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Wahid KA, Rooney MK, Gunther JR, Moreno AC, Pinnix CC, Thomas CR, Fuller CD. Empirically Derived Principles for Research Funding Success: A Primer for Early Career Academic Investigators. Int J Radiat Oncol Biol Phys 2024; 118:590-594. [PMID: 38340768 PMCID: PMC10914061 DOI: 10.1016/j.ijrobp.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/11/2023] [Accepted: 09/18/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Kareem A Wahid
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Michael K Rooney
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jillian R Gunther
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Moreno
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chelsea C Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles R Thomas
- Radiation Oncology Department, Dartmouth Cancer Center & Geisel School of Medicine, Lebanon, New Hampshire
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Hsu EJ, Lin TA, Dabush DR, McCaw Z, Koong A, Lin C, Abi Jaoude J, Patel R, Kouzy R, El Alam MB, Noticewala S, Yang Y, Sherry AD, Fuller CD, Thomas CR, Tang C, Msaouel P, Das P, Huang B, Tian L, Sun R, Lee JJ, Meirson T, Ludmir EB. Association of differential censoring with survival and suboptimal control arms among oncology clinical trials. J Natl Cancer Inst 2024:djae028. [PMID: 38331394 DOI: 10.1093/jnci/djae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
Differential censoring (DC), referring to censoring imbalance between treatment arms, may bias the interpretation of survival outcomes in clinical trials. In 146 phase 3 oncology trials with statistically significant time-to-event surrogate primary endpoints (PEPs), we evaluated the association between DC in the surrogate PEP, control arm adequacy, and the subsequent statistical significance of OS results. Twenty-four (16%) trials exhibited DC favoring the control arm (ConDC), while 15 (10%) exhibited experimental arm DC (ExpDC). Positive OS was more common in ConDC trials (63%) than trials without DC (37%) or with ExpDC (47%; odds ratio [OR] 2.64, 95% CI 1.10-7.20; P=.04). ConDC trials more frequently used suboptimal control arms (46%) compared to 20% without DC and 13% with ExpDC (OR 3.60, 95% CI 1.29-10.0; P=.007). The presence of ConDC in trials with surrogate PEPs, especially in those with OS conversion, may indicate an inadequate control arm and should be examined and explained.
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Affiliation(s)
- Eric J Hsu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy A Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dor R Dabush
- Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
| | - Zachary McCaw
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roshal Patel
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramez Kouzy
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Molly B El Alam
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonal Noticewala
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yumeng Yang
- School of Bioinformatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexander D Sherry
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles R Thomas
- Radiation Oncology, Dartmouth Cancer Center, Geisel School of Medicine, Lebanon, NH, USA
| | - Chad Tang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Ryan Sun
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tomer Meirson
- Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ethan B Ludmir
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Beltrán Ponce S, Gokun Y, Douglass F, Dawson L, Miller E, Thomas CR, Pitter K, Conteh L, Diaz DA. Disparities in outcomes and access to therapy options in hepatocellular carcinoma. J Natl Cancer Inst 2024; 116:264-274. [PMID: 37831897 DOI: 10.1093/jnci/djad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/10/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) disproportionately impacts racial and ethnic minorities and patients with lower socioeconomic status. These social determinants of health (SDH) lead to disparities in access to care and outcomes. We aim to understand the relationship between SDH and survival and locoregional treatment options in HCC. METHODS Using the National Cancer Database, we evaluated survival and access locoregional treatments including non-transplant surgery, liver transplant (LT), and liver-directed radiation therapy (LDRT) in patients with HCC diagnosed between 2004 and 2017. Variables including clinical stage, age, sex, race, income, rurality, year of diagnosis, facility type (FT), Charlson-Deyo score (CD), and insurance were evaluated. Cox proportional hazards multivariable regression and dominance analyses were used for analyses. RESULTS In total, 140 340 patients were included. Worse survival was seen with advanced stage, older age, Black race, rurality, public insurance, treatment at a nonacademic center, and lower income. The top predictors for survival included stage, age, and income. Completion of non-transplant surgery was best predicted by stage, FT, and insurance type, whereas LT was predicted by age, year of diagnosis, and CD score. LDRT utilization was most associated with year of diagnosis, FT, and CD score. CONCLUSION For patients with HCC, survival was predicted primarily by stage, age, and income. The primary sociodemographic factors associated with access to surgical treatments, in addition to FT, were insurance and income, highlighting the financial burdens of health care. Work is needed to address disparities in access to care, including improved insurance access, addressing financial inequities and financial toxicities of treatments, and equalizing care opportunities in community centers.
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Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yevgeniya Gokun
- Secondary Data Core, Center for Biostatistics, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | | | - Laura Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Kenneth Pitter
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Lanla Conteh
- Division of Hepatology, Department of Gastroenterology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
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Affiliation(s)
- Charles R Thomas
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Beltrán Ponce S, Jagsi R, Florez N, Thomas CR, Banerjee A, Jasti S, Bailey MM, Lawton CAF, Johnstone C, Clarke CN, Bedi M, Jovanovic M, Saeed H. Can I Leave? Perspectives on Parental Leave and Parenthood in Medical Training Among Program Directors and Trainees in Oncologic Specialties. J Womens Health (Larchmt) 2024; 33:218-227. [PMID: 38011014 DOI: 10.1089/jwh.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Purpose: Peak fertility commonly occurs during medical training, and delaying parenthood can complicate pregnancies. Trainee parental leave policies are varied and lack transparency. Research on the impacts of parenthood on trainee education is limited. Methods: A Qualtrics-based survey was distributed via e-mail/social media to program directors (PDs) within oncologic specialties with a request to forward a parallel survey to trainees. Questions assessed awareness of parental leave policies, supportiveness of parenthood, and impacts on trainee education. Statistical analyses included descriptive frequencies and bivariable comparisons by key groups. Results: A total of 195 PDs and 286 trainees responded. Twelve percent and 29% of PDs were unsure of maternity/paternity leave options, respectively. PDs felt they were more supportive of trainee parenthood than trainees perceived they were. Thirty-nine percent of nonparent trainees (NPTs) would have children already if not in medicine, and >80% of women trainees were concerned about declining fertility. Perceived impacts of parenthood on trainee overall education and academic productivity were more negative for women trainees when rated by PDs and NPTs; however, men/women parents self-reported equal impacts. Leave burden was perceived as higher for women trainees. Conclusions: A significant portion of PDs lack awareness of parental leave policies, highlighting needs for increased transparency. Trainees' perception of PD support for parenthood is less than PD self-reported support. Alongside significant rates of delayed parenthood and fertility concerns, this poses a problem for trainees seeking to start a family, particularly women who are perceived more negatively. Further work is needed to create a supportive culture for trainee parenthood.
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Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- The Cancer Care Equity Program, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shravya Jasti
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Morgan M Bailey
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Colleen A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Hina Saeed
- Baptist Health Medical Group, Boca Raton, Florida, USA
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Bleyer A, Siegel SE, Thomas CR. Retrospective evidence for pediatric benefit of U.S. assault weapons ban as rationale for implementing an even more effective ban. J Natl Med Assoc 2023; 115:528-538. [PMID: 37880064 DOI: 10.1016/j.jnma.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND With data available since 1981, firearm death rates in American children and adolescents can be evaluated for trends during the 13 years before, the decade of, and during 16 years since the United States (U.S.) 1994-2004 Federal Assault Weapons Ban (FAWB). METHODS National and regional firearm mortality trends in the U.S. during 1981-2020 were assessed with joinpoint regression applied to Centers for Disease Control and Prevention data. RESULTS After increasing exponentially before the FAWB, the national firearm death rate in 0-14 year-olds promptly reversed course and declined throughout the FAWB and then reversed again after the FAWB and resumed an exponential increase (all phases p<0.001). The reduction in firearm death rate occurred within 1-3 years of the start of the FAWB, in both sexes, in all four census regions of the U.S., and in all four major race/ethnicity subgroups, especially non-Hispanic blacks. No other form of violence in 0-14 year-olds had this temporal relationship with the FAWB. The firearm mortality reduction during the FAWB is strongly-highly correlated with the concomitant reduction in handgun manufacturing in 91 % of 24 sex, race/ethnicity and region subsets analyzed, These FAWB-related trends were also apparent in older adolescents and young adults and less so in older persons. CONCLUSIONS Firearm death rates in 0-14 year-olds before, during, and after the FAWB, and no other type of injury, implicate the FAWB as having had a beneficial effect. Legislation to mitigate firearm mortality and injury inclusive of a FAWB should be especially beneficial to children and young adolescents, and regardless of sex, race/ethnicity or region in the U.S.
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Affiliation(s)
- Archie Bleyer
- Oregon Health and Science University, Portland, OR, USA; University of Texas McGovern Medical School, Houston, TX, USA.
| | | | - Charles R Thomas
- Radiation Oncology, Geisel School of Medicine @ Dartmouth, Hanover, NH, USA
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Tavakkoli AD, Clark MA, Kheirollah A, Sloop AM, Soderholm HE, Daniel NJ, Petusseau AF, Huang YH, Thomas CR, Jarvis LA, Zhang R, Pogue BW, Gladstone DJ, Hoopes PJ. Anesthetic oxygen use and sex are critical factors in the FLASH sparing effect. bioRxiv 2023:2023.11.04.565626. [PMID: 37961549 PMCID: PMC10635148 DOI: 10.1101/2023.11.04.565626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Introduction Ultra-high dose-rate (UHDR) radiation has been reported to spare normal tissue compared to conventional dose-rate (CDR) radiation. However, reproducibility of the FLASH effect remains challenging due to varying dose ranges, radiation beam structure, and in-vivo endpoints. A better understanding of these inconsistencies may shed light on the mechanism of FLASH sparing. Here, we evaluate whether sex and/or use of 100% oxygen as carrier gas during irradiation contribute to the variability of the FLASH effect. Methods C57BL/6 mice (24 male, 24 female) were anesthetized using isoflurane mixed with either room air or 100% oxygen. Subsequently, the mice received 27 Gy of either 9 MeV electron UHDR or CDR to a 1.6 cm2 diameter area of the right leg skin using the Mobetron linear accelerator. The primary post-radiation endpoint was time to full thickness skin ulceration. In a separate cohort of mice (4 male, 4 female) skin oxygenation was measured using PdG4 Oxyphor under identical anesthesia conditions. Results In the UHDR group, time to ulceration was significantly shorter in mice that received 100% oxygen compared to room air, and amongst them female mice ulcerated sooner compared to males. However, no significant difference was observed between male and female UHDR mice that received room air. Oxygen measurements showed significantly higher tissue oxygenation using 100% oxygen as the anesthesia carrier gas compared to room air, and female mice showed higher levels of tissue oxygenation compared to males under 100% oxygen. Conclusion The FLASH sparing effect is significantly reduced using oxygen during anesthesia compared to room air. The FLASH sparing was significantly lower in female mice compared to males. Both tissue oxygenation and sex are likely sources of variability in UHDR studies. These results suggest an oxygen-based mechanism for FLASH, as well as a key role for sex in the FLASH skin sparing effect.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Charles R. Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Medical Center
| | - Lesley A. Jarvis
- Department of Radiation Oncology, Dartmouth-Hitchcock Medical Center
| | - Rongxiao Zhang
- Department of Radiation Medicine, New York Medical College
| | - Brian W. Pogue
- Department of Medical Physics, University of Wisconsin School of Medicine
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Corrigan KL, Rooney MK, Kouzy R, Manzar G, Thomas CR, Ludmir EB. Selection and Prejudice: Addressing Clinical Trial Disparities With a Review of Current Shortcomings and Future Directions. Semin Radiat Oncol 2023; 33:367-373. [PMID: 37684066 DOI: 10.1016/j.semradonc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Growing evidence has demonstrated significant, persistent, and widespread disparities in cancer clinical trial enrollment across myriad disease sites and target populations. Although mechanisms underlying such disparities are complex and multifactorial, clinical trial eligibility criteria may serve as a key structural barrier to equitable and diverse trial enrollment. In this review, we provide an overview of the data describing historical and current disparities in cancer clinical trial enrollment and subsequently describe several patient-, institution-, and trial-related factors which appear to be key drivers of enrollment inequity, with specific discussion regarding the impact of eligibility criteria. We further describe the landscape of ongoing professional efforts aimed at eliminating clinical trial disparities through various medical, professional, and advocacy groups. The review concludes with a practical discussion of how modernization of eligibility criteria in clinical trials may decrease or eliminate trial disparities, including specific actionable recommendations aimed at improving the quality of future eligibility criteria.
