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Tchelebi LT, Segovia D, Smith K, Shi Q, Fitzgerald TJ, Chuong MD, Zemla TJ, O'Reilly EM, Meyerhardt JA, Koay EJ, Lowenstein J, Shergill A, Katz MHG, Herman JM. Radiation Therapy Quality Assurance Analysis of Alliance A021501: Preoperative mFOLFIRINOX or mFOLFIRINOX Plus Hypofractionated Radiation Therapy for Borderline Resectable Adenocarcinoma of the Pancreas. Int J Radiat Oncol Biol Phys 2024; 120:111-119. [PMID: 38492812 PMCID: PMC11329353 DOI: 10.1016/j.ijrobp.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Alliance A021501 is the first randomized trial to evaluate stereotactic body radiation therapy (SBRT) for borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemotherapy. In this post hoc study, we reviewed the quality of radiation therapy (RT) delivered. METHODS AND MATERIALS SBRT (6.6 Gy × 5) was intended but hypofractionated RT (5 Gy × 5) was permitted if SBRT specifications could not be met. Institutional credentialing through the National Cancer Institute-funded Imaging and Radiation Oncology Core (IROC) was required. Rigorous RT quality assurance (RT QA) was mandated, including pretreatment review by a radiation oncologist. Revisions were required for unacceptable deviations. Additionally, we performed a post hoc RT QA analysis in which contours and plans were reviewed by 3 radiation oncologists and assigned a score (1, 2, or 3) based on adequacy. A score of 1 indicated no deviation, 2 indicated minor deviation, and 3 indicated a major deviation that could be clinically significant. Clinical outcomes were compared by treatment modality and by case score. RESULTS Forty patients were registered to receive RT (1 planned but not treated) at 27 centers (18 academic and 9 community). Twenty-three centers were appropriately credentialed for moving lung/liver targets and 4 for static head and neck only. Thirty-two of 39 patients (82.1%) were treated with SBRT and 7 (17.9%) with hypofractionated RT. Five cases (13%) required revision before treatment. On post hoc review, 23 patients (59.0%) were noted to have suboptimal contours or plan coverage, 12 (30.8%) were scored a 2, and 11 (28.2%) were scored a 3. There were no apparent differences in failure patterns or surgical outcomes based on treatment technique or post hoc case score. Details related to on-treatment imaging were not recorded. CONCLUSIONS Despite rigorous QA, we encountered variability in simulation, contouring, plan coverage, and dose on trial. Although clinical outcomes did not appear to have been affected, findings from this analysis serve to inform subsequent PDAC SBRT trial designs and QA requirements.
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Affiliation(s)
| | - Diana Segovia
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Koren Smith
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - T J Fitzgerald
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Michael D Chuong
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Tyler J Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | | | | | - Eugene J Koay
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Sheikh S, Bruno DS, Sun Y, Deng V, McClelland S, Obi E, Vinson V, Firstencel A, Lanese B, Lausin L, Dorth JA, Zaorsky NG, Hoy K, Krishnamurthi S. Impact of Clinical Trial Design on Recruitment of Racial and Ethnic Minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02440-x. [PMID: 38637443 DOI: 10.1007/s13187-024-02440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations.
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Affiliation(s)
- Saad Sheikh
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh PA, 15232, USA.
| | - Debora S Bruno
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Yilun Sun
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Victoria Deng
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Shearwood McClelland
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Elizabeth Obi
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Valerie Vinson
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - April Firstencel
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Bob Lanese
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Loretta Lausin
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Jennifer A Dorth
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kevin Hoy
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 44195, USA
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Fountzilas E, Tsimberidou AM, Hiep Vo H, Kurzrock R. Tumor-agnostic baskets to N-of-1 platform trials and real-world data: Transforming precision oncology clinical trial design. Cancer Treat Rev 2024; 125:102703. [PMID: 38484408 DOI: 10.1016/j.ctrv.2024.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
Choosing the right drug(s) for the right patient via advanced genomic sequencing and multi-omic interrogation is the sine qua non of precision cancer medicine. Traditional cancer clinical trial designs follow well-defined protocols to evaluate the efficacy of new therapies in patient groups, usually identified by their histology/tissue of origin of their malignancy. In contrast, precision medicine seeks to optimize benefit in individual patients, i.e., to define who benefits rather than determine whether the overall group benefits. Since cancer is a disease driven by molecular alterations, innovative trial designs, including biomarker-defined tumor-agnostic basket trials, are driving ground-breaking regulatory approvals and deployment of gene- and immune-targeted drugs. Molecular interrogation further reveals the disruptive reality that advanced cancers are extraordinarily complex and individually distinct. Therefore, optimized treatment often requires drug combinations and N-of-1 customization, addressed by a new generation of N-of-1 trials. Real-world data and structured master registry trials are also providing massive datasets that are further fueling a transformation in oncology. Finally, machine learning is facilitating rapid discovery, and it is plausible that high-throughput computing, in silico modeling, and 3-dimensional printing may be exploitable in the near future to discover and design customized drugs in real time.
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Affiliation(s)
- Elena Fountzilas
- Department of Medical Oncology, St Luke's Clinic, Thessaloniki, Greece; European University Cyprus, German Oncology Center, Nicosia, Cyprus
| | - Apostolia-Maria Tsimberidou
- The University of Texas MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics, Houston, TX, USA.
