JCO oncology practice最新文献

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.

Purpose: Travel-related burdens are an ongoing issue for cancer and other specialty care patients. To address these issues, the Veterans Health Administration (VA) National Oncology Program sponsors the Close to Me (CTM) care model to facilitate novel care delivery strategies throughout the VA system. The VA Ann Arbor Healthcare System (VAAAHS) Hematology-Oncology Clinic implemented CTM, using local VA clinics and home-based therapies to reduce travel burdens for Veterans.

Methods: Veterans eligible for CTM included those receiving infusion treatments through the VAAAHS who lived near a VA community-based outpatient clinic (CBOC) regardless of primary specialty, and Veterans with multiple myeloma receiving bortezomib subcutaneously. After enrollment, Veterans received their infusion therapies at a CBOC, administered by traveling VAAAHS infusion nurses. Veterans with multiple myeloma self-administered bortezomib at home under direct observation of an infusion nurse.

Results: From October 2024 to June 2025, we enrolled 102 patients in the CTM program. Patients saved 21,840 total travel miles, for an estimated $8,954 of travel-related costs saved by patients receiving care at a local clinic or at home. A total of 261 treatment visits were completed, with an estimated $403,432 of potential drug cost-savings on the basis of VA versus Medicare Average Sales Pricing File data. There were no serious adverse events related to patients receiving therapy locally or at home, with overall 98.5% treatment adherence. Patient satisfaction was high, with most patients rating their experience as excellent and reporting that they would recommend this service to others.

Conclusion: The VAAAHS CTM program demonstrates the safety and feasibility of a local clinic and home-based infusion program through the VA, resulting in significant travel and cost-savings for patients. Our experience addresses issues related to the delivery of cancer care in both VA and non-VA settings.

Purpose: The purpose of this quality improvement project was to evaluate the impact of the Suspected Cancer Initiative (SCI)-an electronic medical record (EMR)-based suspected cancer flag-on diagnostic timeliness across a large public hospital system. We aimed to analyze the program's impact on reducing time to diagnostic workup and to explore demographic factors associated with diagnosis timeliness.

Methods: NYC Health + Hospitals is the municipal safety net health system in New York City. Before the SCI, there was no process for tracking and triaging patients with suspected cancer. We implemented the SCI across four components: (1) an EMR referral flag within the physician workflow, (2) referral guidelines embedded into the EMR, (3) a dashboard to track metrics, and (4) a steering committee with specialty leaders. The primary outcomes measured were time from referral to (1) specialty appointment scheduling, (2) specialty appointment, (3) biopsy, and (4) diagnosis.

Results: The manuscript analyzes data from 6,087 patients referred through the SCI. In all, 61.1% of patients were female and 41.5% were age ≥65 years. In total, 40.3% were Hispanic, 36.8% were African American, and 57.1% spoke English. Compared with the first month of implementation, we saw a 56.6% improvement (10.9 days) in time from referral to specialty appointment scheduling, a 57.2% improvement (31.2 days) in time from referral to specialty appointment, a 69.6% improvement (80.9 days) in time from referral to biopsy, and a 68.2% improvement (63 days) in time from referral to diagnosis.

Conclusion: Prioritizing patients with suspected cancer using a multipronged approach improved the timeliness of care. An SCI was implemented using existing resources and served as a cost-effective way to improve care for high-risk patients.

Purpose: Racial and ethnic disparities in the incidence and prognosis of adult-type diffuse glioma (ADG) are well-documented, but previous research was limited by outdated histologic classifications and the aggregation of heterogeneous Asian populations. This study aimed to re-evaluate these disparities using contemporary molecular classifications and granular ethnic data, with a focus on  isocitrate dehydrogenase (IDH) wild-type glioblastoma.

Methods: This was a population-based cohort study using data from the US SEER program. The study included patients with molecularly defined ADG per the 2021 WHO CNS Classification. Age-adjusted incidence rates were calculated, and overall survival (OS) was analyzed using the Kaplan-Meier method, multivariable Cox regression, propensity score matching, and multiple imputation. The Asian/Pacific Islander (API) group was disaggregated into specific ethnicities for survival analysis.

