American Journal of Clinical Oncology-Cancer Clinical Trials最新文献

{"title":"Medical Racism and Physician Trust Impressions of African-American Breast Cancer Patients Enrolled on the Navigator-Assisted Hypofractionation (NAVAH) Phase I Clinical Trial.","authors":"Kamryn J Davis, Ursula J Burnette, Yilun Sun, Maya J Stephens, Louisa Onyewadume, Shearwood McClelland","doi":"10.1097/COC.0000000000001183","DOIUrl":"10.1097/COC.0000000000001183","url":null,"abstract":"<p><strong>Objectives: </strong>The historical distrust between the African-American community and the medical system, rooted in systemic racism, continues to affect health care outcomes today. Although Caucasian women have the largest incidence of breast cancer diagnoses, African-American women have the highest mortality rate. Furthermore, studies show African-American women are less likely to receive hypofractionated radiation therapy (RT). The Navigation-Assisted Hypofractionation (NAVAH) program was designed to identify the barriers preventing equal access to adjuvant hypofractionated RT while also addressing the inequities by utilizing patient navigation services to improve breast cancer survivorship in African-American women. This study explored patients' perceptions of racism in medicine, offering new insights into this critical, yet understudied aspect of health care disparities.</p><p><strong>Methods: </strong>This is a prospective study of African-American breast cancer patients enrolled in the ongoing NAVAH phase I clinical trial. Following consent to receive RT, pretreatment surveys were administered. Surveys assessed participants' distrust of medical professionals and if care was impacted as a result. Each patient answered a series of questions with responses on a scale from strongly agree to strongly disagree. The significance of patients' views on medical racism and physician trust was evaluated using the Kendall tau correlation. A P -value of ≤0.05 was considered statistically significant.</p><p><strong>Results: </strong>The Kendall tau test was used to analyze the data accounting for the possible nonlinear, monotonic nature of the data. Patients believing harmful events have taken place at medical centers were significantly less likely to trust doctors ( P =0.03). Of the remaining sets of questions assessed, only the correlation between the belief that African-Americans receive the same care as other patients and the likelihood of following hospital-given advice approached statistical significance ( P =0.055).</p><p><strong>Lessons: </strong>Patients' perception of treatment within the medical system can greatly impact their decision to seek care and adhere to treatment, which in return can have a substantial impact on oncologic outcomes. Our findings indicate that patient trust in physicians is significantly impacted by patient perceptions of the likelihood of harmful event occurrence at medical centers, with the correlation of perceived medical racism and obeying hospital-given advice trending towards significance.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05978232.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"339-341"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Cancer Screening Impressions of African-American Breast Cancer Patients Enrolled on the Navigator-Assisted Hypofractionation (NAVAH) Trial.","authors":"Jessica Y Aduwo, Ursula J Burnette, Louisa Onyewadume, Maya J Stephens, Kamryn J Davis, Shearwood McClelland","doi":"10.1097/COC.0000000000001189","DOIUrl":"10.1097/COC.0000000000001189","url":null,"abstract":"<p><strong>Objectives: </strong>African-Americans have the highest cancer mortality rates and the lowest survival rates compared with other racial groups in the US. The Navigator-Assisted Hypofractionation (NAVAH) program includes a culturally sensitive survey to assess the impact of patient navigation on access to hypofractionated radiation therapy (RT) for African-American breast cancer patients. This study reports cancer screening impressions of participants enrolled in the ongoing NAVAH phase I clinical trial, marking a significant first in this field.</p><p><strong>Methods: </strong>After a referral for RT from a multidisciplinary tumor board, trial-eligible patients were invited to participate in the NAVAH trial. Surveys were administered before RT to assess overall cancer screening knowledge, categorizing responses as outstanding (18 to 23 points), excellent (24 to 29 points), good (30 to 35 points), average (36 to 42 points), or below average (>43 points). Knowledge was further stratified through 3 specific criteria: early screening, prognosis, and toxicity awareness with responses categorized as excellent, good, or average for each domain. Correlations between education levels and responses were analyzed using variance analysis ( P <0.05).