JCO oncology practice最新文献

{"title":"Cancer Screening, Diagnosis, and Treatment for Vulnerable Patients Incarcerated in US Prisons.","authors":"Christopher R Manz, Brett Nava-Coulter, Emma Voligny, Daniel A Gundersen, Alexi A Wright","doi":"10.1200/OP-25-00361","DOIUrl":"https://doi.org/10.1200/OP-25-00361","url":null,"abstract":"<p><strong>Purpose: </strong>Cancer is the leading cause of death in US prisons, where incarcerated patients have substantially worse survival than nonincarcerated patients. Yet, cancer care delivery in US prisons has not been well described. This study describes cancer care delivery across the cancer continuum for individuals incarcerated in US prisons.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 32 prison medical directors, primary care clinicians (PCPs), and oncologists caring for patients with cancer incarcerated in 16 US state and federal prison systems between September 2023 and April 2024. A member-checking focus group of 22 prison medical directors and clinicians was held in February 2025.</p><p><strong>Results: </strong>Interview participants included nine prison medical directors, six PCPs, one gynecologist, 15 oncologists, and one palliative care clinician. Themes identified distinct logistics related to screening, diagnosis, treatment, symptom management, survivorship, and end-of-life care, and several cross-cutting topics including communication, scheduling, community transitions, and payment models. Participants reported that screening is widely available for some but not all cancers in prison. Prison clinicians and staff manage most screening and diagnostic evaluations, which require lengthy, sequential approval processes. Radiographic imaging, procedures, surgery, and treatment usually occur outside of prisons. Prison primary care teams manage many tasks usually overseen by oncology teams, including scheduling, care coordination, and management of symptoms from cancer and treatment. Policies limit clinician communication and family involvement, with important care ramifications. Security requirements and staff shortages complicate care coordination and scheduling. The focus group reinforced these themes and did not identify new themes.</p><p><strong>Conclusion: </strong>The unique and complicated logistics of cancer care for patients incarcerated in US prisons differ from care provided to nonincarcerated patients and may negatively affect their cancer outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500361"},"PeriodicalIF":4.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642507","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":"Subcutaneous Immunotherapies in Solid Tumors: Are We Truly Expanding Access and Efficiency?","authors":"Gogo-Ogute Ibodeng, Chelsee Jensen, Scott A Soefje, Aakash Desai","doi":"10.1200/OP-25-00052","DOIUrl":"https://doi.org/10.1200/OP-25-00052","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500052"},"PeriodicalIF":4.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637064","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":"Long-Term Performance of Prognostic Models for Advanced Renal Cell Carcinoma in the Era of Improved Survival With Immune Checkpoint Inhibitors.","authors":"Charlene M Mantia, Opeyemi A Jegede, David F McDermott, Daniel Y C Heng, Wanling Xie, Toni K Choueiri, Michael B Atkins, Meredith M Regan","doi":"10.1200/OP-25-00089","DOIUrl":"10.1200/OP-25-00089","url":null,"abstract":"<p><strong>Purpose: </strong>In the era of prolonged survival for advanced renal cell carcinoma (aRCC) with standard-of-care first-line therapy now including immune checkpoint inhibitor, re-evaluation of the Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic RCC Database Consortium (IMDC) prognostic models is overdue.</p><p><strong>Methods: </strong>Data from 1,052 patients with aRCC treated on the CheckMate-214 phase III randomized trial with first-line nivolumab + ipilimumab or sunitinib were analyzed after minimum 5 years of follow-up. The end point was overall survival (OS). To investigate long-term prognostication with each treatment approach, model performance based upon continuous risk score was assessed in a time-dependent manner of increasing 6-month intervals and globally over full follow-up, using discrimination concordance (c)-indices.</p><p><strong>Results: </strong>With time-dependent assessment, the IMDC and MSKCC models maintained their performance over approximately 2 years from sunitinib initiation (c ≥0.69 through 18-24 months); thereafter, the models' performances with long-term OS attenuated. Over full follow-up, the models' discrimination was c = 0.66 (95% CI, 0.658 to 0.664) and c = 0.64 (95% CI, 0.640 to 0.645), respectively, for the sunitinib group. After nivolumab + ipilimumab initiation, the IMDC and MSKCC models' global discrimination was c = 0.63 (95% CI, 0.628 to 0.634) and c = 0.61 (95% CI, 0.607 to 0.614), respectively. The models' performances were attenuated in the short term (c ranging 0.64-0.69 through 18-24 months) and the long term.