{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:13:07Z","timestamp":1790140387880,"version":"4.0.1"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-ooi230080-4\"><jats:title>Importance<\/jats:title><jats:p>Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus\u2212associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230080-5\"><jats:title>Objective<\/jats:title><jats:p>To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230080-6\"><jats:title>Design, Settings, and Participants<\/jats:title><jats:p>This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230080-7\"><jats:title>Outcome Measures<\/jats:title><jats:p>QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired <jats:italic>t<\/jats:italic> tests assessed change between the baseline and 12- or 24-month patient-reported outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230080-8\"><jats:title>Results<\/jats:title><jats:p>Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, \u22124.18 to 16.49) and composite scores (mean difference, 2.73;  95% CI, \u22121.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230080-9\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.3781","type":"journal-article","created":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T16:32:48Z","timestamp":1701966768000},"page":"65","source":"Crossref","is-referenced-by-count":18,"title":["Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer"],"prefix":"10.1001","volume":"150","author":[{"given":"Jennifer A.","family":"Silver","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Bouganim","sequence":"additional","affiliation":[{"name":"Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada"},{"name":"Research Institute of McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A.","family":"Mascarella","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Ramirez-GarciaLuna","sequence":"additional","affiliation":[{"name":"Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahid","family":"Golabi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex M.","family":"Mlynarek","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Zeitouni","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Hier","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derin","family":"Caglar","sequence":"additional","affiliation":[{"name":"Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khashayar","family":"Esfahani","sequence":"additional","affiliation":[{"name":"Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2212Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Research Institute of McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"ooi230080r1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3747\/co.20.1375","article-title":"The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population.","volume":"20","author":"Nichols","year":"2013","journal-title":"Curr Oncol"},{"issue":"1","key":"ooi230080r2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.v71.1","article-title":"Cancer statistics, 2021.","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"32","key":"ooi230080r3","doi-asserted-by":"publisher","first-page":"4294","DOI":"10.1200\/JCO.2011.36.4596","article-title":"Human papillomavirus and rising oropharyngeal cancer incidence in the United States.","volume":"29","author":"Chaturvedi","year":"2011","journal-title":"J Clin Oncol"},{"key":"ooi230080r4","doi-asserted-by":"publisher","first-page":"2","DOI":"10.21037\/ajo","article-title":"Human papillomavirus and oropharyngeal squamous cell carcinoma: a 12-year retrospective review in a New South Wales tertiary referral centre.","author":"Taylor","year":"2019","journal-title":"Aust J Otolaryngol"},{"issue":"1","key":"ooi230080r5","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer.","volume":"363","author":"Ang","year":"2010","journal-title":"N Engl J Med"},{"issue":"3","key":"ooi230080r6","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1093\/ije\/dyw069","article-title":"Combined effects of smoking and HPV16 in oropharyngeal cancer.","volume":"45","author":"Anantharaman","year":"2016","journal-title":"Int J Epidemiol"},{"issue":"5","key":"ooi230080r7","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1001\/jamaoto.2014.141","article-title":"Initial symptoms in patients with HPV-positive and HPV-negative oropharyngeal cancer.","volume":"140","author":"McIlwain","year":"2014","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"4","key":"ooi230080r8","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1002\/lary.v129.4","article-title":"Initial presentation of human papillomavirus-related head and neck cancer: a retrospective review.","volume":"129","author":"Khalid","year":"2019","journal-title":"Laryngoscope"},{"issue":"3","key":"ooi230080r9","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1177\/0194599814538605","article-title":"The \u201cnew\u201d head and neck cancer patient-young, nonsmoker, nondrinker, and HPV positive: evaluation.","volume":"151","author":"Deschler","year":"2014","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi230080r10","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1200\/JCO.21.01752","article-title":"Phase II randomized trial of transoral surgery and low-dose intensity modulated radiation therapy in resectable p16+ locally advanced oropharynx cancer: an ECOG-ACRIN Cancer Research Group Trial (E3311).","volume":"40","author":"Ferris","year":"2022","journal-title":"J Clin Oncol"},{"issue":"6","key":"ooi230080r12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamaoncol.2022.0615","article-title":"Assessment of toxic effects and survival in treatment de-escalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 randomized clinical trial.","volume":"8","author":"Palma","year":"2022","journal-title":"JAMA Oncol"},{"issue":"5","key":"ooi230080r13","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1016\/j.ijrobp.2014.12.045","article-title":"Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer.","volume":"91","author":"Vainshtein","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"ooi230080r14","doi-asserted-by":"publisher","first-page":"S58","DOI":"10.1016\/j.ijrobp.2009.06.090","article-title":"Radiotherapy dose-volume effects on salivary gland function.","volume":"76","author":"Deasy","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"21","key":"ooi230080r15","doi-asserted-by":"publisher","first-page":"3582","DOI":"10.1200\/JCO.2007.14.8841","article-title":"Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis.","volume":"26","author":"Machtay","year":"2008","journal-title":"J Clin Oncol"},{"issue":"8","key":"ooi230080r16","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1002\/hed.v42.8","article-title":"Neoadjuvant chemotherapy followed by surgery for HPV-associated locoregionally advanced oropharynx cancer.","volume":"42","author":"Sadeghi","year":"2020","journal-title":"Head Neck"},{"issue":"12","key":"ooi230080r17","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1002\/hed.v38.12","article-title":"Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach.","volume":"38","author":"Sadeghi","year":"2016","journal-title":"Head Neck"},{"issue":"3","key":"ooi230080r18","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1002\/hed.v42.3","article-title":"Pathologic response to neoadjuvant chemotherapy in HPV-associated oropharynx cancer.","volume":"42","author":"Sadeghi","year":"2020","journal-title":"Head Neck"},{"issue":"2","key":"ooi230080r20","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"ooi230080r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners.","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"5","key":"ooi230080r23","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.","volume":"85","author":"Aaronson","year":"1993","journal-title":"J Natl Cancer Inst"},{"issue":"14","key":"ooi230080r24","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1016\/S0959-8049(00)00186-6","article-title":"A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients.","volume":"36","author":"Bjordal","year":"2000","journal-title":"Eur J Cancer"},{"issue":"8","key":"ooi230080r25","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1007\/s11136-012-0325-1","article-title":"Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review.","volume":"22","author":"Singer","year":"2013","journal-title":"Qual Life Res"},{"issue":"7","key":"ooi230080r26","first-page":"870","article-title":"The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson dysphagia inventory.","volume":"127","author":"Chen","year":"2001","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi230080r27","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1002\/hed.v39.11","article-title":"Symptom burden as a driver of decisional regret in long-term oropharyngeal carcinoma survivors.","volume":"39","author":"Goepfert","year":"2017","journal-title":"Head Neck"},{"issue":"4","key":"ooi230080r28","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1002\/pon.v16:4","article-title":"Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction.","volume":"16","author":"Sheehan","year":"2007","journal-title":"Psychooncology"},{"issue":"3","key":"ooi230080r29","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1200\/JCO.1999.17.3.1008","article-title":"Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35.","volume":"17","author":"Bjordal","year":"1999","journal-title":"J Clin Oncol"},{"issue":"12","key":"ooi230080r32","doi-asserted-by":"publisher","first-page":"2990","DOI":"10.3390\/cancers14122990","article-title":"Close surgical margins in oral and oropharyngeal cancer: do they impact prognosis?","volume":"14","author":"Lee","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"8","key":"ooi230080r33","doi-asserted-by":"publisher","first-page":"2434","DOI":"10.1002\/hed.v43.8","article-title":"Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma.","volume":"43","author":"Holcomb","year":"2021","journal-title":"Head