JCO oncology practice最新文献

{"title":"\"Paying to Be a Patient in the Hospital and the Parking Lot\": Patient-Caregiver Dyad Perspectives on Health-Related Transportation Access in Multiple Myeloma.","authors":"Shakira J Grant, Gabriell Erisnor, Jiona A Mills, Esther Wang, Lauren C Bates-Fraser, Leah Adams, Paul Mihas","doi":"10.1200/OP.24.00289","DOIUrl":"https://doi.org/10.1200/OP.24.00289","url":null,"abstract":"<p><strong>Purpose: </strong>Transportation affects access to quality medical care and health equity, especially for vulnerable populations. Little is known about patients'(PTs) experiences, particularly Black Americans with cancers like multiple myeloma (MM), regarding transportation access, despite its impact on clinical outcomes and survival.</p><p><strong>Methods: </strong>Using the National Institute on Minority Health and Health Disparities research framework, we conducted a qualitative study from November 2021 to April 2022. Twenty-one PT-informal caregiver (CG) dyads (42 participants) from the Lineberger Comprehensive Cancer Center participated in semistructured interviews. These interviews allowed participants to discuss their experiences with MM-related health issues. We used ATLAS.ti v9 for project management and data analysis using the Sort and Sift, Think and Shift approach by ResearchTalk Inc. All participants completed a sociodemographic survey.</p><p><strong>Results: </strong>The average age of participants was 68 ± 10.13 years, with half identifying as Black and 53% as female. Three themes emerged related to health care access and transportation: (1) individual factors, including attitudes toward transportation; (2) interpersonal factors, such as reliance on CGs, family, or friends; and (3) organizational factors, such as high parking costs and structural barriers limiting access. Participants primarily recommended solutions aimed at addressing financial challenges and improving accessibility.</p><p><strong>Conclusion: </strong>Older adults with MM and their CGs face complex transportation challenges when accessing cancer care, including high travel-related expenses, limited parking options with accessibility concerns, and long travel times. Addressing these issues requires multilevel interventions, such as including transportation coverage in health insurance and improving infrastructure, especially in underserved areas. Community solutions like volunteer driver programs and expanded telehealth can also help. Further research is needed to refine these solutions and assess their impact on health equity.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400289"},"PeriodicalIF":4.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752745","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 Impact of Low-Grade Toxicities to Adjuvant Pembrolizumab in Stage III Melanoma.","authors":"Nasreen Abdul Aziz, David Burke, Sharanniyan Ragavan, Ruth Board, Olabode Oladipo","doi":"10.1200/OP-24-01013","DOIUrl":"https://doi.org/10.1200/OP-24-01013","url":null,"abstract":"<p><strong>Purpose: </strong>Primary malignant melanoma is a curable disease, with surgical resection being the gold standard of treatment. For stage III melanoma, which poses a high risk of recurrence, adjuvant checkpoint inhibitors are used to reduce the risk of relapse. However, adjuvant treatment carries a risk of immune-related adverse events that can significantly impact on quality of life. Although the impact of grade 3 to 4 toxicities has been well characterized, the impact of lower-grade toxicity in this setting has not been as robustly discussed in the literature.</p><p><strong>Methods: </strong>We gathered retrospective data on patients with stage III melanoma who underwent adjuvant pembrolizumab treatment between December 2019 and December 2022 from two sites (Belfast City Hospital and Royal Preston Hospital). This included information on toxicity on the basis of Common Terminology Criteria for Adverse Events grading (version 5), treatment discontinuation, hospital admission, toxicity treatments, and disease progression.</p><p><strong>Results: </strong>Data were collected on 142 patients. 67 (47%) completed a 1-year course of adjuvant pembrolizumab. Median recurrence-free survival was 36.2 months. One hundred (70%) experienced treatment-related toxicity, of whom 72 (51%) had only low-grade toxicity (grade 1 to 2). In patients with only low-grade toxicity, 15% were hospitalized, 31% had treatment stopped because of toxicity, and 33% required immunosuppression treatment. The rate of early treatment discontinuation was higher among patients age 65 years or older compared with patients younger than 65 years (66% <i>v</i> 38%, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>In addition to the impact of grade 3 to 4 toxicities, there is a substantial burden of low-grade toxicity in patients undergoing adjuvant pembrolizumab treatment for stage III melanoma. Clinicians should discuss its potentially significant impact with patients and prepare to support them through these effects.