CA: A Cancer Journal for Clinicians最新文献

{"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":"<p>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.</p><p>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.</p><p>A study appearing in <i>Cancer</i> (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.</p><p>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.</p><p>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 (<i>n</i> = 5034), mostly heterosexual (<i>n</i> = 1825), bisexual (<i>n</i> = 394), and lesbian (<i>n</i> = 996). These groups were compared to a “reference” group that self-identified as lifelong heterosexual (<i>n</i> = 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.</p><p>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":232.4,"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":"Overlooked barriers to implementation of geriatric assessment","authors":"Banu E. Symington MD, Paul G. Montgomery MD","doi":"10.3322/caac.21865","DOIUrl":"10.3322/caac.21865","url":null,"abstract":"<p>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.<span><sup>1</sup></span></p><p>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<span><sup>2</sup></span> or GA-driven intervention,<span><sup>3</sup></span> 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.</p><p>These observations led to the development of an American Society of Clinical Oncology guideline recommending GA-guided management of cancer treatment in elderly adults.<span><sup>4</sup></span> However, it is widely recognized that this tool is underused by practicing oncologists.<span><sup>5</sup></span> The <i>whys</i> have been explored by Magnuson et al. and others<span><sup>5, 6</sup></span> 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.</p><p>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<span><sup>7</sup></span> 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":232.4,"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":232.4,"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}

{"title":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019","authors":"Farhad Islami MD, PhD,&nbsp;Emily C. Marlow PhD,&nbsp;Blake Thomson DPhil, MPhil,&nbsp;Marjorie L. McCullough ScD, RD,&nbsp;Harriet Rumgay PhD,&nbsp;Susan M. Gapstur PhD, MPH,&nbsp;Alpa V. Patel PhD,&nbsp;Isabelle Soerjomataram MD, PhD, MSc,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21858","DOIUrl":"10.3322/caac.21858","url":null,"abstract":"<p>In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating for and informing cancer prevention and control. Herein, based on up-to-date relative risk and cancer occurrence data, the authors estimated the proportion and number of invasive cancer cases (excluding nonmelanoma skin cancers) and deaths, overall and for 30 cancer types among adults who were aged 30 years and older in 2019 in the United States, that were attributable to potentially modifiable risk factors. These included cigarette smoking; second-hand smoke; excess body weight; alcohol consumption; consumption of red and processed meat; low consumption of fruits and vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and seven carcinogenic infections. Numbers of cancer cases and deaths were obtained from data sources with complete national coverage, risk factor prevalence estimates from nationally representative surveys, and associated relative risks of cancer from published large-scale pooled or meta-analyses. In 2019, an estimated 40.0% (713,340 of 1,781,649) of all incident cancers (excluding nonmelanoma skin cancers) and 44.0% (262,120 of 595,737) of all cancer deaths in adults aged 30 years and older in the United States were attributable to the evaluated risk factors. Cigarette smoking was the leading risk factor contributing to cancer cases and deaths overall (19.3% and 28.5%, respectively), followed by excess body weight (7.6% and 7.3%, respectively), and alcohol consumption (5.4% and 4.1%, respectively). For 19 of 30 evaluated cancer types, more than one half of the cancer cases and deaths were attributable to the potentially modifiable risk factors considered in this study. Lung cancer had the highest number of cancer cases (201,660) and deaths (122,740) attributable to evaluated risk factors, followed by female breast cancer (83,840 cases), skin melanoma (82,710), and colorectal cancer (78,440) for attributable cases and by colorectal (25,800 deaths), liver (14,720), and esophageal (13,600) cancer for attributable deaths. Large numbers of cancer cases and deaths in the United States are attributable to potentially modifiable risk factors, underscoring the potential to substantially reduce the cancer burden through broad and equitable implementation of preventive initiatives.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"405-432"},"PeriodicalIF":232.4,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578363","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":"Key issues face AI deployment in cancer care","authors":"Mike Fillon","doi":"10.3322/caac.21860","DOIUrl":"10.3322/caac.21860","url":null,"abstract":"&lt;p&gt;With artificial intelligence (AI) erupting across all aspects of life, including health care, oncology is a logical field ripe for new applications. AI is already used in cancer care and diagnosis, such as tumor identification on x-rays and pathology slides. Beyond that, emerging technology is using AI to forecast the prognosis of patients and to assess their treatment options. One unknown is how oncologists feel about this trend, which includes possibly relinquishing some control over their profession and patients.