</p><p><strong>Results: </strong>An initial cohort of 35 trial participants was assessed. The average cancer screening and treatment knowledge score was 27.6. Participants showed excellent understanding of early screening and prognosis and good knowledge of toxicity. There was no significant correlation between educational attainment and cancer knowledge or income levels. This ongoing phase I clinical trial highlights a relative deficiency in toxicity knowledge compared with prognosis and early screening.</p><p><strong>Conclusions: </strong>Early impressions indicate that African-American breast cancer patients have an overall excellent knowledge of cancer screening and treatment, not correlated with socioeconomic or educational status, except treatment toxicity knowledge. Future education initiatives should focus on treatment toxicity to optimize patient awareness before adjuvant breast cancer RT.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"362-364"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic Barriers to Successful Implementation of Optune in Glioblastoma Multiforme Patients.","authors":"Nandika Kapur, Clark Anderson, Shraddha Dalwadi, Eva Galvan, Luis Carranza, Joel Michalek","doi":"10.1097/COC.0000000000001188","DOIUrl":"10.1097/COC.0000000000001188","url":null,"abstract":"<p><strong>Objectives: </strong>Tumor-treating fields (TTFields), or Optune, is a therapy that utilizes electrical fields to stagnate tumor growth in patients with glioblastoma multiforme (GBM). This retrospective review of a single institution's experience identifies sociodemographic hurdles to patient compliance, initiation, and continuation with TTFields. We aimed to isolate patients who were not offered TTFields and those who terminated treatment so that we could hypothesize ways to overcome common barriers for our future patients.</p><p><strong>Methods: </strong>Socioeconomic and demographic information between 2015 and 2022 was collected from 178 GBM patient records and analyzed using R. Device usage information was provided by Novocure. Kaplan-Meier survival estimates and reasons for termination were recorded.</p><p><strong>Results: </strong>Of the 178 patients, 96 were offered TTFields. Among the 82 patients not offered Optune, 66% did not receive the treatment due to their poor KPS. The insurance provider ( P =0.86) did not play a role in Optune being offered. Of the 112 patients with spousal support, 65 started treatment (58%) as compared with 47% (29/62) of those without spousal support starting treatment. For those that started TTFields, disease progression was the primary reason for terminating device usage (26%) followed by discomfort from wearing the device (10%). Patient outcomes showed an elevated median survival in patients who used the device (21 mo vs. 9 mo).</p><p><strong>Conclusion: </strong>Although TTFields is effective, we identified several obstacles to initiating and sustaining treatment. Future work into finding initiatives to help patients overcome these barriers is imperative to increasing its use in all patient populations.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"372-375"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Executive Summary of the American Radium Society Appropriate Use Criteria for the Use of Esophageal Stents in Patients With Esophageal Cancer: Systematic Review and Guidelines.","authors":"Suzanne Russo, Christopher J Anker, D Chamil Codipilly, Gerard Abood, Dmitriy Akselrod, Christopher L Hallemeier, Krishan R Jethwa, Zhaohui Jin, Ed Kim, Timothy Kennedy, Percy Lee, Eric D Miller, Neil B Newman, J Eva Selfridge, Navesh Sharma, William Small, Leila Tchelebi, Vonetta M Williams, Charles B Simone","doi":"10.1097/COC.0000000000001222","DOIUrl":"10.1097/COC.0000000000001222","url":null,"abstract":"<p><strong>Objectives: </strong>Esophageal cancer (EC) often presents with dysphagia due to tumor obstruction. Esophageal stenting has the potential of palliating dysphagia, improving nutrition, preventing aspiration, and improving quality of life (QoL) but may be associated with risks. The present systematic review and guidelines are intended to assist treatment decision-making when considering stent placement in patients with EC based on the available evidence.</p><p><strong>Methods: </strong>Using the population, intervention, comparator, outcome, timing and study design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective phase II-III trials and retrospective analyses published between January 1, 2010 and December 3, 2024 in the Ovid Medline database. These references were assessed by American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. RAND-UCLA consensus methodology was used to rate the appropriateness of the use of stents.