JCO oncology practice最新文献

{"title":"Trends in Long-Term Survival Among Patients With De Novo Metastatic Cancer.","authors":"Saad Badat, Braden Lau, Fang Wang, Ming Wang, Daniel M Trifiletti, Luke Rothermel, Richard Hoehn, Melina Hsu, Daniel E Spratt, Nicholas G Zaorsky","doi":"10.1200/OP-25-01154","DOIUrl":"https://doi.org/10.1200/OP-25-01154","url":null,"abstract":"<p><strong>Purpose: </strong>Although outcomes for nonmetastatic cancers have improved since the 1970s, it remains uncertain whether long-term survival has improved among patients presenting with de novo metastatic disease, defined as cancer presenting with distant metastases at the time of initial diagnosis. This study evaluated changes in 5-year survival among patients with de novo metastatic cancer diagnosed in 1976 versus 2015, with a minimum 5-year follow-up through 1981 and 2020, respectively.</p><p><strong>Methods: </strong>Population-based data were obtained from the SEER database. Patients diagnosed with de novo metastatic cancer in 1976 (n = 11,864) and 2015 (n = 26,324) were included. Five-year overall survival (OS) was compared between cohorts, and multivariable logistic regression identified demographic and clinical factors associated with survival.</p><p><strong>Results: </strong>The 5-year OS increased significantly from 10.6% in 1976-1981 to 23.6% in 2015-2020 (<i>P</i> < .001). Survival gains were largest in breast cancer (12.6%-34.2%; <i>P</i> < .001), ovarian cancer (14.4%-32.5%; <i>P</i> < .001), colorectal cancer (3.7%-15.0%; <i>P</i> < .001), and hematologic malignancies (24.3%-53.9%; <i>P</i> < .001). Minimal improvement occurred in pancreatic cancer (0.25%-1.6%; <i>P</i> = .007) and small cell lung cancer (0.8%-3.1%; <i>P</i> = .008). Multivariable analysis demonstrated that older age, male sex, and Black race were associated with lower odds of 5-year survival (all <i>P</i> < .01).</p><p><strong>Conclusion: </strong>Over the past four decades, long-term survival among patients with de novo metastatic cancer has more than doubled; however, progress remains uneven across cancer types. Gains appear concentrated in malignancies with substantial therapeutic advances, whereas others show persistently poor outcomes. Continued efforts are needed to address disparities and improve survival in resistant cancer types.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501154"},"PeriodicalIF":4.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Treatment Patterns and Outcomes Among Patients With Newly Diagnosed AML in the United States.","authors":"Elizabeth Dianne Pulte, Laura L Fernandes, Kelly Norsworthy, Joseph Wynne, Eric Hansen, Andrew J Belli, Anna Barcellos, Christina M Zettler, Rebecca Bystrom, Jonathon Vallejo, Catherine Lerro, Ching-Kun Wang, Donna Rivera, Angelo de Claro","doi":"10.1200/OP-25-00885","DOIUrl":"https://doi.org/10.1200/OP-25-00885","url":null,"abstract":"<p><strong>Purpose: </strong>The US Food and Drug Administration has approved multiple new treatments for AML since 2017 based on demonstrated efficacy and safety in clinical trials. However, the uptake of new treatments and effectiveness in the routine clinical practice are largely unknown.</p><p><strong>Methods: </strong>A retrospective observational study was conducted to examine first-line therapy in patients with AML who were treated at institutions providing data to the COTA database. Information on demographics, disease characteristics, treatments, and outcomes was collected and analyzed descriptively.</p><p><strong>Results: </strong>Among the 2,516 patients eligible for inclusion in our analysis, cytarabine-based intensive chemotherapy (IC w/cytara) was the most commonly used treatment, followed by hypomethylating agents (HMA) with venetoclax (HMA+ven), HMA alone, and investigational treatment. Use of HMA+ven increased over time since its approval in 2018, whereas use of IC w/cytara and HMA alone decreased. Complete remission rates were 45% overall and highest in patients treated with IC w/cytara (61%) or investigational therapy (62%).