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Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer. 医疗补助扩展与 HR 阴性、HER2 阳性乳腺癌患者及时接受治疗和存活率的关系》(Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer)。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-23 DOI: 10.6004/jnccn.2024.7041
Kewei Sylvia Shi, Xu Ji, Changchuan Jiang, Kathryn J Ruddy, Sharon M Castellino, K Robin Yabroff, Xuesong Han

Background: Hormone receptor (HR)-negative, HER2-positive (also called HER2-enriched) breast cancer has no worse prognosis than other breast cancers if it is treated with HER2-targeted therapy. Medicaid expansion under the Affordable Care Act (ACA) has been shown to be associated with improved access to care and outcomes for many cancers, but its association with receipt of care for HR-negative, HER2-positive breast cancer is unknown. We examined the association of Medicaid expansion with receipt of guideline-concordant treatment, time to treatment initiation, and survival among nonelderly women newly diagnosed with HR-negative, HER2-positive breast cancer.

Patients and methods: Women aged 18 to 62 years newly diagnosed with HR-negative, HER2-positive breast cancer between 2010 and 2018 were identified from the National Cancer Database. Outcomes included receipt of stage-based guideline-concordant treatment, timely initiation of treatment (<30 days, <60 days, <90 days from diagnosis), and stage-specific 2-year overall survival. A difference-in-differences (DID) analytic approach compared outcome changes following Medicaid expansion in expansion versus nonexpansion states. Multivariable linear probability models were used to estimate treatment outcomes, and flexible parametric survival models were used to evaluate survival, adjusting for sociodemographic and clinical confounders.

Results: A total of 31,401 patients were included. Medicaid expansion was associated with an increase of 0.58 percentage points (ppt; 95% CI, 0.01-1.16) in receipt of guideline-concordant treatment overall, a 2.43-ppt (95% CI, 0.68-4.18) increase in initiating guideline-concordant treatment <60 days after diagnosis, and a 1.17-ppt (95% CI, 0.02-2.32) increase in 2-year survival rate. The increase in 2-year survival associated with Medicaid expansion was most prominent for patients with stage III disease (DID, 3.81; 95% CI, 0.82-6.80).

Conclusions: Medicaid expansion was associated with improved care and survival for patients with HR-negative, HER2-positive breast cancer, an aggressive cancer type for which prognosis largely depends on access to effective treatment.

背景:激素受体(HR)阴性、HER2 阳性(也称为 HER2 富集)乳腺癌如果接受 HER2 靶向治疗,其预后并不比其他乳腺癌差。根据《可负担医疗法案》(ACA)扩大医疗补助范围已被证明与改善许多癌症的治疗机会和治疗效果有关,但其与接受 HR 阴性、HER2 阳性乳腺癌治疗的关系尚不清楚。我们研究了医疗补助计划的扩展与新诊断出患有 HR 阴性、HER2 阳性乳腺癌的非老年女性接受与指南一致的治疗、开始治疗的时间以及存活率之间的关系:从国家癌症数据库中筛选出2010年至2018年间新诊断为HR阴性、HER2阳性乳腺癌的18至62岁女性。结果包括接受基于分期指南的一致性治疗、及时开始治疗(结果:共有 31401 名患者接受了基于分期指南的一致性治疗)、及时开始治疗(结果:共有 11720 名患者接受了基于分期指南的一致性治疗)、及时开始治疗(结果:共有 11720 名患者接受了基于分期指南的一致性治疗):共纳入 31,401 名患者。医疗补助计划的扩大与接受指南协调治疗的总体比例增加 0.58 个百分点(ppt;95% CI,0.01-1.16)和开始指南协调治疗的比例增加 2.43 个百分点(95% CI,0.68-4.18)有关:扩大医疗补助计划与改善 HR 阴性、HER2 阳性乳腺癌患者的护理和生存率有关,这种侵袭性癌症的预后在很大程度上取决于能否获得有效的治疗。
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引用次数: 0
Association of Intellectual and Developmental Disabilities With Worse Outcomes After Surgical Treatment of Cancer. 智力和发育障碍与癌症手术治疗后较差的预后有关。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-22 DOI: 10.6004/jnccn.2024.7038
Vivian Resende, Selamawit Woldesenbet, Erryk Katayama, Muhammad Musaab Munir, Henrique Araújo Lima, Mujtaba Khalil, Karol Rawicz-Pruszyński, Muhammad Muntazir Mehdi Khan, Usama Waqar, Parit Mavani, Yutaka Endo, Timothy M Pawlik

Background: Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a "textbook outcome" (TO) following a cancer operation among a nationally representative cohort of patients.

