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

{"title":"NCCN Guidelines® Insights: Multiple Myeloma, Version 3.2022.","authors":"Natalie S Callander,&nbsp;Muhamed Baljevic,&nbsp;Kehinde Adekola,&nbsp;Larry D Anderson,&nbsp;Erica Campagnaro,&nbsp;Jorge J Castillo,&nbsp;Caitlin Costello,&nbsp;Srinivas Devarakonda,&nbsp;Noura Elsedawy,&nbsp;Matthew Faiman,&nbsp;Alfred Garfall,&nbsp;Kelly Godby,&nbsp;Jens Hillengass,&nbsp;Leona Holmberg,&nbsp;Myo Htut,&nbsp;Carol Ann Huff,&nbsp;Malin Hultcrantz,&nbsp;Yubin Kang,&nbsp;Sarah Larson,&nbsp;Michaela Liedtke,&nbsp;Thomas Martin,&nbsp;James Omel,&nbsp;Douglas Sborov,&nbsp;Kenneth Shain,&nbsp;Keith Stockerl-Goldstein,&nbsp;Donna Weber,&nbsp;Ryan A Berardi,&nbsp;Rashmi Kumar,&nbsp;Shaji K Kumar","doi":"10.6004/jnccn.2022.0002","DOIUrl":"https://doi.org/10.6004/jnccn.2022.0002","url":null,"abstract":"<p><p>The NCCN Guidelines for Multiple Myeloma provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with various plasma cell neoplasms, including multiple myeloma. These NCCN Guidelines Insights highlight some of the important updates/changes specific to the treatment of patients with multiple myeloma in the 2022 version of the guidelines.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"8-19"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879953","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: Differentiating Between Intentional Versus Unintentional Weight Loss.","authors":"Leah Puklin,&nbsp;Melinda L Irwin,&nbsp;Tara Sanft,&nbsp;Leah M Ferrucci","doi":"10.6004/jnccn.2021.7052","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7052","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"xliv"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879952","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":"Starting Over, Again!","authors":"Margaret Tempero","doi":"10.1164/jnccn.2022.0003","DOIUrl":"https://doi.org/10.1164/jnccn.2022.0003","url":null,"abstract":"","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879947","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":"Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria.","authors":"Nirmala K Manjappachar,&nbsp;John A Cuenca,&nbsp;Claudia M Ramírez,&nbsp;Mike Hernandez,&nbsp;Peyton Martin,&nbsp;Maria P Reyes,&nbsp;Alba J Heatter,&nbsp;Cristina Gutierrez,&nbsp;Nisha Rathi,&nbsp;Charles L Sprung,&nbsp;Kristen J Price,&nbsp;Joseph L Nates","doi":"10.6004/jnccn.2021.7046","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7046","url":null,"abstract":"<p><strong>Background: </strong>To describe short-term outcomes and independent predictors of 28-dayx mortality in adult patients with hematologic malignancies and septic shock defined by the new Third International Consensus Definitions (Sepsis-3) criteria.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients admitted to the medical ICU with septic shock from April 2016 to March 2019. Demographic and clinical features and short-term outcomes were collected. We used descriptive statistics to summarize patient characteristics, logistic regression to identify predictors of 28-day mortality, and Kaplan-Meier plots to assess survival.</p><p><strong>Results: </strong>Among the 459 hematologic patients with septic shock admitted to the ICU, 109 (23.7%) had received hematopoietic stem cell transplant. The median age was 63 years (range, 18-89 years), and 179 (39%) were women. Nonsurvivors had a higher Charlson comorbidity index (P=.007), longer length of stay before ICU admission (P=.01), and greater illness severity at diagnosis and throughout the hospital course (P<.001). The mortality rate at 28 days was 67.8% and increased with increasing sequential organ failure assessment score on admission (odds ratio [OR], 1.11; 95% CI, 1.03-1.20), respiratory failure (OR, 3.12; 95% CI, 1.49-6.51), and maximum lactate level (OR, 1.16; 95% CI, 1.10-1.22). Aminoglycosides administration (OR, 0.42; 95% CI, 0.26-0.69), serum albumin (OR, 0.51; 95% CI, 0.31-0.86), and granulocyte colony-stimulating factor (G-CSF) (OR, 0.40; 95% CI, 0.24-0.65) were associated with lower 28-day mortality. Life support limitations were present in 81.6% of patients at death. At 90 days, 19.4% of the patients were alive.</p><p><strong>Conclusions: </strong>Despite efforts to enhance survival, septic shock in patients with hematologic malignancies is still associated with high mortality rates and poor 90-day survival. These results demonstrate the need for an urgent call to action with higher awareness, including the further evaluation of interventions such as earlier ICU admission, aminoglycosides administration, and G-CSF treatment.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"45-53"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879946","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":"Optimizing Thromboembolism Prophylaxis for the Contemporary Age of Multiple Myeloma.","authors":"Muhamed Baljevic,&nbsp;Douglas W Sborov,&nbsp;Ming Y Lim,&nbsp;Jens Hillengass,&nbsp;Thomas Martin,&nbsp;Jorge J Castillo,&nbsp;Michael B Streiff,&nbsp;Shaji K Kumar,&nbsp;Natalie S Callander","doi":"10.6004/jnccn.2021.7112","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7112","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a major complication in all patients with cancer. Compared with the general population, patients with multiple myeloma (MM) have a 9-fold increase in VTE risk, likely because of their malignancy, its treatments, and other additional patient-related factors. In MM, thromboembolism events tend to occur within 6 months of treatment initiation, regardless of treatment regimen; however, the use of immunomodulatory agents such as thalidomide or lenalidomide, especially in combination