</p><p><strong>Conclusion: </strong>Overall survival was highest for patients treated with IC w/cytara, although differences in baseline patient characteristics make direct comparison infeasible. Uptake of HMA+ven as a first-line treatment for patients with AML has been more rapid compared with other newly approved therapies. Outcomes for patients treated in routine practice were similar to those seen in clinical trials. Further research may be helpful in characterizing real-world effectiveness and safety in specific subpopulations and disease subtypes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500885"},"PeriodicalIF":4.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Knowledge and Decisional Satisfaction Across Genomic Sequencing Consent Processes in Pediatric Cancer.","authors":"Meaghann S Weaver, Liza-Marie Johnson, Katianne M Howard Sharp, Faith Preston, Jiaming Li, Yiwang Zhou, Alise Blake, Roya Mostafavi, Jeffery M Klco, Jamie L Maciaszek, Kim E Nichols, Belinda N Mandrell","doi":"10.1200/OP-25-01126","DOIUrl":"https://doi.org/10.1200/OP-25-01126","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether transitioning from a two-visit consent process led by an expert consenter to a decentralized model of consenting using an educational video and a clinical care provider translated into sustained decisional satisfaction and comparable levels of understanding about genomic sequencing for cancer predisposition.</p><p><strong>Materials and methods: </strong>A total of 150 parents of children with cancer agreed to participate in this study approximately 4 weeks (±2 weeks) after a consent conversation for genomic sequencing using a decentralized model to assess their genetic knowledge and decision satisfaction. Results were compared with a cohort of parents (n = 121) consented with an expert consenter using a two-visit process consisting of an informational session followed by knowledge reinforcement 5 weeks (±3 weeks) after diagnosis.</p><p><strong>Results: </strong>Among parents in the decentralized consent process, 94% recalled providing consent. However, 53% could not recall who conducted the consent conversation. Less than half (44%) recalled reviewing a copy of the consent form, and only 17% viewed the educational video. Overall, parents endorsed consenting to sequencing as the right choice (mean 4.4/5-point Likert) without decisional regret (1.5 of 5). Parents who consented through the decentralized process did not significantly differ in genetic knowledge from the baseline preconsent genetic knowledge assessment for the comparison sample. Only 56% of parents who consented through the decentralized process answered at least 75% of the knowledge questions correctly (<i>P</i> < .001), compared with 82% of parents who consented through the expert consenter model.</p><p><strong>Conclusion: </strong>While the decentralized consenting processes translated into lower knowledge scores, parents maintained high levels of decisional satisfaction. Further research is warranted to maximize knowledge exchange and ensure values-aligned consent in decentralized models.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501126"},"PeriodicalIF":4.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cascade Genetic Testing Among Relatives at Risk for Lynch Syndrome: A Systematic Review and Meta-Analysis.","authors":"Isabelle R Chandler, Muhammad Danyal Ahsan, Nicole M Frontera, Steve Lopez, Eleanore McFarland, Sarah R Levi, Becky Baltich Nelson, Joanne Yuen Yie Ngeow, Ravi N Sharaf, Melissa K Frey","doi":"10.1200/OP-26-00004","DOIUrl":"https://doi.org/10.1200/OP-26-00004","url":null,"abstract":"<p><strong>Purpose: </strong>This is a systematic review and meta-analysis to evaluate the uptake of cascade genetic counseling and testing within families with Lynch syndrome. Our goal was to provide a more current estimate of testing rates specific to this population to inform future efforts aimed at improving the identification of individuals with Lynch syndrome.</p><p><strong>Methods: </strong>This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was preregistered with PROSPERO (registration No.: CRD42024542006). A comprehensive literature search was conducted on electronic databases. Data from eligible studies were meta-analyzed to determine uptake rates of cascade genetic counseling and testing within families with Lynch syndrome.