Lindsey Bandini, Rebecca Caires, Linda Jacobs, Dori Klemanski, Donna Berizzi, Sheetal Kircher, Rachael Schmidt, Jessica Sugalski, Crystal S Denlinger, Susan Brown
Background: It is estimated that there are >18 million cancer survivors in the United States, and there is a growing number of survivorship programs across the country to care for these individuals. There is a clear need for survivorship care; however, evidence is still emerging on how to best operationalize the guidance from nationally recognized organizations and clinical practice guidelines.
Methods: The NCCN Best Practices Committee (BPC) recently conducted a survey to better understand survivorship clinics at NCCN Member Institutions. Representatives from 24 of the 33 NCCN Member Institutions (73%) submitted responses to the survey.
Results: Although all responding centers see cancer survivors, most (92%) have ≥1 dedicated survivorship clinics. Of those centers with dedicated survivorship clinics (n=22), 9 (41%) reported general survivorship clinics for all cancer types, and 13 (59%) indicated their center offered ≥1 disease-specific survivorship clinics. Most centers (55%) use a mix of physicians and advanced practice providers (APPs; nurse practitioners and/or physician assistants) to staff survivorship clinics; however, 9 (41%) are staffed entirely by APPs and 1 (4%) is staffed entirely by physicians. The vast majority (91%) have dedicated scheduling templates, and most (73%) have dedicated clinic space for survivorship clinics. The referral process for survivorship clinics varies across centers, with 16 (73%) using algorithms, guidelines, or pathways to determine when a patient is referred to a survivorship clinic. Findings may reflect the evolution of survivorship care and indicate a move toward standardizing which patients are seen and when. It is notable that >50% of institutions reported a model in which they follow survivors for their lifetime.
Conclusions: Given the number of patients impacted by cancer, these data highlight the need to continue refining how survivorship care models are integrated into cancer centers to best serve patients with cancer and cancer survivors.
{"title":"Oncology Survivorship Care Clinics: Design and Implementation of Survivorship Care Delivery Systems at NCCN Member Institutions.","authors":"Lindsey Bandini, Rebecca Caires, Linda Jacobs, Dori Klemanski, Donna Berizzi, Sheetal Kircher, Rachael Schmidt, Jessica Sugalski, Crystal S Denlinger, Susan Brown","doi":"10.6004/jnccn.2024.7060","DOIUrl":"10.6004/jnccn.2024.7060","url":null,"abstract":"<p><strong>Background: </strong>It is estimated that there are >18 million cancer survivors in the United States, and there is a growing number of survivorship programs across the country to care for these individuals. There is a clear need for survivorship care; however, evidence is still emerging on how to best operationalize the guidance from nationally recognized organizations and clinical practice guidelines.</p><p><strong>Methods: </strong>The NCCN Best Practices Committee (BPC) recently conducted a survey to better understand survivorship clinics at NCCN Member Institutions. Representatives from 24 of the 33 NCCN Member Institutions (73%) submitted responses to the survey.</p><p><strong>Results: </strong>Although all responding centers see cancer survivors, most (92%) have ≥1 dedicated survivorship clinics. Of those centers with dedicated survivorship clinics (n=22), 9 (41%) reported general survivorship clinics for all cancer types, and 13 (59%) indicated their center offered ≥1 disease-specific survivorship clinics. Most centers (55%) use a mix of physicians and advanced practice providers (APPs; nurse practitioners and/or physician assistants) to staff survivorship clinics; however, 9 (41%) are staffed entirely by APPs and 1 (4%) is staffed entirely by physicians. The vast majority (91%) have dedicated scheduling templates, and most (73%) have dedicated clinic space for survivorship clinics. The referral process for survivorship clinics varies across centers, with 16 (73%) using algorithms, guidelines, or pathways to determine when a patient is referred to a survivorship clinic. Findings may reflect the evolution of survivorship care and indicate a move toward standardizing which patients are seen and when. It is notable that >50% of institutions reported a model in which they follow survivors for their lifetime.