with dexamethasone or multiagent chemotherapy, is known to create a significant risk for VTE. Currently, official recommendations for VTE prophylaxis in MM outlined in various national guidelines or multidisciplinary society panels are based on expert opinion, because data from randomized controlled trials are scarce. Large studies which have mainly focused on the efficacy of thromboprophylaxis in patients with cancer at higher risk for VTE either had a very low representation of patients with MM, or excluded them all together, limiting our ability to draw evidence-based conclusions on how to effectively protect MM population from VTE. In this brief perspective, we highlight some of the greatest challenges that have hampered the field concerning the availability of high-quality clinical trial data for the formulation of best VTE prophylaxis strategies in patients with newly diagnosed MM, as well as the rationale for the latest updates in the NCCN Guidelines on this topic.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"91-95"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879954","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":"NCCN Distress Thermometer Problem List Update.","authors":"Kristine A Donovan,&nbsp;George Handzo,&nbsp;Cheyenne Corbett,&nbsp;Jessica Vanderlan,&nbsp;Benjamin W Brewer,&nbsp;Kauser Ahmed","doi":"10.6004/jnccn.2022.0004","DOIUrl":"https://doi.org/10.6004/jnccn.2022.0004","url":null,"abstract":"The NCCN Distress Thermometer (DT), first described by Roth et al 1 in 1998, was developed for the purpose of assessing distress in patients with cancer. A list of common concerns, called the “Problem List” (PL), was added the following year to identify potential sources of distress and to personalize triage by facilitating access to the most appropriate support services. The grouping of the PL items into physical, practical, family, emotional, and spiritual/religious categories aligned with the 4 categories of Cicely Saunders’s concept of total pain: physical, emotional, social, and spiritual. Specific items were included in the PL based on expert consensus and evidence available at the time. The DT and accompanying PL are included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress Management. These guidelines are updated annually by a multidisciplinary panel of healthcare professionals based on new evidence and current practice in psycho-oncology. Over the years, the panel has reviewed and evaluated various aspects of the DT, including the appropriate cutoff score for clinically significant distress, general validation concerns, and how widely the instrument is used in clinical practice. The PL has received less attention and has evolved in an ad hoc fashion, with items added or removed with little consideration of the PL as a whole. This process is, in part, because the PL was never meant to be a mandated set of concerns. Instead it was meant to provide context for the DT score and to help direct clinical practice. This process has also led to the creation of different versions of the PL over time, and many institutions have rightly customized it for their setting. Therefore, the panel also recognizes that routine changes may impose a significant burden on institutions when the DT and PL are used for distress screening and are embedded in the electronic health record. During the August 2020 annual review of the NCCN Guidelines for Distress Management, a proposal was adopted by the panel to update the PL, and over the next year, a subcommittee consisting of the authors of this commentary endeavored to do so. The full panel reviewed and discussed changes in detail during the August 2021 annual review, and the updated PL was approved by the full panel in September 2021. The subcommittee’s efforts were driven by several observations. First, the original PL was heavily weighted toward physical concerns because that was the category best understood as a source of distress. However, many of these concerns have become standard for symptommanagement in the oncology clinic, thus making them redundant. Additionally, emotional concerns such as loneliness have emerged as additional risk factors for poor health outcomes, whereas many guidelines recommend screening and assessing patients with cancer for depression and anxiety in routine cancer care. The list of practical and family concerns was out of step with current practi","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"96-98"},"PeriodicalIF":13.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879950","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":"Meeting Patients Where They Are: Policy Platform for Telehealth and Cancer Care Delivery.","authors":"Sheetal Kircher,&nbsp;Nicole Braccio,&nbsp;Kathleen Gallagher,&nbsp;Ruth Carlos,&nbsp;Lynne Wagner,&nbsp;Mary Lou Smith,&nbsp;Alan Balch,&nbsp;Al B Benson","doi":"10.6004/jnccn.2021.7111","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7111","url":null,"abstract":"T he COVID-19 pandemic broadly curtailed access to cancer care and highlighted the need to meet patients “ where they are, ” which included remote access provisions. This need triggered multiple policy changes in 2020 that have accelerated adoption of telehealth strategies and impacted how patients with cancer receive care nationwide. In a survey conducted by the Patient Advocate Foundation (PAF) from 2019 through 2020, 64% of patients with cancer changed the way they accessed/received care during the pandemic, 66% experi-enced their fi rst telehealth visit, and 77% felt that telehealth was bene fi cial (PAF, data unpublished, 2021). The Coronavirus Aid, Relief, and Economic Security Act (CARES), signed into law on March 27, 2020, included a provision allowing the Secretary of the Department of Health & Human Services to waive certainrequirements for Medicare telehealth payment that existed prior to the pandemic, expanding the range of telehealth services qualifying for reimbursement. 