JCO oncology practice最新文献

Purpose: Ten pediatric cancer treatment sites previously implemented site-specific symptom management care pathways for 15 symptoms, which were based upon clinical practice guidelines (CPGs). The primary objective of this analysis was to describe the prevalence of care pathway- and CPG-consistent care for symptom management. The secondary objective was to identify factors associated with care pathway-consistent care.

Methods: Participants were patients age 8-18 years diagnosed with cancer within the previous 4 weeks. We identified any intervention to manage each of 15 symptoms during a 3-day period 8 weeks after enrollment. We determined whether the intervention appeared in that site's care pathway and whether it was recommended in the CPG. We determined whether type of symptom (observable v nonobservable) or patient characteristics were associated with care pathway-consistent care.

Results: Two hundred twenty participants were analyzed. The prevalence of care pathway-consistent care for each symptom ranged from 0% (problems thinking, body or face changes, and diarrhea) to 52.3% (throwing up) and was <27% for 14 of 15 symptoms. Similarly, the prevalence of CPG-consistent care was <50% across all symptoms. Participants received significantly more care pathway-consistent interventions for observable symptoms compared with nonobservable symptoms (difference 30% [95% CI, 3 to 54]). Factors associated with receipt of at least one care pathway-consistent intervention were age group, race, ethnicity, and cancer type.

Conclusion: Care pathway- and CPG-consistent care were surprisingly uncommon. Care pathway-consistent interventions were more common for observable than nonobservable symptoms and were associated with patient characteristics. Future work should identify approaches to improve care pathway-consistent care delivery.

Purpose: Effective methods to improve body composition and metabolic/hormonal dysregulation are central to breast cancer care. We hypothesized that a nutrition regimen focused on food quality and an observed exercise regimen using high-load resistance training during or after cancer treatment would improve body composition and functional capacity.

Methods: Forty-four women with breast cancer, including survivors on therapy and in surveillance, excluding chemotherapy, underwent a continuously monitored dose-escalated exercise regimen utilizing heavy weights and linear progression in an exercise oncology facility along with a diet focused on food quality and adequate protein intake. Dietary strategy was discussed during each exercise session and twice monthly meetings. Pre- and post-workout assessment of body composition, functional mobility, balance, activity levels, and quality of life were compared via paired T-test and Wilcoxon signed-rank test.

Results: Forty-four women completed the protocol, with a median age of 54 years and BMI of 30.3. Most participants reported cancer-related symptoms (79.5%). Across compound exercises, composite load lifted increased by 36.5% (P < .001) and bilateral Y-balance scores increased 18% (P < .001). A 6.6% reduction in body fat was observed (1.8 kg; P < .001) alongside a 1.4% increase in muscle mass (0.5 kg; P = .003). Resting metabolic rate increased by 0.8% (P = .018). Significant improvements were uniformly demonstrated across quality-of-life scores (European Quality of Life 5-Dimension Score, Patient Health Questionnaire 9 Depression Scale, and Generalized Anxiety Disorder 7 questionnaires).

Conclusion: A 3-month regimen of nutrition counseling and high-intensity resistance training promoted significant muscle mass gain and adipose tissue loss, alongside significant improvements across body composition, strength, mobility, and functional status, and patient-reported quality of life.

Purpose: The Enhancing Oncology Model (EOM) is a voluntary, risk-based payment model implemented by the Centers for Medicare & Medicaid Services (CMS) to improve cancer care while reducing the total cost of care (TCOC). The US Oncology Network (The Network) comprises approximately 50% of all prescribers participating in EOM nationwide across 12 practice sites. In The Network, drug costs represented an average of 63% of a patient's TCOC. The aim of this study was to demonstrate the impact of a remote clinical pharmacist in reducing TCOC in the EOM.

Methods: Medication initiatives were clinically evaluated and adopted at an individual practice level and included: monoclonal antibody (moAB) dose rounding, pembrolizumab dose banding, biosimilar therapeutic interchange (TIC), use of a preferred PD-1 agent, decreased up-front usage of long-acting growth factor in metastatic cancer, and use of zoledronic acid over alternatives. ClinReview pharmacists (CRPs) remotely reviewed oncology treatment orders for cost-saving opportunities and updated orders per protocols. Interventions were tracked by the CRP, and TCOC reduction was calculated using the difference between the CMS allowable for the original treatment ordered and the new order.

