In order to maintain the high standards of CA’s content, the Editors of CA rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.
We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2023, to June 30, 2024. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews. Peer review is an essential component of scholarly publishing, and we sincerely appreciate the time and expertise volunteered by these participants.
{"title":"Reviewer acknowledgement 2024","authors":"","doi":"10.3322/caac.21866","DOIUrl":"https://doi.org/10.3322/caac.21866","url":null,"abstract":"<p>In order to maintain the high standards of <i>CA</i>’s content, the Editors of <i>CA</i> rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.</p>\u0000<p>We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2023, to June 30, 2024. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews. Peer review is an essential component of scholarly publishing, and we sincerely appreciate the time and expertise volunteered by these participants.</p>\u0000<p>Dina Amin</p>\u0000<p>Eric Bernicker</p>\u0000<p>Chao Cao</p>\u0000<p>Raymond Chan</p>\u0000<p>Paul Daeninck</p>\u0000<p>Fernando Diaz</p>\u0000<p>Tanya Dorff</p>\u0000<p>Georges Gebrael</p>\u0000<p>Samir Hanash</p>\u0000<p>Vida Henderson</p>\u0000<p>Hormuzd Katki</p>\u0000<p>Shumei Kato</p>\u0000<p>Amir Khan</p>\u0000<p>Allison J. Lazard</p>\u0000<p>Mark Lewis</p>\u0000<p>Kim Margolin</p>\u0000<p>Joaquin Mateo</p>\u0000<p>Justin Moyers</p>\u0000<p>Maria Pisu</p>\u0000<p>Gwendolyn Quinn</p>\u0000<p>Paul Riviere</p>\u0000<p>Jason Sicklick</p>\u0000<p>Zbyslaw Sondka</p>\u0000<p>Conor Steuer</p>\u0000<p>Kristine Swartz</p>\u0000<p>Randy Sweis</p>\u0000<p>Peter Yu</p>\u0000<p>Xue Qin Yu</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":254.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142237013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>It has been widely reported that patients who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-diverse characteristic) have more health risks than the cisgender and/or heterosexual population. According to previous studies, most of the disparity has been attributed to the minority stress theory: Members of these communities disproportionally experience discrimination, and this results in mistrust in medical settings—further increasing stress.</p><p>Regarding cancer specifically, these society-derived stressors have been reported to lead to lower rates of timely screening, higher rates of infection with cancer-causing viruses, and higher rates of health risk behaviors—increasing the potential risk for various cancers in the LGBTQ+ community. Another issue builds on the aforementioned minority stress theory, which can result in avoidance because of the fear that a health care provider will refuse to care for them. Importantly, the LGBTQ+ communities are diverse, and cancer incidences may differ within specific gender identities and/or sexual orientations (SOs). Because of insufficient details from previous studies, accurate data regarding cancer incidence in specific groups have been lacking.</p><p>A study appearing in <i>Cancer</i> (doi: 10.1002/cncr.35356) adds new evidence of the disproportional cancer burden faced by sexual minoritized people. Study author Aimee K. Huang, MD, MPH, a junior faculty member at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, says that most prior studies relied on indirect approximations of incidence and prevalence. “However, for studies that were able to directly measure incidence, the scopes of their investigations were often limited to the most common cancers, unidimensional SO measurements, or had other methodological challenges due to data limitations,” she says.</p><p>For the study, researchers culled SO and cancer diagnosis data (from 1989 to 2017) from the Nurses’ Health Study II (NHSII), a longitudinal cohort of 101,543 nurses across the United States. The mean ages and race/ethnicity compositions were similar across all the groups.</p><p>The primary outcome was the self-disclosed and electronic health record–verified incidences of cancer among four different sexual minority groups: heterosexual with a past same-sex attraction/behavior/identity (<i>n</i> = 5034), mostly heterosexual (<i>n</i> = 1825), bisexual (<i>n</i> = 394), and lesbian (<i>n</i> = 996). These groups were compared to a “reference” group that self-identified as lifelong heterosexual (<i>n</i> = 93,294). The researchers also determined the case numbers, incidence rates, and age-adjusted incidence rate ratios (aIRRs) of 21 site-specific cancers for each group. Using aIRRs, they compared incidence rates between the reference group and the four SO subgroups.</p><p>The researchers reported that the cancer incidence rate (cases per 100,000 person-years) was highest for those