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Affiliation(s)
- Kelsey L Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael K Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramez Kouzy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gohar Manzar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Center, Lebanon, NH
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX..
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Mattes MD, Thomas CR, Deville C. In Reply to Shueng et al. Int J Radiat Oncol Biol Phys 2023; 117:516-517. [PMID: 37652612 DOI: 10.1016/j.ijrobp.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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Puckett LL, Titi M, Kujundzic K, Dawes SL, Gore EM, Katsoulakis E, Park JH, Solanki AA, Kapoor R, Kelly M, Palta J, Chetty IJ, Jabbour SK, Liao Z, Movsas B, Thomas CR, Timmerman RD, Werner-Wasik M, Kudner R, Wilson E, Simone CB. Consensus Quality Measures and Dose Constraints for Lung Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and ASTRO Expert Panel. Pract Radiat Oncol 2023; 13:413-428. [PMID: 37075838 DOI: 10.1016/j.prro.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high-quality care. The US Department of Veterans Affairs (VA) National Radiation Oncology Program partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. This article presents recently updated consensus quality measures and dose-volume histogram (DVH) constraints. METHODS AND MATERIALS A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for (1) initial consultation and workup; (2) simulation, treatment planning, and treatment delivery; and (3) follow-up. The DVH metrics for target and organ-at-risk treatment planning dose constraints were also reviewed and defined. RESULTS Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens, including ultrahypofractionated (1, 3, 4, or 5 fractions), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions). CONCLUSIONS The devised measures will be implemented for quality surveillance for veterans both inside and outside of the VA system and will provide a resource for lung cancer-specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence- and expert consensus-based constraints across multiple fractionation schemas.
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Affiliation(s)
- Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
| | - Mohammad Titi
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida
| | - John H Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University and Hines VA Medical Center, Chicago, Illinois
| | - Rishabh Kapoor
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Maria Kelly
- Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zhongxing Liao
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Charles R Thomas
- Radiation Oncology, Dartmouth Cancer Institute, Hanover, New Hampshire
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sydney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Chaklai A, Canaday P, O’Niel A, Cucinotta FA, Sloop A, Gladstone D, Pogue B, Zhang R, Sunnerberg J, Kheirollah A, Thomas CR, Hoopes PJ, Raber J. Effects of UHDR and Conventional Irradiation on Behavioral and Cognitive Performance and the Percentage of Ly6G+ CD45+ Cells in the Hippocampus. Int J Mol Sci 2023; 24:12497. [PMID: 37569869 PMCID: PMC10419899 DOI: 10.3390/ijms241512497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
We assessed the effects of conventional and ultra-high dose rate (UHDR) electron irradiation on behavioral and cognitive performance one month following exposure and assessed whether these effects were associated with alterations in the number of immune cells in the hippocampus using flow cytometry. Two-month-old female and male C57BL/6J mice received whole-brain conventional or UHDR irradiation. UHDR mice were irradiated with 9 MeV electrons, delivered by the Linac-based/modified beam control. The mice were irradiated or sham-irradiated at Dartmouth, the following week shipped to OHSU, and behaviorally and cognitively tested between 27 and 41 days after exposure. Conventional- and UHDR-irradiated mice showed impaired novel object recognition. During fear learning, conventional- and UHDR-irradiated mice moved less during the inter-stimulus interval (ISI) and UHDR-irradiated mice also moved less during the baseline period (prior to the first tone). In irradiated mice, reduced activity levels were also seen in the home cage: conventional- and UHDR-irradiated mice moved less during the light period and UHDR-irradiated mice moved less during the dark period. Following behavioral and cognitive testing, infiltrating immune cells in the hippocampus were analyzed by flow cytometry. The percentage of Ly6G+ CD45+ cells in the hippocampus was lower in conventional- and UHDR-irradiated than sham-irradiated mice, suggesting that neutrophils might be particularly sensitive to radiation. The percentage of Ly6G+ CD45+ cells in the hippocampus was positively correlated with the time spent exploring the novel object in the object recognition test. Under the experimental conditions used, cognitive injury was comparable in conventional and UHDR mice. However, the percentage of CD45+ CD11b+ Ly6+ and CD45+ CD11b+ Ly6G- cells in the hippocampus cells in the hippocampus was altered in conventional- but not UHDR-irradiated mice and the reduced percentage of Ly6G+ CD45+ cells in the hippocampus might mediate some of the detrimental radiation-induced cognitive effects.
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Affiliation(s)
- Ariel Chaklai
- Department of Behavioral Neuroscience, Oregon Health Science University, Portland, OR 97239, USA; (A.C.); (A.O.)
| | - Pamela Canaday
- Knight Flow Cytometry Core OHSU, Portland, OR 97239, USA;
| | - Abigail O’Niel
- Department of Behavioral Neuroscience, Oregon Health Science University, Portland, OR 97239, USA; (A.C.); (A.O.)
| | - Francis A. Cucinotta
- Department of Health Physics and Diagnostic Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| | - Austin Sloop
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - David Gladstone
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - Brian Pogue
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA;
| | - Rongxiao Zhang
- Department of Radiation Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Jacob Sunnerberg
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - Alireza Kheirollah
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - Charles R. Thomas
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - P. Jack Hoopes
- Department of Radiation Oncology, Geisel School of Medicine, The Thayer School of Engineering, The Dartmouth Cancer Center, at Dartmouth College and the Dartmouth-Hitchcock Medical Center (DHMC), Hanover, NH 03755, USA; (A.S.); (D.G.); (J.S.); (A.K.); (P.J.H.)
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health Science University, Portland, OR 97239, USA; (A.C.); (A.O.)
- Departments of Neurology and Radiation Medicine, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, OR 97239, USA
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12
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Baniel CC, Ponce SB, Lichter KE, Peters GW, Small C, Seldon C, Nguyen KT, Khan AF, Thomas CR, Small W, Kahn JM, Olivier KR, Masters AH, Barry PN, Pollom EL, Jagsi R. Society for Women in Radiation Oncology Consensus Statement on Family and Medical Leave. Int J Radiat Oncol Biol Phys 2023; 116:270-275. [PMID: 37179087 DOI: 10.1016/j.ijrobp.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Claire Christine Baniel
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| | - Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Katarina T Nguyen
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | | | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Jenna M Kahn
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | | | - Adrianna Henson Masters
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Parul N Barry
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Reshma Jagsi
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
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13
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Thomas CR. CRT Maxims for the Department Chair Role in Inclusiveness in Academic Radiation Oncology. Int J Radiat Oncol Biol Phys 2023; 116:229-231. [PMID: 37179086 DOI: 10.1016/j.ijrobp.2022.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Charles R Thomas
- Radiation Oncology Department, Dartmouth Cancer Center & Geisel School of Medicine, Lebanon, New Hampshire.
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14
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Chen EY, Kardosh A, Nabavizadeh N, Foster B, Mayo SC, Billingsley KG, Gilbert EW, Lanciault C, Grossberg A, Bensch KG, Maynard E, Anderson EC, Sheppard BC, Thomas CR, Lopez CD, Vaccaro GM. Phase 2 study of preoperative chemotherapy with nab-paclitaxel and gemcitabine followed by chemoradiation for borderline resectable or node-positive pancreatic ductal adenocarcinoma. Cancer Med 2023. [PMID: 37132281 DOI: 10.1002/cam4.5971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Neoadjuvant treatment with nab-paclitaxel and gemcitabine for potentially operable pancreatic adenocarcinoma has not been well studied in a prospective interventional trial and could down-stage tumors to achieve negative surgical margins. METHODS A single-arm, open-label phase 2 trial (NCT02427841) enrolled patients with pancreatic adenocarcinoma deemed to be borderline resectable or clinically node-positive from March 17, 2016 to October 5, 2019. Patients received preoperative gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2 on Days 1, 8, 15, every 28 days for two cycles followed by chemoradiation with 50.4 Gy intensity-modulated radiation over 28 fractions with concurrent fluoropyrimidine chemotherapy. After definitive resection, patients received four additional cycles of gemcitabine and nab-paclitaxel. The primary endpoint was R0 resection rate. Other endpoints included treatment completion rate, resection rate, radiographic response rate, survival, and adverse events. RESULTS Nineteen patients were enrolled, with the majority having head of pancreas primary tumors, both arterial and venous vasculature involvement, and clinically positive nodes on imaging. Among them, 11 (58%) underwent definitive resection and eight of 19 (42%) achieved R0 resection. Disease progression and functional decline were primary reasons for deferring surgical resection after neoadjuvant treatment. Pathologic near-complete response was observed in two of 11 (18%) resection specimens. Among the 19 patients, the 12-month progression-free survival was 58%, and 12-month overall survival was 79%. Common adverse events were alopecia, nausea, vomiting, fatigue, myalgia, peripheral neuropathy, rash, and neutropenia. CONCLUSION Gemcitabine and nab-paclitaxel followed by long-course chemoradiation represents a feasible neoadjuvant treatment strategy for borderline resectable or node-positive pancreatic cancer.