| | - Henry Hiep Vo
- The University of Texas MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics, Houston, TX, USA
| | - Razelle Kurzrock
- WIN Consortium for Precision Medicine, France; Medical College of Wisconsin, USA
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Cheng X, Liu Z, Chang H, Liang W, Li P, Gao Y. WD repeat domain 76 predicts poor prognosis in lower grade glioma and provides an original target for immunotherapy. Eur J Med Res 2024; 29:13. [PMID: 38173030 PMCID: PMC10763342 DOI: 10.1186/s40001-023-01605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The WD40 repeat (WDR) domain provides scaffolds for numerous protein-protein interactions in multiple biological processes. WDR domain 76 (WDR76) has complex functionality owing to its diversified interactions; however, its mechanism in LGG has not yet been reported. METHODS Transcriptomic data from public databases were multifariously analyzed to explore the role of WDR76 in LGG pathology and tumor immunity. Laboratory experiments were conducted to confirm these results. RESULTS The results first confirmed that high expression of WDR76 in LGG was not only positively associated with clinical and molecular features of malignant LGG, but also served as an independent prognostic factor that predicted shorter survival in patients with LGG. Furthermore, high expression of WDR76 resulted in the upregulation of oncogenes, such as PRC1 and NUSAP1, and the activation of oncogenic mechanisms, such as the cell cycle and Notch signaling pathway. Finally, WDR76 was shown to be involved in LGG tumor immunity by promoting the infiltration of immune cells, such as M2 macrophages, and the expression of immune checkpoints, such as PDCD1 (encoding PD-1). CONCLUSIONS This study shows for the first time the diagnostic and prognostic value of WDR76 in LGG and provides a novel personalized biomarker for future targeted therapy and immunotherapy. Thus, WDR76 may significantly improve the prognosis of patients with LGG.
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Affiliation(s)
- Xingbo Cheng
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Zhendong Liu
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Haigang Chang
- Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Wenjia Liang
- People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Pengxu Li
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Yanzheng Gao
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.
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Donzo MW, Nguyen G, Nemeth JK, Owoc MS, Mady LJ, Chen AY, Schmitt NC. Effects of socioeconomic status on enrollment in clinical trials for cancer: A systematic review. Cancer Med 2024; 13:e6905. [PMID: 38169154 PMCID: PMC10807561 DOI: 10.1002/cam4.6905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To achieve equitable access to cancer clinical trials (CCTs), patients must overcome structural, clinical, and attitudinal barriers to trial enrollment. The goal of this systematic review was to study the relationship between socioeconomic status (SES), assessed either by direct or proxy measures, and CCT enrollment. METHODS The review team and medical librarian developed search strategies for each database to identify studies for this systematic review, which was conducted according to PRISMA guidelines. Inclusion criteria were as follows: studies published in relevant scientific journals between January 2000 and July 2022, primary sources, English literature, and studies conducted in the US. Sixteen studies fulfilled the inclusion criteria and were reviewed. The risk of bias assessment was conducted independently by two reviewers using the Newcastle Ottawa scale. RESULTS The initial search yielded 4070 citations, and 16 studies were included in our review. Four of the studies included used patient reported annual income as a measure of SES, while the remaining 12 studies used patient zip code as a proxy measurement of SES. Consistent with our hypothesis, 13 studies showed a positive association between high SES (patient-reported or proxy measurement) and CCT enrollment. Two studies showed a negative association, and one study showed no relationship. CONCLUSIONS The existing literature suggests that low SES is associated with lower participation in CCT. The small number of studies identified on this topic highlights the need for additional research on SES and other barriers to CCT participation.
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Affiliation(s)
- Maja Wichhart Donzo
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Grace Nguyen
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - John K. Nemeth
- Woodruff Health Sciences Center LibraryEmory UniversityAtlantaGeorgiaUSA
| | - Maryanna S. Owoc
- University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Leila J. Mady
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amy Y. Chen
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Nicole C. Schmitt
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
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6
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Gard G, Oakley J, Harold M, Colyer D, Benson W, Gray K, Zeps N, Gibbs P. Facilitating increased participation in clinical trials: what do consumers expect of clinical trial matching websites? Intern Med J 2023; 53:2111-2114. [PMID: 37997269 DOI: 10.1111/imj.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/29/2023] [Indexed: 11/25/2023]
Abstract
Clinical trials offer access to novel therapies and potential major benefits for patients, but identifying and accessing suitable trials remains a significant challenge for consumers. A burgeoning range of online services aims to meet this need; however, there is a paucity of data on whether these services are addressing the requirements and concerns of consumers. Here, we report our findings from a survey of cancer consumers, with results we believe are relevant to the broader research community.
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Affiliation(s)
- Grace Gard
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Joanna Oakley
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- WEHI Consumer Program, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Michael Harold
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Duncan Colyer
- Clinical Research, Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia
| | - Wendy Benson
- WEHI Consumer Program, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Katya Gray
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- WEHI Consumer Program, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Nik Zeps
- Monash Partners, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
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Rhodin KE, Raman V, Kanu E, Eckhoff A, Nussbaum DP, Lidsky ME, Blazer DG. Trends and Disparities in Clinical Trial Enrollment as Part of First-Line Treatment for Upper Gastrointestinal and Hepatopancreatobiliary Malignancies. Ann Surg Oncol 2023; 30:5323-5326. [PMID: 37191858 PMCID: PMC10526627 DOI: 10.1245/s10434-023-13641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Kristen E Rhodin
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Vignesh Raman
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Elishama Kanu
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Austin Eckhoff
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Daniel P Nussbaum
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Michael E Lidsky
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dan G Blazer
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Smith AJB, Alvarez R, Heintz J, Simpkins F, Ko EM. Disparities in clinical trial participation in ovarian cancer: A real-world analysis. Gynecol Oncol 2023; 175:25-31. [PMID: 37300995 DOI: 10.1016/j.ygyno.2023.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer. METHODS We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices. We used multivariable Poisson regression modeling to analyze the association of ever participating in an ovarian cancer clinical drug trial with patient, sociodemographic, health system, and cancer factors. RESULTS Of the 7540 patients with ovarian cancer, 5.0% (95% CI 4.5-5.5) ever participated in a clinical drug trial. Patients of Hispanic or Latino ethnicity were 71% less likely to participate in clinical trials (RR 0.29, 95% CI 0.13-0.61) than non-Hispanic patients, and patients whose race was unknown or other than Black or White were 40% less likely to participate in clinical trials (RR 0.68, 95% CI 0.52-0.89). Patients who had Medicaid insurance were 51% less likely (RR 0.49, 95% CI 0.28-0.87) and those with Medicare were 32% (RR 0.48-0.97) less likely to participate in clinical trials than privately-insured patients. CONCLUSION In this national cohort study, only 5% of patients with ovarian cancer participated in clinical drug trials. Interventions are needed to decrease race, ethnicity, and insurance disparities in clinical trial participation.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.