{"title":"Cancer disparities for LGBTQ+ patients identified more fully","authors":"Mike Fillon","doi":"10.3322/caac.21861","DOIUrl":"10.3322/caac.21861","url":null,"abstract":"<p>It has been widely reported that patients who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-diverse characteristic) have more health risks than the cisgender and/or heterosexual population. According to previous studies, most of the disparity has been attributed to the minority stress theory: Members of these communities disproportionally experience discrimination, and this results in mistrust in medical settings—further increasing stress.</p><p>Regarding cancer specifically, these society-derived stressors have been reported to lead to lower rates of timely screening, higher rates of infection with cancer-causing viruses, and higher rates of health risk behaviors—increasing the potential risk for various cancers in the LGBTQ+ community. Another issue builds on the aforementioned minority stress theory, which can result in avoidance because of the fear that a health care provider will refuse to care for them. Importantly, the LGBTQ+ communities are diverse, and cancer incidences may differ within specific gender identities and/or sexual orientations (SOs). Because of insufficient details from previous studies, accurate data regarding cancer incidence in specific groups have been lacking.</p><p>A study appearing in <i>Cancer</i> (doi: 10.1002/cncr.35356) adds new evidence of the disproportional cancer burden faced by sexual minoritized people. Study author Aimee K. Huang, MD, MPH, a junior faculty member at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, says that most prior studies relied on indirect approximations of incidence and prevalence. “However, for studies that were able to directly measure incidence, the scopes of their investigations were often limited to the most common cancers, unidimensional SO measurements, or had other methodological challenges due to data limitations,” she says.</p><p>For the study, researchers culled SO and cancer diagnosis data (from 1989 to 2017) from the Nurses’ Health Study II (NHSII), a longitudinal cohort of 101,543 nurses across the United States. The mean ages and race/ethnicity compositions were similar across all the groups.</p><p>The primary outcome was the self-disclosed and electronic health record–verified incidences of cancer among four different sexual minority groups: heterosexual with a past same-sex attraction/behavior/identity (<i>n</i> = 5034), mostly heterosexual (<i>n</i> = 1825), bisexual (<i>n</i> = 394), and lesbian (<i>n</i> = 996). These groups were compared to a “reference” group that self-identified as lifelong heterosexual (<i>n</i> = 93,294). The researchers also determined the case numbers, incidence rates, and age-adjusted incidence rate ratios (aIRRs) of 21 site-specific cancers for each group. Using aIRRs, they compared incidence rates between the reference group and the four SO subgroups.</p><p>The researchers reported that the cancer incidence rate (cases per 100,000 person-years) was highest for those ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Investigators for the phase 3 LAURA trial reported that for patients with unresectable stage III non–small cell lung cancer (NSCLC) harboring an <i>EGFR</i> mutation after chemoradiotherapy, osimertinib significantly prolonged progression-free survival (PFS) versus a placebo. The study appears in <i>The New England Journal of Medicine</i> (doi:10.1056/NEJMoa2402614).</p><p>“This is the first randomized trial conducted specifically for patients with unresectable stage III lung cancer with <i>EGFR</i> mutation,” says Suresh S. Ramalingam, MD, professor of hematology and medical oncology and executive director of the Winship Cancer Institute at the Emory University School of Medicine and LAURA trial investigator. “The study shows a clear benefit with osimertinib compared to placebo in terms of progression-free survival and lower risk of brain progression.”</p><p>Study results show that treatment with osimertinib reduced the risk of progression or death by 84% in comparison with the placebo. The study was presented during a press briefing at the 2024 annual meeting of the American Society of Clinical Oncology held in Chicago, Illinois.</p><p>The LAURA trial included patients at least 18 years old (20 years old in Japan) with locally advanced and unresectable stage III NSCLC harboring an <i>EGFR</i> exon 19 deletion or L858R mutation from August 2018 through July 2022. None of the patients had disease progression after definitive chemoradiotherapy. A total of 216 patients underwent randomization; 143 were assigned to receive osimertinib, and 73 received the placebo.</p><p>The median age of the patients was 62 years in the osimertinib arm and 64 years in the placebo group. Most were male (63% in the osimertinib arm and 58% in the placebo arm). The majority never smoked (71% and 67%, respectively).</p><p>Both groups included enrollment from Asian countries (81% in the osimertinib arm vs. 85% in the placebo arm), had stage IIIB disease (47% vs. 52%) and adenocarcinoma (97% vs. 95%), and harbored <i>EGFR</i> exon 19 deletions (52% vs. 59%). Also, most received concurrent chemoradiotherapy: 92% in the osimertinib group and 85% in the placebo group.</p><p>Patients needed to have a World Health Organization (WHO) performance-status score of 0 or 1. (Note that this was based on a scale of 0–5, with a higher number indicating more disability.) Six weeks was the maximum interval between the last dose of chemoradiotherapy and randomization. At the baseline, patients were largely balanced between the two groups, although there were more patients with a WHO performance-status score of 0 in the osimertinib group versus the placebo group (56% vs. 42%).</p><p>The patients were randomly assigned 2:1 to receive 80 mg of oral osimertinib or the placebo once per day. Blinded independent central review (BICR) of PFS per the Response Evaluation Criteria in Solid Tumors (Version 1.1) was the trial’s primary end point. Secondary end points included overall survival (OS),