1 fi nalized Physician Fee 2 end is last","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1470-1474"},"PeriodicalIF":13.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723383","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":"Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center.","authors":"Luke D Rothermel,&nbsp;Claire C Conley,&nbsp;Anuja L Sarode,&nbsp;Michael F Young,&nbsp;Zulema L Uscanga,&nbsp;McKenzie McIntyre,&nbsp;Jason B Fleming,&nbsp;Susan T Vadaparampil","doi":"10.6004/jnccn.2021.7029","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7029","url":null,"abstract":"<p><strong>Background: </strong>Low health literacy is associated with increased resource use and poorer outcomes in medical and surgical patients with various diseases. This observational study was designed to determine (1) the prevalence of low health literacy among surgical patients with cancer at an NCI-designated Comprehensive Cancer Center (CCC), and (2) associations between health literacy and clinical outcomes.</p><p><strong>Methods: </strong>Patients receiving surgery (N=218) for gastrointestinal (60%) or genitourinary cancers (22%) or sarcomas (18%) were recruited during their postsurgical hospitalization. Patients self-reported health literacy using the Brief Health Literacy Screening Tool (BRIEF). Clinical data (length of stay [LoS], postacute care needs, and unplanned presentation for care within 30 days) were abstracted from the electronic medical records 90 days after surgery. Multivariate linear and logistic regressions were used to examine the relationship between health literacy and clinical outcomes, adjusting for potential confounding variables.</p><p><strong>Results: </strong>Of 218 participants, 31 (14%) showed low health literacy (BRIEF score ≤12). In regression analyses including 212 patients with complete data, low health literacy significantly predicted LoS (β = -1.82; 95% CI, -3.00 to -0.66; P=.002) and postacute care needs (odds ratio [OR], 0.25; 95% CI, 0.07-0.91). However, health literacy was not significantly associated with unplanned presentation for care in the 30 days after surgery (OR, 0.51; 95% CI, 0.20-1.29).</p><p><strong>Conclusions: </strong>This study demonstrates the prevalence of low health literacy in a surgical cancer population at a high-volume NCI-designated CCC and its association with important clinical outcomes, including hospital LoS and postacute care needs. Universal screening and patient navigation may be 2 approaches to mitigate the impact of low health literacy on postsurgical outcomes.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1407-1414"},"PeriodicalIF":13.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862511/pdf/nihms-1776209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan.","authors":"Kara Martin,&nbsp;Alyssa A Schatz,&nbsp;Jan S White,&nbsp;Hyman Muss,&nbsp;Aarati Didwania,&nbsp;Leigh Gallo,&nbsp;Robert W Carlson","doi":"10.6004/jnccn.2021.7087","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7087","url":null,"abstract":"<p><p>Patients with cancer have widely divergent experiences throughout their care from screening through survivorship. Differences in care delivery and outcomes may be due to varying patient preferences, patient needs according to stage of life, access to care, and implicit or explicit bias in care according to patient age. NCCN convened a series of stakeholder meetings with patients, caregivers, and patient advocacy groups to discuss the complex challenges and robust opportunities in this space. These meetings informed the NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan held on December 10, 2020, which featured a keynote presentation, multidisciplinary panels, and presentations from patient advocacy organizations. This article encapsulates and expounds upon the findings from the stakeholder meetings and discussions during the summit.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1395-1400"},"PeriodicalIF":13.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723385","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":"Role of Prophylactic Cranial Irradiation in Extensive-Stage Small Cell Lung Cancer.","authors":"Nathan Y Yu,&nbsp;Terence T Sio,&nbsp;Vinicius Ernani,&nbsp;Panayiotis Savvides,&nbsp;Steven E Schild","doi":"10.6004/jnccn.2021.7105","DOIUrl":"https://doi.org/10.6004/jnccn.2021.7105","url":null,"abstract":"<p><p>Patients with small cell lung cancer (SCLC) are at significant risk of developing brain metastases during their disease course. Prophylactic cranial irradiation (PCI) has been incorporated into SCLC treatment guidelines to diminish the risk of developing brain metastases. In 2007, a randomized trial suggested that PCI decreases the incidence of brain metastases and prolongs overall survival (OS) in patients with extensive-stage SCLC (ES-SCLC) who have responded to initial therapy. However, this study did not include modern central nervous system imaging with CT or MRI prior to randomization. A more recent Japanese trial with MRI staging and surveillance demonstrated that PCI diminished the incidence of brain metastases but did not improve survival. This review examines the largest clinical studies, controversies, and future directions of PCI in patients with ES-SCLC.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1465-1469"},"PeriodicalIF":13.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723386","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}