Methods: Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression.

Results: Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46-0.53; P<.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43-1.64), extended length of stay (OR, 2.06; 95% CI, 1.93-2.21), 90-day readmission (OR, 1.15; 95% CI, 1.07-1.24), 90-day mortality (OR, 1.90; 95% CI, 1.70-2.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97-4.62) (all P<.001).

Conclusions: Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.

背景:智力和发育障碍(IDD)患者面临着独特的挑战,导致他们在医疗保健方面存在差异。我们试图在一个具有全国代表性的患者群体中确定智力发育障碍对癌症手术后实现 "教科书结果"(TO)的影响:从100%医疗保险标准分析档案数据库中提取了2014年至2020年期间因恶性适应症(包括肺、乳腺、肝脏、胆道、胰腺和结直肠)接受手术的患者数据。使用多变量逻辑回归评估了IDD与TO(定义为无术后并发症、住院时间延长、90天再入院和90天死亡率)、支出和出院状态的关系:在 500,472 位医疗保险受益人中,4,326 位(0.9%)IDD 患者被诊断为癌症(乳腺癌,481 人;肺癌,419 人;肝胆癌,194 人;胰腺癌,145 人;结肠直肠癌,3,087 人)。虽然TO的总发生率为50.5%,但IDD患者获得TO的几率低于非IDD患者(分别为37.1% vs 50.6%;几率比[OR],0.50;95% CI,0.46-0.53;PConclusions:IDD患者术后获得TO以及出院到非家庭环境的几率要低得多。这些数据凸显了改善IDD患者护理的必要性,以确保肿瘤手术护理的公平性。
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引用次数: 0
Systemic Therapy Options for Peritoneal Mesothelioma. 腹膜间皮瘤的系统治疗方案。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7031
Tawee Tanvetyanon, George R Simon

Peritoneal mesothelioma is an uncommon malignancy affecting approximately 300 new patients annually in the United States. Due to its low incidence, prospective clinical trials specific to this disease are scant. Recommendations regarding systemic therapy are mostly extrapolated from clinical trials conducted among patients with pleural mesothelioma. At present, the recommended first-line systemic treatment options may include immunotherapy with nivolumab plus ipilimumab or chemotherapy with pemetrexed plus either cisplatin or carboplatin. For second-line treatment, the other previously unchosen first-line option can be used. Off-label bevacizumab may be considered in combination with chemotherapy among carefully selected patients. The benefit of third-line treatment or beyond is less clear. Nonetheless, a number of single-agent regimens show modest activity. Anecdotal reports of children or young adults with peritoneal mesothelioma harboring ALK rearrangement have suggested the efficacy of ALK inhibitors for this rare population. In summary, there is a growing number of systemic therapy options for peritoneal mesothelioma. To gain a better insight into this disease, future prospective trials in mesothelioma should include more patients with peritoneal mesothelioma.

腹膜间皮瘤是一种不常见的恶性肿瘤,美国每年新增约 300 名患者。由于发病率低,专门针对这种疾病的前瞻性临床试验很少。有关全身治疗的建议大多是从胸膜间皮瘤患者的临床试验中推断出来的。目前,推荐的一线系统治疗方案可包括尼伐单抗加伊匹单抗的免疫疗法,或培美曲塞加顺铂或卡铂的化疗。在二线治疗中,可以使用之前未选择的其他一线治疗方案。对于经过严格筛选的患者,可考虑在标示外使用贝伐单抗与化疗联合治疗。三线或三线以上治疗的益处尚不明确。然而,一些单药治疗方案显示出适度的活性。一些关于儿童或年轻成人腹膜间皮瘤患者携带 ALK 重排的轶事报道表明,ALK 抑制剂对这一罕见人群具有疗效。总之,腹膜间皮瘤的系统治疗选择越来越多。为了更好地了解这种疾病,未来的间皮瘤前瞻性试验应包括更多的腹膜间皮瘤患者。
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引用次数: 0
Is it Time to Forget the 5-Fluorouracil Bolus? 是时候忘记 5 氟尿嘧啶注射液了吗?
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7075
E Gabriela Chiorean
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引用次数: 0
Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity. 综合财务导航干预对减少癌症相关财务毒性的影响。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7030
Stephanie B Wheeler, Michelle L Manning, Mindy Gellin, Neda Padilla, Lisa P Spees, Caitlin B Biddell, Victoria Petermann, Allison Deal, Cindy Rogers, Julia Rodriguez-O'Donnell, Cleo Samuel-Ryals, Katherine Reeder-Hayes, Donald L Rosenstein

Background: Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center.