</p><p><strong>Conclusion: </strong>This retrospective analysis of the CheckMate-214 trial, in which nivolumab + ipilimumab improved survival versus sunitinib with 48% and 37% of patients, respectively, surviving beyond 5 years, confirmed the strength of the models' prognostication for the early years after first-line sunitinib initiation continuing to stratify three prognostic categories, but also diminished discrimination among long-term survivors and with initiation of nivolumab + ipilimumab. As novel treatments are developed and patients with aRCC live longer, new models to estimate long-term prognosis are needed.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500089"},"PeriodicalIF":4.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637063","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":"Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large Cancer Center.","authors":"Aditya Narayan, Kaitlyn Lapen, Edward Christopher Dee, Bridgette Thom, Emeline M Aviki, Fumiko Chino","doi":"10.1200/OP-25-00218","DOIUrl":"10.1200/OP-25-00218","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.</p><p><strong>Methods: </strong>From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.</p><p><strong>Results: </strong>Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; <i>P</i> < .001), advanced disease (stage III [β, 1.33; <i>P</i> < .001]; IV [β, 1.56; <i>P</i> < .001]), recent treatment (β, 3.23; <i>P</i> < .001), and anal (β, 1.97; <i>P</i> = .003), esophageal (β, 1.66; <i>P</i> = .005), or hepatobiliary cancer (β, 1.05; <i>P</i> = .031). Older age (≥65 years [β, -5.17; <i>P</i> < .001]), higher income ($100,000-$200,000 [β, -1.81; <i>P</i> < .001]; >$200,000 [β, -3.80; <i>P</i> < .001]), and private insurance (β, -1.70; <i>P</i> < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; <i>P</i> < .001), advanced disease (stage III [OR, 1.31; <i>P</i> = .001]; IV [OR, 1.24; <i>P</i> = .010]), recent treatment (OR, 1.20; <i>P</i> = .001), and gastric cancer (OR, 1.25; <i>P</i> = .027). Lower HRSR was associated with older age (OR, 0.59; <i>P</i> < .001), higher income ($100,000-$200,000 [OR, 0.66; <i>P</i> < .001]; >$200,000 [OR, 0.48; <i>P</i> < .001]), and private insurance (OR, 0.64; <i>P</i> < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; <i>P</i> < .001) and reduced medication adherence (β, 0.11; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500218"},"PeriodicalIF":4.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612152","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":"Impact of Industry Collaboration on US Food and Drug Administration Approval Success in Genitourinary Malignancy Phase III Clinical Trials.","authors":"Kamil Malshy, Matthew Steidle, Trevor C Hunt, Zijing Cheng, Ashley Li, Timothy D Campbell, Jathin Bandari","doi":"10.1200/OP-25-00194","DOIUrl":"https://doi.org/10.1200/OP-25-00194","url":null,"abstract":"<p><strong>Purpose: </strong>Collaboration among trial sponsors can pool expertise and resources, potentially accelerating drug development and regulatory success. This study assessed whether collaborations between drug sponsors influence the likelihood and timing of US Food and Drug Administration (FDA) approval for phase III clinical trials in genitourinary cancers.</p><p><strong>Methods: </strong>We queried ClinicalTrials.gov for all industry-sponsored, interventional phase III trials in genitourinary malignancies completed between January 1, 2010, and October 1, 2024. Trials involving supportive agents, nontherapeutics, or bioequivalence studies were excluded. Eligible trials were grouped by sponsorship structure: single-sponsor (SS) or sponsor-collaborator (S-C). Time to FDA approval was compared using Kaplan-Meier estimates and log-rank tests. Stratified Cox regression assessed the impact of collaboration across subgroups (disease site, stage, and previous drug approval). An additional analysis examined trials that met their primary end points.</p><p><strong>Results: </strong>Seventy-eight trials met inclusion criteria from an initial 183. Of these, 51 (65.4%) were SS trials and 27 (34.6%) were S-C. FDA approval was granted for 20 of 27 S-C trials (74.1%) versus 20 of 51 SS trials (39.2%). S-C trials had significantly faster approval (hazard ratio [HR], 2.75 [95% CI, 1.46 to 5.18]; <i>P</i> = .0009). One- and 2-year approval rates were, respectively, 50.0% and 73.6% for S-C, compared with 19.6% and 31.4% for SS trials. Subgroup analyses confirmed consistent benefits across metastatic disease, prostate cancer, and previously approved drugs. Among the 50 trials that met their primary end points, S-C trials had a higher approval likelihood (HR, 2.23 [95% CI, 1.13 to 4.38]; <i>P</i> = .013).</p><p><strong>Conclusion: </strong>Sponsor collaboration significantly improves FDA approval rates and timelines in phase III genitourinary cancer trials, including those meeting primary end points. This strategy may enhance trial success and accelerate access to new therapies.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500194"},"PeriodicalIF":4.