JCO oncology practice最新文献

{"title":"Factors Associated With Symptom Burden Among Pediatric Patients With Cancer.","authors":"Adam P Yan, L Lee Dupuis, Catherine Aftandilian, Vibhuti Agarwal, Christina Baggott, Melissa P Beauchemin, Scott M Bradfield, Daniel Cannone, Emi H Caywood, Nicole Crellin-Parsons, Jenna Demedis, David Dickens, Adam J Esbenshade, David R Freyer, Allison C Grimes, Kara M Kelly, Allison A King, Lisa M Klesges, Wade Kyono, Ramamoorthy Nagasubramanian, Etan Orgel, Andrea D Orsey, Michael E Roth, Farha Sherani, Emily Vettese, Alexandra Walsh, Wendy Woods-Swafford, Lolie C Yu, George A Tomlinson, Lillian Sung","doi":"10.1200/OP-25-00244","DOIUrl":"10.1200/OP-25-00244","url":null,"abstract":"<p><strong>Purpose: </strong>The objective was to identify factors associated with self-reported symptom burden measured using Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.</p><p><strong>Methods: </strong>This was a secondary analysis of a cluster randomized trial enrolling pediatric patients newly diagnosed with cancer. Twenty sites were randomized to routine symptom screening versus usual care. Intervention included thrice-weekly symptom screening with SSPedi, delivery of severely bothersome scores to health care teams, and implementation of locally adapted symptom management care pathways. Primary outcome was total SSPedi scores, 0 (no bothersome symptoms) to 60 (worst bothersome symptoms), obtained at baseline, week four, and week eight in 430 patients (n = 217 intervention and n = 213 usual care). We created a mixed linear regression model evaluating design (including time point), patient/guardian, and site characteristics for their associations with symptom burden after controlling for treatment assignment.</p><p><strong>Results: </strong>SSPedi scores were significantly lower at weeks 4 and 8 compared with baseline (<i>P</i> < .0001 overall), and at intervention versus control sites (<i>P</i> < .0001). In the full model, males (estimate, -3.3 [95% CI, -4.6 to -2.0]; <i>P</i> < .0001) and sites with higher physician staffing ratios (each physician full-time equivalent per 100 new diagnoses estimate -0.20 [95% CI, -0.5 to 0.0]; <i>P</i> = .024) had significantly lower total SSPedi scores.</p><p><strong>Conclusion: </strong>Total symptom burden was reduced by time, intervention (symptom screening and care pathways), and greater physician staffing ratio. Females had higher symptom burden. These data may inform programmatic implementation of routine symptom screening in pediatric patients with cancer.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500244"},"PeriodicalIF":4.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855251","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":"Shared Decision Making Can-and Should-Actively Involve Family Caregivers.","authors":"Karina Dahl Steffensen, Leonard Berry","doi":"10.1200/OP-25-00340","DOIUrl":"https://doi.org/10.1200/OP-25-00340","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500340"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144846535","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":"Beyond Infusion: Real-World Insights Into Infusion-Related Reactions in Monoclonal Antibody Therapy.","authors":"Elise J Smolders, Elianne C S de Boer, Helle-Brit Fiebrich-Westra, Remco van der Galiën, Peter M J Plomp, Jan Willem B de Groot, Jan Gerard Maring","doi":"10.1200/OP-25-00275","DOIUrl":"10.1200/OP-25-00275","url":null,"abstract":"<p><strong>Purpose: </strong>The exact mechanism responsible for infusion-related reactions (IRRs) after monoclonal antibody (mAb) therapy is unclear. It is also unknown before treatment which patient will develop IRRs. The reported incidence of IRRs varies per and between mAbs, and real-world incidence data are scarce. The purpose of this study was to evaluate the real-world incidence of IRRs in our large tertiary teaching hospital.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients treated with at least one of the following mAbs: atezolizumab, bevacizumab, durvalumab, ipilimumab, nivolumab, panitumumab, pembrolizumab, trastuzumab, pertuzumab, and rituximab. Patient data were included between January 01, 2021, and June 30, 2022. IRRs were graded according to Common Terminology Criteria for Adverse Events.</p><p><strong>Results: </strong>We included 692 patients, of whom 6.7% (n = 47) had experienced one or more IRRs (n = 63). The highest incidence of IRRs (n = 50) were found in patients treated with rituximab (incidence IRR 26%), followed by patients treated with ipilimumab plus nivolumab (IRR incidence 13%), which was mostly attributed to nivolumab (9%). This is higher compared with literature (2.2%-4.0%). In patients treated with trastuzumab plus pertuzumab, 3.8% had an IRR (n = 3 patients; n = 4 IRRs). For the other drugs, no IRRs were reported.