3期LAURA试验的研究人员报告说，对于化放疗后不可切除的携带表皮生长因子受体突变的III期非小细胞肺癌（NSCLC）患者，与安慰剂相比，奥希替尼能显著延长无进展生存期（PFS）。这项研究发表在《新英格兰医学杂志》上（doi:10.1056/NEJMoa2402614）。"这是第一项专门针对EGFR突变的不可切除III期肺癌患者进行的随机试验，"埃默里大学医学院血液学和肿瘤内科学教授、温希普癌症研究所执行主任、LAURA试验研究者Suresh S. Ramalingam医学博士说。"研究结果显示，与安慰剂相比，使用奥希替尼治疗可将病情恶化或死亡风险降低84%。这项研究是在伊利诺伊州芝加哥市举行的美国临床肿瘤学会2024年年会上的新闻发布会上公布的。"LAURA "试验纳入了2018年8月至2022年7月期间年满18岁（日本为20岁）、携带表皮生长因子受体外显子19缺失或L858R突变的局部晚期和不可切除的III期NSCLC患者。这些患者在接受明确的化放疗后均没有出现疾病进展。共有216名患者接受了随机分配，其中143人被分配接受奥希替尼治疗，73人接受安慰剂治疗。大多数患者为男性（奥希莫替尼组为63%，安慰剂组为58%）。两组患者均来自亚洲国家（奥西替尼组为81%，安慰剂组为85%），均为IIIB期疾病（47%对52%）和腺癌（97%对95%），均携带表皮生长因子受体外显子19缺失（52%对59%）。此外，大多数患者同时接受了化疗放疗：奥西美替尼组为92%，安慰剂组为85%。患者的世界卫生组织（WHO）表现状态评分需为0或1分（请注意，评分标准为0-5分，数字越大表示残疾程度越高）。最后一次化放疗剂量与随机化之间的最长间隔为六周。在基线时，两组患者的情况基本平衡，但奥希替尼组与安慰剂组相比，WHO表现状态评分为0分的患者更多（56%对42%）。患者按2:1的比例随机分配，每天一次口服80毫克奥希替尼或安慰剂。根据《实体瘤反应评价标准》（1.1版）进行的盲法独立中央审查（BICR）是该试验的主要终点。次要终点包括总生存期（OS）、中枢神经系统 PFS 和安全性。治疗一直持续到 BICR 确定的疾病进展、不可接受的毒性或事先商定的其他终止标准出现为止。肿瘤评估最初通过胸部CT/MRI和脑部MRI进行，第48周之前每8周评估一次，之后每12周评估一次，直到BICR确认病情进展。在两组患者中，只有8%的患者无法进行评估。奥西替尼组的中位应答持续时间为36.9个月，安慰剂组为6.5个月。其他数据显示，奥西替尼组有22名患者出现了新病灶，而安慰剂组有68名患者出现了新病灶。出现新病变的部位包括大脑（8 名奥希替尼患者对 29 名安慰剂患者）、肺部（6 名患者对 29 名患者）和肝脏（3 名患者对 7 名患者）。Ramalingam 博士说，化放疗后奥希替尼的研究结果符合 EGFR 抑制剂已知的安全性特征，而且副作用是可控的。他补充说，大多数不良反应都很轻微（1/2级），不会导致治疗中断，而且与之前的研究结果一致。至少有10%的患者出现了任何级别的不良反应，其中最常见的不良反应包括放射性肺炎（奥西替尼组48%的患者与安慰剂组38%的患者）。在至少10%的患者中，最常见的任何级别的不良反应包括放射性肺炎（奥希莫替尼组48%的患者对安慰剂组38%的患者）、腹泻（36%对14%）、皮疹（24%对14%）、COVID-19（20%对8%）、副癣（17%对1%）和咳嗽（16%对10%）。此外，奥希替尼组和安慰剂组还出现了食欲下降（15% vs. 5%）、皮肤干燥（13% vs. 5%）、瘙痒（13% vs. 7%）、口腔炎（12% vs. 3%）、白细胞计数下降（12% vs. 3%）、肺炎（11% vs. 8%）、贫血（10% vs. 4%）和肌肉骨骼胸痛（3% vs. 12%）。
{"title":"Osimertinib prolongs progression-free lung cancer survival after chemotherapy","authors":"Mike Fillon","doi":"10.3322/caac.21862","DOIUrl":"10.3322/caac.21862","url":null,"abstract":"<p>Investigators for the phase 3 LAURA trial reported that for patients with unresectable stage III non–small cell lung cancer (NSCLC) harboring an <i>EGFR</i> mutation after chemoradiotherapy, osimertinib significantly prolonged progression-free survival (PFS) versus a placebo. The study appears in <i>The New England Journal of Medicine</i> (doi:10.1056/NEJMoa2402614).</p><p>“This is the first randomized trial conducted specifically for patients with unresectable stage III lung cancer with <i>EGFR</i> mutation,” says Suresh S. Ramalingam, MD, professor of hematology and medical oncology and executive director of the Winship Cancer Institute at the Emory University School of Medicine and LAURA trial investigator. “The study shows a clear benefit with osimertinib compared to placebo in terms of progression-free survival and lower risk of brain progression.”</p><p>Study results show that treatment with osimertinib reduced the risk of progression or death by 84% in comparison with the placebo. The study was presented during a press briefing at the 2024 annual meeting of the American Society of Clinical Oncology held in Chicago, Illinois.</p><p>The LAURA trial included patients at least 18 years old (20 years old in Japan) with locally advanced and unresectable stage III NSCLC harboring an <i>EGFR</i> exon 19 deletion or L858R mutation from August 2018 through July 2022. None of the patients had disease progression after definitive chemoradiotherapy. A total of 216 patients underwent randomization; 143 were assigned to receive osimertinib, and 73 received the placebo.</p><p>The median age of the patients was 62 years in the osimertinib arm and 64 years in the placebo group. Most were male (63% in the osimertinib arm and 58% in the placebo arm). The majority never smoked (71% and 67%, respectively).</p><p>Both groups included enrollment from Asian countries (81% in the osimertinib arm vs. 85% in the placebo arm), had stage IIIB disease (47% vs. 52%) and adenocarcinoma (97% vs. 95%), and harbored <i>EGFR</i> exon 19 deletions (52% vs. 59%). Also, most received concurrent chemoradiotherapy: 92% in the osimertinib group and 85% in the placebo group.</p><p>Patients needed to have a World Health Organization (WHO) performance-status score of 0 or 1. (Note that this was based on a scale of 0–5, with a higher number indicating more disability.) Six weeks was the maximum interval between the last dose of chemoradiotherapy and randomization. At the baseline, patients were largely balanced between the two groups, although there were more patients with a WHO performance-status score of 0 in the osimertinib group versus the placebo group (56% vs. 42%).