Results: Non-Hispanic White (NHW) patients had the highest incidence of ADG and all molecular subtypes. In patients with IDH wild-type glioblastoma, analysis showed that Hispanic (hazard ratio [HR], 0.88 [95% CI, 0.80 to 0.96]), Non-Hispanic Black (HR, 0.80 [95% CI, 0.71 to 0.91]), and API (HR, 0.77 [95% CI, 0.67 to 0.88]) patients had significantly better OS than NHW patients. Disaggregation of the Asian category revealed that this advantage was driven almost exclusively by patients of Chinese ethnicity, who demonstrated a profound survival benefit (HR, 0.58 [95% CI, 0.43 to 0.77]; P < .001). This finding was robust across multiple sensitivity analyses. No significant prognostic differences were found for IDH-mutant gliomas.

Conclusion: In the molecular era, NHW individuals have the highest incidence of ADG. However, patients of Chinese-and more broadly East Asian-ethnicity with IDH wild-type glioblastoma exhibit a pronounced and robust survival advantage. This highlights the critical need to consider ancestral diversity in future glioma research to uncover biological mechanisms and improve patient outcomes.

Purpose: De novo metastatic breast cancer (dnMBC) is typically a fatal diagnosis. Although better treatments have improved survival, it is unclear whether these improvements confer similar benefits for all patients. We sought to evaluate the association of race/ethnicity and insurance status with survival outcomes in patients with dnMBC.

Methods: Patients diagnosed with dnMBC between 1988 and 2016 were selected from SEER. Differences were examined by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], non-Hispanic other [NHO], or Hispanic) and insurance status (private/Medicare, Medicaid, or uninsured). Overall survival (OS) and cancer-specific survival were estimated, and multivariable models were used to identify factors associated with survival, after adjustment.

Results: 47,034 patients were included (median follow-up, 91 months). Most patients were NHW (67.2%) and insured (73.9%). Overall, NHB patients had the worst outcomes (median OS, 21 months), while NHO patients had the best (34 months). Similarly, uninsured patients had the worst survival outcomes (22 months), while insured (private/Medicare) patients had the best (31 months). Over time, survival generally improved across all groups, although disparities persisted. After adjustment, only NHB patients had significantly worse outcomes compared with NHW patients (OS: hazard ratio [HR], 1.24 [95% CI, 1.17 to 1.31]; P < .001), as did uninsured compared with insured patients (OS: HR, 1.29 [95% CI, 1.16 to 1.44]; P < .001).

Conclusion: Racial/ethnic and insurance disparities in breast cancer survival persist, even in a dnMBC-only cohort, with notably worse outcomes for NHB and uninsured patients. Given that race and ethnicity are often considered social constructs in the United States specifically, improving health care access has the potential to improve survival in this patient population. Systemic factors other than insurance status leading to disparities must be identified and addressed to provide equitable treatment in this vulnerable patient population.

Purpose: Despite evidence supporting the benefits of early referral to palliative care (PC), many patients with advanced cancer continue to experience delayed referral or no referral at all. This study evaluated trends in outpatient PC consultation over 7 years at a comprehensive cancer center and identified predictors of timely referral to PC.

Methods: We randomly selected 700 patients seen at our outpatient supportive care center (100 per year, 2017-2023). Demographics, cancer diagnosis, symptom burden, date of outpatient PC consultation, and survival status were retrieved from their electronic medical records. The primary outcome was overall survival (OS), defined as time from outpatient PC consultation to death or last follow-up. Timely referral to PC was defined as occurring ≥6 months before death or last follow-up from outpatient PC consultation. Univariable and multivariable logistic regression models identified predictors associated with timely referral.

Results: Among 700 patients (median age 62 years, 54% female, 92% with advanced cancer), the median OS increased from 9.3 months in 2017 to 31.7 months in 2021 (P = .0001). The median follow-up for living individuals at the data cutoff was 19.1 months. The median number of PC visits increased from 3 to 7 between 2017 and 2023. Four hundred forty-nine (72%) patients received timely referral. In multivariable analysis, timely referral was independently associated with male sex (odds ratio [OR], 1.85; P = .014), head and neck cancer (OR, 4.64; P < .001), hematologic malignancies (OR, 3.31; P = .013), lower pain (OR, 0.9; P = .008), lower anorexia (OR, 0.88; P = .001), year of consultation (OR, 1.12; P = .038), and better performance status (OR, 0.70; P = .006).

