Big Data,Machine Learning,and Artificial Intelligence to Advance Cancer Care: Opportunities and Challenges

ObjectivesThe rapid advances in artificial intelligence (AI), big data, and machine learning (ML) technologies hold promise for personalized, equitable cancer care and improved health outcomes within the context of cancer and beyond. Furthermore, integrating these technologies into cancer research has been effective in addressing many of the challenges for cancer control and cure. This can be achieved through the insights generated from massive amounts of data, in ways that can help inform decisions, interventions, and precision cancer care. AI, big data, and ML technologies offer, either in isolation or in combination, unconventional pathways that facilitate the better understanding and management of cancer and its impact on the person. The value of AI, big data, and ML technologies has been acknowledged and integrated within the Cancer Moonshot program in the U.S. and the EU Beating Cancer Plan in Europe.Data SourcesRelevant studies on the topic have formed the basis for this article.ConclusionIn a shifting health care environment where cancer care is becoming more complex and demanding, big data and AI technologies can act as a vehicle to facilitating the care continuum. An increasing body of literature demonstrates their impactful contributions in areas such as treatment and diagnosis. These technologies, however, create additional requirements from health care professionals in terms of capacity and preparedness to integrate them effectively and efficiently in clinical practice. Therefore, there is an increasing need for investment and training in oncology to combat and overcome some of the challenges posed by cancer control.Implications for Nursing PracticeAI, big data, and ML are increasingly integrated in various aspects of health care. As a result, health care professionals, including nurses, will need to adjust in an ever-changing practice environment where these technologies have potential applications in clinical settings to improve risk stratification, early detection, and surveillance management of cancer patients.     

Essential of Immediate Exercises on Cancer-Related Fatigue in Patients with Prostate Cancer Receiving Androgen Deprivation Therapy: A Meta-Analysis of Randomized Controlled Trials

ObjectiveAndrogen deprivation therapy (ADT) can cause several adverse effects, including cancer-related fatigue (CRF). CRF has multiple manifestations, with no definitive treatment to date. Among management, exercise has been a field with high complexity and uncertainty. In other words, it has much potential to be explored. To evaluate whether exercise reduces cancer-related fatigue (CRF) in patients receiving androgen deprivation therapy (ADT).Data SourcesRandomized controlled trials were included and searches were performed from PubMed, Embase, and Cochrane Library databases. We extracted and pooled the CRF, quality of life (QoL), muscle strength, and adverse event severity. The study is registered with PROSPERO (number: CRD 42020203165). Eightteen RCTs were included. The CRF in the exercise group (SMD: −0.18, 95% CI: −0.31 to −0.05) was significantly lower than in the usual care group. The CRF subgroup analysis showed a significant reduction in the immediate exercise group (SMD: −0.37, 95% CI: −0.61 to −0.13), and the combined exercise group (aerobic plus resistance)(SMD: −0.18, 95% CI: −0.36 to −0.01). QoL improvement was also known in the exercise group (SMD: 0.16, 95% CI: 0.01 to 0.32). Leg press and chess press increase ability in the exercise group (SMD: 0.5, 95% CI: 0.42 to 1.05; SMD: 0.42, 95% CI: 0.17 to 0.67, respectively). The enhanced ability of leg press and chess press can also help patients deal with the feeling of CRF.ConclusionExercises improve CRF, QoL, and muscle strength in patients receiving ADT.Implications for Nursing Practice We suggest immediate combined exercise intervention as supportive therapy to relieve cancer-related fatigue and enhance QoL.     

冬虫夏草介导SLC7A11/GPX4/ACSL4轴抑制铁死亡抵抗放射性直肠炎研究

目的 探讨冬虫夏草治疗急性放射性直肠炎的疗效及可能的作用机制。方法 将25只小鼠随机分为5组：对照组、模型组和冬虫夏草低、中、高剂量（0.25、0.50、1.00 g·kg^-1）组，每组5只，除对照组外的4组小鼠予直线加速器6-MV的X射线行下腹部照射，总剂量12 Gy，建立急性放射性直肠炎模型。照射后次日开始ig给药，观察并记录各组小鼠状态、体质量变化情况；HE染色观察各组小鼠肠道组织病理学改变；ELISA法检测各组小鼠血清丙二醛（MDA）、超氧化物歧化酶（SOD）、Fe²⁺以及炎症因子白细胞介素-6 （IL-6）、白细胞介素-1β （IL-1β）、肿瘤坏死因子-α （TNF-α）水平； Western blotting检测各组小鼠直肠组织中中铁死亡相关蛋白：长链酯酰辅酶A合成酶（ACSL4）、溶质载体家族7成员11（SLC7A11）、谷胱甘肽过氧化物酶4（GPX4）表达水平；透射电镜观察各组小鼠直肠细胞中线粒体数量及形态结构的变化情况。结果 与对照组相比，模型组小鼠精神萎靡，体质量下降，部分小鼠有肛门出血的症状；与模型组比较，冬虫夏草组小鼠症状普遍缓解。HE染色结果显示模型组肠道上皮细胞坏死脱落，黏膜层出现不同程度地出血水肿；用药后，肠道黏膜有所恢复，病变程度明显好转。ELISA结果显示，与对照组相比，模型组炎症因子TNF-α、IL-6、IL-1β、MDA、Fe²⁺水平显著升高（P<0.001），SOD水平显著下降（P<0.001）；治疗后，与模型组相比，冬虫夏草中、高剂量组TNF-α、IL-6、IL-1β、MDA、Fe²⁺含量显著下降，SOD含量显著增高（P<0.001）。Western blotting实验结果显示，与对照组比较，模型组ACSL4蛋白表达水平显著升高（P<0.05），SLC7A11及GPX4蛋白表达水平显著降低（P<0.05）；与模型组比较，冬虫夏草中、高剂量组ACSL4蛋白的表达水平显著降低（P<0.05），同时SLC7A11、GPX4蛋白表达水平显著升高。透射电镜结果发现，模型组线粒体数量下降，体积变小，膜密度增加，嵴减少；冬虫夏草治疗后各组线粒体结构损伤程度较模型组有所缓解。结论 冬虫夏草能缓解放射性直肠炎，作用机制可能与调控SLC7A11、GPX4、ACSL4蛋白的表达，同时抑制炎症因子，增加机体的抗铁死亡能力相关。     

