Cancer patients who scored lower on health literacy screening experienced higher all-cause mortality, according to a study published in the journal Cancer.

The study followed Vanderbilt-Ingram Cancer Center patients for a median of 3.1 years who had taken the Brief Health Literacy Screen. Patients who had high health literacy on the screening lived 9.4 months longer compared to those with low health literacy (score of nine or lower). The 9,603 patients in the retrospective cohort study were diagnosed with either prostate, lung, breast, renal, colorectal, brain, head and neck, bladder, pancreatic, liver, sarcoma or gastric cancer.

“Cancer care is extremely complex, and we highlight that health literacy is an important risk factor in terms of survival in one of the largest studies conducted evaluating the impact of health literacy and cancer survival,” said the study’s senior author, Kamran Idrees, MD, MSCI, MMHC, Ingram Professor of Cancer Research, professor of Surgery and chief of the Division of Surgical Oncology and Endocrine Surgery.

He further stated, “Since health literacy is a modifiable risk factor, it provides us an opportunity for real-time identification of patients with low health literacy to personalize care, provide health literacy sensitive resources, tailored instruction and education to improve their cancer care.”

The screening consists of three multiple-choice questions about patients’ comfort levels with understanding medical information and filling out hospital forms. A point system, ranging from one to five, is assessed according to answers to the questions.

Although the study did not seek to discover causal findings, such as direct links between patient mortality and patients’ ability to make informed decisions about treatment scenarios, the investigators surmised the difference in outcomes was likely multifactorial.

The investigators stated they endorsed the routine collection of health literacy information for patients diagnosed with cancer and that they encouraged the adoption of strategies to improve organizational health literacy in facilities that provide cancer care. They noted that not all cancer patients with low health literacy experienced worse outcomes. Observational studies for specific cancer types that assess health literacy are needed to evaluate interventions aimed at improving outcomes, they said.

Other Vanderbilt authors on the study included Kelvin Moses, MD, PhD, Julia Whitman, MS, and Sunil Kripalani, MD, MSc.

The investigators state that to their knowledge the study is the first to assess the association between health literacy and all-cause mortality among different cancer types.

The research received support from a Society of Surgical Oncology Foundation Investigator Award for a grant titled “Health Literacy and Cancer Outcomes.”

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An early-stage clinical trial, supported by the Department of Defense, has demonstrated that the targeted cancer drug trametinib shows potential as an interventional therapy to reprogram precancerous gastric lesions, potentially preventing them from becoming malignant, and that it can be administered safely.

The results of the Phase 1 trial involving 15 patients, which were published recently in Gastroenterology, were pleasantly surprising, said James Goldenring, MD, PhD, professor of Surgery and of Cell and Developmental Biology at Vanderbilt University Medical Center.

The primary goal of this trial was to evaluate whether a low-dose, limited duration treatment of two weeks with trametinib would be safe for patients at risk for developing a second cancer after having undergone resection of a Stage 1 gastric cancer. The drug also showed promise that it could be the first therapeutic intervention against precancerous lesions in the stomach.

Endoscopies revealed that trametinib reversed metaplasia, which is an abnormal change of cells into ones that are non-native to the tissue and can progress to dysplasia, an irreversible change in cell development that can lead to cancer. While the 15 patients in the study had no evidence of recurrent cancer, they did have extensive metaplasia when they entered the study.

“I was pleasantly surprised at how much benefit we could see in the endoscopies after one month and one year; it really was pretty remarkable,” said Goldenring, the Paul W. Sanger Professor of Experimental Surgery.

The reversal of the metaplasia could be viewed in endoscopic images and was confirmed with biopsies.

“I think that’s almost more compelling than anything else in this study,” Goldenring said. “I honestly did not expect endoscopies to be that different, but they were.”

However, he noted that follow-up clinical trials with more participants are needed to further validate the drug’s efficacy. The only significant side effect among the participants was one patient with a mild increase in blood pressure after trametinib treatment that returned to normal after the patient stopped taking the drug.

