26
|
Harzstark A, Herrinton LJ, Walker LC, Liu L, Kolevska T, St. Lezin M, Nichols CR, Daneshmand S, Presti J. Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
39 Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were < 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.
Collapse
|
27
|
Neeman E, Kolevska T, Reed M, Sundaresan T, Arora A, Li Y, Seaward S, Kuehner G, Likely S, Trossman J, Weldon C, Liu R. Abstract S06-03: Cancer care telehealth utilization rates and provider attitudes in the wake of the novel coronavirus pandemic: The Kaiser Permanente Northern California experience. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-s06-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In response to the SARS-CoV-2 pandemic, the multidisciplinary care of cancer patients has rapidly evolved. This study aims to determine utilization trends of in-person, telephone, and video visits, before and after the California shelter-in-place (SIP) orders on 3/19/20, and assess perspectives of cancer care providers on telehealth.
Methods: This study was conducted in 22 medical centers of a large integrated health care system. Utilization of different visit types in medical oncology (excluding infusion visits) was collected between 12/1/2019–5/24/2020, for a total of 104,588 visits. Chi-square with Yates correction was used for p-values. Voluntary, anonymous electronic surveys were sent to 276 cancer care providers measuring attitudes and experiences with telehealth. Overall, 68.8% responded: 101/128 medical oncologists (MedOnc), 34/37 radiation oncologists (RadOnc), 16/62 breast surgeons (Brst Surg), 18/28 breast oncology nurse navigators (OncNav), and 21/21 cancer survivorship advanced practitioners (SurvOnc).
Results: Comparing visit types prior to and after SIP, in-person visits went from 55.3% to 3.3%, telephone visits went from 44.2% to 79%, and video visits went from 0.5% to 17.8% (p<.0001). Between 12/2019 and 05/2020, video visits increased from 0.42% to 31.3%. Telephone visits increased from 39.3 to a peak of 86.6% in 04/2020 and then decreased to 63.7%. In-person visits dropped from 60.3% to 2.3% in 04/2020 and then increased to 5.0% (p<.0001). Satisfaction with telehealth was high: 87.1% of MedOnc, 91.2% of RadOnc, 68.6% of BrstSurg, 72.2% of OncNav, and 90.4% SurvOnc providers were very or somewhat satisfied. Most providers preferred to increase or maintain telehealth utilization after the pandemic: 84% of MedOnc, 85% of RadOnc, 81% of BrstSurg, 51% of OncNav, and 90% of SurvOnc. Among most providers, highest cited benefits of telehealth included work from home, reduced commute, staying on time, flexible hours, and shorter visits. Commonly cited challenges included connection/equipment problems, need for physical exam, difficulty evaluating performance status, and in-person visit required anyway. Of MedOnc, 11.8% responded that a patient suffered an adverse effect that could have been prevented with in-person visit. In-person visits were thought to promote the strongest provider-patient connection, followed by video, telephone visits, and emails. MedOnc providers deemed in-person visits were needed for end-of-life discussion (49%), discussing a new diagnosis (47.1%), palliative care discussion (34.3%), and clinical trial enrollment (34.3%). Activities for which email or phone visits were most accepted included check-in pretreatment, survivorship planning/follow-up, and patient navigation.
Conclusion: Overall, telehealth utilization has rapidly increased and is well accepted by various cancer care providers. Addressing technical issues and tailoring visit type to specific activities may further promote telehealth adoption and satisfaction.
Citation Format: Elad Neeman, Tatjana Kolevska, Mary Reed, Tilak Sundaresan, Amit Arora, Yan Li, Samantha Seaward, Gillian Kuehner, Sharon Likely, Julia Trossman, Christine Weldon, Raymond Liu. Cancer care telehealth utilization rates and provider attitudes in the wake of the novel coronavirus pandemic: The Kaiser Permanente Northern California experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S06-03.
Collapse
|
28
|
Liu R, Sundaresan T, Reed ME, Trosman JR, Weldon CB, Kolevska T. Telehealth in Oncology During the COVID-19 Outbreak: Bringing the House Call Back Virtually. JCO Oncol Pract 2020; 16:289-293. [DOI: 10.1200/op.20.00199] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
29
|
Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry C, Kolevska T, Avins AL. A Randomized Controlled Trial of mHealth Mindfulness Intervention for Cancer Patients and Informal Cancer Caregivers: A Feasibility Study Within an Integrated Health Care Delivery System. Integr Cancer Ther 2019; 18:1534735419850634. [PMID: 31092044 PMCID: PMC6537293 DOI: 10.1177/1534735419850634] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To assess feasibility and preliminary efficacy of a
mobile/online-based (mHealth) mindfulness intervention for cancer patients and
their caregivers to reduce distress and improve quality of life (QoL).
