CA: A Cancer Journal for Clinicians最新文献

{"title":"Density Modifications Toward High Mechanical Performance Nanocellulose Aerogels","authors":"Gaigai Duan, Qin Qin, Rubei Hu, Zhao Liang, Xiaoshuai Han, Haoqi Yang, Yong Huang, Chunmei Zhang, Shuijian He, Shaohua Jiang","doi":"10.1002/pol.20240736","DOIUrl":"https://doi.org/10.1002/pol.20240736","url":null,"abstract":"Mechanical properties are crucial for the application of nanocellulose aerogels. In this work, a series of nanocellulose aerogels with solid content concentration gradient (0.5, 1.0, 1.5, 2.0 wt%) of precursor dispersion are prepared by freeze-drying method, and the effect of nanocellulose solid content on the mechanical properties of nanocellulose aerogels was investigated. As the solid content concentration increased, the internal microstructure of the aerogel underwent a transition from a sparse reticular structure to a tightly arranged lamellar structure. This transition led to a substantial improvement in the mechanical properties of the aerogel. At 50% strain, the compressive strength of the aerogel increased from 8.4 to 37.56 kPa with the increase of nanofibrillar cellulose solid content. Furthermore, the specific strength, specific modulus, and compressive modulus also increased, while maintaining a low density (20.02 mg/cm³) and high porosity (98.63%). This work confirms the feasibility of structural strengthening and mechanical property enhancement of nanocellulose aerogels by density modification, which provides a guidance for the design of durability enhancement of nanocellulose aerogels for broadening their application fields.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"11 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral mastectomy may not reduce mortality risk","authors":"Mike Fillon","doi":"10.3322/caac.21869","DOIUrl":"10.3322/caac.21869","url":null,"abstract":"<p>Although rates of contralateral prophylactic mastectomy and bilateral mastectomy are increasing among women with unilateral sporadic breast cancer, a new study reports that despite the procedure diminishing the risk of contralateral breast cancer, the patients experienced mortality rates similar to those of patients treated with lumpectomy or unilateral mastectomy.</p><p>The primary goal of the study, appearing in <i>JAMA Oncology</i> (doi:10.1001/jamaoncol.2024.2212), was to determine the 20-year cumulative risk of breast cancer mortality among women with stage 0–III unilateral breast cancer divided by each patient’s initial surgical procedures.</p><p>In an editorial accompanying the study, Seema A. Khan, MD, Bluhm Family Professor of Cancer Research at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, and Masha Kocherginsky, PhD, professor of biostatistics and director of the Quantitative Data Sciences Core at the Robert H. Lurie Comprehensive Cancer Center at Northwestern Medicine, wrote that although contralateral breast cancer is the most frequent second malignant tumor among women who have experienced a diagnosis of primary breast cancer, it is less frequent and less ominous than recurrence of the initial cancer. “Nevertheless,” they wrote, “for many patients with newly diagnosed unilateral breast cancer, it can be a prominent source of worry as they navigate their treatment decisions. This worry is accentuated among young patients and those with early-stage disease.”</p><p>The cohort study included patients from the Surveillance, Epidemiology, and End Results Program registry database. The researchers identified 661,270 eligible women with unilateral breast cancer diagnosed from 2000 to 2019. The average age of the patients was 58.7 years. In each treatment group, approximately 83% were White, just over 8% were Black, approximately 2% were East Asian, and 2% were Southeast Asian. The remainder of the patients were American Indian/Alaska Native, Pacific Islander, South Asian, or “unknown” (approximately 1% in each category).</p><p>The research team identified 564,062 cases of invasive breast cancer (85.3%) and 97,208 cases of ductal carcinoma in situ (14.7%). According to study author Steven A. Narod, MD, a professor in the Dalla Lana School of Public Health and the Department of Medicine at the University of Toronto, the researchers matched 90.7% of the patients with bilateral mastectomy into three surgical groups of equal size (36,028 women in each treatment group): lumpectomy, unilateral mastectomy, and bilateral mastectomy. All three groups were similar across demographic, clinical, and treatment variables and propensity scores. More than 70% of the cohort had undergone breast-conserving surgery, whereas 23.4% had undergone unilateral mastectomy, and 6.0% had undergone bilateral mastectomy.