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612151","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":"Patterns of Cannabis Use Among Cancer Survivors: Insights From the Behavioral Risk Factor Surveillance System.","authors":"Zayed Rashid, Ghee Rye Lee, Mujtaba Khalil, Abdullah Altaf, Shahzaib Zindani, Azza Sarfraz, Timothy M Pawlik","doi":"10.1200/OP-25-00121","DOIUrl":"https://doi.org/10.1200/OP-25-00121","url":null,"abstract":"<p><strong>Purpose: </strong>Cannabis has been legalized across multiple states over the past decade; however, its use among cancer survivors remains understudied. Therefore, we sought to define factors associated with cannabis use among cancer survivors.</p><p><strong>Materials and methods: </strong>This study used the Behavioral Risk Factor Surveillance System to identify cancer survivors across 23 states that completed the optional cannabis module in 2021. Weighted multivariable regression models were used to study the factors associated with cannabis use among cancer survivors.</p><p><strong>Results: </strong>Among 6,168,964 cancer survivors, most were female (n = 3,621,182, 58.7%), White (n = 5,009,199, 81.2%), and older than 65 years (n = 3,565,661, 57.8%); 8.8% (n = 542,868) of individuals used cannabis and most used it for nonmedical reasons (n = 3,251,044, 52.7%); roughly an equal proportion of patients reported low (n = 3,090,651, 50.1%) versus high (n = 3,078,313, 49.9%) frequency use. Male (ref. female: odds ratio [OR], 1.54 [95% CI, 1.34 to 1.77]) and Black (ref. White: OR, 1.35 [95% CI, 1.01 to 1.81]) individuals and younger individuals (ref. aged ≥65: OR, 4 [95% CI, 3.22 to 4.96]) had higher odds of cannabis use. Male (ref. female: OR, 2.57 [95% CI, 1.50 to 4.41]) and individuals with heavy alcohol intake (ref. low intake: OR, 2.41 [95% CI, 1.28 to 4.54]) had higher odds of cannabis use for nonmedical reasons. State-level legalization of cannabis was associated with an increase in cannabis use over time (4.5% [95% CI, 4.3 to 4.8]; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Roughly 1 in 12 cancer survivors used cannabis. The pattern of use varied based on clinicodemographic factors and concurrent substance use such as tobacco or alcohol. Cannabis use among cancer survivors who resided in states that legalized cannabis was higher.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500121"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600426","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":"Human Epidermal Growth Factor Receptor 2 Positivity a Moving Target in the Era of Antibody-Drug Conjugates.","authors":"Marko Velimirovic, Jame Abraham","doi":"10.1200/OP-25-00525","DOIUrl":"https://doi.org/10.1200/OP-25-00525","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500525"},"PeriodicalIF":4.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591264","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":"Women's Insights on Sexual Health After Breast Cancer (WISH-BREAST) Survey.","authors":"Laila S Agrawal, Eleonora Teplinsky, Yana B Feygin, Theresa Kluthe, Sarah Marcovici, Corinne Menn","doi":"10.1200/OP-25-00043","DOIUrl":"https://doi.org/10.1200/OP-25-00043","url":null,"abstract":"<p><strong>Purpose: </strong>Sexual health is a highly prevalent concern after breast cancer treatment; however, it remains largely unaddressed. This study evaluates the sexual health concerns of breast cancer survivors, experiences seeking information and treatment for sexual health concerns after cancer diagnosis, and the role of social media.</p><p><strong>Methods: </strong>The Women's Insight in Sexual Health after Breast Cancer (WISH-BREAST) study was an online, anonymous survey-based analysis of breast cancer survivors' experience with sexual health concerns. The 44-question online survey was distributed over social media and email.</p><p><strong>Results: </strong>There were a total of 1,775 respondents to the survey (90% White; 99.9% identified as women; median age, 47.5 years; range, 23-75). 89.5% reported a moderate to great deal of change to their sexual health and 84.8% reported a moderate to great deal of distress because of sexual health changes. The most common sexual symptoms were decreased interest in sex (85.8%), vaginal dryness (78.2%), decreased arousal (69.2%), body image concerns (60%), and dyspareunia (59.4%), fatigue (46.1%), and difficulty with orgasm (41%). 72.3% reported sexual health changes have affected their relationships with their partner. Seventy-three percent did not receive information from about sexual health from their health care team and of those who did, 71% initiated the conversation themselves. Eighty percent of patients received information about sexual health from social media, primarily from health care professional accounts (71%).</p><p><strong>Conclusion: </strong>Sexual health concerns are highly prevalent and distressing for breast cancer survivors and currently remain largely unaddressed and untreated, and these results demonstrate the need to address sexual health concerns and highlight the role of social media for education.