JCO oncology practice最新文献

{"title":"Reproducibility Status of Economic Evaluations of Cancer Drugs: An Assessment of 150 Cost-Effectiveness Models.","authors":"Naimi Johansson, Jonathan Siverskog, Martin Henriksson, Mikael Svensson","doi":"10.1200/OP-26-00690","DOIUrl":"https://doi.org/10.1200/OP-26-00690","url":null,"abstract":"<p><strong>Purpose: </strong>Model-based cost-effectiveness analyses (CEAs) published in scientific journals have increased in recent years. The studies involve many discretionary judgements that, if not properly reported and justified, may reduce the credibility of cost-effectiveness evidence. In this study, we aimed to evaluate the reproducibility of published model-based CEAs and to explore associations between reproducibility and study characteristics.</p><p><strong>Methods: </strong>We conducted a systematic search for model-based CEAs of cancer drugs. Data were extracted on the journal type, impact factor, study design, model structure, and model inputs. Reproducibility was assessed based on access to model code (Computational Reproducibility) and whether reporting was transparent and sufficiently detailed across four criteria (model structure, transitions, costs, and health outcomes) for an external researcher to recreate the model (Recreate Reproducibility). Logistic regression was used to investigate associations between reproducibility and study characteristics.</p><p><strong>Results: </strong>Among 266 eligible CEAs, 150 were randomly selected for full-text review, of which 2.7% (95% CI, 1.0 to 6.7) were assessed as Computationally Reproducible and 16.7% (95% CI, 11.6 to 23.4) as Recreate Reproducible. While most studies reported the overall model structure (85% [95% CI, 77 to 91]), only 39% (95% CI, 28 to 51) fully reported all cost inputs. Regression analyses showed no association between reproducibility and study characteristics such as funding source, country setting, or journal impact factor.</p><p><strong>Conclusion: </strong>Only a small fraction of oncology CEAs was assessed as reproducible, irrespective of journal or study characteristics. Critical information necessary for external review and reproducibility remains largely unavailable, even in high-impact oncology journals. Standardized reporting and open modeling practices are needed to strengthen the scientific reliability of cost-effectiveness evidence in oncology.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600690"},"PeriodicalIF":5.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206850","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":"Promoting High-Quality, Accessible Cancer Care for People With Disabilities.","authors":"Sean Smith, Maggie Salinger, Rebecca A Spence, Ash B Alpert, Deborah B Doroshow, Leila Hamroun-Yazid, Yara Abdou, Samilia Obeng-Gyasi, Lori J Pierce","doi":"10.1200/OP-26-00656","DOIUrl":"https://doi.org/10.1200/OP-26-00656","url":null,"abstract":"<p><p>People with disabilities (PWD) face numerous challenges throughout the continuum of cancer care. Many of these are due to personal and structural biases that have historically made it more difficult for PWD to access oncologic care and which can be dehumanizing. We provide a narrative review of these challenges, starting with a review of disability statistics and methodologic considerations when reviewing the epidemiology of disability. We then discuss historic legal frameworks designed to support PWD, and barriers to oncology care faced by PWD, organized around the following primary topics: (1) biases faced by PWD from health care professionals, (2) screening, (3) diagnosis, (4) treatment, (5) survivorship, and (6) historical exclusion from oncology research. We conclude by identifying key areas that must be addressed to provide high-quality oncologic care for PWD. A variety of suggestions for addressing these issues are presented, including additional education of oncology providers, rethinking performance status, engaging stakeholders in the disability community, improving enrollment in clinical trials for PWD, and collecting consistent disability-related data.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600656"},"PeriodicalIF":5.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181838","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":"When Truth Becomes Asymmetrical: Toxicity, Benefit, and Vulnerable Autonomy in Oncology.","authors":"Gianmauro Numico, Anna Merlotti, Elvio G Russi","doi":"10.1200/OP-26-00592","DOIUrl":"https://doi.org/10.1200/OP-26-00592","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600592"},"PeriodicalIF":5.