</p><p><strong>Conclusions: </strong>Given the number of patients impacted by cancer, these data highlight the need to continue refining how survivorship care models are integrated into cancer centers to best serve patients with cancer and cancer survivors.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":" ","pages":"659-662"},"PeriodicalIF":14.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623150","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}
John A Thompson, Bryan J Schneider, Julie Brahmer, Mohammad Abu Zaid, Amaka Achufusi, Philippe Armand, Meghan K Berkenstock, Bonnie Bermas, Tawnie Braaten, Lihua E Budde, Saurin Chokshi, Zachary D Crees, Marianne Davies, Changchun Deng, Yaron Gesthalter, Michael Jain, Prantesh Jain, Andrew Jallouk, Benjamin H Kaffenberger, Maya Khalil, Melissa G Lechner, Tianhong Li, Alissa Marr, Suzanne McGettigan, Jordan McPherson, Theresa Medina, Nisha A Mohindra, Anthony J Olszanski, Olalekan Oluwole, Sandip P Patel, Jason Prosek, Sunil Reddy, Pankti Reid, John Ryan, Mabel Ryder, Huda Salman, Bianca Santomasso, Scott Shofer, Jeffrey A Sosman, Yinghong Wang, Vlad G Zaha, Stephen Zucker, Megan Lyons, Ajibola Awotiwon, Lisa Hang
The NCCN Guidelines for the Management of Immunotherapy-Related Toxicities are intended to provide oncology practitioners with guidance on how to manage the wide-ranging and potentially fatal toxicities that may occur with cancer immunotherapy. The guidelines address immune-related adverse events related to immune checkpoint inhibitors, CAR T-cell therapies, and lymphocyte engagers (which include T-cell-engaging bispecific antibodies). These NCCN Guidelines Insights highlight recent guideline updates pertaining to the management of emerging toxicities related to cancer immunotherapy.
NCCN 《免疫疗法相关毒性管理指南》旨在为肿瘤医生提供指导,帮助他们管理癌症免疫疗法可能出现的各种潜在致命毒性。该指南针对与免疫检查点抑制剂、CAR T 细胞疗法和淋巴细胞激活剂(包括 T 细胞激活双特异性抗体)相关的免疫相关不良事件。这些 "NCCN 指南透视 "重点介绍了与癌症免疫疗法相关的新发毒性管理有关的最新指南更新。
{"title":"NCCN Guidelines® Insights: Management of Immunotherapy-Related Toxicities, Version 2.2024.","authors":"John A Thompson, Bryan J Schneider, Julie Brahmer, Mohammad Abu Zaid, Amaka Achufusi, Philippe Armand, Meghan K Berkenstock, Bonnie Bermas, Tawnie Braaten, Lihua E Budde, Saurin Chokshi, Zachary D Crees, Marianne Davies, Changchun Deng, Yaron Gesthalter, Michael Jain, Prantesh Jain, Andrew Jallouk, Benjamin H Kaffenberger, Maya Khalil, Melissa G Lechner, Tianhong Li, Alissa Marr, Suzanne McGettigan, Jordan McPherson, Theresa Medina, Nisha A Mohindra, Anthony J Olszanski, Olalekan Oluwole, Sandip P Patel, Jason Prosek, Sunil Reddy, Pankti Reid, John Ryan, Mabel Ryder, Huda Salman, Bianca Santomasso, Scott Shofer, Jeffrey A Sosman, Yinghong Wang, Vlad G Zaha, Stephen Zucker, Megan Lyons, Ajibola Awotiwon, Lisa Hang","doi":"10.6004/jnccn.2024.0057","DOIUrl":"https://doi.org/10.6004/jnccn.2024.0057","url":null,"abstract":"<p><p>The NCCN Guidelines for the Management of Immunotherapy-Related Toxicities are intended to provide oncology practitioners with guidance on how to manage the wide-ranging and potentially fatal toxicities that may occur with cancer immunotherapy. The guidelines address immune-related adverse events related to immune checkpoint inhibitors, CAR T-cell therapies, and lymphocyte engagers (which include T-cell-engaging bispecific antibodies). These NCCN Guidelines Insights highlight recent guideline updates pertaining to the management of emerging toxicities related to cancer immunotherapy.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":"582-592"},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623174","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}
Background: The objective of this study was to assess the impact of statin use on overall survival (OS) and nasopharyngeal cancer (NPC)-specific survival in patients with advanced NPC who underwent standard concurrent chemoradiotherapy (CCRT).