| | | | - Jonathan Heintz
- Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Fiona Simpkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
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Shinder BM, Kim S, Srivastava A, Patel HV, Jang TL, Mayer TM, Saraiya B, Ghodoussipour SB, Singer EA. Factors associated with clinical trial participation for patients with renal cell carcinoma. Urol Oncol 2023; 41:208.e1-208.e8. [PMID: 36868881 PMCID: PMC10106382 DOI: 10.1016/j.urolonc.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Recruitment of a diverse and representative study population is critical to the external validity of oncology clinical trials. The primary objective of this study was to characterize the factors associated with clinical trial participation for patients with renal cell carcinoma and the secondary objective was to examine differences in survival outcomes. MATERIALS AND METHODS We used a matched case-control design by querying the National Cancer Database for patients with renal cell carcinoma who were coded as having enrolled in a clinical trial. Trial patients were matched in a 1:5 ratio to the control cohort based on clinical stage and then sociodemographic variables were compared between the 2 groups. Multivariable conditional logistic regression models evaluated factors associated with clinical trial participation. The trial patient cohort was then matched again in a 1:10 ratio based on age, clinical stage, and comorbidities. Log-rank test was used to compare overall survival (OS) between these groups. RESULTS From 2004 to 2014, 681 patients enrolled in clinical trials were identified. Clinical trial patients were significantly younger and had a lower Charlson-Deyo comorbidity score. On multivariate analysis, male patients and white patients were more likely to participate compared to their Black counterparts. Having Medicaid or Medicare negatively associated with trial participation. Median OS was greater among clinical trial participants. CONCLUSION Patient sociodemographic factors remain significantly associated with clinical trial participation and trial participants experienced superior OS to their matched counterparts.
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Affiliation(s)
- Brian M Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sinae Kim
- Section of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum B Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH.
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10
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Jorge S, Masshoor S, Gray HJ, Swisher EM, Doll KM. Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials. J Natl Compr Canc Netw 2023; 21:27-32.e2. [PMID: 36634612 DOI: 10.6004/jnccn.2022.7068] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. METHODS In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access-related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. RESULTS Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11-0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12-0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. CONCLUSIONS Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.
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Affiliation(s)
- Soledad Jorge
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | | | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
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11
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Lee B, Gately L, Lok SW, Tran B, Lee M, Wong R, Markman B, Dunn K, Wong V, Loft M, Jalili A, Anton A, To R, Andrews M, Gibbs P. Leveraging Comprehensive Cancer Registry Data to Enable a Broad Range of Research, Audit and Patient Support Activities. Cancers (Basel) 2022; 14:cancers14174131. [PMID: 36077668 PMCID: PMC9454529 DOI: 10.3390/cancers14174131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Registry data has the potential to support a broad range of research, audit and education initiatives. Here, we describe the experience and learnings of a series of large multi-institutional cancer registries that leverage real-world clinical data for a range of purposes, that informs the conduct and output of each registry in a virtuous cycle. Lessons learnt include the need for careful and continuous curation of information being collected, regular database updates, and the need for a continued focus on data quality. As a standalone resource, each registry has supported numerous projects, but linkage with external datasets with patients in common has enhanced the research potential. Multiple projects have linked registry data with matched tissue specimens to support the discovery and valiation of prognostic and predictive markers in the tumour and blood specimens. Registry-based biomarker trials have been successfully supported, generating novel and practice-changing data. Registry-based clinical trials, particularly studies exploring the best use of drug options are now complementing the research conducted in traditional clinical trials. More recent projects supported by the registries include health economic studies, personalised patient education material, and increased consumer engagement, including consumer entered data. Abstract Traditional cancer registries have often been siloed efforts, established by single groups with limited objectives. There is the potential for registry data to support a broad range of research, audit and education initiatives. Here, we describe the establishment of a series of comprehensive cancer registries across the spectrum of common solid cancers. The experience and learnings of each registry team as they develop, implement and then use collected data for a range of purposes, that informs the conduct and output of other registries in a virtuous cycle. Each registry is multi-site, multi-disciplinary and aims to collect data of maximal interest and value to a broad range of enquiry, which would be accessible to any researcher with a high-quality proposal. Lessons learnt include the need for careful and continuous curation of data fields, with regular database updates, and the need for a continued focus on data quality. The registry data as a standalone resource has supported numerous projects, but linkage with external datasets with patients in common has enhanced the audit and research potential. Multiple projects have linked registry data with matched tissue specimens to support prognostic and predictive biomarker studies, both validation and discovery. Registry-based biomarker trials have been successfully supported, generating novel and practice-changing data. Registry-based clinical trials, particularly randomised studies exploring the optimal use of available therapy options are now complementing the research conducted in traditional clinical trials. More recent projects supported by the registries include health economic studies, personalised patient education material, and increased consumer engagement, including consumer entered data.