Methods: We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability).

Results: All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance.

Conclusions: A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.

背景:尽管人们普遍认为有必要降低癌症患者的经济毒性影响,但很少有干预措施能够解决这一问题。我们在一家大型学术医疗中心测试了一种新颖的、多阶段的、以患者为中心的财务导航(FN)干预措施:方法:我们开发了一种财务毒性筛查工具,该工具由财务毒性综合评分(COST)和几个基于患者反馈的附加项目组成。将筛查过程系统化后,北卡罗来纳州巴斯奈特癌症医院的 50 名患者在财务困境筛查(COST 评分结果)呈阳性后被纳入 FN 干预:所有 50 名接受研究资格评估的患者均通过了财务困境筛查。共有 46 名患者完成了干预前和干预后的 COST 工具和其他测量。干预后的平均 COST 得分从基线时的 6.4 分提高到 FN 后的 13.3 分(结论:以患者为中心的 FN 干预措施与其他干预措施相结合,能有效减轻患者的经济压力:以患者为中心的 FN 干预措施完全融入了现有的护理协调模式,有助于减轻经济窘迫的癌症患者与癌症相关的经济负担。需要进一步开展研究,以测试在各种肿瘤环境和目标人群中采取的 FN 干预措施。
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引用次数: 0
Sympathetic Blockade for Pain Associated With Nonaxial Bone Lesions in Patients With Cancer: An Uncontrolled Cohort. 交感神经阻滞治疗癌症患者非轴性骨病变引起的疼痛:无对照队列
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7028
Carlos J Roldan, Alice L Ye, Edward Podgorski, Jonathan Song, Matthew Chung, Billy Huh

Background: Cancer-related bone pain remains a prevalent and frequently incapacitating ailment. Although conventional approaches effectively alleviate pain in most individuals, a subset of patients may continue to experience intractable pain. Current recommendations for treating cancer-related bone pain include oral analgesics and multimodal adjuvants, radiation therapy, and, in selected cases, intrathecal therapy. Cancer-related bone pain is mediated by a proliferation of sensory and sympathetic fibers. Thus, we believe that this pain can be successfully managed with minimally invasive sympathetic blockade (SB).

Methods: In a retrospective observational cohort, we reviewed patients who underwent single-shot SB for uncontrolled cancer-related bone pain despite receiving opiate analgesics and other interventions. We documented the Edmonton Symptom Assessment Scale (ESAS) ratings, the numeric rating scale (NRS) pain scores, and the morphine equivalent daily dose (MEDD) before and after SB.

Results: The final cohort included 43 patients (median age, 58 years [range, 23-86 years]) with a history of bone pain experienced for a median of 6 months (IQR, 3-12 months). Comparing before and after the SB, patients had pain reduction -6 (IQR, -7 to -4; P<.001), reduction of ESAS scores of -17 (IQR, -23 to -3; P<.001), and reduction of MEDD -57 mg (95% CI, -79 to -34; P<.001). The treatment was well tolerated.

Conclusions: Blockade of sympathetic afferent innervation is an effective and cost-effective modality that can be safely used to palliate intractable pain in patients with malignant bone pain.

