{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:54:02Z","timestamp":1780448042976,"version":"3.54.1"},"reference-count":64,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>A cancer diagnosis often triggers profound psychological and emotional distress as individuals reflect on existential issues such as life and death. The aim of this review was to provide estimates of suicide risk associated with digestive cancer worldwide, and to identify sociodemographic, psychological, and clinical factors associated with suicide risk in patients with digestive cancer. Materials and methods: The literature search was guided by the following question: What is the relationship between suicide and digestive cancer, and what sociodemographic, psychological, and clinical factors contribute to the risk of suicide in these patients? We searched PubMed, PsycINFO, Embase, CINAHL, and Web of Science, and systematically reviewed the evidence, according to PRISMA guidelines, from relevant articles on the association between digestive system cancers and suicide outcomes published over a 14-year period (2011\u20132024). Eligible studies were searched in the main scientific databases up to August 2024. Results: There are many reasons why people die by suicide, including challenges faced by patients in mentally adapting to their new condition and physical illness. Studies have shown that the highest suicide rates in digestive cancer patients are observed in males, older age groups, single people, those with a poor cancer prognosis, and those with a lack of treatment provision (surgery or chemotherapy). The risk of suicide peaks at six months post-discrimination, remains stable for three years, and then declines. Conclusions: Systematic changes in cancer care, such as aggressive treatment of pain and physical symptoms, management of delirium and cognitive impairment, routine screening, increased monitoring, and proactive measures for high-risk patients, can play a critical role in preventing unnecessary deaths and addressing the increased vulnerability of cancer patients, underscoring the need for targeted psychological support and early intervention, especially during critical periods like diagnosis and post-treatment recovery.<\/jats:p>","DOI":"10.3390\/cancers17091427","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T09:26:58Z","timestamp":1745486818000},"page":"1427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-6466","authenticated-orcid":false,"given":"Diana Elena","family":"Lazar","sequence":"first","affiliation":[{"name":"Doctoral School, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Oncology, Municipal Hospital \u201cSt. Hierarch Dr. Luca\u201d, 601048 Onesti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Hanganu","sequence":"additional","affiliation":[{"name":"III-rd Medical Department, Legal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Postolica","sequence":"additional","affiliation":[{"name":"Department of Psychology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia Liana","family":"Buhas","sequence":"additional","affiliation":[{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Paparau","sequence":"additional","affiliation":[{"name":"Dambovita County Forensic Medicine Service, Targoviste Emergency County Hospital, 130086 Targoviste, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice Gabriela","family":"Ioan","sequence":"additional","affiliation":[{"name":"III-rd Medical Department, Legal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics, 2019","volume":"69","author":"Siegel","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"(2024, April 08). American Cancer Society Releases Latest Global Cancer Statistics; Cancer Cases Expected to Rise to 35 Million Worldwide by 2050. Available online: https:\/\/pressroom.cancer.org\/GlobalCancerStatistics2024."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3322\/caac.21871","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","unstructured":"Australian Institute of Health and Welfare (2018). Colorectal and Other Digestive-Tract Cancers."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1016\/j.ejca.2010.03.033","article-title":"Psychological distress in cancer from survivorship to end of life care: Prevalence, associated factors and clinical implications","volume":"46","author":"Gao","year":"2010","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yang, M., Zhang, Z., Nice, E.C., Wang, C., Zhang, W., and Huang, C. (2022). Psychological intervention to treat distress: An emerging frontier in cancer prevention and therapy. Biochim. Biophys. Acta Rev. Cancer, 1877.","DOI":"10.1016\/j.bbcan.2021.188665"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ebob-Anya, B.A., and Bassah, N. (2022). Psychosocial distress and the quality of life of cancer patients in two health facilities in Cameroon. BMC Palliat. Care, 21.","DOI":"10.1186\/s12904-022-00981-w"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"691","DOI":"10.2147\/PRBM.S209896","article-title":"Assessment of psychological distress among cancer patients undergoing radiotherapy in Saudi Arabia","volume":"12","author":"Almigbal","year":"2019","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"445","DOI":"10.4103\/IJPC.IJPC_82_17","article-title":"Quality of Life among Cancer Patients","volume":"23","author":"Nayak","year":"2017","journal-title":"Indian. J. Palliat. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e05250","DOI":"10.1016\/j.heliyon.2020.e05250","article-title":"Quality of Life (QoL) of cancer patients and its association with nutritional and performance status: A pilot study","volume":"6","author":"Alam","year":"2020","journal-title":"Heliyon"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Wan, M., Luo, X., Wang, J., Mvogo Ndzana, L.B., Chang, C., Li, Z., and Zhang, J. (2020). The impact on quality of life from informing diagnosis in patients with cancer: A systematic review and meta-analysis. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-07096-6"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sibeoni, J., Picard, C., Orri, M., Labey, M., Bousquet, G., Verneuil, L., and Revah-Levy, A. (2018). Patients\u2019 quality of life during active cancer treatment: A qualitative study. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4868-6"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Covrig, V.I., Laz\u0103r, D.E., Costan, V.V., Postolic\u0103, R., and Ioan, B.G. (2021). The Psychosocial Role of Body Image in the Quality of Life of Head and Neck Cancer Patients. What Does the Future Hold?