMI-CG), we found that caregiver-reported apathy consistently exceeded self-reported levels across all conditions. Moreover, self-reported apathy accounted for only 14.1% of the variance in caregiver ratings. This apathy reporting discrepancy was most pronounced in conditions associated with impaired insight, such as behavioural variant frontotemporal dementia, and was significantly correlated with cognitive impairment. Deficits in memory and fluency explained an additional 11.2% of the variance in caregiver-reported apathy. Specifically, executive function deficits (e.g. indexed by fluency) and memory impairments may contribute to behavioural inertia or recall of it. These findings highlight the need to integrate patient and caregiver perspectives in apathy assessments, especially for conditions with prominent cognitive impairment. To improve diagnostic accuracy and deepen our understanding of apathy across neurological disorders, we highlight the need for adapted apathy assessment strategies that account for cognitive impairment particularly in individuals with insight or memory deficits. Understanding the cognitive mechanisms underpinning discordant apathy reporting in dementia might help inform targeted clinical interventions and reduce caregiver burden.

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing cancer, with the most common sites being colorectal, duodenal/ampullary and thyroid. In the last decade, an alarming increase in gastric cancer has been reported in the Western FAP population. These cancers are often diagnosed at an advanced stage with poor prognosis, even in patients undergoing regular upper endoscopic surveillance. Most gastric cancers in Western patients with FAP occur in the proximal stomach, where a carpeting of fundic gland polyposis hampers visualization of gastric cancer and its precursor lesions during endoscopic surveillance. Although fundic gland polyps are the most prevalent proximal polyp, several different dysplastic lesions can be found in the stomachs of patients with FAP. including fundic gland polyps with dysplasia, foveolar-type adenomas, pyloric gland adenomas, and intestinal-type adenomas. Although adenomas are the most likely precursors to gastric cancer, the exact lesions responsible for gastric cancer in FAP are not yet fully understood. This review focuses on gastric polyposis and the characteristics of gastric cancer in Western patients with FAP, including risk factors, lesion detection, surveillance and management of gastric polyposis, and areas for future research.

Thymomas and thymic carcinomas are rare mediastinal tumors that originate in the thymus. Patients with thymoma may experience symptoms associated with autoimmune paraneoplastic diseases (such as myasthenia gravis), which typically do not occur in patients with thymic carcinoma. The NCCN Guidelines for Thymomas and Thymic Carcinomas provide guidance for the diagnosis, treatment, and surveillance of patients with thymoma and thymic carcinoma. Involvement of a multidisciplinary team with experience treating thymomas and thymic carcinomas is highly recommended.

Objective: To evaluate the first 3 years of compliance with the American College of Surgeons Commission on Cancer (CoC) Operative Standards. Background: CoC implemented evidence-based standards to improve the quality of sentinel lymph node biopsy and axillary lymph node dissection for breast cancer (operative standards 5.3 and 5.4), wide local excision for melanoma (5.5), colectomy for colon cancer (5.6), proctectomy for rectal cancer (5.7), and pulmonary resection for lung cancer (5.8) at ∼1400 programs treating >74% of US cancer patients. Each operative standard defines a technical element of the operation and structured documentation. Methods: Compliance data are from site visits conducted between January 1, 2022, and December 31, 2024 (implementation/site visits began in 2021/2022 for 5.7 and 5.8 and 2023/2024 for 5.3–5.6). Compliance with each operative standard was determined by evaluation of 7 operative (5.3–5.6) or pathology (5.7, 5.8) reports. Deficiency in technical performance, documentation, or both was considered noncompliance. Results: Reviewers conducted 974 site visits of Comprehensive Community (44%), Community (23%), Academic Comprehensive (16%), network (12%), NCI-Designated Comprehensive (4%), and other (1%) cancer programs. Program compliance rates ranged from 53% to 88%. Documentation noncompliance was more common for standards 5.3 to 5.6 (based on operative reports), and technical noncompliance was more common for 5.7 and 5.8 (based on pathology reports). Compliance significantly (P=0.006) varied by program type for 5.8 (highest: 66% at NCI-designated Comprehensive programs; lowest: 37% at Community Cancer programs). Conclusions: Early compliance with CoC operative standards varied, indicating local and large-scale national quality improvement efforts are needed.