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2401013"},"PeriodicalIF":4.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735870","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":"Disparities in Endometrial Cancer Mortality: Will Increasing Use of Targeted Therapies Widen the Gap?","authors":"M Larissa Weirich, Jennifer M Scalici, Sarah E Dilley","doi":"10.1200/OP-25-00017","DOIUrl":"https://doi.org/10.1200/OP-25-00017","url":null,"abstract":"<p><strong>Importance: </strong>Incidence and mortality in endometrial cancer (EC) have been steadily increasing in the United States over the past two decades, with Black women experiencing disproportionately higher rates of advanced disease and cancer mortality. Recent treatment advances show promising improvements in EC survival, but as seen in other malignancies, access to and clinical benefits of these novel therapies are often not equitably shared.</p><p><strong>Observations: </strong>In some gynecologic malignancies such as ovarian cancer, Black women are less likely than White women to receive targeted therapies for treatment of their disease. The reasons for this are multifactorial and include higher medication costs, decreased rates of insurance coverage, lower median income, lower rates of clinical trial enrollment, and lack of social support among Black patients. Several studies have examined racial differences in molecular tumor classification in EC, and these have shown that Black women are at least equally eligible for use of immunotherapy on the basis of tumor classification alone.</p><p><strong>Conclusion and relevance: </strong>Immunotherapy is a recent addition to treatment of some advanced and recurrent ECs. On the basis of these findings alone, use of immunotherapy should be increased among Black patients given their higher rates of advanced disease at diagnosis. Yet trends in treatment of other malignancies raise concerns that Black patients may not have adequate access to targeted and immunotherapy agents for treatment of EC in the coming years.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500017"},"PeriodicalIF":4.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730087","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":"Changing What Can Be Changed: Validating Navigation as Essential Care in Modern Oncology.","authors":"David L Schwartz, Christopher Brett, John P Gleysteen","doi":"10.1200/OP-25-00020","DOIUrl":"https://doi.org/10.1200/OP-25-00020","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500020"},"PeriodicalIF":4.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730085","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":"Trends in Outpatient Opioid Prescriptions for Cancer Pain Between 2016 and 2021.","authors":"Sonal Admane, Patricia S Bramati, Bryan Fellman, Ali Rizvi, Evelin Kolenc, Annie Berly, Aline Rozman de Moraes, David Hui, Ali Haider, Eduardo Bruera","doi":"10.1200/OP-24-00782","DOIUrl":"10.1200/OP-24-00782","url":null,"abstract":"<p><strong>Purpose: </strong>Increasing opioid regulations have resulted in reduced opioid prescriptions, including for cancer pain, despite guideline exemptions. Data after 2017 following the Centers for Disease Control's 2016 pain management guidelines are limited on opioid prescribing practices of oncologists. The purpose of this study was to examine the trend in dose of opioids prescribed by oncologists to patients with cancer pain referred to outpatient palliative care between 2016 and 2021.</p><p><strong>Methods: </strong>A single-center, cross-sectional, retrospective study was conducted at a tertiary cancer center's outpatient palliative care clinic including 375 adult patients referred for initial consultation for cancer pain between 2016 and 2021. The main outcome was the trend in prescribed opioid doses, expressed as morphine-equivalent daily dose in mg/day. Additional analyses were conducted to identify predictors of opioid prescriptions.</p><p><strong>Results: </strong>The median age (range) was 61 (19-85), 50% were women, 67% were non-Hispanic White, 80% had advanced cancer, and 91% reported proficiency in English. Ninety-five percent had solid tumors, predominantly GI (22%), breast (15%), and genitourinary (14%). From 2016 to 2021, the median dose of opioids decreased from 37.5 to 7.5 (<i>P</i> < .001). The proportion of patients on long-acting opioid decreased from 26% to 12% (<i>P</i> = .019), whereas that of patients without opioids increased from 28% to 41% (<i>P</i> = .008). CAGE-AID score (reflecting potential for substance abuse; β Coefficient, 43.2 [95% CI, 23.3 to 63.2], <i>P</i> < .001) and pain on the Edmonton Symptom Assessment Scale (5.77 [95% CI, 2.6 to 8.9], <i>P</i> < .001) predicted higher opioid dose, whereas non-English language predicted lower dose (-26.9 [95% CI, -53.1 to -0.8], <i>P</i> = .043).