</p><p><strong>Results: </strong>Across all 18 studies included in the meta-analysis, there was a total of 4,939 probands, and 10,461 relatives were used in the evaluation of the uptake rate of cascade genetic testing. Eight of these studies reported on the uptake of genetic counseling for cascade testing, with 42% (95% CI, 18 to 67) of relatives engaging in counseling. Across the 18 studies in the meta-analysis, the overall uptake of cascade genetic testing was 46% (95% CI, 32 to 60), with higher uptake among female compared with male relatives, and among first-degree compared with second-degree relatives.</p><p><strong>Conclusion: </strong>The utilization of cascade genetic testing among people at risk for Lynch syndrome remains suboptimal, particularly among male relatives and more distant relatives. Targeted interventions are urgently needed to improve equitable uptake rates of cascade genetic testing among relatives at risk for Lynch syndrome.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600004"},"PeriodicalIF":4.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Antibiotic Therapy and Treatment Effectiveness in Patients With Renal Cell Carcinoma Receiving Immune Checkpoint Inhibitors or Tyrosine Kinase Inhibitors.","authors":"Avery E Braun, Hamed Hesami, Mengying Deng, Jill S Hasler, Laura Bukavina, Elizabeth Handorf, Philip H Abbosh","doi":"10.1200/OP-25-00963","DOIUrl":"https://doi.org/10.1200/OP-25-00963","url":null,"abstract":"<p><strong>Purpose: </strong>It has been theorized that antibiotic therapy (ABT) affects response to immune checkpoint inhibition (ICI) by inducing dysbiosis of the gut microbiome (GM). To investigate the association between ABT and real-world overall survival (rwOS)/progression-free survival (rwPFS) in patients with metastatic renal cell carcinoma (mRCC) receiving ICI versus tyrosine kinase inhibitors (TKIs).</p><p><strong>Methods: </strong>In total, 5,237 patients with mRCC from a nationwide electronic health record-derived deidentified database who received ICI or TKI first-line after diagnosis were included. ABT exposure was stratified by exposure (yes or no), timing (before <i>v</i> after treatment initiation <i>v</i> none), excretion modes (hepatic <i>v</i> renal excretion <i>v</i> none), and administration routes (oral <i>v</i> intravenous <i>v</i> none). Three-month landmark Kaplan-Meier estimation and log-rank tests were used to compare rwOS/rwPFS among ABT groups. Multivariable Cox proportional hazards models with time-varying coefficients investigated the association between rwPFS, rwOS, ABT, and treatment modality.</p><p><strong>Results: </strong>ABT exposure was negatively associated with rwOS/rwPFS in both ICI (rwOS [23.9 <i>v</i> 33.6 months, <i>P</i> = .029]; rwPFS [8.8 <i>v</i> 11.6 months, <i>P</i> < .001]) and TKI (rwOS [17.4 <i>v</i> 26.2 months, <i>P</i> < .001]; rwPFS [8.0 <i>v</i> 9.7 months, <i>P</i> < .001]) recipients. For ICI patients only, a negative correlation between ABT after treatment initiation (rwOS, <i>P</i> = .003, rwPFS <0.001) and oral administration route (rwOS <i>P</i> = .004, rwPFS <i>P</i> = .001) was identified. In time-varying Cox proportional models, the effect of ABT on rwPFS beyond 12 months was only statistically significant in ICI patients (ICI, hazard ratio [HR], 1.67, <i>P</i> = .013; TKI, HR, 0.95; <i>P</i> = .7).</p><p><strong>Conclusion: </strong>In our observational study, we identified a potential unique and complex association between ABT and rwOS/rwPFS in patients with mRCC receiving ICI. We found a negative correlation between ABT use after treatment initiation or via the oral route on oncologic outcomes in ICI patients. Moreover, there appears to be an ICI-specific negative association of ABT on rwPFS beyond 1 year. Our findings are associative, but they emphasize the importance of antibiotic stewardship in this space.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500963"},"PeriodicalIF":4.