JCO oncology practice最新文献

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) can have deleterious effects on mobility and quality of life in people with cancer. Vibration therapy shows promise as a CIPN intervention but is understudied. We investigated the feasibility and preliminary efficacy of low-intensity vibration (LIV) in cancer survivors with CIPN.

Methods: We conducted a pilot randomized controlled trial in adult cancer survivors with persistent CIPN symptoms. Participants were randomly assigned to twice-daily LIV sessions (10 min/session; 30 Hz, 0.4 g) for 12 weeks or usual care (UC). We assessed feasibility by accrual, retention, adherence, and adverse event (AE) reporting. We evaluated preliminary efficacy by changes in patient-reported CIPN symptoms (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity), pain (Brief Pain Inventory), fatigue (Patient-Reported Outcome Measurement Information System Fatigue), and physical functioning (Late-Life Function and Disability Instrument) and objectively measured physical functioning (chair stand time, gait speed), stability (postural sway), and mobility (Timed-Up-and-Go). Linear regression models were used to generate effect size estimates (Cohen's d).

Results: We accrued 95% of our target sample (n = 38, mean age: 62.6 ± 9.9 years, 89% female, median time since chemotherapy completion: 18 [6-39] months), with 20 participants randomly assigned to LIV and 18 to UC. Trial retention was 97% and mean adherence to LIV was 77% ± 18%. There were no serious AEs. Compared with UC, LIV participants reported greater improvements in sensory neuropathy symptoms (LIV, +1.4 ± 3.3 points; UC, +0.2 ± 2.8 points; Cohen's d = 0.45) and basic lower extremity function (LIV, +5.3 ± 8.5 points; UC, -0.7 ± 9.2 points; Cohen's d = 0.80), with moderate-to-large effect sizes for changes in stability, mobility, and gait (Cohen's d = 0.60-0.66).

Conclusion: LIV is safe, feasible, and shows preliminary efficacy for CIPN symptom relief and improving physical functioning in cancer survivors with CIPN.

Purpose: For patients with newly diagnosed AML not suitable for intensive induction chemotherapy, venetoclax (VEN) plus azacitidine (AZA) is a standard of care therapy. This study describes real-world (rw) treatment patterns and outcomes of patients with AML receiving initial VEN-based therapy.

Methods: Patients age ≥18 years diagnosed with AML who received first-line (1L) VEN-based therapy and had available dosing information were included from the COTA rw, electronic health records-based database. Patients with missing/imprecise key study dates were excluded. The index date for the study was the date of 1L initiation, unless otherwise noted. Rw time to next treatment, rw event-free survival, and rw overall survival (rwOS) were analyzed using the Kaplan-Meier method.

Results: A total of 331 patients met the inclusion criteria, of which the majority were male, White, and treated in community practices. In patients with available molecular data for the given marker, 8.8%, 19.7%, 11.0%, and 19.7% had mutations in IDH1, IDH2, FLT3-ITD, and NPM1, respectively. Following 1L, 115 patients initiated second-line (2L) therapy, of which 26.1% received intensive chemotherapy, 60.9% received low-intensity regimens, and 8.7% received investigational therapy. The median rwOS overall was 13.9 months and differed by mutation status (13.1 months for IDH1-positive patients, 42.0 months for IDH2-positive patients, not reached for FLT3-ITD-positive patients, and 42.0 months for NPM1-positive patients).

Conclusion: The median rwOS for this study was comparable with results in the VIALE-A trial, despite the community-based nature of these data. There was no clear standard of care for patients who received 2L+ therapy. These data highlight the need for novel treatment for patients with AML following 1L VEN-based therapy.

Testicular cancer is the most common malignancy in males age 15-40 years and one of the most curable cancers, with a cumulative 10-year survival rate exceeding 90%. Management strategies depend on the histologic subtype, stage at diagnosis, sites of disease, tumor markers, and risk classification. Germ cell tumors, including seminomas and nonseminomas, constitute the majority of testicular cancers and require distinct therapeutic approaches. For localized disease, radical orchidectomy remains the cornerstone of treatment, followed by active surveillance, chemotherapy, or primary retroperitoneal lymph node dissection, depending on the histology and the risk of relapse. Seminomas are highly curable, with low-stage patients often managed through surveillance or postoperative single-agent carboplatin. By contrast, nonseminomas typically require adjuvant multiagent chemotherapy, such as bleomycin, etoposide, and cisplatin, particularly in higher-risk patients. For metastatic disease, chemotherapy remains the standard of care, achieving excellent cure rates even in patients with bulky tumors. Surgical resection of residual masses is especially critical in nonseminomatous germ cell tumors to remove viable cancer or teratoma components. The treatment of refractory or relapsed disease frequently involves second-line standard-dose or high-dose chemotherapy with autologous stem-cell transplantation, ideally performed in specialized high-volume centers. Before, during, and after treatment, multidisciplinary care is essential to addressing psychosocial challenges, optimizing fertility preservation, and enhancing quality of life. After curative treatments, long-term management involves regular follow-up to monitor for recurrence, late toxicities, and secondary malignancies, with survivorship programs playing a crucial role in meeting patients' ongoing needs. Advances in molecular diagnostics for early relapse detection and the introduction of targeted therapies continue to improve outcomes, particularly in resistant patients.