&lt;/p&gt;&lt;p&gt;A new study asked 204 oncologists for their views on the rapidly developing AI tools. Specifically, they were asked about ethical issues that they face regarding the deployment of AI (e.g., whether they believed that AI could be used effectively in patient-care decisions). The main issue that the researchers investigated was to what degree patients should provide explicit informed consent for the use of AI during treatment decision-making. The study appears in &lt;i&gt;JAMA Network Open&lt;/i&gt; (doi:10.1001/jamanetworkopen.2024.4077).&lt;/p&gt;&lt;p&gt;In the study, which was conducted from November 15, 2022 to July 31, 2023, a random sample of oncologists from across the country were asked 24 questions via traditional mail (which included a $25 gift card) about their views on the use of AI in clinical practice. Follow-ups with nonresponders were conducted via email and phone calls.&lt;/p&gt;&lt;p&gt;Issues covered bias, responsibilities, and whether they would be able to explain to patients how the technology was deployed in determining their care. There were 387 surveys sent to oncologists; 52.7% (&lt;i&gt;n&lt;/i&gt; = 204) were completed. Those responding came from 37 states; 63.7% (&lt;i&gt;n&lt;/i&gt; = 120) were male, and 62.7% (&lt;i&gt;n&lt;/i&gt; = 128) identified as non-Hispanic White.&lt;/p&gt;&lt;p&gt;Very few respondents said that AI prognostic and clinical decision models could be used clinically when only researchers could explain them (13.2% of respondents [&lt;i&gt;n&lt;/i&gt; = 27] for prognosis and 7.8% [&lt;i&gt;n&lt;/i&gt; = 16] for clinical decisions).&lt;/p&gt;&lt;p&gt;For AI prognostic and clinical decision models that oncologists could explain, the percentages were much higher: 81.3% (&lt;i&gt;n&lt;/i&gt; = 165) and 84.8% (&lt;i&gt;n&lt;/i&gt; = 173), respectively. Fewer respondents—13.8% (&lt;i&gt;n&lt;/i&gt; = 28) and 23.0% (&lt;i&gt;n&lt;/i&gt; = 47), respectively—reported that the models also needed to be explainable by patients.&lt;/p&gt;&lt;p&gt;The survey also found that 36.8% of oncologists (&lt;i&gt;n&lt;/i&gt; = 75) believed that if an AI system selected a treatment regimen different from what they would recommend, they would present both options and let the patient decide. Although that represented less than half of the respondents, it was the most common answer.&lt;/p&gt;&lt;p&gt;Regarding responsibility for medical or legal problems arising from AI use, 90.7% of respondents (&lt;i&gt;n&lt;/i&gt; = 185) indicated that AI developers should be held accountable. This was considerably higher than the 47.1% (&lt;i&gt;n&lt;/i&gt; = 96) who felt that the responsibility should be shared with physicians and the 43.1% (","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"320-322"},"PeriodicalIF":232.4,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532957","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":"Colon cancer blood test effective for average-risk population","authors":"Mike Fillon","doi":"10.3322/caac.21859","DOIUrl":"10.3322/caac.21859","url":null,"abstract":"&lt;p&gt;A new study appearing in The &lt;i&gt;New England Journal of Medicine&lt;/i&gt; (&lt;i&gt;NEJM&lt;/i&gt;) investigated the effectiveness of an emerging colon cancer screening option—a cell-free DNA (cfDNA) blood-based test known as Shield—that researchers and clinicians hope will encourage more people to be screened for colorectal cancer (CRC) (doi:10.1056/NEJMoa2304714).&lt;/p&gt;&lt;p&gt;Allison Rosen, MS, from Houston, Texas, is a 12-year CRC survivor who says that she is alive today because of timely colon cancer screening. “Unfortunately,” says Ms Rosen, “after talking with the community about the importance of screening and even with the knowledge that screening can save their life, people tell me every day that they refuse to get screened because both stool-based tests and colonoscopies have very negative stigmas.”&lt;/p&gt;&lt;p&gt;Ms Rosen points to American Cancer Society (ACS) data showing that one third of the screening-eligible population is not getting screened even though 90% of CRC deaths can be prevented with timely screening. Ms Rosen is the director of the ACS’s Project ECHO (Extension for Community Healthcare Outcomes) in Houston, Texas.&lt;/p&gt;&lt;p&gt;The Shield test is a blood-based CRC screening test meant for average-risk people with no family history of CRC and no personal history of CRC or advanced polyps (large polyps). Targeted patients are also CRC symptom–free.&lt;/p&gt;&lt;p&gt;The researchers who conducted the &lt;i&gt;NEJM&lt;/i&gt; study believe that this screening test option could be key to improving screening rates, leading to fewer colon cancer deaths.&lt;/p&gt;&lt;p&gt;According to study author William M. Grady, MD, medical director of the Gastrointestinal Cancer Prevention Program at the Fred Hutchinson Cancer Center in Seattle, Washington, the test is on par with stool-based CRC screening tests, such as the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test, for the detection of CRC.