Journal of the National Comprehensive Cancer Network : JNCCN最新文献

{"title":"Integrating Goals-of-Care Documentation Into the Electronic Health Record: Three-Year Results and Insights of the Improving Goal Concordant Care (IGCC) Initiative Across 10 Cancer Centers.","authors":"Kristen McNiff Landrum, Amy A Case, Marcin Chwistek, Andrew S Epstein, Steven R Grossman, Jillian L Gustin, Charlotta Lindvall, Elizabeth T Loggers, Judith E Nelson, Nico Nortjé, Peter G Phung, Sahana Rajasekhara, Christine Sam, James A Tulsky, Joe Papio, Jack Kolosky, Finly Zachariah","doi":"10.6004/jnccn.2026.7032","DOIUrl":"10.6004/jnccn.2026.7032","url":null,"abstract":"<p><strong>Background: </strong>Earlier and more frequent goals-of-care conversations (GOCCs) for patients with cancer have the potential to enhance person-centered care delivery. Structured electronic health record (EHR) functionality may support more consistent GOCCs and documentation; however, large-scale, multisite implementations remain limited. This study describes the implementation and evaluation of EHR-based goals-of-care documentation (GOCD) across 10 dedicated cancer centers participating in the Improving Goal Concordant Care (IGCC) initiative.</p><p><strong>Patients and methods: </strong>The IGCC initiative was a multicomponent collaborative quality improvement project led by the Alliance of Dedicated Cancer Centers (ADCC) between 2020 and 2023. Participants developed a consensus definition of structured EHR GOCD to guide implementation at participating sites. Centers also used a range of enabling strategies to promote GOCD. Evaluation included process assessments and quarterly reporting on the percentage of deceased patients with at least one documented GOCC.</p><p><strong>Results: </strong>All 10 sites implemented structured GOCD templates. Across the study period, aggregate GOCD rates improved significantly, increasing from 18% to 37% among all decedents and from 25% to 52% among inpatient decedents. However, the collaborative consensus goal of 70% was not achieved. Significant improvements in GOCD rates were observed among all decedents in 5 of 8 centers and among inpatient decedents in 6 of 9 centers. Sites that implemented clinician nudges or financial incentives achieved significantly higher final GOCD rates.</p><p><strong>Conclusions: </strong>This multicenter initiative demonstrated that structured EHR tools, paired with institutional engagement and behavioral strategies, can improve documentation of GOCCs in oncology. Variation in implementation across sites highlights the importance of local adaptation and sustained programmatic support in driving meaningful practice change.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Tumor Multifocality on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma: Implications for Future Staging Systems.","authors":"Kever A Lewis, Elena Panettieri, Galen C Gist, Francesco Ardito, Mario De Bellis, Andrea Ruzzenente, Iolanda Scoleri, Emmanueal Boleslawski, Kristoffer Watten Brudvik, Guillaume Passot, Madhulika Eluri, Sunyoung Lee, Ian Hu, Shubham Pant, Milind Javle, Adriana C Gamboa, Yun Shin Chun, Ching-Wei D Tzeng, Felice Giuliante, Jean-Nicolas Vauthey, Hop S Tran Cao, Timothy E Newhook","doi":"10.6004/jnccn.2026.7028","DOIUrl":"10.6004/jnccn.2026.7028","url":null,"abstract":"<p><strong>Background: </strong>The AJCC staging system has assigned variable prognostic weight to multifocal disease across versions for intrahepatic cholangiocarcinoma (iCCA). We aimed to better delineate how multifocality influences survival in patients with resectable iCCA to refine clinical staging and better inform treatment sequencing.</p><p><strong>Patients and methods: </strong>We retrospectively identified patients undergoing curative-intent hepatectomy for iCCA between 2000 and 2024 from 6 international, high-volume hepatobiliary centers. Patients were stratified by multifocality, T classification, and N classification. Overall survival (OS) was evaluated using Kaplan-Meier and Cox regression analyses, and a novel modified system was proposed based on current AJCC groupings.</p><p><strong>Results: </strong>A total of 731 patients met the study inclusion criteria. Multifocal disease was present in 36% of patients with T2-T4 tumors and was independently associated with worse OS (hazard ratio, 1.64; 95% CI, 1.21-2.22; P=.002) compared with solitary tumors on multivariable analysis. This survival disadvantage persisted across T2 classification (28.8 vs 44.8 months; P=.001) and T3 classification (21.2 vs 36.5 months; P=.003), and remained significant after adjustment for nodal status (P=.003 and P=.017, respectively). Compared with solitary disease, multifocality also conferred worse OS in patients with node-negative (36.0 vs 58.9 months; P=.003) and regionally node-positive disease (19.2 vs 23.8 months; P=.016). Current AJCC staging failed to distinguish prognostic differences between stage II and stage IIIA disease (48.3 vs 46.9 months; P=.190). However, our proposed modifications, which classify multifocal tumors as T3 and upstage multifocality from stage II to stage IIIA in node-negative disease and from stage IIIB to a newly defined stage IIIC in node-positive disease, better stratified overall risk (P<.001).