背景:与癌症相关的骨痛仍然是一种普遍存在且经常使人丧失工作能力的疾病。尽管传统方法能有效缓解大多数患者的疼痛,但仍有一部分患者可能会继续经历难以忍受的疼痛。目前治疗癌症相关骨痛的建议包括口服镇痛药和多模式辅助药物、放射治疗,以及在特定情况下的鞘内治疗。与癌症相关的骨痛是由感觉和交感神经纤维的增殖介导的。因此,我们认为这种疼痛可以通过微创交感神经阻断术(SB)得到成功控制:在一项回顾性观察队列中,我们回顾了因癌症相关骨痛无法控制而接受单次交感神经阻断术的患者,尽管他们接受了阿片类镇痛药和其他干预措施。我们记录了SB前后的埃德蒙顿症状评估量表(ESAS)评分、疼痛数字评分量表(NRS)评分和吗啡每日当量剂量(MEDD):最终的研究对象包括 43 名患者(中位年龄 58 岁[23-86 岁]),他们的骨痛病史中位数为 6 个月(IQR,3-12 个月)。对比接受 SB 治疗前后,患者的疼痛减轻了-6(IQR,-7 至-4;PC 结论:阻断交感神经传入神经支配是一种有效且具有成本效益的方法,可安全地用于缓解恶性骨痛患者的难治性疼痛。
{"title":"Sympathetic Blockade for Pain Associated With Nonaxial Bone Lesions in Patients With Cancer: An Uncontrolled Cohort.","authors":"Carlos J Roldan, Alice L Ye, Edward Podgorski, Jonathan Song, Matthew Chung, Billy Huh","doi":"10.6004/jnccn.2024.7028","DOIUrl":"10.6004/jnccn.2024.7028","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related bone pain remains a prevalent and frequently incapacitating ailment. Although conventional approaches effectively alleviate pain in most individuals, a subset of patients may continue to experience intractable pain. Current recommendations for treating cancer-related bone pain include oral analgesics and multimodal adjuvants, radiation therapy, and, in selected cases, intrathecal therapy. Cancer-related bone pain is mediated by a proliferation of sensory and sympathetic fibers. Thus, we believe that this pain can be successfully managed with minimally invasive sympathetic blockade (SB).</p><p><strong>Methods: </strong>In a retrospective observational cohort, we reviewed patients who underwent single-shot SB for uncontrolled cancer-related bone pain despite receiving opiate analgesics and other interventions. We documented the Edmonton Symptom Assessment Scale (ESAS) ratings, the numeric rating scale (NRS) pain scores, and the morphine equivalent daily dose (MEDD) before and after SB.</p><p><strong>Results: </strong>The final cohort included 43 patients (median age, 58 years [range, 23-86 years]) with a history of bone pain experienced for a median of 6 months (IQR, 3-12 months). Comparing before and after the SB, patients had pain reduction -6 (IQR, -7 to -4; P<.001), reduction of ESAS scores of -17 (IQR, -23 to -3; P<.001), and reduction of MEDD -57 mg (95% CI, -79 to -34; P<.001). The treatment was well tolerated.</p><p><strong>Conclusions: </strong>Blockade of sympathetic afferent innervation is an effective and cost-effective modality that can be safely used to palliate intractable pain in patients with malignant bone pain.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":null,"pages":null},"PeriodicalIF":14.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tailoring Escalation Adjuvant Therapy for Early-Stage Triple-Negative Breast Cancer in the CBCSG010 Clinical Trial Biomarker Analysis. CBCSG010临床试验生物标志物分析中的早期三阴性乳腺癌升级辅助疗法定制研究
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7032
Wenya Wu, Yunsong Yang, Wentao Yang, Da Pang, Yunjiang Liu, Yuan Sheng, Xinzheng Li, Shiyou Yu, Yali Cao, Guoqin Jiang, Feng Jin, Binlin Ma, Junjie Li, Zhiming Shao

Background: Triple-negative breast cancer (TNBC) is a highly heterogeneous disease. The CBCSG010 trial is a prospective and multicenter phase III clinical trial confirming that adding adjuvant capecitabine significantly improved the 5-year disease-free survival (DFS) rate in patients with TNBC by 5.9%. In this study, we attempted to identify the specific population that benefited from adjuvant therapy.

Methods: In this retrospective exploratory analysis, we performed RNA sequencing of tumor tissues from patients with TNBC in the CBCSG010 clinical trial. A single-sample gene set enrichment analysis algorithm and survival analysis were performed to characterize the intrinsic molecular features of the TNBC microenvironment and assess the associations between immune-related gene expression levels or immune cell counts with capecitabine treatment efficacy. Additionally, we performed immunohistochemical staining of 2 markers, PD-L1 and CD8, and hematoxylin-eosin staining of stromal tumor-infiltrating lymphocytes (sTILs) on formalin-fixed, paraffin-embedded specimens to validate findings from bioinformatics analyses.