</p><p>Nearly two-thirds of the patients underwent radiotherapy, whereas approximately 37% received chemotherapy. T","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"469-470"},"PeriodicalIF":503.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Most young female cancer survivors are at minimal risk for obstetric problems","authors":"Mike Fillon","doi":"10.3322/caac.21868","DOIUrl":"10.3322/caac.21868","url":null,"abstract":"<p>A study based in the United Kingdom reports that, in general, most women between the ages of 15 and 39 years who have survived a cancer diagnosis are at low risk for pregnancy complications later in their lives. The study appears in <i>The Lancet Oncology</i> (doi:10.1016/S1470-2045(24)00269-9).</p><p>According to the study authors, limited data are available on the risks of obstetric complications among survivors of adolescent and young adult (AYA) cancer, and they noted that most earlier studies report risks only for all types of cancers combined. The purpose of this population-based cohort study—the Teenage and Young Adult Cancer Survivor Study—was to determine whether there was a negative impact on birth rates and risks of obstetric complications after treatment for one of 17 cancers in the AYA population. The authors compared the observed number of births affected to the number expected based on general population rates.</p><p>The study included more than 200,000 5-year survivors of cancer from England and Wales who were initially diagnosed between the ages of 15 and 39 years. The cohort was based on cancer registrations obtained through the Office for National Statistics and the Welsh Cancer Registry. The investigators ascertained 27 specific obstetric complications among 96,947 female survivors. They compared the observed number of affected births in the cohort with the expected number in the general population of England.</p><p>Specifically, the researchers found that between April 1, 1997 and March 31, 2022, 22,033 births occurred among 14,051 female survivors of AYA cancer from England. They also found that survivors of cervical cancer and leukemia had an increased risk for more than two specific complications from among the 27 complications investigated.</p><p>Overall, the number of births was “lower than expected” (observed-to-expected ratio, 0.68; 95% CI, 0.67–0.69). Notably, the researchers reported that survivors of genitourinary, cervical, and breast cancers reported a birth rate that was less than 50% of that in the general population.</p><p>When they focused on more common obstetric complications that were above normal, they discovered that survivors of cervical cancer were at risk of many serious pregnancy and labor complications: malpresentation of fetus, obstructed labor, amniotic fluid and membrane disorders, premature rupture of membranes, preterm birth, placental disorders (including placenta previa), and antepartum hemorrhage.</p><p>Also of particular concern were patients with leukemia, who were at greater risk of preterm delivery, obstructed labor, postpartum hemorrhage, and retained placenta. By contrast, the other cancers observed had two or fewer obstetric complications that exceeded an “observed-to-expected ratio of 1:25 or greater.” Based on their data, the researchers concluded that survivors of cervical cancer and leukemia are at risk of several serious obstetric complications: “Therefore, any pregnancy in the","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"467-468"},"PeriodicalIF":503.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer statistics 2024","authors":"Angela N. Giaquinto MSPH,&nbsp;Hyuna Sung PhD,&nbsp;Lisa A. Newman MD, MPH,&nbsp;Rachel A. Freedman MD, MPH,&nbsp;Robert A. Smith PhD,&nbsp;Jessica Star MA, MPH,&nbsp;Ahmedin Jemal DVM, PhD,&nbsp;Rebecca L. Siegel MPH","doi":"10.3322/caac.21863","DOIUrl":"10.3322/caac.21863","url":null,"abstract":"<p>This is the American Cancer Society's biennial update of statistics on breast cancer among women based on high-quality incidence and mortality data from the National Cancer Institute and the Centers for Disease Control and Prevention. Breast cancer incidence continued an upward trend, rising