JCO oncology practice最新文献

{"title":"Rural Cancer Care Delivery in the United States: A 2026 Update on Disparities, Vulnerable Populations, and Emerging Models.","authors":"Wade Swenson, Zachary Schroeder","doi":"10.1200/OP-26-00440","DOIUrl":"https://doi.org/10.1200/OP-26-00440","url":null,"abstract":"<p><p>Rural Americans with cancer face persistent and widening disparities in incidence, stage at diagnosis, treatment access, and mortality. This paper synthesizes evidence on the financial sustainability of rural oncology programs, the populations bearing the greatest burden of rural cancer disparities, and the care delivery models most likely to narrow those gaps. We conducted a narrative review of English-language literature published through early 2026, drawing from peer-reviewed articles, national surveillance data, ASCO abstracts, and policy analyses. Rural oncology programs face significant financial challenges: 85% of rural hospitals are strained or vulnerable, cancer services at critical access hospitals (CAHs) have declined, and the 340B Drug Pricing Program's orphan-drug exclusion for CAHs represents an underappreciated structural gap that undermines program sustainability for the facilities most dependent on it. Rural-urban cancer mortality gaps are widest among adults younger than 65 years (the age paradox), who lack Medicare's partial safety net. Racial and ethnic minorities in rural areas, particularly Black Americans and American Indian/Alaska Natives, face compounding geographic and structural barriers. Counter to longstanding assumptions, the per-capita supply of rural oncologists grew approximately 20% nationally from 2012 to 2022, with 67% growth in the most isolated areas. Several models show promise, including hub-and-spoke networks, teleoncology, Project Extension for Community Healthcare Outcomes (ECHO) telementoring, CAH-based programs, patient navigation, oncology hospital-at-home, and National Cancer Institute Community Oncology Research Program (NCORP) sites. However, a key paradox persists: regions with the poorest geographic access to cancer centers have the lowest telehealth utilization rates. Rural cancer disparities are fundamentally a policy and equity problem, not a technology or geography problem. Proven delivery models exist, but they require concurrent policy investment to realize their full potential. Closing the gap requires permanent telehealth authorization, with payment parity, Medicaid expansion, advanced practice provider workforce investment, targeted 340B reform for CAHs, and interstate licensure reform. Oncologists and health systems have both the evidence and the ethical obligation to advocate for these changes, including through participation in hub-and-spoke affiliate networks, NCORP sites, or ECHO programs in their own communities.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600440"},"PeriodicalIF":5.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017022","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":"Oncology Care Model-Related Increases in Screening for Depression and Pain and Patient-Reported Symptoms.","authors":"Tina Q Huang, Sean R McClellan, Gabriel A Brooks, Matthew J Trombley, Colleen M Kummet, Nancy L Keating","doi":"10.1200/OP-26-00383","DOIUrl":"https://doi.org/10.1200/OP-26-00383","url":null,"abstract":"<p><strong>Purpose: </strong>Many patients with cancer experience pain or depression. The Centers for Medicare & Medicaid Services' Oncology Care Model (OCM) included practice-reported quality measures aiming to improve screening and management of pain and depression. We described changes over time and assessed concurrent changes in patient-reported symptoms over time.</p><p><strong>Methods: </strong>We studied patients receiving chemotherapy at OCM-participating practices. We evaluated practice-reported information about screening and management of pain and depression and patient experience survey data collected quarterly during 2017-2022. We assessed changes in practice-reported rates of screening and management of pain and depression. We also estimated time trends in patient-reported symptoms of pain and emotional problems, such as anxiety and depression, as well as receipt of help for these problems, using a spline function at the start of the COVID-19 public health emergency, adjusting for patient and practice characteristics.</p><p><strong>Results: </strong>Practice-reported rates of pain screening and management improved from 76.5% to 92.6% from 2017 to 2022; depression screening and management rates improved from 56.6% to 81.7%. Concurrent assessments of patient-reported pain (-0.2 percentage points (pp)/quarter; <i>P</i> = .002) and emotional problems (-0.1 pp/quarter; <i>P</i> = .001) decreased slightly pre-COVID; trends for both symptoms were stable during COVID-19 (<i>P</i> > .20). Among patients reporting pain or emotional problems, there were slight decreases in reports of receiving help with these symptoms from their cancer care team before and during COVID-19 (all <i>P</i> < .06).