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Affiliation(s)
- Belinda Lee
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Northern Health, Epping, VIC 3076, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence:
| | - Lucy Gately
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Cabrini Haematology and Oncology Centre, Malvern, VIC 3144, Australia
| | - Sheau Wen Lok
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Ben Tran
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Margaret Lee
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
| | - Rachel Wong
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
- Eastern Health Clinical School, Monash University, Clayton, VIC 3800, Australia
| | - Ben Markman
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Kate Dunn
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Vanessa Wong
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Ballarat Health Service, Ballarat Central, VIC 3350, Australia
| | - Matthew Loft
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Azim Jalili
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Northern Health, Epping, VIC 3076, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
| | - Angelyn Anton
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
| | - Richard To
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
| | - Miles Andrews
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter Gibbs
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
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12
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Elshami M, Hue JJ, Hoehn RS, Rothermel LD, Bajor D, Mohamed A, Selfridge JE, Chavin KD, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. A nationwide analysis of clinical trial participation for common hepato-pancreato-biliary malignancies demonstrates survival advantages for subsets of trial patients but disparities in and infrequency of enrollment. HPB (Oxford) 2022; 24:1280-1290. [PMID: 35063353 DOI: 10.1016/j.hpb.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND We describe factors associated with trial enrollment for patients with hepato-pancreato-biliary (HPB) malignancies. We analyzed the association and effect of trial enrollment on overall survival (OS). METHODS The National Cancer Database (2004-2017) was queried for common HPB malignancies (pancreatic adenocarcinoma [PDAC] & neuroendocrine tumors, hepatocellular carcinoma [HCC], biliary tract cancers [BTC]). Multivariable logistic regression was used to identify factors associated with trial enrollment. OS was analyzed by multivariable Cox regression. Inverse-probability-weighted Cox regression was utilized to determine the effect of trial enrollment on OS. RESULTS A total of 1573 (0.3%) of 511,639 patients were enrolled in trials; pancreatic malignancy: 1214 (0.4%); HCC: 217 (0.14%); BTC: 106 (0.15%). HCC and BTC were associated with lower likelihood of enrollment compared with pancreatic malignancy. Black and Hispanic patients were less likely to be enrolled compared to White patients. Treatment at academic facilities and metastatic disease were associated with higher likelihood of enrollment. Enrollment was associated with higher OS for PDAC, metastatic HCC, and metastatic BTC. Trial enrollment exhibited an OS advantage for PDAC and metastatic HCC. CONCLUSION Nationally, fewer than 1% of patients with HPB malignancies were enrolled in clinical trials. There are racial, sociodemographic, and facility-based disparities in trial enrollment.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richard S Hoehn
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luke D Rothermel
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Bajor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mohamed
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer E Selfridge
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth D Chavin
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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13
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Okado I, Pagano I, Cassel K, Su'esu'e A, Rhee J, Berenberg J, Holcombe RF. Clinical Research Professional Providing Care Coordination Support: A Study of Hawaii Minority/Underserved NCORP Community Site Trial Participants. JCO Oncol Pract 2022; 18:e1114-e1121. [PMID: 35294261 PMCID: PMC10530402 DOI: 10.1200/op.21.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/23/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although effective care coordination (CC) is recognized as a vital component of a patient-centered, high-quality cancer care delivery system, CC experiences of patients who enroll and receive treatment through clinical trials (CTs) are relatively unknown. Using mixed methods, we examined perceptions of CC among patients enrolled onto therapeutic CTs through the Hawaii Minority/Underserved National Cancer Institute Community Oncology Research Program. METHODS The Care Coordination Instrument, a validated instrument, was used to measure patients' perceptions of CC among CT participants (n = 45) and matched controls (n = 45). Paired t-tests were used to compare overall and three CC domain scores (Communication, Navigation, and Operational) between the groups. Semistructured focus group interviews were conducted virtually with 14 CT participants in 2020/2021. RESULTS CT participants reported significantly higher total CC scores than non-CT participants (P = .0008). Similar trends were found for Navigation and Operational domain scores (P = .007 and .001, respectively). Twenty-nine percent of CT participants reported receiving high-intensity CC assistance from their clinical research professionals (CRPs). Content analysis of focus group discussions revealed that nearly half of the focus group discussions centered on CRPs (47%), including CC support provided by CRPs (26%). Other key themes included general CT experiences (22%) and CRP involvement as an additional benefit to CT participation (15%). CONCLUSION Our results show that patients on CTs in this study had a more positive CC experience. This may be attributable in part to CC support provided by CRPs. These findings highlight both the improved experience of treatment for patients participating in a trial and the generally unrecognized yet integral role of CRPs as part of a cancer CT care team.
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Affiliation(s)
- Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI
| | - Kevin Cassel
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Jessica Rhee
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Randall F. Holcombe
- University of Hawaii Cancer Center, Honolulu, HI
- Current Affiliation: University of Vermont Cancer Center, Burlington, VT
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14
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Presti D, Havas J, Soldato D, Lapidari P, Martin E, Pistilli B, Jouannaud C, Emile G, Rigal O, Fournier M, Soulie P, Mouret-Reynier MA, Tarpin C, Campone M, Guillermet S, Martin AL, Everhard S, Di Meglio A. Factors associated with enrolment in clinical trials among women with early-stage breast cancer. ESMO Open 2022; 7:100513. [PMID: 35724624 PMCID: PMC9271499 DOI: 10.1016/j.esmoop.2022.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer. Methods We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment. Results Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707). Conclusions In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment. The proportion of patients who access innovation through participation in clinical trials is generally limited. Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings. Clinical and geographical factors were associated to access to innovation in clinical trials. Enrolment in clinical trials is associated with better quality of life and clinical outcomes.
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Affiliation(s)
- D Presti
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - J Havas
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - D Soldato
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - P Lapidari
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - E Martin
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - G Emile
- Centre François Baclesse, Caen, France
| | - O Rigal
- Centre Henri Becquerel, Rouen, France
| | | | - P Soulie
- Institut de Cancérologie de L'ouest -Paul Papin, Angers, France
| | | | - C Tarpin
- Institut Paoli Calmettes, Marseille, France
| | - M Campone
- Institut de Cancérologie de l'Ouest - Site de Nantes - Centre René Gauducheau, Nantes, France
| | | | | | | | - A Di Meglio
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.
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15
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Bruno DS, Hess LM, Li X, Su EW, Patel M. Disparities in Biomarker Testing and Clinical Trial Enrollment Among Patients With Lung, Breast, or Colorectal Cancers in the United States. JCO Precis Oncol 2022; 6:e2100427. [PMID: 35737912 DOI: 10.1200/po.21.00427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Comprehensive tumor biomarker testing is a fundamental step in the selection of highly effective molecularly driven therapies for a variety of solid tumors. The primary objective of this study was to examine racial differences in biomarker testing and clinical trial participation in the United States using a real-world database. METHODS Patients in a real-world deidentified database diagnosed with advanced/metastatic non-small-cell lung cancer (NSCLC), metastatic colorectal cancer (CRC), or metastatic breast cancer were eligible. Biomarker testing and clinical trial participation was compared between Black and White racial groups using chi-squared test and stepwise logistic regression controlling for baseline covariates. RESULTS A total of 23,488 patients met eligibility criteria. Next-generation sequencing (NGS) testing rates differed significantly between White versus Black race before first-line therapy (36.6% v 29.7%, P < .0001) and at any given time (54.7% v 43.8%, P < .0001) in the nonsquamous NSCLC cohort. Similar disparities in NGS testing rates at any time during the study were observed among patients with CRC (White 51.6%; Black 41.8%, P < .0001). No differences were observed in the breast cancer cohort. Patients of Black race were less likely to be treated in a clinical trial in the overall NSCLC cohort when compared with White counterparts (3.9% v 2.1%, P = .0002). A statistically significant relationship between biomarker/NGS testing and clinical trial enrollment was observed in all cohorts (P < .003) after adjusting for covariates. CONCLUSION In a real-world database, significant disparities in NGS-based testing rates were observed between Black and White races in NSCLC and CRC. NGS and any biomarker testing were both associated with trial enrollment in all cohorts. There is a need for interventions to promote access to comprehensive testing for patients with advanced/metastatic tumors.