Patients and methods: This propensity score matched cohort study used data from the Taiwan Cancer Registry Database and National Health Insurance Research Database to examine the impact of statin use during CCRT on both OS and NPC-specific survival.
Results: Statin use during CCRT demonstrated significant and independent prognostic value for both OS and NPC-specific survival. The adjusted hazard ratio for all-cause mortality in the statin group compared with the nonstatin group was 0.48 (95% CI, 0.34-0.68; P<.0001). Similarly, the adjusted hazard ratio for NPC-specific mortality in the statin group compared with the nonstatin group was 0.43 (95% CI, 0.29-0.65; P<.0001). Rosuvastatin, atorvastatin, and lovastatin demonstrated significant efficacy in improving NPC-specific survival outcomes. Moreover, our findings indicate a dose-response relationship, with higher cumulative defined daily doses and greater daily intensity of statin use associated with reduced mortality.
Conclusions: This study suggests an association between statin use during the CCRT period for NPC and potential enhancements in both OS and NPC-specific survival. Our findings indicate a possible survival benefit of rosuvastatin, atorvastatin, and lovastatin for patients with NPC undergoing CCRT. The observed dose-response relationship underscores the potential importance of higher statin use in mitigating NPC-specific mortality, but further research is needed to establish a definitive causal relationship.
研究背景本研究旨在评估他汀类药物的使用对接受标准同期化放疗(CCRT)的晚期鼻咽癌患者的总生存期(OS)和鼻咽癌特异性生存期的影响:这项倾向得分匹配队列研究使用了台湾癌症登记数据库和国民健康保险研究数据库的数据,研究在CCRT期间使用他汀类药物对OS和鼻咽癌特异性生存率的影响:结果:CCRT期间使用他汀类药物对OS和NPC特异性生存有显著的独立预后价值。他汀类药物组与非他汀类药物组相比,调整后的全因死亡率危险比为0.48(95% CI,0.34-0.68;PC结论:本研究表明,在鼻咽癌 CCRT 期间使用他汀类药物可能会提高 OS 和鼻咽癌特异性生存率。我们的研究结果表明,洛伐他汀、阿托伐他汀和洛伐他汀可能对接受 CCRT 的鼻咽癌患者的生存有益。观察到的剂量-反应关系强调了更多地使用他汀类药物在降低鼻咽癌特异性死亡率方面的潜在重要性,但要建立明确的因果关系还需要进一步的研究。
{"title":"Statin Use During Concurrent Chemoradiotherapy for Advanced Nasopharyngeal Cancer.","authors":"Jung-Min Yu, Chia-Lun Chang, Kuan-Chou Lin, Wan-Ming Chen, Ben-Chang Shia, Szu-Yuan Wu","doi":"10.6004/jnccn.2024.7046","DOIUrl":"https://doi.org/10.6004/jnccn.2024.7046","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to assess the impact of statin use on overall survival (OS) and nasopharyngeal cancer (NPC)-specific survival in patients with advanced NPC who underwent standard concurrent chemoradiotherapy (CCRT).</p><p><strong>Patients and methods: </strong>This propensity score matched cohort study used data from the Taiwan Cancer Registry Database and National Health Insurance Research Database to examine the impact of statin use during CCRT on both OS and NPC-specific survival.</p><p><strong>Results: </strong>Statin use during CCRT demonstrated significant and independent prognostic value for both OS and NPC-specific survival. The adjusted hazard ratio for all-cause mortality in the statin group compared with the nonstatin group was 0.48 (95% CI, 0.34-0.68; P<.0001). Similarly, the adjusted hazard ratio for NPC-specific mortality in the statin group compared with the nonstatin group was 0.43 (95% CI, 0.29-0.65; P<.0001). Rosuvastatin, atorvastatin, and lovastatin demonstrated significant efficacy in improving NPC-specific survival outcomes. Moreover, our findings indicate a dose-response relationship, with higher cumulative defined daily doses and greater daily intensity of statin use associated with reduced mortality.