</p><p><strong>Conclusion: </strong>Despite substantial practice-reported increases in screening for pain and depression, concurrently collected measures of patient-reported pain and emotional problems declined very slightly and patient reports of receiving help from their cancer care team for these symptoms did not improve. Strategies beyond screening may be needed to better address pain and depression among patients receiving cancer treatment.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600383"},"PeriodicalIF":5.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989994","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":"Early Termination of Phase II-III Genitourinary Oncology Trials: A Two-Decade Analysis of Causes and Trial-Level Risk Factors.","authors":"Kamil Malshy, Jiacheng Wang, Yusheng Jia, Matthew Steidle, Trevor C Hunt, Denzel Zhu, Suiyue Cui, Zijing Cheng, Jathin Bandari","doi":"10.1200/OP-26-00162","DOIUrl":"https://doi.org/10.1200/OP-26-00162","url":null,"abstract":"<p><strong>Purpose: </strong>Early termination of clinical trials delays scientific progress and wastes resources, yet factors associated with trial completion in genitourinary (GU) oncology remain incompletely characterized. We investigated trial-level factors associated with premature discontinuation of phase II-III GU oncology clinical trials.</p><p><strong>Materials and methods: </strong>We analyzed US phase II-III interventional GU oncology trials registered on ClinicalTrials.gov that were completed or terminated between January 1, 2005, and January 1, 2025. Prespecified operational and trial-level characteristics at initiation included disease site, phase, randomization, masking, sponsor type, number of sites, multinational status, data monitoring committee (DMC) presence, and intervention category. Reasons for early termination were categorized, and associations with premature discontinuation were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 1,597 trials, 445 (27.9%) were terminated early and 1,152 (72.1%) were completed. Poor accrual accounted for 41.8% of terminations, followed by sponsor or business decisions (14.6%) and interim futility or efficacy findings (10.3%). In multivariable analysis, prostate cancer trials were more likely to complete than bladder cancer trials (odds ratio [OR], 1.77, 95% CI, 1.25 to 2.50), as were multinational (OR, 1.96, 95% CI, 1.27 to 3.02) and multisite studies (OR, 1.72, 95% CI, 1.28 to 2.30). Trials enrolling metastatic-only (OR, 0.45, 95% CI, 0.29 to 0.72) or mixed-stage populations (OR, 0.55, 95% CI, 0.36 to 0.86), as well as those with DMC oversight (OR, 0.62, 95% CI, 0.47 to 0.81), were less likely to complete.</p><p><strong>Conclusion: </strong>More than one quarter of GU oncology trials terminate prematurely, most often due to accrual failure. Early termination is associated with identifiable disease-specific, structural, and operational trial characteristics. Recognition of these patterns may help inform feasibility assessment, trial planning, and resource allocation, with the goal of reducing preventable trial failure in GU oncology research.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600162"},"PeriodicalIF":5.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982653","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":"Elephant in the Radiation Oncology Practice.","authors":"Rick Davis","doi":"10.1200/OP-26-00928","DOIUrl":"https://doi.org/10.1200/OP-26-00928","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600928"},"PeriodicalIF":5.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982693","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":"Before the Blue-Implementing the SAGE Team to Support Oncology Clinicians.","authors":"Justin M O'Leary, Deborah Stein, Gabriela Bambrick-Santoyo, Tara Buchholz, Kristy Deyeso, Barbara Mitchell, Rev Molly O'Neil Frank, Michelle Rausen, Patricia Spellman, Sanjay Chawla","doi":"10.1200/OP-26-00134","DOIUrl":"https://doi.org/10.1200/OP-26-00134","url":null,"abstract":"<p><strong>Purpose: </strong>Frontline staff frequently experience discomfort caring for patients with cancer nearing the end of life who have no further treatment options and request cardiopulmonary resuscitation (CPR). We developed a program to address staff concerns while honoring patient/family preferences for CPR.</p><p><strong>Methods: </strong>Following the Institute for Healthcare Improvement Model for Improvement, a 24/7 interdisciplinary response team, the Staff Assistance Guiding End-of-life resuscitation and care (SAGE) Team, was created to provide support and minimize staff distress before anticipated cardiopulmonary arrest. The SAGE Team is composed of a rapid response advance practice provider, rapid response nurse, respiratory therapy supervisor, social worker, and spiritual care provider. Together, they identify needed resources for staff, provide education to perform patient care, recommend team composition and roles in advance, address perceived ethical dilemmas and moral distress, and provide psychosocial support to frontline staff before impending resuscitation. The program was evaluated by monitoring team activations, case reviews, and postactivation surveys measuring staff comfort.