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Affiliation(s)
- Emerson Y Chen
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
| | - Adel Kardosh
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Bryan Foster
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Skye C Mayo
- Division of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
| | | | - Erin W Gilbert
- Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Aaron Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Erin Maynard
- Portland VA Medical Center, Portland, Oregon, USA
| | - Eric C Anderson
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
| | - Brett C Sheppard
- Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Radiation Oncology, Geisel School of Medicine at Dartmouth and Dartmouth Cancer Center, New Hampshire, Lebanon, USA
| | - Charles D Lopez
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
| | - Gina M Vaccaro
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon, USA
- Providence Cancer Institute, Portland, Oregon, USA
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15
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Florez MA, Jaoude JA, Patel RR, Kouzy R, Lin TA, De B, Beck EJ, Taniguchi CM, Minsky BD, Fuller CD, Lee JJ, Kupferman M, Raghav KP, Overman MJ, Thomas CR, Ludmir EB. Incidence of Primary End Point Changes Among Active Cancer Phase 3 Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2313819. [PMID: 37195664 DOI: 10.1001/jamanetworkopen.2023.13819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Importance Primary end point (PEP) changes to an active clinical trial raise questions regarding trial quality and the risk of outcome reporting bias. It is unknown how the frequency and transparency of the reported changes depend on reporting method and whether the PEP changes are associated with trial positivity (ie, the trial met the prespecified statistical threshold for PEP positivity). Objectives To assess the frequency of reported PEP changes in oncology randomized clinical trials (RCTs) and whether these changes are associated with trial positivity. Design, Setting, and Participants This cross-sectional study used publicly available data for complete oncology phase 3 RCTs registered in ClinicalTrials.gov from inception through February 2020. Main Outcomes and Measures The main outcome was change between the initial PEP and the final reported PEP, assessed using 3 methods: (1) history of tracked changes on ClinicalTrials.gov, (2) self-reported changes noted in the article, and (3) changes reported within the protocol, including all available protocol documents. Logistic regression analyses were performed to evaluate whether PEP changes were associated with US Food and Drug Administration approval or trial positivity. Results Of 755 included trials, 145 (19.2%) had PEP changes found by at least 1 of the 3 detection methods. Of the 145 trials with PEP changes, 102 (70.3%) did not have PEP changes disclosed within the manuscript. There was significant variability in rates of PEP detection by each method (χ2 = 72.1; P < .001). Across all methods, PEP changes were detected at higher rates when multiple versions of the protocol (47 of 148 [31.8%]) were available compared with 1 version (22 of 134 [16.4%]) or no protocol (76 of 473 [16.1%]) (χ2 = 18.7; P < .001). Multivariable analysis demonstrated that PEP changes were associated with trial positivity (odds ratio, 1.86; 95% CI, 1.25-2.82; P = .003). Conclusions and Relevance This cross-sectional study revealed substantial rates of PEP changes among active RCTs; PEP changes were markedly underreported in published articles and mostly occurred after reported study completion dates. Significant discrepancies in the rate of detected PEP changes call into question the role of increased protocol transparency and completeness in identifying key changes occurring in active trials.
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Affiliation(s)
- Marcus A Florez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, Texas
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Roshal R Patel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ramez Kouzy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy A Lin
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Esther J Beck
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cullen M Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Kanwal P Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
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16
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Mattes MD, Gayed G, Thomas CR, Deville C. Impact of a Virtual Introduction to Radiation Oncology Presentation on Stimulating Interest in the Specialty Among Diverse Medical Students at Multiple Institutions. J Am Coll Radiol 2023; 20:243-250. [PMID: 36513260 DOI: 10.1016/j.jacr.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Many US medical students lack access to radiation oncology (RO). The authors' hypothesis was that a virtual, cross-institutional presentation introducing students to a career in RO would be valuable in exposing students to RO who are less likely to access it otherwise and would increase students' interest in a career in RO regardless of their gender, race, or ethnicity. METHODS A 1-hour, live, virtual, extracurricular presentation was offered to deans of US medical schools lacking affiliated RO departments and/or having high enrollments of students underrepresented in medicine (UIM) and also student groups composed primarily of UIM students. Presentations were given individually to each school by a single radiation oncologist. An electronic survey captured data from participating students. RESULTS One hundred ninety-seven students from 13 institutions attended presentations; 114 students responded to the survey (response rate, 58%). Ninety-two students (81%) were aware of the specialty of RO before the presentation; however, UIM students were significantly less likely to be aware of RO than all others (69% versus 87%, P = .05). Only 19 students (17%) reported previously hearing presentations from radiation oncologist (29% among second- to fourth-year students versus 9% among first-year students, P = .01). Ninety-eight students (86%) expressed more interest in pursuing a career in RO after the presentation. There was no significant difference in interest in RO for any demographic subgroups. CONCLUSIONS Virtual RO exposure was feasible to deliver to students less likely to be exposed otherwise and successfully stimulated interest in the specialty regardless of students' gender, race, or ethnicity.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; Medical Student Clerkship Director at Rutgers New Jersey Medical School.
| | - George Gayed
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Charles R Thomas
- Chief of Radiation Oncology, Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland; Medical Director of the Johns Hopkins Proton Therapy Center; and Clinical Director of Radiation Oncology at the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital
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17
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Chen EYS, Nabavizadeh N, Herzig D, Korngold E, Kardosh A, Pegna GJ, Bensch KG, Anderson EC, Tsikitis VL, Lu K, Mayo SC, Brinkerhoff B, Goodyear S, Wong M, Fahlman A, Taber E, Vo J, Thomas CR, Lopez CD. Phase 1b study to assess the safety of neoadjuvant trifluridine/tipiracil with concurrent radiation in resectable stage II/III rectal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
TPS274 Background: Treatment of locally advanced rectal cancer currently involves tri-modal therapy with pre-operative chemo-radiation (CRT), surgery, and combination chemotherapy. Total neoadjuvant therapy (TNT) is emerging as an important treatment pathway that can increase rates of complete response (CR) leading to better overall outcomes. Novel radio-sensitizing agents may improve rates of CR. Trifluridine/tipiracil (TFD/TPI) is a novel fluoropyrimidine that has demonstrated clinical efficacy in patients with treatment-refractory metastatic colorectal cancer. Importantly, TFD/TPI has superior radio-sensitization in vitro compared to 5-fluorouracil, and we hypothesize that this can improve the tumor response of patients. This phase 1 study assesses the safety and preliminary efficacy of using TFD/TPI for long-course CRT for rectal cancer followed by FOLFOX chemotherapy in the TNT setting. Methods: NCT04104139 is a prospective, dose-finding phase I study using Bayesian Optimal Interval (BOIN) design to determine the maximum tolerated dose (MTD) of TFD/TPI with concurrent standard dose/fractionation radiation for resectable rectal cancer. Adults with previously untreated rectal adenocarcinoma, with clinical stage II (T3-4aN0) and stage III (T1-4aN1+) by MRI and endoscopy are eligible. Patients must first receive CRT with standard radiation (45-50 Gy over 25-28 fractions) followed by up to 8 cycles of standard FOLFOX, or alternatively 5 cycles of CAPOX chemotherapy. During CRT, the first dose level of TFD/TPI is PO 25mg/m2 twice a day from Mon to Fri (5 weekdays) alternating on weeks 1, 3, and 5 concurrent with 5-6 weeks of radiation. The second dose level is 30mg/m2, and third dose level is 35mg/m2. The MTD of TFD/TPI in combination with radiation is the dose corresponding to a dose limiting toxicity (DLT) probability of 30% using the BOIN design with escalation/de-escalation of each dose level occurring in cohorts of 3 participants until a maximum total of 18 participants, sub-total of 12 patients within one dose level, or another stopping rule based on serious toxicities. The primary endpoint is proportion of DLTs for TFD/TPI at MTD. Secondary endpoints include overall tolerability profile, delayed toxicities during FOLFOX, rates of clinical CR, rates of pathologic CR, and correlative biomarkers. The study was activated December 2019 and has accrued 8 of intended 18 patients. Clinical trial information: NCT04104139 .
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kim Lu
- Oregon Health & Science University, Portland, OR
| | | | | | - Shaun Goodyear
- Oregon Health & Science University, Knight Cancer Institute, Portland, OR
| | - Melissa Wong
- Oregon Health & Science University, Portland, OR
| | - Anne Fahlman
- Oregon Health & Science University, Portland, OR
| | - Erin Taber
- Oregon Health & Science University, Portland, OR
| | - Johnson Vo
- Oregon Health & Science University, Portland, OR
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18
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Mattes MD, Munoz SM, Thomas CR, Deville C. Pilot Study Exploring the Feasibility of Incorporating Radiation Oncology Into Pre-existing Early Pathway Programs for Diverse Premedical Students. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00063-9. [PMID: 36702316 DOI: 10.1016/j.ijrobp.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Many medical schools in the United States have affiliated pathway, preparatory, and/or prematriculation programs that enroll a high percentage of students historically underrepresented in medicine (URiM). The purpose of this pilot study was to better characterize exposures to radiation oncology (RO) among students in these programs and determine the feasibility of incorporating a radiation oncologist within their pre-existing format if nonexistent. METHODS AND MATERIALS During the summers of 2021 and 2022, a radiation oncologist gave a presentation about basic principles of cancer care to 18 unique student groups in 12 premedical programs affiliated with 8 medical schools. Participating students were asked to complete an anonymous postpresentation questionnaire. Descriptive statistics are reported. RESULTS A total of 467 students attended the presentations, and 241 completed the questionnaire (response rate 52.0%). The majority of participants reported being female (63.5%), URiM (66.4%), and low income (57.3%). Students were less likely to report previous teaching from a radiation oncologist (11.2%) than a surgical (17.0%) or medical oncologist (18.3%). Prior clinical shadowing with a radiation oncologist (2.9%) was also less likely than shadowing a surgical oncologist (5.0%), medical oncologist (6.6%), or any other physician (53.1%). Students were also less likely to previously believe that radiation could cure cancer (65.8%) compared with surgery (74.9%) or chemotherapy (89.3%). After the presentation, 168 students (69.7%) were more interested in a career in RO, and 211 students (87.6%) responded that the presentation was either quite or extremely valuable (median Likert-type score, 5; interquartile range, 4-5). CONCLUSIONS Many of the students in premedical programs lack prior exposure to RO or knowledge of multidisciplinary cancer care, which was ameliorated by a simple yet effective presentation across a variety of different types of programs in this study. Longitudinal assessment of different types of educational initiatives and students' ultimate career trajectory will help optimize future RO initiatives among premedical URiM students.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | | | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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19
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Ohaegbulam KC, Koethe Y, Fung A, Mayo SC, Grossberg AJ, Chen EY, Sharzehi K, Kardosh A, Farsad K, Rocha FG, Thomas CR, Nabavizadeh N. The multidisciplinary management of cholangiocarcinoma. Cancer 2023; 129:184-214. [PMID: 36382577 DOI: 10.1002/cncr.34541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Cholangiocarcinoma is a lethal malignancy of the biliary epithelium that can arise anywhere along the biliary tract. Surgical resection confers the greatest likelihood of long-term survivability. However, its insidious onset, difficult diagnostics, and resultant advanced presentation render the majority of patients unresectable, highlighting the importance of early detection with novel biomarkers. Developing liver-directed therapies and emerging targeted therapeutics may offer improved survivability for patients with unresectable or advanced disease. In this article, the authors review the current multidisciplinary standards of care in resectable and unresectable cholangiocarcinoma, with an emphasis on novel biomarkers for early detection and nonsurgical locoregional therapy options.