Wearable-Technology-Assisted Interventions for Breast-Cancer Survivors: A Meta-Analysis and Meta-Regression

ObjectivesThis review, meta-analysis, and meta-regression aimed to (1) evaluate the effect of wearable-technology-assisted interventions on the physical activity and weight of breast cancer survivors, (2) identify the essential features of wearable-technology-assisted interventions, and (3) explore the covariates of the treatment effect.Data SourcesRandomized controlled trials were obtained from 10 databases and trial registries from inception until December 21, 2021. Trials that examined the effects of wearable-technology-assisted interventions for individuals with breast cancer were included. The mean and standard deviation scores were used to compute the effect sizes.ConclusionThe meta-analyses revealed significantly improved in moderate-to-vigorous activity, total physical activity, and weight control. The findings from this review suggest that wearable-technology-assisted interventions may be a potential solution to improve physical activity and weight in breast cancer survivors. Future studies should include high-quality trials with large sample sizes.Implications for Nursing PracticeWearable technology has promising effects on physical activity and could be incorporated into routine care for breast cancer survivors.     

A Systematic Review of Systematic Reviews and Pooled Meta-Analysis on Psychosocial Interventions for Improving Cancer-Related Fatigue

ObjectivesPsychosocial care is essential in oncology to address specific cancer-related fatigue dimensions. Psychosocial interventions have been defined as nonpharmacologic interventions that address psychological or social factors rather than biological mechanisms and might positively influence symptoms, quality of life, and social functioning. This systematic review of systematic reviews pooled the effects from the recent systematic reviews describing the relationships between psychosocial interventions and fatigue in adult patients with cancer, providing an overall estimate of their effect on cancer-related fatigue.Data SourcesPubMed, CINAHL, Cochrane Database of Systematic Reviews, PEDro, and PsycINFO were searched from 2010 through 2022. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias in eligible systematic reviews was assessed using the Cochrane Collaboration's risk of bias tool (ROBIS). Protocol registration: Prospero (CRD42020194254).ConclusionPsychosocial interventions are a promising option to reduce cancer-related fatigue, albeit with short-term effects. However, further research is needed to evaluate the efficacy of specific interventions within population clusters and to examine their long-term effectiveness.Implications for Nursing PracticeNurses play a crucial role in promoting psychosocial dimensions in cancer care. This study provides clinicians and researchers with up-to-date information on the efficacy of psychosocial interventions for reducing cancer-related fatigue overcoming the limits of several separate systematic reviews. The results might guide future research and facilitate the translation of the evidence into clinical practice, acknowledging that a gap between the unmet needs of patients with cancer and appropriate health care services still needs addressing.     

Preoperative serum CA125 level and age at diagnosis: An effective prognosis prediction tool for patients with early-stage endometrial cancer

Objective

To investigate the combined predictive value of the preoperative serum cancer antigen 125 (CA125) level and age at diagnosis among patients with early-stage endometrial cancer (EC) after initial treatment.

Methods

We retrospectively analyzed data from patients with early-stage EC from 1999 to 2015 in multiple institutions in China. All 447 patients received postoperative adjuvant radiotherapy for FIGO 2009 stage I and II EC with complete data on preoperative serum CA125 levels. All patients were divided into four groups according to the ESMO-ESGO-ESTRO risk classification. The predictive probability of 5-year overall survival (OS) and the sensitivity and specificity of CA125 and age were calculated.

Results

The median follow-up time was 59 months (3–201 months). The 5-year OS and disease-free survival rates were 94.4% and 89.1%. Multivariate analysis showed that the preoperative CA125 level and age at diagnosis were independent prognostic factors for 5-year OS. The area under the curve for CA125 combined with age at diagnosis for 5-year OS was .692, and the corresponding sensitivity and specificity were 68.2% and 68.2% (p < .002), which were significantly better than the corresponding values for CA125 or age alone. After all 447 patients were divided into four groups according to CA125 combined with age, the 5-year OS of the elderly and higher CA125 group was only 73.7%.

Conclusions

Although preoperative CA125 had limited sensitivity in predicting the prognosis for early-stage EC after initial treatment, it remains a useful serum marker for risk assessment of early-stage EC. Combining CA125 with age may increase its predictive sensitivity.     

The prognostic signature based on glycolysis-immune related genes for acute myeloid leukemia patients

Acute myeloid leukemia (AML) is widely considered an immunoresponsive malignancy. However, potential association between glycolysis-immune related genes and AML patients’ prognosis has been seldom studied. AML-related data was downloaded from TCGA and GEO databases. We grouped patients according to Glycolysis status, Immune Score and combination analysis, basing on which overlapped differentially expressed genes (DEGs) were identified. The Risk Score model was then established. The results showed that totally 142 overlapped genes were probably correlated with glycolysis-immunity in AML patients, among which 6 optimal genes were screened to construct Risk Score. High Risk Score was an independent poor prognostic factor for AML. In conclusion, we established a relatively reliable prognostic signature of AML based on glycolysis-immunity related genes, including METTL7B, HTR7, ITGAX, TNNI2, SIX3 and PURG.