</p><p><strong>Results: </strong>ARS AUC recommendations include (1) esophageal stenting is usually not appropriate in patients with early-stage EC in whom upfront surgery is planned; (2) esophageal stenting is usually not appropriate in patients with locally-advanced EC in whom neoadjuvant/perioperative therapy and esophagectomy or definitive chemoradiation is planned; (3) esophageal stenting may be appropriate in the setting of metastatic EC, especially in patients with short life expectancy with limited treatment options; (4) esophageal stenting is usually not appropriate for benign stricture following curative-intent therapy; (5) esophageal stenting is usually not appropriate for locally recurrent tumor in the setting of prior radiation; and (6) esophageal stenting is usually appropriate for management of tracheoesophageal fistula before curative-intent treatment.</p><p><strong>Conclusions: </strong>This ARS AUC summary provides guidelines for the use of esophageal stents in patients with EC provides based on available evidence.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR-ARS Practice Parameter for the Performance of Stereotactic Body Radiation Therapy.","authors":"Samuel T Chao, Aviva Berkowitz, Eleanor E R Harris, Mark A Henderson, Simon S Lo, Matthew Pacella, Joshua Palmer, Hina Saeed, Charles B Simone, Benjamin P Ziemer, William Small, Naomi R Schechter","doi":"10.1097/COC.0000000000001224","DOIUrl":"https://doi.org/10.1097/COC.0000000000001224","url":null,"abstract":"<p><strong>Objectives: </strong>This practice parameter was revised collaboratively by the American College of Radiology (ACR) and American Radium Society (ARS). Stereotactic body radiation therapy (SBRT) precisely delivers higher dose(s) of radiation in 5 of fewer fractions, compared with conventional radiation. Given the complexity and technical nature of this treatment technique, practice parameters are needed to provide guidance to physicians and physicists.</p><p><strong>Methods: </strong>This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS.</p><p><strong>Results: </strong>Workflow, qualifications/responsibilities of personnel, quality control, and treatment delivery/verification are reviewed. Notable elements of SBRT include image guidance, immobilization, and motion management, with the treatment planning goal of minimizing the volume of normal tissue exposed to medium and high dose levels and maximizing dose safely to the target. Specialized training is encouraged, as some technologies are not used in standard treatments.</p><p><strong>Conclusions: </strong>This practice parameter provides direction on key components recommended for SBRT and may be used as a guide to physicians and physicists wanting to provide this treatment to their patients.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR-ARS Practice Parameter for Image-Guided Radiation Therapy (IGRT).","authors":"Adam Garsa, Courtney R Buckey, Brian J Davis, Laura Freedman, Sebastien A A Gros, Christopher L Hallemeier, Simon S Lo, Michael T Milano, Hina Saeed, Jason C Ye, William Small, Naomi R Schechter","doi":"10.1097/COC.0000000000001220","DOIUrl":"10.1097/COC.0000000000001220","url":null,"abstract":"<p><strong>Objectives: </strong>This practice parameter was revised collaboratively by the American College of Radiology (ACR), and American Radium Society (ARS). Image-guided radiation therapy (IGRT) uses various imaging modalities to maximize the accuracy and precision of radiation treatment delivery.</p><p><strong>Methods: </strong>This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS.</p><p><strong>Results: </strong>This practice parameter for IGRT addresses qualifications and responsibilities of personnel, clinical IGRT implementation, documentation, quality control and improvement, safety, and patient education. Since the publication of the ACR-ASTRO Practice Parameter in 2019, there is now more clarity as to what criteria and parameters need to be documented in the medical record, a better appreciation of the large amount of imaging data, how to interpret such data, as well as the complex interactions of multiple systems in the implementation of IGRT.</p><p><strong>Conclusions: </strong>This practice parameter assists practitioners in the clinical use of IGRT. IGRT should complement and be used in combination with other quality assurance processes. IGRT is a rapidly evolving field, and practitioners should have a thorough understanding of its strengths and potential limitations.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of Postdiagnosis Cancer Patient Navigation.","authors":"Sarojini Posani, Ursula J Burnette, Shearwood McClelland","doi":"10.1097/COC.0000000000001225","DOIUrl":"https://doi.org/10.1097/COC.0000000000001225","url":null,"abstract":"<p><strong>Objectives: </strong>Patient navigation is a key component in achieving optimal cancer care outcomes. While a vast amount of literature suggests its clear benefits in cancer care, limited objective data exists regarding navigation metrics, specifically the number of navigator-patient contacts and time spent with patients. This study attempts to attain findings from the published literature to better understand navigation metrics to achieve optimal cancer care outcomes.