Results: We found that patients with TNBC with high immune-infiltration treated with capecitabine were more likely to have a better prognosis. We used a cutoff of ≥25 combined positive score (CPS) of PD-L1, ≥10% positive sTILs, and ≥10% positive cells of CD8 to define the "immune-hot" patients. Among immune-hot patients, Kaplan-Meier curves showed that 5-year DFS rates were 96.9% and 79.4% in the capecitabine and control groups, respectively (hazard ratio, 0.13; 95% CI, 0.03-0.52; P=.049 in favor of capecitabine). In the capecitabine group, the 5-year DFS rate was higher for immune-hot patients than for immune-cold patients (96.9% vs 76.4%; hazard ratio, 0.11; 95% CI, 0.04-0.29; P=.028).

Conclusions: Our study suggested that immune-hot patients with TNBC are more likely to benefit from adjuvant capecitabine, and that combining immunotherapy with chemotherapy may be expected to be more effective in immune-hot patients.

背景:三阴性乳腺癌(TNBC)是一种高度异质性疾病:三阴性乳腺癌(TNBC)是一种高度异质性疾病。CBCSG010试验是一项前瞻性多中心III期临床试验,证实了在TNBC患者中添加卡培他滨辅助治疗可显著提高5.9%的5年无病生存率(DFS)。在这项研究中,我们试图确定从辅助治疗中获益的特定人群:在这项回顾性探索分析中,我们对 CBCSG010 临床试验中 TNBC 患者的肿瘤组织进行了 RNA 测序。我们采用单样本基因组富集分析算法和生存分析来描述TNBC微环境的内在分子特征,并评估免疫相关基因表达水平或免疫细胞数量与卡培他滨疗效之间的关联。此外,我们还对福尔马林固定、石蜡包埋的标本进行了PD-L1和CD8两种标记物的免疫组化染色以及基质肿瘤浸润淋巴细胞(sTILs)的苏木精-伊红染色,以验证生物信息学分析的结果:结果:我们发现,接受卡培他滨治疗的TNBC患者免疫浸润较高,预后较好。我们用PD-L1联合阳性评分(CPS)≥25分、sTIL阳性细胞≥10%和CD8阳性细胞≥10%作为界定 "免疫热 "患者的临界值。Kaplan-Meier曲线显示,在免疫热患者中,卡培他滨组和对照组的5年DFS率分别为96.9%和79.4%(危险比为0.13;95% CI为0.03-0.52;P=0.049,卡培他滨更优)。在卡培他滨组,免疫热患者的5年DFS率高于免疫冷患者(96.9% vs 76.4%;危险比,0.11;95% CI,0.04-0.29;P=.028):我们的研究表明,免疫热型TNBC患者更有可能从卡培他滨辅助治疗中获益,而且免疫治疗与化疗相结合对免疫热型患者可能更有效。
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引用次数: 0
NCCN Guidelines® Insights: Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer, Version 3.2024. NCCN Guidelines® Insights:卵巢癌/输卵管癌/原发性腹膜癌,3.2024 版。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.0052
Joyce Liu, Andrew Berchuck, Floor J Backes, Joshua Cohen, Rachel Grisham, Charles A Leath, Lainie Martin, Daniela Matei, David S Miller, Sharon Robertson, Lisa Barroilhet, Shitanshu Uppal, Andrea Wahner Hendrickson, David M Gershenson, Heidi J Gray, Ardeshir Hakam, Angela Jain, Gottfried E Konecny, John Moroney, Elena Ratner, John Schorge, Premal H Thaker, Theresa L Werner, Emese Zsiros, Kian Behbakht, Lee-May Chen, Marie DeRosa, Eric L Eisenhauer, Gary Leiserowitz, Babak Litkouhi, Michael McHale, Sanja Percac-Lima, Kerry Rodabaugh, Roberto Vargas, Frankie Jones, Emily Kovach, Lisa Hang, Swathi Ramakrishnan, Ronald D Alvarez, Deborah K Armstrong

The NCCN Guidelines for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer provide multidisciplinary diagnostic workup, staging, and treatment recommendations for this disease. These NCCN Guidelines Insights detail how the evolution of the use of PARP inhibitors as maintenance and single-agent regimens for the treatment of ovarian cancer informed panel recommendations in the guidelines.

