CA: A Cancer Journal for Clinicians最新文献

{"title":"Study identifies signs and symptoms of colorectal cancer risk at younger ages","authors":"Mike Fillon","doi":"10.3322/caac.21810","DOIUrl":"https://doi.org/10.3322/caac.21810","url":null,"abstract":"<p>Eight years ago, Paula Chambers-Raney from Houston, Texas, suffered from stomach pain, blood in her stool, and anemia. Her primary care physician told her that she had hemorrhoids. Then, over the next 18 months, other clinicians told her that she might have irritable bowel syndrome, she had probably eaten something red, and she should eat more green leafy vegetables for her anemia. After losing her job because of the number of sick days she had taken, with her health still not improving, she went to her county hospital’s emergency room for a colonoscopy. “They found a baseball-sized tumor,” says Chambers-Raney. “I was 44 years old and up until then was told I was too young to have something serious like colon cancer.”</p><p>Recognizing the alarming trend of younger people being diagnosed with colorectal cancer (CRC), in 2018, the American Cancer Society, followed by other health organizations, began recommending lowering the age for screening from the age of 50 years to the age of 45 years. A new study appearing in the Journal of the National Cancer Institute (doi:10.1093/jnci/djad068) is the latest to validate this change.</p><p>In the study, the researchers looked for abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia, with each indicating an increased risk for early-onset CRC. They sought to determine if these four symptoms—identified as red flags—might be key to the detection of early-onset CRC. To perform this work, the researchers conducted a nested case-control study from the IBM MarketScan Commercial Database, which includes individual claims data from approximately 113 million insured adults aged 18–64 years from across the United States. The primary analyses were restricted to adults aged 18–49 years with at least 2 years of continuous enrollment before the index date. For the secondary analyses, they included adults aged 50–64 years.</p><p>The primary analyses focused on identifying red-flag indications that appeared 3 months to 2 years before the index date of diagnosis. “Ultimately, the overarching objective is to improve the early detection of CRC at younger ages, which holds significant potential for improving patient outcomes,” says senior study author Yin Cao, ScD, MPH, an associate professor of surgery in the Division of Public Health Sciences of the Department of Surgery at Washington University School of Medicine in St. Louis, Missouri.</p><p>“To our knowledge, this study is among the first large-scale studies to identify predictive red-flag signs and symptoms for early-onset CRC compared to a matched control group and in comparison with signs and symptoms in people with CRC diagnosed at older ages,” she says.</p><p>The researchers found that 19.3% of people with early-onset CRC had symptoms beginning within 3 months to 2 years of their diagnosis with a median diagnostic interval of 8.7 months. In addition, 49.1% first showed symptoms within 3 months of their diagnosis. Also, the median diagnostic interva","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"448-450"},"PeriodicalIF":254.7,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5975403","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":"Adding immunotherapy to chemotherapy improves survival for endometrial cancer patients","authors":"Mike Fillon","doi":"10.3322/caac.21809","DOIUrl":"https://doi.org/10.3322/caac.21809","url":null,"abstract":"<p>There is encouraging news for patients with endometrial cancer based on the results of two recent phase 3 clinical trials: Immunotherapy combined with chemotherapy may appreciably increase progression-free survival for patients with advanced or recurrent endometrial cancer.</p><p>Both trials—NRG-GY018 and RUBY— were presented at the Society of Gynecologic Oncology 2023 Annual Meeting on Women’s Cancer in Tampa, Florida. Both also appear in <i>The New England Journal of Medicine.</i>\u0000 </p><p>The NRG-GY018 trial (doi:10.1056/NEJMoa2302312) was a double-blind, placebo-controlled, randomized study. Enrolled were 816 volunteers with stage III/IVA, stage IVB, or recurrent endometrial cancer who were randomized 1:1 to receive either pembrolizumab—an immune checkpoint inhibitor—plus chemotherapy with paclitaxel and carboplatin or a placebo plus chemotherapy for six cycles. They then received as many as 14 cycles of maintenance pembrolizumab or placebo.