</p><p>The patients were randomly assigned 2:1 to receive 80 mg of oral osimertinib or the placebo once per day. Blinded independent central review (BICR) of PFS per the Response Evaluation Criteria in Solid Tumors (Version 1.1) was the trial’s primary end point. Secondary end points included overall survival (OS), ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this issue of the journal, Magnuson et al. provide a comprehensive review of available geriatric assessment (GA) tools and their impact on outcomes for solid tumors and hematologic malignancies. In addition, the authors provide a clear guide for clinicians to help understand the importance of GA and management.<span><sup>1</sup></span></p> <p>An assumption inherent in the GA is that improvement in outcomes is driven by modifications in treatment delivery or implementation of features to make activities of daily living safer. In other words, GA-guided management<span><sup>2</sup></span> or GA-driven intervention,<span><sup>3</sup></span> rather than simply performing the GA, is what leads to outcome improvement. These modifications are implemented using a multidisciplinary team of geriatric trained specialists. Examples include occupational therapists to improve home safety, physical therapists to improve gait and balance, pharmacists to review home medications and adjust based on anticipated adverse drug interactions, dietitians to improve nutrition, etc. Most of the studies included showed benefit, either in survival, reduced toxicity, improved quality of life, or cost effectiveness.</p> <p>These observations led to the development of an American Society of Clinical Oncology guideline recommending GA-guided management of cancer treatment in elderly adults.<span><sup>4</sup></span> However, it is widely recognized that this tool is underused by practicing oncologists.<span><sup>5</sup></span> The <i>whys</i> have been explored by Magnuson et al. and others<span><sup>5, 6</sup></span> and included the belief that the GA was too cumbersome in addition to the perception that it added little or no value. Based on these assumptions, making assessment tools more efficient and educating providers about their evidence-generated benefits have been the focus of efforts to improve GA use. To encourage greater uptake of the tool, Magnuson and co-authors detail ways to educate providers and simplify the GA.</p> <p>What is not discussed that may be an important root cause of poor uptake of GA is resource scarcity, which takes two forms. The first is the lack of available services to support GA-modified treatment. Substantial numbers of communities, particularly in rural sites, do not have consistent—if any—access to the specialists required to modify treatment in a GA-guided manner. These practices almost certainly do not have geriatricians or geriatric-trained nurse practitioners; and they may not have physical therapists, occupational therapists, chemotherapy-dedicated pharmacists, or even social workers. Rural sites particularly often have one oncology provider whose job is to meet all the needs of every oncology patient in their practice. This distributive inequity of resources<span><sup>7</sup></span> has always existed and will continue to plague rural communities. In this context, even if one performed a GA, opportunities to make care delivery saf
远程医疗在肿瘤学的许多方面都取得了成功，从监测到毒性监测，并可用于老年病咨询和管理。我们的全国性组织（如美国临床肿瘤学会和美国癌症学会）可以帮助建立一个由全国认证的老年病学专家组成的小组，提供远程会诊，以解决老年病这方面的问题。不过，这要假定有足够多的老年病学专家愿意并能够满足日益增长的老年人口不断扩大的需求。一个更难解决的问题是，如何组建一个多学科团队来实现老年医学的建议，包括更广泛地获得职业和物理治疗的评估和管理，这需要亲临现场、亲力亲为的访问。解决这一人力问题的新方法或许是帮助创建一个新的辅助专业领域，即老年评估实施技术人员（GAITs）。这种老年评估实施技术员将由非专业人员担任，他们将接受相对短暂的集中培训，然后获得认证，类似于非专业导航员。这些人经过培训后，可以进行居家评估，为安全实施化疗做出必要的改变，并可部署到服务不足的社区和农村地区。如果设计得当，在缺乏经济机会的社区，这可能是一个有吸引力且有用的职业选择，并能为老龄化人口所代表的日益增长的需求提供解决方案。这两个要素，即支持当地医生的远程保健老年医学和补充远程保健职业治疗/物理治疗的 GAIT，将需要额外的资金，并需要实施研究，以确定这些增强措施是否和/或如何改善结果。设想支持这些举措所需的资源似乎令人生畏。如果我们想改善 GA 在所有肿瘤治疗实践中的应用，仅仅教育肿瘤学家和简化工具是不够的。我们必须帮助资源不足的诊疗机构实施基于 GA 的变革，我们需要将所需的专科诊疗带到农村环境中。牢记服务不足社区的需求对于继续推出的所有指南取得成功至关重要。
{"title":"Overlooked barriers to implementation of geriatric assessment","authors":"Banu E. Symington, Paul G. Montgomery","doi":"10.3322/caac.21865","DOIUrl":"https://doi.org/10.3322/caac.21865","url":null,"abstract":"<p>In this issue of the journal, Magnuson et al. provide a comprehensive review of available geriatric assessment (GA) tools and their impact on outcomes for solid tumors and hematologic malignancies. In addition, the authors provide a clear guide for clinicians to help understand the importance of GA and management.<span><sup>1</sup></span></p>\u0000<p>An assumption inherent in the GA is that improvement in outcomes is driven by modifications in treatment delivery or implementation of features to make activities of daily living safer. In other words, GA-guided management<span><sup>2</sup></span> or GA-driven intervention,<span><sup>3</sup></span> rather than simply performing the GA, is what leads to outcome improvement. These modifications are implemented using a multidisciplinary team of geriatric trained specialists. Examples include occupational therapists to improve home safety, physical therapists to improve gait and balance, pharmacists to review home medications and adjust based on anticipated adverse drug interactions, dietitians to improve nutrition, etc. Most of the studies included showed benefit, either in survival, reduced toxicity, improved quality of life, or cost effectiveness.