</p><p><strong>Conclusion: </strong>During the study period, we observed a five-fold decline in opioid dose prescribed by oncologists for cancer pain. This raises concerns for undertreatment of pain in patients with cancer.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400782"},"PeriodicalIF":4.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730091","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":"Treatment Patterns, Trends, and Outcomes of Neoadjuvant Chemotherapy Use Among Patients With Early-Stage Invasive Triple-Negative Breast Cancer.","authors":"Inimfon Jackson, Xiudong Lei, Catalina Malinowski, Sharon H Giordano, Mariana Chavez-MacGregor","doi":"10.1200/OP-24-00871","DOIUrl":"10.1200/OP-24-00871","url":null,"abstract":"<p><strong>Purpose: </strong>Triple-negative breast cancer (TNBC) is a clinically aggressive subtype associated with poorer survival outcomes. We examined the patterns and trends in neoadjuvant chemotherapy (NACT) use, pathologic complete response (pCR), and overall survival (OS). Furthermore, we evaluated the association between pCR and OS in a large cohort of patients.</p><p><strong>Methods: </strong>Patients aged 18 years and older with stage I-III TNBC diagnosed between 2010 and 2021 were identified in the National Cancer Database. Trends in NACT use, pCR, and OS were assessed using the Cochran-Armitage test for time trends. Multivariable logistic regression was used to evaluate the factors associated with NACT use and pCR. The impact of pCR on OS was examined using a multivariable Cox proportional hazards model with propensity score (PS) adjustment and matching.</p><p><strong>Results: </strong>The rate of NACT receipt increased from 19.1% to 56.4% (<i>P</i> < .001) between 2010 and 2021. Among those who received NACT, pCR rates increased from 19.6% to 40.3% between 2010 and 2021 (<i>P</i> < .001). Notably, 3- and 5-year OS rates increased among those with residual disease, while OS remained stable among those who achieved a pCR. Compared with non-Hispanic White patients, Black patients were less likely to receive NACT (adjusted odds ratio [aOR], 0.88 [95% CI, 0.85 to 0.91]) or achieve pCR (aOR, 0.90 [95% CI, 0.85 to 0.95]). Among patients treated with NACT, having a pCR was associated with a lower risk of death (adjusted hazard ratio, [aHR], 0.26 [95% CI, 0.24 to 0.29]).</p><p><strong>Conclusion: </strong>The use of NACT among patients with TNBC has dramatically increased in the past decade. Although TNBC is more prevalent in Black patients, they were less likely to be treated with NACT and less likely to achieve a pCR. Further research is needed to elucidate the underlying disparities and advance drug development to enhance outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400871"},"PeriodicalIF":4.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700237","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":"Housing-Related Disparities in Receipt of Breast Cancer Screening Among Women Medicaid Beneficiaries.","authors":"Youngmin Kwon, Eric T Roberts, Howard B Degenholtz, Bruce L Jacobs, Lindsay M Sabik, Evan S Cole","doi":"10.1200/OP-24-01094","DOIUrl":"https://doi.org/10.1200/OP-24-01094","url":null,"abstract":"<p><strong>Purpose: </strong>People experiencing housing insecurity (PEHI) may face barriers to preventive cancer screening, but the extent to which PEHI receive screening at the population level is understudied. Therefore, this study examined disparities in utilization of breast cancer screening associated with housing insecurity (HI) among women beneficiaries enrolled in a large Medicaid program.</p><p><strong>Methods: </strong>We assessed receipt of biennial mammography among women Medicaid beneficiaries, age 50-64 years, in administrative Medicaid data linked to encounter-level records on housing-related services in Pennsylvania (PA; Homelessness Management Information System [HMIS]) from 2011 to 2019. We characterized disparities in screening between beneficiaries with an encounter for housing-related services in HMIS (indicating experience or history of HI) compared with beneficiaries without any such encounters.