</p><p><strong>Conclusions: </strong>This study suggests an association between statin use during the CCRT period for NPC and potential enhancements in both OS and NPC-specific survival. Our findings indicate a possible survival benefit of rosuvastatin, atorvastatin, and lovastatin for patients with NPC undergoing CCRT. The observed dose-response relationship underscores the potential importance of higher statin use in mitigating NPC-specific mortality, but further research is needed to establish a definitive causal relationship.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623187","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}
Nicole L Henderson, Etzael Ortiz-Olguin, Garrett Bourne, Cameron Pywell, J Bart Rose, Grant R Williams, Ryan D Nipp, Gabrielle B Rocque
Background: The incorporation of electronic patient-reported outcomes (ePROs), such as the Geriatric Assessment (GA) and treatment preferences, into decision-making for pancreatic cancer has been limited by clinician- and system-level barriers concerning workflow. We hypothesized that ePRO inclusion within multidisciplinary tumor boards (MDTBs) would circumvent barriers and provide a venue for systematic consideration of critical patient-provided information.
Patients and methods: The INtegrating Systematic PatIent-Reported Evaluations (INSPIRE) intervention consists of (1) patient survey completion, including GA and patient preferences, and (2) screensharing patient ePROs during MDTBs. Proctor et al's implementation outcomes were assessed, with penetration (the proportion of consented patients who were presented at MDTBs) acting as the primary outcome (considered successful at 70%). Secondary outcomes included adoption, feasibility, acceptability, appropriateness, cost, and sustainability, assessed by clinician post-MDTB exit surveys, clinician postintervention surveys, clinician postintervention semistructured interviews, and time-coding analysis of recorded and transcribed historical (November 2021-February 2022) and intervention (September 2022-June 2023) MDTBs.
Results: A total of 50 patients completed surveys and all were presented at MDTBs (penetration=100%). All eligible clinicians (n=9) enrolled patients (adoption=100%) and reported that ePROs were useful in 90% and led to a change in treatment plan in 30% of cases. In postintervention surveys and interviews, clinicians primarily responded positively to feasibility, acceptability, and appropriateness questions. Time-coding analysis found a modest time cost of an additional 51.1 seconds in mean discussion time-per-patient between preintervention (mean [SD], 172.7 [111.4] seconds) and intervention patients (mean [SD], 223.8 [107.1] seconds); 86% of clinicians reported the intervention did not take too much time. All surveyed clinicians reported interest in continuing the intervention and suggested adaptations to further promote sustainability.
Conclusions: The integration of ePROs into pancreatic MDTBs was feasible and acceptable, providing a potential approach to increase the utilization of ePROs by clinical teams in their management of patients with pancreatic cancer.