-A Review of the Literature. Medicina, 57.","DOI":"10.3390\/medicina57101078"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1200\/JCO.19.01856","article-title":"Impact of Cancer on Employment","volume":"38","author":"Blinder","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s10865-016-9819-6","article-title":"Engagement in health-promoting behaviors and patient-caregiver interdependence in dyads facing advanced cancer: An exploratory study","volume":"40","author":"Ellis","year":"2017","journal-title":"J. Behav. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1016\/j.pec.2021.01.033","article-title":"Obesity status on associations between cancer-related beliefs and health behaviors in cancer survivors: Implications for patient-clinician communication","volume":"104","author":"Lin","year":"2021","journal-title":"Patient Educ. Couns."},{"key":"ref_18","first-page":"5208","article-title":"The influential factors and intervention strategies that engage malignant cancer patients in health-promoting behaviors during PICC line maintenance","volume":"13","author":"Wang","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_19","unstructured":"(2025, January 01). Available online: https:\/\/dictionary.cambridge.org\/dictionary\/english\/suicide."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Misra, N., and Srivastava, S. (2021). The Fallacy of Happiness: A Psychological Investigation of Suicide among Successful People. Suicide.","DOI":"10.5772\/intechopen.99425"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.1097\/NCC.0b013e31822fc76c","article-title":"A literature review of suicide in cancer patients","volume":"35","author":"Anguiano","year":"2012","journal-title":"Cancer Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Chochinov, H.M., and Breitbart, W. (2023). Suicide and desire for hastened death in the terminally ill. Handbook of Psychiatry in Palliative Medicine: Psychosocial Care of the Terminally Ill, Oxford University Press. [3rd ed.].","DOI":"10.1093\/med\/9780197583838.003.0005"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/jjco\/hyd057","article-title":"Suicidal ideation in cancer patients with major depression","volume":"30","author":"Akechi","year":"2000","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1176\/ajp.152.8.1185","article-title":"Desire for death in the terminally ill","volume":"152","author":"Chochinov","year":"1995","journal-title":"Am. J. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/S0033-3182(98)71325-8","article-title":"Depression, hope-lessness, and suicidal ideation in the terminally ill","volume":"39","author":"Chochinov","year":"1998","journal-title":"Psychosomatics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2907","DOI":"10.1001\/jama.284.22.2907","article-title":"Depression, hopeless-ness, and desire for hastened death in terminally ill patients with cancer","volume":"284","author":"Breitbart","year":"2000","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1002\/pon.1717","article-title":"The risk of suicide in cancer patients: A review of the literature","volume":"19","author":"Robson","year":"2010","journal-title":"Psychooncology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jaclp.2021.09.003","article-title":"Suicidal Thoughts in Patients With Cancer and Comorbid Major Depression: Findings From a Depression Screening Program","volume":"63","author":"Walker","year":"2022","journal-title":"J. Acad. Consult. Liaison Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ma, Y., Lyu, J., Yang, B., Yan, T., Ma, Q., Wu, Z., Wang, Z., and He, H. (2022). Incidence and risk factors of suicide among patients with pancreatic cancer: A population-based analysis from 2000 to 2018. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.972908"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.ejso.2020.10.001","article-title":"Risk factors associated with suicide among hepatocellular carcinoma patients: A surveillance, epidemiology, and end results analysis","volume":"47 Pt B","author":"Chen","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Chen, C., Lin, H., Xu, F., Liu, J., Cai, Q., Yang, F., Lv, L., and Jiang, Y. (2021). Risk factors associated with suicide among esophageal carcinoma patients from 1975 to 2016. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-98260-w"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamapsychiatry.2018.3181","article-title":"Risk of Suicide After Cancer Diagnosis in England","volume":"76","author":"Henson","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1002\/pon.4827","article-title":"Suicide rates among patients with cancers of the digestive system","volume":"27","author":"Anderson","year":"2018","journal-title":"Psychooncology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s00384-018-03228-4","article-title":"Suicide risk among colorectal cancer patients in Lithuania","volume":"34","author":"Dulskas","year":"2019","journal-title":"Int. J. Color. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e513","DOI":"10.3747\/co.24.3713","article-title":"Risk and predictors of suicide in colorectal cancer patients: A Surveillance, Epidemiology, and End Results analysis","volume":"24","author":"Samawi","year":"2017","journal-title":"Curr. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1093\/jjco\/hyw075","article-title":"Suicide in patients with gastric cancer: A population-based study","volume":"46","author":"Sugawara","year":"2016","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1002\/cncr.25428","article-title":"Suicide in patients with pancreatic cancer","volume":"117","author":"Turaga","year":"2011","journal-title":"Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1111\/codi.17047","article-title":"Suicide after colorectal cancer\u2014A national population- based study","volume":"26","author":"Larsson","year":"2024","journal-title":"Color. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.3747\/co.v18i2.883","article-title":"Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls","volume":"18","author":"Pereira","year":"2011","journal-title":"Curr. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1136\/bmj.330.7496.865-a","article-title":"\u201cFighting spirit\u201d after cancer diagnosis does not improve outcome","volume":"330","author":"Dobson","year":"2005","journal-title":"BMJ"},{"key":"ref_41","first-page":"2024","article-title":"Exploring psychosocial distress in cancer patients and survivors: A quick overview","volume":"5","author":"Shivappa","year":"2024","journal-title":"New Emir. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Y\u00f6yen, E., and Kele\u015f, M. (2024). First- and Second-Generation Psychological Theories of Suicidal Behaviour. Behav. Sci., 14.","DOI":"10.3390\/bs14080710"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.3892\/ol.2015.2944","article-title":"Depression in cancer patients: Pathogenesis, implications and treatment (Review)","volume":"9","author":"Smith","year":"2015","journal-title":"Oncol. Lett."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Xia, W., Ou, M., Chen, Y., Chen, F., Yan, M., Xiao, Z., and Xu, X. (2024). Experiences of patients with advanced cancer coping with chronic pain: A qualitative analysis. BMC Palliat. Care, 23.","DOI":"10.1186\/s12904-024-01418-2"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Kwon, C.Y., and Lee, B. (2023). Prevalence of suicidal behavior in patients with chronic pain: A systematic review and meta-analysis of observational studies. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.1217299"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20551029221121526","DOI":"10.1177\/20551029221121526","article-title":"A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer","volume":"9","author":"Hayden","year":"2022","journal-title":"Health Psychol. Open"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wang, C., Qiu, X., Yang, X., Mao, J., and Li, Q. (2024). Factors Influencing Social Isolation among Cancer Patients: A Systematic Review. Healthcare, 12.","DOI":"10.3390\/healthcare12101042"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/pon.5859","article-title":"Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress","volume":"31","author":"Warner","year":"2022","journal-title":"Psychooncology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s41398-022-02178-4","article-title":"The effects of social isolation stress and discrimination on mental health","volume":"12","author":"Brandt","year":"2022","journal-title":"Transl. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.pec.2020.08.013","article-title":"Cancer patients\u2019 perspectives on financial burden in a universal healthcare system: Analysis of qualitative data from participants from 20 provincial cancer centers in Canada","volume":"104","author":"Fitch","year":"2021","journal-title":"Patient Educ. Couns."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3322\/caac.21443","article-title":"The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment","volume":"68","author":"Carrera","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.jacr.2024.04.024","article-title":"Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review","volume":"21","author":"Samaha","year":"2024","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Kang, D., Bae, K.R., Kim, H.Y., Ahn, Y., Kim, N., Shim, Y., Sohn, T.S., Lee, W.Y., Baek, J.H., and Kweon, S.S. (2022). Changes in working status after cancer diagnosis and socio-demographic, clinical, work-related, and psychological factors associated with it. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-10013-8"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1037\/0033-2909.127.4.472","article-title":"Marriage and health: His and hers","volume":"127","author":"Newton","year":"2001","journal-title":"Psychol. Bull."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"140","DOI":"10.2307\/2137252","article-title":"Marital status and psychiatric disorders among blacks and whites","volume":"33","author":"Williams","year":"1992","journal-title":"J. Health Soc. Behav."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2307\/353867","article-title":"Marital status and happiness: A 17-nation study","volume":"60","author":"Stack","year":"1998","journal-title":"J. Marriage Fam."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1002\/pon.3993","article-title":"Change in psychological distress in longer-term oesophageal cancer carers: Are clusters of illness perception change a useful determinant?","volume":"25","author":"Graham","year":"2016","journal-title":"Psychooncology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1080\/0284186X.2017.1287945","article-title":"A longitudinal assessment of psychological distress after oesophageal cancer surgery","volume":"56","author":"Hellstadius","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_59","first-page":"176","article-title":"Quality of life outcomes in patients living with stoma","volume":"18","author":"Anaraki","year":"2013","journal-title":"Indian. J. Palliat. Care"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/01.WON.0000436670.56153.7b","article-title":"Psychological well-being and quality of life in Crohn\u2019s disease patients with an ostomy: A preliminary investigation","volume":"46","author":"Knowles","year":"2013","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_61","first-page":"196","article-title":"Factors associated with stoma quality of life among stoma patients","volume":"1","author":"Liao","year":"2014","journal-title":"Int. J. Nurs. Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1002\/cam4.739","article-title":"Effects of psychological interventions and patients\u2019 affect on short-term quality of life in patients undergoing colorectal surgery","volume":"5","author":"Koplin","year":"2016","journal-title":"Cancer Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/WON.0000000000000235","article-title":"Quality of life after ostomy surgery in muslim patients: A systematic review of the literature and suggestions for clinical practice","volume":"43","author":"Iqbal","year":"2016","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.canep.2013.05.009","article-title":"Suicides among cancer patients in Lithuania: A population-based census-linked study","volume":"37","author":"Smailyte","year":"2013","journal-title":"Cancer Epidemiol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1427\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:20:54Z","timestamp":1760030454000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":64,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17091427"],"URL":"https:\/\/doi.org\/10.3390\/cancers17091427","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,24]]}}}