JCO oncology practice最新文献

Purpose: Limited access to high-speed internet (broadband [BB]) may pose challenges to video telehealth visit (VTV) utilization. This study explored barriers, facilitators, and attitudes toward VTV adoption in patients with cancer residing in low-BB settings.

Methods: We examined a cohort of patients with cancer receiving longitudinal care at Mayo Clinic Cancer Practice in the Upper Midwest. Eligible patients had ≥6 in-person visits during July 2020-October 2022, received oncology care at Mayo Clinic sites, were alive at sampling, and resided in low-BB areas defined by Federal Communications Commission data as 0 or 1 internet service provider offering <25 Mbps. We enrolled 24 participants stratified into two groups: (1) Transitioned users (TUs): adopted VTVs postpandemic (November 2022-December 2023); (2) persistent nonusers (PNUs): received exclusively in-person visits. Semistructured telephone interviews were conducted in June 2024 and thematically analyzed.

Results: The average age of participants was 71.3 years (range, 42-88), 50% was female, and all identified as White. Three themes emerged: (1) Structural and clinical constraints-physical examinations, laboratory testing, and chemotherapy administration were viewed as requiring in-person care, whereas VTVs were perceived acceptable for routine follow-ups; (2) Skills and experience-digital literacy was generally adequate, but confidence and direct exposure to VTV distinguished TU from PNU; (3) Motivations-both groups preferred in-person care for cancer-related emotional reassurance. TU cited weather, travel burden, and proactive provider offering as adoption triggers, whereas PNU reported that VTV was rarely offered. TU focused on system-level solutions, whereas PNUs preferred individual-level resources.

Conclusion: Differential VTV adoption in low-BB settings reflected exposure, provider offering, and situational necessity rather than BB access alone. Oncology practices should consider normalizing the hybrid care model combining in-person and video appointment visits and provide tailored supports to advance equitable telemedicine. Expanding video care in oncology requires more than digital access and depends on patient experience, care context, and human connection inherent in oncology care.

Purpose: Patients overestimate their likelihood of benefit from early phase clinical trials (EPCT). Concerns about taking away hope from patients represent a purported barrier to prognostic discussions. In this study, we aimed to assess prognostic perceptions and hope among patients with advanced cancer at the time of enrollment in an EPCT.

Methods: We enrolled patients at the time of EPCT enrollment at an academic medical center. Participants completed questionnaires assessing prognostic perceptions (Prognosis and Treatment Perceptions Questionnaire), hope (Herth Hope Index; range, 12-48, higher scores indicate higher hope), and symptoms (Edmonton Symptom Assessment System-Revised). We used descriptive statistics and regression models to explore associations of prognostic perceptions and hope.

Results: Among 189 study participants (mean age = 62.5 years, 56.6% female, 93.1% White), 27.4% reported that the goal of their cancer treatment was to cure their cancer and 62.2% reported having conversations with their oncologist about prognosis. The majority (92.4%) reported that knowing about prognosis was extremely/very helpful. Patients' mean hope score was 39.1 (standard deviation, 5.1). We found no association between hope and perceptions of the intent of cancer therapy (B = -0.59, P = .486) or hope and patient-reported frequency of conversations with their oncologist about prognosis (B = -1.25, P = .125).

Conclusion: At the time of enrollment in an EPCT, we found no association between patients' hope and perception of the intent of cancer therapy or report of having discussed their prognosis with their oncologist. These findings suggest that patients can have hope despite acknowledging the noncurative intent of their therapy and prognostic discussions.

Purpose: Over 90% of people with hereditary cancer syndromes in the United States remain unidentified. The Genetic Cancer Risk Detector (GARDE) is an open-source, electronic health record (EHR)-integrated, digital health platform that can facilitate genetic cancer risk assessment and genetic testing. This study evaluates its budget impact on health care institutions.

Methods: A budget impact analysis was performed from the perspective of a US health care provider system over a 3-year horizon. Data from the BRIDGE randomized controlled trial data from the University of Utah Health (UHealth) were used, where eligible primary care patients were screened for genetic cancer risk via GARDE. Costs of GARDE were categorized across planning, implementation, and operational phases. Revenue projections were based on Centers for Medicare & Medicaid Services reimbursement rates. Scenario analyses varied uptake of interventions, surveillance intervals, reimbursement rates, and implementation scale.

