American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care

This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.

Abstract S06-01: Changes implemented by U.S. oncology practices in response to COVID-19 pandemic: Initial report from the ASCO Registry on COVID-19 and cancer

Background: In April 2020, ASCO initiated a registry to capture and analyze status and outcomes of patients with cancer and COVID-19, and to describe effects of the pandemic on U.S. cancer practices. Initial findings of changes to care delivery are included.

Methods: Practices provide data on changes to care delivery due to COVID-19 and longitudinal data on patients with cancer and confirmed COVID-19. At present, 26 cancer practices have enrolled in the Registry—5 academic, 15 hospital/health-system (H/HS) owned, and 6 physician-owned (P-O) located in 19 states. Enrollment of practices and data collection is ongoing.

Results: Twenty sites, from 17 practices (3 academic, 9 H/HS owned, and 5 P-O in 15 states) responded (April 20-June 4). All incorporated telemedicine visits; 90% reported use of telemedicine was new. 30% reported “declining some but not all” new patient requests. For patients with cancer not on active therapy, 15% of sites postponed some routine visits, 35% conducted virtually all routine visits by telemedicine, and 50% used telemedicine for some routine visits. Most sites (95%) reported following clinical guidelines for visit postponement; 90% reported following local health authorities on when to resume routine visits. 90% screened patients prior to in-office visits for COVID-19 symptoms by phone and at clinic entrance; 10% screened patients using only one method. 30% modified intravenous (IV) drug infusions, including halting some or all (10%), shortening some or all (20%), or switching from IV to oral drugs (15%). While no sites conducted home-based, anticancer drug infusions, 30% are considering this option if COVID19 conditions change. Most sites modified laboratory specimen collection, including allowing a collection site closer to home (60%) and collection in a patient’s home (1 site). Two sites only allowed patients on oral anticancer drugs to use alternate collection sites. Only 1 site reported specimen collection in patients’ homes. All reported making the following changes to clinic arrangements: requiring use of masks, eliminating accompaniment by a support person (with exceptions), and reducing the visit numbers or increasing time between visits. No sites reported shortages of anticancer or supportive care drugs. 45% experienced shortages of nasopharyngeal swabs, 45% of medical hand sanitizer, and 75% of personal protective equipment. 40% of sites have experienced staffing reductions or changes due to reduced patient visits (30%), transfer to other clinical areas (20%), availability (15%), and COVID-19 illness (15%).

Conclusions: The COVID-19 pandemic has had a substantial impact on most aspects of cancer care delivery in U.S. oncology practices. All practices incorporated telemedicine, which is new to most. Adjustments were made to patient visits and scheduled IV drug infusions. Sites reported shortages of equipment related to COVID-19, not cancer or supportive care drug shortages. At the time of the AACR meeting we expect to have data from more practices.

Citation Format: Suanna S. Bruinooge, Elizabeth Garrett-Mayer, Stephen Meersman, Patricia Hurley, Brian Bourbeau, Allyn Moushey, Sybil Green, Deborah Kamin, Stephen Grubbs, Richard L. Schilsky. Changes implemented by U.S. oncology practices in response to COVID-19 pandemic: Initial report from the ASCO Registry on COVID-19 and cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S06-01.

Depot-specific regulation of glucose uptake and insulin sensitivity in HIV-lipodystrophy

Altered fat distribution is associated with insulin resistance in HIV, but little is known about regional glucose metabolism in fat and muscle depots in this patient population. The aim of the present study was to quantify regional fat, muscle, and whole body glucose disposal in HIV-infected men with lipoatrophy. Whole body glucose disposal was determined by hyperinsulinemic clamp technique (80 mU x m(-2) x min(-1)) in 6 HIV-infected men and 5 age/weight-matched healthy volunteers. Regional glucose uptake in muscle and subcutaneous (SAT) and visceral adipose tissue (VAT) was quantified in fasting and insulin-stimulated states using 2-deoxy-[18F]fluoro-D-glucose positron emission tomography. HIV-infected subjects with lipoatrophy had significantly increased glucose uptake into SAT (3.8 +/- 0.4 vs. 2.3 +/- 0.5 micromol x kg tissue(-1) x min(-1), P < 0.05) in the fasted state. Glucose uptake into VAT did not differ between groups. VAT area was inversely related with whole body glucose disposal, insulin sensitivity, and muscle glucose uptake during insulin stimulation. VAT area was highly predictive of whole body glucose disposal (r2 = 0.94, P < 0.0001). This may be mediated by adiponectin, which was significantly associated with VAT area (r = -0.75, P = 0.008), and whole body glucose disposal (r = 0.80, P = 0.003). This is the first study to directly demonstrate increased glucose uptake in subcutaneous fat of lipoatrophic patients, which may partially compensate for loss of SAT. Furthermore, we demonstrate a clear relationship between VAT and glucose metabolism in multiple fat and muscle depots, suggesting the critical importance of this depot in the regulation of glucose and highlighting the significant potential role of adiponectin in this process.