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engendering Reproductive Health Within Oncologic Survivorship Trial, ECOG-ACRIN E1Q11.","authors":"Ashlesha A Patel, Ju-Whei Lee, Howard A Zaren, Erika K Radeke, Thomas E Lad, Urjeet A Patel, Rachel E Lerner, Jami A Fukui, Della F Makower, Deimante M Tamkus, Kendrith M Rowland, William M Adler, Alyssa D Throckmorton, Sharad A Ghamande, Jessica J Croley, Mary H Hackney, Andrew W Pippas, Rubina Qamar, Gary V Burton, David J Andosky, Amanda R Hathaway, Nanda K Methuku, William V Tomlinson, David Cella, Michael J Fisch, Lynne I Wagner","doi":"10.1200/OP-25-00532","DOIUrl":"https://doi.org/10.1200/OP-25-00532","url":null,"abstract":"<p><strong>Purpose: </strong>For the 10% of women diagnosed with cancer within reproductive age, reproductive health is a critical component of oncologic survivorship. Variable attention to guidelines pertaining to oncocontraception and oncofertility results in cancer care discordant with a patient's reproductive health goals, negatively affecting quality of life. This study aimed to determine if the Engendering Reproductive Health within Oncologic Survivorship (EROS) multilevel intervention improves reproductive health goal-concordant management within 3 months of cancer diagnosis.</p><p><strong>Patients and methods: </strong>EROS is a cluster randomized trial, with 17 US-based National Cancer Institute Community Oncology Research Program (NCORP) sites (including Minority/Underserved Sites) randomly assigned to receive either reproductive health intervention (RHI; eight sites) or standard of care (SC; nine sites). Eligible patients included patients age 15-55 years with a new cancer diagnosis. The multilevel intervention included reproductive health education and navigation components. The primary study outcome is reproductive health goal-concordant management.</p><p><strong>Results: </strong>This ECOG-ACRIN trial enrolled 420 eligible patients from 17 NCORP sites, of which 379 had available data for the primary analysis (RHI n = 134; SC n = 245). Reproductive health goal-concordant management was achieved in 65.7% of women from RHI sites and 47.3% of women at SC sites (odds ratio [OR, RHI/SC], 2.07, 90% CI, 1.29 to 3.31). The intervention effect on reproductive health goal-concordant management was significant for women who had completed childbearing (OR [RHI/SC], 2.92 [90% CI, 1.65 to 5.17]; <i>P</i> = .002), whereas no such effect was observed among those who had not completed childbearing (OR [RHI/SC], 1.17 [90% CI, 0.72 to 1.89]; <i>P</i> = .60).</p><p><strong>Conclusion: </strong>The EROS intervention demonstrated marked improvement of reproductive health goal-concordant care, especially among patients who had completed childbearing. The multilevel EROS intervention demonstrates promise to improve adherence to national cancer guidelines at the complex intersection of reproductive health and cancer survivorship.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500532"},"PeriodicalIF":4.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy Declination Among Patients With Early-Stage Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer and High Oncotype DX Recurrence Scores.","authors":"Inimfon Jackson, Xiudong Lei, Marija Sullivan, Carlos H Barcenas, Sharon H Giordano, Mariana Chavez-MacGregor","doi":"10.1200/OP-25-01106","DOIUrl":"https://doi.org/10.1200/OP-25-01106","url":null,"abstract":"<p><strong>Purpose: </strong>Although the 21-gene Oncotype DX assay predicts chemotherapy (CT) benefit in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC), some patients decline CT despite their physician recommendations. We examined factors associated with CT declination and its impact on overall survival (OS) among patients with early-stage disease and high recurrence scores (RS).</p><p><strong>Methods: </strong>Patients aged 18 years and older diagnosed with clinical stage I-II HR-positive/HER2-negative BC who underwent definitive surgery between 2018 and 2022 and had RS > 25 were identified in the National Cancer Database. Multivariable logistic regression was used to identify factors associated with CT declination. Multivariable Cox proportional hazards regression was used to examine the association between CT declination and OS in a 1:5 propensity score-matched cohort.</p><p><strong>Results: </strong>Among 30,326 patients with RS > 25, 10.9% declined CT. 15.5% of patients who declined CT also declined hormonal therapy. Higher RS was associated with lower odds of CT declination (adjusted odds ratio [aOR], 0.97; 95% CI, 0.96 to 0.97). A more recent year of diagnosis and Hispanic race (aOR, 0.83; 95% CI, 0.70 to 0.98) were associated with lower odds of CT declination, while older age and Black race (aOR, 1.29; 95% CI, 1.15 to 1.45) were associated with higher odds. Patients on Medicaid (aOR, 1.53; 95% CI, 1.31 to 1.79) and Medicare (aOR, 1.19; 95% CI, 1.05 to 1.34) had higher odds of declination compared with those on private insurance. Having pathologic Nodal 1 (pN1) disease was associated with lower odds of declination than pN0 disease. Notably, CT declination was associated with an increased risk of death (aHR, 1.43; 95% CI, 1.20 to 1.69).