NCCN 《卵巢癌/输卵管癌/原发性腹膜癌指南》为该疾病提供了多学科诊断、分期和治疗建议。这些 "NCCN 指南透视 "详细介绍了将 PARP 抑制剂作为卵巢癌维持治疗和单药治疗方案的演变如何为指南中的专家小组建议提供依据。
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引用次数: 0
The Role of CAR T-Cell Therapy in Relapsed/Refractory Adult B-ALL. CAR T 细胞疗法在复发/难治性成人 B-ALL 中的作用。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7065
Tamer Othman, Aaron C Logan, Lori Muffly, Jessica Leonard, Jae Park, Bijal Shah, Ibrahim Aldoss

CAR T-cell therapy is a recent therapeutic advancement that has transformed the management of relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). To date, there are 2 FDA-approved CAR-T products for R/R B-ALL: tisagenlecleucel in patients aged <26 years and brexucabtagene autoleucel in those aged ≥18 years. This review summarizes the pivotal clinical trials that led to FDA approval of these 2 products and highlight emerging data addressing key questions pertinent to CAR-T utilization in the rapidly evolving landscape of R/R ALL management. These include optimal sequencing of CAR-T among other novel immunotherapeutic agents, the role of consolidation and maintenance following CAR-T, novel CAR-T constructs currently under clinical development, and strategies to optimize use of commercially available CAR-T products to improve patient outcomes.

CAR T 细胞疗法是最近的一项治疗进展,它改变了对复发/难治(R/R)B 细胞急性淋巴细胞白血病(B-ALL)的治疗。迄今为止,美国 FDA 批准了 2 种用于治疗复发性/难治性 B 细胞急性淋巴细胞白血病(B-ALL)的 CAR-T 产品:tisagenlecleucel,用于治疗年龄在 50 岁以下的患者。
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引用次数: 0
Rehabilitation in Oncology Care Guidelines: A Gap Analysis. 肿瘤治疗中的康复指南:差距分析。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.6004/jnccn.2024.7033
Cristina Kline-Quiroz, Cody Andrews, Patrick Martone, James Thomas Pastrnak, Katherine Power, Sean R Smith, Eric Wisotzky

Background: Cancer survivors experience a high prevalence of functional impairments. Rehabilitation interventions include an expansive array of services that can help optimize function, address pain, decrease symptom burden, and improve quality of life. Nonetheless, rehabilitation services remain underutilized. Thus, it is important to enhance the understanding of and establish guidelines for specific rehabilitation disciplines and interventions.

Methods: This is a gap analysis of rehabilitation recommendations in published oncology guidelines from selected nationally recognized organizations. Symptom-specific guidelines and cancer type-specific guidelines were analyzed for inclusion of common functional impairments (fatigue, pain, peripheral neuropathy, cognitive dysfunction, and lymphedema) and the rehabilitation discipline recommendations.

Results: The prevalence of recommendations for rehabilitation in cancer type-specific guidelines was 29%, and was higher in symptom-specific guidelines at 60%. However, the frequency of specific rehabilitation disciplines (physiatry, physical therapy, occupational therapy, speech-language pathology, and rehabilitation psychology/neuropsychology) was notably lower. Overall rehabilitation was mentioned in 33% and physiatry in 18%. Nonrehabilitation specialties were recommended in 18% of the guidelines. No specialty referral was endorsed in 53% of guidelines in which 1 of 5 symptoms were discussed. This highlights the relative paucity of recommendations for specific rehabilitation disciplines in oncology guidelines. The more general term "rehabilitation" was included more frequently but lacks critical guidance for oncology providers. Other crucial rehabilitation services may be underrecognized and underutilized. Rehabilitation specialists must work to improve patient access and the presence of indicated specific rehabilitation disciplines and goals within guidelines.

Conclusions: Most oncology guidelines do not include specific recommendations for rehabilitation disciplines. However, including specific rehabilitation disciplines is more common in symptom-specific guidelines. With a stronger evidence base and increased involvement of rehabilitation specialists in guideline development, rehabilitation recommendations in oncologic guidelines may be more precise, leading to improved utilization of rehabilitation services to optimize function and quality of life.