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181898","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":"Novel Tool to Predict Primary Tumor Location in the Setting of Metastatic Cancer With Unknown Primary.","authors":"Kerolous Eldeeb, Saad Badat, Haley K Perlow, Atallah Baydoun, Prashant Vempati, Yifan Yang, Daniel E Spratt, Ming Wang, Nicholas G Zaorsky","doi":"10.1200/OP-26-00212","DOIUrl":"https://doi.org/10.1200/OP-26-00212","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop and validate a tool to predict the primary tumor site in patients with metastatic cancer of unknown primary using demographic and clinical variables, including imaging-derived sites of metastasis, without pathology or laboratory data.</p><p><strong>Methods: </strong>In this population-based study, data were extracted from the SEER database. Patients diagnosed between 2010 and 2020 with a known primary cancer site, metastatic staging, and metastasis in the bone, liver, brain, and lungs were included. Patients were randomly split into training (70%) and/or testing (30%) sets. A total of 27 primary tumor sites were included. A gradient boosting model was trained to predict the primary tumor site, with random forest and classification tree models evaluated as comparators. Random guess and frequency-weighted guessing models were used for baseline comparison.</p><p><strong>Results: </strong>A total of 689,715 patients were included from 9,208,295 queried. The most common primary cancer sites were non-small cell lung cancer (NSCLC) (n = 211,338), intestines (n = 64,187), and pancreas (n = 60,310). The baseline models achieved Top-5 accuracies of 0.179 for a random guess and 0.476 for a frequency-weighted guess. The gradient boosting model achieved Top-1, Top-3, and Top-5 accuracies of 0.40 ± 0.001, 0.680 ± 0.001, and 0.790 ± 0.001, respectively, across 100 Monte-Carlo replicates. Top-5 accuracy was highest for primary NSCLC (0.990 ± 0.001) and intestinal cancer (0.900 ± 0.003). Our model was most influenced by sex (gain = 0.27) and metastasis to bone (gain = 0.20). A web app was constructed: primarycancerpredictor.netlify.app.</p><p><strong>Conclusion: </strong>This study developed and evaluated a gradient boosting machine learning model and a user-friendly web tool to aid in the diagnosis of cancer of unknown primary.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600212"},"PeriodicalIF":5.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165977","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":"Interpreting BRCA1/2 Clonal Hematopoiesis in the ASCO Circulating Tumor DNA Testing Guideline.","authors":"Alexander Gamisch","doi":"10.1200/OP-26-01043","DOIUrl":"https://doi.org/10.1200/OP-26-01043","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2601043"},"PeriodicalIF":5.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166762","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":"Participation of Patients With Gynecologic Cancer in Phase I Clinical Trials: Experience From Two National Cancer Institute-Designated Comprehensive Cancer Centers.","authors":"Anusha Adkoli, Charlotte Hadjadj, Krystle Vera, Patrick Glennan, Viswanathan Shankar, Meng-Shiou Shieh, Kevin Yeung, Demmie Aguilar, Mohammad Ghalib, Imran Chaudhary, Radhashree Maitra, Eugenia Girda, Sanjay Goel","doi":"10.1200/OP-26-00217","DOIUrl":"https://doi.org/10.1200/OP-26-00217","url":null,"abstract":"<p><strong>Purpose: </strong>Phase I trials are intended to define the safety of novel therapeutics, yet they offer alternative options long before they are approved. Limited data exist regarding access to and participation in phase I trials among gynecologic oncology patients. The purpose of this study is to assess the efficacy, toxicities, and prognostic factors of phase I trials in advanced gynecologic malignancies.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with gynecologic malignancies enrolled in phase I clinical trials at two National Cancer Institute-designated Comprehensive Cancer Centers between 2000 and 2022. Demographic, clinical, treatment, and toxicity data were collected via chart review. Overall survival (OS) was estimated using Kaplan-Meier curves. Cox proportional hazards models were used to evaluate prognostic factors, with multiple imputations for missing data.</p><p><strong>Results: </strong>Three hundred thirty-five patients were included, with a mean age of 58.8 years (standard deviation, 11.5). Most were heavily pretreated with a median of three prior lines of therapy. The clinical benefit rate among response-evaluable patients was 56.2%, primarily driven by stable disease. The median OS was 1.16 years, with a significant improvement over time, favoring patients enrolled between 2015 and 2022, who had a median OS of 2.17 years (<i>P</i> < .0001). Non-Hispanic Black patients experienced a higher risk of mortality compared with non-Hispanic White patients. Treatment was generally well tolerated, with only 3.9% experiencing dose-limiting toxicities.