by 1% annually during 2012–2021, largely confined to localized-stage and hormone receptor-positive disease. A steeper increase in women younger than 50 years (1.4% annually) versus 50 years and older (0.7%) overall was only significant among White women. Asian American/Pacific Islander women had the fastest increase in both age groups (2.7% and 2.5% per year, respectively); consequently, young Asian American/Pacific Islander women had the second lowest rate in 2000 (57.4 per 100,000) but the highest rate in 2021 (86.3 per 100,000) alongside White women (86.4 per 100,000), surpassing Black women (81.5 per 100,000). In contrast, the overall breast cancer death rate continuously declined during 1989–2022 by 44% overall, translating to 517,900 fewer breast cancer deaths during this time. However, not all women have experienced this progress; mortality remained unchanged since 1990 in American Indian/Alaska Native women, and Black women have 38% higher mortality than White women despite 5% lower incidence. Although the Black-White disparity partly reflects more triple-negative cancers, Black women have the lowest survival for every breast cancer subtype and stage except localized disease, with which they are 10% less likely to be diagnosed than White women (58% vs. 68%), highlighting disadvantages in social determinants of health. Progress against breast cancer could be accelerated by mitigating racial, ethnic, and social disparities through improved clinical trial representation and access to high-quality screening and treatment.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"477-495"},"PeriodicalIF":503.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer: The good, the bad, and an important call to effective risk reduction strategies","authors":"Virginia G. Kaklamani MD, DSc,&nbsp;Carlos L. Arteaga MD","doi":"10.3322/caac.21867","DOIUrl":"10.3322/caac.21867","url":null,"abstract":"&lt;p&gt;The 2024 Breast Cancer Statistics highlight a few interesting trends: breast cancer incidence is increasing, there is a greater increase in younger women, and most of this increase is driven by early stage diagnosis and hormone receptor (HR)-positive disease.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In addition, compared with other racial groups, women with Asian American/Pacific Islander (AAPI) heritage have a greater increase in breast cancer; and, despite overall declining death rates from breast cancer, Black women continue to have higher mortality compared with White women. Let us consider these findings in more detail.&lt;/p&gt;&lt;p&gt;Breast cancer incidence in the United States briefly decreased in the early 2000s, possibly related to a decline in the use of hormone-replacement therapy, but it has since shown an increase of approximately 1% per year. This increase is associated with HR-positive breast cancers and is mostly seen in younger women. A potential contributing factor for this association may be a decrease in the number of live births.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Another possibility may be the greater incidence of young-onset HR-positive breast cancer in Indian and Chinese women.&lt;span&gt;&lt;sup&gt;3-5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;AAPI women have a greater increase in breast cancer incidence, which is largely noted in Asian women immigrating to the United States rather than Asian women born in the United States.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Compared with Asian American women born in the United States, Asian American women who have immigrated to the United States and have lived more than 50% of their life in the United States, on average, are three times more likely to be diagnosed with breast cancer.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Specifically for Indian women, there has been a rise in breast cancer incidence by almost 50% between 1965 and 1985,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and Chinese women are projected to have a rise in breast cancer incidence by greater than 11% by 2030.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In the past 35 years, breast cancer mortality rates have decreased by 44%. This decrease is attributed to early diagnosis stemming from nationwide screening recommendations as well as treatment advances in all disease stages.