</p><p><strong>Conclusion: </strong>In this large real-world cohort, we found higher-than-expected numbers of IRRs of patients treated with ipilimumab plus nivolumab. Our research shows that when IRRs are adequately recognized and managed, all patients can safely continue with mAb treatment.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500275"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799077","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":"Daily Patient-Reported Symptoms as Predictors of Unplanned Health Care Encounters During Chemotherapy: Longitudinal Observational Study.","authors":"Elizabeth Kairis, Jennifer Fedor, Christianna Bartel, Krina C Durica, Heidi S Donovan, Roby Thomas, Carissa A Low","doi":"10.1200/OP-25-00177","DOIUrl":"10.1200/OP-25-00177","url":null,"abstract":"<p><strong>Purpose: </strong>Chemotherapy can cause symptoms that impair quality of life and lead to unplanned health care encounters (UHEs) such as emergency department visits and inpatient admissions. Collecting patient-reported symptom data between clinic visits can enable timely identification of symptoms. This observational study aimed to identify how daily individual symptoms are associated with UHE.</p><p><strong>Methods: </strong>We recruited patients (n = 183) receiving cytotoxic chemotherapy for solid tumors into our 90-day study. Participants completed a modified version of the patient-reported outcome-Common Terminology Criteria for Adverse Events questionnaire assessing common chemotherapy symptoms daily, and UHE information was extracted from medical records. We fit a series of logistic generalized estimating equations to evaluate day-level associations between moderate-to-severe daily symptoms and the occurrence of UHE within 7 days.</p><p><strong>Results: </strong>On days with moderate-to-severe symptom levels, the odds of having one or more UHE within 7 days were 4.53 times higher for vomiting (95% CI, 1.77 to 11.58; <i>P</i> = .002), 2.84 times higher for decreased appetite (95% CI, 1.94 to 4.17; <i>P</i> < .001), 2.5 times higher for shortness of breath (95% CI, 1.44 to 4.34; <i>P</i> = .001), 1.76 times higher for diarrhea (95% CI, 1.11 to 2.79; <i>P</i> = .02), 1.65 times higher for fatigue (95% CI, 1.20 to 2.26; <i>P</i> = .002), and 1.58 times higher for pain (95% CI, 1.01 to 2.48; <i>P</i> = .04) relative to days with no-to-mild levels of that symptom. After adjusting for days since study enrollment, the odds of UHE were 2.17 times higher on days with moderate-to-severe pain in the abdomen (95% CI, 1.31 to 3.58; <i>P</i> = .003). The odds of UHE within 7 days also increased significantly as the number of moderate-to-severe symptoms increased (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Specific daily symptoms were associated with increased risk of subsequent UHE during chemotherapy. Interventional studies are needed to better understand whether daily remote monitoring of these symptoms can reduce UHE.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500177"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12333548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799078","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 and Ethnic Disparities in Receipt of Guideline-Concordant Pancreatic Cancer Care Among Older Adults in the United States.","authors":"Joshua Herb, Kai-Ping Liao, John K Lin, Kever A Lewis, Sharon H Giordano, Matthew H G Katz, Rebecca A Snyder","doi":"10.1200/OP-25-00351","DOIUrl":"10.1200/OP-25-00351","url":null,"abstract":"<p><strong>Purpose: </strong>Patients racialized as Black experience a higher mortality from pancreatic cancer (PC). Worse survival outcomes may relate to differences in delivered treatment. This study examined differences in receipt of guideline-concordant care (GCC) among older adults with PC according to race and ethnicity.</p><p><strong>Methods: </strong>Patients 65 years and older with incident PC racialized as non-Hispanic White (NH-White) or racialized as NH-Black or of Hispanic ethnicity were identified in the SEER-Medicare database from 2004 to 2019. The primary outcome was receipt of stage-specific GCC. Multivariable logistic regression identified factors associated with GCC. Oaxaca-Blinder decomposition examined the contribution of measured and unmeasured variables to racial disparities in receipt of GCC.