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Affiliation(s)
- Debora S Bruno
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Cleveland, OH
| | | | | | | | - Monaliben Patel
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Cleveland, OH
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16
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Espinoza-Gutarra MR, Duma N, Aristizabal P, Segarra-Vazquez B, Borno H, Halbert CH, Simon MA, Velazquez AI. The Problem of Hispanic/Latinx Under-Representation in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:380-384. [PMID: 35544652 DOI: 10.1200/op.22.00214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Narjust Duma
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Paula Aristizabal
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, San Diego, CA.,Rady Children's Hospital San Diego, Peckham Center for Cancer and Blood Disorders, San Diego, CA.,University of California San Diego Moores Cancer Center, Population Sciences Disparities and Community Engagement, San Diego, CA
| | | | - Hala Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Melissa A Simon
- Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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17
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Joshi M, Polimera H, Krupski T, Necchi A. Geography Should Not Be an "Oncologic Destiny" for Urothelial Cancer: Improving Access to Care by Removing Local, Regional, and International Barriers. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35471833 DOI: 10.1200/edbk_350478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urothelial cancer care is particularly susceptible to geographical health disparity given its complex nature, requiring access to several specialists such as a urologist, a medical oncologist, a radiation oncologist, a surgical oncologist, and multidisciplinary care teams. Furthermore, other barriers to care access in underserved areas include travel burden, longer wait times, late-stage disease at the time of diagnosis, cost, type of treatment, less enrollment in clinical trials, lack of follow-up among cancer survivors, and less research funding in this area. Here, we discuss the impact of geographical location on access to urothelial cancer care, management decisions, and outcomes and we reflect on how to address geographical disparities in care delivery.
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Affiliation(s)
- Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Hyma Polimera
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Tracey Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Andrea Necchi
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS Ospedale San Raffaele, Milan, Italy
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18
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Zaorsky NG, Wang X, Garrett SM, Lehrer EJ, Lin C, DeGraff DJ, Spratt DE, Trifiletti DM, Kishan AU, Showalter TN, Park HS, Yang JT, Chinchilli VM, Wang M. Pan-cancer analysis of prognostic metastatic phenotypes. Int J Cancer 2022; 150:132-141. [PMID: 34287840 PMCID: PMC8595638 DOI: 10.1002/ijc.33744] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
Although cancer is highly heterogeneous, all metastatic cancer is considered American Joint Committee on Cancer (AJCC) Stage IV disease. The purpose of this project was to redefine staging of metastatic cancer. Internal validation of nationally representative patient data from the National Cancer Database (n = 461 357; 2010-2013), and external validation using the Surveillance, Epidemiology and End Results database (n = 106 595; 2014-2015) were assessed using the concordance index for evaluation of survival prediction. A Cox proportional hazards model was used for overall survival by considering identified phenotypes (latent classes) and other confounding variables. Latent class analysis was performed for phenotype identification, where Bayesian information criterion (BIC) and sample-size-adjusted BIC were used to select the optimal number of distinct clusters. Kappa coefficients assessed external cluster validation. Latent class analysis identified five metastatic phenotypes with differences in overall survival (P < .0001): (Stage IVA) nearly exclusive bone-only metastases (n = 59 049, 12.8%; median survival 12.7 months; common in lung, breast and prostate cancers); (IVB) predominant lung metastases (n = 62 491, 13.5%; 11.4 months; common in breast, stomach, kidney, ovary, uterus, thyroid, cervix and soft tissue cancers); (IVC) predominant liver/lung metastases (n = 130 014, 28.2%; 7.0 months; common in colorectum, pancreatic, lung, esophagus and stomach cancers); (IVD) bone/liver/lung metastases predominant over brain (n = 61 004, 13.2%; 5.9 months; common in lung and breast cancers); and (IVE) brain/lung metastases predominant over bone/liver (n = 148 799, 32.3%; 5.7 months; lung cancer and melanoma). Long-term survivors were identified, particularly in Stages IVA-B. A pan-cancer nomogram model to predict survival (STARS: site, tumor, age, race, sex) was created, validated and provides 13% better prognostication than AJCC: 1-month concordance index of 0.67 (95% confidence interval [CI]: 0.66-0.67) vs 0.61 (95% CI: 0.60-0.61). STARS is simple, uses easily accessible variables, better prognosticates survival outcomes and provides a platform to develop novel metastasis-directed clinical trials.
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Affiliation(s)
- Nicholas G. Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA,Corresponding author: Nicholas G. Zaorsky, MD MS, Department of Radiation Oncology, Penn State Cancer Institute and Department of Public Health Sciences, Penn State College of Medicine, ; , Twitter: @NicholasZaorsky
| | - Xi Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sara M. Garrett
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David J. DeGraff
- Division of Experimental Pathology, Department of Pathology and Laboratory Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | | | - Henry S. Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Jonathan T. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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19
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Torres MB, Dixon MEB, Gusani NJ. Undertreatment of Pancreatic Cancer: The Intersection of Bias, Biology, and Geography. Surg Oncol Clin N Am 2021; 31:43-54. [PMID: 34776063 DOI: 10.1016/j.soc.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Black patients with pancreatic cancer experience higher incidence and increased mortality. Although racial biologic differences exist, socioeconomic status, insurance type, physician bias, and patient beliefs contribute to the disparities in outcomes observed among patients who are Black, indigenous, and people of color.