Conclusion: This study reveals a gradual and consistent shift toward earlier PC referral at a comprehensive cancer center, demonstrating that timely referral to PC with a follow-up of 30+ months is possible.

Purpose: Ovarian cancer (OC) is a leading cause of gynecologic cancer mortality, with poor survival rates for advanced-stage disease. Comprehensive national data detailing contemporary patterns of care remain scarce. This study uses data from Australia's National Gynae-Oncology Registry (NGOR) to delineate current patterns of care against clinical quality indicators (CQIs) and correlate adherence to these measures with overall survival (OS).

Methods: This prospective study analyzed NGOR data for women with newly diagnosed epithelial OC across 47 sites between April 2017 and March 2024. Adherence to 15 predefined CQIs was assessed. OS, adjusted for key prognostic factors (Eastern Cooperative Oncology Group, age, stage, comorbidity), was estimated using Cox proportional hazards regression.

Results: A total of 3,133 patients were included. In an adjusted multivariate analysis, significantly improved OS was associated with receiving first-line platinum-taxane doublet chemotherapy (hazard ratio [HR], 0.57 [95% CI, 0.47 to 0.68], P < .001), undergoing germline or somatic BRCA1/2 testing (HR, 0.66 [95% CI, 0.56 to 0.78], P < .001), and achieving no macroscopic residual disease after primary (HR, 0.48 [95% CI, 0.34 to 0.68], P < .001) or interval debulking surgery (HR, 0.56 [95% CI, 0.44 to 0.71], P < .001). Adjusted 5-year OS rates for International Federation of Gynecology and Obstetrics stages I, II, III, and IV were 87%, 76%, 42%, and 28%, respectively.

Conclusion: This national registry reveals variations in CQI adherence. While survival for advanced-stage disease has improved, it remains suboptimal. Adherence to specific quality indicators-notably optimal surgical cytoreduction, standard first-line chemotherapy, and genetic testing-is significantly associated with improved survival. Continuous monitoring and targeted quality improvement initiatives are essential for enhancing survival for women with OC.

Purpose: Oncofertility, a multidisciplinary field that integrates oncology and reproductive medicine, is a vital component of comprehensive cancer care. This review compares fertility-related recommendations for adults with newly diagnosed cancer who are considering fertility preservation (FP) before treatment. Guidelines reviewed include the 2025 National Comprehensive Cancer Network (NCCN) Survivorship Guideline, 2025 ASCO Guideline on FP, 2022 Clinical Oncology Society of Australia (COSA) FP Guideline, and 2020 European Society for Medical Oncology (ESMO) Clinical Practice Guideline.

Methods: Recent guidelines from NCCN, ASCO, COSA, and ESMO were reviewed and compared for recommendations on fertility risk discussions, female and male preservation methods, multidisciplinary care, future pregnancy, and contraception.

Results: All guidelines emphasize early, patient-centered discussions about fertility risks and preservation options before initiating cancer treatment. Embryo and oocyte cryopreservation are universally recommended as standard and effective FP methods for women. Ovarian tissue cryopreservation and ovarian transposition are recommended as alternative options. Sperm cryopreservation is strongly recommended, with ASCO and NCCN additionally supporting testicular sperm extraction for post-treatment FP. The use of gonadotropin-releasing hormone agonists is supported by COSA, ESMO, and NCCN in people with breast cancer at diagnosis, while ASCO limits its recommendation to adjunct use alongside established FP techniques. All guidelines highlight the importance of multidisciplinary care, including specialized oncofertility counseling and referrals to fertility and mental health specialists. Pregnancy after cancer treatment is generally considered safe across all guidelines, and only COSA and ESMO provide specific recommendations regarding contraception.

Conclusion: There is a strong consensus on FP methods and the importance of early counseling. However, further high-quality research is necessary to strengthen the evidence base and improve guideline recommendations for fertility in people with cancer.