</p>\u0000<p>These observations led to the development of an American Society of Clinical Oncology guideline recommending GA-guided management of cancer treatment in elderly adults.<span><sup>4</sup></span> However, it is widely recognized that this tool is underused by practicing oncologists.<span><sup>5</sup></span> The <i>whys</i> have been explored by Magnuson et al. and others<span><sup>5, 6</sup></span> and included the belief that the GA was too cumbersome in addition to the perception that it added little or no value. Based on these assumptions, making assessment tools more efficient and educating providers about their evidence-generated benefits have been the focus of efforts to improve GA use. To encourage greater uptake of the tool, Magnuson and co-authors detail ways to educate providers and simplify the GA.</p>\u0000<p>What is not discussed that may be an important root cause of poor uptake of GA is resource scarcity, which takes two forms. The first is the lack of available services to support GA-modified treatment. Substantial numbers of communities, particularly in rural sites, do not have consistent—if any—access to the specialists required to modify treatment in a GA-guided manner. These practices almost certainly do not have geriatricians or geriatric-trained nurse practitioners; and they may not have physical therapists, occupational therapists, chemotherapy-dedicated pharmacists, or even social workers. Rural sites particularly often have one oncology provider whose job is to meet all the needs of every oncology patient in their practice. This distributive inequity of resources<span><sup>7</sup></span> has always existed and will continue to plague rural communities. In this context, even if one performed a GA, opportunities to make care delivery saf","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":254.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allison Magnuson, Kah Poh Loh, Fiona Stauffer, William Dale, Nikesha Gilmore, Sindhuja Kadambi, Heidi D. Klepin, Kaitlin Kyi, Lisa M. Lowenstein, Tanyanika Phillips, Erika Ramsdale, Melody K. Schiaffino, John F. Simmons, Grant R. Williams, Jason Zittel, Supriya Mohile
Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.
{"title":"Geriatric assessment for the practicing clinician: The why, what, and how","authors":"Allison Magnuson, Kah Poh Loh, Fiona Stauffer, William Dale, Nikesha Gilmore, Sindhuja Kadambi, Heidi D. Klepin, Kaitlin Kyi, Lisa M. Lowenstein, Tanyanika Phillips, Erika Ramsdale, Melody K. Schiaffino, John F. Simmons, Grant R. Williams, Jason Zittel, Supriya Mohile","doi":"10.3322/caac.21864","DOIUrl":"https://doi.org/10.3322/caac.21864","url":null,"abstract":"Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":254.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farhad Islami MD, PhD, Emily C. Marlow PhD, Blake Thomson DPhil, MPhil, Marjorie L. McCullough ScD, RD, Harriet Rumgay PhD, Susan M. Gapstur PhD, MPH, Alpa V. Patel PhD, Isabelle Soerjomataram MD, PhD, MSc, Ahmedin Jemal DVM, PhD
In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating for and informing cancer prevention and control. Herein, based on up-to-date relative risk and cancer occurrence data, the authors estimated the proportion and number of invasive cancer cases (excluding nonmelanoma skin cancers) and deaths, overall and for 30 cancer types among adults who were aged 30 years and older in 2019 in the United States, that were attributable to potentially modifiable risk factors. These included cigarette smoking; second-hand smoke; excess body weight; alcohol consumption; consumption of red and processed meat; low consumption of fruits and vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and seven carcinogenic infections. Numbers of cancer cases and deaths were obtained from data sources with complete national coverage, risk factor prevalence estimates from nationally representative surveys, and associated relative risks of cancer from published large-scale pooled or meta-analyses. In 2019, an estimated 40.0% (713,340 of 1,781,649) of all incident cancers (excluding nonmelanoma skin cancers) and 44.0% (262,120 of 595,737) of all cancer deaths in adults aged 30 years and older in the United States were attributable to the evaluated risk factors. Cigarette smoking was the leading risk factor contributing to cancer cases and deaths overall (19.3% and 28.5%, respectively), followed by excess body weight (7.6% and 7.3%, respectively), and alcohol consumption (5.4% and 4.1%, respectively). For 19 of 30 evaluated cancer types, more than one half of the cancer cases and deaths were attributable to the potentially modifiable risk factors considered in this study. Lung cancer had the highest number of cancer cases (201,660) and deaths (122,740) attributable to evaluated risk factors, followed by female breast cancer (83,840 cases), skin melanoma (82,710), and colorectal cancer (78,440) for attributable cases and by colorectal (25,800 deaths), liver (14,720), and esophageal (13,600) cancer for attributable deaths. Large numbers of cancer cases and deaths in the United States are attributable to potentially modifiable risk factors, underscoring the potential to substantially reduce the cancer burden through broad and equitable implementation of preventive initiatives.
