JCO oncology practice最新文献

Purpose: Patients with cancer receiving immune checkpoint inhibitors (CPIs) may experience immune-related adverse events (IRAEs) due to immune system overactivation. Concurrently, infections such as seasonal influenza can be more severe in cancer patients because of their compromised immune function, making influenza vaccination particularly important. In this multicenter retrospective study, we investigated whether influenza vaccination during CPI treatment influences CPI effectiveness and rates of IRAEs.

Patients and methods: We conducted a retrospective cohort study across three Swedish centers involving patients with metastatic cancer treated with CPIs-either PD-1/PD-L1 inhibitors or combination immunotherapy-between January 1, 2016, and December 31, 2021. To address immortal time bias in time-to-event outcomes, different statistical strategies were employed including time-dependent Cox regression and landmark analyses.

Results: In total, 587 patients treated with CPIs during the study period were identified. The most common malignancy was non-small cell lung cancer (NSCLC; 34.4%), followed by cutaneous malignant melanoma (CMM; 32.5%). Time-dependent Cox regression analysis showed that real-world progression-free survival was significantly longer in influenza-vaccinated patients compared with unvaccinated in overall cohort (hazard ratio [HR], 0.59 [95% CI, 0.44 to 0.79]). No statistically significant differences in the occurrence of any grade IRAEs (48.4% v 51.2%, P = .455) or multiple IRAEs (15.1% v 19.2%, P = .297) between the vaccinated and unvaccinated groups were observed. The survival benefit was more pronounced in patients with CMM, whereas no statistically significant effect was observed in patients with NSCLC.

Conclusion: Our findings suggest a potential association between influenza vaccination and improved survival in CPI-treated patients, without a corresponding increase in IRAEs, supporting current vaccination recommendations. The observed association in patients with CMM may reflect underlying biological mechanisms and is hypothesis-generating for further investigation.

Purpose: To assess the ongoing citation of the 2009 Nature Genetics article by Ross et al linking TPMT to cisplatin-induced ototoxicity and to evaluate the extent to which its disputed findings persist in the literature.

Methods: A total of 378 Google Scholar citations of the 2009 Nature Genetics publication from 2009 to 2025 were examined, of which 214 PubMed-indexed manuscripts were screened and categorized by citation nuance (positive, negative/mixed) and citation characteristics using the framework proposed by Suelzer et al in a 2019 JAMA Network Opens study. Citation context was independently assessed by two reviewers, with discrepancies resolved by consensus of all three authors.

Results: Most articles cited the 2009 publication in a favorable or uncritical manner, even in publications after 2015 US Food and Drug Administration's cisplatin label revision acknowledging that the 2009 findings were flawed. A minority of citations acknowledged conflicting evidence or questioned the study's validity.

Conclusion: Although the 2009 publication's findings have been widely challenged, many subsequent authors continue to cite the study without acknowledging its limitations. This pattern highlights the need for stronger postpublication oversight, more transparent editorial practices by high-impact journals, and greater critical engagement by authors when citing foundational literature to ensure that clinical and research narratives are shaped by reliable and current evidence.

Purpose: Despite evidence of diagnostic accuracy but unclear long-term clinical benefit, national utilization patterns of prostate-specific membrane antigen positron emission tomography (PSMA-PET) are undefined.

Methods: We conducted a serial cross-sectional study to evaluate the use of PET imaging among commercial insurance beneficiaries with prostate cancer using administrative claims from deidentified Blue Cross Blue Shield Axis database. Eligible patients included prevalent and incident prostate cancer cases. We calculated the proportions undergoing PET imaging in semiannual periods from January 1, 2016, through December 31, 2024. We examined the association between regional-level contextual sociodemographic and health care characteristics, and regional use of PSMA-PET imaging in 2024.

Results: A total of 514,750 male beneficiaries age 40-89 years with prostate cancer were identified between 2016 and 2024. The proportion of individuals with prostate cancer undergoing PET imaging increased from 4.5 [95% CI, 4.1 to 4.9] per 1,000 in the first half of 2016 to 77.6 (95% CI, 76.2 to 79.1) per 1,000 in the second half of 2024, P < .001. Increases in PET were driven by uptake of PSMA-PET following approval in 2021, which increased from 0.8 (95% CI, 0.6 to 0.9) per 1,000 in the second half of 2021 to 77.0 (95% CI, 75.5 to 78.5) per 1,000 in the second half of 2024, P < .001. PSMA-PET use in 2024 was higher in regions with greater education (99.3 v 114.6 per 1,000 in lowest [Q1] v highest [Q4] educated) and income (95.4 v 112.3 per 1,000 in Q1 v Q4 income) measures, P < .001.

Conclusion: PSMA-PET was rapidly incorporated into clinical practice among commercial insurance beneficiaries with prostate cancer with higher adoption in geographic regions with higher income and education.

Purpose: Adolescents and young adults (AYAs) with cancer face distinct medical, psychosocial, and survivorship challenges not fully addressed by traditional pediatric or adult oncology services. This study describes the development, structure, and growth of a multidisciplinary AYA oncology program at a large academic cancer center and presents initial measures of patient satisfaction and program reach.

Methods: We conducted a retrospective descriptive evaluation of the AYA Program at MD Anderson Cancer Center, a centralized outpatient clinic offering navigation, oncofertility counseling, medical and survivorship care, psychosocial and vocational support, genetic counseling, and nutrition services. Data sources included electronic health records for clinic volume and demographics, postvisit satisfaction surveys, and participation in structured AYA programming.