The patients in the study were recruited from Japan, where the clinical trial was led by Sachiyo Nomura, MD, PhD, in collaboration with Goldenring. Trametinib is an inhibitor of the MEK signaling pathway. MEK, an abbreviation for the mitogen-activated extracellular signal-regulated kinase pathway, plays an integral role in the development of stomach cancer.

The study was supported by a $2.5 million Department of Defense Translational Team Science Award, which is also supporting another clinical trial in the United States with similar aims. The U.S. clinical trial will evaluate the effectiveness of pyrvinium, an existing medicine that has been used for the past 70 years to treat pinworms in children, for a new purpose — reversing metaplasia of stomach cells and killing dysplastic precancerous cells. Pyrvinium also blocks the MEK pathway.

While stomach cancer is one of the three leading causes of cancer-related deaths worldwide, its incidence is lower is the U.S. Nevertheless, it does occur more frequently among minority ethnic groups, and incidence has been rising among young women. DOD support for clinical trials reflects the increased incidence of stomach cancer in minority groups, which make up a higher percentage of the U.S. armed services than of the general population. In the U.S., most stomach cancers are diagnosed at late stages when they are more difficult to treat.

Goldenring said he hopes the MEK inhibitor study will spur more research into therapeutic interventions for people with precancerous lesions who are at high risk for cancer.

“I’m hoping that this is a direction that multiple researchers might take in the future to really change the dynamics of how we’re going to intervene so that people don’t develop cancer,” he said. “That’s a different mindset than we’ve had previously.”

Eunyoung Choi, PhD, associate professor of Surgery and of Cell and Developmental Biology, is a co-principal investigator of the pyrvinium study along with Katherine Garman, MD, associate professor of Medicine at Duke University. Choi is also a co-author of the study published in Gastroenterology.

Goldenring is supported by grants from the Department of Defense, a Department of Veterans Affairs Merit Review Award, and the National Institutes of Health (R01DK101332 and R01CA272687. Choi is supported by grants from the National Institutes of Health (R37CA244970 and R01CA272687), the Department of Defense, the American Association for Cancer Research, and an American Gastroenterological Association Robert & Sally Funderburg Research Award.

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Aimal Khan, MD, assistant professor of Surgery at Vanderbilt University Medical Center, noticed the puzzled or anxious expressions of patients trying to fully comprehend what he was saying during preoperative consultations, so he devised visual aids — three-dimensional models of the lower digestive tract. 

The 3D models allowed patients to easily distinguish the ascending colon from the sigmoid colon, along with other parts of the digestive system. Patients could actually see where the surgery would occur, and Khan noticed that they asked more questions, felt more confident and seemed less anxious.  He devised a study to determine whether his personal observations were scientifically valid. 

The study, which was published June 3 in JAMA Network Open, determined that the 3D models made patients feel they played a bigger role in decision-making and that their anxiety levels decreased. 

The patients were scheduled for partial or complete colon and/or rectal resections for colorectal cancer, diverticulitis or inflammatory disease. Fifty-one patients participated in the study with 28 receiving consultations using the 3D models and 23 receiving conventional consultations. The patients in the 3D arm of the study reported a significantly higher involvement in shared decision-making and significantly reduced anxiety levels compared to the other patients. 

Khan and five other Vanderbilt surgeons conducted the study from March 2022 to June 2023.  

“Using 3D models during consultations allowed our patients to truly visualize their surgery, which not only empowered them to take an active role in decision-making but also significantly eased their anxiety. This approach has the potential to transform how we communicate complex information to our patients. We are currently working with surgeons from other specialties, including thoracic surgery, ENT and surgical oncology, to validate these findings in a multicenter randomized trial,” Khan said. 

The findings are important because other studies have shown that improvements in shared decision-making are associated with reduced hospital stays, lower health care utilization, improvement in patient-reported health outcomes and fewer emergency department visits.  

The 3D models used in the study were developed in collaboration with the Department of Radiology. The modular designs, which were made with 3D printing, allowed each segment of the colon and rectum to be magnetically detached and reattached. 

To the knowledge of the study’s authors, this is the first randomized clinical trial to compare the effectiveness of a 3D-printed model with usual care on colorectal surgery patients’ involvement in decision-making, anxiety and education. 

