JCO oncology practice最新文献

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.

Purpose: We evaluated a survivorship program Engage, aimed at improving childhood cancer survivors' health-related self-efficacy and their health-related quality of life (HRQoL).

Materials and methods: Engage provides (1) a telehealth nurse-led health assessment, (2) a remote multidisciplinary case review, (3) personalized recommendations and care plan for survivors and their primary care physician (PCP), and (4) a telehealth nurse-led consultation to promote survivors' understanding of the recommendations. We recruited survivors >5 years postdiagnosis of any age who had not received cancer-related care in the past 24 months. We assessed survivors' outcomes pre-intervention and at 1-, 6-, 12-, and 24-month follow-ups.

Results: Seventy-eight survivors participated: 62% male, median age = 30 years, and 14% lived regionally/rurally. Participating survivors' self-efficacy scores improved from baseline to 1 month and were maintained at 6-, 12-, and 24-month follow-ups (P < .001). Survivors' HRQoL remained similar from baseline to postintervention, as did the proportion of survivors reporting a regular PCP or engaging in health/risky behaviors (eg, exercise). Survivors' distress, anxiety, and anger significantly decreased pre- to 6 months postintervention. Survivors' satisfaction with care increased by 28% (P < .001) and was maintained across follow-up (P = .002). Information needs reduced from baseline to 1 month postintervention (P = .023) although they were similar at further follow-up.

Conclusion: Survivors' self-efficacy, satisfaction with care, and some psychosocial outcomes improved after participating in Engage. Further effort is needed to improve survivors' primary care engagement and health behaviors.

Purpose: Implementation of patient-reported outcome measures (PROMs) in routine care continues to be limited, despite their demonstrated efficacy and substantial investments. We report on the lessons learned and the challenges of the concerted implementation of the same PROMs across teams in nine provinces/territories (jurisdictions) in Canada, as well as the solutions to move implementation forward despite cost containments and the COVID-19 pandemic.

Methods: Each team from nine jurisdictions submitted a final report describing their PROM implementation project. Reports were analyzed for themes on lessons learned, challenges, and solutions. Themes were compared for similarities and differences. The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were used.

Results: Six key lessons learned were identified from eight challenges. To address these challenges, 27 solutions were used. The six lessons learned were as follows: Harness the power of change management, ensure consistent stakeholder engagement at all levels for success, establish buy-in as soon as possible, plan to maintain buy-in through changing circumstances, identify ways to make technology the solution, and optimal implementation includes a sustainability plan. Examples of solutions included the following: develop a multipronged, multilevel communication plan; include change management experts on the team; identify champions; restructure and reprioritize as needed; leverage existing technology; and leave a permanent trace of the project.

Conclusion: To our knowledge, this is the first analysis to synthesize lessons learned from real-world PROM implementation across geographically diverse jurisdictions. We identified generalizable solutions that other health care managers and policymakers can use to accelerate PROM implementation, despite pervasive implementation barriers. Future studies can integrate these solutions with methods and tools from implementation science (eg, theoretical frameworks, implementation strategies) for more successful spread and scale of PROMs.

Purpose: Immune checkpoint inhibitors (ICIs) have revolutionized the care of patients with cancer, but use among hospitalized patients is controversial as a result of questionable benefit and high costs. To evaluate the role of ICIs in the inpatient (IP) setting, we conducted the Inpatient Immunotherapy Outcomes Study (IIOS) to describe characteristics and outcomes of patients who received IP ICIs.

Methods: IIOS is a retrospective study of patients treated with ICIs during hospitalization between 2012 and 2021 at five academic institutions. Data collection was performed using each institution's electronic medical record. We estimated overall survival (OS) from the first administration of ICI using the Kaplan-Meier method and used adjusted Cox proportional hazards models to explore associations between clinicodemographic variables and OS.

Results: Two hundred fifteen patients received IP ICIs (median age 60 years; 55% White; 14% Black; 13% Hispanic). Thoracic and head and neck (24%), GI (21%), and hematologic (19%) malignancies were most common. Most of the patients were ICI-naïve (75%), had stage IV solid malignancies (75%) at the time of IP ICI initiation, and had no radiographic response to ICI therapy (88%). Median OS from the first IP ICI dose was 1.55 months (95% CI, 1.08 to 1.81) for all patients and 1.28 months (95% CI, 0.95 to 1.80) for patients with advanced solid malignancies. Multivariable Cox proportional hazards model analysis found no clinicodemographic variables associated with improved OS after IP ICI administration.

Conclusion: IIOS is the largest multi-institutional effort to describe outcomes after IP ICI administration. Clinical outcomes are poor after IP ICI use and IP ICIs should be used with caution.

Purpose: Patients with cancer face increasing difficulty securing access to timely, quality oncologic care. A virtual consultation program at a tertiary academic center could eliminate physical barriers while providing treatment recommendations that could be executed locally.