</p><p>All had newly diagnosed stage III or IVA disease with Response Evaluation Criteria for Solid Tumors– measurable disease or stage IVB or recurrent endometrial cancer with or without measurable disease.</p><p>The volunteers were divided into two cohorts: those who had mismatch repair–deficient (dMMR) disease and those who had mismatch repair–proficient (pMMR) disease. The primary outcome was progression-free survival in both cohorts. Interim analyses were scheduled after 84 events of death or progression in the cohort with dMMR disease and at least 196 events in the cohort with pMMR disease.</p><p>The double-blind, placebo-controlled RUBY trial (doi:10.1056/NEJMoa2216334) enrolled 494 patients with first recurrent or primary advanced stage III or IV endometrial cancer. Measurable disease was required for stages IIIA–C1, and 49 patients with carcinosarcoma—a rare and difficult-to-treat subset of endometrial cancer—were included. Volunteers were randomly assigned in a 1:1 ratio to receive 500 mg of dostarlimab or a placebo intravenously in combination with paclitaxel plus carboplatin. Doses were received every 3 weeks for the first six cycles. This was followed by 1000 mg of dostarlimab or the placebo intravenously every 6 weeks for up to 3 years.</p><p>Computed tomography or magnetic resonance imaging was performed every 6 weeks until Cycle 8 and then every 9 weeks until Week 52. Imaging was then performed every 12 weeks. There were 118 volunteers (23.9%) who had dMMR, microsatellite instability–high tumors.</p><p>For the NRG-GY018 study, the primary outcome was investigator-assessed progression-free survival according to the Response Evaluation Criteria for Solid Tumors (version 1.1). Key secondary outcomes included safety, overall survival, and health-related quality of life as assessed, the researchers reported.</p><p>“At 12-months, the percent of patients who were without evidence of disease progression or death in the dMMR cohort was 74% for the pembrolizumab group and 38% for the pla","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"445-447"},"PeriodicalIF":254.7,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5975407","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":"The evolving landscape of salivary gland tumors","authors":"Conor E. Steuer MD,&nbsp;Glenn J. Hanna MD,&nbsp;Kartik Viswanathan MD, PhD,&nbsp;James E. Bates MD,&nbsp;Azeem S. Kaka MD,&nbsp;Nicole C. Schmitt MD,&nbsp;Alan L. Ho MD,&nbsp;Nabil F. Saba MD","doi":"10.3322/caac.21807","DOIUrl":"10.3322/caac.21807","url":null,"abstract":"<p>Salivary gland cancers are a rare, histologically diverse group of tumors. They range from indolent to aggressive and can cause significant morbidity and mortality. Surgical resection remains the mainstay of treatment, but radiation and systemic therapy are also critical parts of the care paradigm. Given the rarity and heterogeneity of these cancers, they are best managed in a multidisciplinary program. In this review, the authors highlight standards of care as well as exciting new research for salivary gland cancers that will strive for better patient outcomes.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"597-619"},"PeriodicalIF":254.7,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10228650","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":"Does distance deter male fertility preservation?","authors":"Mike Fillon","doi":"10.3322/caac.21804","DOIUrl":"https://doi.org/10.3322/caac.21804","url":null,"abstract":"&lt;p&gt;For patients with cancer under-going gonadotoxic therapies who wish to undergo sperm banking, distance may have an impact on their decision for making the trek from their homes to the clinic according to a new retrospective study. Overall, researchers at the University of Pittsburgh Medical Center (UPMC) found that distance seemed to play a role in whether or not men underwent fertility preservation (FP).&lt;/p&gt;&lt;p&gt;The study appears in &lt;i&gt;JCO Oncology Practice&lt;/i&gt; (doi:10.1200/OP.22.00789).&lt;/p&gt;&lt;p&gt;The study authors note that although nearly 90% of the US population lives within a half-hour’s drive to a urologist, there is a steep dropoff for males who live close to specialists and medical centers offering FP. Lead author Daniel Pelzman, MD, resident physician at UPMC’s Department of Urology in Pittsburgh, Pennsylvania, says that this was a key reason prompting the study. “There has been so little research done about geography as a potential barrier to fertility preservation in men. We believe this is the first study to investigate whether the distances from fertility centers decreased the odds of males taking advantage of FP after referral.”