&lt;/p&gt;&lt;p&gt;The results of the &lt;i&gt;NEJM&lt;/i&gt; study were derived from the ECLIPSE (Evaluation of the ctDNA LUNAR Test in an Average Patient Screening Episode) study, a multisite clinical trial of nearly 8000 people aged 45–84 years. The study was underwritten and led by Guardant Health (based in Palo Alto, California). The focus of the study was the comparison of the effectiveness of the blood test and colonoscopies for CRC sensitivity and for advanced neoplasia, including CRC and advanced precancerous lesions. Also investigated was the sensitivity for discovering if advanced precancerous lesions had a negative cfDNA blood-based test.&lt;/p&gt;&lt;p&gt;Of the 7861 patients who met the study criteria, 83.1% with colonoscopy-detected CRC registered a positive cfDNA test; 16.9% had a negative test (i.e., a colonoscopy detected CRC, but a circulating tumor DNA [ctDNA] test did not). Overall, the researchers found that the blood test was most sensitive for CRCs, including early-stage cancers. They also found that it was less sensitive for advanced precancerous lesions, which may become cancerous later.&lt;/p&gt;&lt;p&gt;Furthe","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 4","pages":"317-319"},"PeriodicalIF":232.4,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141532956","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 misinformation on social media","authors":"Stacy Loeb MD, MSc, PhD (Hon),&nbsp;Aisha T. Langford PhD, MPH,&nbsp;Marie A. Bragg PhD,&nbsp;Robert Sherman BA,&nbsp;June M. Chan ScD","doi":"10.3322/caac.21857","DOIUrl":"10.3322/caac.21857","url":null,"abstract":"<p>Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks—such as their extensive use and the relative ease it allows to share information quickly—facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give <i>information prescriptions</i> to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"453-464"},"PeriodicalIF":232.4,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141425293","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 tissue-agnostic therapies in precision oncology","authors":"Vivek Subbiah MD,&nbsp;Mohamed A. Gouda MD,&nbsp;Bettina Ryll MD, PhD,&nbsp;Howard A. Burris III MD,&nbsp;Razelle Kurzrock MD","doi":"10.3322/caac.21844","DOIUrl":"10.3322/caac.21844","url":null,"abstract":"<p>Tumor-agnostic therapies represent a paradigm shift in oncology by altering the traditional means of characterizing tumors based on their origin or location. Instead, they zero in on specific genetic anomalies responsible for fueling malignant growth. The watershed moment for tumor-agnostic therapies arrived in 2017, with the US Food and Drug Administration's historic approval of pembrolizumab, an immune checkpoint inhibitor. This milestone marked the <i>marriage</i> of genomics and immunology fields, as an immunotherapeutic agent gained approval based on genomic biomarkers, specifically, microsatellite instability-high or mismatch repair deficiency (dMMR). Subsequently, the approval of NTRK inhibitors, designed to combat <i>NTRK</i> gene fusions prevalent in various tumor types, including pediatric cancers and adult solid tumors, further underscored the potential of tumor-agnostic therapies. The US Food and Drug Administration approvals of targeted therapies (<i>BRAF</i> V600E, <i>RET</i> fusion), immunotherapies (tumor mutational burden ≥10 mutations per megabase, dMMR) and an antibody-drug conjugate (Her2-positive–immunohistochemistry 3+ expression) with pan-cancer efficacy have continued, offering newfound hope to patients grappling with advanced solid tumors that harbor particular biomarkers. In this comprehensive review, the authors delve into the expansive landscape of tissue-agnostic targets and drugs, shedding light on the rationale underpinning this approach, the hurdles it faces, presently approved therapies, voices from the patient advocacy perspective, and the tantalizing prospects on the horizon. This is a welcome advance in oncology that transcends the boundaries of histology and location to provide personalized options.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 5","pages":"433-452"},"PeriodicalIF":232.4,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174107","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":"Better communication is key for quality-of-life improvement in low-income and minority patients","authors":"Mike Fillon","doi":"10.3322/caac.21842","DOIUrl":"10.3322/caac.21842","url":null,"abstract":"&lt;p&gt;Although approximately half of patients with cancer receive symptom management and advance care planning (ACP), a new study reports that the percentage is much worse—only approximately 20%—for low-income and minority patients. The researchers note that this disparity results in not just reduced quality of life for the patients but also increased costs of care for individuals and overall.&lt;/p&gt;&lt;p&gt;The study found a slew of obstacles behind this imbalance, including inadequate time with clinicians, a lack of sufficient reimbursement, and social biases such as racism. “Yet few interventions address such disparate care,” wrote the researchers. The study appears in the &lt;i&gt;Journal of Clinical Oncology&lt;/i&gt; (doi:10.1200/JCO.23.00309).&lt;/p&gt;&lt;p&gt;The randomized clinical trial was a collaboration between Unite Here Health (UHH) centers in Atlantic City, New Jersey, and Chicago, Illinois. UHH is an employer–union health fund that serves low-income and minority workers and their families.&lt;/p&gt;&lt;p&gt;The researchers developed a community advisory board and recruited 160 patients newly diagnosed with solid tumors and hematologic malignancies from the UHH membership who were considered to have poor health-related quality of life (HRQOL) and inadequate care. They called the program LEAPS (Lay Health Workers Educate, Engage, and Activate Patients to Share). They also included a study component that added patients with unaddressed health-related social needs (HRSNs).