</p><p><strong>Conclusion: </strong>Phase I clinical trial participation in gynecologic cancers may provide clinically meaningful benefits, favorable toxicity profiles, and improved median OS over time. These findings support careful consideration of integrating phase I trials into treatment paradigms and highlight the ongoing necessity to address persistent disparities in trial enrollment and outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600217"},"PeriodicalIF":5.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169998","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":"Impact of Primary Prophylactic Colony-Stimulating Factor Delivery Method on Febrile Neutropenia: Secondary Analysis of a Pragmatic Cluster Randomized Clinical Trial.","authors":"Lauren Shih, Kathryn B Arnold, Aasthaa Bansal, Ari Bell-Brown, Kate Watabayashi, Dawn L Hershman, Scott D Ramsey","doi":"10.1200/OP-26-00296","DOIUrl":"10.1200/OP-26-00296","url":null,"abstract":"<p><strong>Purpose: </strong>Primary prophylactic colony-stimulating factor (PP-CSF) is recommended for patients receiving chemotherapy with high risk of febrile neutropenia (FN). The impact of PP-CSF delivery method on FN is unknown. We performed a secondary analysis of SWOG S1415CD (Trial Assessing CSF Prescribing Effectiveness and Risk), a pragmatic, cluster-randomized trial evaluating a guideline-informed standing order system to improve PP-CSF use, to evaluate associations between PP-CSF delivery method and FN.</p><p><strong>Methods: </strong>Female patients with breast cancer receiving first-line chemotherapy and PP-CSF with a known delivery method (administration in-clinic [IC], home delivery via an on-body device [OBD], or home self-injection [SI]) were included. The primary outcome was FN within 6 months of chemotherapy initiation, defined per the Common Terminology Criteria for Adverse Events.</p><p><strong>Results: </strong>Among 1,713 patients, the median age was 55 years (IQR, 46-64). By stage, 566 (33%) were local, 709 (41%) regional, 41 (2%) distant, and 397 (23%) unknown. PP-CSF was delivered IC in 773 (45%), OBD in 862 (50%), and SI in 78 (5%). Most received high-risk FN regimens. Pegfilgrastim use was nearly exclusive in IC and OBD (98% and 99%), versus 29% in SI. FN incidence was low: IC 3.8% (95% CI, 2.5 to 5.3), OBD 5.0% (95% CI, 3.6 to 6.6), and SI 6.4% (95% CI, 2.1 to 14.3; <i>P</i> = .29). FN was associated with high-risk FN regimens (odds ratio [OR], 2.97 [95% CI, 1.2 to 9.9]; <i>P</i> = .04) and Zubrod performance status ≥2 (OR, 4.99 [95% CI, 1.12 to 15.9]; <i>P</i> = .01), but not with delivery method or PP-CSF agent.</p><p><strong>Conclusion: </strong>Women with breast cancer receiving chemotherapy and PP-CSF had low rates of FN regardless of PP-CSF delivery method or agent. Delivery decisions may be guided by patient-centered factors including cost, convenience, and access.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600296"},"PeriodicalIF":5.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Vaginal Estrogen in Breast and Gynecologic Cancer Survivors.","authors":"Jersey B Burns, Mariam M AlHilli, Azka Ali, Erin Roesch, Deepanjana Das","doi":"10.1200/OP-26-00625","DOIUrl":"https://doi.org/10.1200/OP-26-00625","url":null,"abstract":"<p><p>To review the safety, efficacy, and clinical considerations of vaginal estrogen therapy for the treatment of genitourinary syndrome of menopause (GSM) in patients with a history of breast or gynecologic cancer. This is a narrative review of the current literature and clinical guidelines which evaluate vaginal estrogen use in cancer survivors, with a focus on the key outcomes of cancer recurrence and mortality as well as dosing considerations. Vaginal estrogen therapy is consistently associated with significant improvement in GSM symptoms and quality of life. There is minimal systemic absorption with low-dose formulations, with serum estradiol levels remaining within postmenopausal ranges. Large observational studies and meta-analyses show no increased risk of breast cancer recurrence or mortality among users, including those with estrogen receptor-positive disease and those on tamoxifen. Data on patients receiving aromatase inhibitors (AIs) are more limited. Current evidence supports the safety and efficacy of low-dose vaginal estrogen for GSM in most cancer survivors, with no clear increase in recurrence or mortality. Although nonhormonal therapies should be considered first-line, low-dose vaginal estrogen is an appropriate and effective option for patients with refractory symptoms along with shared decision making and multidisciplinary care. Further prospective studies are needed, especially in patients receiving AIs.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600625"},"PeriodicalIF":5.