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Affiliation(s)
- Madeline B Torres
- General Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H149, Hershey, PA 17033, USA. https://twitter.com/MadelineBTorres
| | - Matthew E B Dixon
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H070, Hershey, PA 17036, USA. https://twitter.com/mebdixon
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL 32207, USA.
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20
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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21
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Zaorsky NG, Khunsriraksakul C, Acri SL, Liu DJ, Ba DM, Lin JL, Liu G, Segel JE, Drabick JJ, Mackley HB, Leslie DL. Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US. JAMA Netw Open 2021; 4:e2127784. [PMID: 34613403 PMCID: PMC8495533 DOI: 10.1001/jamanetworkopen.2021.27784] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Currently, there are limited published data regarding resource use and spending on cancer care in the US. OBJECTIVE To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. EXPOSURES Evaluation and management as prescribed by treating care team. MAIN OUTCOMES AND MEASURES Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. RESULTS The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). CONCLUSIONS AND RELEVANCE This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US.
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Affiliation(s)
- Nicholas G. Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Samantha L. Acri
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John L. Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joel E. Segel
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Pennsylvania State University, University Park
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Joseph J. Drabick
- Department of Medical Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B. Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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22
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Eng C, Chen EY, Rogers J, Lewis M, Strosberg J, Thota R, Krishnamurthi S, Oberstein P, Govindarajan R, Buchschacher G, Patel S, Sohal D, Al-Toubah T, Philip P, Dasari A, Kennecke H, Stein S. Moving Beyond the Momentum: Innovative Approaches to Clinical Trial Implementation. JCO Oncol Pract 2021; 17:607-614. [PMID: 33534616 PMCID: PMC8791825 DOI: 10.1200/op.20.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
Despite efforts to enhance enrollment and the merger of national cooperative groups, < 5% of patients with cancer will enroll into a clinical trial. Additionally, clinical trials are affected by a lack of diversity inclusive of minority patients, rural residents, or low-income individuals. COVID-19 further exacerbated known barriers of reduced physician-patient interaction, physician availability, trial activation and enrollment, financial resources, and capacity for conducting research. Based on the cumulative insight of academic and community clinical researchers, we have created a white paper identifying existing challenges in clinical trial conduct and have provided specific recommendations of sustainable modifications to improve efficiency in the activation and conduct of clinical trials with an overarching goal of providing improved access and care to our patients with cancer.
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Affiliation(s)
- Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Emerson Y. Chen
- Division of Hematology and Oncology, Oregon Health and Science University, Knight Cancer Institute, Portland, OR
| | - Jane Rogers
- University of Texas MD Anderson Cancer Center Pharmacy Clinical Programs, Houston, TX
| | | | | | | | | | | | - Rang Govindarajan
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas, Little Rock, AR
| | | | - Sandip Patel
- Moores Cancer Center, UC San Diego Health, La Jolla, CA
| | - Davendra Sohal
- University of Cincinnati Health Barrett Cancer Center, Cincinnati, OH
| | | | | | - Arvind Dasari
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stacey Stein
- Smilow Cancer Center, Yale School of Medicine, New Haven, CT
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23
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Tchelebi LT, Shen B, Wang M, Gusani NJ, Walter V, Abrams R, Verma V, Zaorsky NG. Impact of radiation therapy facility volume on survival in patients with cancer. Cancer 2021; 127:4081-4090. [PMID: 34398470 DOI: 10.1002/cncr.33777] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study examined whether radiation therapy facility volumes correlate with survival after curative intent treatment of solid tumors. METHODS The National Cancer Database was queried for patients with solid tumors treated with curative-intent radiation therapy from 2004-2013. Facilities were stratified into 4 volume categories: low, intermediate, high, and very high. Primary cancer sites were divided into neoadjuvant, adjuvant, or definitive radiation subgroups. Kaplan-Meier curves of 5-year postradiation survival probability, stratified by facility volume, were generated with log-rank tests for group comparisons. Cox proportional hazard models were used to evaluate the effect of facility volume on survival, adjusted for multiple covariates. RESULTS There were 253,422 patients treated at 1289 facilities: 6231 received neoadjuvant radiation, 147,980 received adjuvant radiation, and 99,211 received definitive radiation without surgery. Among patients receiving neoadjuvant radiation, survival correlated with facility volume for patients with rectal cancer (hazard ratio [HR], 0.75; 95% CI, 0.6-0.94; P = .01). For cancers of the breast and uterus, patients receiving adjuvant radiation at very high-volume facilities (vs low volume) had improved survival (HR, 0.83; 95% CI, 0.77-0.90; P < .001 and HR, 0.77, 95% CI, 0.62-0.97; P = .03, respectively). For patients receiving definitive radiation for prostate, non-small cell lung, pancreas, and head and neck cancer, there was an improvement in survival for patients treated at very high-volume centers (P < .05). CONCLUSIONS For select cancer patients, treatment with curative radiation at higher volume facilities is associated with improved survival. In particular, patients receiving radiation therapy in the definitive setting without surgery may benefit most from treatment at high-volume centers.