Methods: We evaluated an Online Second Opinions Program to increase access to expert care via a cloud-based platform through Included Health. This program was open to any patient globally who had a local treating physician. Patient records were compiled and sent to a disease expert at Stanford Healthcare. A report detailing an assessment and treatment recommendation was then returned within 3 days. We analyzed the characteristics of the patient base and the frequency with which treatment change was recommended.

Results: Between November 2018 and August 2020, 657 patients participated in the program. The majority of patients were female (58.4%) with a mean age of 60 years. A majority lived out-of-state (62%, with 24.7% of total patients from outside the United States) and had advanced disease (77.2% diagnosed at stage III or IV). Breast cancer was the most common diagnosis (24.7%). Physicians providing the virtual service were primarily medical oncologists (67.6%) and reported to have recommended a treatment change in more than half of the cases reviewed (53.8%). A treatment change was most often recommended for patients with stage II disease (64%), and least often for stage I and III disease (both 45%).

Conclusion: To our knowledge, this is one of the first studies to describe patients who use virtual second-opinion programs for oncology, showing that more than half of the patients were recommended to have a treatment change. Although patients most often had advanced disease, those with stage II disease most often received a treatment change recommendation.

Purpose: Treatment of limited-stage small cell lung cancer (LS-SCLC) with twice-a-day radiation therapy (RT) has remained the standard of care for many decades. Growing evidence suggests that outcomes with dose escalated twice-a-day RT may further improve outcomes. However, once-daily treatment remains common. The purpose of this study was to evaluate individual treatment facilities for utilization of twice-a-day RT.

Methods: Patients with LS-SCLC treated with definitive chemoradiation from 2004 to 2019 were identified in the National Cancer Database. RT was classified as twice-a-day (45 Gy in 30 fractions) or once-daily (59.4-70.2 Gy in 30-39 fractions). Patients were excluded if surgery was performed. All patients received doublet chemotherapy. Unique treatment facilities delivering at least one twice-a-day treatment course during the study period were classified as BID-treating. Facilities not delivering any twice-a-day RT were classified as QD-only. The proportion of QD-only facilities was identified. Facility-level characteristics associated with QD-only classification were analyzed.

Results: A total of 22,362 patients with LS-SCLC were treated at 1,222 unique facilities. A slight majority of facilities (n = 644, 52.7%) were BID-treating, whereas fewer (n = 578, 47.3%) were QD-only. A total of 73.9% of academic facilities were BID-treating versus 48.3% of nonacademic facility types (P < .001). Only 20.7% of low volume treatment facilities (lowest quartile of patients with LS-SCLC treated) used twice-a-day fractionation versus 78.2% of the highest quartile volume facilities (P < .001). On multivariable analysis, academic and high-volume facilities were statistically significantly associated with BID-treating classification (adjusted odds ratio, 2.5 [P < .001] and 4.2 [P < .001], respectively).

Conclusion: Nearly half of facilities treating LS-SCLC with definitive chemoradiation do not use twice-a-day fractionation schedules despite ongoing and growing evidence of superiority to once-daily fractionation. High-volume, academic facilities were more likely to offer twice-a-day fractionation.

Purpose: Many patients face barriers to cancer care, leading to disparities in cancer-specific outcomes. Specifically, missing multiple radiation treatments can be associated with increased locoregional recurrence. We sought to assess the frequency and reasons for missed radiotherapy among accredited cancer programs participating in a national quality improvement (QI) collaborative addressing barriers to care.

Methods: The Breaking Barriers National QI Collaborative conducted through the American College of Surgeons Cancer Programs enrolled 342 accredited cancer programs, prospectively recording patients scheduled for a 15-45-day course of radiotherapy over five separate, 60-day data collection periods (March-December 2023). Programs identified those who missed ≥three treatments, referred to as at risk of worse outcomes, and queried reasons for missed radiotherapy. Kruskal-Wallis tests assessed differences in rates of missed treatments.

Results: In total, 332 programs (97.1%) identified at-risk patients, totaling 5,221 patients who missed ≥three treatments. The median percentage of at-risk patients per program was 9.4% (IQR, 4.5-16.5). Programs located in the Northeast (median, 11.3% [IQR, 5.4-17.3]) had the highest proportion of at-risk patients (P = .014). Patients with rectal (13.0%) and gynecologic (11.4%) cancers were most frequently at risk (P < .001). Overall, 91.0% of hospitals reported missed radiation treatments due to illness unrelated to treatment, 71.7% due to transportation, 54.2% due to conflicting appointments, and 53.0% due to no longer wishing to pursue treatment.

Conclusion: Barriers to completing radiotherapy are prevalent among accredited cancer programs nationwide. Future work developing interventions in response to identified barriers in this national QI collaborative may be scalable to other areas of cancer care to improve outcomes.