{"title":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019","authors":"Farhad Islami MD, PhD, Emily C. Marlow PhD, Blake Thomson DPhil, MPhil, Marjorie L. McCullough ScD, RD, Harriet Rumgay PhD, Susan M. Gapstur PhD, MPH, Alpa V. Patel PhD, Isabelle Soerjomataram MD, PhD, MSc, Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21858","DOIUrl":"10.3322/caac.21858","url":null,"abstract":"<p>In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating for and informing cancer prevention and control. Herein, based on up-to-date relative risk and cancer occurrence data, the authors estimated the proportion and number of invasive cancer cases (excluding nonmelanoma skin cancers) and deaths, overall and for 30 cancer types among adults who were aged 30 years and older in 2019 in the United States, that were attributable to potentially modifiable risk factors. These included cigarette smoking; second-hand smoke; excess body weight; alcohol consumption; consumption of red and processed meat; low consumption of fruits and vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and seven carcinogenic infections. Numbers of cancer cases and deaths were obtained from data sources with complete national coverage, risk factor prevalence estimates from nationally representative surveys, and associated relative risks of cancer from published large-scale pooled or meta-analyses. In 2019, an estimated 40.0% (713,340 of 1,781,649) of all incident cancers (excluding nonmelanoma skin cancers) and 44.0% (262,120 of 595,737) of all cancer deaths in adults aged 30 years and older in the United States were attributable to the evaluated risk factors. Cigarette smoking was the leading risk factor contributing to cancer cases and deaths overall (19.3% and 28.5%, respectively), followed by excess body weight (7.6% and 7.3%, respectively), and alcohol consumption (5.4% and 4.1%, respectively). For 19 of 30 evaluated cancer types, more than one half of the cancer cases and deaths were attributable to the potentially modifiable risk factors considered in this study. Lung cancer had the highest number of cancer cases (201,660) and deaths (122,740) attributable to evaluated risk factors, followed by female breast cancer (83,840 cases), skin melanoma (82,710), and colorectal cancer (78,440) for attributable cases and by colorectal (25,800 deaths), liver (14,720), and esophageal (13,600) cancer for attributable deaths. Large numbers of cancer cases and deaths in the United States are attributable to potentially modifiable risk factors, underscoring the potential to substantially reduce the cancer burden through broad and equitable implementation of preventive initiatives.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With artificial intelligence (AI) erupting across all aspects of life, including health care, oncology is a logical field ripe for new applications. AI is already used in cancer care and diagnosis, such as tumor identification on x-rays and pathology slides. Beyond that, emerging technology is using AI to forecast the prognosis of patients and to assess their treatment options. One unknown is how oncologists feel about this trend, which includes possibly relinquishing some control over their profession and patients.
A new study asked 204 oncologists for their views on the rapidly developing AI tools. Specifically, they were asked about ethical issues that they face regarding the deployment of AI (e.g., whether they believed that AI could be used effectively in patient-care decisions). The main issue that the researchers investigated was to what degree patients should provide explicit informed consent for the use of AI during treatment decision-making. The study appears in JAMA Network Open (doi:10.1001/jamanetworkopen.2024.4077).
In the study, which was conducted from November 15, 2022 to July 31, 2023, a random sample of oncologists from across the country were asked 24 questions via traditional mail (which included a $25 gift card) about their views on the use of AI in clinical practice. Follow-ups with nonresponders were conducted via email and phone calls.
Issues covered bias, responsibilities, and whether they would be able to explain to patients how the technology was deployed in determining their care. There were 387 surveys sent to oncologists; 52.7% (n = 204) were completed. Those responding came from 37 states; 63.7% (n = 120) were male, and 62.7% (n = 128) identified as non-Hispanic White.
Very few respondents said that AI prognostic and clinical decision models could be used clinically when only researchers could explain them (13.2% of respondents [n = 27] for prognosis and 7.8% [n = 16] for clinical decisions).
For AI prognostic and clinical decision models that oncologists could explain, the percentages were much higher: 81.3% (n = 165) and 84.8% (n = 173), respectively. Fewer respondents—13.8% (n = 28) and 23.0% (n = 47), respectively—reported that the models also needed to be explainable by patients.
The survey also found that 36.8% of oncologists (n = 75) believed that if an AI system selected a treatment regimen different from what they would recommend, they would present both options and let the patient decide. Although that represented less than half of the respondents, it was the most common answer.
Regarding responsibility for medical or legal problems arising from AI use, 90.7% of respondents (n = 185) indicated that AI developers should be held accountable. This was considerably higher than the 47.1% (n = 96) who felt that the responsibility should be shared with physicians and the 43.1% (
{"title":"Key issues face AI deployment in cancer care","authors":"Mike Fillon","doi":"10.3322/caac.21860","DOIUrl":"10.3322/caac.21860","url":null,"abstract":"<p>With artificial intelligence (AI) erupting across all aspects of life, including health care, oncology is a logical field ripe for new applications. AI is already used in cancer care and diagnosis, such as tumor identification on x-rays and pathology slides. Beyond that, emerging technology is using AI to forecast the prognosis of patients and to assess their treatment options. One unknown is how oncologists feel about this trend, which includes possibly relinquishing some control over their profession and patients.</p><p>A new study asked 204 oncologists for their views on the rapidly developing AI tools. Specifically, they were asked about ethical issues that they face regarding the deployment of AI (e.g., whether they believed that AI could be used effectively in patient-care decisions). The main issue that the researchers investigated was to what degree patients should provide explicit informed consent for the use of AI during treatment decision-making. The study appears in <i>JAMA Network Open</i> (doi:10.1001/jamanetworkopen.2024.4077).</p><p>In the study, which was conducted from November 15, 2022 to July 31, 2023, a random sample of oncologists from across the country were asked 24 questions via traditional mail (which included a $25 gift card) about their views on the use of AI in clinical practice. Follow-ups with nonresponders were conducted via email and phone calls.</p><p>Issues covered bias, responsibilities, and whether they would be able to explain to patients how the technology was deployed in determining their care. There were 387 surveys sent to oncologists; 52.7% (<i>n</i> = 204) were completed. Those responding came from 37 states; 63.7% (<i>n</i> = 120) were male, and 62.7% (<i>n</i> = 128) identified as non-Hispanic White.</p><p>Very few respondents said that AI prognostic and clinical decision models could be used clinically when only researchers could explain them (13.2% of respondents [<i>n</i> = 27] for prognosis and 7.8% [<i>n</i> = 16] for clinical decisions).</p><p>For AI prognostic and clinical decision models that oncologists could explain, the percentages were much higher: 81.3% (<i>n</i> = 165) and 84.8% (<i>n</i> = 173), respectively. Fewer respondents—13.8% (<i>n</i> = 28) and 23.0% (<i>n</i> = 47), respectively—reported that the models also needed to be explainable by patients.</p><p>The survey also found that 36.8% of oncologists (<i>n</i> = 75) believed that if an AI system selected a treatment regimen different from what they would recommend, they would present both options and let the patient decide. Although that represented less than half of the respondents, it was the most common answer.</p><p>Regarding responsibility for medical or legal problems arising from AI use, 90.7% of respondents (<i>n</i> = 185) indicated that AI developers should be held accountable. This was considerably higher than the 47.1% (<i>n</i> = 96) who felt that the responsibility should be shared with physicians and the 43.1% (","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A new study appearing in The New England Journal of Medicine (NEJM) investigated the effectiveness of an emerging colon cancer screening option—a cell-free DNA (cfDNA) blood-based test known as Shield—that researchers and clinicians hope will encourage more people to be screened for colorectal cancer (CRC) (doi:10.1056/NEJMoa2304714).
