JCO oncology practice最新文献

{"title":"Estimated Glomerular Filtration Rate Equations Overestimate Renal Function Compared With Measured Glomerular Filtration Rate Using 24-Hour Urine Creatinine Clearance.","authors":"Reza Lahiji, Ernest Allen Morton, Lorenzo Storino Ramacciotti, Edouard H Nicaise, Siddharth Marthi, Benjamin N Schmeusser, Alexander Abdollahzadeh, Gregory Steven Palmateer, Khushali Vashi, Subir Goyal, Yuan Liu, Eric Midenberg, Dattatraya Patil, R Donald Harvey, Michael J Connor, Mohammad Hajiha, Kenneth Ogan, Mehmet A Bilen, Viraj A Master","doi":"10.1200/OP-25-00895","DOIUrl":"10.1200/OP-25-00895","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of renal function is critical in the management of renal cell carcinoma (RCC), influencing surgical planning, systemic therapy eligibility, and clinical trial inclusion. Estimated glomerular filtration rate (eGFR) equations are commonly used in clinical practice but may not reflect true kidney function when compared with more accurate methods of determining renal function such as measured GFR using 24-hour urine creatinine clearance.</p><p><strong>Methods: </strong>In this prospective study, 72 patients with nonmetastatic RCC undergoing preoperative evaluation completed serum creatinine, cystatin C, and 24-hour urine collections. eGFR values were calculated using multiple established equations, both race-inclusive and race-neutral. The agreement between eGFR and measured GFR was assessed using Passing-Bablok regression. Linear regression estimated the discrepancy between eGFR and measured GFR at clinically relevant cutoffs of 45 and 60 mL/min/1.73 m².</p><p><strong>Results: </strong>Across all equations, eGFR consistently overestimated renal function compared with measured GFR. At a measured GFR of 45, corresponding eGFR values ranged from 53 to 59 mL/min/1.73 m²; at a measured GFR of 60, eGFR values ranged from 63 to 68 mL/min/1.73 m². The greatest overestimation was observed with race-neutral Chronic Kidney Disease Epidemiology Collaboration 2021 equations.</p><p><strong>Conclusion: </strong>eGFR equations significantly overestimate renal function in patients with renal masses when compared with 24-hour CrCl-derived measured GFR, particularly near clinically meaningful thresholds. This misclassification may result in inappropriate exposure to potentially harmful treatments, including nephrotoxic chemotherapy and radical nephrectomy. Confirmatory measured GFR testing should be considered in patients with renal function within a ±10 mL/min/1.73 m² range of clinically significant cutoff values to ensure accurate, safe, and appropriate therapeutic decision making. Clinical guidance should specify whether physicians should use eGFR or measured GFR when determining eligibility.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1812-1819"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768112","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":"Outcomes of Patients With Solid Tumor Treated on Phase I Clinical Trials Within a Comprehensive Cancer Center's Private and Safety-Net Hospitals.","authors":"Jacob Stephen Thomas, Gage Guerra, Sabrina Woll, Austin Luong, Rebecca Umayam, Xiomara Menendez, Jessica Levano, Lorraine Martinez Seng, Hadi Erfani, Emmeline Friedman, Varsha Tulpule, Anastasia Martynova, Diana Hanna, Anthony El-Khoueiry","doi":"10.1200/OP-25-00542","DOIUrl":"10.1200/OP-25-00542","url":null,"abstract":"<p><strong>Purpose: </strong>Despite a shift toward targeted therapies and immunotherapies, enrollment to phase I clinical trials for patients with solid tumor remains challenging. Historically, racial and ethnic minority populations are under-represented in clinical trial enrollment in the United States. Multiple barriers exist, including geographic distance from academic centers, restrictive eligibility criteria, and provider or patient factors. The University of Southern California (USC) Norris Comprehensive Cancer Center (USC Norris) clinical sites include both a private hospital and a safety-net hospital. In this report, we describe demographics and outcomes of patients enrolled to phase I clinical trials based on site of care.</p><p><strong>Methods: </strong>Patients enrolled to early-phase clinical trials at USC Norris between January 1, 2015, and December 31, 2022, were included in this study. Patient demographics and outcomes were recorded in a database.