Challenges in Diversity, Equity, and Inclusion in Research and Clinical Oncology

Assessing the Landscape in Medical Education Literature in Medical Oncology: A Scoping Review

PURPOSE

Medical oncology and medical education (ME) have both expanded exponentially over the past 50 years; thus, it is important to understand the current status of postgraduate medical oncology education and develop ways to advance this field. This study undertakes a scoping review of ME literature in medical oncology to inform future scholarship in this area.

METHODS

MEDLINE, Embase, ERIC, and Web of Science were searched to find peer-reviewed English language articles on postgraduate ME in medical oncology published from 2009 to 2020. Established scoping review methodologies were used in study design; articles were classified by specialty, learner training level, region of authorship, institution type, year of publication, journal type, study methodology, and research topic. Curriculum intervention, scholarship, and domain(s) of physician competency were also assessed. The results were interpreted using descriptive statistics and collated using predetermined conceptual frameworks.

RESULTS

A total of 2,959 references were initially found across four databases. After title and abstract screening, 305 articles remained; after full-text review, 144 articles were included in final analysis. Postgraduate medical oncology education research is increasing, with the majority of articles published in North America. Quantitative studies were most common, primarily survey approaches. For physician competencies, professionalism and medical expertise comprised the large majority of article focuses, whereas very few articles addressed leadership or health advocacy. Curriculum development, professional development, and communication skills were dominant research themes while no articles discussed teacher training.

CONCLUSION

Although areas such as professionalism and communication skills are well-studied, medical oncology ME research is lacking in leadership, health advocacy, and teacher training. This study provides valuable guidance for future ME research in medical oncology and establishes a benchmark to examine changes in educational scholarship over time.

Summer Cancer Research Experience for High School Students from Historically Marginalized Populations in Kansas City

The Accelerate Cancer Education (ACE) summer research program at The University of Kansas Cancer Center (KUCC) is a six-week, cancer-focused, summer research experience for high school students from historically marginalized populations in the Kansas City metropolitan area. Cancer affects all populations and continues to be the second leading cause of death in the United States, and a large number of disparities impact racial and ethnic minorities, including increased cancer incidence and mortality. Critically, strategies to bolster diversity, equity, inclusion, and accessibility are needed to address persistent cancer disparities. The ACE program offers an educational opportunity for a population of students who otherwise would not have easy access onto a medical center campus to make connections with cancer physicians and researchers and provides a vital response to the need for a more diverse and expansive oncology workforce. Students grow their technical, social, and professional skills and develop self-efficacy and long-lasting connections that help them matriculate and persist through post-secondary education. Developed in 2018, the ACE program has trained 37 high school junior and senior students. This article describes the need for and how we successfully developed and implemented the ACE program.

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline

PURPOSE

To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.

RECOMMENDATIONS

Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.

DISCUSSION

Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.

Evolution of the Oncologist Clinician Educator

Today’s oncologist clinician educator must promote DEI, well-being, and educational scholarship.

Use of artificial intelligence for cancer clinical trial enrollment: a systematic review and meta-analysis

BACKGROUND

The aim of this study is to provide a comprehensive understanding of the current landscape of artificial intelligence (AI) for cancer clinical trial enrollment and its predictive accuracy in identifying eligible patients for inclusion in such trials.

METHODS

Databases of PubMed, Embase, and Cochrane CENTRAL were searched until June 2022. Articles were included if they reported on AI actively being used in the clinical trial enrollment process. Narrative synthesis was conducted among all extracted data: accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. For studies where the 2x2 contingency table could be calculated or supplied by authors, a meta-analysis to calculate summary statistics was conducted using the hierarchical summary receiver operating characteristics curve model.

RESULTS

Ten articles reporting on more than 50 000 patients in 19 datasets were included. Accuracy, sensitivity, and specificity exceeded 80% in all but 1 dataset. Positive predictive value exceeded 80% in 5 of 17 datasets. Negative predictive value exceeded 80% in all datasets. Summary sensitivity was 90.5% (95% confidence interval [CI] = 70.9% to 97.4%); summary specificity was 99.3% (95% CI = 81.8% to 99.9%).

CONCLUSIONS

AI demonstrated comparable, if not superior, performance to manual screening for patient enrollment into cancer clinical trials. As well, AI is highly efficient, requiring less time and human resources to screen patients. AI should be further investigated and implemented for patient recruitment into cancer clinical trials. Future research should validate the use of AI for clinical trials enrollment in less resource-rich regions and ensure broad inclusion for generalizability to all sexes, ages, and ethnicities.

How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens.

Health Care Utilization and Anti-Cancer Drug Expenditure for Six Solid Cancers in Korea From 2007 to 2019

Background

The burden of care continues to rise considerably worldwide and the challenge of diversity in cancer research has become important. We aimed to examine trends of cancer care utilization and anti-cancer medication among patients with six solid cancers (gastric, colorectal, liver, lung, breast, and prostate cancer) in South Korea.

Methods

This study analyzed patients diagnosed with six types of solid cancer from 2007 to 2019 using data from the National Health Insurance claims database. We analyzed the total number of cancer cases, each patient’s length of stay (LOS) in a hospital, the number of outpatient physician visits, total medical care costs, total out-of-pocket (OOP) costs, and expenditures on anti-cancer drugs.

Results

Utilization of healthcare services and spending on cancer care including anti-cancer drugs both increased in the 13-year study period. The average LOS was the highest for colorectal cancer patients at 43.5 days, and breast cancer patients had the highest average number of physician visits at 11.8. Breast cancer patients had the highest total medical costs (USD 923 million), anti-cancer drug spending (USD 156 million), and the largest increase (5 times) over the 13-year period. The anti-cancer drugs with the largest market shares were ramucirumab for gastric cancer; oxaliplatin for colorectal cancer; sorafenib for liver cancer; pembrolizumab, nivolumab, for lung cancer; trastuzumab for breast cancer; and bicalutamide for prostate cancer.

Conclusion

This study was a large-scale analysis from a nationally representative database of the total population. The study also shows the pattern of cancer care in an Asian country and can provide implications for future cancer research.