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Affiliation(s)
- Kim C Ohaegbulam
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yilun Koethe
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Emerson Y Chen
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kaveh Sharzehi
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Adel Kardosh
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Flavio G Rocha
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Department of Radiation Oncology, Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
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20
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Maloney LT, Latour E, Chen Y, Rice D, Grossblatt-Wait A, Nabavizadeh N, Thomas CR, Young KH, Walker JM, Holland J, Grossberg AJ. Angiotensin receptor blockade and stereotactic body radiation therapy for early stage lung cancer ARB & SBRT for early stage lung cancer. Cancer Biol Ther 2022; 23:1-8. [PMID: 36201632 PMCID: PMC9542943 DOI: 10.1080/15384047.2022.2126250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) demonstrates excellent local control in early stage lung cancer, however a quarter of patients develop recurrence or distant metastasis. Transforming growth factor-beta (TGF-β) supports metastasis and treatment resistance, and angiotensin receptor blockade (ARB) indirectly suppresses TGF-β signaling. This study investigates whether patients taking ARBs while undergoing SBRT for early stage lung cancer exhibited improved overall survival (OS) or recurrence free survival (RFS) compared to patients not taking ARBs. This was a single institution retrospective analysis of 272 patients treated with SBRT for early stage lung cancer between 2009 and 2018. Patient health data was abstracted from the electronic medical record. OS and RFS were assessed using Kaplan-Meier method. Log-rank test was used to compare unadjusted survival between groups. Univariable and multivariable Cox proportional hazard regression models were used to estimate hazard ratios (HRs). Of 247 patients analyzed, 24 (10%) patients took ARBs for the duration of radiotherapy. There was no difference in mean age, median tumor diameter, or median biologic effective dose between patients taking ARBs or not. Patients taking ARBs exhibited increased OS (ARB = 96.7 mo.; no ARB = 43.3 mo.; HR = 0.25 [95% CI: 0.10 to 0.62, P = .003]) and increased RFS (median RFS, ARB = 64.3 mo.; No ARB = 35.1 mo.; HR = 0.26 [95% CI: 0.10 to 0.63, P = .003]). These effects were not seen in patients taking angiotensin converting enzyme inhibitors (ACEIs) or statins. ARB use while undergoing SBRT for early stage lung cancer may increase OS and RFS, but ACEI use does not show the same effect.
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Affiliation(s)
- Lauren T. Maloney
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Emile Latour
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Yiyi Chen
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Douglas Rice
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Alison Grossblatt-Wait
- Brenden Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, OR, USA,Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Charles R. Thomas
- Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Kristina H. Young
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA,The Oregon Clinic, Radiation Oncology Division, Portland, OR, USA
| | - Joshua M. Walker
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA,Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - John Holland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Aaron J. Grossberg
- Brenden Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, OR, USA,Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA,Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA,CONTACT Aaron J. Grossberg Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
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21
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McGinnis GJ, Holden S, Yu B, Ransom C, Guidarelli C, De B, Diao K, Boyce D, Thomas CR, Winters-Stone K, Raber J. Association of fall rate and functional status by APOE genotype in cancer survivors after exercise intervention. Oncotarget 2022; 13:1259-1270. [PMID: 36441715 DOI: 10.18632/oncotarget.28310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE/OBJECTIVES Cancer treatment survivors often report impaired functioning and increased falls. Not all survivors experience the same symptom burden, suggesting individual susceptibilities. APOE genotype is a potential genetic risk factor for cancer treatment related side effects. Lifestyle factors such as physical activity can mitigate the effect of APOE genotype on measures of clinical interest in individuals without a history of cancer. We tested the hypothesis that APOE genotype influences cancer treatment related side effects and symptoms as well as response to exercise intervention. MATERIALS AND METHODS Data from a subsample of a study of fall prevention exercise in post-treatment female cancer survivors aged 50-75 years old (https://clinicaltrials.gov NCT01635413) were used to conduct a secondary data analysis. ApoE genotype was determined by serum sampling. Physical functioning, frequency of falls, and symptom burden were assessed using survey instruments. RESULTS Data from 126 female cancer survivors a median of 49 months out from cancer diagnosis were analyzed. ApoE4 carriers trended toward a higher fall rate at baseline (p = 0.059), but after exercise intervention had a fall rate lower than E4 non-carriers both immediately after structured intervention (p = 0.013) and after 6 months of follow up (p = 0.002). E2 carriers did not show improved measures of depressive symptoms and self-report disability after exercise intervention. E3 homozygotes showed increased self report physical activity after the 6 month exercise intervention, but E4 and E2 carriers did not. CONCLUSIONS APOE genotype may modulate cancer treatment related side effects and symptoms and response to exercise intervention.
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Affiliation(s)
- Gwendolyn J McGinnis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sarah Holden
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA
| | - Betty Yu
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA
| | - Charlton Ransom
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA
| | - Carolyn Guidarelli
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, USA
| | - Brian De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David Boyce
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR 97239, USA.,Department of Radiation Oncology, Dartmouth-Hitchcock's Dartmouth Cancer Center, Lebanon, NH 03756, USA
| | - Kerri Winters-Stone
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, USA.,Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA.,Joint last authors
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA.,Department of Radiation Medicine, Oregon Health and Science University, Portland, OR 97239, USA.,Department of Neurology and Division of Neuroscience, ONPRC, Oregon Health and Science University, Portland, OR 97239, USA.,Joint last authors
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22
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Gould Rothberg BE, Quest TE, Yeung SCJ, Pelosof LC, Gerber DE, Seltzer JA, Bischof JJ, Thomas CR, Akhter N, Mamtani M, Stutman RE, Baugh CW, Anantharaman V, Pettit NR, Klotz AD, Gibbs MA, Kyriacou DN. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin 2022; 72:570-593. [PMID: 35653456 DOI: 10.3322/caac.21727] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high-acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up-to-date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy-induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug-conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T-cells, are summarized. Finally, strategies for facilitating same-day direct admission to hospice from the ED are discussed. This article not only can serve as a point-of-care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.
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Affiliation(s)
- Bonnie E Gould Rothberg
- Yale Cancer Center Innovations Laboratory, Yale Comprehensive Cancer Center, New Haven, Connecticut
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lorraine C Pelosof
- Office of Oncologic Diseases, US Food and Drug Administration, Silver Spring, Maryland
| | - David E Gerber
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas
| | - Justin A Seltzer
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mira Mamtani
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robin E Stutman
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, SingHealth Duke-National University of Singapore Academic Medical Center, Singapore, Singapore
| | - Nicholas R Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D Klotz
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Gibbs
- Department of Emergency Medicine, Atrium Health-Carolinas Medical Center, Charlotte, North Carolina
| | - Demetrios N Kyriacou
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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23
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DuRoss AN, Phan J, Lazar AJ, Walker JM, Guimaraes AR, Baas C, Krishnan S, Thomas CR, Sun C, Bagley AF. Radiotherapy reimagined: Integrating nanomedicines into radiotherapy clinical trials. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2022; 15:e1867. [PMID: 36308008 DOI: 10.1002/wnan.1867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 04/16/2023]
Abstract
Radioenhancing nanoparticles (NPs) are being evaluated in ongoing clinical trials for various cancers including head and neck, lung, esophagus, pancreas, prostate, and soft tissue sarcoma. Supported by decades of preclinical investigation and recent randomized trial data establishing clinical activity, these agents are poised to influence future multimodality treatment paradigms involving radiotherapy. Although the physical interactions between NPs and ionizing radiation are well characterized, less is known about how these agents modify the tumor microenvironment, particularly regarding tumor immunogenicity. In this review, we describe the key multidisciplinary considerations related to radiation, surgery, immunology, and pathology for designing radioenhancing NP clinical trials. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Allison N DuRoss
- Department of Pharmaceutical Sciences, Oregon State University, Portland, Oregon, USA
| | - Jack Phan
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J Lazar
- Department of Pathology and Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua M Walker
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Carole Baas
- National Cancer Institute, Bethesda, Maryland, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Radiation Oncology, Norris Cotton Cancer Center, Dartmouth University, Lebanon, New Hampshire, USA
| | - Conroy Sun
- Department of Pharmaceutical Sciences, Oregon State University, Portland, Oregon, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexander F Bagley
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Radiation Oncology, Samaritan Health Services, Corvallis, Oregon, USA
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24
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Dengina N, Chernykh M, Degnin C, Chen Y, Tsimafeyeu I, Karaseva VV, Tjulandin S, Laktionov K, Thomas CR, Mitin T. Patterns of Care and Barriers to Utilization of Definitive Concurrent Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer in Russia. J Cancer Educ 2022; 37:1378-1384. [PMID: 33533013 DOI: 10.1007/s13187-021-01966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Definitive concurrent chemoradiation (cCRT) is offered to only 3% of Russian patients with stage III NSCLC. To determine the patterns of care and barriers to cCRT utilization in Russia, we conducted a survey of practicing radiation oncologists (ROs). METHODS Electronic IRB-approved survey containing 15 questions was distributed to Russian ROs. Fisher's exact test or Cochran-Armitage test of trend was used to assess the associations between clinical experience, practice type, and patterns of care. RESULTS We analyzed 58 questionnaires completed by ROs-16 respondents from tertiary referral hospitals, and 42 from community or private centers. A total of 88% of respondents formulate treatment recommendations in multi-disciplinary tumor boards. For unresectable stage III NSCLC, the most common recommendation is sequential CRT (50%), followed by concurrent CRT (40%), with an observed higher utilization of cCRT in tertiary centers (9/16, 56% vs 14/42, 33%). Of the respondents, 31% do not offer cCRT to their pts. Among reasons for avoiding cCRT are (1) poor performance of pts (76%); (2) high toxicity of therapy (55%); (3) lack of consensus among tumor board members (33%); and (4) preference for sequential CRT (31%). Only 3% do not irradiate elective LNs. Eighty-six percent of respondents counsel their NSCLC pts regarding smoking cessation. CONCLUSIONS Despite level 1 evidence, cCRT is rarely used in Russia for pts with locally advanced NSCLC, and preference for sequential therapy and concerns over high toxicity are the most common barriers. Education of Russian ROs may increase cCRT utilization, leading to improved survival, notably in the era of maintenance immunotherapy.
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Affiliation(s)
- Natalia Dengina
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk, Oblast, Russia
| | | | - Catherine Degnin
- Biostatics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yiyi Chen
- Biostatics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA
| | | | | | | | | | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA
| | - Timur Mitin
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA.
