Jeffrey Zhong

Background: As the number of cancer survivors continues to grow, optimizing long-term survivorship care models has become increasingly important. Telehealth has the potential to improve access to health care for survivors; however, studies evaluating telehealth in this population remain limited. Additionally, concerns persist regarding equity in technology access and digital literacy. Objective: This study aimed to examine demographic factors and patient attitudes influencing telehealth use among cancer survivors compared to the general population. Methods: Adult participants were identified from the nationally representative database Health Information National Trends Survey 6 (HINTS 6). Multivariable logistic regression was used to calculate the predictors of telehealth use among cancer survivors. χ ² tests compared the prevalence of reported reasons of not using telehealth in the last 12 months between cancer survivors and the general population. Results: A total of 5793 (weighted n=239,557,883) individuals were included in this study, 7.7% (weighted n=18,545,434) who are cancer survivors. 5092 individuals from the general population and 701 cancer survivors were included. Older age was associated with lower telehealth use (adjusted odds ratio [aOR] 0.11; 95% CI 0.02‐0.59 for patients aged ≥65, compared to those under 40 y old). Higher education (aOR 2.55; 95% CI 1.24‐5.27) and heart disease history (aOR 2.52; 95% CI 1.20‐5.28) were associated with increased telehealth use. Employed (aOR 0.46; 95% CI 0.22‐0.97) and retired (aOR=0.37; 95% CI: 0.18‐0.77) cancer survivors were less likely to use telehealth than unemployed individuals. Of the nonusers, over 60% reported that telehealth options were not offered, and 80% preferred in-person visits. Technical issues and privacy concerns were not major factors in utilizing telehealth. Conclusions: Despite greater telehealth use among cancer survivors, a negative association between older age and telemedicine utilization persists. Efforts should focus on improving access for older cancer survivors and addressing employment-related factors, patient attitudes, and telehealth availability. Future studies should explore personalized approaches to enhance cancer survivors’ health care experiences. Our findings emphasize the need to address specific factors including age and employment related disparities, patient preferences and telehealth availability to optimize equitable access to telehealth and enhance the delivery of cancer survivorship care.

Background: Anitens are a family of oral N-terminal domain inhibitors of the androgen receptor (AR). In prostate cancer, they may help overcome AR resistance mechanisms at the ligand-binding domain, which is the binding site of approved androgen receptor pathway inhibitors like enzalutamide. Masofaniten (EPI-7386) is a next-generation aniten with promising activity and safety in patients with metastatic castrate-resistant prostate cancer (mCRPC). Methods: In this investigator-initiated, phase II, single-arm, single-institution trial, patients with treatment-naïve metastatic hormone-sensitive prostate cancer (mHSPC) were enrolled in a Simon 2-stage study design to receive the combination of masofaniten 600 mg BID and enzalutamide 160 mg daily with androgen deprivation therapy (ADT). The study was designed to enroll 35 patients (13 patients in stage 1, then 22 patients in stage 2). The trial would move to stage 2 if 9 or more subjects achieved a biochemical response at 6 months. Results: Thirteen patients were screened and enrolled into stage 1. Five were African American, and 8 were Caucasian. The median age was 68 years (range 52-75) at time of enrollment. Median follow-up time was 9.9 months (range 7.7-13.6). Ten of 13 patients (77% with 95% CI: 50%-92%) achieved a PSA <0.2 ng/mL at 6 months, achieving the threshold to move on to stage 2. Only one patient had disease progression to mCRPC and died of disease at the time of data cutoff. Patients continued enzalutamide and ADT after trial closure. Conclusion: The combination of masofaniten and enzalutamide for treatment-naïve mHSPC did show efficacy and had an acceptable safety profile. These results support further investigation of the dual AR blockade in mHSPC (ClinicalTrials.gov Identifier: NCT06312670).

The REnal cancer consortium for Focused Investigation of Novel biomarkers and Expression (REFINE) consortium represents an important initiative in integrating clinical data with molecular sequencing in patients with advanced renal cell carcinoma (RCC) treated with immunotherapy-based approaches. By leveraging real-world evidence and genomic analysis, this consortium aims to explore putative predictive biomarkers with the potential to inform personalized treatment strategies. Findings from the REFINE database may further contribute to our understanding of disease courses of immunotherapy-based approaches for various molecular subtypes of RCC, associations of race and ethnicity with RCC treatment and outcomes with representation of patient populations underrepresented in clinical trials, and optimizing treatment sequencing.

Lung cancer is the leading cause of cancer-related death worldwide, and patients with operable early-stage NSCLC are typically managed surgically. While effective, surgical resection can significantly impact pulmonary function and quality of life. Pulmonary rehabilitation (PR) is a comprehensive, multimodal approach that is an established cornerstone in the treatment of COPD. It has similarly demonstrated multiple benefits in patients with lung cancer who have undergone lobectomy or resection by improving pulmonary function, increasing exercise tolerance, improving nutritional status, providing psychological support, and enhancing quality of life. Despite this, PR for early-stage operable NSCLC is oftentimes not standardized, and challenges to adherence remain. In this review, we examine the components of PR, the role of PR in pre- and postoperative settings in patients with early-stage NSCLC, implementation strategies for PR, and future directions and challenges of PR in operable NSCLC.

Background: An immune checkpoint inhibitor (ICI) backbone is a standard of care for frontline metastatic clear cell renal cell carcinoma, involving either ICI doublet or tyrosine kinase inhibitor (TKI) with ICI. These phase 3 trials used a sunitinib control arm. The optimal regimen is uncertain. Objective: To compare long-term responders of these trials using extended follow-up data stratified by International Metastatic RCC Database Consortium risk group. Methods: Phase 3 trial data (CheckMate 214, KEYNOTE-426, CheckMate 9ER, and CLEAR) with a minimum follow-up of four years was used. Pseudo individual patient data (IPD) was obtained from Kaplan-Meier curves using the graph digitizer software IPDfromKM R package to extract coordinates of points on the curves and to apply a numerical algorithm to reconstruct progression-free survival (PFS) and overall survival (OS) results. Durable response (DR) was defined as PFS ≥ 24 months, extreme durable response (EDR) as PFS ≥ 36 months, and long-term OS as OS ≥ 48 months. Results: For the favorable risk group, lenvatinib-pembrolizumab had the highest DR and EDR, while ipilimumab-nivolumab had the lowest DR, and cabozantinib-nivolumab had the lowest EDR; there was no difference in long-term OS among the regimens ( p = 0.11). For the intermediate/poor risk group, lenvatinib-pembrolizumab also had the highest DR and EDR compared to other regimens with similar DR and EDR; there was also no difference in long-term OS among the regimens ( p = 0.22). Conclusion: TKI-ICI was overall associated with higher DR and EDR regardless of risk status compared to ICI doublet. Yet, OS at 48 months were similar when stratified by favorable versus intermediate/poor risk.

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.