</p><p><strong>Results: </strong>Between January 1, 2015, and December 31, 2022, there were 611 patients enrolled. In all, 43.2% of patients enrolled were non-Hispanic White, followed by 26.2% Hispanic White, 20.6% Asian, 4.9% unknown, 3.9% non-Hispanic Black, and <1% each of American Indian/Alaskan Native or Native Hawaiian/Pacific Islander. The median overall survival was 6.5 months. The median progression-free survival was 2.3 months. The best response was complete response in 1.0%, partial response in 6.4%, stable disease in 36.8%, progression of disease in 44.5%, and not evaluable in 11.3%. The overall response rate was 7.4%.</p><p><strong>Conclusion: </strong>Enrollment of patients into early-phase clinical trials for solid tumors is challenging, but it is feasible to enroll patients both in a private hospital setting and in a safety-net hospital. Patient outcomes are similar regardless of enrollment site, and racial/ethnic diversity is increased compared with historic national averages in the United States.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1837-1843"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668042","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":"Timing of Durvalumab Consolidation and Survival in Non-Small Cell Lung Cancer: A Population-Based Analysis.","authors":"Tawee Tanvetyanon, Dung-Tsa Chen, Jhanelle E Gray","doi":"10.1200/OP-25-00259","DOIUrl":"10.1200/OP-25-00259","url":null,"abstract":"<p><strong>Purpose: </strong>Consolidation durvalumab after concurrent chemoradiation (CCRT) for locally advanced non-small cell lung cancer (NSCLC) extends survival. In the PACIFIC trial, the timing to initiate durvalumab was 1-42 days after CCRT. However, in practice, many patients are treated outside this time frame. This study examined the impact of treatment timing.</p><p><strong>Methods: </strong>We performed an analysis of a nationwide electronic health record-derived deidentified database. Patients with stage III NSCLC diagnosed in 2019-2023 and treated with CCRT were identified. Outcomes were overall survival and time to durvalumab discontinuation (TDD). Sequential landmark and propensity score analyses were performed to investigate timing of durvalumab initiation from week 1 to 13 after CCRT.</p><p><strong>Results: </strong>Among 854 patients analyzed, durvalumab was initiated at a median of 5.6 weeks after CCRT (IQR, 4.0-8.3 weeks). When not considering the timing of durvalumab, patients who received durvalumab had better survival than those who did not: adjusted HR, 0.44 (95% CI, 0.34 to 0.56, <i>P</i> < .001). When considering the timing of durvalumab, no significant survival difference was found when durvalumab was initiated on or before week 4: adjusted HR, 0.81 (95% CI, 0.62 to 1.05, <i>P</i> = .07). The survival benefit increased over time and became significant on or after week 5. We found no deterioration in survival benefit when durvalumab was started after week 6. No significant difference in TDD by durvalumab timing was found.</p><p><strong>Conclusion: </strong>This analysis demonstrated the survival benefit of durvalumab consolidation in the real-world setting. However, the benefit was not significant when durvalumab was initiated on or before week 4 after CCRT.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1765-1775"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723372","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":"Project 5 in 5: Paving the Way for <i>Increasing</i> Pragmatism in Clinical Oncology Trials.","authors":"Steven Clark Cunningham, Kelly Norsworthy, Jennifer J Gao, Paul G Kluetz, Donna R Rivera, Richard Pazdur","doi":"10.1200/OP-25-00593","DOIUrl":"10.1200/OP-25-00593","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1691-1694"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944175","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":"Fifteen-Year National Trends in Single-Fraction Stereotactic Body Radiation Therapy Utilization for Stage I Non-Small Cell Lung Cancer.","authors":"Drew Moghanaki, Gregory Videtic, Anurag K Singh, Shankar Siva, Diana L Gage, Alan Lee, Jie Deng, Michael Xiang","doi":"10.1200/OP-25-00826","DOIUrl":"10.1200/OP-25-00826","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate utilization trends and survival outcomes of single-fraction stereotactic body radiation therapy (SF-SBRT) for early-stage non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>The National Cancer Database (2006-2021) was queried to identify patients with stage I NSCLC treated with either SF-SBRT or multifraction (MF) SBRT delivered in 3-5 fractions. Patients receiving chemotherapy or surgery were excluded. Utilization trends were assessed using the Cochran-Armitage test. Predictors of SF-SBRT use were evaluated via multivariable logistic regression. Overall survival (OS) was compared using the log-rank test.