Results: Of 1,444 patients identified by GARDE at UHealth and enrolled in the BRIDGE trial, 205 completed genetic testing, with 15 found to carry pathogenic variants. The total 3-year implementation cost was $29,217 US dollars (USD). Revenue from guideline-recommended procedures totaled $86,563 USD, yielding a net positive budget impact of $57,347 USD. Most revenue (76.4%) was generated by surgical risk-reduction procedures. Scenario analyses revealed high sensitivity to cancer risk-reducing surgery uptake and implementation scale. Modeling 100% uptake of risk-reducing surgeries increased revenue to $128,102 USD, while 20-fold scaling of the implementation population increased revenue to $1.7 million USD. Commercial insurance reimbursement assumptions further amplified revenue.

Conclusion: GARDE enables scalable hereditary cancer risk assessment within a health care provider system. Even with modest uptake, it yields a positive financial return, and significantly greater revenue is achievable with broader implementation. These findings support adoption of EHR-integrated tools to enhance clinical outcomes in precision cancer prevention and risk management, in an economically viable manner.

Purpose: As survival rates among patients with chronic myeloid leukemia (CML) have improved significantly, treatment goals have expanded from disease control to optimizing long-term quality of life (QoL).

Methods: The multicenter cross-sectional study used relevant survey questionnaires to gather comprehensive data on baseline characteristics, clinical treatment, economic burdens, psychological status, adverse events (AEs), and QoL among patients with CML.

Results: In all, 2,035 valid questionnaires were included for analysis. Psychological burden assessments indicate a high prevalence of mental health symptoms: 38.5% of patients report experiencing anxiety symptoms, whereas 46% exhibit symptoms of depression. This study identified a high-burden group experiencing significant economic and psychological stressors, which are associated with poor clinical responses. Psychological burden is central to the psychosocial clinical network and exhibits the strongest correlation with QoL (r = 0.64). Notably, the mediation model indicates that psychological burden fully mediates the effect of economic burden on QoL (85.3%) and partially mediates its influence on medication adherence (35.5%). Furthermore, we identified a clinically significant subgroup characterized as QoL lag-patients who achieve deep molecular response but report low QoL. This discrepancy is independently predicted by multiple AEs (≥6 types: OR = 2.09), serious AEs (OR = 1.90), comorbidities (OR = 2.44), and escalating psychological burden (OR = 1.59).

Conclusion: The findings underscore the need to shift the treatment of CML toward a holistic management paradigm. Clinical practice must actively engage with patients' concerns to optimize treatment efficacy, adjust drug dosages appropriately, and integrate social resources to provide psychological, economic, and familial support.

Purpose: Oncotype DX (ODX) is a validated gene expression assay that provides prognostic and predictive information to guide adjuvant chemotherapy (ACT) decisions in hormone receptor-positive, HER2-negative (HR+/HER2-) early breast cancer (eBC), including node-negative (N0) and 1-3 node-positive (N1) disease. In Brazil, limited access to gene expression signatures (GES) remains a barrier to individualized treatment decisions.

Methods: We conducted a multicenter retrospective study across nine Brazilian private cancer centers to evaluate clinicopathologic predictors of high genomic risk (ODX recurrence score [RS] >25) and to assess the clinical impact of ODX on ACT decision making.

Results: Between 2005 and 2024, 935 patients were included, with a notably higher representation of young (≤40 years: 10.9%) and premenopausal (40.7%) women than typically reported in randomized clinical trials. Ki-67 >20%, progesterone receptor (PR) expression ≤30%, and histologic grade 3 were independently associated with high RS in both univariable and multivariable analyses (all P <.001), with Ki-67 emerging as the strongest clinicopathologic predictor. Overall, ODX testing was associated with an estimated 12.6% absolute reduction in ACT recommendations, with substantial impact among postmenopausal patients with N1 disease (94% absolute reduction) and N0 patients older than 50 years with high clinical risk (65.2% absolute reduction). With a median follow-up of 4.8 years, the estimated 5-year real-world invasive disease-free survival and distant disease-free survival were 100% and 100% for those with RS <11, 98.2% and 99.4% for RS 11-25, and 90.9% and 92.5% for RS >25, respectively.

Conclusion: In this data set, ODX demonstrated utility in guiding ACT decision making and supporting personalized treatment by reducing both overtreatment and undertreatment. In resource-constrained settings, surrogate markers such as Ki-67, PR expression, and histologic grade may serve as practical tools to guide risk-adapted clinical decisions.