The study addresses a longstanding issue in clinical research: although pharmaceutical companies are essential to the development and testing of new medicines, many important cancer questions extend beyond the evaluation of a single product. Researchers may need to determine whether surgery, radiation, immunotherapy, chemotherapy, targeted treatment, behavioral support, screening, surveillance, or other interventions work best alone or in combination. They may also need to establish whether patients can safely receive less treatment after responding well to initial therapy. Such studies can be clinically important even when they are unlikely to produce a new commercial drug.

The investigators compared trials according to their sponsorship and intervention characteristics. A single-agent drug trial generally evaluates the safety, optimal dose, pharmacokinetics, or therapeutic effectiveness of one principal medicine, sometimes against a placebo or an established standard of care. These studies are central to regulatory approval because they can generate the controlled evidence needed to determine whether a new compound benefits patients. Their concentration among industry-sponsored trials is consistent with the role of pharmaceutical companies in developing and bringing proprietary medicines to market.

Federally sponsored trials showed a broader research profile. They were more likely to study nontreatment interventions, a category that can include prevention, diagnosis, screening, supportive care, follow-up, symptom management, health services, or other approaches not centered on administering an anticancer drug. These interventions may affect outcomes by identifying disease earlier, reducing complications, improving quality of life, or helping patients remain on treatment. They can also address questions involving care delivery and long-term survivorship, areas that may not provide a direct commercial return but can influence the effectiveness and value of cancer care across entire health systems.

Federal studies were also more likely to evaluate multimodality treatment strategies. Cancer therapy frequently depends on the interaction of different approaches: an operation may remove the primary tumor, radiation may target residual disease, and systemic therapy may eliminate cancer cells that have spread elsewhere. Determining the correct sequence, timing, and intensity of these treatments requires trials that are often logistically complex. Such research may involve multiple specialties, long follow-up periods, and comparisons between complete treatment programs rather than between individual drugs. The analysis suggests that public sponsorship plays a particularly important role in supporting this type of coordinated investigation.

Another distinguishing feature of federally sponsored research was a greater emphasis on deescalation. In oncology, deescalation means reducing the amount, duration, or intensity of treatment while preserving the same level of disease control. A trial might test fewer chemotherapy cycles, a smaller radiation dose, less extensive surgery, or the omission of a treatment that appears unnecessary for a biologically defined group of patients. These questions have become increasingly important as survival improves and clinicians pay greater attention to toxic effects, infertility, cardiac injury, secondary cancers, cognitive changes, and other long-term consequences. A therapy that is effective is not automatically optimal if a safer and less burdensome approach can achieve the same outcome.

The study also found that federally sponsored trials were more likely to address rare cancers and childhood cancers. These diseases often present a difficult funding environment because the number of potential participants is small, recruitment can take years, and the commercial market may not be large enough to justify extensive private investment. Pediatric oncology introduces additional scientific and ethical complexities, including differences in drug metabolism, organ development, late effects, and the need to assess how treatment influences growth and lifelong health. Publicly coordinated research can help assemble patients across institutions and preserve studies that would otherwise be too difficult or costly to conduct.

The findings do not mean that one sponsorship model is inherently superior or that industry-supported research lacks clinical value. Drug development depends on industry expertise, manufacturing capacity, regulatory knowledge, and investment. Nor does federal sponsorship guarantee that a trial will be free of limitations or produce a positive result. Instead, the analysis illustrates how the incentives and responsibilities of different sponsors can influence the distribution of research topics. A balanced cancer research ecosystem requires both the testing of new medicines and sustained support for questions involving prevention, treatment combinations, reduced toxicity, rare diseases, children, and the organization of care.

The authors’ comparison may therefore have implications for research policy and funding priorities. If clinical research relies too heavily on commercially attractive questions, important evidence gaps could persist in diseases with small patient populations or in interventions that do not generate a marketable product. Federal agencies, academic institutions, patient organizations, and other nonprofit funders can help fill those gaps by supporting cooperative groups, multisite trials, shared data systems, and studies with long-term follow-up. The analysis provides a quantitative basis for understanding that division of labor and underscores that progress in oncology depends not only on discovering more powerful treatments, but also on determining when, how, and for whom treatment can be delivered more safely and effectively.