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25
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Nugent SM, Golden SE, Sullivan DR, Thomas CR, Wisnivesky J, Saha S, Slatore CG. Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study. Med Oncol 2022; 39:203. [PMID: 36175802 DOI: 10.1007/s12032-022-01776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
Among patients with suspected early-stage non-small cell lung cancer (NSCLC), we sought to evaluate the association of patient-clinician communication (PCC) with patient-centered outcomes (PCOs). We conducted a multicenter, prospective cohort study examining PCOs at five time points, up to 12-months post-treatment. We used generalized estimating equation (GEE) models adjusted for sociodemographic and clinical variables to examine the relationship between PCC (dichotomized as high- or low-quality) and decisional conflict, treatment self-efficacy, and anxiety. The cohort included 165 patients who were 62% male with a mean age of 70.7 ± SD 8.1 years. Adjusted GEE analysis including 810 observations revealed high-quality PCC was associated with no decisional conflict (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.07 to 0.27) and higher self-efficacy (β = -0.26, 95% CI = -0.37 to -0.14). High-quality PCC was not associated with moderately severe anxiety (aOR = 0.68, 95% CI = 0.41 to 1.09), though was associated with decreased anxiety scores (β = -3.91, 95% CI = -6.48 to -1.35). Among individuals with suspected early-stage NSCLC, high-quality PCC is associated with less decisional conflict and higher self-efficacy; the relationship with anxiety is unclear. Clinicians should prioritize enhanced treatment-related communication at critical and vulnerable periods in the cancer care trajectory to improve PCOs.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA. .,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. .,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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26
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Bischof JJ, Elsaid MI, Bridges JFP, Rosko AE, Presley CJ, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Coyne CJ, Durham DD, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Yilmaz S, Caterino JM. Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study. J Geriatr Oncol 2022; 13:943-951. [PMID: 35718667 DOI: 10.1016/j.jgo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/05/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. MATERIALS AND METHODS Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. RESULTS Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. DISCUSSION We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.
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Affiliation(s)
- Jason J Bischof
- Departments of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - John F P Bridges
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital - Troy Campus, Troy, MI, USA.
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA.
| | - Danielle D Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Troy E Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine @ Dartmouth, Lebanon, NH, USA.
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sule Yilmaz
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jeffrey M Caterino
- Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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27
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Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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28
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Chapman BV, Rooney MK, Ludmir EB, De La Cruz D, Salcedo A, Pinnix CC, Das P, Jagsi R, Thomas CR, Holliday EB. Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants from 2015 to 2019. J Cancer Educ 2022; 37:965-972. [PMID: 33111188 PMCID: PMC7591242 DOI: 10.1007/s13187-020-01907-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 05/09/2023]
Abstract
We aimed to investigate whether implicit linguistic biases exist in letters of recommendation (LORs) for applicants to radiation oncology (RO) residency. LORs (n = 487) written for applicants (n = 125) invited to interview at a single RO residency program from the 2015 to 2019 application cycles were included for analysis. Linguistic Inquiry and Word Count (LIWC) software was used to evaluate LORs for length and a dictionary of predetermined themes. Language was evaluated for gender bias using a publicly available gender bias calculator. Non-parametric tests were used to compare linguistic domain scores. The median number of the LORs per applicant was 4 (range 3-5). No significant differences by applicant gender were detected in LIWC score domains or gender bias calculator (P > 0.05). However, LORs for applicants from racial/ethnic backgrounds underrepresented in medicine were less likely to include standout descriptors (P = 0.008). Male writers were less likely to describe applicant characteristics related to patient care (P < 0.0001) and agentic personality (P = 0.006). LORs written by RO were shorter (P < 0.0001) and included fewer standout descriptors (P = 0.014) but were also more likely to include statements regarding applicant desirability (P = 0.045) and research (P = 0.008). While language was globally male-biased, assistant professors were less likely than associate professors (P = 0.0064) and full professors (P = 0.023) to use male-biased language. Significant linguistic differences were observed in RO residency LORs, suggesting that implicit biases related to both applicants and letter writers may exist. Recognition, and ideally eradication, of such biases are crucial for fair and equitable evaluation of a diverse applicant pool of RO residency candidates.
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Affiliation(s)
- Bhavana V Chapman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Michael K Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Denise De La Cruz
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Abigail Salcedo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA
| | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1140, Houston, TX, 77030, USA.
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Yilmaz S, Grudzen CR, Durham DD, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby C, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department. J Palliat Med 2022; 25:1115-1121. [PMID: 35559758 PMCID: PMC9467631 DOI: 10.1089/jpm.2021.0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
- Address correspondence to: Sule Yilmaz, PhD, Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Danielle D. Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital—Troy Campus, Troy, Michigan, USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel J. Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Troy E. Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel J. Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Richard J. Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Zhang R, Rahman M, Bruza P, Thomas CR, Jarvis LA, Hoopes PJ, Gladstone DJ, Pogue BW. Electron flash-RT program in clinical setting for human translation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13596 Background: A FLASH-RT program was established at Dartmouth-Hitchcock Medical Center in minimally-modified clinical setting by joint efforts of biomedical engineering, radiation oncology, radiation biology and medical physics teams. Various projects on dosimetry, chemical sensing, molecular profiling, software/hardware development, and translational studies have been conducted. The aim is to share logistical considerations and experience on running a FLASH-RT program to support institution-wide academic activities with an ultimate goal of treating human patients with FLASH-RT in 2022. Methods: A linac was converted in the clinical setting by qualified engineers to deliver an ultra-high dose rate (UHDR) electron beam. Routine safety and dosimetry checks were done by physicists for every reversible conversion. Long-term record-keeping and retrospective surveys were carried out to demonstrate the feasibility, safety, stability and accuracy of this dual-purpose (FLASH and conventional RT) approach. Comprehensive failure mode and effects analysis (FMEA) has been completed to systematically evaluate safety related considerations. A treatment planning system (TPS) has been developed in Varian Eclipse to facilitated comparative studies. The FLASH-capable linac has been utilized as shared resource to support institution-wide academic activities as well as normal clinical treatments. Results: With its safety (no accident or FLASH-related malfunction), flexibility (> 100 conversions in 2 years), reliability (̃6000 hours in flash mode and ̃5x105 Gy accumulative dose delivered at isocenter) and accuracy (̃5% conversion-to-conversion variations) demonstrated by commissioning, long-term user experience and comprehensive FMEA analysis, the FLASH-RT platform has been actively utilized for researches in six major categories 1) FLASH beam dosimetry; 2) real-time beam delivery monitoring and control; 3) oximetry and chemical sensing; 4) preclinical/translational small/large animal treatment with tumor control and normal tissue complication endpoints, 5) treatment plan and delivery optimization; 6) the design of phase I/II trials. Key findings in each category will be reported. Conclusions: A FLASH-RT program in clinical setting is established at Dartmouth with joint efforts, promoting collaborative projects to advance FLASH-RT to clinical treatment. The system has been reliably utilized for over two years for mechanistic as well as translational studies and support a phase I/II trial treating cutaneous lymphoma with eFLASH-RT.
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Affiliation(s)
| | | | | | - Charles R. Thomas
- Geisel School of Medicine at Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Lin T, Koong A, Lin C, Abi Jaoude J, Patel R, Kouzy R, El Alam MB, Noticewala SS, Sun R, Fuller CD, Thomas CR, McCaw Z, Ludmir EB. Incidence and impact of proportional hazards violations in phase 3 cancer clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1561 Background: Hazard ratio (HR)-based analyses used in oncology trials rely on the assumption of proportional hazards, i.e. a HR that is constant over time. Proportional hazards violations (PHVs) may lead to misinterpretation of trial results. Restricted mean survival time (RMST) is valid with non-proportional hazards and has received recent attention specifically for immunotherapy (IO) trials but has not been routinely adopted in oncology trial design as a whole. We aimed to comprehensively characterize the incidence and factors associated with PHVs among phase 3 oncology trials and assess RMST as an alternate measure of treatment effect in survival analysis. Methods: We used Clinicaltrials.gov to identify all superiority-design, 2-arm phase 3 cancer trials with time-dependent endpoints with published results through February 2020. We manually reconstructed patient-level data from published Kaplan-Meier (KM) curves, assessed PHVs with the Schoenfeld residual test (p <.05) and analyzed the RMST. To assess reconstruction accuracy, reported and reconstructed HRs were compared. Univariable logistic regression was used to assess the likelihood of PHVs by trial characteristic, with statistically significant factors (p <.05) included in a multivariable analysis. Concordance of RMST-based and HR-based analysis was established when both tests agreed as to the statistical significance of the comparison. Results: Of 342 KM comparisons eligible for reconstruction, 318 comparisons across 315 trials, enrolling 347,538 patients from 1989-2017, were accurately reconstructed and analyzed. PHVs were identified in 76/318 (23.9%) trials. There was no difference in likelihood of PHVs among IO vs non-IO trials (LR 2.31, 95% CI 0.30 17.85, P =.37), nor by disease site, year of trial initiation, or sample size. Few trials with PHVs (16/76) pre-specified a plan to account for non-proportional hazards in statistical design. Trials with an overall survival (OS) primary endpoint (PEP) were less likely to have PHVs than trials with a non-OS PEP (LR: 0.50, 95% CI 0.28 - 0.90, P =.02). Trials whose PEP was non-significant were more likely to have PHVs (LR 1.73, 95% CI 1.01 - 2.97, P =.047). No factor remained significantly associated with PHV in multivariable analysis. Overall, 291/318 (91.5%) KM comparisons were concordant. Among trials with PHVs, 5/76 were significant by RMST but not HR, and 5/76 were significant by HR but not RMST. Of these, 1 led to FDA drug approval, and 2 others are cited in NCCN guidelines. Conclusions: PHVs are common across all phase 3 cancer clinical trials. Attempts to account for PHVs in trial design are lacking despite the potential for trial misinterpretation in the event of non-proportional hazards. RMST-based analysis is broadly concordant with HR-based analysis and may aid in interpretation of trials with PHVs. Hence, we recommend that prospective trials include a priori a statistical plan to account for PHVs.
