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Samson S, Northey JJ, Acerbi I, Goga A, Flink CL, Weaver VM, LaBarge MA. NCI's publication affiliation conundrum: Reframing innovation to incentivize an equitable path for advocate representation. Transl Oncol 2022; 16:101325. [PMID: 34974281 PMCID: PMC8728534 DOI: 10.1016/j.tranon.2021.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022] Open
Abstract
Advocacy engagement has been at the forefront of National Cancer Institute (NCI) efforts to advance scientific discoveries and transform medical interventions. Nonetheless, the journey for advocates has been uneven. Case in Point: NCI publication affiliation rules of engagement pose unique equity challenges while raising questions about structural representation in biomedical research. Abiding by the core rationale that publication affiliation should be tailored to employment status, the NCI has systematically denied research advocate volunteers the opportunity to specifically list NCI as an institutional affiliation on academic publications. Unpacking advocate NCI publication affiliation restrictions and its links with advocacy heritage preservation and convergent science goals poses unique diversity, equity, and inclusion challenges and opportunities. Improving the quality of structural representation in biomedical research requires new theories of action and flexible planning to advance, promote and build capacity for strategic advocacy inclusion and equity within publication affiliation initiatives. Here we highlight several opportunities for how leadership might formulate a radically different vision for NCI's approach. This perspective interrogates the best way forward for ensuring that biomedical employee and volunteer advocate workforce publication affiliation intersections are characterized by increased creativity and representation parity. Imbuing the scientist and clinical researcher archetype with social dimensions, we join NCI critical thinkers in urging employees, funded academics, and volunteer citizen scientists to collectively assume the role as paladins of science and integrity who view the triumphs of making a difference in science alongside the social responsibility of promoting transdisciplinary professionalism and the democratization of science.
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Affiliation(s)
- Susan Samson
- Breast Oncology Program, Breast Science Advocacy Core (BSAC), University of California, San Francisco, 2340 Sutter Street, San Francisco, CA 94115; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94115, United States; Physical Sciences and Oncology Network Program, University of California, San Francisco, CA 94115, United States.
| | - Jason J Northey
- Department of Surgery and Center for Bioengineering and Tissue Regeneration, University of California, San Francisco, CA 94143, United States
| | - Irene Acerbi
- Department of Surgery and Center for Bioengineering and Tissue Regeneration, University of California, San Francisco, CA 94143, United States
| | - Andrei Goga
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94115, United States; Department of Cell and Tissue Biology and Medicine, University of California, San Francisco, CA 94143, United States
| | - Carl L Flink
- College of Liberal Arts, Theatre Arts and Dance, University of Minnesota, Minneapolis, MN 55455, United States
| | - Valerie M Weaver
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94115, United States; Department of Surgery and Center for Bioengineering and Tissue Regeneration, University of California, San Francisco, CA 94143, United States
| | - Mark A LaBarge
- Beckman Research Institute, City of Hope, Duarte, CA 91010, United States
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Zdenkowski N, Butow P, Mann GB, Fewster S, Beckmore C, Isaacs R, Douglas C, Boyle FM. A survey of Australian and New Zealand clinical practice with neoadjuvant systemic therapy for breast cancer. Intern Med J 2017; 46:677-83. [PMID: 26929045 DOI: 10.1111/imj.13049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer. AIM We aimed to better understand NAST treatment patterns, barriers and facilitators in Australia and New Zealand. METHODS We undertook a cross-sectional survey of the current clinical practice of Australian and New Zealand breast cancer specialists. Questions included referral patterns for NAST, patient selection, logistics, decision making and barriers. RESULTS Of 207 respondents, 162 (78%) reported routinely offering NAST to selected patients with operable breast cancer (median 9% of patients offered NAST). Specialty, location, practice type, gender or years of experience did not predict for offering NAST. In all, 45 and 58% wanted to increase the number of patients who receive NAST in routine care and in clinical trials respectively. Facilitators included the multidisciplinary team meeting and access to NAST clinical trials. Specialist-reported patient barriers included: patient desire for immediate surgery (63% rated as important/very important); lack of awareness of NAST (50%); concern about progression (43%) and disinterest in downstaging (32%). Forty-three per cent of participants experienced system-related barriers to the use of NAST, including other clinicians' lack of interest (27%); lack of clinical trials (24%) and unacceptable wait for a medical oncology appointment (37%). CONCLUSION This group of Australian and New Zealand clinicians are interested in NAST for operable breast cancer in routine care and clinical trials. Patient- and system-related barriers that prevent the optimal uptake of this treatment approach will need to be systematically addressed if NAST is to become a more common approach.