Other Vanderbilt researchers who authored the study are Danish Ali, MD, Shannon McChesney, MD, Michael Hopkins, MD, Molly Ford, MD, Roberta Muldoon, MD, Timothy Geiger, MD, MMHC, Alexander Hawkins, MD, MPH, Georgina Sellyn, MA, Hillary Samaras, RN, and Dann Martin, MD, MS.

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Researchers at Vanderbilt University Medical Center using artificial intelligence have helped develop two technologies for improving cancer care. 

One technology called MSI-SEER, described in a study published in npj Digital Medicine, better predicts microsatellite instability-high status from standard pathology slides and provides clinicians with specific data, including any uncertainties with predictions. The other technology, a breakthrough three-dimensional imaging tool described in a study published in Nature Communications, has transformative potential beyond cancer diagnostics. 

These new technologies showcase how VUMC researchers are using the power of AI to meet a wide range of medical needs, said Tae Hyun Hwang, PhD, professor of Surgery, founding director of the Molecular AI Initiative, and director of AI Research for the Vanderbilt Section of Surgical Sciences. He noted that the 3D imaging could significantly advance development of therapeutic drugs, provide more detailed assessments of organ transplant rejections, assist with personalized medicine, and aid with tissue analysis for biopharmaceutical development. 

“This technology fundamentally redefines how we visualize and analyze tissue architecture, moving from traditional two-dimensional views to full 3D microenvironment mapping at the subcellular level,” said Hwang, a corresponding author of the study, who provided senior leadership in the development, validation and translational development of the technology. 

The 3D study published in Nature Communications introduced an innovative framework that integrates holotomography with deep learning to generate hematoxylin- and eosin-stained images directly from thick tissue samples. This noninvasive, AI-driven approach preserves tissue integrity, overcomes the traditional 4- to 5-micron thickness limit of routine histology, and enables volumetric visualization of biological structures up to 50 microns thick. 

By preserving tissue samples and avoiding chemical alteration, this method also ensures compatibility with downstream molecular assays, such as spatial transcriptomics, proteomics and genomic profiling — enhancing the breadth and depth of diagnostic and research capabilities.  

“This is not just a digital copy of hematoxylin- and eosin-staining,” Hwang said. “It is a foundational platform for AI-driven volumetric tissue analysis that accelerates discoveries in oncology, immunology, regenerative medicine and therapeutic development.” 

The multi-institutional effort also included researchers from KAIST, Tomocube Inc., Yonsei University College of Medicine and Mayo Clinic. Hwang received funding support from the National Cancer Institute (grants R01CA276690, R37CA265967, U01CA294518). 

VUMC researchers developed the MSI-SEER predictor technology in collaboration with Mayo Clinic, Yonsei Severance Hospital and Seoul St. Mary’s Hospital in South Korea. This technology identifies patients who will benefit from an immunotherapy that might otherwise be missed with existing prediction models. 

Microsatellite instability-high (MSI-H) status is a well-established biomarker used to identify patients likely to respond to immune checkpoint inhibitors, especially patients with gastrointestinal cancers. However, traditional testing methods — including immunohistochemistry and PCR-based assays — offer only a binary result and often miss focal or heterogeneous MSI-H regions within tumors.  

MSI-SEER overcomes this limitation by dividing each pathology slide into thousands of image tiles and generating region-by-region predictions of MSI-H probability. This enables visualization of the tumor’s spatial heterogeneity and quantification of the MSI-H fraction across the tumor. In multiple cases, MSI-SEER identified MSI-H regions in tumors previously classified as microsatellite stability, and those patients subsequently responded to immunotherapy. 

“This is analogous to what we say in HER2-low gastric cancer, where patients previously not eligible for targeted therapy are now being treated with agents like trastuzumab deruxtecan,” Hwang said. “Likewise, patients with low or heterogeneous MSI-features may now be reconsidered for immunotherapy if spatially resolved analysis like MSI-SEER is used.” 

A key innovation of MSI-SEER is its ability to report not only predictions but the confidence level for each result.  