</p><p><strong>Results: </strong>We included 73,456 women Medicaid beneficiaries in PA, including 1,792 HMIS service recipients and 71,664 comparison beneficiaries. The mammography rate was 44.8% among HMIS service recipients and 50.1% among comparison beneficiaries, representing a disparity of 5.3 percentage-points (pp; <i>P</i> < .001). This disparity was pronounced between HMIS service recipients with chronic experience of homelessness and comparison beneficiaries (-9.4 pp; <i>P</i> = .036). In stratified analyses, beneficiaries without any primary care visits had the lowest rate of mammography, although realized access to primary care did not eliminate the disparity in screening associated with HI.</p><p><strong>Conclusion: </strong>HI was associated with a significant disparity in mammography among women Medicaid beneficiaries, underscoring the need for efforts to improve preventive care among housing-insecure populations.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2401094"},"PeriodicalIF":4.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673877","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":"Erratum: Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients With Acute Myeloid Leukemia.","authors":"John M Pagel, Megan Othus, Guillermo Garcia-Manero, Min Fang, Jerald P Radich, David A Rizzieri, Guido Marcucci, Stephen A Strickland, Mark R Litzow, M Lynn Savoie, Stephen R Spellman, Dennis L Confer, Jeffrey W Chell, Maria Brown, Bruno C Medeiros, Mikkael A Sekeres, Tara L Lin, Geoffrey L Uy, Bayard L Powell, Ruthee-Lu Bayer, Richard A Larson, Richard M Stone, David Claxton, James Essell, Selina M Luger, Sanjay R Mohan, Anna Moseley, Harry P Erba, Frederick R Appelbaum","doi":"10.1200/OP-25-00135","DOIUrl":"https://doi.org/10.1200/OP-25-00135","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500135"},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669853","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":"Call to Action for Treatment of Food Insecurity: A Vital Element of Equitable Cancer Care.","authors":"Francesca M Gany","doi":"10.1200/OP-25-00092","DOIUrl":"https://doi.org/10.1200/OP-25-00092","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500092"},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669851","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":"<i>Help Navigate the Process</i>: Early Information and Communication About Late Effects of Pediatric and Adolescent Cancer.","authors":"Katie A Greenzang, Clara C Hatch, Anna C Revette, Obed Posada Villanueva, Lisa B Kenney, Jennifer W Mack, Lynda M Vrooman","doi":"10.1200/OP-24-00841","DOIUrl":"https://doi.org/10.1200/OP-24-00841","url":null,"abstract":"<p><strong>Purpose: </strong>Families value up-front information about potential late effects (LE) of their child's cancer treatment. Yet, many parents and survivors feel uninformed about the risks of LE and unprepared for survivorship. We sought to identify patient, survivor, and parent information needs and preferences for early communication about LE.</p><p><strong>Methods: </strong>We conducted a single-institution qualitative semistructured interview study with parents of children with cancer (on treatment and survivors) and adolescent and young adult (AYA) patients (on treatment and survivors) from April 2022 to April 2023. Purposeful sampling ensured diversity in diagnoses and sociodemographics. Interviews were audio-recorded, transcribed, and individually coded. Team-based iterative analysis identified themes within and across participant groups to identify areas of alignment and differences.</p><p><strong>Results: </strong>Thirty-six semistructured interviews were conducted with 42 participants: parents of patients receiving treatment (n = 13), parents of survivors (PSs, n = 12), AYA patients receiving treatment (n = 7), and AYA survivors (n = 10). Two key themes emerged: participants (1) valued LE information to prepare for the future although it can be emotionally difficult to hear and (2) expressed widespread support for a personalized, early LE communication resource. Key distinctions emerged between those actively receiving treatment and survivors: active treatment patients and parents endorsed feeling overwhelmed and preferred graduated LE information, whereas survivors and PSs more uniformly valued early information and were more likely to perceive gaps. Comparing parent and patient perspectives, parents expressed considerable worry about LE; many AYAs voiced lack of concern.</p><p><strong>Conclusion: </strong>Parents and patients value LE information but have varied preferences for detail and timing. In survivorship, many wished that they had received more comprehensive up-front information. Further efforts are needed to tailor personalized communication regarding risks of LE.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400841"},"PeriodicalIF":4.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669849","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}