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Affiliation(s)
- N Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.,Schools of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - P Butow
- Schools of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - G B Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Fewster
- Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - C Beckmore
- Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - R Isaacs
- Department of Medical Oncology, MidCentral Regional Cancer Treatment Service, Palmerston North, New Zealand
| | - C Douglas
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - F M Boyle
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.,Schools of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Zdenkowski N, Butow P, Hutchings E, Douglas C, Coll JR, Boyle FM. A Decision Aid for Women Considering Neoadjuvant Systemic Therapy for Operable Invasive Breast Cancer: Development and Protocol of a Phase II Evaluation Study (ANZ1301 DOMINO). JMIR Res Protoc 2016; 5:e88. [PMID: 27207563 PMCID: PMC4893151 DOI: 10.2196/resprot.5641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 01/09/2023] Open
Abstract
Background Neoadjuvant systemic therapy is offered to selected women with large and/or highly proliferative operable breast cancers. This option adds further complexity to an already complex breast cancer treatment decision tree. Patient decision aids are an established method of increasing patient involvement and knowledge while decreasing decisional conflict. There is currently no decision aid available for women considering neoadjuvant systemic therapy. Objective We aimed to develop a decision aid for women diagnosed with operable breast cancer and considered suitable for neoadjuvant systemic therapy, and the protocol for a multicenter pre-post study evaluating the acceptability and feasibility of the decision aid. Methods The decision aid was developed through literature review, expert advisory panel, adherence to the International Patient Decision Aid Standards, and iterative review. The protocol for evaluation of the decision aid consists of the following: eligible women will undertake a series of questionnaires prior to and after using the decision aid. The primary endpoint is decision aid acceptability to patients and investigators and the feasibility of use. Secondary endpoints include change in decisional conflict, participant knowledge, and information involvement preference. Feasibility is defined as the proportion of eligible participants who use the decision aid to help inform their treatment decision. Results This study has recruited 29 out of a planned 50 participants at four Australian sites. A 12-month recruitment period is expected with a further 12-months follow-up. Conclusions The decision aid has the potential to allow patients with operable breast cancer, who have been offered neoadjuvant systemic therapy, decreased decisional conflict, and greater involvement in the decision. If this study finds that an online decision aid is feasible and acceptable, it will be made widely available for routine clinical practice. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12614001267640; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614001267640&isBasic=True (Archived by WebCite at http://www.webcitation.org/6gh7BPZdG)
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Affiliation(s)
- Nicholas Zdenkowski
- Northern Clinical School, Faculty of Medicine, University of Sydney, North Sydney, Australia.
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Nelson NC, Keating P, Cambrosio A, Aguilar-Mahecha A, Basik M. Testing devices or experimental systems? Cancer clinical trials take the genomic turn. Soc Sci Med 2014; 111:74-83. [PMID: 24768778 DOI: 10.1016/j.socscimed.2014.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 02/03/2023]
Abstract
Clinical trials are often described as machine-like systems for generating specific information concerning drug safety and efficacy, and are understood as a component of the industrial drug development processes. This paper argues that contemporary clinical trials in oncology are not reducible to mere drug testing. Drawing on ethnographic fieldwork and interviews with researchers in the field of oncology from 2010 to 2013, we introduce a conceptual contrast between trials as testing machines and trials as clinical experimental systems to draw attention to the ways trials are increasingly being used to ask open-ended scientific questions. When viewed as testing machines, clinical trials are seen as a means to produce answers to straightforward questions and deviations from the protocol are seen as bugs in the system; but practitioners can also treat trials as clinical experimental systems to investigate as yet undefined problems and where heterogeneity becomes a means to produce novel biological or clinical insights. The rise of "biomarker-driven" clinical trials in oncology, which link measurable biological characteristics such as genetic mutations to clinical features such as a patient's response to a particular drug, exemplifies a trend towards more experimental styles of clinical work. These transformations are congruent with changes in the institutional structure of clinical research in oncology, including a movement towards more flexible, networked research arrangements, and towards using individual patients as model systems for asking biological questions.
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Affiliation(s)
- Nicole C Nelson
- Department of the History of Science, University of Wisconsin-Madison, 1225 Linden Drive, Madison, WI 53706, USA.
| | - Peter Keating
- Department of History, Université du Québec à Montréal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montréal, Quebec H3T 1N, Canada.
| | - Alberto Cambrosio
- Department of Social Studies of Medicine, McGill University, Peel 3647, Montreal, Quebec H3A 1X1, Canada.
| | - Adriana Aguilar-Mahecha
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec H3T 1E2, Canada.
| | - Mark Basik
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec H3T 1E2, Canada.
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Abstract
INTRODUCTION Advanced urothelial carcinoma is associated with a poor prognosis. In the metastatic setting, the response rate to first-line, cisplatin-containing chemotherapy is high, but survival is poor. Second-line treatment options are limited. Advanced age at diagnosis and the presence of comorbidities often preclude treatment with cisplatin-containing regimens. AREAS COVERED This review addresses the current therapy of urothelial carcinoma, the unmet needs in treatment and the status of drug development in this disease. The molecular targets identified and efforts to incorporate targeted agents into therapy will be addressed. EXPERT OPINION There have been no major advances in the treatment of urothelial carcinoma in three decades. Despite high response rates in the first-line setting, survival is limited. Major impediments to improved outcomes include poor durability of response to first-line chemotherapy and lack of second-line treatments. Better understanding in tumor biology has identified multiple targets in urothelial carcinoma; however, such discoveries have yet to lead to the incorporation of targeted agents into the routine treatment of urothelial carcinoma. Multiple ongoing clinical trials are investigating the use of targeted agents in urothelial carcinoma. Continued efforts are underway to better understand the molecular drivers of disease and such efforts are likely to identify additional therapeutic targets.
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Affiliation(s)
- Benjamin A Gartrell
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medical Oncology , 111 E 210th St, Bronx, NY, 10467 , USA +1 718 920 4826 ; +1 718 798 7474 ;
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Molecular subtyping of early-stage breast cancer identifies a group of patients who do not benefit from neoadjuvant chemotherapy. Breast Cancer Res Treat 2013; 139:759-67. [DOI: 10.1007/s10549-013-2572-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 01/20/2023]
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Schott AF, Hayes DF. Reply to J. Perlmutter et al and D. Yee et al. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.45.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne F. Schott
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Daniel F. Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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