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Affiliation(s)
- Timothy Lin
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alex Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Roshal Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramez Kouzy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ryan Sun
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX
| | | | - Charles R. Thomas
- Geisel School of Medicine at Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Ethan B. Ludmir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Gheewala R, Paez WA, Stadtlander W, Lucke-Wold B, Jaboin JJ, Thomas CR, Mitin T, Ciporen JN. Geriatric patient outcomes in a multidisciplinary central nervous system community hospital clinic for radiation oncology and neurosurgery (RADIANS). J Geriatr Oncol 2022; 13:648-653. [PMID: 34972643 DOI: 10.1016/j.jgo.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Management of older adult patients with central nervous system (CNS) cancers requires a patient-centric, multidisciplinary approach. Assessment of neurosurgical and radiation treatment outcomes can assist in establishing guidelines for this patient population. We previously reported on the RADIANS clinic, a novel community hospital-based multidisciplinary clinic (MDC) for CNS cancer care, providing simultaneous radiation oncology and neurosurgery evaluation in a same-day, single-setting clinic. We now provide a focused analysis of our older adult patient population and recommendations for triage and standardization of care. METHODS Consecutive older adult patients (age ≥ 65) evaluated at the RADIANS clinic for CNS disease were identified and retrospectively reviewed. Observed 30-day neurosurgical outcomes were compared to predicted outcomes determined by the American College of Physicians NSQIP Surgical Risk Calculator. One-sample binomial exact tests were used to evaluate binary outcome measures. A two-sample t-test was used to evaluate the length of hospital stay. Brier Scores were calculated to assess the deviation between predicted probabilities and observed outcomes for binary outcome measures. Overall survival at 90 days was reported. RESULTS Fifty-six older adult patients with malignant (42/56) and benign (14/56) CNS disease were evaluated. Mean distance traveled for multidisciplinary evaluation at the RADIANS clinic was 43.4 miles. There was no incidence of radiation-induced toxicity. Mean length of hospital stay for RADIANS patients was significantly shorter by about 1.5 to 3.5 days (95% CI). There was no statistically significant difference for other outcome measures, however, Brier Scores demonstrated that NSQIP was not a good predictive tool for any or serious complications, UTI, venous thromboembolism, return to OR, readmission, or death in our cohort. Local tumor control rate and progression-free survival at 90 days were 97.4% and 76.9%, respectively. CONCLUSIONS This is the first report of CNS disease outcomes in older adult patients evaluated by radiation oncology and neurosurgery at a community hospital-based MDC. We observed minimal adverse radiation outcomes and high tumor control in our cohort. Findings show significantly shorter postoperative hospital stay for patients evaluated and managed at the RADIANS clinic.
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Affiliation(s)
- Rohi Gheewala
- School of Medicine, Oregon Health and Science University, USA
| | - Wencesley A Paez
- Department of Radiation Medicine, Oregon Health and Science University, USA.
| | | | | | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, USA; Geisel School of Medicine, Norris Cotton Cancer Center, Dartmouth College, USA
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, USA
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health and Science University, USA
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Hudson MF, Strassels SA, Durham DD, Siddique S, Adler D, Yeung SJ, Bernstein SL, Baugh CW, Coyne CJ, Grudzen CR, Henning DJ, Klotz A, Madsen TE, Pallin DJ, Rico JF, Ryan RJ, Shapiro NI, Swor R, Venkat A, Wilson J, Thomas CR, Bischof JJ, Lyman GH, Caterino JM. Examining pain among non-Hispanic Black and non-Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network). Acad Emerg Med 2022; 29:364-368. [PMID: 34606137 DOI: 10.1111/acem.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Scott A. Strassels
- Division of Pharmacy Atrium Health Charlotte North Carolina USA
- Department of Surgery The Ohio State University Columbus Ohio USA
| | - Danielle D. Durham
- Department of Radiology School of Medicine University of North Carolina Chapel Hill North Carolina USA
| | - Sunny Siddique
- Healthcare Delivery Research Program Division of Cancer Control and Population Sciences National Cancer Institute Rockville Maryland USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Sai‐Ching J. Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Dartmouth Hitchcock Medical Center Hanover New Hampshire USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health New York University School of Medicine New York New York USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Adam Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City, Utah USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Juan F. Rico
- Department of Pediatrics University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Jason J. Bischof
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine University of Washington School of Medicine Seattle Washington USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
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Odei BC, Pan X, Bello-Pardo E, Mitchell D, Thomas CR, Diaz DA. Racial and Gender Differences in Patient Satisfaction Scores Among Oncologists. Am J Clin Oncol 2022; 45:112-115. [PMID: 35195560 DOI: 10.1097/coc.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient satisfaction scores (PSS) have been adopted in health care reimbursement and faculty promotion metrics. Oncology patients face a challenging prognosis, where PSS may be perceived differently. We hypothesized that PSS differed based on gender and racial demographics of oncologists. MATERIALS AND METHODS This was an institutional review board exempt cross-sectional study utilizing PSS data for outpatient oncologists within a large comprehensive cancer center. Patient demographics included age, gender, race/ethnicity, geographical residence, and disease site. Characteristics of oncologists included gender and race/ethnicity. We used PSS ≥95 to make comparisons. The association between patient and physician characteristics were evaluated using the t test and χ2 test. RESULTS A total of 15,849 oncology patients were identified between 2011 and 2020. Survey respondents were predominantly female (53.2%), white (93.4%), between 50 and 70 years of age (55.3%), and living in an urban setting (63.6%). There were 303 oncologists with the majority being male (64.4%) and white (58.1%). Compared with white oncologists, Asian and Hispanic oncologists received lower PSS (P=0.001 and 0.0085, respectively). On subset analysis, these differences were significant among patients older than 50 years, living in rural counties, and reporting white or non-Hispanic race/ethnicity, or among patients of either gender (all P<0.05). Patients with genitourinary malignancies provided lower PSS for female oncologists (P=0.005). CONCLUSIONS Asian and Hispanic oncologists were more likely to receive lower PSS. In addition, female oncologists treating genitourinary malignancies received lower PSS. Appropriate statistical adjustments are needed for PSS among oncologists to account for race, gender, and physician subspecialization to allow for equitable professional opportunities across demographics.
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Affiliation(s)
- Bismarck C Odei
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State Unviersity
| | | | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
| | - Charles R Thomas
- Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
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Patel RR, Parisi R, Verma V, Kouzy R, Abi Jaoude J, Lin TA, Fuller CD, VanderWalde NA, Jagsi R, Smith BD, Guadagnolo BA, Thomas CR, Ludmir EB. Association between Prior Malignancy Exclusion Criteria and Age Disparities in Cancer Clinical Trials. Cancers (Basel) 2022; 14:cancers14041048. [PMID: 35205795 PMCID: PMC8870379 DOI: 10.3390/cancers14041048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
Simple Summary Recent studies have shown that the incidence of age disparities in cancer clinical trials may be increasing over time. Excluding patients with prior malignancies is one such eligibility criterion through which elderly may inadvertently be excluded from clinical trial participation. While strict enrollment criteria may improve internal validity of studies, they can also negatively impact generalizability of results. As such, we sought to characterize the incidence of prior malignancy exclusion criteria in phase III cancer clinical trials and assess if this eligibility criterion may directly contribute to age disparities. These data support efforts to modernize eligibility criteria and inform best practices regarding acceptable versus unacceptable exclusionary timeframes for prior malignancy exclusion criteria. Abstract Prior malignancy exclusion criteria (PMEC) are often utilized in cancer clinical trials; however, the incidence of PMEC and the association of PMEC with trial participant age disparities remain poorly understood. This study aimed to identify age disparities in oncologic randomized clinical trials as a result of PMEC. Using a comprehensive collection of modern phase III cancer clinical trials obtained via ClinicalTrials.gov, we assessed the incidence and covariates associated with trials excluding patients with prior cancers within 5+ years from registration (PMEC-5). Using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database, we further sought to determine the correlation between PMEC-5 and age disparities. PMEC-5 were used in 41% of all trials, with higher PMEC-5 utilization among industry-supported trials as well as trials evaluating a targeted therapy. Comparing trial patient median ages with population-matched median ages by disease site and time-period, we assessed the association between PMEC-5 and age disparities among trial participants. PMEC-5 were independently associated with heightened age disparities, which further worsened with longer exclusionary timeframes. Together, PMEC likely contribute to age disparities, suggesting that eligibility criteria modernization through narrower PMEC timeframes may work toward reducing such disparities in cancer clinical trial enrollment.
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Affiliation(s)
- Roshal R. Patel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA
- Albany Medical College, Albany, NY 12208, USA;
| | - Rose Parisi
- Albany Medical College, Albany, NY 12208, USA;
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Ramez Kouzy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Timothy A. Lin
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Noam A. VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, Memphis, TN 38138, USA;
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Beverly Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
| | - Charles R. Thomas
- Department of Radiation Oncology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.R.P.); (V.V.); (R.K.); (J.A.J.); (C.D.F.); (B.D.S.); (B.A.G.)
- Correspondence:
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Gill GS, Hunt B, Zhang R, Williams BB, Thomas CR, Zaki BI. Initial observation of contrast profiles for 3D and 2D MRI sequences in MR-guided radiation therapy for locally advanced pancreatic cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
541 Background: MR-guided stereotactic body radiation therapy (MR-SBRT) is a novel method of treating mobile tumors with soft-tissue gating and on-table adaptive planning. In our experience using the ViewRay MRIdian system (VR) for treating locally advanced pancreatic cancer (PA) with MR-SBRT, the true-fast imaging with steady-state free precession (TRUFI) sequences on the VR impart differing intensities for relevant structures seen on the pre-treatment high resolution 3D MRI (3D MRI) versus the real-time 2D cine MRI (2D cine) used for target tracking. Since these variations can confound target tracking selection, we propose that an understanding of the differing contrast profiles could improve selection of tracking structures and optimize treatment delivery. Methods: We retrospectively reviewed both 3D MRI and 2D cine images for patients (pts) with PA (n =20) treated on the VR. At simulation, an appropriate tracking target was identified and contoured on a single 3mm sagittal slice of the 3D MRI. This sagittal slice was directly compared to the registered 7mm 2D cine to identify structures with notable discrepancies in signal intensity. The 3D MRI was then explored in additional planes to confirm structure identities. For quantitative verification of the clinically observed differences, the pixel intensity distributions of 3D MRI and 2D cine DICOM image datasets were statistically compared. Results: In all pts reviewed, arteries (aorta, celiac, SMA) appeared with similar contrast profiles on both images. However, veins (portal vein, SMV) appeared hypointense on 3D MRI but hyperintense on 2D cine. Biliary structures appeared hyperintense on 3D MRI but only mildly hyperintense on 2D cine. The pixel intensity distributions extracted from 3D MRI and 2D cine images were confirmed to differ significantly (two sample Kolmogorov-Smirnov test; test statistic =0.40; p < 0.001). Conclusions: There are significant variations in image intensity between the initial treatment planning 3D MRI and the immediate pre-treatment 2D cine obtained with the VR. Understanding these discrepancies can guide radiation oncologists in choosing optimal tracking targets. Future work will focus on identifying the particular causes and frequencies of target tracking failures and exploring alternative tracking algorithms using artificial intelligence which could ultimately allow for VMAT on the ViewRay system.