Results: In 2024, the AYA program provided care to over 1,600 unique AYAs, with a 12% annual increase in clinic volume and 43% of visits conducted via telehealth. The mean patient age was 29 years, 61% were female, and the highest referring centers were pediatrics, breast oncology, lymphoma, sarcoma, and gynecologic oncology. Mental health counseling services were expanded, and the program delivered a range of structured peer support activities and connections. Patient satisfaction was high, with 98% rating their experience as good or excellent, and 100% indicating they would recommend the clinic to peers.

Conclusion: Implementation of an integrated, multidisciplinary care model within an academic cancer center has expanded access to specialized AYA services, streamlined care coordination, and addressed unmet needs across the cancer continuum. A centralized AYA oncology program can provide age-specific supportive cancer care and may serve as a scalable framework for institutions aiming to enhance care delivery and survivorship support.

Purpose: Oligometastatic breast cancer (oligo-mBC) represents up to 40% of newly diagnosed metastatic breast cancers. The current standard of care in the United States is to treat metastatic breast cancer palliatively although optimal management of de novo oligo-mBC remains uncertain and practice patterns in the treatment of oligo-mBC vary. We present a survey of US medical oncologists regarding their management of de novo oligo-mBC.

Methods: All ASCO members who participate in the ASCO Survey Pool (999) were sent an invitation e-mail between November 14, 2023, and January 2, 2024. The survey asked eight demographic questions, and four questions focused on treatment preferences, per receptor subtype-estrogen receptor-positive, human epidermal growth factor receptor 2-positive (HER2+), and triple-negative disease.

Results: A total of 144 of 193 respondents met the criteria of medical oncologists who treat breast cancer. A total of 136 medical oncologists who treat breast cancer completed the survey. The majority of respondents recommend initial palliative systemic chemotherapy; however, if a patient shows a positive response to initial chemotherapy, a substantial amount of respondents (42%-54%) recommend ablative radiation of all residual lesions and 38%-52% recommend surgical resection of the primary tumor. The results varied by receptor subtype, with the highest percentage of respondents recommending curative-intent therapies in HER2+ disease, although these differences were not statistically significant.

Conclusion: Our results indicate varied practice patterns in the treatment of de novo oligo-mBC. A substantial number of medical oncologists recommend ablative radiation and surgical resection of the primary breast tumor. This highlights the need for clarity regarding practice guidelines in de novo oligo-mBC.

Purpose: In 2009, a regional audit on ovarian cancer in the Regional Cancer Care Network (RCCN) of Piemonte (Italy) documented that patients were widely distributed across different treatment centers, with evidence of suboptimal care. We present the re-audit and feedback (A&F) intervention performed in 2016-2020 and the variation on quality of care and outcomes.

Methods: An A&F intervention was implemented across gynecologic units treating ovarian cancer in Piemonte. Key recommendations and indicators were identified from international guidelines. Global adherence to guideline recommendations was measured as the mean percentage of adherence across all the indicators. Data were collected retrospectively (May-December 2016, baseline period) and prospectively (May 2017-September 2020). Change in adherence to recommendations over time was monitored and feedback provided during quarterly meetings. Overall survival was identified as clinical outcome.

Results: Among 1,030 women (77% advanced stage), the global adherence to guidelines increased by 2.1% (95% CI, 1.6 to 2.6) every 6 months, from 51.3% to 70.4%. The likelihood of treatment in high-volume surgical centers and multidisciplinary team discussions before treatment increased over time (odds ratio [OR], 1.15 [95% CI, 1.08 to 1.21] and OR, 1.21 [95% CI, 1.15 to 1.28]). Five-year survival was 47% overall (87% among early and 35% among advanced stages). Although no consistent trend in survival was observed during the A&F period, a 10% increase in global adherence was associated with improved 5-year survival (hazard ratio, 0.91 [95% CI, 0.87 to 0.95]).

Conclusion: The implementation of this A&F initiative was associated with improvements in quality-of-care indicators for ovarian cancer, highlighting the potential value of A&F methodologies to support quality improvement activities.

Purpose: Cancer-related financial hardship, encompassing the high out-of-pocket treatment costs and associated distress, is associated with adverse treatment outcomes. However, its impact on clinical outcomes such as pain remains underexplored.

Methods: This secondary, retrospective cohort study examined associations between financial hardship and pain among patients with cancer initiating systemic therapy. Patient-reported pain was captured weekly over the first 6 months of treatment via remote symptom monitoring. Financial hardship was assessed at treatment initiation via the FACIT-COST instrument. Opioid use was abstracted from electronic medical records. Generalized linear models estimated associations between pain and financial hardship using relative risks (RR), predicted probabilities, and corresponding 95% CIs. Associations between financial hardship and opioid use were similarly modeled, stratified by pain severity.

Results: Of 331 patients (median age 60 years; 28% Black; 40% stage IV), 48% reported financial hardship. Moderate/severe pain was reported by 25% and 24% at 3 and 6 months after treatment initiation, respectively. In adjusted models, patients reporting financial hardship had a 37% higher risk of moderate/severe pain over 6 months compared with those reporting no/minimal financial hardship (RR, 1.37 [95% CI, 1.04 to 1.80]). During cancer treatment, patients reporting financial hardship had higher probabilities of opioid use than those reporting no/minimal financial hardship, both among those with moderate/severe (55% [95% CI, 40 to 77] v 44% [95% CI, 30 to 63]) and no/mild pain (40 [95% CI, 30 to 53] v 30% [95% CI, 21 to 42]).

Conclusion: Financial hardship is associated with increased risk of pain and greater opioid use during cancer treatment. Integrating financial screening into clinical workflows may identify high-risk patients and inform interventions, such as financial navigation and tailored pain management, to mitigate the clinical consequences of financial hardship.