&lt;/p&gt;&lt;p&gt;For the study, the researchers investigated male patients who were referred to the UPMC fertility clinic for FP between 2013 and 2021. Each subject had at least reached puberty, and all had FP recommended by a reproductive specialist. Semen was collected at a time chosen by the patients. Although not all patients saw a reproductive urologist before FP, all of them agreed to counseling with an FP coordinator by phone or in person.&lt;/p&gt;&lt;p&gt;Specifically, the study reported that for all cancer types, 73.6% (182) of the patients who lived no more than 20 miles away from the UPMC fertility clinic underwent FP. Although a slightly higher proportion of those living 20–40 miles away (70 men) underwent FP (76.1%), rates consistently dropped the farther out people lived from the UPMC fertility clinic; only 59.6% (28 of 47) of the patients who lived 40–60 miles from the clinic and 58.3% (14 of 24) of the patients who lived 80–100 miles from the clinic underwent sperm banking at the UPMC fertility clinic. Still, the researchers noted that the proportion of patients undergoing FP was consistently high (i.e., &gt;50%). “This finding confirms that men &lt;i&gt;want&lt;/i&gt; to pursue fertility preservation after referral, even if it is difficult logistically,” Dr Pelzman concluded.&lt;/p&gt;&lt;p&gt;Timothy D. Gilligan, MD, vice-chair for education and associate professor of medicine at the Cleveland Clinic’s Taussig Cancer Institute in Cleveland, Ohio, agrees that men would be more likely to complete sperm banking if there were a facility for doing so closer to where they live. “The study was not able to determine whether the men who lived farther away simply went somewhere else closer to do sperm banking, however,” he adds. “In other words, it’s possible that the men who did not complete sperm banking in Pittsburgh did complete it somewhere el","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 4","pages":"344-345"},"PeriodicalIF":254.7,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21804","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5682605","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":"Clinicians need to stay current with polypharmacy concerns","authors":"Mike Fillon","doi":"10.3322/caac.21803","DOIUrl":"https://doi.org/10.3322/caac.21803","url":null,"abstract":"&lt;p&gt;Anew study raises an alarm over polypharmacy, an issue that is not new but may become more worrisome because of an aging population and a myriad of new drugs coming to market, including cancer drugs. The study appears in &lt;i&gt;Cancer&lt;/i&gt; (doi:10.1002/cncr.34642).&lt;/p&gt;&lt;p&gt;Corresponding author Erika Ramsdale, MD, MS, geriatric oncologist and associate professor of hematology/oncology in the Department of Medicine at the University of Rochester in Rochester, New York, warns that although there is some evidence that cancer treatment outcomes may be affected by taking multiple medications and/or potentially inappropriate medications (PIMs), “the research is still very sparse.”&lt;/p&gt;&lt;p&gt;Dr Ramsdale says that the main goal of this new study was to examine the associations between polypharmacy, PIMs, and potential drug–drug interactions (PDIs) and adverse cancer treatment outcomes in a large national cohort of older adults with advanced cancer. The authors note that polypharmacy and PIMs have suspected roles in many adverse events in older patients with cancer, including toxicities, but cause and effect links have been unclear.&lt;/p&gt;&lt;p&gt;This secondary analysis uses data from an earlier nationwide, multicenter, cluster-randomized study by the same team that appeared in &lt;i&gt;The Lancet&lt;/i&gt; (doi:10.1016/S01406736(21)01789-X). Known as the Geriatric Assessment for Patients 70 Years and Older (GAP70+) study, it assessed clinician-rated grade 3–5 chemotherapy toxicity in older adults with advanced cancer who were undergoing a new cancer treatment regimen.&lt;/p&gt;&lt;p&gt;In the &lt;i&gt;Cancer&lt;/i&gt; study, the authors note that a host of variables exist beyond the age and possible disabilities of the patients. Other factors that can contribute to difficulties include health care system–level issues, such as poor transitions of care, interdepartmental communication, multiple pharmacies, and “prescribing cascades.”&lt;/p&gt;&lt;p&gt;There were 718 patients enrolled in the study between July 2014 and March 2019 who had provided written consent. The subjects ranged in age from 70 to 94 years, were predominantly male (56.4%) and non-Hispanic White (87.5%), and had a stage III/IV solid tumor or lymphoma (87.5%). Gastrointestinal cancer was the most common type (246 patients; 34.3%), and it was followed by lung cancer (180 patients; 25.1%).