Subject of Research: Differences in the focus of industry-sponsored and federally sponsored cancer clinical trials in the United States.

Web References: https://jamanetwork.com/channels/trials

References: Unger JM et al. Comparative study of 11,681 US cancer clinical trials. JAMA Oncology. DOI: 10.1001/jamaoncol.2026.3026.

Keywords: Cancer clinical trials, federal research funding, industry-sponsored research, oncology, drug therapy, multimodality treatment, deescalation, rare cancers, pediatric cancer, clinical research policy.

Despite agreement among clinicians about the importance of integrating patient preferences into routine healthcare decision-making, progress in this area has been slow. Few decision-making aids—such as educational materials to help patients understand complex medical information and consider treatment options—have been developed specifically for older adults. More evidence is needed about general healthcare preferences, especially among this population. 

In the new study, researchers used data from wave 8 (2016/2017) of the English Longitudinal Study of Ageing (ELSA), a nationally representative biennial survey of people living in private households in England. 6,098 adults aged 50 and over answered at least one of the six healthcare preference questions and were included in the new analysis. The questions covered risk aversion, weighing present versus future quality of life, quality versus length of life, body function versus appearance, openness to experimental treatments, and preference to leave treatment decisions to a doctor.

Healthcare preferences varied substantially across individuals. Women were more likely than men to want to avoid risks, prioritize quality of life over length of life, and avoid experimental treatments, and were less likely to want to defer treatment decisions to doctors. Adults aged 75 and over were more likely than those aged 50–64 to want to avoid risks, prioritize body function over appearance, avoid experimental treatments, and leave treatment decisions to doctors.

The study was limited to hypothetical preferences that have not been tested against real healthcare decisions, and findings may not generalize beyond England. However, the researchers conclude that there are systematic differences in healthcare preferences by age and sex, which may offer a useful starting point for clinicians seeking to elicit patient preferences.

Prof. Nicholas Steel adds: “Women were significantly more likely to prioritize quality of life over length of life and less likely to want doctors to make healthcare decisions on their behalf. They were also more cautious about risks and less willing to try experimental treatments. Men, meanwhile, were more likely to hand decision-making power to medical professionals and were less likely to put quality of life ahead of simply living longer.”

“People aged 75 and over were more likely to avoid risks, reject experimental treatments and leave healthcare decisions to their doctor than those in their 50s and early 60s. We also found that older participants were more likely to prioritize how well their body functions rather than how it looks.

“But perhaps the most surprising finding was just how varied people’s views were. While age, sex and education can offer useful clues about healthcare preferences, every patient’s wishes remain unique. Understanding those preferences more quickly could improve both patient satisfaction and health outcomes. This work provides a valuable starting point for more personalized care as Britain’s population continues to age and healthcare decisions become increasingly complex.”

Dr. Oby Enwo adds: “We found that older adults have different views about their health and that age, sex and education each shaped health preferences in different ways. The finding that stood out to me the most was around education – people who had fewer educational opportunities were more likely to leave treatment decisions to their doctors. To me, this highlights the need to explore how we can ensure shared decision-making reaches everyone equally.”

“Working with ELSA data has been a privilege because thousands of older adults have given up their time to make research like this possible. I hope our findings emphasize the importance of treating every consultation as a conversation on what matters most to each person.”

Prof. James Banks adds: “I thought it was interesting and important for us to show just how diverse people’s health and healthcare preferences were across different dimensions and that they can’t be summarized by a simple one- or two-dimensional measure. With patient-centered care being so important, we need more systematic measures of these preferences on an ongoing basis, not just for other populations, but importantly over time so we can see how these preferences change as people get older and as various life-events occur.”

“The relationship between education and peoples’ preferences regarding types of treatment and also how involved they wanted to be in treatment decisions seemed important and interesting to me.”

“I thought it was particularly important to see and document the strong preference, on average, for quality of life over length of life.”