{"title":"Implementation of ePROs Into Multidisciplinary Tumor Board Discussions for Patients With Pancreatic Cancer: The INSPIRE Intervention.","authors":"Nicole L Henderson, Etzael Ortiz-Olguin, Garrett Bourne, Cameron Pywell, J Bart Rose, Grant R Williams, Ryan D Nipp, Gabrielle B Rocque","doi":"10.6004/jnccn.2024.7052","DOIUrl":"https://doi.org/10.6004/jnccn.2024.7052","url":null,"abstract":"<p><strong>Background: </strong>The incorporation of electronic patient-reported outcomes (ePROs), such as the Geriatric Assessment (GA) and treatment preferences, into decision-making for pancreatic cancer has been limited by clinician- and system-level barriers concerning workflow. We hypothesized that ePRO inclusion within multidisciplinary tumor boards (MDTBs) would circumvent barriers and provide a venue for systematic consideration of critical patient-provided information.</p><p><strong>Patients and methods: </strong>The INtegrating Systematic PatIent-Reported Evaluations (INSPIRE) intervention consists of (1) patient survey completion, including GA and patient preferences, and (2) screensharing patient ePROs during MDTBs. Proctor et al's implementation outcomes were assessed, with penetration (the proportion of consented patients who were presented at MDTBs) acting as the primary outcome (considered successful at 70%). Secondary outcomes included adoption, feasibility, acceptability, appropriateness, cost, and sustainability, assessed by clinician post-MDTB exit surveys, clinician postintervention surveys, clinician postintervention semistructured interviews, and time-coding analysis of recorded and transcribed historical (November 2021-February 2022) and intervention (September 2022-June 2023) MDTBs.</p><p><strong>Results: </strong>A total of 50 patients completed surveys and all were presented at MDTBs (penetration=100%). All eligible clinicians (n=9) enrolled patients (adoption=100%) and reported that ePROs were useful in 90% and led to a change in treatment plan in 30% of cases. In postintervention surveys and interviews, clinicians primarily responded positively to feasibility, acceptability, and appropriateness questions. Time-coding analysis found a modest time cost of an additional 51.1 seconds in mean discussion time-per-patient between preintervention (mean [SD], 172.7 [111.4] seconds) and intervention patients (mean [SD], 223.8 [107.1] seconds); 86% of clinicians reported the intervention did not take too much time. All surveyed clinicians reported interest in continuing the intervention and suggested adaptations to further promote sustainability.</p><p><strong>Conclusions: </strong>The integration of ePROs into pancreatic MDTBs was feasible and acceptable, providing a potential approach to increase the utilization of ePROs by clinical teams in their management of patients with pancreatic cancer.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":"602-609"},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623161","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}
{"title":"Letter to the Editor: Enhancing the Readability of Online Patient-Facing Content Using AI Chatbots.","authors":"Qiqi Wu","doi":"10.6004/jnccn.2024.7054","DOIUrl":"https://doi.org/10.6004/jnccn.2024.7054","url":null,"abstract":"","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623164","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}
Lindsey Robert Baden, Sankar Swaminathan, Nikolaos G Almyroudis, Michael Angarone, Aliyah Baluch, Nicolas Barros, Brian Buss, Stuart Cohen, Brenda Cooper, Augusto Dulanto Chiang, Zeinab El Boghdadly, Kevin Gregg, Hana Hakim, Dora Ho, Fareed Khawaja, Rachael Lee, Francesca Lee, Cathy Logan, Kristen Manley, Ashrit Multani, Anupam Pande, Steven Pergam, Jennifer Pisano, Jennifer Saullo, Mindy Schuster, Susan K Seo, Shmuel Shoham, Randy Taplitz, Jeffrey Topal, John W Wilson, Andrea Zimmer, Carly J Cassara, Rashmi Kumar, Zeenat Diwan
There is an increased risk of infection in patients with cancer that results in higher morbidity and mortality. Several risk factors can predispose these patients to infectious complications. Some such factors include immunocompromised states like neutropenia, allogeneic hematopoietic cell transplantation, and graft-versus-host disease, while others include immunosuppressive agents like corticosteroids, purine analogs, monoclonal antibodies, and other emerging cancer therapeutics like CAR T-cell therapy. The NCCN Guidelines for the Prevention and Treatment of Cancer-Related Infections address infection concerns that may be observed in these immunocompromised populations and characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This paper highlights 2 recently updated sections of the guidelines, namely, infection concerns related to CAR T-cell therapy and antimicrobial prophylaxis recommendations, including vaccination, in patients at high-risk for infections.