Results: From July 1, 2023, to December 31, 2024, seven CRPs within five of The Network's EOM participating practices evaluated over 5,600 patients. A total of 1,180 interventions were accepted, with moAB dose rounding and TIC being top contributors. The projected sum of TCOC reduction amounted to $8,982,235, or $1,604 USD per patient. In addition to the six initiatives, the CRP contributed an additional $1,201,326 USD in medication savings associated with drug selection.

Conclusion: CRP's medication initiatives within The Network's EOM participation reduced TCOC by nearly $9 USD million, highlighting the potential for pharmacist-driven interventions to lower costs and drive the success of value-based care models in oncology practices.

Stage II testicular seminoma is highly curable when treated using standard-of-care cisplatin-based chemotherapy or radiotherapy. However, these treatments can affect long-term quality of life because of the development long-term, or chronic, toxicities and late effects. In recent years, multiple emerging treatment strategies for stage II seminoma have been explored with the principal aim of minimizing toxicity in this young patient population. These strategies have included cisplatin-sparing chemotherapy, combined modality chemoradiotherapy, and surgery in the form of primary retroperitoneal lymph node dissection; small cohort studies for each approach have reported promising efficacy with minimal toxicity, albeit without long-term follow up. While there is a need to optimize and rationalize treatment to ensure that quality of life is front of mind, it is essential that the excellent outcomes using standard-of-care treatment are not taken for granted and that cure is not compromised for young patients with stage II seminoma. This review assesses the relative merits and deficiencies of each emerging treatment strategy, with one lens focused on preventing harm and the other focused on preserving disease control and cure.

The oligometastatic paradigm, conceptualized over 3 decades ago, challenges the binary view of cancer as strictly localized or widely metastatic and suggests that some patients present with a limited number of metastatic deposits amenable to local therapy that can allow for prolonged disease-free survival or in some cases no recurrence of disease. Advances in radiation delivery, particularly stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiation therapy, have enabled the safe and effective delivery of high-dose, ablative radiation to discrete tumor sites, providing a highly attractive noninvasive local therapy option for patients with oligometastatic disease (OMD). Growing evidence supports the role of SBRT in improving progression-free survival, delaying systemic therapy change, and potentially enhancing overall survival in select patients. This review synthesizes current data on SBRT for OMD across tumor sites, discusses patient selection considerations, and explores ongoing controversies and future directions including integration with immunotherapy and novel systemic agents.

Purpose: Altmetric Attention Score (AAS) is a measure of the quantity of attention that a scholarly work receives, and evidence about gender gaps in AAS in oncology is lacking. Our objective was to analyze potential disparities in the AAS within oncology by comparing research publications authored by women first and last authors with those authored by men. Secondarily, we aimed to quantify the extent of over-/undercitation by gender.

Materials and methods: The initial data set was compiled from the Altmetric database through Application Programming Interface (API) using oncology-related search terms. Author gender categories were assigned on the basis of the Gender Guesser API. For example, those with first and last authors labeled woman were categorized as woman first author/woman last author (WW). Over-/undercitation was calculated using observed citations and expected citations. Analyses were completed both for the oncology literature as a whole and for prominent subspecialty peer-reviewed journals.

Results: Our search yielded 652,834 articles published between January 1, 2009, and January 31, 2024. For AAS, women in the first author position had a 15.2% lower score compared with men counterparts and women in the last author position had an 8.3% lower score than men (P < .01 for both). Although the proportion of WW authors in oncology publications increased over time, the man first author/man last author combination was overcited (mean citation percentage difference [MCD] = +16.2%), whereas WW was undercited (MCD = -7.7%). There was variation in both proportion of WW papers and over-/undercitation among oncologic subspecialties.

Conclusion: Significant gender disparities in citation rates and AAS exist across various fields within oncology. This highlights a systemic issue where woman-authored research is undercited and receives less attention compared with man-authored work, with the potential to affect career advancement, funding opportunities, and academic recognition.