In your coverage, please use this URL to provide access to the freely available article in PLOS One:

Citation: Steel N, Zaninotto P, Enwo OO, Banks J (2026) General healthcare preferences for people aged 50 and over in England: English longitudinal study of ageing. PLoS One 21(7): e0341994.

Author countries: UK.

Funding: Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG017644. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ELSA is funded by the NIHR Policy Research Programme (HEI) 198_1074_03. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

                        Journal

                        PLOS One

                        DOI

                        10.1371/journal.pone.0341994 
                        Method of Research

                        Survey
                        Subject of Research

                        Not applicable
                        Article Title

                        General healthcare preferences for people aged 50 and over in England: English longitudinal study of ageing
                        Article Publication Date

                        29-Jul-2026
                        COI Statement

                        The authors have declared that no competing interests exist.
            Media Contact
                                Hanna Abdallah
                PLOS
            onepress@plos.org
                        Journal

                        PLOS One
                        DOI

                        10.1371/journal.pone.0341994 
                        Method of Research

                        Survey
                        Subject of Research

                        Not applicable
                        Article Title

                        General healthcare preferences for people aged 50 and over in England: English longitudinal study of ageing
                        Article Publication Date

                        29-Jul-2026
                        COI Statement

                        The authors have declared that no competing interests exist.
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		https://scienmag.com/late-surfactant-effects-vary-by-pda-in-preemies/
		
		
		Mon, 20 Apr 2026 18:21:43 +0000
				
		
		
		
		
		
		
		
		
		
		
		
		
		
		https://scienmag.com/late-surfactant-effects-vary-by-pda-in-preemies/

					
										In the ever-evolving field of neonatology, the quest to improve outcomes for preterm infants remains a paramount challenge. A recent pivotal study published in the Journal of Perinatology sheds new light on the interplay between two critical factors in the management of ventilated preterm infants: late surfactant therapy and the status of patent ductus arteriosus (PDA). This research, led by Peebles, P.J., Eickhoff, J.C., Elgin, T.G., and colleagues, offers a nuanced understanding of how these treatments interact, or rather, how one does not seem to significantly alter the effects of the other.