</p><p><strong>Results: </strong>The SAGE Team was activated 62 times within its first year-three times the expected yearly volume. Nurses primarily used the resource, along with members of the interdisciplinary team across specialties. Thirteen patients required resuscitation and expired within the hospital. The team was activated earlier than expected 54% of the time. Postactivation surveys revealed a 31% increase in staff comfort caring for this patient population.</p><p><strong>Conclusion: </strong>Patients with terminal illness are often medically complex, and aligning goals of care and preferences regarding CPR at end of life is nuanced and distressing to clinicians. Supporting frontline staff before cardiopulmonary arrest in this population can increase comfort in providing direct care. SAGE offers a holistic approach to support and decrease staff distress.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600134"},"PeriodicalIF":5.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976696","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":"Multicancer Detection Tests for Population-Wide Screening of Asymptomatic Individuals: A Systematic Review.","authors":"Suzanne Hughes, Priscilla Chan, Chelsea Carle Harrison, Susan Yuill, Katherine Barron, Qingwei Luo, Sibel Saya, Javiera Martinez-Gutierrez, Peter Sasieni, Natalie Taylor, Karen Canfell, Jon Emery, Nehmat Houssami, Julia Steinberg","doi":"10.1200/OP-26-00570","DOIUrl":"https://doi.org/10.1200/OP-26-00570","url":null,"abstract":"<p><strong>Purpose: </strong>Multicancer detection (MCD) tests aim to detect different cancer types using a single test. However, evidence on their potential for screening asymptomatic populations remains limited. We consolidated evidence from prospective cohort studies evaluating blood-based MCD tests in primarily asymptomatic adults to contextualize upcoming randomized controlled trial results.</p><p><strong>Materials and methods: </strong>We updated and extended a prior review (to September 2023), conducting comprehensive Medline/Embase searches to February 1, 2026. Key outcomes included cancers detected and not detected by MCD tests, false-positive MCD tests, and diagnostic investigation pathways. Risk of bias (RoB) was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 tool.</p><p><strong>Results: </strong>From 2,723 screened records (244 previously shortlisted to 2023, 2,479 records for 2023-2026), we included 18 articles (12 studies, nine MCD tests); of these, 11 articles had not appeared in prior reviews. Cancer detection rates varied widely between studies, for example, new MCD-test-detected invasive cancers diagnosed ≤12 months post-test ranging from 18.8 (95% CI, 11.0 to 30.1) to 43.8 (95% CI, 29.4 to 62.8) per 10,000 tested, with MCD-test-detected invasive stage I to II cancers ranging from 9.0 (95% CI, 4.2 to 17.2) to 21.0 (95% CI, 11.6 to 35.5) per 10,000 tested. False-positives exceeded MCD-test-detected cancers (eg, approximately 1.6-fold in PATHFINDER, 1.5-fold K-DETEK, 4.2-fold DETECT-A, 8.1-fold SeekInCare studies). Diagnostic investigation pathways were prespecified/suggested in four of eight interventional studies. Where reported, the median time to diagnostic resolution varied from <0.1 months to 4 months for MCD-test-detected cancers, with substantially higher 75th percentiles (3.1-7 months), and similar patterns were observed for false-positive MCD tests. No study was judged to have overall low RoB.</p><p><strong>Conclusion: </strong>Substantial heterogeneity in cancer yield metrics likely reflects differences in MCD technologies, diagnostic pathways, follow-up duration, and background standard-of-care screening. Long-term follow-up, randomized trials, fully-paired test comparisons, and implementation research are essential to determine the potential of MCD tests for population screening.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600570"},"PeriodicalIF":5.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968902","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":"OP Acknowledgment of Reviewers 2026.","authors":"","doi":"10.1200/OP-26-01070","DOIUrl":"https://doi.org/10.1200/OP-26-01070","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2601070"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944930","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":"Social Determinants of Health Coding Among Hospital Visits Made by Adults With Cancer.","authors":"Malcolm Su, Samar Bhat, Michael D Dang, Deborah Freeland, Benjamin Johnson, Jessica I Billig, Navid Sadeghi, Arthur S Hong","doi":"10.1200/OP-25-01288","DOIUrl":"10.1200/OP-25-01288","url":null,"abstract":"<p><strong>Purpose: </strong>Social determinants of health (SDOH) affect clinical outcomes among patients diagnosed with cancer. In 2015, International Classification of Diseases-10 diagnosis codes starting with Z prefix, or Z-codes, were introduced to capture SDOH complexity. We examined Z-code uptake for patients treated by an academic medical center and county safety-net health system and their comprehensive hospital visits from a regional health information exchange.