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Based on simulation models, 25% of the reduction in mortality rates comes from screening mammography, 29% comes from treatment advances in metastatic disease, and 47% comes from treatment advances in early stage disease. The addition of trastuzumab has increased survival in metastatic HER2-positive breast cancer by 16 months&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; and, in early stage disease, by 26%–37%.&lt;span&gt;&lt;sup&gt;10-12&lt;/sup&gt;&lt;/span&gt; Most recently, the addition of CDK4/6 inhibitors has broken the 5-year barrier in median overall survival in metastatic HR-positive breast cancer,&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt; suggesting that mortality rates will continue to show an improvement in patient survival in subsequent iterations of the breast cancer statistics.&lt;/p&gt;&lt;p&gt;Non","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"471-474"},"PeriodicalIF":503.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewer acknowledgement 2024","authors":"","doi":"10.3322/caac.21866","DOIUrl":"10.3322/caac.21866","url":null,"abstract":"<p>In order to maintain the high standards of <i>CA</i>’s content, the Editors of <i>CA</i> rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.</p><p>We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2023, to June 30, 2024. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews. Peer review is an essential component of scholarly publishing, and we sincerely appreciate the time and expertise volunteered by these participants.</p><p>Dina Amin</p><p>Eric Bernicker</p><p>Chao Cao</p><p>Raymond Chan</p><p>Paul Daeninck</p><p>Fernando Diaz</p><p>Tanya Dorff</p><p>Georges Gebrael</p><p>Samir Hanash</p><p>Vida Henderson</p><p>Hormuzd Katki</p><p>Shumei Kato</p><p>Amir Khan</p><p>Allison J. Lazard</p><p>Mark Lewis</p><p>Kim Margolin</p><p>Joaquin Mateo</p><p>Justin Moyers</p><p>Maria Pisu</p><p>Gwendolyn Quinn</p><p>Paul Riviere</p><p>Jason Sicklick</p><p>Zbyslaw Sondka</p><p>Conor Steuer</p><p>Kristine Swartz</p><p>Randy Sweis</p><p>Peter Yu</p><p>Xue Qin Yu</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"519"},"PeriodicalIF":503.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142237013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer disparities for LGBTQ+ patients identified more fully","authors":"Mike Fillon","doi":"10.3322/caac.21861","DOIUrl":"10.3322/caac.21861","url":null,"abstract":"&lt;p&gt;It has been widely reported that patients who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-diverse characteristic) have more health risks than the cisgender and/or heterosexual population. According to previous studies, most of the disparity has been attributed to the minority stress theory: Members of these communities disproportionally experience discrimination, and this results in mistrust in medical settings—further increasing stress.&lt;/p&gt;&lt;p&gt;Regarding cancer specifically, these society-derived stressors have been reported to lead to lower rates of timely screening, higher rates of infection with cancer-causing viruses, and higher rates of health risk behaviors—increasing the potential risk for various cancers in the LGBTQ+ community. Another issue builds on the aforementioned minority stress theory, which can result in avoidance because of the fear that a health care provider will refuse to care for them. Importantly, the LGBTQ+ communities are diverse, and cancer incidences may differ within specific gender identities and/or sexual orientations (SOs). Because of insufficient details from previous studies, accurate data regarding cancer incidence in specific groups have been lacking.&lt;/p&gt;&lt;p&gt;A study appearing in &lt;i&gt;Cancer&lt;/i&gt; (doi: 10.1002/cncr.35356) adds new evidence of the disproportional cancer burden faced by sexual minoritized people. Study author Aimee K. Huang, MD, MPH, a junior faculty member at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, says that most prior studies relied on indirect approximations of incidence and prevalence. “However, for studies that were able to directly measure incidence, the scopes of their investigations were often limited to the most common cancers, unidimensional SO measurements, or had other methodological challenges due to data limitations,” she says.&lt;/p&gt;&lt;p&gt;For the study, researchers culled SO and cancer diagnosis data (from 1989 to 2017) from the Nurses’ Health Study II (NHSII), a longitudinal cohort of 101,543 nurses across the United States. The mean ages and race/ethnicity compositions were similar across all the groups.