Surfactant therapy, a cornerstone intervention for preterm infants struggling with respiratory distress syndrome (RDS), is well known for its life-saving properties. Typically administered early after birth, surfactant helps reduce the surface tension within the lungs, allowing for better gas exchange and oxygenation. However, the timing and influence of surfactant administration later in the neonatal period—referred to as late surfactant therapy—have been subjects of ongoing investigation. The question arises as to whether the presence of other complicated neonatal conditions, such as PDA, modulates the efficacy of late surfactant treatment.
PDA, a common congenital cardiac anomaly in preterm infants, involves the persistence of a fetal blood vessel called the ductus arteriosus that normally closes soon after birth. Its persistence can lead to significant hemodynamic disturbances, increasing the risk of morbidity and mortality via pulmonary overcirculation and systemic hypoperfusion. Given these physiological complexities, it has been hypothesized that PDA status might influence the outcomes of interventions aimed at ameliorating respiratory conditions like bronchopulmonary dysplasia (BPD).
The study in question undertakes a secondary analysis of a randomized clinical trial involving ventilated preterm infants receiving inhaled nitric oxide (iNO), an agent used to improve oxygenation, to explore whether PDA status modifies the therapeutic effect of late surfactant administration. The primary outcome examined was survival without BPD at 36 and 40 weeks’ postmenstrual age (PMA), a critical milestone for assessing long-term pulmonary function in preterm infants.
Remarkably, the findings demonstrate that the presence or absence of PDA did not significantly influence the outcome efficacy of late surfactant treatment. This suggests that the physiological challenges posed by PDA do not diminish or enhance the potential benefits of surfactant administered later in the clinical course. Moreover, secondary outcomes related to respiratory support parameters, duration of ventilation, and other morbidity indices corroborated the lack of effect modification by PDA status.
These insights carry profound implications for clinical practice. They suggest that clinicians may not need to tailor surfactant administration based on PDA status, streamlining treatment protocols and potentially simplifying decision-making processes in the neonatal intensive care unit (NICU). It also underscores the resilience and independent mechanism of action of surfactant therapy, unaffected by the hemodynamic perturbations caused by PDA.
From a pathophysiological perspective, this uncoupling between PDA status and surfactant efficacy highlights the distinct therapeutic pathways these conditions traverse. While PDA primarily affects cardiovascular dynamics and pulmonary blood flow, surfactant therapy primarily targets alveolar mechanics and pulmonary compliance. This distinction perhaps explains why their interplay does not yield a compounded or mitigated clinical effect when combined.
Further, the study’s utilization of a robust randomized clinical trial framework lends credence to the reliability of the findings. Rigorous randomization and controlled conditions ensure that confounding variables were minimized, bolstering confidence in the interpretation that PDA does not modulate late surfactant treatment effects. This methodological strength is critical given the complex and multifactorial nature of neonatal morbidities.
In addition, the sample population—ventilated preterm infants receiving iNO—represents a clinically high-risk cohort, further emphasizing the significance of these results. Ventilation and iNO therapy are indicators of severe respiratory compromise; thus, demonstrating efficacy or lack of modification in this subset suggests broad applicability of the findings across various neonatal care scenarios.
Beyond immediate clinical implications, these results invite further research into tailored therapies for preterm infants with PDA. Although PDA may not influence late surfactant efficacy, it remains a significant contributor to neonatal morbidity. Future studies might explore adjunctive or alternative therapies that target PDA-related complications without impacting surfactant administration strategies.
Moreover, understanding the molecular and cellular pathways involved in surfactant metabolism and PDA pathogenesis may illuminate new therapeutic targets. For instance, investigations into how inflammation, oxidative stress, or endothelial dysfunction associated with PDA influence lung development and function could open avenues for combination therapies that enhance overall outcomes in these vulnerable infants.
This research also adds a new layer to the ongoing discourse regarding the timing and indications for surfactant therapy. While early administration remains the gold standard, late surfactant use may have a nuanced role in mitigating long-term pulmonary sequelae. Clarity on factors that do not modify its efficacy, such as PDA, refines this therapeutic landscape and supports more evidence-based guidelines and protocols.
The collaborative efforts of Peebles, Eickhoff, Elgin, and colleagues underscore the importance of multidisciplinary and multicenter approaches to neonatal research. Their work illustrates how secondary analyses of clinical trials, when rigorously designed and executed, can yield important findings beyond the initial study questions, influencing clinical paradigms and patient care.
In summary, the current investigation provides compelling evidence that the presence of patent ductus arteriosus does not alter the therapeutic benefit of late surfactant administration in ventilated preterm infants receiving inhaled nitric oxide. This clarity informs NICU protocols, optimizes treatment pathways, and directs future research toward exploring novel interventions for PDA management without concern for interference with surfactant therapy outcomes. The study represents a significant step forward in refining neonatal respiratory care and enhancing survival and quality of life for some of the most vulnerable patients.
As neonatology strives to evolve with precision medicine, such findings highlight the intricate balance of interventions that may be administered concurrently yet operate through independent mechanisms. Integrating these nuanced insights into clinical practice will ensure that emerging therapies are implemented with maximal efficacy and safety, ultimately improving the prognosis of preterm infants worldwide.
The publication of this research is a testament to the relentless pursuit of knowledge and continuous improvement in neonatal care, showing that even in the face of complex cardiac and respiratory comorbidities, targeted therapies can maintain their intended benefits. With ongoing advancements, the future holds promise for even more personalized and effective treatments that cater to the diverse needs of preterm infants.

Subject of Research: The interaction between late surfactant therapy and patent ductus arteriosus status in ventilated preterm infants receiving inhaled nitric oxide, focusing on survival without bronchopulmonary dysplasia and related secondary outcomes.
Article Title: Effect modification of late surfactant treatment by patent ductus arteriosus status in ventilated preterm infants: a secondary analysis of a randomized clinical trial.
Article References:

Peebles, P.J., Eickhoff, J.C., Elgin, T.G. et al. Effect modification of late surfactant treatment by patent ductus arteriosus status in ventilated preterm infants: a secondary analysis of a randomized clinical trial. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02705-x
Image Credits: AI Generated
DOI: 20 April 2026
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