背景:癌症幸存者普遍存在功能障碍。康复干预包括一系列广泛的服务,有助于优化功能、解决疼痛、减轻症状负担和提高生活质量。然而,康复服务仍未得到充分利用。因此,加强对特定康复学科和干预措施的了解并制定相关指南非常重要:方法:这是对部分国家认可的组织已发布的肿瘤指南中的康复建议进行的差距分析。分析了针对特定症状的指南和针对特定癌症类型的指南,以纳入常见功能障碍(疲劳、疼痛、周围神经病变、认知功能障碍和淋巴水肿)和康复学科建议:结果:针对癌症类型的指南中康复建议的比例为 29%,针对症状的指南中康复建议的比例更高,为 60%。然而,特定康复学科(物理治疗、物理治疗、职业治疗、言语病理学和康复心理学/神经心理学)的频率明显较低。33% 的人提到过整体康复,18% 的人提到过物理治疗。18%的指南推荐了非康复专科。有 53% 的指南在讨论 5 个症状中的 1 个症状时,没有推荐任何专科。这突显出肿瘤指南中对特定康复学科的推荐相对较少。康复 "这一较为笼统的术语被纳入的频率较高,但却缺乏对肿瘤服务提供者的重要指导。其他重要的康复服务可能未被充分认识和利用。康复专家必须努力提高患者获得康复服务的机会,并在指南中指明具体的康复学科和目标:结论:大多数肿瘤指南都不包括康复学科的具体建议。然而,在针对特定症状的指南中,包含特定康复学科的情况更为常见。随着证据基础的加强和康复专家更多地参与指南的制定,肿瘤指南中的康复建议可能会更加精确,从而提高康复服务的利用率,优化功能和生活质量。
{"title":"Rehabilitation in Oncology Care Guidelines: A Gap Analysis.","authors":"Cristina Kline-Quiroz, Cody Andrews, Patrick Martone, James Thomas Pastrnak, Katherine Power, Sean R Smith, Eric Wisotzky","doi":"10.6004/jnccn.2024.7033","DOIUrl":"10.6004/jnccn.2024.7033","url":null,"abstract":"<p><strong>Background: </strong>Cancer survivors experience a high prevalence of functional impairments. Rehabilitation interventions include an expansive array of services that can help optimize function, address pain, decrease symptom burden, and improve quality of life. Nonetheless, rehabilitation services remain underutilized. Thus, it is important to enhance the understanding of and establish guidelines for specific rehabilitation disciplines and interventions.</p><p><strong>Methods: </strong>This is a gap analysis of rehabilitation recommendations in published oncology guidelines from selected nationally recognized organizations. Symptom-specific guidelines and cancer type-specific guidelines were analyzed for inclusion of common functional impairments (fatigue, pain, peripheral neuropathy, cognitive dysfunction, and lymphedema) and the rehabilitation discipline recommendations.</p><p><strong>Results: </strong>The prevalence of recommendations for rehabilitation in cancer type-specific guidelines was 29%, and was higher in symptom-specific guidelines at 60%. However, the frequency of specific rehabilitation disciplines (physiatry, physical therapy, occupational therapy, speech-language pathology, and rehabilitation psychology/neuropsychology) was notably lower. Overall rehabilitation was mentioned in 33% and physiatry in 18%. Nonrehabilitation specialties were recommended in 18% of the guidelines. No specialty referral was endorsed in 53% of guidelines in which 1 of 5 symptoms were discussed. This highlights the relative paucity of recommendations for specific rehabilitation disciplines in oncology guidelines. The more general term \"rehabilitation\" was included more frequently but lacks critical guidance for oncology providers. Other crucial rehabilitation services may be underrecognized and underutilized. Rehabilitation specialists must work to improve patient access and the presence of indicated specific rehabilitation disciplines and goals within guidelines.</p><p><strong>Conclusions: </strong>Most oncology guidelines do not include specific recommendations for rehabilitation disciplines. However, including specific rehabilitation disciplines is more common in symptom-specific guidelines. With a stronger evidence base and increased involvement of rehabilitation specialists in guideline development, rehabilitation recommendations in oncologic guidelines may be more precise, leading to improved utilization of rehabilitation services to optimize function and quality of life.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":null,"pages":null},"PeriodicalIF":14.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Journal of the National Comprehensive Cancer Network
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