</p><p><strong>Results: </strong>A total of 83,377 patients were identified, of whom 937 (1.1%) received SF-SBRT. The proportion of SF-SBRT rose from 0% in 2006 to 1.6% in 2021 (<i>P</i> < .0001). The most frequent SF-SBRT prescriptions were 34 Gy (39%), 27 Gy (28%), and 30 Gy (28%); the most frequent MF-SBRT prescriptions were 10 Gy × 5 (42%), 18 Gy × 3 (14%), and 12 Gy × 4 (14%). The proportion of facilities delivering SF-SBRT increased from 0% in 2006 to 11% in 2021 (<i>P</i> < .0001) and, as of 2021, varied significantly by annual lung SBRT case volume: 6% for centers treating <10 patients, 25% for centers treating 10-19 patients, 41% for centers treating 20-29 patients, and 69% for centers treating ≥30 patients per year. Factors associated with SF-SBRT utilization included smaller tumor size (≤2 cm), treatment at a high-volume center or academic facility, and later year of treatment (all <i>P</i> < .0001). There was no difference in OS between patients treated with SF-SBRT and MF-SBRT (<i>P</i> = .89).</p><p><strong>Conclusion: </strong>Utilization of SF-SBRT for stage I NSCLC is increasing, particularly at high-volume and/or academic centers. Yet, its overall utilization remains low despite evidence supporting its safety and efficacy.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1756-1764"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714307","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":"Clinician- and Facility-Level Factors Associated With Receipt of Nonguideline Chemotherapy Regimens in Women With Stage I-IIIA Breast Cancer.","authors":"Yashasvini Sampathkumar, Ziad Zakaria, Kelli O'Connell, Jenna Bhimani, Victoria S Blinder, Rachael Burganowski, Isaac J Ergas, Grace B Gallagher, Jennifer J Griggs, Narre Heon, Tatjana Kolevska, Yuriy Kotsurovskyy, Candyce H Kroenke, Cecile A Laurent, Raymond Liu, Kanichi G Nakata, Sonia Persaud, Janise M Roh, Sara Tabatabai, Emily Valice, Elisa V Bandera, Erin J Aiello Bowles, Lawrence H Kushi, Elizabeth D Kantor","doi":"10.1200/OP-25-00086","DOIUrl":"10.1200/OP-25-00086","url":null,"abstract":"<p><strong>Purpose: </strong>We examined clinician- and facility-level factors associated with selection of nonguideline chemotherapy at treatment initiation in women with stage I-IIIA breast cancer (BC).</p><p><strong>Methods: </strong>The Optimal Breast Cancer Chemotherapy Dosing Study collected information on chemotherapy delivery in an integrated health care delivery system. This analysis included 9,758 women treated with chemotherapy for stage I-IIIA BC between 2006 and 2019 at Kaiser Permanente Northern California (KPNC). Prevalence ratios (PRs) and corresponding 95% CIs were estimated for the clinician and facility factors in relation to nonguideline regimen (NGR) use. Analyses were stratified by time (pre- and post-2015) to reflect the period before and after KPNC's transition to a subspecialized care model. Secondary outcomes focused on nonguideline drug combinations (NGDCs) and nonguideline administration schedules (NGASs).</p><p><strong>Results: </strong>Women treated by clinicians with substantially greater time since medical school (30+ years <i>v</i> <10 years since medical school) were more likely to receive NGR (PR, 1.38; 95% CI, 1.01 to 1.88; <i>P</i> trend = .01) with significant associations observed for both NGDC and NGAS. While not associated in the primary analysis, larger practice size (10+ oncologists) was associated with a lower likelihood of NGDC use compared with smaller practices (<5 oncologists; PR, 0.43; 95% CI, 0.26 to 0.70; <i>P</i> trend = .01). Time stratification revealed that, in the study's early years, clinician sex and years since medical school were associated with NGR use, but neither association remained post-2015.</p><p><strong>Conclusion: </strong>Clinician and facility characteristics significantly influenced the use of NGR in stage I-IIIA BC treatment. Notably, associations diminished over time, suggesting that health system changes in care delivery may enhance guideline adherence and reduce the impact of nonclinical factors on treatment decisions.