癌症患者的感染风险增加,导致发病率和死亡率升高。有几种风险因素会使这些患者容易出现感染并发症。其中一些因素包括中性粒细胞减少症、异基因造血细胞移植和移植物抗宿主病等免疫功能低下状态,而其他因素则包括皮质类固醇、嘌呤类似物、单克隆抗体等免疫抑制剂,以及 CAR T 细胞疗法等其他新兴癌症疗法。NCCN 癌症相关感染的预防和治疗指南》解决了这些免疫力低下人群可能出现的感染问题,并描述了癌症患者易感的主要病原体,重点关注主要常见感染和机会性感染的预防、诊断和治疗。本文重点介绍了指南中最近更新的两个部分,即与 CAR T 细胞疗法相关的感染问题和感染高危患者的抗菌药物预防建议,包括疫苗接种。
{"title":"Prevention and Treatment of Cancer-Related Infections, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology.","authors":"Lindsey Robert Baden, Sankar Swaminathan, Nikolaos G Almyroudis, Michael Angarone, Aliyah Baluch, Nicolas Barros, Brian Buss, Stuart Cohen, Brenda Cooper, Augusto Dulanto Chiang, Zeinab El Boghdadly, Kevin Gregg, Hana Hakim, Dora Ho, Fareed Khawaja, Rachael Lee, Francesca Lee, Cathy Logan, Kristen Manley, Ashrit Multani, Anupam Pande, Steven Pergam, Jennifer Pisano, Jennifer Saullo, Mindy Schuster, Susan K Seo, Shmuel Shoham, Randy Taplitz, Jeffrey Topal, John W Wilson, Andrea Zimmer, Carly J Cassara, Rashmi Kumar, Zeenat Diwan","doi":"10.6004/jnccn.2024.0056","DOIUrl":"https://doi.org/10.6004/jnccn.2024.0056","url":null,"abstract":"<p><p>There is an increased risk of infection in patients with cancer that results in higher morbidity and mortality. Several risk factors can predispose these patients to infectious complications. Some such factors include immunocompromised states like neutropenia, allogeneic hematopoietic cell transplantation, and graft-versus-host disease, while others include immunosuppressive agents like corticosteroids, purine analogs, monoclonal antibodies, and other emerging cancer therapeutics like CAR T-cell therapy. The NCCN Guidelines for the Prevention and Treatment of Cancer-Related Infections address infection concerns that may be observed in these immunocompromised populations and characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This paper highlights 2 recently updated sections of the guidelines, namely, infection concerns related to CAR T-cell therapy and antimicrobial prophylaxis recommendations, including vaccination, in patients at high-risk for infections.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":"617-644"},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623180","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}
Andres A Abreu, Ricardo E Nunez-Rocha, Gilbert Z Murimwa, Patricio M Polanco
{"title":"Authors' Reply to the Letter to the Editor by Wu Re: Enhancing the Readability of Online Patient-Facing Content Using AI Chatbots.","authors":"Andres A Abreu, Ricardo E Nunez-Rocha, Gilbert Z Murimwa, Patricio M Polanco","doi":"10.6004/jnccn.2024.7081","DOIUrl":"https://doi.org/10.6004/jnccn.2024.7081","url":null,"abstract":"","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623156","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}
{"title":"Progress in Cancer 2024.","authors":"Daniel M Geynisman","doi":"10.6004/jnccn.2024.0058","DOIUrl":"https://doi.org/10.6004/jnccn.2024.0058","url":null,"abstract":"","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":"581"},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623184","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}
Yishan Liu, Zheshun Jiang, Jan Sundquist, Kristina Sundquist, Jianguang Ji
Background: Parents experience a range of mental health disorders following their child's cancer diagnosis. It is thus essential to explore how the child's cancer diagnosis affects the dosage of psychotropic medication in both short- and long-term use, as well as potential disparities in utilization patterns between mothers and fathers.