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Affiliation(s)
| | - Brady Hunt
- Thayer School of Engineering at Dartmouth, Lebanon, NH
| | | | | | - Charles R. Thomas
- Geisel School of Medicine at Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Affiliation(s)
- Frederick Lansigan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Charles R Thomas
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Deputy Editor, JAMA Oncology
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Klotz AD, Caterino JM, Durham D, Felipe Rico J, Pallin DJ, Grudzen CR, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Lyman GH, Madsen TE, Reyes‐Gibby CC, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Jim Yeung S, Yilmaz S, Stutman R, Baugh CW. Observation unit use among patients with cancer following emergency department visits: Results of a multicenter prospective cohort from CONCERN. Acad Emerg Med 2021; 29:174-183. [PMID: 34811858 PMCID: PMC10359998 DOI: 10.1111/acem.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Emergency department (ED) visits by patients with cancer frequently end in hospitalization. As concerns about ED and hospital crowding increase, observation unit care may be an important strategy to deliver safe and efficient treatment for eligible patients. In this investigation, we compared the prevalence and clinical characteristics of cancer patients who received observation unit care with those who were admitted to the hospital from the ED. METHODS We performed a multicenter prospective cohort study of patients with cancer presenting to an ED affiliated with one of 18 hospitals of the Comprehensive Oncologic Emergency Research Network (CONCERN) between March 1, 2016 and January 30, 2017. We compared patient characteristics with the prevalence of observation unit care usage, hospital admission, and length of stay. RESULTS Of 1051 enrolled patients, 596 (56.7%) were admitted as inpatients, and 72 (6.9%) were placed in an observation unit. For patients admitted as inpatients, 23.7% had a length of stay ≤2 days. The conversion rate from observation to inpatient was 17.1% (95% CI 14.6-19.4) among those receiving care in an observation unit. The average observation unit length of stay was 14.7 h. Patient factors associated ED disposition to observation unit care were female gender and low Charlson Comorbidity Index. CONCLUSION In this multicenter prospective cohort study, the discrepancy between observation unit care use and short inpatient hospitalization may represent underutilization of this resource and a target for process change.
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Affiliation(s)
- Adam D. Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jeffrey M. Caterino
- Departments of Emergency Medicine and Internal Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Danielle Durham
- Department of Radiology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Juan Felipe Rico
- Department of Pediatrics Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | - Beau Abar
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital Troy Michigan USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Jason J. Bischof
- Department of Emergency Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center and the Department of Medicine Hutchinson Institute for Cancer Outcomes Research University of Washington School of Medicine Seattle Washington USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City Utah USA
| | - Cielito C. Reyes‐Gibby
- Department of Emergency Medicine and Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Sai‐Ching Jim Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sule Yilmaz
- Department of Geriatric Oncology University of Rochester Medical center Rochester New York USA
| | - Robin Stutman
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
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DuRoss AN, Landry MR, Thomas CR, Neufeld MJ, Sun C. Preclinical data on co-delivery of temozolomide and talazoparib by fucodain-coated nanoscale metal organic frameworks for colorectal cancer chemoradiation. Data Brief 2021; 38:107394. [PMID: 34632011 PMCID: PMC8488234 DOI: 10.1016/j.dib.2021.107394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Nanoparticle characterization and in vitro data on the effects of combined PARP inhibition and DNA damage by chemoradiation are shown. This data accompanies the research article “Fucoidan-coated nanoparticles target radiation-induced P-selectin to enhance chemoradiotherapy in murine colorectal cancer” (DuRoss et al., 2021) Additional characterization of the physiochemical properties of nanoscale metal organic frameworks (nMOFs) comprised of hafnium and 1,4-dicarboxybenzene (Hf-BDC) loaded with temozolomide (TMZ) and talazoparib (Tal) are presented. Toxicity data of the drug-loaded nMOF coated with fucoidan (TT@Hf-BDC-Fuco) in colorectal cancer cells, CT-26, from alamarBlue-based chemoradiation experiments are shown. Experimental methods for the nanoparticle characterization and cell-based assays of the nMOF formulation are presented.
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Affiliation(s)
- Allison N DuRoss
- Department of Pharmaceutical Sciences, Oregon State University, 2730 SW Moody Ave, Portland, OR 97201, USA
| | - Madeleine R Landry
- Department of Pharmaceutical Sciences, Oregon State University, 2730 SW Moody Ave, Portland, OR 97201, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.,Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Megan J Neufeld
- Department of Pharmaceutical Sciences, Oregon State University, 2730 SW Moody Ave, Portland, OR 97201, USA
| | - Conroy Sun
- Department of Pharmaceutical Sciences, Oregon State University, 2730 SW Moody Ave, Portland, OR 97201, USA.,Department of Radiation Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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40
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Mitin T, Dengina N, Chernykh M, Usychkin S, Gladkov O, Degnin C, Chen Y, Nosov D, Tsimafeyeu I, Thomas CR, Tjulandin S. Management of Muscle Invasive Bladder Cancer with Bladder Preservation in Russia: a Survey-Based Analysis of Current Practice and the Impact of an Educational Workshop on Clinical Expertise. J Cancer Educ 2021; 36:1005-1013. [PMID: 32130672 DOI: 10.1007/s13187-020-01728-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Trimodality bladder preservation (BP) is an accepted alternative to radical cystectomy for patients with muscle invasive bladder cancer (MIBC). The global utilization of BP is variable, and practice patterns have not been previously studied in Russia. We sought to elucidate the contemporary BP practice patterns in Russia and determine the impact of the BP workshop on attitudes of Russian radiation oncologists (ROs) towards BP. The workshop was focused on patient workup, selection for BP, chemotherapy choices, radiation therapy (RT) contouring and planning, patient counseling. A total of 77 pre- and 32 matched post-workshop IRB-approved surveys, based on the workshop content, were analyzed using descriptive statistics to determine baseline clinical experience and patterns of care. The impact was judged by changes in participants' responses. A total of 56% of respondents had experience with delivering bladder-directed RT, and 60% of those treated both operable and inoperable MIBC patients. Only 10% felt uncomfortable offering an operable patient BP modality. Prior to the workshop, almost half of respondents estimated universal poor bladder (44%) and erectile functions (47%) after BP. The workshop resulted in dramatic change in participants' attitudes towards long-term urinary (Stuart-Maxwell test, p < 0.01) and sexual (exact McNemar test, p < 0.01) side effects. Prior to the workshop, only 47% of respondents routinely discussed smoking cessation (SC) with their patients, whereas after workshop, 88% agreed that SC discussion is mandatory (exact McNemar test, p = 0.04). BP for MIBC is commonly used in Russia. Our workshop resulted in dramatically improved understanding of long-term BP toxicities and inspired Russian ROs to incorporate SC counseling into routine clinical management.
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Affiliation(s)
- Timur Mitin
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
| | - Natalia Dengina
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk, Ulyanovsk oblast, Russia
| | | | | | | | - Catherine Degnin
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yiyi Chen
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dmitry Nosov
- The Central Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia
| | | | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
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41
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Sutton TL, Walker BS, Nabavizadeh N, Grossberg A, Thomas CR, Lopez CD, Kardosh A, Chen EY, Sheppard BC, Mayo SC. ASO Visual Abstract: Geographic Disparities in Referral Rates and Oncologic Outcomes of Intrahepatic Cholangiocarcinoma: A Population-Based Study. Ann Surg Oncol 2021. [PMID: 34515888 DOI: 10.1245/s10434-021-10751-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Heath and Science University (OHSU), Portland, OR, USA
| | - Brett S Walker
- Department of Surgery, Oregon Heath and Science University (OHSU), Portland, OR, USA
| | | | | | | | - Charles D Lopez
- Division of Hematology/Oncology, OHSU Department of Medicine, Portland, OR, USA.,The Knight Cancer Institute at OHSU, Portland, OR, USA
| | - Adel Kardosh
- Division of Hematology/Oncology, OHSU Department of Medicine, Portland, OR, USA.,The Knight Cancer Institute at OHSU, Portland, OR, USA
| | - Emerson Y Chen
- Division of Hematology/Oncology, OHSU Department of Medicine, Portland, OR, USA.,The Knight Cancer Institute at OHSU, Portland, OR, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Heath and Science University (OHSU), Portland, OR, USA
| | - Skye C Mayo
- The Knight Cancer Institute at OHSU, Portland, OR, USA. .,Division of Surgical Oncology, OHSU Department of Surgery, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
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Wairiri LW, Fields EC, Kumar K, Rosenberg S, Park HS, Frakes J, Beriwal S, Parekh A, Stadtlander W, Thomas CR, Kahn JM. Implementation of a Multi-Institutional Virtual Radiation Oncology Clerkship. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.05.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Sutton TL, Walker BS, Nabavizadeh N, Grossberg A, Thomas CR, Lopez CD, Kardosh A, Chen EY, Sheppard BC, Mayo SC. Geographic Disparities in Referral Rates and Oncologic Outcomes of Intrahepatic Cholangiocarcinoma: A Population-Based Study. Ann Surg Oncol 2021; 28:8152-8159. [PMID: 34448960 PMCID: PMC8393777 DOI: 10.1245/s10434-021-10650-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/03/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is a rare cancer. Patients in rural areas may face reduced access to advanced treatments often only available at referral centers. We evaluated the association of referral center treatment with treatment patterns, outcomes, and geography in patients with ICC. METHODS We queried the Oregon State Cancer Registry for ICC between 1997 and 2016, collecting clinicopathologic, demographic, and oncologic data. Patients were classified by treatment at a referral center or non-referral center. 'Crowfly' distance to the nearest referral center (DRC) was calculated. Outcomes were evaluated using Kaplan-Meier, Cox proportional hazards modeling, and logistic regression. RESULTS Over 20 years, 740 patients with ICC had a median age of 66 years. Slightly more than half (n = 424, 57%) were non-referral center treated and 316 (43%) were referral center treated. Referral center treatment increased over time (odds ratio [OR] 1.03/year, p < 0.05). Referral center-treated patients had improved overall survival in all patients (median 9 vs. 4 months, p < 0.001), in the non-metastatic group (median 13 vs. 6 months, p < 0.001), and in patients not receiving liver resection (median 6 vs. 3 months, p < 0.05). On multivariable analysis, referral center-treated patients more often underwent chemotherapy, resection, or radiation (all p < 0.05). Increasing DRC (OR 0.98/20 km, p < 0.05) was independently associated with non-referral center treatment. CONCLUSION Patients with ICC who are evaluated at a referral center are more likely to receive treatments associated with better oncologic outcomes, including patients who are not managed with hepatic resection. Increasing the DRC is associated with treatment at a non-referral center; interventions to facilitate referral, such as telemedicine, may lead to improved outcomes for patients with ICC in rural states.
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Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Brett S Walker
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Aaron Grossberg
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Charles D Lopez
- Division of Hematology/Oncology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA
| | - Adel Kardosh
- Division of Hematology/Oncology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA
| | - Emerson Y Chen
- Division of Hematology/Oncology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Skye C Mayo
- The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA. .,Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
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44
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Metzger AL, Kusi Appiah A, Wright CM, Jairam V, Amini A, Park HS, Welsh JW, Thomas CR, Verma V, Ludmir EB. Financial relationships between industry and principal investigators of US cooperative group randomized cancer clinical trials. Int J Cancer 2021; 149:1683-1690. [PMID: 34173669 DOI: 10.1002/ijc.33719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Abstract
Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For our study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014 to 2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945, respectively, and $301 693 and $49 824 RF, respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < .05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < .001 GP, P = .008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential "industry bias" that could influence the integrity of their conclusions.