“AI should not dictate clinical decisions; it should support them,” Hwang said. “MSI-SEER gives clinicians both the answer and a measure of how reliable the answer is. It’s not about replacing human expertise but about combining the best of AI computation with physician judgment to drive safe, precise decisions.” 

Hwang, who conceptualized the study and is the paper’s senior author, received research support from the National Cancer Institute and the Department of Defense. He also received support from the Eric and Wendy Schmidt Fund for AI Research and Innovation and the American Association for Cancer Research Innovation and Discovery Grant.  

Other VUMC researchers who authored the study are Sunho Park, PhD, Minji Kim, MS, Jean Clemenceau, PhD, and Inyeop Jang, PhD. 

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Eunyoung Choi, PhD, associate professor of Surgery and of Cell and Developmental Biology is the recipient of the Young Investigator Award in Basic Science from the American Gastroenterological Association (AGA). 

Each year, the AGA honors two early-career investigators, one in basic science and one in clinical science, for their research achievements. The honorees must have held an academic faculty position for less than seven years. 

The AGA honored Choi for her work defining key oncogenes critical to gastric carcinogenesis, and for identifying potential drug candidates to target gastric precancerous stem cells. Choi specializes in the cellular mechanisms that drive the evolution of precancerous cells in gastric cancer and has pioneered the use of transgenic animal and precancer organoid models. 

An active AGA member, she serves as an abstract reviewer and council member for the AGA Council Cellular & Molecular Gastroenterology Section. Her accolades include the NIH/NCI Outstanding MERIT Award and the AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer, American Association for Cancer Research-Debbie’s Dream Foundation Innovation Grant, and the Vanderbilt University Stanley Cohen Innovation Fund Award. 

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Researchers from Vanderbilt University Medical Center are set to play a pivotal role at the American Association for Cancer Research (AACR) Annual Meeting 2025, co-organizing a methods workshop that highlights the integration of computational pathology, artificial intelligence (AI) and spatial multiomics to advance cancer research and precision oncology. 

The workshop, “Integrating Computational Pathology, AI, and Spatial Multi-Omics in 2D and 3D,” will take place April 26 from 8 a.m. to 9:30 a.m.It will be co-chaired by Tae Hyun Hwang, PhD (VUMC), Linghua Wang, MD, PhD (University of Texas MD Anderson Cancer Center), and Mingyao Li, PhD (University of Pennsylvania). This session will provide a deep dive into how AI-driven 3D spatial molecular and multimodal approaches are transforming the landscape of oncology research and clinical applications. 

Hwang, a national leader in AI-driven oncology research and director of AI Research in the Section of Surgical Sciences at VUMC, is the founding director of VUMC’s Molecular AI Initiative. He will present a talk titled “AI-Driven 3D Spatial Mapping of the Tumor Immune Microenvironment for Precision Oncology,” based on novel technologies his lab is utilizing and developing, integrating advanced holotomography with AI-driven spatial sorting and molecular profiling techniques. 

Hwang co-leads the National Cancer Institute Pre-Gastric Cancer Human Tumor Atlas Network and serves as an executive committee member of the Center for Computational Systems Biology at Vanderbilt University. His research focuses on leveraging AI and machine learning coupled with innovative experimental approaches to analyze 3D and 4D tumor ecosystems at single-cell and subcellular resolutions, integrating spatial molecular data to reveal key mechanisms of cancer progression, immune interactions and therapeutic response. This cutting-edge approach aims to enhance early detection, refine treatment strategies, advance therapeutic development and propel next-generation precision medicine. 

As part of Vanderbilt’s Molecular AI Initiative, Hwang and his team are pioneering holotomography-based 3D reconstructions of tumor tissue samples, integrating AI-driven spatial molecular profiling for advanced characterization of cancer biology. This work is at the forefront of predicting disease progression and therapeutic response, ultimately informing the future of cancer treatment. 

Through this workshop, VUMC continues to assert itself as a global leader in AI-driven precision oncology, fostering collaborations with leading cancer research institutions and pushing the boundaries of AI-powered cancer diagnostics and therapeutic innovations.  For more information, please visit the AACR Annual Meeting Website or contact Hwang at taehyun.hwang@vumc.org. 

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