Material and Methods: Two-arm randomized controlled trial
within Kaiser Permanente Northern California targeting cancer patients who
received chemotherapy and their informal caregivers. The intervention group
received a commercially available mindfulness program for 8 weeks. The wait-list
control group received usual care. We assessed feasibility using retention and
adherence rates and obtained participant-reported data on distress, QoL, sleep,
mindfulness, and posttraumatic growth before and immediately after the
intervention. Results: Ninety-seven patients (median age 59 years;
female 69%; 65% whites) and 31 caregivers (median age 63 years; female 58%; 77%
whites) were randomized. Among randomized participants, 74% of the patients and
84% of the caregivers completed the study. Among those in the intervention arm
who initiated the mindfulness program, 65% practiced at least 50% of the days
during the intervention period. We observed significantly greater improvement in
QoL among patients in the intervention arm compared with controls. Caregivers in
the intervention group experienced increased mindfulness compared with controls.
Participants appreciated the convenience of the intervention and the mindfulness
skills they obtained from the program. Conclusion: We demonstrated
the feasibility of conducting a randomized trial of an mHealth mindfulness
intervention for cancer patients and their informal caregivers. Results from
fully powered efficacy trials would inform the potential for clinicians to use
this scalable intervention to help improve QoL of those affected by cancer and
their caregivers.
Collapse
|
30
|
Coombs LA, Max W, Kolevska T, Tonner C, Stephens C. Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer. J Am Geriatr Soc 2019; 67:1489-1494. [PMID: 31059140 PMCID: PMC6612567 DOI: 10.1111/jgs.15931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the composition of the US provider workforce for adults with cancer older than 65 years and to determine whether there were differences in patients who received care from different providers (eg, nurse practitioners [NPs], physician assistants [PAs], and specialty physicians). DESIGN Observational, cross-sectional study. SETTING Adults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database. PARTICIPANTS Medicare beneficiaries who received ambulatory care for any solid or hematologic malignancies. MEASUREMENTS International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes were used to identify Medicare patient claims for malignancies in older adults. Providers for those ambulatory claims were identified using taxonomy codes associated with their National Provider Identifier number. RESULTS A total of 2.5 million malignancy claims were identified for 201, 237 patients, with 15, 227 providers linked to claims. NPs comprised the largest group (31.5%; n = 4,806), followed by hematology/oncology physicians (27.7%; n = 4,222), PAs (24.7%; n = 3767), medical oncologists (10.9%; n = 661), gynecological oncologists (2.6%; n = 403), and hematologists (2.4%; n = 368). Rural cancer patients were more likely to receive care from NPs (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.65-2.05) or PAs (OR = 1.57; 95% CI = 1.40-1.77) than from physicians. Patients in the South were more likely to receive care from NPs (OR = 1.36; 95% CI = 1.24-1.49). CONCLUSIONS A large proportion of older adults with cancer receive care from NPs and PAs, particularly those who reside in rural settings and in the southern United States. Workforce strategies need to integrate these provider groups to effectively respond to the rising need for cancer care within the older adult population.
Collapse
|
31
|
Truong TG, Chohan K, Price A, Fevrier HB, Peng PD, Kavanagh MA, Jones MS, Soni AX, Price MA, Rasgon BM, Adad B, Martin PA, Rangel J, Kavecansky J, Reddy MN, Wang SE, Herrinton LJ, Kolevska T, Morris JP, Chang CK. Early case ascertainment and prospective multidisciplinary review for management of new melanoma diagnoses within an integrated healthcare system: The Kaiser Permanente Northern California experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6523 Background: Appropriate surgical treatment of early-stage melanoma yields a high cure rate, but this management can be nuanced. In particular, surgical management, including sentinel lymph node biopsy (SLNB), of thin melanoma (≤1.0mm) is not well-defined. Methods: Biopsies with new melanoma diagnoses were identified electronically and manually reviewed. In a community oncology setting, we organized a review panel of physicians specialized in melanoma from dermatology, medical oncology, nuclear medicine, radiation oncology, and surgical subspecialties (oncology, plastics, head and neck). Patients were assigned to care pathways based on NCCN and ASCO guidelines, including guidance on SLNB for thin melanomas with high-risk features like lymphovascular invasion, high mitotic rate, positive deep margin, and ulceration. These recommendations were documented in the chart and communicated directly to the patients care team. Results: From 11/2016 through 10/2018, our multidisciplinary committee reviewed 3626 patients with new melanoma from 22 sites in our integrated, regional hospital system. Median age was 66 (range 19-99); 60% were male. cT2N0 tumors comprised 7%, cT3 3%, and cT4 2%. Thin melanomas ≤1.0mm represented 71% of cases, of which 34% were ≤0.5mm. SLNB was performed in 9.8% of thin melanomas, and 18% were positive, much higher than historical positive rates of 3-4%. Conclusions: Early case ascertainment and prospective multidisciplinary review in a community oncology setting resulted in increased identification of high-risk thin melanoma, and consequently increased identification of nodal disease through SLNB. Positive SLNB triggers important clinical decision-making regarding need for node dissection versus clinical surveillance, and need for adjuvant therapy, which have been shown to improve survival. This clinical practice structure improved risk-stratification and adherence to national guidelines. We plan to further study the impact of these improvements to melanoma care on disease-free survival and overall survival.