Allison Rosen, MS, from Houston, Texas, is a 12-year CRC survivor who says that she is alive today because of timely colon cancer screening. “Unfortunately,” says Ms Rosen, “after talking with the community about the importance of screening and even with the knowledge that screening can save their life, people tell me every day that they refuse to get screened because both stool-based tests and colonoscopies have very negative stigmas.”
Ms Rosen points to American Cancer Society (ACS) data showing that one third of the screening-eligible population is not getting screened even though 90% of CRC deaths can be prevented with timely screening. Ms Rosen is the director of the ACS’s Project ECHO (Extension for Community Healthcare Outcomes) in Houston, Texas.
The Shield test is a blood-based CRC screening test meant for average-risk people with no family history of CRC and no personal history of CRC or advanced polyps (large polyps). Targeted patients are also CRC symptom–free.
The researchers who conducted the NEJM study believe that this screening test option could be key to improving screening rates, leading to fewer colon cancer deaths.
According to study author William M. Grady, MD, medical director of the Gastrointestinal Cancer Prevention Program at the Fred Hutchinson Cancer Center in Seattle, Washington, the test is on par with stool-based CRC screening tests, such as the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test, for the detection of CRC.
The results of the NEJM study were derived from the ECLIPSE (Evaluation of the ctDNA LUNAR Test in an Average Patient Screening Episode) study, a multisite clinical trial of nearly 8000 people aged 45–84 years. The study was underwritten and led by Guardant Health (based in Palo Alto, California). The focus of the study was the comparison of the effectiveness of the blood test and colonoscopies for CRC sensitivity and for advanced neoplasia, including CRC and advanced precancerous lesions. Also investigated was the sensitivity for discovering if advanced precancerous lesions had a negative cfDNA blood-based test.
Of the 7861 patients who met the study criteria, 83.1% with colonoscopy-detected CRC registered a positive cfDNA test; 16.9% had a negative test (i.e., a colonoscopy detected CRC, but a circulating tumor DNA [ctDNA] test did not). Overall, the researchers found that the blood test was most sensitive for CRCs, including early-stage cancers. They also found that it was less sensitive for advanced precancerous lesions, which may become cancerous later.
{"title":"Colon cancer blood test effective for average-risk population","authors":"Mike Fillon","doi":"10.3322/caac.21859","DOIUrl":"10.3322/caac.21859","url":null,"abstract":"<p>A new study appearing in The <i>New England Journal of Medicine</i> (<i>NEJM</i>) investigated the effectiveness of an emerging colon cancer screening option—a cell-free DNA (cfDNA) blood-based test known as Shield—that researchers and clinicians hope will encourage more people to be screened for colorectal cancer (CRC) (doi:10.1056/NEJMoa2304714).</p><p>Allison Rosen, MS, from Houston, Texas, is a 12-year CRC survivor who says that she is alive today because of timely colon cancer screening. “Unfortunately,” says Ms Rosen, “after talking with the community about the importance of screening and even with the knowledge that screening can save their life, people tell me every day that they refuse to get screened because both stool-based tests and colonoscopies have very negative stigmas.”</p><p>Ms Rosen points to American Cancer Society (ACS) data showing that one third of the screening-eligible population is not getting screened even though 90% of CRC deaths can be prevented with timely screening. Ms Rosen is the director of the ACS’s Project ECHO (Extension for Community Healthcare Outcomes) in Houston, Texas.</p><p>The Shield test is a blood-based CRC screening test meant for average-risk people with no family history of CRC and no personal history of CRC or advanced polyps (large polyps). Targeted patients are also CRC symptom–free.</p><p>The researchers who conducted the <i>NEJM</i> study believe that this screening test option could be key to improving screening rates, leading to fewer colon cancer deaths.</p><p>According to study author William M. Grady, MD, medical director of the Gastrointestinal Cancer Prevention Program at the Fred Hutchinson Cancer Center in Seattle, Washington, the test is on par with stool-based CRC screening tests, such as the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test, for the detection of CRC.</p><p>The results of the <i>NEJM</i> study were derived from the ECLIPSE (Evaluation of the ctDNA LUNAR Test in an Average Patient Screening Episode) study, a multisite clinical trial of nearly 8000 people aged 45–84 years. The study was underwritten and led by Guardant Health (based in Palo Alto, California). The focus of the study was the comparison of the effectiveness of the blood test and colonoscopies for CRC sensitivity and for advanced neoplasia, including CRC and advanced precancerous lesions. Also investigated was the sensitivity for discovering if advanced precancerous lesions had a negative cfDNA blood-based test.</p><p>Of the 7861 patients who met the study criteria, 83.1% with colonoscopy-detected CRC registered a positive cfDNA test; 16.9% had a negative test (i.e., a colonoscopy detected CRC, but a circulating tumor DNA [ctDNA] test did not). Overall, the researchers found that the blood test was most sensitive for CRCs, including early-stage cancers. They also found that it was less sensitive for advanced precancerous lesions, which may become cancerous later.</p><p>Furthe","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stacy Loeb MD, MSc, PhD (Hon), Aisha T. Langford PhD, MPH, Marie A. Bragg PhD, Robert Sherman BA, June M. Chan ScD
Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks—such as their extensive use and the relative ease it allows to share information quickly—facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.