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Affiliation(s)
- April L Metzger
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher M Wright
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James W Welsh
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center @ Dartmouth University, Lebanon, New Hampshire, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Abstract
Oncology care is increasingly a multidisciplinary endeavour, and radiation therapy continues to have a key role across the disease spectrum in nearly every cancer. However, the field of radiation oncology is still one of the most poorly understood of the cancer disciplines. In this Review, we attempt to summarise and contextualise developments within the field of radiation oncology for the non-radiation oncologist. We discuss advancements in treatment technologies and imaging, followed by an overview of the interplay with advancements in systemic therapy and surgical techniques. Finally, we review new frontiers in radiation oncology, including advances within the metastatic disease continuum, reirradiation, and emerging types of radiation therapy.
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Affiliation(s)
- Ravi A Chandra
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Francine E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
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46
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Diaz DA, Suneja G, Jagsi R, Barry P, Thomas CR, Deville C, Winkfield K, Siker M, Bott-Kothari T. Mitigating Implicit Bias in Radiation Oncology. Adv Radiat Oncol 2021; 6:100738. [PMID: 34381930 PMCID: PMC8339323 DOI: 10.1016/j.adro.2021.100738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Implicit bias is one of the most insidious and least recognizable mechanisms that can cause inequity and disparities. There is increasing evidence that both implicit and explicit biases have a negative effect on patient outcomes and patient-physician relationships. Given the impact of Implicit bias, a joint session between ASTROs Committee on Health Equity, Diversity, and Inclusion and the National Cancer Institute (the ASTRO-National Cancer Institute Diversity Symposium) was held during the American Society of Radiation Oncology (ASTRO) 2020 Annual Meeting, to address the effect of implicit bias in radiation oncology through real life and synthesized hypothetical scenario discussions. Given the value of this session to the radiation oncology community, the scenarios and discussion are summarized in this manuscript. Our goal is to heighten awareness of the multiple settings in which implicit bias can occur as well as discuss resources to address bias.
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Affiliation(s)
| | - Gita Suneja
- Department of Radiation Oncology University of Utah, Salt Lake city, Utah
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Parul Barry
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles R Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Curtiland Deville
- The Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Malika Siker
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terri Bott-Kothari
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Ludmir EB, Mainwaring W, Lin TA, Miller AB, Jethanandani A, Espinoza AF, Mandel JJ, Lin SH, Smith BD, Smith GL, VanderWalde NA, Minsky BD, Koong AC, Stinchcombe TE, Jagsi R, Gomez DR, Thomas CR, Fuller CD. Factors Associated With Age Disparities Among Cancer Clinical Trial Participants. JAMA Oncol 2021; 5:1769-1773. [PMID: 31158272 DOI: 10.1001/jamaoncol.2019.2055] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Seminal investigation 2 decades ago alerted the oncology community to age disparities in participation in cooperative group trials; less is known about whether these disparities persist in industry-funded research. Objective To characterize the age disparities among trial enrollees on randomized clinical trials (RCTs) of common cancers in clinical oncology and identify factors associated with wider age imbalances. Data Sources Phase 3 clinical oncology RCTs were identified through ClinicalTrials.gov. Study Selection Multiarm RCTs assessing a therapeutic intervention for patients with breast, prostate, colorectal, or lung cancer (the 4 most common cancer disease sites) were included. Data Extraction and Synthesis Trial data were extracted from ClinicalTrials.gov. Trial screening and parameter identification were independently performed by 2 individuals. Data were analyzed in 2018. Main Outcomes and Measures The difference in median age (DMA) between the trial participant median age and the population-based disease-site-specific median age was determined for each trial. Results Three hundred two trials met inclusion criteria. The trials collectively enrolled 262 354 participants; 249 trials (82.5%) were industry-funded. For all trials, the trial median age of trial participants was a mean of 6.49 years younger than the population median age (95% CI, -7.17 to -5.81 years; P < .001). Age disparities were heightened among industry-funded trials compared with non-industry-funded trials (mean DMA, -6.84 vs -4.72 years; P = .002). Enrollment criteria restrictions based on performance status or age cutoffs were associated with age disparities; however, industry-funded trials were not more likely to use these enrollment restrictions than non-industry-funded trials. Age disparities were also larger among trials that evaluated a targeted systemic therapy and among lung cancer trials. Linear regression modeling revealed a widening gap between trial and population median ages over time at a rate of -0.19 years annually (95% CI, -0.37 to -0.01 years; P = .04). Conclusions and Relevance Age disparities between trial participants and the incident disease population are pervasive across trials and appear to be increasing over time. Industry sponsorship of trials is associated with heightened age imbalances among trial participants. With an increasing role of industry funding among cancer trials, efforts to understand and address age disparities are necessary to ensure generalizability of trial results as well as equity in trial access.
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Affiliation(s)
- Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Timothy A Lin
- The University of Texas MD Anderson Cancer Center, Houston.,Baylor College of Medicine, Houston, Texas
| | | | - Amit Jethanandani
- The University of Texas MD Anderson Cancer Center, Houston.,The University of Tennessee Health Science Center, Memphis
| | | | | | - Steven H Lin
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Grace L Smith
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Bruce D Minsky
- The University of Texas MD Anderson Cancer Center, Houston
| | - Albert C Koong
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Daniel R Gomez
- The University of Texas MD Anderson Cancer Center, Houston.,Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles R Thomas
- Oregon Health and Science University, Portland.,Deupty Editor, JAMA Oncology
| | - C David Fuller
- The University of Texas MD Anderson Cancer Center, Houston
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48
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Marsiglio JA, Rosenberg DM, Rooney MK, Goodman CR, Gillespie EF, Hirsch AE, Holliday EB, Kimple RJ, Thomas CR, Golden DW. Mentorship Initiatives in Radiation Oncology: A Scoping Review of the Literature. Int J Radiat Oncol Biol Phys 2021; 110:292-302. [PMID: 33412265 DOI: 10.1016/j.ijrobp.2020.12.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Although mentorship is described extensively in academic medical literature, there are few descriptions of mentorship specific to radiation oncology. The goal of the current study was to investigate the state of mentorship in radiation oncology through a scoping review of the literature. METHODS AND MATERIALS A search protocol was defined according to Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Predefined search terms and medical subject headings were used to search PubMed for English language articles published after January 1, 1990, on mentorship in radiation oncology. Additionally, in-press articles from major radiation oncology and medical education journals were searched. Three reviewers determined article eligibility. Included articles were classified based on predefined evaluation criteria. RESULTS Fourteen publications from 2008 to 2019 met inclusion criteria. The most commonly described form of mentorship was the dyad (64.3%), followed by team (14.3%) and peer (7.1%); 2 articles did not specify mentorship type (14.3%). The most commonly mentored participants were residents (35.7%), followed by medical students (35.7%) and attendings (21.4%); 1 study included participants of all levels (7.1%). Thirteen studies (92.9%) identified an experimental study design, most of which were cross-sectional (42.9%), followed by cohort studies (28.6%) and before/after (21.4%). Median sample size, reported in 12 of 13 experimental studies, was 132 (coefficient of variation, 1.06). Although outcomes varied widely, the majority described successful implementation of mentorship initiatives with high levels of participant satisfaction. CONCLUSIONS Although few initiatives are currently reported, the present study suggests that these initiatives are successful in promoting career development and increasing professional satisfaction. The interventions overwhelmingly described mentorship dyads; other forms of mentorship are either less common or understudied. Limitations included interventions not being evaluated in a controlled setting, and many were assessed using surveys with low response rates. This review highlights rich opportunities for future scholarship to develop, evaluate, and disseminate radiation oncology mentorship initiatives.
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Affiliation(s)
- John A Marsiglio
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - David M Rosenberg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael K Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chelain R Goodman
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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Thomas CR. Radiation-Induced Toxicity in the Era of Stereotactic Body Radiation Therapy-Lessons From NRG-BR001. JAMA Oncol 2021; 7:852. [PMID: 33885756 DOI: 10.1001/jamaoncol.2021.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Charles R Thomas
- Radiation Medicine, Oregon Health Sciences University, Portland.,Deputy Editor, JAMA Oncology
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50
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Noticewala SS, Jaoude JA, Kouzy R, Patel R, Chino F, Smith GL, Fuller CD, Thomas CR, Koong AC, Das P, Taniguchi CM, Ludmir EB. Lack of pre-planned financial outcomes evaluation in phase 3 cancer trials. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18826 Background: New cancer treatments have the potential to cause economic stress at the personal and societal level. Little is known on the evaluation of financial outcomes in clinical trials. We hypothesized that randomized controlled trials (RCTs) are unlikely to have pre-planned analyses to look at economic outcomes that address financial toxicity to patients and cost-effectiveness to society. Methods: Interventional therapeutic-intent phase 3 cancer-specific RCTs were identified through ClinicalTrials.gov. Pre-planned economic outcomes addressing financial toxicity or cost-effectiveness were identified. Results: We identified 1,069 interventional phase 3 oncology RCTs. Overall, 101 (9.4%) had pre-planned to evaluate quality of life using the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Questionnaire (EORTC QLQ-C30) instrument, of which a single question (Q28) relates to financial toxicity. However, only ten (0.94%) trials included pre-planned financial/economic endpoints; all were secondary endpoints. Among those planning to evaluate economic outcomes, 6/10 planned to collect data and report on financial distress using Q28 on EORTC QLQ-C30 and 3/10 pre-planned performing cost-effectiveness analyses. One study planned to perform an economic evaluation, including health utilities, as measured by the EuroQol-Five Dimension (EQ-5D) Questionnaire. All ten trials were industry–sponsored, and two were co-sponsored by a National Cancer Institute (NCI) cooperative group. The majority (8/10) were superiority-designed trials, and 6/10 included progression-free survival as the primary endpoint. The majority (6/10) assessed targeted therapy as the primary intervention. Multinational enrollment was predominant (8/10). Of the 10 trials, nine had a published manuscript. One was closed because of accrual issues. Among the six trials that had pre-specified reporting on financial distress, two published on financial toxicity. Of the two trials that had a priori planned to do a cost-effective analysis, one was published. However, overall 3/9 had published a cost-effective analysis. Conclusions: Less than one percent of oncology RCTs have pre-specified plans to evaluate economic outcomes associated with personal financial distress or cost-effectiveness. For the trials that had pre-planned reporting on financial toxicity, the instrument used to evaluate financial toxicity is a single question which has not been validated as a standalone assessment. Cost-effectiveness analyses were more likely to be published than on financial toxicity and were often completed as a post-hoc analysis. Given that many newly investigated therapies increase the financial burden on patients and add cost to the healthcare system more broadly, pre-planned evaluation of economic outcomes in RCTs is imperative in order to create a value-based framework in assessing new therapies.
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Affiliation(s)
| | | | - Ramez Kouzy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Grace L. Smith
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Albert C. Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ethan B. Ludmir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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