&lt;/p&gt;&lt;p&gt;The primary outcome was the self-disclosed and electronic health record–verified incidences of cancer among four different sexual minority groups: heterosexual with a past same-sex attraction/behavior/identity (&lt;i&gt;n&lt;/i&gt; = 5034), mostly heterosexual (&lt;i&gt;n&lt;/i&gt; = 1825), bisexual (&lt;i&gt;n&lt;/i&gt; = 394), and lesbian (&lt;i&gt;n&lt;/i&gt; = 996). These groups were compared to a “reference” group that self-identified as lifelong heterosexual (&lt;i&gt;n&lt;/i&gt; = 93,294). The researchers also determined the case numbers, incidence rates, and age-adjusted incidence rate ratios (aIRRs) of 21 site-specific cancers for each group. Using aIRRs, they compared incidence rates between the reference group and the four SO subgroups.&lt;/p&gt;&lt;p&gt;The researchers reported that the cancer incidence rate (cases per 100,000 person-years) was highest for those ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"399-401"},"PeriodicalIF":503.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osimertinib prolongs progression-free lung cancer survival after chemotherapy","authors":"Mike Fillon","doi":"10.3322/caac.21862","DOIUrl":"10.3322/caac.21862","url":null,"abstract":"&lt;p&gt;Investigators for the phase 3 LAURA trial reported that for patients with unresectable stage III non–small cell lung cancer (NSCLC) harboring an &lt;i&gt;EGFR&lt;/i&gt; mutation after chemoradiotherapy, osimertinib significantly prolonged progression-free survival (PFS) versus a placebo. The study appears in &lt;i&gt;The New England Journal of Medicine&lt;/i&gt; (doi:10.1056/NEJMoa2402614).&lt;/p&gt;&lt;p&gt;“This is the first randomized trial conducted specifically for patients with unresectable stage III lung cancer with &lt;i&gt;EGFR&lt;/i&gt; mutation,” says Suresh S. Ramalingam, MD, professor of hematology and medical oncology and executive director of the Winship Cancer Institute at the Emory University School of Medicine and LAURA trial investigator. “The study shows a clear benefit with osimertinib compared to placebo in terms of progression-free survival and lower risk of brain progression.”&lt;/p&gt;&lt;p&gt;Study results show that treatment with osimertinib reduced the risk of progression or death by 84% in comparison with the placebo. The study was presented during a press briefing at the 2024 annual meeting of the American Society of Clinical Oncology held in Chicago, Illinois.&lt;/p&gt;&lt;p&gt;The LAURA trial included patients at least 18 years old (20 years old in Japan) with locally advanced and unresectable stage III NSCLC harboring an &lt;i&gt;EGFR&lt;/i&gt; exon 19 deletion or L858R mutation from August 2018 through July 2022. None of the patients had disease progression after definitive chemoradiotherapy. A total of 216 patients underwent randomization; 143 were assigned to receive osimertinib, and 73 received the placebo.&lt;/p&gt;&lt;p&gt;The median age of the patients was 62 years in the osimertinib arm and 64 years in the placebo group. Most were male (63% in the osimertinib arm and 58% in the placebo arm). The majority never smoked (71% and 67%, respectively).&lt;/p&gt;&lt;p&gt;Both groups included enrollment from Asian countries (81% in the osimertinib arm vs. 85% in the placebo arm), had stage IIIB disease (47% vs. 52%) and adenocarcinoma (97% vs. 95%), and harbored &lt;i&gt;EGFR&lt;/i&gt; exon 19 deletions (52% vs. 59%). Also, most received concurrent chemoradiotherapy: 92% in the osimertinib group and 85% in the placebo group.&lt;/p&gt;&lt;p&gt;Patients needed to have a World Health Organization (WHO) performance-status score of 0 or 1. (Note that this was based on a scale of 0–5, with a higher number indicating more disability.) Six weeks was the maximum interval between the last dose of chemoradiotherapy and randomization. At the baseline, patients were largely balanced between the two groups, although there were more patients with a WHO performance-status score of 0 in the osimertinib group versus the placebo group (56% vs. 42%).&lt;/p&gt;&lt;p&gt;The patients were randomly assigned 2:1 to receive 80 mg of oral osimertinib or the placebo once per day. Blinded independent central review (BICR) of PFS per the Response Evaluation Criteria in Solid Tumors (Version 1.1) was the trial’s primary end point. Secondary end points included overall survival (OS), ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"402-404"},"PeriodicalIF":503.