Background: Testicular germ cell tumors (TGCTs) are the most common malignancy in men 15-35 years of age. Management options for men with TGCTs include surgery, radiation, and/or chemotherapy. Given TGCTs’ excellent survival, most patients live long enough to experience delayed treatment toxicities, warranting careful consideration of therapeutic decisions. An important outcome of interest is the development of secondary malignant neoplasms (SMNs). Methods: A systematic literature search was conducted through a combination of database searches (Medline, EMBASE, and Cochrane library) and manual review. Studies evaluating the incidence of SMNs in patients following treatment for TGCTs were identified. Our primary outcome was the diagnosis of any non-germ cell SMN following treatment, compared with the general population. Meta-analyses were performed using random-effects models, with outcomes reported as standardized incidence ratios (SIRs). Strength of evidence was evaluated using the GRADE framework. Results: Twenty-one studies including 88 863 patients with 5180 SMNs were included. Median follow-up was 12.5 years. The incidence of non-germ cell SMNs following definitive treatment of TGCTs varied by treatment modality. Surgery alone was not associated with an increased risk (SIR = 0.99, 95% confidence interval [CI] = 0.84 to 1.17); radiation (SIR = 1.66, 95% CI = 1.43 to 1.93), chemotherapy (SIR = 1.65, 95% CI = 1.39 to 1.96), and combined chemotherapy and radiation (SIR = 2.73, 95% CI = 2.23 to 3.33) were associated with a moderate to large increase in risk. There was low to moderate certainty in quality of evidence by GRADE framework. Conclusions: Chemotherapy, radiation, and their combination are associated with an increased risk of non-germ cell SMNs after the treatment of TGCTs.

Introduction: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations. Methods: We adapted Risso-Gill and colleagues’ framework for a Health Systems Appraisal (HSA), to identify HCPs’ perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018—participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology. Results: Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs. Conclusions: Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.

Introduction: Cervical cancer is the fourth most common cancer in women globally and the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. Methods: We adapted Risso-Gill and colleagues’ framework for a Health Systems Appraisal (HSA), to identify HCPs' perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014-2018 –participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data was analyzed using reflexive thematic analysis methodology. Results: Seven themes emerged from our analysis of semi-structured interviews and focus groups: 1) knowledge of cervical cancer risk and the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), 2) training and knowledge of HCPs, 3) knowledge of cervical cancer screening among women at risk, 4) beliefs about cervical cancer screening, 5) role of traditional medicine, 6) risk factors, and 7) symptoms and signs. Conclusion: It is evident that there is a low level of knowledge of cervical cancer risk and the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.

Guidelines usually recommend chemotherapy rather than primary retroperitoneal lymph node dissection (pRPLND) for clinical stage II non-seminomatous germ cell tumours (NSGCTs) with elevated serum tumour markers (STMs). This study evaluated oncologic and perioperative outcomes of pRPLND in patients with marker-positive versus marker-negative CSII NSGCT. A retrospective review from our prospectively maintained database identified patients undergoing pRPLND (1983-2022). The primary endpoint was relapse-free survival (RFS). Secondary endpoints included cancer-specific survival (CSS), relapse location, and perioperative outcomes. Outcomes were compared using Kaplan-Meier analysis, log-rank testing, and multivariable COX regression. Among 207 patients with, 65 (31%) had elevated STMs (AFP: 12-376 µg/L; bHCG: 3-354 IU/L). Marker elevation was associated with higher relapse risk, with 5-year RFS of 75% vs. 93% for marker-negative patients (p<0.001). Five-year CSS was 96% vs. 100%, respectively (p=0.009). Of four cancer-specific deaths, two involved somatic transformation, one patient declined chemotherapy at relapse, and one death occurred during chemotherapy. Elevated AFP correlated with worse CSS, and dual marker elevation predicted greater relapse risk. Surgical complications rates did not differ between groups. Although elevated STMs are associated with increased relapse and mortality risk, pRPLND is associated with long-term disease control in approximately 75% of patients. Most relapses can be successfully treated in compliant individuals. Multidisciplinary decision-making should weigh relapse risk and potential salvage chemotherapy needs against the long-term morbidity of primary chemotherapy.

Attainment of the A1C target of ≤7.0% is consistently low among those living with type 1 diabetes (T1D). We evaluated endocrinologists' acceptability and implementation of A1C targets. All 309 adult endocrinologists in Ontario were invited to complete an online questionnaire between October 31, 2023 and Jan 16, 2024. The questionnaire consisted of four sections: 1) Acceptability of the A1C target of ≤7.0%, evaluated by agreement with statements pertaining to the seven domains of the Theoretical Framework of Acceptability (TFA); 2) Endocrinologists' perceptions of patient attainment of A1C targets, frequency of setting and discussing A1c targets, common targets used, and open-ended questions regarding A1C targets; 3) Influence of patient characteristics on selecting individualized A1C targets different from 7.0%; and 4) Respondent characteristics. 148 endocrinologists (48%) completed the questionnaire. Endocrinologists agreed that the A1C target of ≤7.0% is important (87% agreed or strongly agreed) and the correct threshold (75% agreed or strongly agreed). However, endocrinologists over-estimated A1C target attainment among their own patients, and recognized the A1C target of <7.0% may be unrealistic for patients, difficult to achieve, and could cause patient distress. Patients' psychosocial characteristics (such as mental health disorders) and use of technologies (such as continuous glucose monitors and automated insulin delivery systems) emerged as important yet previously under-emphasized factors when selecting individualized A1C targets. Endocrinologists endorsed the A1C target of ≤7.0%, yet simultaneously expressed concerns regarding its feasibility. Future studies should evaluate how this discrepancy might impact physician discussions and counselling regarding A1C targets.