{"title":"Cancer misinformation on social media","authors":"Stacy Loeb MD, MSc, PhD (Hon), Aisha T. Langford PhD, MPH, Marie A. Bragg PhD, Robert Sherman BA, June M. Chan ScD","doi":"10.3322/caac.21857","DOIUrl":"10.3322/caac.21857","url":null,"abstract":"<p>Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks—such as their extensive use and the relative ease it allows to share information quickly—facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give <i>information prescriptions</i> to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141425293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vivek Subbiah MD, Mohamed A. Gouda MD, Bettina Ryll MD, PhD, Howard A. Burris III MD, Razelle Kurzrock MD
Tumor-agnostic therapies represent a paradigm shift in oncology by altering the traditional means of characterizing tumors based on their origin or location. Instead, they zero in on specific genetic anomalies responsible for fueling malignant growth. The watershed moment for tumor-agnostic therapies arrived in 2017, with the US Food and Drug Administration's historic approval of pembrolizumab, an immune checkpoint inhibitor. This milestone marked the marriage of genomics and immunology fields, as an immunotherapeutic agent gained approval based on genomic biomarkers, specifically, microsatellite instability-high or mismatch repair deficiency (dMMR). Subsequently, the approval of NTRK inhibitors, designed to combat NTRK gene fusions prevalent in various tumor types, including pediatric cancers and adult solid tumors, further underscored the potential of tumor-agnostic therapies. The US Food and Drug Administration approvals of targeted therapies (BRAF V600E, RET fusion), immunotherapies (tumor mutational burden ≥10 mutations per megabase, dMMR) and an antibody-drug conjugate (Her2-positive–immunohistochemistry 3+ expression) with pan-cancer efficacy have continued, offering newfound hope to patients grappling with advanced solid tumors that harbor particular biomarkers. In this comprehensive review, the authors delve into the expansive landscape of tissue-agnostic targets and drugs, shedding light on the rationale underpinning this approach, the hurdles it faces, presently approved therapies, voices from the patient advocacy perspective, and the tantalizing prospects on the horizon. This is a welcome advance in oncology that transcends the boundaries of histology and location to provide personalized options.
{"title":"The evolving landscape of tissue-agnostic therapies in precision oncology","authors":"Vivek Subbiah MD, Mohamed A. Gouda MD, Bettina Ryll MD, PhD, Howard A. Burris III MD, Razelle Kurzrock MD","doi":"10.3322/caac.21844","DOIUrl":"10.3322/caac.21844","url":null,"abstract":"<p>Tumor-agnostic therapies represent a paradigm shift in oncology by altering the traditional means of characterizing tumors based on their origin or location. Instead, they zero in on specific genetic anomalies responsible for fueling malignant growth. The watershed moment for tumor-agnostic therapies arrived in 2017, with the US Food and Drug Administration's historic approval of pembrolizumab, an immune checkpoint inhibitor. This milestone marked the <i>marriage</i> of genomics and immunology fields, as an immunotherapeutic agent gained approval based on genomic biomarkers, specifically, microsatellite instability-high or mismatch repair deficiency (dMMR). Subsequently, the approval of NTRK inhibitors, designed to combat <i>NTRK</i> gene fusions prevalent in various tumor types, including pediatric cancers and adult solid tumors, further underscored the potential of tumor-agnostic therapies. The US Food and Drug Administration approvals of targeted therapies (<i>BRAF</i> V600E, <i>RET</i> fusion), immunotherapies (tumor mutational burden ≥10 mutations per megabase, dMMR) and an antibody-drug conjugate (Her2-positive–immunohistochemistry 3+ expression) with pan-cancer efficacy have continued, offering newfound hope to patients grappling with advanced solid tumors that harbor particular biomarkers. In this comprehensive review, the authors delve into the expansive landscape of tissue-agnostic targets and drugs, shedding light on the rationale underpinning this approach, the hurdles it faces, presently approved therapies, voices from the patient advocacy perspective, and the tantalizing prospects on the horizon. This is a welcome advance in oncology that transcends the boundaries of histology and location to provide personalized options.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":null,"pages":null},"PeriodicalIF":503.1,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号