JCO oncology practice最新文献

Purpose: As oncologic precision medicine develops, there is concern that tumor genomic profiling among Black patients and other underrepresented demographics will lag and amplify health disparities. We evaluate whether a precision medicine navigator (PMN), a clinical navigator specialized in obtaining tumor genomic testing for patients, is associated with increased genomic testing rates and whether this is the case among Black patients and other disadvantaged groups.

Methods: We retrospectively reviewed prostate cancer consults within one health care system from November 2, 2021, to January 2, 2023. We compared the proportion of patients who received genomic testing in the 7 months before the PMN start (pre-PMN) to the 7 months afterward (post-PMN). Binary logistic regression was used to calculate the odds of receiving testing.

Results: The sample included 693 patients, 311 pre-PMN and 382 post-PMN. Racial distribution and clinical stage were well-balanced between the pre- and post-PMN groups. From pre- to post-PMN, the proportion of patients receiving testing increased from 18% to 70% (P = .0002). Significant increases in testing post-PMN occurred among Black patients, lower median income patients, patients with Medicare/Medicaid, and community hospital patients. However, utilization post-PMN was significantly higher in non-Black compared with Black patients, 75.4% and 58.5%, respectively (P = .0006).

Conclusion: For patients with prostate cancer, the presence of a PMN is associated with increased rates of genomic testing overall, including among Black patients and other groups that experience health inequities. Utilization post-PMN was significantly lower in Black patients compared with non-Black patients. More research is needed into why Black patients show lower rates of genomic testing.

Radiation oncology has undergone a profound transformation over the past 50 years, evolving from broad techniques to highly conformal, precision-guided treatments. This review synthesizes key advancements in the field, first from technological innovations allowing the provision of precisely aligned and uniquely tailored radiation, customized to patient anatomy (such as intensity modulated radiation therapy, stereotactic body radiation therapy, and MR Linac) to emerging applications of particle beams, radiopharmaceuticals, and adaptive planning platforms. These advances have facilitated more accurate treatments and decreased side effect burden. The role of radiation therapy has also expanded in the management of metastatic disease beyond simply palliation, with ablative techniques leading to improved progression-free survival in oligometastatic settings. The combination of radiation with immunotherapy can introduce synergistic effects and is reshaping treatment paradigms across disease sites. However, widespread adoption of radiation innovation faces challenges, including rising financial toxicity, geographic disparities in access, and administrative burdens of prior authorization. As radiation oncology enters a new era, oncologists across specialties must remain informed about the evolving factors that affect timely radiation delivery.

Purpose: The causal link between smoking and bladder cancer (BC) development is well established but the long-term impact of tobacco taxation and health policy on BC mortality and disability-adjusted life years (DALYs) has not been fully elucidated. Given the protracted latency of carcinogenesis, this study examines whether historical changes in tobacco taxation and smoke-free laws are associated with reductions in BC disease burden and mortality in the United States.

Methods: Smoking-attributable BC mortality and DALY data, and federal and state tobacco taxation data were differenced as time series to achieve stationarity. Cross-correlation analysis identified optimal lag times. A semilogarithmic multivariable linear regression was used to estimate the percent change in BC outcomes per 1% increase in tobacco tax. Analyses were adjusted for national health expenditures and stratified by state.

Results: The median lag time between tobacco tax changes and smoking-attributable BC mortality was 17 years, whereas the lag to DALYs was 24 years. National-level regression showed no significant association between taxation and BC mortality (-0.09%, P = .64) or DALYs (1.77%, P = .051). However, 22 states exhibited significant reductions in mortality, with the greatest observed in Arkansas (-3.64%, P < .001), California, and Indiana. Sixteen states showed significant DALY reductions, led by California (-4.68%). The implementation of smoke-free laws alone was not associated with decreases in smoking-attributable BC mortality and DALY.

Conclusion: Tobacco taxation is significantly associated with long-term reductions in smoking-attributable BC mortality and DALYs at the state level, but not nationally. These findings demonstrate the importance of adjunctive localized public health policy and the delayed impact of tobacco control measures on cancer outcomes. Further investigation is warranted to understand the mechanisms driving state-level variability and to inform targeted prevention strategies.

Purpose: Androgen receptor signaling inhibitors (ARSIs) are mainstay treatments for metastatic prostate cancer. Hyperglycemia is a common side effect, but limited data exist on outcomes such as acute care use among patients on these medications. This study aimed to assess the impact of diabetes on acute care use in older patients with metastatic prostate cancer on ARSIs.

Methods: We used SEER-Medicare data for patients 66 years and older with de novo metastatic prostate cancer who were prescribed abiraterone, enzalutamide, or apalutamide from 2010 to 2017. Negative binomial regression calculated incidence rate ratios of acute care use (total hospital or emergency admissions divided by total time at risk) for each model covariate among diabetic and nondiabetic patients after initiation of ARSI.

Results: A total of 2,697 patients were included, of which 17.4% had diabetes. The average age was 75.0 years, and most were White (80.3%). Most (85.3%) patients received androgen deprivation therapy before ARSI. Acute care use within 6 months occurred in 29.5% of patients, with 39.9% in the diabetes group and 27.4% in the nondiabetes group (P < .0001). Adjusted for covariates, patients with diabetes had an increased rate of acute care use (Incidence rate ratio [IRR] = 1.38 [95% CI, 1.11 to 1.70]; P = .003) compared with those without diabetes. In addition, compared with those who were prescribed only enzalutamide or apalutamide, patients who were prescribed abiraterone had an increased rate of acute care use (IRR, 1.43 [95% CI, 1.12 to 1.82]; P = .005).