</p><p><strong>Methods: </strong>We identified adults age 18 years or older from two tumor registries, diagnosed from January 1, 2015, to December 31, 2023, and identifiably linked them to their longitudinal, comprehensive hospital visits. We characterized Z-code uptake trends as patients visited over 80 hospitals, for all payers including the uninsured.</p><p><strong>Results: </strong>We identified 57,598 patients with 181,684 associated ED and inpatient hospital discharges across more than 80 regional hospitals. Approximately 4.7% of patients had at least one Z-code entered during any hospital visit, and Z-codes were present in just 2.8% of all hospital discharges. Z-code use rose over time from 1.1% of visits in 2016 to 11.3% by 2023. Of the cohort, 23.9% were treated by the county safety-net system; 9.4% had Medicaid and 28.6% were uninsured/charity care at diagnosis; and 24.4% had advanced-stage disease. The most common Z-code was Z59 (housing and economic circumstances), accounting for 48.6% of all Z-codes. Documentation was nearly three-fold higher at the county safety-net system than at the academic center (8.6% <i>v</i> 2.9%; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>In a population-based sample of adults with cancer and their comprehensive hospital visits, Z-code use increased to over 11% of hospital visits by 2023, and housing and economic problems were most prominent. Future work should explore the validity of this coding at an individual patient level.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2501288"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944902","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":"Considerations for Implementing Taxane Infusion Titration Protocols in Clinical Practice.","authors":"Kofi Sefah, Jon Shaffer, Sarfraz Ahmad, Robert W Holloway","doi":"10.1200/OP-26-00888","DOIUrl":"https://doi.org/10.1200/OP-26-00888","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600888"},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944895","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":"Neutropenic Diet Versus Liberalized Diet in Patients With Cancer: A Systematic Review and Meta-Analysis.","authors":"Fares Jamal, Ayla Kouli, Abdullah Alsulaiman, Khalid Benkhadra, Brittney Munayirji, Wallace Klein Schwengber, Abdullah Hamad, Zaryab Bin Riaz, Hani Abou Hatab, Talal Hilal, Mohamad Bassam Sonbol","doi":"10.1200/OP-26-00405","DOIUrl":"https://doi.org/10.1200/OP-26-00405","url":null,"abstract":"<p><strong>Purpose: </strong>Neutropenic diet (ND) has historically been recommended to reduce infectious complications in patients with cancer. Although its use has declined over the past decade, recent studies, particularly in patients undergoing hematopoietic stem-cell transplantation (HSCT), have renewed concern regarding the safety of a liberalized diet (LD). We performed a meta-analysis of studies comparing ND with LD in patients with cancer.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Cochrane databases from inception through January 2026. Comparative studies evaluating ND versus LD in adults or children with cancer were included. Primary outcomes were major infections and bacteremia/fungemia; secondary outcomes were pneumonia, diarrhea, and mortality. Random-effects meta-analyses were performed to calculate pooled relative risks (RRs) with 95% CIs.</p><p><strong>Results: </strong>Fifteen studies including 4,320 patients met criteria for analysis. ND was not associated with significant differences in major infections (RR, 1.02 [95% CI, 0.88 to 1.18]; <i>P</i> = .795), bacteremia/fungemia (RR, 0.97 [95% CI, 0.78 to 1.22]; <i>P</i> = .805), pneumonia (RR, 0.98 [95% CI, 0.59 to 1.63]; <i>P</i> = .933), diarrhea (RR, 1.12 [95% CI, 0.96 to 1.31]; <i>P</i> = .159), or mortality (RR, 0.94 [95% CI, 0.77 to 1.15]; <i>P</i> = .632). Sensitivity analyses restricted to randomized controlled trials (RCTs) were consistent. In hematologic malignancy/HSCT studies (9 studies; 1,769 patients), no differences were observed across outcomes. In RCTs limited to these patients (6 studies; 855 patients), ND was associated with lower bacteremia/fungemia risk (RR, 0.67 [95% CI, 0.47 to 0.95]; <i>P</i> = .023), with no differences in other outcomes.</p><p><strong>Conclusion: </strong>ND was not associated with reductions in major infections, pneumonia, diarrhea, or mortality compared with LD. These findings do not support routine implementation of ND for patients with short-term neutropenia or lower-risk cancer populations although selected high-risk patients, particularly those undergoing HSCT or experiencing prolonged neutropenia related to hematologic malignancies, may still warrant cautious dietary practices.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2600405"},"PeriodicalIF":5.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929821","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}