</p><p><strong>Conclusions: </strong>Multifocality independently predicts poor prognosis in resectable iCCA. Refining the current staging system by reclassifying multifocal tumors as T3 may improve prognostic stratification and better inform treatment sequencing.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Evidence-Based Study on Treatment-Free Remission in Chronic Myeloid Leukemia.","authors":"Fang Cheng, Yu Wang, Yu Zhu, Yunfan Yang, Jianyu Weng, Na Xu, Jian Huang, Zhenfang Liu, Hongbo Ren, Huifang Zhao, Huanling Zhu, Yajuan Ke, Weiyan Wu, Xin Du, Qian Jiang, Yanli Zhang, Weiming Li","doi":"10.6004/jnccn.2026.7026","DOIUrl":"10.6004/jnccn.2026.7026","url":null,"abstract":"<p><strong>Background: </strong>Treatment-free remission (TFR) has become a treatment goal for chronic myeloid leukemia (CML). This study aimed to define precise conditions for treatment discontinuation and to develop TFR prediction models in a Chinese population.</p><p><strong>Patients and methods: </strong>This study collected data from 11 centers involving 802 cases of tyrosine kinase inhibitor (TKI) discontinuation in patients with CML. Eligible patients had received any TKI for at least 3 years and had maintained a deep molecular response (DMR) for at least 2 years. The primary endpoint was maintenance of major molecular response (MMR) within 12 months after discontinuation.</p><p><strong>Results: </strong>Among 698 eligible patients (459 in the learning cohort and 239 in the validation cohort), 318 (45.6%) lost MMR, most commonly within the first 6 months after discontinuation (234/318; 73.6%). TFR rates were 66.5% at 6 months, 57.7% at 12 months, and 55.5% at 24 months. All patients regained MMR/DMR upon TKI reinitiation, with no disease progression. Longer treatment duration and sustained DMR were associated with higher TFR rates for both imatinib and second-generation TKIs. Superior outcomes correlated with low Sokal risk, no resistance, ≥5 years of TKI therapy, optimal DMR duration, and achievement of MMR at 12 months. The rate of sustained TFR was 73.5%, 60.0%, 44.6%, and 20.6% for patients with 0, 1, 2, and ≥3 nonoptimal factors, respectively. We developed predictive models and created a web-based calculator to assist clinicians in decision-making.</p><p><strong>Conclusions: </strong>Patients achieving durable DMR can safely discontinue therapy with rigorous monitoring. TFR attempts remain viable even under nonoptimal conditions, provided that adequate DMR duration and close monitoring are maintained.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Combination Amivantamab-Lazertinib, Osimertinib Plus Chemotherapy, and Osimertinib Monotherapy in Lung Cancer.","authors":"Jui-Hung Tsai, Sheng-Han Tsai, Li-Jun Chen, Szu-Chun Yang","doi":"10.6004/jnccn.2026.7017","DOIUrl":"10.6004/jnccn.2026.7017","url":null,"abstract":"<p><strong>Background: </strong>Combination amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy are the current standard first-line therapies for treatment-naïve patients with EGFR-mutated advanced lung cancer. We aim to compare the cost-effectiveness of all 3 regimens.</p><p><strong>Methods: </strong>This economic evaluation with a 20-year time horizon and annual 3% discount was conducted from the perspective of the health care sectors in Taiwan and the Unites States (US). Simulated patients were entered into partitioned survival models upon initiation of amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy. Model inputs were derived from trials and network meta-analyses (progression-free/overall survival, adverse events, and subsequent therapies), insurance payments or retail prices (costs of drug administration, physician visits, monitoring, and end-of-life care), and hospital cohorts (health utility). Subgroup, one-way deterministic, and probabilistic analyses were performed.