Living donor liver transplantation for oncologic indications is a complex topic that involves transplantation, oncology, and ethical considerations. The incidence of primary and secondary malignancy of the liver is growing. As transplant oncology continues to provide promising outcomes, the patient population that may benefit from transplantation will grow. In this review, we provide evidence that justify attempting transplantation for oncologic indications through the exploration of outcomes in both deceased donor and living donor liver transplants. This will focus on outcomes for patients with hepatocellular carcinoma, cholangiocarcinoma, neuroendocrine liver metastasis, and colorectal liver metastases. This review aims to summarize the current status of transplant oncology and to develop the considerations of living donor liver transplantation for these indications.

For over a century, scientists reported the disruption of normal nuclear shape and size in cancer. These changes have long been used as tools for diagnosis and staging of malignancies. However, to date, the mechanisms underlying these aberrant nuclear phenotypes and their biological significance remain poorly understood. Using a model of pancreatic ductal adenocarcinoma (PDAC), the major histological subtypes of pancreatic cancer, we found that oncogenic mutant KRAS reduces nuclear size. Transcriptomic and protein expression analysis of mutant KRAS–expressing PDAC cells revealed differential levels of several nuclear envelope–associated genes. Further analysis demonstrated the nuclear lamina protein, Emerin (EMD), acted downstream of KRAS to mediate nuclear size reduction in PDAC. Analysis of human PDAC samples showed that increased EMD expression associates with reduced nuclear size. Finally, in vivo genetic depletion of EMD in a mutant KRAS–driven PDAC model resulted in increased nuclear size and a reduced incidence of poorly differentiated PDAC. Thus, our data provide evidence of a potentially novel mechanism underlying nuclear size regulation and its effect in PDAC carcinogenesis.

OBJECTIVE The purpose of this study was to identify risk factors for mechanical complications following complex spinal reconstruction for spondylectomy of primary spinal column tumors. METHODS A retrospective chart review identified patients treated with spondylectomy for primary spinal column tumors in the thoracic or lumbar spine followed by posterior instrumentation and anterior column reconstruction. Variables collected included basic demographics, smoking status, chronic steroid use, frailty (Charlson Comorbidity Index), extent of resection, Weinstein-Boriani-Biagini classification, tumor volume, Spine Instability Neoplastic Score, anterior column reconstruction and fixation techniques, rod characteristics, Hounsfield units (HUs), and neoadjuvant/adjuvant chemoradiation. RESULTS Twenty-five patients were included (14 men, 11 women) with an average (± SD) age of 45 ± 18 years, BMI of 28 ± 5.7, and follow-up of 6.0 ± 6.2 years. Primary spinal column tumor pathology included chordoma (40%), chondrosarcoma (16%), giant cell tumor (16%), osteosarcoma (16%), osteoblastoma (8%), and aneurysmal bone cyst (4%). Six patients (24%) experienced mechanical complications, including rod fractures (n = 5) and distal junctional failure (n = 1). Of the 6 patients with mechanical complications, 4 (67%) underwent reoperation. The length of follow-up was the only statistically significant risk factor for patients with mechanical complications (average 11 years) compared to those without complications (average 4.4 years, p = 0.047). Average HUs were 144 for mechanical complication patients versus 180 for those without (p = 0.08). Anterior column reconstruction materials included a titanium cage (13 patients, 3 failures), structural allograft (6 patients, 2 failures), vascularized fibular strut autograft (6 patients, no failures), nonvascularized structural autograft (5 patients, 1 failure), vascularized rib autograft (5 patients, 2 failures), and a polyetheretherketone cage (2 patients, no failures). The vascularized fibular strut autograft had a 0% mechanical failure rate, but this did not reach statistical significance (p = 0.28). Twelve patients (48%) had anterior fixation placed, with a 17% rate of mechanical complications (p = 0.65). Five patients (20%) had > 2-rod constructs, with a 20% mechanical complication rate (p = 0.99). CONCLUSIONS Reconstruction following primary spinal column tumor resection is a significant challenge, as evident by a high rate of mechanical complications and instrumentation failure. Future studies are needed with larger sample sizes to identify techniques that may mitigate the risk of failure.