&lt;/p&gt;&lt;p&gt;The goal of the study was to evaluate the effectiveness of LEAPS in improving HRQOL outcomes. Patients self-reported their age, gender, race, ethnicity, education, and household income.&lt;/p&gt;&lt;p&gt;The median age of the patients was 58 years, and there were 83 females (51.8%). The study group included 82 Whites (51.3%), 47 Hispanics (29.4%), and 44 African Americans and other Blacks (27.5%). There were also two American Indians or Alaska Natives (1.3%), 31 Asians (19.4%), and one Native Hawaiian (0.6%). The annual household income for 127 of the patients (79.4%) was less than $35,000. Thirty-seven of the patients (23.1%) had breast cancer, and 64 of the patients (40.0%) had stage IV disease.&lt;/p&gt;&lt;p&gt;The patients were randomly assigned equally to a usual-care control group, which included outpatient oncology services and case management by a union-affiliated nurse, and to an intervention group, which comprised usual care plus access to a trained community health worker (CHW) for 12 months. The researchers ensured that the groups were similar in demographic and clinical variables.&lt;/p&gt;&lt;p&gt;The CHWs, who were bilingual and covered multiple languages, assisted participants with ACP, screened them for symptoms, and referred them to community-based resources for their individual HRSNs. Patients in the intervention group received weekly telephone calls for 4 months and then monthly calls for 1 year. ACP education in the preferred language of each patient was included.&lt;/p&gt;&lt;p&gt;The main end point evaluation was each patient’s ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"207-209"},"PeriodicalIF":232.4,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21842","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891479","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 association between menopausal hormone therapy and breast cancer remains unsettled","authors":"Mike Fillon","doi":"10.3322/caac.21843","DOIUrl":"10.3322/caac.21843","url":null,"abstract":"&lt;p&gt;It has been more than 2 decades since the Women’s Health Initiative (WHI; https://www.whi.org/) alarmed clinicians with a report that found that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA), when administered to postmenopausal women, increased breast cancer risk as well as the risks for coronary heart disease, stroke, and total mortality without improving quality of life. Since then, several researchers have questioned the findings, and the overarching conclusions have been revisited by WHI investigators themselves. Despite this, clinicians and their patients continue to take on a “safer rather than sorry” stance and often decide against taking the menopausal hormone therapy (HT), regardless of what symptoms may be present.&lt;/p&gt;&lt;p&gt;For example, in a study appearing in the journal Menopause: The Journal of The Menopause Society in April 2023 (doi:10.1097/GME.0000000000002154), WHI investigators conceded that HT yielded considerable benefits. However, they continued to assert that the associated increase in the risk of breast cancer with combined HT (CEE and MPA) remained a valid concern.&lt;/p&gt;&lt;p&gt;In response, a review published in the journal sought to rectify the association between breast cancer and HT—both CEE alone and CEE in combination with MPA, a large source of the misinterpretation (doi:10.1097/GME.0000000000002267). One of the authors, Avrum Z. Bluming, MD, an oncologist at the Keck School of Medicine at the University of Southern California in Los Angeles, explains it this way: “According to WHI’s own data, estrogen alone significantly decreases the risk of breast cancer development (by 23%) and the risk of breast cancer death (by 40%)—crucial information for women who have had hysterectomies.” In addition, “when started within 10 years of a woman’s final period (the ‘window of opportunity’), the WHI now agrees,” says Dr Bluming, that “it significantly decreases the risk for coronary heart disease, improves longevity, is the best and safest treatment for menopausal symptoms, and does not increase the risk of stroke. Further, it decreases the risk of osteoporotic hip fracture, colon cancer, and diabetes mellitus.” The sole issue at play is the association between combined HT (CEE plus MPA) and the risk of breast cancer.&lt;/p&gt;&lt;p&gt;In their review, Dr Bluming and his colleagues write that “the association between combined HT and an ‘increased breast cancer risk’ is actually not statistically significant. Further, even if one were to accept that the WHI’s claims of an increased risk were accurate, that increase would amount to one additional case of breast cancer for every 1,000 women treated per year but no increase in the risk of dying from breast cancer.” In addition, they argue that the assertion from WHI investigators that there is an association between the declining incidence of breast cancer and the reduction in HT prescriptions is not supported by several lines of data, including the fact that","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 3","pages":"210-212"},"PeriodicalIF":232.4,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891481","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}