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlooked barriers to implementation of geriatric assessment","authors":"Banu E. Symington MD,&nbsp;Paul G. Montgomery MD","doi":"10.3322/caac.21865","DOIUrl":"10.3322/caac.21865","url":null,"abstract":"&lt;p&gt;In this issue of the journal, Magnuson et al. provide a comprehensive review of available geriatric assessment (GA) tools and their impact on outcomes for solid tumors and hematologic malignancies. In addition, the authors provide a clear guide for clinicians to help understand the importance of GA and management.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;An assumption inherent in the GA is that improvement in outcomes is driven by modifications in treatment delivery or implementation of features to make activities of daily living safer. In other words, GA-guided management&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; or GA-driven intervention,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; rather than simply performing the GA, is what leads to outcome improvement. These modifications are implemented using a multidisciplinary team of geriatric trained specialists. Examples include occupational therapists to improve home safety, physical therapists to improve gait and balance, pharmacists to review home medications and adjust based on anticipated adverse drug interactions, dietitians to improve nutrition, etc. Most of the studies included showed benefit, either in survival, reduced toxicity, improved quality of life, or cost effectiveness.&lt;/p&gt;&lt;p&gt;These observations led to the development of an American Society of Clinical Oncology guideline recommending GA-guided management of cancer treatment in elderly adults.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; However, it is widely recognized that this tool is underused by practicing oncologists.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The &lt;i&gt;whys&lt;/i&gt; have been explored by Magnuson et al. and others&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; and included the belief that the GA was too cumbersome in addition to the perception that it added little or no value. Based on these assumptions, making assessment tools more efficient and educating providers about their evidence-generated benefits have been the focus of efforts to improve GA use. To encourage greater uptake of the tool, Magnuson and co-authors detail ways to educate providers and simplify the GA.&lt;/p&gt;&lt;p&gt;What is not discussed that may be an important root cause of poor uptake of GA is resource scarcity, which takes two forms. The first is the lack of available services to support GA-modified treatment. Substantial numbers of communities, particularly in rural sites, do not have consistent—if any—access to the specialists required to modify treatment in a GA-guided manner. These practices almost certainly do not have geriatricians or geriatric-trained nurse practitioners; and they may not have physical therapists, occupational therapists, chemotherapy-dedicated pharmacists, or even social workers. Rural sites particularly often have one oncology provider whose job is to meet all the needs of every oncology patient in their practice. This distributive inequity of resources&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; has always existed and will continue to plague rural communities. In this context, even if one performed a GA, opportunities to make care delivery safer ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"475-476"},"PeriodicalIF":503.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric assessment for the practicing clinician: The why, what, and how","authors":"Allison Magnuson DO, MS,&nbsp;Kah Poh Loh MBBCh BAO, MS,&nbsp;Fiona Stauffer MS,&nbsp;William Dale MD, PhD,&nbsp;Nikesha Gilmore PhD, MS,&nbsp;Sindhuja Kadambi MD,&nbsp;Heidi D. Klepin MD, MS,&nbsp;Kaitlin Kyi MD,&nbsp;Lisa M. Lowenstein PhD,&nbsp;Tanyanika Phillips MD, MPH,&nbsp;Erika Ramsdale MD, MS,&nbsp;Melody K. Schiaffino PhD, MPH,&nbsp;John F. Simmons Jr MD,&nbsp;Grant R. Williams MD, MSPH,&nbsp;Jason Zittel MD,&nbsp;Supriya Mohile MD, MS","doi":"10.3322/caac.21864","DOIUrl":"10.3322/caac.21864","url":null,"abstract":"<p>Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 6","pages":"496-518"},"PeriodicalIF":503.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}