</p><p><strong>Conclusion: </strong>Despite a decrease in CT declination over time, disparities persist, and declination is associated with worse OS. Further research is needed to understand these disparities and improve cancer care delivery and outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501106"},"PeriodicalIF":4.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yoga for Patients Undergoing Thoracic Radiotherapy and Their Family Caregivers: Results of a Randomized Controlled Trial.","authors":"Kathrin Milbury, Aileen Chen, Yisheng Li, Zhongxing Liao, Meagan Whisenant, Scherezade K Mama, Jason R Bentley, Vickie Shannon, Sania Yousuf, Rosangela F Silva, Anne S Tsao, Eduardo Bruera, Lorenzo Cohen","doi":"10.1200/OP-25-01079","DOIUrl":"https://doi.org/10.1200/OP-25-01079","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with advanced thoracic cancers undergoing standard radiotherapy (RT) have a high risk of experiencing performance declines and poor quality of life (QOL). Exercise programs may improve objective and subjective performance; yet, adherence remains poor. Including family caregivers as active intervention, participants may improve adherence and thus efficacy. Thus, this clinical trial seeks to examine the efficacy of a patient-caregiver dyadic yoga intervention relative to a dose-matched education/support (ES) intervention.</p><p><strong>Materials and methods: </strong>Patients with lung or esophageal cancer undergoing at least 5 weeks of RT and their family caregivers were randomly assigned to either a 15-session yoga or ES comparison intervention. Patients and caregivers were assessed at baseline (T1), the last day of RT (T2) and 1 (T3), 2 (T4), and 3 (T5) months later. Patients completed the 6-minute walk test (6MWT; primary outcome) and both patients and caregivers completed a validated QOL measure (secondary outcomes).</p><p><strong>Results: </strong>A total of 222 participants were randomly assigned. For the 6MWT, patients in the yoga group performed significantly better than those in the ES group across T2-T5 (least squared means [LSMs] in meters: yoga = 469 <i>v</i> ES = 441, <i>P</i> = .03). Patients in the yoga group also reported improved physical (LSMs: yoga = 44.7 <i>v</i> ES = 41.6, <i>P</i> = .03) but not mental QOL scores across T2-T5 compared with those in the ES group. As exploratory outcomes, patients in the yoga group also reported improved sleep (<i>P</i> = .01) and coping efficacy (<i>P</i> = .02).</p><p><strong>Conclusion: </strong>Yoga significantly improves functional capacity and subjective physical QOL in patients undergoing thoracic RT. Involving a family caregiver may improve intervention adherence.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501079"},"PeriodicalIF":4.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes, Practices, and Barriers to Spiritual Care for Patients With Cancer: An International Survey.","authors":"Carla Ida Ripamonti, Junita Henry, Christina M Puchalski, Carlotta Tagliaferro, Florian Scotte', Katherine Ast, Alessandra Fabi, Andrea Antonuzzo, Marco Ladetto, Maura Dowling, Heather Coats, Joana Marinho, Tracy A Balboni","doi":"10.1200/OP-25-01129","DOIUrl":"https://doi.org/10.1200/OP-25-01129","url":null,"abstract":"<p><strong>Purpose: </strong>Spiritual care is recognized by the WHO and consensus frameworks as integral to whole-person oncology care, yet its integration into practice remains limited. Global data on clinician beliefs, practices, and barriers are limited. The aim was to characterize oncology and palliative care clinicians' attitudes, practices, and barriers regarding spiritual care and to examine variation by characteristics such as role, region, age, sex, years of experience, setting, and place of clinical practice.