&lt;/p&gt;&lt;p&gt;Four hundred forty of the 718 patients (61.3%) were taking five or more medications, 198 (27.6%) were taking eight or more, and 104 (14.5%) were taking more than 10. The researchers found that 447 patients (62.3%) received one or more PIMs according to the 2019 American Geriatrics Society Beers Criteria (range, 0–8 PIMs), and 206 (28.7%) received at least one PIM according to the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria. All told, there were 482 patients (67.1%) with one or more PIMs.&lt;/p&gt;&lt;p&gt;There were 177 patients who had at least one potentially major PDI (category D or X).&lt;/p&gt;&lt;p&gt;The researchers found that the mean number of grade 2 or high","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 4","pages":"341-343"},"PeriodicalIF":254.7,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6048738","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":"Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature","authors":"Raymond J. Chan RN, PhD,&nbsp;Vivienne E. Milch MBBS(Hons), MHPol,&nbsp;Fiona Crawford-Williams PhD,&nbsp;Oluwaseyifunmi Andi Agbejule BRadTherapy,&nbsp;Ria Joseph MNutrDiet,&nbsp;Jolyn Johal BND(Hons),&nbsp;Narayanee Dick BSc(Hons),&nbsp;Matthew P. Wallen PhD,&nbsp;Julie Ratcliffe PhD,&nbsp;Anupriya Agarwal MBBS,&nbsp;Larissa Nekhlyudov MD,&nbsp;Matthew Tieu PhD,&nbsp;Manaf Al-Momani BPharm,&nbsp;Scott Turnbull PhD,&nbsp;Rahul Sathiaraj MPH,&nbsp;Dorothy Keefe MBBS, MD,&nbsp;Nicolas H. Hart PhD","doi":"10.3322/caac.21788","DOIUrl":"10.3322/caac.21788","url":null,"abstract":"<p>Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"565-589"},"PeriodicalIF":254.7,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060076","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":"Isn’t there enough evidence on the benefits of patient navigation?","authors":"Electra D. Paskett PhD,&nbsp;Tracy Battaglia MD, MPH,&nbsp;Elizabeth A. Calhoun PhD, MEd,&nbsp;Michelle C. Chappell MS,&nbsp;Andrea Dwyer BS,&nbsp;Linda G. Fleisher PhD, MPH,&nbsp;Jennifer Greenwald MPH,&nbsp;Kristen J. Wells PhD, MPH","doi":"10.3322/caac.21805","DOIUrl":"10.3322/caac.21805","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt;, Chan and colleagues&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; describe an umbrella review of 61 systematic reviews published between 2012 and 2022, along with a review of 53 primary studies published globally since 2021. Patient navigation (PN) has many definitions, and, in this, review PN was defined according to the definition of Wells et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; combined with that of Dalton et al.,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; which expanded the definition of PN to also include care coordination. Their primary research question focused on evaluating the effectiveness and cost-effectiveness of different cancer navigation models and programs. Multiple databases were searched to find quantitative PN intervention studies with any comparator as well as qualitative, mixed-methods, and systematic reviews. The Joanna Briggs Institute’s JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used to examine the risk of bias for each of the systematic reviews. Findings of this umbrella review indicated that the risk of bias of the included systematic reviews seemed low; however, fewer than one half of the included reviews reported the likelihood of publication bias. The review concluded that PN is effective in increasing uptake or adherence to cancer screening, reducing the time from screening abnormality to diagnosis, increasing rates of diagnostic resolution, reducing the time from diagnostic resolution to treatment initiation, increasing treatment completion, increasing treatment adherence, increasing survivorship surveillance appointments for breast or cervical cancer, increasing quality of life, and increasing satisfaction with care. Furthermore, the review pointed to a lack of evidence regarding PN in palliative care and end-of-life phases. The review also concluded that most effectiveness and cost-effectiveness data for PN interventions were collected in the United States; therefore, Chan and colleagues call for additional research to evaluate the effectiveness and cost-effectiveness of PN outside of the United States, in survivorship and palliative care phases of the cancer continuum, for indigenous populations, and for individuals affected by rare cancers, hematologic malignancies, as well as advanced or metastatic cancer.