</p><p><strong>Methods: </strong>A systematic PubMed search was performed in April 2025 focusing on cancer patient navigation, with the term \"patient navigation or navigator in postdiagnosis cancer care-contact metrics.\" Important metrics analysed were the median number of navigator-patient contacts, the median time spent per patient, the most common barriers addressed, and their respective improved outcomes. These metrics were then compared with results from the ongoing Phase I Navigator-Assisted Hypofractionation (NAVAH) trial (clinicaltrials.gov, NCT05978232).</p><p><strong>Results: </strong>A total of 7 peer-reviewed studies met the inclusion criteria. The number of patient-navigator contacts widely ranged from 1 to 119; the average being 13.4 (∼0.3 times/mo, compared with 2 times/mo in NAVAH). The median time spent per patient varied from 40 minutes to over 10 hours (compared with 20 mins/encounter in NAVAH). The most commonly discussed topic was financial assistance, which is consistent with NAVAH findings. Improved outcomes were significantly reduced treatment interruption days and securing early specialist appointments.</p><p><strong>Conclusions: </strong>As previously published data depicted wide variability, it highlights the need for standardized data collection and reporting practices, as such quantitative data can facilitate the evolution of patient navigation in achieving improved cancer care outcomes.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and Use of Medical Cannabis in Patients with Head and Neck Cancer.","authors":"Jennifer S Chiang, Jennifer Hall, Sara Richter, Scott Jackson, Vera Qu, Erqi Pollom, Beth M Beadle","doi":"10.1097/COC.0000000000001218","DOIUrl":"https://doi.org/10.1097/COC.0000000000001218","url":null,"abstract":"<p><strong>Objectives: </strong>A survey was conducted to evaluate perceptions, use, and information sources of medical cannabis (MC) among patients with head and neck cancer and identify opportunities for providers to clarify its use.</p><p><strong>Methods: </strong>Two hundred eighty-nine consecutive patients with head and neck cancer seen in the radiation oncology department at a single institution in CA (October 2022 to June 2023; November 2023 to January 2024) were screened for eligibility and invited to participate. Surveys were emailed. Demographic/clinical data were collected and recorded from the electronic health record and surveys, including age, gender, race, ethnicity, metastatic status, COVID-19 vaccination status, substance use history, relationship and employment status, and education level. Associations between clinical/socioeconomic factors and perception/use of MC were analyzed using χ2 tests.</p><p><strong>Results: </strong>Of 258 eligible patients, 122 completed the survey. Most reported reliance on the internet for MC information (70%); only 20% reported consulting with their cancer treatment team. Most (75%) agreed MC can help reduce cancer-related symptoms. Some agreed or were neutral regarding the potential of MC to cure cancer (37%) or prolong life (61%). Overall, 61% of patients reported having used MC, primarily for recreation (72%) or symptom relief (37%). MC use was more common among white (P=0.001), unmarried (P=0.001), and tobacco-using individuals (P=0.045). COVID-vaccinated individuals more often believed MC reduces symptoms (P=0.015).</p><p><strong>Conclusion: </strong>Many patients rely on unregulated sources regarding MC. This highlights the potential for improved provider-patient discussions to support informed decision-making regarding risks, benefits, and questions of MC in cancer care.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Sequencing of Treatment Modalities on Survival in Nonmetastatic Hepatocellular Carcinoma.","authors":"Bakr Alhayek, Firas Baidoun, Danny Hadidi, Muhamad A Moustafa, Omar Abdel-Rahman","doi":"10.1097/COC.0000000000001221","DOIUrl":"https://doi.org/10.1097/COC.0000000000001221","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Hepatocellular carcinoma (HCC) is the most common type of liver malignancy and the third leading cause of cancer-related death in the world. Liver transplant is a cornerstone in treating nonmetastatic disease, but a significant portion of patients miss the opportunity of upfront liver transplant given the long waiting time for donor organs. Herein, we compare the survival outcomes between upfront liver transplant, liver transplant with bridge systemic therapy, and systemic therapy