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Affiliation(s)
- Leila T Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Niraj J Gusani
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vonn Walter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ross Abrams
- Department of Radiation Oncology, Sharett Cancer Institute, Hadassah Medical Center, Ein Kerem Jerusalem, Israel
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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24
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Stoltzfus KC, Shen B, Tchelebi L, Trifiletti DM, Gusani NJ, Walter V, Wang M, Zaorsky NG. Authors' Reply: To the Letter to the Editor by Kessel et al. J Natl Compr Canc Netw 2021; 19:xliii-xliv. [PMID: 34340211 DOI: 10.6004/jnccn.2021.7068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Biyi Shen
- bPenn State College of Medicine, Hershey, Pennsylvania
| | | | | | - Niraj J Gusani
- bPenn State College of Medicine, Hershey, Pennsylvania.,dBaptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Vonn Walter
- bPenn State College of Medicine, Hershey, Pennsylvania
| | - Ming Wang
- bPenn State College of Medicine, Hershey, Pennsylvania
| | - Nicholas G Zaorsky
- aPenn State Cancer Institute, Hershey, Pennsylvania.,bPenn State College of Medicine, Hershey, Pennsylvania
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25
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Almodallal Y, Le-Rademacher JG, Cook KD, Yadav S, Singh AB, Lee M, Lammert LM, Jatoi A. Observations with alpelisib in older patients (≥ 65 year of age) with breast cancer in a non-clinical trial setting. Breast Cancer Res Treat 2021; 188:15-20. [PMID: 34117959 DOI: 10.1007/s10549-021-06277-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Alpelisib is newly-available breast cancer agent that targets PIK3 mutations and confers a somewhat unusual adverse event profile. This study focused on older patients (≥ 65 years of age) treated outside a clinical trial to gain further experience on how these under-studied patients do with this new agent. METHODS This descriptive, multi-site study relied on medical record review. RESULTS Fifty-one older breast cancer patients were started on alpelisib between May 2019 and September 2020. The median age and number of comorbidities at alpelisib initiation was 71 years and 4, respectively. Thirty-five patients had stopped alpelisib (median time on drug 2.6 months (range: < 1, 9.5 months)) for the following reasons: alpelisib adverse events (n = 15), cancer progression (n = 13), and other/unknown (n = 7). Alpelisib adverse events included hyperglycemia (n = 37), diarrhea (n = 23), rash (n = 19), fatigue (n = 12), and mouth sores (n = 7); (numbers in parentheses indicate the number of patients with at least one such event). Five patients were hospitalized for hyperglycemia. At the time of report, 14 patients were deceased, and median survival had not been reached. CONCLUSION Older patients might derive further benefit from alpelisib if the adverse event profile of this agent, particularly the hyperglycemia, were able to be better managed.
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Affiliation(s)
- Yahya Almodallal
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Kathryn D Cook
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Siddhartha Yadav
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amrit B Singh
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Minji Lee
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lisa M Lammert
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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26
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Sae-Hau M, Disare K, Michaels M, Gentile A, Szumita L, Treiman K, Weiss ES. Overcoming Barriers to Clinical Trial Participation: Outcomes of a National Clinical Trial Matching and Navigation Service for Patients With a Blood Cancer. JCO Oncol Pract 2021; 17:e1866-e1878. [PMID: 34077244 DOI: 10.1200/op.20.01068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There are numerous barriers to cancer clinical trial participation in the United States. This paper describes the approach and outcomes of The Leukemia & Lymphoma Society's Clinical Trial Support Center (CTSC), whose nurse navigators assist patients with a blood cancer and their oncologists by identifying all appropriate trials based on clinical data and patient preference, facilitating informed and shared decision making, and minimizing enrollment barriers. METHODS Data on patients served from October 2017 to October 2019 were analyzed using bivariate and multivariate analyses to determine demographic and clinical characteristics associated with enrollment. Reasons for nonenrollment were examined. RESULTS The CTSC opened 906 patient cases during this time frame. Among all US patients with a closed case (n = 750), the clinical trial enrollment rate was 16.1%. Among those with a known enrollment outcome after a trial search (n = 537), the enrollment rate was 22.5%. Multivariate analysis controlling for variables significant in bivariate analyses (insurance, treatment status, Eastern Cooperative Oncology Group performance status, and urban or rural residence) revealed that patients with Medicaid were less likely to enroll than those with private or commercial insurance (adjusted odds ratio, 0.054; CI, 0.003 to 0.899), and patients in treatment or maintenance were less likely to enroll than those relapsed or refractory to most recent therapy (adjusted odds ratio, 0.312; CI, 0.139 to 0.702). Primary reasons for nonenrollment were preference for standard of care (66.3%) and patient passed away (16.1%). CONCLUSION The CTSC is an effective, replicable model for addressing multilevel barriers to clinical trial participation. The findings highlight the need to increase opportunities for trial participation sooner after diagnosis and among patients with Medicaid.
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Affiliation(s)
| | - Kate Disare
- The Leukemia & Lymphoma Society, Rye Brook, NY
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27
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Hoffman-Censits J, Kanesvaran R, Bangs R, Fashoyin-Aje L, Weinstock C. Breaking Barriers: Addressing Issues of Inequality in Trial Enrollment and Clinical Outcomes for Patients With Kidney and Bladder Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e174-e181. [PMID: 34061566 DOI: 10.1200/edbk_320273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recent treatment advances, kidney and bladder cancer cases have continued to rise in both incidence and mortality over the last few decades. Not every demographic subgroup of patients diagnosed with these cancers has an equivalent outcome. Women diagnosed with bladder cancer have worse overall survival than men diagnosed with bladder cancer. Older adults with muscle-invasive bladder cancer have worse cancer-specific outcomes than do younger patients. Black patients diagnosed with kidney and bladder cancers appear to have worse overall survival than White patients diagnosed with these cancers. Although these differences in outcomes are likely multifactorial, in many cases they may be based on modifiable approaches to screening, diagnosing, and treating patients. We explore various causes of these differences in outcomes between patients and address patient engagement strategies and avenues to effect change. In 2021, equity in cancer and cancer care delivery has a more prominent place in the hierarchy of the continuum of medicine. Continued focus on this topic is critical, with clear accountabilities established and barriers to best care for patients eliminated.