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although this review has many important contributions to the literature, there are points that need to be addressed. First, although Chan and colleagues updated the more recent literature, their conclusions do not differ from those of the myriad of other reviews. Now is the time for the implementation of PN in health care because the amount and consistency of evidence is sufficient demonstrating the impact of PN across the cancer continuum. This report solidifies the evidence—when can we all agree that enough evidence is enough and that PN needs to be an integral part of usual clinical care with reimbursement? The next phas","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"562-564"},"PeriodicalIF":254.7,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060078","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":"Survival outcomes used to validate version 9 of the American Joint Committee on Cancer staging system for appendiceal cancer","authors":"Lauren M. Janczewski MD, MS,&nbsp;Amanda E. Browner MS,&nbsp;Joseph H. Cotler PhD,&nbsp;Heidi Nelson MD,&nbsp;Sanjay Kakar MD,&nbsp;Norman J. Carr MBBS,&nbsp;Nader N. Hanna MD,&nbsp;Andreana N. Holowatyj PhD, MS,&nbsp;Richard M. Goldberg MD,&nbsp;M. Kay Washington MD, PhD,&nbsp;Elliot A. Asare MD, MS,&nbsp;Michael J. Overman MD,&nbsp;the American Joint Committee on Cancer Expert Panel on Cancers for the Lower Gastrointestinal Appendix Disease Site","doi":"10.3322/caac.21806","DOIUrl":"10.3322/caac.21806","url":null,"abstract":"<p>The standard for cancer staging in the United States for all cancer sites, including primary carcinomas of the appendix, is the American Joint Committee on Cancer (AJCC) staging system. AJCC staging criteria undergo periodic revisions, led by a panel of site-specific experts, to maintain contemporary staging definitions through the evaluation of new evidence. Since its last revision, the AJCC has restructured its processes to include prospectively collected data because large data sets have become increasingly robust and available over time. Thus survival analyses using AJCC eighth edition staging criteria were used to inform stage group revisions in the version 9 AJCC staging system, including appendiceal cancer. Although the current AJCC staging definitions were maintained for appendiceal cancer, incorporating survival analysis into the version 9 staging system provided unique insight into the clinical challenges in staging rare malignancies. This article highlights the critical clinical components of the now published version 9 AJCC staging system for appendix cancer, which (1) justified the separation of three different histologies (non-mucinous, mucinous, signet-ring cell) in terms of prognostic variance, (2) demonstrated the clinical implications and challenges in staging heterogeneous and rare tumors, and (3) emphasized the influence of data limitations on survival analysis for low-grade appendiceal mucinous neoplasms.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"590-596"},"PeriodicalIF":254.7,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9689775","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":"Implementation in action: Collaborating on the transition to primary HPV screening for cervical cancer in the United States","authors":"Levi S. Downs Jr MD,&nbsp;Ritu Nayar MD,&nbsp;Jane Gerndt MPH,&nbsp;Debbie Saslow PhD,&nbsp;for the American Cancer Society Primary HPV Screening Initiative Steering Committee","doi":"10.3322/caac.21786","DOIUrl":"https://doi.org/10.3322/caac.21786","url":null,"abstract":"&lt;p&gt;In July 2020, the American Cancer Society (ACS) released an updated cervical cancer screening guideline calling for primary human papillomavirus (HPV) screening as the preferred strategy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; &lt;i&gt;Primary HPV screening&lt;/i&gt; refers to cervical cancer screening with an HPV test alone as the initial screening modality. Under this strategy, cervical cytology is reserved for use as one option for a triage test should the HPV test result be positive. The scientific data supporting this recommendation have been reviewed both in the United States and in other countries that have transitioned to primary HPV screening.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The Primary HPV Screening Initiative (PHSI), nested under the ACS National Roundtable on Cervical Cancer, is a national consortium supported by the ACS that convenes key partners and experts on six workgroups and a Steering Committee charged with identifying critical barriers and opportunities for transitioning to primary HPV screening. The workgroups engage approximately 100 volunteers who began their activities in the fall of 2021. Workgroup members are multiprofessional and include leaders in health care policy, health care delivery, and patient care as well as patient advocates. The project is overseen by a Steering Committee (Figure 1) made up of the co-chairs of each of the six workgroups and other experts identified for their leadership in the areas of cervical cancer screening and health care policy. The final deliverable is an implementation report (&lt;i&gt;roadmap&lt;/i&gt;), complete with tools and recommendations to support health systems, laboratories, providers, patients, and payors as they make this transition.