Background: Real-world data provide insights into populations underrepresented in clinical trials such as non-small-cell cancer (NSCLC) patients with brain metastases (BMs). Despite global survival improvement due to novel drug employment, their impact in resource-limited settings like Serbia remains underexplored. This study analyzes the overall survival (OS) of NSCLC patients with BMs treated in routine clinical practice, considering patient-, disease- and treatment-related factors amid restricted access to novel drugs. Methods: We retrospectively analyzed 267 NSCLC patients diagnosed with BMs from 2018 to 2022 at a single Serbian clinical center. Inclusion required histologically confirmed NSCLC, radiologically verified BMs and complete clinical data. OS was defined as the time from BM verification to death or last follow-up. Kaplan–Meier curves and Cox regression were used for survival analysis. Results: Median OS (mOS) was 5.0 months. Univariate analysis linked age < 65 years, female gender, single BM, asymptomatic BMs, ECOG PS 0–1, BM verification at diagnosis and combined systemic and local therapy to better OS. Combined therapy offered the best survival rates (mOS: 9.0 months), while best supportive care and local-only therapy both resulted in a poor mOS of 2.0 months. Immunotherapy and targeted therapy were associated with the highest mOS, outperforming chemotherapy alone (13.0 vs. 7.0 months, p < 0.001). Multivariate analysis confirmed younger age, single BM, early BM verification and combined therapy as independent predictors of improved survival. Conclusions: limited access to novel therapies remains associated with poor patient survival, highlighting the need for better global availability.

Objective Considering the established intertwined relationships between burnout and other psychiatric disorders, this study aimed to clarify the existing levels of depression, anxiety, stress, emotional exhaustion, depersonalization, and personal accomplishment and their relationship among oncologists—a seemingly professional group at risk for mental health issues development.Methods A cross-sectional observational study was conducted in January 2024, involving 159 oncologists from Serbia and the Serbian Republic. Participants completed an online questionnaire assessing socio-demographic characteristics and working conditons, depression, anxiety, stress, and burnout using validated scales—the Depression Anxiety Stress Scale-21 and the Maslach Burnout Inventory-Human Services Survey.Results Results indicate that respondents were mildly depressed, moderately anxious, and mildly stressed overall. Regarding three dimensions of burnout respondents have moderate emotional exhaustion, depersonalization, and low personal accomplishment. No significant differences were found in depression, anxiety, and stress among medical, surgical, and radiation oncologists. Whether the respondents are seeing a psychiatrist and/or undergoing psychiatric therapy was predictive of depression, anxiety, and stress. Economic status was predictive for depression and stress, while an additional predictive factor of anxiety was the presence of somatic illness. Further analysis showed depression and stress levels can be predicted by all three dimensions of burnout, whereas anxiety levels can be predicted by the level of depersonalization.Conclusion These findings emphasize the complex interplay between burnout and other mental health disorders in oncologists, highlighting the need for targeted mental health interventions and support systems within the oncology field to mitigate the psychological toll on these physicians.

Background/Objectives: Drug prescribing in elderly people with chronic diseases carries certain risks. The desire to treat several different diseases at the same time increases the risk of inadequate drug prescribing. Prostate cancer is a disease of older men and occurs in most men over the age of 65. With age, the risk of prostate cancer increases, but so does the risk of the inadequate prescription of drugs. Our research aimed to highlight the potential inadequate prescription of drugs in patients with prostate cancer, considering that it is mostly a population of older men in whom a greater number of comorbidities is expected, followed by the use of a greater number of drugs. Methods: Our investigation was designed as an observational, cross-sectional study of 334 male patients who presented at the Multidisciplinary Tumor Board (MDT) for urological cancers at the University Clinical Center Kragujevac, Kragujevac, Serbia, from 1 September to 15 December 2023. Our primary outcome was obtaining the MAI score. Results: Our study showed that a significant number of drugs per patient with a prostate cancer diagnosis were prescribed potentially inadequately. The factors associated with greater risk for PIP were the initial level of PSA, ADT meta (intermittent), and several prescribed drugs; on the other hand, secondary hormonal therapy was the reason for less frequent PIP. Conclusions: In conclusion, patients with prostate cancer are under increased risk of inappropriate prescribing when they are prescribed more medication, have high PSA, and have ADT meta (intermittent). To stop the incidence of inappropriate prescribing and its serious economic and health consequences, clinicians should take special care when prescribing new drugs to such patients.

Background: Colorectal cancer (CRC) remains a global health problem. It is the most common malignancy of the gastrointestinal tract, with a global incidence of over 1.9 million cases, making it the third most common cause of cancer-related deaths worldwide. The incidence is increasing particularly in low- and middle-income countries and among individuals under 50 years of age, with lifestyle and environmental factors contributing to this trend-many of which affect the gut microbiome. Main body: Advances in CRC treatment have introduced immunotherapy, particularly for tumours with mismatch repair deficiency (dMMR) and high microsatellite instability (MSI-H). This review explores the symbiotic relationship between the gut microbiome and immunotherapy in CRC. The human colon harbours a complex microbiome composed of diverse microbial species and vast genetic diversity, with structural, metabolic, and immunomodulatory functions. Dysbiosis, influenced by factors such as diet and lifestyle, contributes to CRC pathogenesis through inflammation and metabolic disruptions. Immunotherapy, specifically immune checkpoint inhibitors (ICIs), has revolutionized cancer treatment by enhancing T cell-mediated immune responses against cancer cells. In CRC, ICIs have demonstrated efficacy in MSI-H/dMMR tumours that represent less than 15% of all CRC cases. Challenges persist in treating microsatellite stable (MSS) CRC in regard to immunotherapy. Emerging evidence suggests that specific gut microbiota compositions influence the response to ICIs by modulating systemic immune responses and tumour microenvironments, potentially having a key role for MSS CRC patients. Strategies to manipulate the gut microbiome, including probiotics and faecal microbiota transplantation, hold promise in augmenting immunotherapy efficacy. Conclusion: The review underscores the potential of the gut microbiome as a predictive biomarker and therapeutic target in CRC immunotherapy. Ultimately, harnessing the therapeutic potential of the gut microbiome represents a promising avenue for enhancing immunotherapy outcomes and advancing personalized medicine in CRC care.

Objective: There is only limited research on suicidal thoughts and behaviors of oncologists. This study examined the prevalence and correlates of suicidal thoughts among oncologists in Serbia. Method: A cross-sectional study was conducted in January 2024 involving 159 oncologists from Serbia and the Republic of Srpska. Respondents completed an online questionnaire which assessed socio-demographic and work characteristics and included the Risk Assessment Suicidality Scale, Depression Anxiety Stress Scale-21, Maslach Burnout Inventory, and Brief Resilience Scale. Results: Results indicated that 21.4% of oncologists reported elevated suicidality scores. Medical oncologists had the highest average suicidality scores compared to surgical and radiation oncologists, although these differences were not statistically significant. Key associated factors with suicidality included seeing a psychiatrist, undergoing psychiatric therapy, having family history of depression, and family history of suicide attempts and/or suicide. Resilience and sense of personal accomplishment were inversely associated with suicidality. Conclusions: The finding that 1 out of 5 oncologists had elevated suicidality scores underscores the urgent need for mental health support for members of this profession, particularly those showing signs of distress. Interventions should promote resilience, enhance personal accomplishment, and ensure easy access to psychiatric care. While these results contribute to the limited data on suicidality among oncologists, they also identify gaps that future studies should address, such as the need for larger sample sizes and the exploration of other potential risk factors. Addressing oncologists’ mental health challenges is critical to reducing suicide risk and fostering well-being in this high-risk profession.