</p><p><strong>Results: </strong>Of 12,772 patients included, 85.5% of patients racialized as NH-White (n = 10,915), 7.8% of patients racialized as NH-Black (n = 992), and 6.8% of patients were of Hispanic ethnicity (n = 865). In total, 56.3% of patients received GCC. On adjusted analysis, patients racialized as NH-Black were less likely to receive GCC for stage I/II disease compared with patients racialized as NH-White (odds ratio [OR], 0.66 [95% CI, 0.53 to 0.83]), but not for stage III (OR, 0.65 [95% CI, 0.41 to 1.01]) or stage IV (OR, 0.87 [95% CI, 0.66 to 1.14]). GCC did not differ between Hispanic patients and NH-White patients. On decomposition analysis, differences in GCC among NH-Black and NH-White patients remained largely unexplained, but dual eligibility, census tract-level poverty, and comorbidities were the measured factors that contributed most to the disparity in GCC.</p><p><strong>Conclusion: </strong>Approximately half of an insured population with PC receives GCC, highlighting a need to improve multidisciplinary access and treatment. Black-White racial disparities in receipt of GCC remain prevalent, particularly for early-stage disease. The unmeasured factors driving treatment disparities warrant prospective studies.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500351"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794454","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":"Management of Anemia in Lower-Risk Myelodysplastic Syndromes/Neoplasms With Novel Agents.","authors":"Fieke W Hoff, Stephen S Chung, Amer M Zeidan, Yazan F Madanat","doi":"10.1200/OP-24-00910","DOIUrl":"https://doi.org/10.1200/OP-24-00910","url":null,"abstract":"<p><p>Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases that are prognostically stratified into lower-risk (LR-MDS) and higher-risk MDS on the basis of the International Prognostic Scoring System (eg, IPSS, revised IPSS, and molecular IPSS). Anemia is a hallmark of MDS and can lead to worsening of preexisting comorbidities, long-term RBC transfusion dependence, and profound fatigue. Although RBC transfusion support provides rapid relief of anemia-associated symptoms, it also carries a risk of iron overload and alloimmunization, and is associated with a decreased quality of life. Thus, many clinical trials and treatment strategies for LR-MDS focus on RBC transfusion independence (RBC-TI) as a primary end point. In this review, we discuss the updated treatment paradigm for anemia in LR-MDS. Novel insights in the pathogenesis of MDS and results from positive phase III clinical trials in LR-MDS have led to a growing number of therapeutic options (eg, luspatercept and imetelstat). Imetelstat was recently added as a new agent for patients who are refractory/resistant or ineligible for erythropoiesis-stimulating agent treatment on the basis of the randomized phase III IMerge trial, showing that imetelstat led to the primary end point of RBC-TI for ≥8 weeks in 40% of patients compared with 15% in patients receiving placebo. However, future clinical trials are needed to investigate the optimal sequencing of different agents and the potential of improving efficacy using combination of therapeutic strategies in LR-MDS.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400910"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789127","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":"Perioperative Supportive Care Interventions in Older Adults With Cancer: Opportunities and Challenges.","authors":"Ying Wang, Fergal Fleming, Kah Poh Loh","doi":"10.1200/OP-25-00032","DOIUrl":"10.1200/OP-25-00032","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1060-1062"},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575717","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":"Role of a Designated Pharmacist in Reducing Adverse Drug Reaction Rates and Preventing Potential Medication Errors in Hematology-Oncology: A Randomized Controlled Trial.","authors":"Areen Khateeb Alabbasi, Manfred S Green, Shuli Brammli-Greenberg, Mouna Ballan Haj, Meir Preis, Naama Schwartz, Ophir Lavon, Shmuel Klang, Shai Cohen","doi":"10.1200/OP-25-00158","DOIUrl":"https://doi.org/10.1200/OP-25-00158","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence is insufficient regarding pharmacists' impact on reducing adverse drug reactions (ADRs) in oncology. This trial evaluated whether including a designated pharmacist in the hematology-oncology team reduced ADRs compared with standard care.