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109619","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":"Pancreatic Cancer Cachexia: Integrating Mechanistic Insights With Clinical Management.","authors":"Lyndon Huang, Valeria Impedovo, Stefano Tiziani, Sarbajit Mukherjee, Adrian Cristian, Kyaw Aung","doi":"10.1200/OP-26-00673","DOIUrl":"https://doi.org/10.1200/OP-26-00673","url":null,"abstract":"<p><p>Cachexia is a multifactorial syndrome characterized by systemic inflammation, weight loss, and muscle wasting, affecting over 80% of patients with pancreatic cancer. It decreases treatment tolerance, quality of life, and survival. Yet, despite its well-recognized detrimental impact, cachexia remains underdiagnosed and undertreated in oncology clinics. This review synthesizes current understanding of pancreatic cancer cachexia with an emphasis on its complex pathophysiology involving inflammatory cytokines, tumor-derived catabolic factors, neuroendocrine disruption, and pancreatic insufficiency as advancing insight into these underlying mechanisms is driving the development of targeted therapies for cachexia. A narrative review of the literature was performed using PubMed, Embase, and Google Scholar to identify studies related to pancreatic cancer cachexia. Relevant peer-reviewed clinical trials, translational studies, and review articles focusing on pathophysiology, nutritional assessment, and management strategies were prioritized. Emerging therapeutic strategies targeting the underlying biology of cachexia, including growth differentiation factor-15 inhibition, inflammatory pathway blockade, and ghrelin receptor agonism, have demonstrated encouraging effects on weight, muscle preservation, appetite, and functional measures. Advances in nutritional assessment, body composition analysis, and biomarker development may further improve early detection and management. Pancreatic cancer cachexia should be recognized as an active and potentially modifiable process rather than an inevitable consequence of advanced disease. Earlier identification, multidisciplinary management, and emerging mechanism-based therapies may improve clinical outcomes and quality of life for patients with pancreatic cancer.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600673"},"PeriodicalIF":5.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109515","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":"Cancer-Related Impacts on Employment and Strategies for Support Among Long-Term Young Adult Survivors of Hematologic Malignancies.","authors":"Timothy J D Ohlsen, Rachel Murphy-Banks, Melissa P Beauchemin, Angie M Rodday, David R Freyer, Kimberly A Miller, Emma Fleisher, Qingyan Xiang, Nadine Linendoll, Randall Y Chan, Howland E Crosswell, Michael E Roth, Susan K Parsons","doi":"10.1200/OP-25-00558","DOIUrl":"10.1200/OP-25-00558","url":null,"abstract":"<p><strong>Purpose: </strong>Employment is a core component of development in young adulthood and may be drastically affected by cancer. As part of a multi-institution financial navigation trial (ClinicalTrials.gov identifier: NCT05620979), we sought to explore employment-related experiences of long-term young adult (YA) survivors of cancer.</p><p><strong>Methods: </strong>We conducted a secondary qualitative analysis of YA (age 18-39 years) survivors of hematologic malignancies. Participants completed baseline questionnaires pertaining to education and work. A subset of participants completed an optional semistructured interview after trial completion, focused on financial experiences. To contextualize the cohort and supplement qualitative findings, survey data were analyzed using descriptive statistics. We analyzed interview transcripts using directed content analysis and inductive reasoning to examine employment-related themes.</p><p><strong>Results: </strong>One hundred thirty YA participants (median 31 years; Q1-Q3, 27-35) were enrolled with median time from cancer diagnosis of 10 years (Q1-Q3, 6-16). Most (82%) were currently employed, 77% of whom worked full time; 21% were students. Almost half (46%) reported that cancer continued to affect their education and/or employment; 29% had taken extended work leave in the previous year for cancer-related reasons. Challenges expressed in interviews with 45 participants included difficulties maintaining work because of treatment and side effects, interruptions affecting employment trajectory, and choosing work primarily for insurance/health-related reasons. Recommendations from YAs included building personal financial literacy, seeking financial resources, and suggesting clinicians incorporate screening and training for vocational and financial challenges.</p><p><strong>Conclusion: </strong>Many long-term YA survivors of cancer reported substantial, ongoing impacts on their work-related achievement and trajectory. These findings underscore the need for universal screening and support throughout the cancer care continuum.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1861-1871"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}