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Affiliation(s)
| | | | | | - Lola Fashoyin-Aje
- Office of Oncologic Diseases, U.S. Food and Drug Administration, White Oak, MD
| | - Chana Weinstock
- Office of Oncologic Diseases, U.S. Food and Drug Administration, White Oak, MD
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28
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Kirshner J, Cohn K, Dunder S, Donahue K, Richey M, Larson P, Sutton L, Siu E, Donegan J, Chen Z, Nightingale C, Estévez M, Hamrick HJ. Automated Electronic Health Record-Based Tool for Identification of Patients With Metastatic Disease to Facilitate Clinical Trial Patient Ascertainment. JCO Clin Cancer Inform 2021; 5:719-727. [PMID: 34197178 DOI: 10.1200/cci.20.00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To facilitate identification of clinical trial participation candidates, we developed a machine learning tool that automates the determination of a patient's metastatic status, on the basis of unstructured electronic health record (EHR) data. METHODS This tool scans EHR documents, extracting text snippet features surrounding key words (such as metastatic, progression, and local). A regularized logistic regression model was trained and used to classify patients across five metastatic categories: highly likely and likely positive, highly likely and likely negative, and unknown. Using a real-world oncology database of patients with solid tumors with manually abstracted information as reference, we calculated sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We validated the performance in a real-world data set, evaluating accuracy gains upon additional user review of tool's outputs after integration into clinic workflows. RESULTS In the training data set (N = 66,532), the model sensitivity and specificity (% [95% CI]) were 82.4 [81.9 to 83.0] and 95.5 [95.3 to 96.7], respectively; the PPV was 89.3 [88.8 to 90.0], and the NPV was 94.0 [93.8 to 94.2]. In the validation sample (n = 200 from five distinct care sites), after user review of model outputs, values increased to 97.1 [85.1 to 99.9] for sensitivity, 98.2 [94.8 to 99.6] for specificity, 91.9 [78.1 to 98.3] for PPV, and 99.4 [96.6 to 100.0] for NPV. The model assigned 163 of 200 patients to the highly likely categories. The error prevalence was 4% before and 2% after user review. CONCLUSION This tool infers metastatic status from unstructured EHR data with high accuracy and high confidence in more than 75% of cases, without requiring additional manual review. By enabling efficient characterization of metastatic status, this tool could mitigate a key barrier for patient ascertainment and clinical trial participation in community clinics.
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Affiliation(s)
- Jeffrey Kirshner
- Hematology Oncology Associates of Central New York, East Syracuse, NY
| | - Kelly Cohn
- Hematology Oncology Associates of Central New York, East Syracuse, NY
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29
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Zaorsky NG, Liang M, Patel R, Lin C, Tchelebi LT, Newport KB, Fox EJ, Wang M. Survival after palliative radiation therapy for cancer: The METSSS model. Radiother Oncol 2021; 158:104-111. [PMID: 33610623 PMCID: PMC9074852 DOI: 10.1016/j.radonc.2021.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND We propose a predictive model that identifies patients at greatest risk of death after palliative radiotherapy, and subsequently, can help medical professionals choose treatments that better align with patient choice and prognosis. METHODS The National Cancer Database was queried for recipients of palliative radiotherapy during first course of treatment. Cox regression models and adjusted hazard ratios with 95% confidence intervals were used to evaluate survival predictors. The mortality risk index was calculated using predictors from the estimated Cox regression model, with higher values indicating higher mortality risk. Based on tertile cutpoints, patients were divided into low, medium, and high risk groups. RESULTS A total of 68,505 patients were included from 2010-2014, median age 65.7 years. Several risk factors were found to predict survival: (1) location of metastases (liver, bone, lung, and brain); (2) age; (3) tumor primary (prostate, breast, lung, other); (4) gender; (5) Charlson-Deyo comorbidity score; and (6) radiotherapy site. The median survival times were 11.66 months, 5.09 months, and 3.28 months in the low (n=22,621), medium (n=22,638), and high risk groups (n=22,611), respectively. A nomogram was created and validated to predict survival, available online, https://tinyurl.com/METSSSmodel. Harrel's C-index was 0.71 and receiver operator characteristic area under the curve was 0.76 at 4 years. CONCLUSION We created a predictive nomogram for survival of patients receiving palliative radiotherapy during their first course of treatment (named METSSS), based on Metastases location, Elderly (age), Tumor primary, Sex, Sickness/comorbidity, and Site of radiotherapy.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA.
| | - Menglu Liang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Rutu Patel
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA
| | - Leila T Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA
| | - Kristina B Newport
- Department of Medicine, Section of Palliative Care, Penn State College of Medicine, Hershey, USA
| | - Edward J Fox
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
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30
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Walker AJ, DeWeese TL, Viswanathan AN. Drug-Radiotherapy Combinations in 2020-A Landmark Year? JAMA Oncol 2021; 7:349-350. [PMID: 33270093 DOI: 10.1001/jamaoncol.2020.6139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amanda J Walker
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Bethesda, Maryland
| | - Theodore L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Bethesda, Maryland
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Bethesda, Maryland
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31
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Li AJ, Dhanraj JP, Lopes G, Parker JL. Clinical trial risk in leukemia: Biomarkers and trial design. Hematol Oncol 2020; 39:105-113. [PMID: 33078436 DOI: 10.1002/hon.2818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
This study analyzed the risk of clinical trial failure for leukemia drug development between January 1999 and January 2020. The specific leukemia subtypes of interest were acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). Drug development was investigated using data obtained from https://www.clinicaltrials.gov and other publicly available databases. Drug compounds were excluded if they began phase I testing for the indication of interest before January 1999, if they were not industry sponsored, or if they treated secondary complications of the disease. Further analysis was conducted on biomarker usage, drug mechanisms of action, and line of treatment. Drugs were identified following our inclusion criteria for ALL (72), CLL (106), AML (159), and CML (47). The likelihood (cumulative pass rate), a drug would pass all phases of clinical testing and obtain Food and Drug Administration approval, was 18% (ALL), 10% (CLL), 7% (AML), and 12% (CML). Biomarker targeted therapies improved the success rates by three- and sevenfold, for ALL and AML, respectively. Enzyme inhibitors doubled the cumulative success rate for AML. First-line therapy and kinase inhibitors both independently doubled the cumulative success rate for CLL. Oncologists enrolling patients in clinical trials can increase success rates by up to sevenfold by prioritizing participation in trials involving biomarker usage, while consideration of factors such as drug mechanism of action and line of therapy can further double the clinical trial success rate.
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Affiliation(s)
- Alice J Li
- Institute for Management and Innovation, Master of Biotechnology Program, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Jasper P Dhanraj
- Institute for Management and Innovation, Master of Biotechnology Program, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Gilberto Lopes
- Department of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Jayson L Parker
- Institute for Management and Innovation, Master of Biotechnology Program, University of Toronto Mississauga, Mississauga, Ontario, Canada.,Department of Biology, University of Toronto Mississauga, Mississauga, Ontario, Canada
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32
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Park HSM. Cancer Clinical Trial Enrollment: OK Doc, but What's in It for Me? J Natl Compr Canc Netw 2019; 17:1404-1405. [PMID: 31693990 DOI: 10.6004/jnccn.2019.7365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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