</p><p><strong>Results: </strong>The incremental cost-effectiveness ratios (ICERs) of osimertinib + chemotherapy versus osimertinib monotherapy (Taiwan: $231,234 per quality-adjusted life-year [QALY]; US: $442,506/QALY) and amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $412,332/QALY; US: $2,623,132/QALY) exceeded willingness-to-pay (WTP) thresholds (Taiwan: $70,000/QALY; US: $150,000/QALY). Cost of drugs and adverse event management accounted for the main cost differences among the 3 strategies. ICERs remained higher than WTP thresholds across patient subgroups. The lowest ICER for amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $232,192/QALY; US: $1,319,408/QALY) was noted among patients aged ≥65 years. Osimertinib + chemotherapy had a 2.0% (Taiwan) and 0.4% (US) probability of being cost-effective at the respective WTP thresholds, with amivantamab-lazertinib showing an even lower probability.</p><p><strong>Conclusions: </strong>Our analysis suggests that despite the superior efficacy of amivantamab-lazertinib and osimertinib + chemotherapy, neither is cost-effective compared with osimertinib as first-line treatment for EGFR-mutated advanced lung cancer.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Poverty and End-of-Life Care Among Adolescents and Young Adults With Cancer.","authors":"Julia Stal, Angel M Cronin, Colin Cernik, Hajime Uno, Lauren Fisher, Lanfang Xu, Cecile A Laurent, Nancy Cannizzaro, Julie Munneke, Robert M Cooper, Joshua R Lakin, Corey M Schwartz, Mallory Casperson, Chun R Chao, Lawrence H Kushi, Lori Wiener, Andrea Altschuler, Jennifer W Mack","doi":"10.6004/jnccn.2026.7027","DOIUrl":"10.6004/jnccn.2026.7027","url":null,"abstract":"<p><strong>Background: </strong>Among older adults with cancer, poverty is associated with end-of-life (EoL) care quality; however, its impact on care among adolescents and young adults (AYAs) is poorly understood. We examined the relationship between neighborhood poverty and EoL care among AYAs.</p><p><strong>Methods: </strong>We identified AYAs with cancer who died between the ages of 12 and 39 years from 2003 to 2019 at Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California. Outcomes abstracted from medical records included care/treatment information, symptom evaluation, and psychosocial/spiritual care. Neighborhood poverty was derived by linking patient ZIP Code Tabulation Areas to the 2009 to 2013 American Community Survey. Multivariable logistic regression models assessed the relationship between neighborhood poverty and outcomes, adjusting for age at death, sex, race, ethnicity, cancer site, and care site.</p><p><strong>Results: </strong>Included AYAs (n=1,905) had median age of 30 years at diagnosis and 32 years at death; 55% were female, 61% were White, 27% were Hispanic/Latino, and 19% were from a high-poverty neighborhood. In bivariate analyses, compared with AYAs from low-poverty neighborhoods, AYAs from high-poverty neighborhoods were more likely to be hospitalized ≥2 times in their last 30 days (29% vs 22%; P=.004) and had lower hospice use (57% vs 64%; P=.008). Pain was assessed among 98% and was assessed less often among AYAs from high-poverty neighborhoods (96% vs 99%; P=.008). In multivariable analyses, AYAs from high-poverty neighborhoods had higher odds of >1 emergency department visit (odds ratio [OR], 1.33; 95% CI, 1.00-1.76) and >1 hospitalization in the last 30 days of life (OR, 1.33; 95% CI, 1.02-1.75), and lower odds of hospice use (OR, 0.76; 95% CI, 0.58-0.98).</p><p><strong>Conclusions: </strong>Sustainable care delivery methods for patients who lack resources to address their EoL needs outside of the health care system are needed.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Role of PD-L1 in Penile Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.","authors":"Nadine Mahmoud, Arfa Mustasam, Justin Miller, Alyssa Lakhram, Firas Hatoum, Zachary J Thompson, Youngchul Kim, Gabriel Roman Souza, Jeffrey S Johnson, Houssein Safa, Philippe E Spiess, Jad Chahoud","doi":"10.6004/jnccn.2026.7025","DOIUrl":"10.6004/jnccn.2026.7025","url":null,"abstract":"<p><strong>Background: </strong>Penile squamous cell carcinoma (PSCC) is a rare but aggressive malignancy, with up to 40% of patients presenting with nodal metastasis and poor survival in advanced stages. PD-L1 is an immune checkpoint molecule implicated in tumor immune evasion, yet its prognostic relevance in PSCC remains uncertain. This study aimed to synthesize available evidence on PD-L1 expression, prevalence, and its association with survival and lymph node metastasis.</p><p><strong>Patients and methods: </strong>PubMed, EMBASE, and the Cochrane Library databases were systematically searched for studies published between January 1996 to June 2025. Eligible studies reported PD-L1 expression in tumor tissue and its correlation with overall survival (OS), cancer-specific survival (CSS), or lymph node metastasis (LNM). Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale. The protocol was registered with PROSPERO (CRD42019129410).</p><p><strong>Results: </strong>Overall, 15 retrospective studies were included (n=1,445), and 57% of tumors were PD-L1-positive (IQR, 44%-66%). Among 796 patients, PD-L1 expression was significantly higher in HPV-negative than HPV-positive tumors (42% vs 13.5%). A total of 8 studies (n=930) evaluated OS, 9 studies (n=1,091) assessed CSS, and 5 studies (n=622) investigated LNM. PD-L1 positivity was associated with reduced OS (HR, 1.52; 95% CI, 1.12-2.05; I2=6.8%), reduced CSS (HR, 1.61; 95% CI, 1.16-2.23; I2=38.3%), and higher odds of LNM (OR, 2.94; 95% CI, 1.28-6.78; I2=57.3%). In meta-regression, HPV adjustment significantly strengthened the CSS association (QM=7.13; P=.008; HR, 2.06; 95% CI, 1.21-3.51), accounting for all observed heterogeneity.</p><p><strong>Conclusions: </strong>This meta-analysis, representing the largest pooled cohort to date, shows that PD-L1 expression is associated with adverse outcomes and greater tumor aggressiveness in PSCC. These findings support further evaluation of PD-L1 as a prognostic biomarker in PSCC and highlight the need for standardized assessment methods.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetics-Supported Mainstream Testing Improves Access and Efficiency for Patients With Breast Cancer.","authors":"Kristen M Shannon, Mackenzie Wooters, Geoffrey G Fell, Hannah Kelly, Devanshi Patel, Taylor X Urban, Amanda M Nieters, Douglas S Micalizzi","doi":"10.6004/jnccn.2026.7020","DOIUrl":"10.6004/jnccn.2026.7020","url":null,"abstract":"<p><strong>Background: </strong>The demand for germline genetic testing in oncology is outpacing traditional genetics service capacity. Mainstream genetic testing, where oncologists initiate testing with structured support, may expand access while maintaining quality.</p><p><strong>Patients and methods: </strong>We performed a retrospective chart review of patients with breast cancer who underwent germline genetic testing at Massachusetts General Hospital from March 2021 to July 2022. Patients were managed via either a traditional model (genetics professional-led) or a genetics supported mainstream model (oncologist-led, with genetic counseling assistant support). Outcomes included test volume, turnaround times, documentation of consent and results disclosure, and follow-up for pathogenic variant (PV) carriers.</p><p><strong>Results: </strong>Among 805 patients (traditional: n=305; mainstream: n=500), the mainstream model significantly shortened the interval from diagnosis to consent (22.4 vs 59.5 days; P<.0001) and from consent to final report (28.2 vs 35.2 days; P=.039). Documentation of informed consent was >99% in both models. However, documentation of final result disclosure was significantly lower in the mainstream model (82.4% vs 100%; P<.0001). All PV carriers were successfully referred to genetic counseling. The mainstream model substantially increased test volume without compromising compliance or follow-up care.</p><p><strong>Conclusions: </strong>A structured mainstream genetic testing model, supported by trained assistants and robust workflows, improves access and test turnaround time for patients with breast cancer while maintaining quality standards, including documentation of consent and test ordering. This study did not evaluate whether surgical decisions were affected; however, timely results may support care planning in select cases. Continued efforts are needed to improve documentation of result disclosure by ordering providers.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Equitable Care Delivery: Insights From the Health Equity Report Card (HERC) Pilot in Academic Cancer Centers.","authors":"Taneal D Carter, Ashley Orr, Carrie Richardson-Slater, Mallory Stubblebine, Lindsey Bandini, Heather McKee Hurwitz, Tiffany Go, Leticia Mercado, Darryl Outlaw, Elizabeth Bouchard, Levent Dumenci, Robert W Carlson, Alyssa A Schatz, Crystal S Denlinger","doi":"10.6004/jnccn.2026.7045","DOIUrl":"10.6004/jnccn.2026.7045","url":null,"abstract":"<p><strong>Background: </strong>The Health Equity Report Card (HERC) was developed to establish best practice recommendations and promote accountability among health systems in addressing care inequities. Recognizing the growing importance of health equity, particularly in cancer care, this study aims to evaluate the feasibility of implementing the HERC within academic cancer centers and to gather insights on its benefits and challenges during implementation to improve its usability.