</p><p><strong>Methods: </strong>This was an international cross-sectional online survey (December 23, 2024-February 7, 2025) disseminated through oncology, hematology, and palliative care societies across 55 countries. Eligible participants were health care professionals involved in cancer care (N = 670). Attitudes toward spiritual care, perceived role, frequency of screening and history-taking, preparedness and training, and barriers were examined. Logistic regression models examined associations by discipline and region.</p><p><strong>Results: </strong>Among 670 respondents (mean age, 47.8 years; 432 [64%] women), 380 (57%) practiced in Europe, and 228 (34%) in North America. Most endorsed spiritual care as essential (587 [90%]) and agreed that spiritual distress impairs outcomes (599 [92%]). Yet, only 87 (13%) always conducted screening and 56 (9%) always took a history. Nearly half of oncologists never did either. Compared with palliative care physicians, oncologists had lower odds of endorsing spiritual care as their role (adjusted odds ratio [aOR], 0.27 [95% CI, 0.12 to 0.59]) and performing screening (aOR, 0.44 [95% CI, 0.21 to 0.95]). Training preparedness was lowest among oncologists (mean, 2.7/10) although 86% sought further training. Key barriers were the lack of time (49%) and role ambiguity (46%).</p><p><strong>Conclusion: </strong>Clinicians worldwide affirm the importance of spiritual care, yet systematic provision is limited. Embedding role-appropriate competencies and integrating screening into routine workflows are needed to advance whole-person cancer care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501129"},"PeriodicalIF":4.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of 177Lu-PSMA-617 in Elderly Patients With Metastatic Castration-Resistant Prostate Cancer.","authors":"Daniel Sentana-Lledo, Avina Rami, Caiwei Zhong, Miguel Muniz, Wanling Xie, Elizabeth Tchitchkan, Hailey Stoltenberg, Irbaz Bin Riaz, Andrew Wolanski, Jolivette Ritzer, Heather Jacene, Kerry Schaffer, Daniel S Childs, Praful Ravi","doi":"10.1200/OP-25-01161","DOIUrl":"https://doi.org/10.1200/OP-25-01161","url":null,"abstract":"<p><strong>Purpose: </strong>177Lu-PSMA-617 (LuPSMA) is an approved prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical therapy for men with metastatic castration-resistant prostate cancer (mCRPC). Older patients, particularly octogenarians, represent a substantial proportion of men with mCRPC but have been traditionally underrepresented in key registrational trials of LuPSMA.</p><p><strong>Methods: </strong>This retrospective multi-institutional study evaluated patients age 80 years and older with mCRPC after chemotherapy treated with ≥1 cycle of LuPSMA from August 2022 to December 2024. Clinical and demographic data were abstracted from electronic medical records. Outcomes included prostate specific antigen (PSA) response (PSA50 and PSA90), progression-free survival (PFS), overall survival (OS), and toxicities. Kaplan-Meier methods estimated PFS/OS; descriptive statistics summarized baseline and safety data.</p><p><strong>Results: </strong>Ninety-five patients (median age, 83 years) were included, of whom 36 (38%) and 21 (22%) had a history of cardiac disease or chronic kidney disease, respectively. Median follow-up was 24.1 months (IQR, 6.7-28.1). Patients received a median of five cycles of LuPSMA. Fifty-two (57%) and 21 (23%) patients achieved a PSA50 and PSA90, respectively. Median PFS and OS were 7.3 months (95% CI, 6.4 to 8.7) and 13.5 months (95% CI, 9.7 to 18.8), respectively. Grade ≥3 hematologic toxicities included anemia (n = 19; 20%) and thrombocytopenia (n = 4, 4%); grade ≥3 acute kidney injury occurred in one patient. Fourteen (15%) patients had dose delays, seven (7%) required reductions, and 10 (11%) discontinued therapy due to toxicity. Thirty-seven patients (39%) were hospitalized during therapy, with intensive care unit-level care required in two patients (2%), and there was one treatment-related death.</p><p><strong>Conclusion: </strong>LuPSMA had comparable outcomes in octogenarians with mCRPC to patients on registrational trials, although 2/5 of patients required hospitalization during therapy. These findings support the feasibility and efficacy of LuPSMA in well-selected older men with mCRPC and suggest a role for closer monitoring of older patients.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501161"},"PeriodicalIF":4.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}