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1776-1787"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12700344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742618","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":"Does Electronic Symptom Monitoring Improve Symptom Burden and Self-Efficacy Among Chemotherapy and Surgery Patients Across Six Cancer Centers?","authors":"Jessica J Bian, Samira L Dias, Paige A Wright, Angela C Tramontano, Christine M Cronin, Raymond U Osarogiagbon, Deb Schrag, Sandra L Wong, Don S Dizon, Hannah Hazard-Jenkins, Michael J Hassett","doi":"10.1200/OP-25-00306","DOIUrl":"10.1200/OP-25-00306","url":null,"abstract":"<p><strong>Purpose: </strong>The multicenter Symptom Management Implementation of Patient Reported Outcomes in Oncology Consortium developed electronic Symptom Management (eSyM), an electronic health record-based symptom management program, to reduce acute care utilization. We hypothesized that implementing eSyM would also improve self-reported symptom burden and self-efficacy.</p><p><strong>Methods: </strong>eSyM was deployed via a pragmatic stepped-wedge cluster randomized trial for adults who started chemotherapy or had surgery for confirmed or suspected GI, gynecologic, or thoracic malignancies across six cancer centers from 2019 to 2023. In parallel, we administered a survey to two distinct cohorts: patients treated before and after eSyM deployment (ie, pre-live and post-live). A REDCap-based survey collected demographic and clinical characteristics and assessed six Patient-Reported Outcomes Measurement Information System measures: self-efficacy for symptom management, pain interference, anxiety, fatigue, depression, and physical function. Differences in mean T-scores were derived for the post-live versus pre-live cohorts among chemotherapy and surgery recipients. Multivariable regression models controlled for relevant patient and clinical characteristics.</p><p><strong>Results: </strong>The pre-live cohort included 1,043 respondents (490 chemotherapy and 553 surgery); the post-live cohort included 1,046 respondents (535 chemotherapy and 511 surgery). After controlling for other clinical and demographic factors, the post-live chemotherapy cohort reported statistically significantly lower fatigue and anxiety, but the reductions did not meet the clinically meaningful threshold (adjusted mean T-score difference: -1.3 and -1.8, respectively; <i>P</i> < .05). The post-live surgery cohort reported statistically significantly lower fatigue and anxiety; the differences met the clinically meaningful threshold (-2.0 and -2.2, respectively; <i>P</i> < .01).</p><p><strong>Conclusion: </strong>eSyM deployment was associated with reduced symptom burden, but clinically meaningful differences were only observed in fatigue and anxiety scores among surgical patients. Future studies should investigate the mechanisms by which symptom reporting affects patient outcomes, such as improving patient-clinician communication, enhancing clinician attention to symptom management, or increasing patient self-efficacy.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1788-1796"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512809","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":"Racial Disparities in the Management of Myeloma Bone Disease: A Retrospective Cohort Study.","authors":"Ruxandra M Irimia, Valentina Goularte, Metodi Balev, Michael Singel, Dan Skoloda, Philip H Imus, Carol Ann Huff, S Abbas Ali, Hua-Ling Tsai, Christian B Gocke","doi":"10.1200/OP-25-00935","DOIUrl":"https://doi.org/10.1200/OP-25-00935","url":null,"abstract":"<p><strong>Purpose: </strong>Skeletal-related events (SREs) are major contributors to morbidity in multiple myeloma (MM) and can be partially prevented with antiresorptive bone-modifying agents (BMAs). African American (AA) patients differ in incidence, disease biology, and outcomes. However, the characteristics and management of SREs in this population remain poorly defined.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 350 patients newly diagnosed with MM (149 AA, 201 White), treated at the Johns Hopkins Hospital between 2016 and 2024. We assessed racial differences in SRE incidence, severity, and timing, as well as BMA administration during year 1 after diagnosis.