Purpose: As the complexity and need for cancer care services continue to grow, time to treatment initiation (TTI) has been increasing across cancer types. Presently there are no comprehensive analyses identifying the recent changes in TTI and the important variables causing variation in TTI for all the most prevalent cancer types.

Methods: This is a retrospective, observational study using data from the National Cancer Database from 2004 to 2015. The database was queried for newly diagnosed patients with cancer stages I-IV who had TTI within 0-180 days. Stepwise linear regression models were used as a variable selection technique to identify the most significant independent variables to evaluate as predictor variables.

Results: The study sample included 5,615,193 patients (median age, 65; 51.5% female; 86.1% White) across 30 different cancer types (most prevalent: breast [22.1%], lung [18.8%], prostate [16.6%]). The median [IQR] TTI across all 30 cancer types was 26 [6-47] days, with an increase of 7 days from 2004 (21 [4-44]) to 2015 (28 [9-49]; P < .001). No individual cancer type decreased in TTI from 2004 to 2015. The proportion of patients diagnosed with new stage I disease increased by 52.2% from 2004 (28.4%, n = 78,732) to 2015 (43.2%, n = 256,150). All other stages decreased in percent incidence. There was a 100.0% increase in median TTI for stage I patients from 2004 to 2015 (14-28 days). Cancer stage was the most important predictor of change in TTI for 16 cancer types (P < .001 for all 16).

Conclusion: TTI is increasing for patients with cancer, and the recent increase in stage I diagnoses is highly associated with this change.

Purpose: Cancer survivors often experience financial hardship, negatively affecting quality of life, health care use, and survival. Health-related social needs (HRSNs)-such as food/housing insecurity and transportation barriers-are prevalent among survivors and may correlate with financial hardship. Research exploring associations between financial hardship and HRSNs is limited. This study quantifies these associations in a nationally representative US sample.

Methods: We identified adult cancer survivors from the 2013 to 2018 National Health Interview Survey. Medical financial hardship was defined as (1) problems paying medical bills, (2) worry about medical bills, or (3) delaying/forgoing care because of cost. HRSNs were defined as (1) food insecurity, (2) housing insecurity, and (3) transportation barriers to care. Multivariable logistic regression models were used to assess associations between financial hardship and each HRSN, controlling for socioeconomic characteristics.

Results: Among 13,626 cancer survivors, 4,623 (34.2%) reported medical financial hardship. Survivors with financial hardship were significantly more likely to report any HRSN compared with those without hardship (53.1% v 8.7%, adjusted odds ratio [aOR], 6.99 [95% CI, 6.06 to 8.07]). This association persisted across household income levels (interaction P = .58). Specifically, survivors with financial hardship were more likely to experience food insecurity (21.9% v 2.2%, aOR, 5.49 [95% CI, 4.38 to 6.87]), housing insecurity (44.6% v 6.4%, aOR, 7.14 [95% CI, 6.1 to 8.35]), and transportation barriers to care (6.6% v 1.1%, aOR, 3.1 [95% CI, 2.27 to 4.22]), than survivors without hardship.

Conclusion: Medical financial hardship among cancer survivors is strongly associated with HRSNs, such as food, housing, and transportation insecurity, across income levels. These findings highlight the importance of systematic screening of financial hardship and HRSNs, along with providing comprehensive socioeconomic support to address the needs of all cancer survivors, regardless of their household income.

Purpose: To develop a clinical practice guideline and recommendations for symptom management of patients with well-differentiated grade 1 to grade 3 metastatic gastroenteropancreatic neuroendocrine tumors.

Methods: ASCO convened an Expert Panel to develop a clinical practice guideline by reviewing the literature for relevant guidelines, systematic reviews, randomized controlled trials (RCTs), and observational studies to develop recommendations for clinical practice.

Results: The literature review identified eight guidelines, 19 systematic reviews, and three RCTs that informed the development of guideline recommendations.

Recommendations: Recommendations are included for carcinoid syndrome, carcinoid heart disease and carcinoid crisis, and functional pancreatic neuroendocrine tumor syndromes. Recommendations are provided for surgical management, liver-directed therapy, and systemic therapy options, as well as palliative care. Limited guidance is provided for sequencing of interventions.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.

Purpose: To understand oncology physician perceptions of and experiences with specialist scarcity in their referral networks, strategies for delivering care after the departure of a colleague who they view as critical to their cancer care networks (ie, a linchpin colleague), and impacts of shortages on patient care.

Methods: We conducted semistructured interviews with oncologists who practice in health systems that serve a predominantly rural patient catchment area. We used deductive and inductive approaches to predetermine codes and then performed a thematic analysis.

Results: We interviewed 20 oncology physicians from five sites. We identified three major themes related to specialist scarcity. The first theme described the effects of physician shortages on care team expertise, collaborative relationships, and patient volume. The second theme uncovered strategies oncologists use when facing physician shortages, including referrals to outside health systems or generalists, practicing outside their subspecialization, and reallocating time from other responsibilities. The third theme identified unintended consequences of adaptive strategies, including greater patient travel burden, less optimal or delayed treatment, reduced access to clinical trials, and increased physician burnout and lower job satisfaction.

Conclusion: Oncology physician shortages lead to myriad adaptive strategies and downstream consequences to patient and physicians. Mapping these cascades can help guide resources to mitigate the negative effects of departures and shortages.