JCO oncology practice最新文献

Purpose: Demand for germline hereditary cancer genetic testing has increased because of reduced cost, gene discovery, expanding indications, and precision cancer therapies. The traditional model for germline testing, where a genetics provider performs all steps of the testing process (pretest counseling, test ordering, results disclosure, and post-test counseling), is no longer able to meet testing needs especially for patients with cancer needing timely germline testing for treatment decisions. Mainstreaming has emerged as an alternative approach to increase testing capacity and efficiency, where nongenetics providers perform these steps and genetics providers focus on post-test counseling for positive results.

Methods: This study reports a 3-year experience with mainstreaming hereditary cancer gene panel testing at Kaiser Permanente Southern California. The study compared demographic characteristics, cancer diagnoses, and test results between patients tested by genetics providers (traditional model) versus nongenetics providers (mainstreaming) over 3 years. Over 32,000 germline hereditary cancer gene panels were completed, including nearly 12,000 mainstreaming tests.

Results: Mainstreaming substantially increased testing volume. Patients undergoing mainstream testing were more likely to have cancer, be male, and self-report being Asian or Black. The positive test rate was slightly lower in the mainstreaming group (11%) compared with the traditional testing model (15%), with similar rates of variants of uncertain significance. Post-test genetic counseling was high in both groups for positive results.

Conclusion: This study demonstrates that mainstreaming can be successfully implemented in a large health care system and significantly expand testing capacity.

Purpose: The European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) and the ASCO Value Framework (ASCO-VF) are tools designed to assess the value of anticancer therapies. International conferences are the primary venues for sharing trial outcomes, often influencing clinical practices even before full publications are available. This analysis compares the ESMO-MCBS and ASCO-VF in evaluating the benefit of all phase III trials presented at the 2022 ASCO Annual Meeting (AM) and to examine the level of agreement between these scales.

Methods: A systematic search of abstracts from the 2022 ASCO AM was conducted, focusing on phase III trial data presented. The clinical benefit of each abstract was assessed using both ESMO-MCBS and ASCO-VF, and Cohen's κ coefficients were calculated to analyze concordance between the tools.

Results: Out of 239 phase III trial abstracts, 90 trials involving 49,721 patients met the inclusion criteria. Of these, 36 (40%) could not be graded by ESMO-MCBS, mainly because of nonsignificant results. Among the 54 gradable abstracts, 61.1% (n = 33) were deemed to provide substantial clinical benefit. ASCO-VF was unable to grade 40 (44.4%) abstracts, with nonsignificant results being the leading cause. Of the 50 gradable abstracts, 20% (n = 10) were considered to offer substantial clinical benefit. Moderate agreement between ESMO-MCBS and ASCO-VF was observed (Cohen's kappa, 0.4783 [95% CI, 0.3673 to 0.6034]). No significant association was found between clinical benefit and research funding or the economic status of the trial's origin country.

Conclusion: Both frameworks showed a high rate of nongradable studies, primarily because of nonsignificant results. ESMO-MCBS identified more studies with substantial clinical benefit, and the agreement between the two tools was moderate.

Purpose: The development of subcutaneous (SC) formulations for monoclonal antibodies (mAbs), as an alternative to conventional intravenous (IV) infusion, represents a shift in health care delivery. The relative environmental impact of these two administration methods is not well understood. Minimizing the environmental footprint of health care is crucial due to its substantial contribution to greenhouse gas (GHG) emissions. This study compared the carbon footprint of SC and IV administration using pertuzumab/trastuzumab as a case example.

Methods: A Life Cycle Assessment was conducted to compare the environmental impacts of IV versus SC administration of pertuzumab/trastuzumab, focusing on climate change impacts expressed in carbon dioxide-equivalents (CO₂e). The analysis included emissions from single-use medical equipment, drug manufacturing, hospital operations, patient and staff transportation, and waste disposal.

Results: SC pertuzumab/trastuzumab resulted in slightly higher GHG emissions than IV administration, with 47.2 kg CO₂e for loading doses compared with 45.9 kg CO₂e, and 33.6 kg CO₂e for maintenance doses compared with 32.9 kg CO₂e. This increase was primarily due to the higher dosage required for SC delivery, with mAb production contributing the most to emissions. Nonetheless, SC administration reduced the use of single-use medical equipment and treatment-related energy consumption in health care facilities. Switching to SC pertuzumab/trastuzumab administration in the Netherlands in 2022 would have increased annual CO₂e emissions by 12.2 tons, equivalent to driving 63,212 km in a petrol-powered car.

Conclusion: Both IV and SC administration routes of mAbs have substantial environmental impacts, dominated by mAb production emissions. This research provides a framework for assessing the environmental impact of health care technologies and underscores the importance of integrating environmental considerations into health technology assessments to mitigate the significant contribution of health care to global GHG emissions.

Purpose: To explore lymphoma survivors' care experiences and needs post-treatment and to determine optimal information and services for a lymphoma survivorship program from the perspectives of both survivors and oncologists.

Methods: We conducted in-depth semi-structured interviews with 32 lymphoma survivors and 13 lymphoma oncology providers. Interviews were analyzed using a template organizing style and iterative immersion/crystallization analysis of retrieved coded segments. Our thematic analysis focused on identifying commonalities and variations of themes related to lymphoma survivors' post-treatment needs, transition from oncology to primary care, and survivors' and providers' recommendations for improving survivorship care for patients with lymphoma.

Results: Three main themes emerged. (1) A predominant unmet need was how to manage the profound fear of recurrence and anxiety post-treatment. Survivors desired more information about signs and symptoms of recurrence and reassurance from their cancer team. (2) There were diverse views regarding the importance of transition from oncologist to primary care providers. Some survivors and oncologists did not value the importance of transitioning to primary care, whereas others recognized the need for primary care but found difficulty with accessing primary care. (3) Psychosocial support, wellness services, and assistance with financial and employment programs are needed for an ideal survivorship program.

Conclusion: This study provides critical insights into optimal survivorship care for patients with lymphoma. Further research is needed to better understand cost-effective models of care for this unique and complex population of lymphoma survivors.

Patients with solid tumors present a higher risk of infectious diseases with worse outcomes compared with immunocompetent patients. Prolonged treatment of prophylactic and empirically chosen antibiotics and health care-acquired infections can predispose patients with cancer to infections with antimicrobial-resistant (AMR) organisms. AMR is a global health priority and can affect patients with cancer. The outcome of patients with cancer worsens dramatically if multidrug-resistant (MDR) microorganisms cause infections. Moreover, the emergence of MDR organisms increases health care costs. Antimicrobial stewardship programs can be useful to monitor and improve the use of antibiotics in all oncological settings, including the palliative setting. Awareness of the magnitude of these issues is still low, so it is important to inform and educate oncologists. This narrative review aims to illustrate the main evidence on infections caused by AMR organisms in patients with cancer and the tools that oncologists should have to enhance their multidisciplinary management.