Collapse
|
32
|
Arora A, Kolevska T, Jiminez J. Patients preference in receiving phone call from oncologist after cancer diagnosis and before in person consultation. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18044 Background: Diagnosis of cancer creates an emotionally challenging time for patients. Waiting period between receiving diagnosis, and formal consultation with an Oncologist is associated with fear, shock, and uncertainty. Understanding patients’ preferences during this sensitive period is essential in providing high quality care. We hypothesized that receiving a call from an Oncologist, while waiting for a formal consultation, would help patients cope with cancer diagnosis. Methods: To assess our hypothesis, we surveyed 171 patients across five Kaiser Permanente medical centers. All patients received a call from an Oncology navigator to onboard them, and assure completion of necessary tests before in-person consultation with Oncologist. Of the 171 patients surveyed, 61 patients received an additional call from their assigned Oncologist before a formal in-person consultation. To understand the impact of the call made by the Oncologist, a survey was administered to patients within a few weeks of consultation. The remaining 110 patients who only received a call from an Oncology navigator were also surveyed to determine if a call from an Oncologist before their consultation could have helped them cope better with their cancer diagnosis. Results: Approximately 45 % of surveyed patients (n = 171) preferred a call from an Oncologist before the formal consultation. Conclusions: Brief telephone contact by Oncologist before in-person consultation supports newly diagnosed cancer patients with high-levels of uncertainty and shock. A substantial portion of newly diagnosed cancer patients prefers to speak with an Oncologists in the days after receiving a cancer diagnosis, and those who do receive an Oncologist call, find it beneficial in coping with their diagnosis.[Table: see text]
Collapse
|
33
|
Check DK, Kwan ML, Chawla N, Dusetzina SB, Valice E, Ergas IJ, Roh JM, Kolevska T, Rosenstein DL, Kushi LH. Opportunities to Improve Detection and Treatment of Depression Among Patients With Breast Cancer Treated in an Integrated Delivery System. J Pain Symptom Manage 2019; 57:587-595. [PMID: 30508637 PMCID: PMC6386165 DOI: 10.1016/j.jpainsymman.2018.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023]
Abstract
CONTEXT Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival. OBJECTIVE Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics. METHODS This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription). RESULTS Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88). CONCLUSION Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.