Conclusion: Acute care use was common among patients with metastatic prostate cancer on ARSIs. Patients with diabetes experienced higher rates of acute care use compared with those without diabetes among all ARSI types. Future studies should assess potential interventions in older patients with diabetes on ARSIs.

Purpose: To assess the impact and outcomes of a novel program for routine preemptive DPYD testing in fluoropyrimidine (FP)-naïve patients.

Patients and methods: This single-center, retrospective cohort study included adult patients who either received a systemic FP or had a DPYD test result between July 1, 2022, and June 30, 2023. Patients were categorized into preemptive or standard cohorts on the basis of the timing of their DPYD test relative to their initial FP dose. Primary outcomes measured were 90-day all-cause mortality, and FP-related hospitalizations and emergency department (ED) visits after the first FP dose. Secondary outcomes included the incidence of empiric dose reductions, FP avoidance, and dose escalation tolerability among patients with dihydropyrimidine dehydrogenase (DPD) deficiency.

Results: Among 1,281 patients, 90-day all-cause mortality was 5.78% in the preemptive cohort versus 8.23% in the standard cohort (adjusted hazard ratio [HR], 0.69 [95% CI, 0.43 to 1.10]; P = .12), with a notable overrepresentation of patients treated with curative intent in the preemptive group (53.0% v 39.4%, P < .0001). Deaths attributed to DPD deficiency were one (0.18%) in the preemptive cohort and four (0.72%) in the standard cohort (not statistically significant with limited power). Hospitalizations and ED visits related to FP toxicity were paradoxically higher in the preemptive cohort (13.99% v 8.69%, adjusted HR, 1.67 [95% CI, 1.15 to 2.43]; P = .007). Among patients with DPD deficiency in the preemptive cohort, 84.6% received an empiric FP dose reduction, and dose escalation was attempted in 52.2% of these cases.

Conclusion: Preemptive DPYD testing did not significantly reduce treatment-related mortality, although a numerical decrease suggests potential benefits that may be substantiated with greater statistical power. Nearly half of the patients managed with a dose reduction did not undergo dose escalation.

Purpose: To update Standards for an Oncology Medical Home (OMH) certification program on the basis of evidence and expert consensus. OMH is a system of care delivery that models coordinated, efficient, accessible, and evidence-based care reinforced by measurement of outcomes to facilitate continuous quality improvement.

Methods: An Expert Panel formed to review and update the OMH Standards. The Panel updated the 2021 systematic literature review on the topics of OMH model of care, clinical pathways, and survivorship care plans (SCPs). New topics for this update include safety and just culture in health care, multidisciplinary team (MDT) management, and geriatric assessment. An informal consensus process was used to revise, update, and add new standards. The process incorporated practice experience gained from a pilot certification process on the basis of the standards. Input was gained from open comment and external review before finalization.

Results: No new evidence was identified to warrant revisions to standards on the overarching OMH model of care, SCPs, and clinical pathways originally reported in the 2021 ASCO-Community Oncology Alliance OMH Standards. An additional literature search on safety and just culture in oncology identified three integrative reviews and one systematic review. This evidence, combined with existing ASCO guidance on MDT management and geriatric assessment, plus Expert Panel survey feedback, resulted in modifications to two existing standards and the addition of four new standards.

Standards: 2025 OMH Standards are provided. The Standards support quality oncology care delivery in the areas of patient engagement, availability and access to care, evidence-based medicine, comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and safe antineoplastic therapy administration.Additional information, including the Standards implementation manual, is available at: www.asco.org/standards.

Radiation therapy represents a cornerstone in the management of breast cancer, from early-stage to advanced cancers. For appropriately selected patients, postmastectomy radiation therapy (PMRT) and regional nodal irradiation (RNI) have historically been shown to improve locoregional control and survival. However, PMRT is associated with an increased risk of cardiopulmonary toxicity, lymphedema, and reconstruction complications. This has led clinicians to re-evaluate a one-size-fits-all approach to PMRT and RNI, instead, looking for a more refined approach to maximizing the therapeutic ratio. This review explores the historical foundations, landmark trials, and paradigm-shifting updates that have transformed PMRT and RNI from broad, uniform strategies into nuanced, patient-specific therapies. Emphasis is placed on the evolution of patient selection, advances in fractionation, and the integration of new approaches. This is a story of progress, precision, and the pursuit of balance in the management of patients with breast cancer.

Purpose: Music medicine is an effective therapeutic tool to improve patient mood during outpatient chemotherapy infusion. Research has yet to explore how music medicine may impact the psychological well-being of caregivers who accompany patients and if there are dyadic effects on well-being when patients and caregivers are both listening to self-selected music during patients' chemotherapy.

Methods: Participants (N = 227) in this multisite, randomized control study were caregivers who accompanied patients during chemotherapy infusion. Participants were randomly assigned to music (listen to self-selected music for ≤60 minutes) or no music conditions. Outcomes were self-reported change in positive and negative mood (Positive and Negative Affect Scale) and distress (Distress Thermometer). LASSO-based penalized linear regression models with leave-one-out cross-validation were used to identify potential covariates. Dyadic analyses used Actor-Partner Interdependence Models (APIM).

Results: Caregivers who listened to music during patients' chemotherapy appointments reported a significant increase in positive mood and decrease in distress compared with caregivers who did not listen to music. There was no effect of music medicine on change in caregiver negative mood. LASSO models did not identify any significant covariates of intervention effects. However, negative mood was positively associated with being African American and baseline anxiety and depression. APIM analyses found largely actor effects for the intervention.

Conclusion: Music medicine is a low-touch, low-risk, and cost-effective way to manage not only patient but also caregiver psychological well-being during chemotherapy. Listening to self-selected music for even a brief period leads to more positive mood and less distress in caregivers, providing evidence for recommending dyadic music medicine interventions during patients' infusion treatments.