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500043"},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583935","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":"State Medigap Policies and Disenrollment From Medicare Advantage Among Beneficiaries With Cancer.","authors":"Brendon Lee, David Pittman, Stacy Cooper, Ravi Gupta, Gerard F Anderson, Angela Liu","doi":"10.1200/OP-25-00069","DOIUrl":"https://doi.org/10.1200/OP-25-00069","url":null,"abstract":"<p><strong>Purpose: </strong>Medicare Advantage (MA) beneficiaries newly diagnosed with cancer may want to switch from MA into traditional Medicare and purchase supplemental insurance (Medigap), which provides important financial protections. However, beneficiaries in states without Medigap consumer protections may be denied or effectively denied (through high premiums) Medigap, potentially trapping them in MA. This study examined whether MA beneficiaries with newly diagnosed cancer were more likely to switch into traditional Medicare in states with stronger Medigap consumer protections.</p><p><strong>Methods: </strong>This retrospective study analyzed Medicare encounter data for beneficiaries age 65 years and older, continuously enrolled in MA from 2018 to 2019, and received a new cancer diagnosis in 2019. The primary exposure was state-level Medigap protections: no protections, community rating only (some protections), or both community rating and guaranteed issue (strongest protections). The outcome of interest was beneficiary-level disenrollment from MA into traditional Medicare in 2020.</p><p><strong>Results: </strong>Among 426,248 MA beneficiaries newly diagnosed with cancer, 2.1% switched into traditional Medicare in states with both community rating and guaranteed issue, 1.1% switched in states with community rating only, and 0.8% switched in states with no Medigap protections. The odds of disenrollment were higher in states with both community rating and guaranteed issue (odds ratio [OR], 2.73 [95% CI, 2.53 to 2.94]; <i>P</i> < .001) and states with community rating only (OR, 1.48 [95% CI, 1.30 to 1.68]; <i>P</i> < .001), compared with states with no protections.</p><p><strong>Conclusion: </strong>MA beneficiaries with newly diagnosed cancers had higher rates of disenrollment from MA into traditional Medicare when state-level Medigap consumer protections were present. Beneficiaries appear more likely to switch if states make it financially easier to obtain Medigap.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500069"},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583934","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":"Physician Specialization and Receipt of Updated Breast Cancer Care in the United States: A SEER-Medicare Analysis.","authors":"Jennifer L Caswell-Jin, Marissa B Reitsma, Hao Tang, James C Dickerson, Shannon Phillips, Esther M John, Allison W Kurian, Becky Staiger, Jeremy D Goldhaber-Fiebert","doi":"10.1200/OP-25-00462","DOIUrl":"10.1200/OP-25-00462","url":null,"abstract":"<p><strong>Purpose: </strong>Advances in breast cancer treatment have reduced mortality and toxicity, but it remains unclear which patients receive updated care and when. We aimed to identify factors associated with receiving updated breast cancer care.</p><p><strong>Methods: </strong>We analyzed patients age 65-85 years with local or regional breast cancer, diagnosed between 2010 and 2018, using the SEER-Medicare database. We included patients who were continuously enrolled in Medicare for 1 year after diagnosis and were eligible for one of four updated treatments: (1) adjuvant paclitaxel-trastuzumab (APT) for human epidermal growth factor receptor 2 (HER2)-positive local disease, (2) pertuzumab for HER2-positive regional disease, (3) neoadjuvant chemotherapy for triple-negative or HER2-positive regional disease, and (4) omission of chemotherapy for hormone receptor-positive, HER2-negative regional disease. We examined the association between treating oncologist specialization (percent of SEER-Medicare patients with breast cancer) and receipt of updated care using multivariable analysis.</p><p><strong>Results: </strong>Of the 21,575 patients eligible for one of these four updated care approaches, use of the APT regimen increased from 30% (95% CI, 23% to 37%) to 72% (95% CI, 67% to 77%), pertuzumab from 0% to 71% (95% CI, 66% to 76%), neoadjuvant chemotherapy from 23% (95% CI, 18% to 28%) to 60% (95% CI, 56% to 65%), and omission of chemotherapy from 54% (95% CI, 52% to 57%) to 61% (95% CI, 59% to 64%) from 2010 to 2018. In multivariable analyses, higher median income of residence county and greater specialization of treating oncologist were statistically significantly associated with receipt of updated care for all four treatment scenarios. Patients from lower-income areas who received care from more specialized oncologists were as likely to receive updated care as those from higher-income areas.</p><p><strong>Conclusion: </strong>Patients from lower-income areas were less likely to receive updated care, but specialized oncologists helped mitigate this disparity. Care models that expand consultative access to specialized oncologists should be prioritized for evaluation.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500462"},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553587","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}