Neck"},{"issue":"9","key":"ooi230080r34","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1002\/hed.v45.9","article-title":"Neoadjuvant chemotherapy enhances tumor-specific T cell immunity in patients with HPV-associated oropharyngeal cancer.","volume":"45","author":"Samaniego","year":"2023","journal-title":"Head Neck"},{"key":"ooi230080r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.105030","article-title":"Locoregional and distant recurrence for HPV-associated oropharyngeal cancer using AJCC 8 staging.","volume":"111","author":"Contrera","year":"2020","journal-title":"Oral Oncol"},{"issue":"4","key":"ooi230080r36","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/j.ijrobp.2012.08.004","article-title":"Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy.","volume":"85","author":"Garden","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"ooi230080r37","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.124762","article-title":"Variations in HPV function are associated with survival in squamous cell carcinoma.","volume":"4","author":"Gleber-Netto","year":"2019","journal-title":"JCI Insight"},{"issue":"15","key":"ooi230080r38","doi-asserted-by":"publisher","first-page":"2636","DOI":"10.1016\/j.ejca.2014.07.001","article-title":"De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials.","volume":"50","author":"Masterson","year":"2014","journal-title":"Eur J Cancer"},{"issue":"1","key":"ooi230080r39","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.oraloncology.2012.07.015","article-title":"Natural course of distant metastases following radiotherapy or chemoradiotherapy in HPV-related oropharyngeal cancer.","volume":"49","author":"Huang","year":"2013","journal-title":"Oral Oncol"},{"issue":"2","key":"ooi230080r40","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s00405-013-2501-5","article-title":"Transoral laser resection versus lip-split mandibulotomy in the management of oropharyngeal squamous cell carcinoma (OPSCC): a case match study.","volume":"271","author":"Williams","year":"2014","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"9","key":"ooi230080r41","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1002\/lary.24712","article-title":"A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review.","volume":"124","author":"de Almeida","year":"2014","journal-title":"Laryngoscope"},{"issue":"2 Pt 1","key":"ooi230080r42","first-page":"315","article-title":"Head and neck complications of systemic cancer chemotherapy.","volume":"89","author":"Goepfert","year":"1979","journal-title":"Laryngoscope"},{"issue":"2","key":"ooi230080r43","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1002\/hed.v37.2","article-title":"Sensorineural hearing loss in patients with head and neck cancer after chemoradiotherapy and radiotherapy: a systematic review of the literature.","volume":"37","author":"Theunissen","year":"2015","journal-title":"Head Neck"},{"key":"ooi230080r44","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.oraloncology.2018.12.010","article-title":"Predictors of cisplatin-induced ototoxicity and survival in chemoradiation treated head and neck cancer patients.","volume":"89","author":"Teft","year":"2019","journal-title":"Oral Oncol"},{"issue":"6","key":"ooi230080r45","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1001\/jamaoto.2015.0347","article-title":"Transoral robotic surgery alone for oropharyngeal cancer: quality-of-life outcomes.","volume":"141","author":"Choby","year":"2015","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"ooi230080r19","volume-title":"AJCC Cancer Staging Manual","author":"American Joint Committee on Cancer","year":"2010","edition":"7th ed"},{"key":"ooi230080r11","unstructured":"National Comprehensive Cancer Network. Head and neck cancers (version 2). 2022. Accessed August 23, 2022. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/head-and-neck.pdf"},{"key":"ooi230080r22","unstructured":"US National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Accessed June 1, 2023. https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/CTCAE_v5_Quick_Reference_8.5x11.pdf."},{"key":"ooi230080r30","unstructured":"International Labour Organization. International Standard Classification of Occupations, Skill Levels. Accessed October 31, 2023. https:\/\/ilostat.ilo.org\/resources\/concepts-and-definitions\/classification-occupation\/"},{"key":"ooi230080r31","unstructured":"Statistics Canada. The Canadian Inex of Multiple Deprivation, 2016. Accessed November 2, 2023. https:\/\/www23.statcan.gc.ca\/imdb\/p2SV.pl?Function=getSurvey&amp;SDDS=5274"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2812399\/jamaotolaryngology_silver_2023_oi_230080_1704922351.42477.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T16:01:10Z","timestamp":1704988870000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2812399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,1]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2023.3781","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1,1]]}}}