</p><p><strong>Methods: </strong>This quality improvement study used a mixed-methods approach, collecting both quantitative and qualitative data over an 18-month period from April 2022 to October 2024 from 5 NCCN Member Institutions. Participants completed self- and third-party scores, as well as survey evaluations providing feedback on the process of using the HERC. Feedback from stakeholders was systematically collected to assess usability and identify areas for improvement.</p><p><strong>Results: </strong>All participating sites successfully achieved the feasibility objectives by completing the self- and third-party scoring processes using the HERC, with unanimous agreement among the sites regarding the feasibility of the HERC for implementation. Site feedback indicated areas for enhancement, particularly in improving question clarity and simplifying the scoring process. Continuous feedback loops facilitated iterative improvements to the HERC, ultimately enhancing user experience and the scoring process.</p><p><strong>Conclusions: </strong>The HERC demonstrates strong potential as a viable framework for prioritizing and assessing equity in care delivery within academic cancer centers. The successful implementation across multiple sites, along with positive stakeholder feedback, underscores its utility in enhancing accountability and promoting best practices in addressing health inequities. Future studies should explore the long-term impacts of HERC implementation on patient outcomes and equity in care delivery. A study testing the HERC for applicability in community oncology settings is ongoing.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148379161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multitarget Stool DNA Versus Fecal Immunochemical Testing: A National Assessment of Follow-Up Colonoscopy by Race and Ethnicity.","authors":"Mallik Greene, Brad Stieber, A Burak Ozbay, Joseph Anderson, Joseph LeMaster, Michael Dore, Igor Stukalin, Jeffrey Arroyo, Derek W Ebner, A Mark Fendrick, Jordan J Karlitz","doi":"10.6004/jnccn.2026.7015","DOIUrl":"10.6004/jnccn.2026.7015","url":null,"abstract":"<p><strong>Background: </strong>Fecal immunochemical tests (FITs), fecal occult blood tests (FOBTs), and multitarget stool DNA (mt-sDNA) tests are convenient, noninvasive colorectal cancer (CRC) screening strategies. However, delays in or failure to complete follow-up colonoscopy (FU-CY) after a positive noninvasive test are associated with higher CRC incidence, complications, and mortality. We sought to evaluate FU-CY rates, time to colonoscopy, and compliance predictors.</p><p><strong>Patients and methods: </strong>This retrospective cohort study linked 2 data sources: Komodo Health Data with Exact Sciences Laboratories. Data were collected from January 2016 to June 2023 and analyzed in 2024. Study participants (ages 45-75 years) were individuals with positive stool-based CRC screening tests (FIT, guaiac-based FOBT, or mt-sDNA tests). FU-CY compliance was assessed at 30-day intervals up to 365 days, and logistic regression was used to identify predictors of FU-CY.</p><p><strong>Results: </strong>Among 362,646 participants, colonoscopy compliance was 77.1% for mt-sDNA and 45.1% for FIT/FOBT (P<.001). Overall FU-CY compliance was lowest among Asian and Black populations, but was significantly higher in these subgroups for mt-sDNA versus FIT (Asian: 74.2% vs 41.1%; Black: 71.3% vs 44.6%). The strongest predictor of compliance was use of mt-sDNA (odds ratio, 3.98; P<.001). More than half of participants across all race groups who completed FU-CY after mt-sDNA did so within the first 120 days, whereas none of the FIT/FOBT racial subgroups reached 50% completion within 365 days.</p><p><strong>Conclusions: </strong>Timely completion of colonoscopy after a noninvasive test is critical, as failure to undergo colonoscopy or delays in completion are associated with increased CRC incidence and more advanced-stage disease. These findings demonstrate that mt-sDNA use may help close CRC screening disparity gaps compared with FIT testing. FU-CY adherence is higher, and time to colonoscopy is shorter following a positive mt-sDNA test versus FIT across all racial and ethnic subgroups.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 7","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Modern Management of Newly Diagnosed Vulvovaginal Melanoma: Is There a Role for Carbon Ion Radiotherapy? A Perspective From the Particle Therapy Co-Operative Group (PTCOG) Gynecological Subcommittee.","authors":"Amelia Barcellini, Lilie L Lin, Marco Durante, Tatsuya Ohno","doi":"10.6004/jnccn.2026.7053","DOIUrl":"10.6004/jnccn.2026.7053","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":"24 7","pages":""},"PeriodicalIF":16.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}