&lt;/p&gt;&lt;p&gt;The &lt;i&gt;Provider Needs Workgroup&lt;/i&gt; is developing resources in a variety of formats both to educate providers and to help them educate their patients about the benefits and safety of primary HPV screening. The deliverables include tools to aid in the management of patients with abnormal screening results. Success will be defined by change in provider behavior and will depend in large part on the degree to which major professional organizations (e.g., American College of Obstetricians and Gynecologists, American Academy of Family Physicians, Nurse Practitioners in Women's Health, and American Society for Colposcopy and Cervical Pathology) promote primary HPV screening as the standard for excellent care. The US Preventive Services Task Force recommends primary HPV screening as one of three strategies to screen for cervical cancer starting at age 30 years but does not give preference to modality.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; As of this writing, updated recommendations from the US Preventive Services Task Force are pending. It is desirable that all organizations agree on preferred screening guidelines to facilitate prevention efforts that are supported by evidence and widely accessible. Providers are most likely to follow guidelines promoted by their professional societies, so t","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"458-460"},"PeriodicalIF":254.7,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5750732","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":"Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions","authors":"Zsolt Megyesfalvi MD, PhD,&nbsp;Carl M. Gay MD, PhD,&nbsp;Helmut Popper MD,&nbsp;Robert Pirker MD,&nbsp;Gyula Ostoros MD, PhD,&nbsp;Simon Heeke PhD,&nbsp;Christian Lang MD,&nbsp;Konrad Hoetzenecker MD, PhD,&nbsp;Anna Schwendenwein MSc,&nbsp;Kristiina Boettiger BSc,&nbsp;Paul A. Bunn jr MD,&nbsp;Ferenc Renyi-Vamos MD, PhD,&nbsp;Karin Schelch MSc, PhD,&nbsp;Helmut Prosch MD,&nbsp;Lauren A. Byers MD, MSc,&nbsp;Fred R. Hirsch MD, PhD,&nbsp;Balazs Dome MD, PhD","doi":"10.3322/caac.21785","DOIUrl":"10.3322/caac.21785","url":null,"abstract":"<p>Small cell lung cancer (SCLC) is characterized by rapid growth and high metastatic capacity. It has strong epidemiologic and biologic links to tobacco carcinogens. Although the majority of SCLCs exhibit neuroendocrine features, an important subset of tumors lacks these properties. Genomic profiling of SCLC reveals genetic instability, almost universal inactivation of the tumor suppressor genes <i>TP53</i> and <i>RB1</i>, and a high mutation burden. Because of early metastasis, only a small fraction of patients are amenable to curative-intent lung resection, and these individuals require adjuvant platinum-etoposide chemotherapy. Therefore, the vast majority of patients are currently being treated with chemoradiation with or without immunotherapy. In patients with disease confined to the chest, standard therapy includes thoracic radiotherapy and concurrent platinum-etoposide chemotherapy. Patients with metastatic (extensive-stage) disease are treated with a combination of platinum-etoposide chemotherapy plus immunotherapy with an anti-programmed death-ligand 1 monoclonal antibody. Although SCLC is initially very responsive to platinum-based chemotherapy, these responses are transient because of the development of drug resistance. In recent years, the authors have witnessed an accelerating pace of biologic insights into the disease, leading to the redefinition of the SCLC classification scheme. This emerging knowledge of SCLC molecular subtypes has the potential to define unique therapeutic vulnerabilities. Synthesizing these new discoveries with the current knowledge of SCLC biology and clinical management may lead to unprecedented advances in SCLC patient care. Here, the authors present an overview of multimodal clinical approaches in SCLC, with a special focus on illuminating how recent advancements in SCLC research could accelerate clinical development.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"620-652"},"PeriodicalIF":254.7,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9645021","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}