Physicians are increasingly utilizing digital health technologies (DHT) such as smartphone applications, network-enabled wearable devices, web-based communication platforms, videoconferencing, chatbots, artificial intelligence and virtual reality to improve access to, and quality of, care. DHT aid in cancer screening, patient education, shared decision-making, promotion of positive health habits, symptom monitoring and intervention, patient–provider communication, provision of psychological support and delivery of effective survivorship care. This narrative review outlines how physicians may utilize digital health to improve or augment their delivery of cancer care. For the full potential of DHT to be realized, experts must develop appropriate solutions to issues surrounding the regulation, liability, quality, security, equity and reimbursement of DHT.

Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004–2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan–Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75–0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30–0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67–0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00–1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93–1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.

PURPOSE: Testing for pathogenic variants can aid in oncologic risk stratification and identification of targeted therapies. Despite known disparities in access to prostate cancer (PCa) care, little has been written about access to germline genetic testing (GGT) for Black men and other historically marginalized populations. This systematic review sought to delineate racial/ethnic disparities in GGT for PCa. METHODS: This systematic review identified articles published from January 1996 through May 2021 in PubMed, Web of Science, and Embase. We included studies that reported rates of GGT in men with PCa in the United States by race/ethnicity as reflective of routine clinical care or research. A narrative synthesis was performed. RESULTS: Of 4,309 unique records, 91 studies examining 50 unique study populations met inclusion criteria. Of these, four populations included men who received GGT through routine clinical care, accounting for 4,415 men (72.6% White and 7.2% Black). The other 46 populations included men who received GGT as part of a research study, accounting for 30,824 men (64.3% White and 21.6% Black). Of these 46 research populations, 19 used targeted methods to increase recruitment from a specific demographic. CONCLUSION: Most studies that report GGT rates by race/ethnicity are in research settings. Many of these studies used targeted recruitment methods and subsequently have a greater proportion of Black men than clinical and US population–based studies. Other historically marginalized populations are not well represented. There remains a knowledge gap regarding the extent of racial disparities in the use of GGT, particularly in the clinical setting.

Purpose:To examine the effect of veteran status on prostate-specific antigen (PSA) screening and whether health coverage available to veterans mitigates racial disparities in PSA screening.Material...

Active surveillance (AS) is an alternative to primary intervention (PI) in the management of small renal masses (SRMs; clinical stage T1a). However, AS remains underutilized due to a lack of strong, prospective data. We herein report mature outcomes after a twelve-year experience with the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry. Multi-institutional prospective comparative study from 2009 to 2022 of patients with SRM who chose to undergo AS or PI. Primary outcomes were cancer-specific survival (CSS) and overall survival (OS). A total of 958 patients were enrolled; 581 chose AS, and 377 chose PI. Ultimately, 88 of 581 AS patients crossed over to delayed intervention (DI). The median follow-up time for the registry was 4.15 years (IQR 2.11-7.31) among patients who were still alive, with 406 patients followed for ≥5 years. Competing-risk CSS cumulative incidence function (CIF) accounting for other causes of mortality for AS at 4 years and beyond is 0.19% (95% CI; 0.3% - 1.4%), and for PI at 4 years and beyond is 0.68% (95% CI; 0.17% - 2.7%). Gray's test for statistical differences between CSS CI curves of PI vs AS showed no statistical difference (P=0.4). However, Kaplan-Meier analysis of OS showed to be higher in patients undergoing PI compared to AS at 4 years (95% vs 88%), 6 years (92% vs 81%), 8 years (90% vs 66%), and 10 years (85% vs 64%), this difference was statistically significant; log-rank P<0.001. In our study cohort, AS is not inferior to PI in patients with SRM suspicious for renal cell carcinoma. Difference in OS between AS and PI is most likely attributable to the increased risk of death from competing causes among AS patients. A priori definitions of progression, including growth rate, should be re-considered.