only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The National Cancer Database was queried for patients diagnosed with non-metastatic hepatocellular carcinoma (HCC) between 2004 and 2017. After including only patients with clinical N0 stage who received either systemic therapy alone, liver transplant alone or liver transplant with bridge systemic therapy, we split the cohort into 3 groups: systemic therapy only (including intra-arterial chemotherapy eg, TACE) group, upfront liver transplant group and liver transplant with bridge systemic therapy group. We evaluated overall survival (OS) among the three groups. We studied the OS using Kaplan-Meier estimates and multivariate Cox regression analyses to evaluate factors associated with overall survival (OS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 29,691 patients with nonmetastatic HCC were included for analysis, of which 25,122 (84.6%) were treated with systemic therapy only, 2513 (8.5%) were treated with bridge systemic therapy followed by liver transplant, and 2056 (6.9%) were treated with upfront liver transplant without systemic therapy bridge. We found that patients who were treated with bridge systemic therapy followed by liver transplant and patients who were treated with upfront liver transplant had a statistically significantly better OS compared to patients who were treated with systemic therapy only (mean OS was 101.9 mo and 98.2 vs. 39.4 mo, respectively, with P&lt;0.001 for all). Whereas there was no significant difference in OS between patients who were treated with bridge systemic therapy followed by liver transplant and patients who were treated with upfront liver transplant (mean OS was 101.9 vs. 98.2 months, P=0.187). On multivariate analysis, factors associated with worse OS were older age (HR: 1.011; 95% CI: 1.010-1.013; P&lt;0.001), Male sex (HR: 1.048; 95% CI: 1.014-1.084; P=0.006), White compared with African American race (HR: 1.055; 95% CI: 1.012-1.099; P=0.011), no insurance status (HR: 1.155; 95% CI: 1.079-1.237; P&lt;0.001), clinical T4 stage compared with T0 stage (HR: 1.366; 95% CI: 1.257-1.483, P&lt;0.001), and systemic therapy alone compared with upfront liver transplant and liver transplant with bridge systemic therapy (HR for upfront liver transplant and transplant with bridge systemic therapy vs. systemic therapy was 0.202; 95% CI: 0.184-0.223, and HR: 0.194, 95% CI: 0.178-0.212, respectively, with P&lt;0.001 for all).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with nonmetastati","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Rectal Cancer Treatment Timing Standardization on Patient Outcomes.","authors":"James Sun, Jordan D Fredette, Jill S Hasler, Joceline V Vu, Matthew Philp, Juan L Poggio, Andrea S Porpiglia, Stephanie H Greco, Sanjay S Reddy, Jeffrey M Farma, Anthony M Villano","doi":"10.1097/COC.0000000000001173","DOIUrl":"10.1097/COC.0000000000001173","url":null,"abstract":"<p><strong>Objectives: </strong>The National Accreditation Program for Rectal Cancer (NAPRC) was established in 2017 to decrease rectal cancer treatment variation and improve oncologic outcomes. Initiating curative intent treatment <60 days of first evaluation is one NAPRC standard. We evaluated whether oncologic outcomes improved with timely treatment and factors associated with its receipt.</p><p><strong>Methods: </strong>Using the NCDB, we identified stage I to III rectal cancer patients treated from 2004 to 2020 treated with curative-intent surgery. Patients were stratified into 2 cohorts (timely [<60 d], delayed [≥60 d]) for survival analysis and exploration of variables associated with timely treatment.</p><p><strong>Results: </strong>We included 117,459 patients with a median age of 61 years (interquartile range: 52 to 70 y). Most patients were male (61.1%), White (86.2%), Charlson 0 (77.1%) with stage II (33.5%) or III (44.3%) cancer treated with chemoradiation (58.1%), or surgery (27.0%) first. Timely treatment was associated with improved overall survival (OS; median OS: 153.26 vs. 128.59 m). Patients in the highest income bracket (odds ratio [OR] 1.30) with stage II (OR: 1.27) or III (OR: 1.50) cancer receiving neoadjuvant chemotherapy (OR: 2.24) or chemoradiation (OR: 1.73) as the first treatment received more timely treatment. Patients with Charlson ≥2 (OR: 0.83) of Black (OR: 0.56) or Hispanic (OR: 0.73) race received more delayed treatment (all P <0.01).</p><p><strong>Conclusions: </strong>Timely rectal cancer treatment is associated with improved survival. Socioeconomic disparities limit timely treatment with attendant worse survival, supporting national homogenization of care. As multimodal care for rectal cancer becomes increasingly complex, timely treatment remains paramount.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"302-309"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}