Patients and methods: Using Swedish registers, we identified all parents whose children were diagnosed with cancer from July 2009 to December 2015 in Sweden. We randomly matched up to 5 parents of cancer-free children conditional on their baseline characteristics. All parents were followed up from 4 years before to 4 years after their child's diagnosis. Psychotropic medication cumulative defined daily doses (DDDs) were retrieved from the Swedish Prescribed Drug Register. Using interrupted time series analyses, we sought to investigate how childhood cancer diagnosis influences the evolving pattern of parental psychotropic medication dosage across time with consideration for potential differences compared with matched parents before the child's cancer diagnosis. We calculated the attributable proportion due to the diagnosis of childhood cancer.
Results: Following a child's cancer diagnosis, mothers experienced a steady increase in psychotropic medication use, averaging 4.9 DDDs per year compared with matched comparisons, with a 46.0% adjusted attributable proportion in the initial year. Fathers had an abrupt increase in psychotropic medication use in the first year after diagnosis, with an adjusted attributable proportion of 72.1%. Parents with lower education attainment tended to use more psychotropic medication.
Conclusions: In response to a child's cancer diagnosis, parents showed increased use of psychotropic medication compared with matched comparisons. Additionally, utilization patterns differed between mothers and fathers. Timely prevention and early support for parents are needed to alleviate their psychological challenges, potentially mitigating the strain on medical resources associated with increased psychotropic medication use.
{"title":"Long-Term Pattern of Psychotropic Medication Uses Among Swedish Parents of Children Diagnosed With Cancer.","authors":"Yishan Liu, Zheshun Jiang, Jan Sundquist, Kristina Sundquist, Jianguang Ji","doi":"10.6004/jnccn.2024.7048","DOIUrl":"https://doi.org/10.6004/jnccn.2024.7048","url":null,"abstract":"<p><strong>Background: </strong>Parents experience a range of mental health disorders following their child's cancer diagnosis. It is thus essential to explore how the child's cancer diagnosis affects the dosage of psychotropic medication in both short- and long-term use, as well as potential disparities in utilization patterns between mothers and fathers.</p><p><strong>Patients and methods: </strong>Using Swedish registers, we identified all parents whose children were diagnosed with cancer from July 2009 to December 2015 in Sweden. We randomly matched up to 5 parents of cancer-free children conditional on their baseline characteristics. All parents were followed up from 4 years before to 4 years after their child's diagnosis. Psychotropic medication cumulative defined daily doses (DDDs) were retrieved from the Swedish Prescribed Drug Register. Using interrupted time series analyses, we sought to investigate how childhood cancer diagnosis influences the evolving pattern of parental psychotropic medication dosage across time with consideration for potential differences compared with matched parents before the child's cancer diagnosis. We calculated the attributable proportion due to the diagnosis of childhood cancer.</p><p><strong>Results: </strong>Following a child's cancer diagnosis, mothers experienced a steady increase in psychotropic medication use, averaging 4.9 DDDs per year compared with matched comparisons, with a 46.0% adjusted attributable proportion in the initial year. Fathers had an abrupt increase in psychotropic medication use in the first year after diagnosis, with an adjusted attributable proportion of 72.1%. Parents with lower education attainment tended to use more psychotropic medication.</p><p><strong>Conclusions: </strong>In response to a child's cancer diagnosis, parents showed increased use of psychotropic medication compared with matched comparisons. Additionally, utilization patterns differed between mothers and fathers. Timely prevention and early support for parents are needed to alleviate their psychological challenges, potentially mitigating the strain on medical resources associated with increased psychotropic medication use.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623169","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}