</p><p><strong>Results: </strong>The proportion of patients receiving BMAs within the first year was significantly lower among AA patients than among White patients (64% <i>v</i> 77%, <i>P</i> = .013), with AA patients also receiving significantly fewer doses (median 5 <i>v</i> 7 doses/year, <i>P</i> < .001) among BMA-treated patients. Most of the SREs in both groups occurred during the peridiagnostic period (40% <i>v</i> 50%, <i>P</i> = .06). Beyond the peridiagnostic period, the 1-year cumulative SRE incidence did not differ significantly (16% <i>v</i> 21%, <i>P</i> = .24). Among AA patients, those with a peridiagnostic SRE had a significantly higher incidence of subsequent SREs compared with those without an early event (<i>P</i> = .02) and, compared with White patients with a peridiagnostic SRE, were less likely to receive at least 4 BMA doses during the first year (46% <i>v</i> 76%, <i>p</i>-adjusted < .001).</p><p><strong>Conclusion: </strong>AA patients with MM receive overall lower-intensity dosing of BMAs, yet experience no significant difference in postdiagnostic SREs during the first year. However, AA patients who experience an early SRE are more likely to be undertreated with BMAs, potentially placing them at increased risk of recurrent events.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500935"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109545","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":"Innovations in Palliative Care Delivery in Oncology.","authors":"Anh B Lam, Laura A Petrillo, Areej El-Jawahri, Jessica Bauman, J Nicholas Odom, Jennifer S Temel, Ryan David Nipp","doi":"10.1200/OP-25-00868","DOIUrl":"10.1200/OP-25-00868","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1713-1718"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984703","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 Study of the Implementation of Early and Systematic Palliative Care for Advanced Colorectal Cancer Care-The Palliative Care Early and Systematic Project.","authors":"Jessica E Simon, Sharon M Watanabe, Patricia A Tang, Marc Kerba, Amy Tan, Madalene Earp, Camille Piquette, Janet Vandale, Patricia Biondo, Philip Akude, Aynharan Sinnarajah","doi":"10.1200/OP-25-00492","DOIUrl":"10.1200/OP-25-00492","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and evaluate real-world interventions to move guidelines on timely palliative care utilization into practice.</p><p><strong>Methods: </strong>A knowledge-to-action cycle theory-informed, process improvement project facilitated implementation of a clinical practice guideline by (1) systematically screening clinic patients for unmet palliative care needs and alerting the oncologist, (2) using a dedicated community-based palliative care nurse for each referral, and (3) using Shared-care letters (structured communication between oncologist, family physician, and patient) to enhance information exchange and awareness of patients' needs. Implementation occurred for advanced colorectal cancer (CRC) within the GI clinics of the Tom Baker Cancer Center, Calgary, AB, Canada, and the neighboring city's Cross Cancer Institute, Edmonton, AB, Canada acted as control. The primary outcome was the proportion of adult decedents with CRC who received early specialist palliative care (SPC; defined as >90 days before death), evaluated using a pragmatic, controlled, before-and-after study. Eligible decedents in each city were identified using provincial cancer registry data and linked with administrative data identifying palliative care consultation, homecare, hospice, or inpatient unit usage.</p><p><strong>Results: </strong>The cohort included 695 decedents: 341 baseline period (153 control, 188 intervention, April 2017-December 2018) and 354 implementation period (145 control, 209 intervention, April 2019-December 2020); the mean age was 66.5 years, 60% was male, and 95.2% was urban-dwelling. In the intervention arm, the proportion of decedents who received palliative care >90 days before death increased from 44.7% at baseline to 57.4% after implementation; in the control arm, the proportion decreased from 47.7% to 44.1% (17.7% difference in differences [95% CI, 3.1-32.4]; <i>P</i> = .018).</p><p><strong>Conclusion: </strong>This intervention effectively increased early SPC utilization and provides a pragmatic approach to achieve and measure system-level change.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1719-1729"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742631","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}