American Society of Clinical Oncology 2001 Presidential Initiative: impact of regulatory burdens on quality cancer care

PURPOSE

This study was conducted as part of the American Society of Clinical Oncology (ASCO) 2001 Presidential Initiative to assess the administrative burden of payer documentation requirements and their impact on oncology practice.

METHODS

The study consisted of a physician questionnaire and an activity log. Site visits were conducted to support survey data. Analysis included 2,493 questionnaires and 1,115 activity logs; data were also collected from site visits to 10 oncology practices.

RESULTS

Increased documentation was the greatest concern among respondents, greater even than the stress of dealing with death and dying. More than 97% of survey respondents reported an increase in documentation (averaging 1.4 h/d) and 77% reported an increase in work hours because of documentation in the past 5 years. As a result, more than 40% of respondents reported decreases in key aspects of patient care and decreases in teaching (48%) and research (39%). Site visit data demonstrate similar trends.

CONCLUSION

It is critical to find ways to decrease physician burden without decreasing the ability to prevent fraud and abuse. Reforms include provisions in a recently passed bill in the United States House of Representatives to streamline Medicare regulation and increase physician education. To address oncology-specific concerns, changes also should be made to supervision requirements for residents and fellows and evaluation and management documentation for oncology follow-up visits.

Stimulus configuration and context effects in perceptual organization in schizophrenia

Two studies assessed perceptual organization in schizophrenia to determine (a) whether inpatient and outpatient groups with poor premorbid schizophrenia have comparable levels of perceptual organization deficit; and (b) whether the deficit could be eliminated by task manipulations. In Study 1, inpatients demonstrated clear evidence of a perceptual organization deficit, whereas outpatients performed similarly to the control groups. In Study 2, a performance pattern that operationally defined a perceptual organization deficit was eliminated by a task manipulation thought to aid in context processing. The perceptual organization deficit is most pronounced in actively symptomatic patients with poor premorbid schizophrenia, and the deficit reflects, in part, deficient top-down influences to basic perceptual processes.

Stimulus configuration and context effects in perceptual organization in schizophrenia

Two studies assessed perceptual organization in schizophrenia to determine (a) whether inpatient and outpatient groups with poor premorbid schizophrenia have comparable levels of perceptual organization deficit; and (b) whether the deficit could be eliminated by task manipulations. In Study 1, inpatients demonstrated clear evidence of a perceptual organization deficit, whereas outpatients performed similarly to the control groups. In Study 2, a performance pattern that operationally defined a perceptual organization deficit was eliminated by a task manipulation thought to aid in context processing. The perceptual organization deficit is most pronounced in actively symptomatic patients with poor premorbid schizophrenia, and the deficit reflects, in part, deficient top-down influences to basic perceptual processes.

Property rights and payment to patients for cell lines derived from human tissues: an economic analysis

The increasing potential for commercial applications in biotechnology has given rise to new legal and ethical questions with regard to ownership of human tissue. As the potential value of human cells and tissue has risen, so have donors' calls for a share in the profits. However, in a recent California ruling (John Moore vs the Regents of the University of California), the court once again held to its traditional position that individuals do not hold property rights in their own tissue and cells. We will show that, in the rare case where tissue value may be determined prospectively, a one-time payment (and, hence granting a property right) is efficient. Moore is such a case. In general, however, the transactions costs of granting full property rights to donors of tissue and cells outweigh the benefits of such a change in policy.