Older patients with multiple myeloma (MM) exhibit wide heterogeneity in their baseline physiologic and functional status, which demands an individualized treatment approach based on biological rather than chronological age. Various frailty scores have been developed for older patients with MM, but they are underutilized in clinical trials and in practice. Older patients with MM are underrepresented in therapeutic clinical trials, and treatment recommendations are currently derived from clinical trials of transplant-ineligible patients. This article provides a summary of phase II and III clinical trials in transplant-ineligible patients with newly diagnosed MM, highlighting outcomes in patients aged ≥75 years and frailty-based outcomes. The data available thus far show that triplet regimens are more efficacious than doublets in older patients but may be associated with higher toxicity. DRd (daratumumab/lenalidomide/dexamethasone) and VRd (bortezomib/lenalidomide/dexamethasone) are good options in patients who are nonfrail, whereas dose-adjusted DRd and VRd-lite should be offered to frail patients. Frailty should be assessed regularly to guide treatment intensification and/or deescalation. It is important that frailty measures are incorporated in clinical trials evaluating novel treatments to inform how older and frail patients will benefit from these treatments.
老年多发性骨髓瘤(MM)患者的基线生理和功能状态表现出很大的异质性,这就要求根据生理年龄而非实际年龄采取个体化治疗方法。目前已为老年多发性骨髓瘤患者制定了各种虚弱评分标准,但在临床试验和实践中并未得到充分利用。在治疗性临床试验中,老年 MM 患者的比例偏低,目前的治疗建议均来自于对不符合移植条件的患者进行的临床试验。本文总结了针对符合移植条件的新诊断 MM 患者的 II 期和 III 期临床试验,重点介绍了年龄≥75 岁患者的疗效和基于虚弱程度的疗效。目前已有的数据显示,在老年患者中,三联方案比二联方案更有效,但可能会有较高的毒性。DRd(daratumumab/来那度胺/地塞米松)和VRd(硼替佐米/来那度胺/地塞米松)是非体弱患者的良好选择,而体弱患者则应接受剂量调整后的DRd和VRd-lite。应定期评估患者的虚弱程度,以指导加强和/或减少治疗。重要的是,在评估新型疗法的临床试验中纳入虚弱程度测量,以便了解年老体弱的患者将如何从这些疗法中获益。
{"title":"Up-Front Treatment of Elderly (Age ≥75 Years) and Frail Patients With Multiple Myeloma.","authors":"Nadine Abdallah, Shaji K Kumar","doi":"10.6004/jnccn.2024.7039","DOIUrl":"10.6004/jnccn.2024.7039","url":null,"abstract":"<p><p>Older patients with multiple myeloma (MM) exhibit wide heterogeneity in their baseline physiologic and functional status, which demands an individualized treatment approach based on biological rather than chronological age. Various frailty scores have been developed for older patients with MM, but they are underutilized in clinical trials and in practice. Older patients with MM are underrepresented in therapeutic clinical trials, and treatment recommendations are currently derived from clinical trials of transplant-ineligible patients. This article provides a summary of phase II and III clinical trials in transplant-ineligible patients with newly diagnosed MM, highlighting outcomes in patients aged ≥75 years and frailty-based outcomes. The data available thus far show that triplet regimens are more efficacious than doublets in older patients but may be associated with higher toxicity. DRd (daratumumab/lenalidomide/dexamethasone) and VRd (bortezomib/lenalidomide/dexamethasone) are good options in patients who are nonfrail, whereas dose-adjusted DRd and VRd-lite should be offered to frail patients. Frailty should be assessed regularly to guide treatment intensification and/or deescalation. It is important that frailty measures are incorporated in clinical trials evaluating novel treatments to inform how older and frail patients will benefit from these treatments.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"22 9","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623191","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}