</p><p><strong>Methods: </strong>This single-center randomized clinical trial was conducted at its outpatient hematology-oncology clinics from July 2020 to October 2022. All consecutive patients meeting study criteria were randomly assigned to receive comprehensive pharmacist intervention or standard care in a 1:1 ratio. Outcomes were monitored over the 4-month intervention period and 1 month afterward. In the intervention group, the pharmacist evaluated treatments, provided medication counseling, and made recommendations to physicians. The control group's treatment charts were evaluated after the intervention ended. In both groups, unrelated pharmacologist physicians determined which recommendations were medication errors (MEs) and assessed their severity levels. The primary outcome was the rates of ADRs. The analysis used the intention-to-treat principle.</p><p><strong>Results: </strong>The study included 182 patients, 91 in each group. The intervention group had lower ADR rates, with an age-adjusted hazard ratio (aHR) of 0.38 (95% CI, 0.23 to 0.65; <i>P</i> < .001) for at least one ADR and an aHR of 0.25 (95% CI, 0.09 to 0.67; <i>P</i> = .006) for at least one moderate or severe ADR. The pharmacist made 588 recommendations for the intervention group, 95% of which were implemented, and identified 287 as MEs. The intervention group also had a higher incidence of detected administration errors (incidence rate ratio, 2.61; 95% CI, 1.38 to 4.92; <i>P</i> = .003) and a higher proportion of potentially serious MEs (<i>P</i> = .003).</p><p><strong>Conclusion: </strong>Integrating an oncology pharmacist into hematology-oncology clinics reduces ADRs and improves the detection and prevention of potentially serious MEs.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500158"},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764867","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":"Let the Music Play.","authors":"Jeffrey Peppercorn","doi":"10.1200/OP-25-00577","DOIUrl":"10.1200/OP-25-00577","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":"21 8","pages":"1049-1051"},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144846536","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 Treatment Patterns After Discontinuation of Venetoclax or BTKis in the Frontline Setting Among Older Adults With Chronic Lymphocytic Leukemia.","authors":"Scott F Huntington, Joanna M Rhodes, Beenish S Manzoor, Dureshahwar Jawaid, Justin T Puckett, Nnadozie Emechebe, Arliene Ravelo, Sachin Kamal-Bahl, Steven E Marx, Jalpa A Doshi","doi":"10.1200/OP.24.00220","DOIUrl":"10.1200/OP.24.00220","url":null,"abstract":"<p><strong>Purpose: </strong>Venetoclax and Bruton's tyrosine kinase inhibitors (BTKis) are key treatment options for patients with chronic lymphocytic leukemia (CLL) in the frontline setting. This study characterized postdiscontinuation treatment patterns and hospitalization of frontline venetoclax and BTKis in a national sample of older adults with CLL.</p><p><strong>Methods: </strong>We identified 1,770 Medicare beneficiaries 66 years and older with CLL initiating venetoclax with obinutuzumab (VEN-O, n = 193) or BTKi treatment (n = 1,577) in the frontline setting between June 01, 2019, and June 30, 2020. Discontinuation was defined as a consecutive 90-day gap in treatment at any point over an 18-month follow-up. BTKi patients were expected to receive treatment continuously; VEN-O patients were expected to complete 11 months of treatment (12 cycles × 28 days = 336 days). The rates of subsequent CLL treatment and all-cause/CLL-related hospitalization were assessed.</p><p><strong>Results: </strong>Over an 18-month follow-up, 102 (52.8%) VEN-O patients discontinued after completing the fixed-duration period; 597 (37.9%) BTKi and 57 (29.5%) VEN-O patients discontinued treatment prematurely. The median time to discontinuation was 11.9 months (VEN-O) and 4.0 months (BTKi patients), respectively. Few patients (n < 11) who discontinued VEN-O initiated another CLL treatment over a median postdiscontinuation follow-up period of 6.1 months. By contrast, 39.0% of discontinuers in the BTKi group had evidence of subsequent CLL treatment over a median 13.8-month postdiscontinuation follow-up period. Post-BTKi regimens included BCL-2 (35.6%), subsequent BTKi (31.8%), chemotherapy (14.6%), anti-CD20 monotherapy (9.9%), and other (8.2%). The rate of postdiscontinuation all-cause and CLL-related hospitalization per 100 patient-months was 2.0 and 1.5 for the VEN-O group and 3.3 and 2.9 for the BTKi group, respectively.</p><p><strong>Conclusion: </strong>In this real-world study, early discontinuation was more common in patients initiating a BTKi in contrast to VEN-O. Patients who initiated a BTKi also had high rates of subsequent treatment and hospitalization.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1124-1133"},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869314","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}