Collapse
|
34
|
Jacobs SA, Lee JJ, George TJ, Yothers G, Kolevska T, Yost KJ, Wade JL, Buchschacher GL, Stella PJ, Shipstone A, Pogue-Geile KL, Srinivasan A, Lucas PC, Allegra CJ. NSABP FC-11: A phase II study of neratinib (N) plus trastuzumab (T) or n plus cetuximab (C) in patients (pts) with "quadruple wild-type (WT)" (KRAS/NRAS/BRAF/PIK3CA WT) metastatic colorectal cancer (mCRC) based on HER2 status—Amplified (amp), non-amplified (non-amp), WT, or mutated (mt). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.tps716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
TPS716 Background: HER2 has been shown to be a validated therapeutic target for the treatment of mCRC. Preclinical and clinical evidence supports the use of HER2-targeted agents in each of these mCRC cohorts. In HERACLES, treatment–refractory, KRAS exon 2 (codons 12 and 13) WT, HER2 amp mCRC pts were treated with T and lapatinib (L). Objective response rate (CR or PR) was 8/27 and disease control rate (CR, PR, and SD > 16 wks) was 16/27. Duration of response ranged from 24-94+ wks. Anecdotal reports have shown activity of N in HER2 mts from several cancer types. In mCRC PDX models with qualifying HER2 mts, T plus N is more active than either drug alone. In quad WT, HER2 non-amp PDX models, C plus TKI resulted in major tumor regressions not seen with C monotherapy. In NSABP FC-7, a trial of C + N in cetuximab refractory pts, HER2 amp was observed in 2/23 primary tissue samples; after C exposure, HER2 amp was seen in 5/17 samples, presumably signal upregulation under selective pressure of C. HER2 amp was concordant in tissue (CISH) and blood using cfDNA. Methods: This multi-center 3-cohort phase II trial is currently enrolling pts (total planned N = 35). Pts with quad WT, HER2 amp (n = 15) with prior anti-EGFR therapy and/or HER2 mt mCRC (n = 5) will receive T 4 mg/kg iv loading dose followed by 2 mg/kg/wk and N 240 mg po daily (Arm 1). Pts with quad WT, HER2 non-amp (n = 15) with no prior anti-EGFR therapy will receive C 400 mg/m2 iv loading dose followed by 250 mg/m2/wk, and N 240 mg (Arm 2). Specific pt eligibility for quad WT and HER2 status are defined below: Arm 1: HER2 amp confirmed in blood by Guardant360 assay, and prior treatment with C or panitumumab (P). HER2 mt (with qualifying mt) with or without prior treatment with C or P. Arm 2: HER2 non-amp or HER2 amp and no prior therapy with C or P. The primary aim is 6-mos progression-free survival for each cohort. Secondary aims: response rates and toxicity. Exploratory aims: genetic and molecular analyses. Specific drug combinations will be evaluated in PDX models. NCT03457896. Support: Puma Biotechnology, Inc.; NSABP Foundation, Inc. Clinical trial information: NCT03457896.
Collapse
|
35
|
Basch E, Dueck AC, Rogak LJ, Mitchell SA, Minasian LM, Denicoff AM, Wind JK, Shaw MC, Heon N, Shi Q, Ginos B, Nelson GD, Meyers JP, Chang GJ, Mamon HJ, Weiser MR, Kolevska T, Reeve BB, Bruner DW, Schrag D. Feasibility of Implementing the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events in a Multicenter Trial: NCCTG N1048. J Clin Oncol 2018; 36:JCO2018788620. [PMID: 30204536 PMCID: PMC6209091 DOI: 10.1200/jco.2018.78.8620] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The US National Cancer Institute (NCI) Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was developed to enable patient reporting of symptomatic adverse events in oncology clinical research. This study was designed to assess the feasibility and resource requirements associated with implementing PRO-CTCAE in a multicenter trial. Methods Patients with locally advanced rectal cancer enrolled in the National Cancer Institute-sponsored North Central Cancer Treatment Group (Alliance) Preoperative Radiation or Selective Preoperative Radiation and Evaluation before Chemotherapy and Total Mesorectal Excision trial were asked to self-report 30 PRO-CTCAE items weekly from home during preoperative therapy, and every 6 months after surgery, via either the Web or an automated telephone system. If participants did not self-report within 3 days, a central coordinator called them to complete the items. Compliance was defined as the proportion of participants who completed PRO-CTCAE assessments at expected time points. Results The prespecified PRO-CTCAE analysis was conducted after the 500th patient completed the 6-month follow-up (median age, 56 years; 33% female; 12% nonwhite; 43% high school education or less; 5% Spanish speaking), across 165 sites. PRO-CTCAE was reported by participants at 4,491 of 4,882 expected preoperative time points (92.0% compliance), of which 3,771 (77.2%) were self-reported by participants and 720 (14.7%) were collected via central coordinator backup. Compliance at 6-month post-treatment follow-up was 333 of 468 (71.2%), with 122 (26.1%) via backup. Site research associates spent a median of 15 minutes on PRO-CTCAE work for each patient visit. Work by a central coordinator required a 50% time commitment. Conclusion Home-based reporting of PRO-CTCAE in a multicenter trial is feasible, with high patient compliance and low site administrative requirements. PRO-CTCAE data capture is improved through centralized backup calls.
Collapse
|
36
|
Check DK, Chawla N, Kwan ML, Pinheiro L, Roh JM, Ergas IJ, Stewart AL, Kolevska T, Ambrosone C, Kushi LH. Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient-provider interactions. Breast Cancer Res Treat 2018; 170:593-603. [PMID: 29623576 PMCID: PMC6528788 DOI: 10.1007/s10549-018-4776-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Racial/ethnic differences in cancer symptom burden are well documented, but limited research has evaluated modifiable factors underlying these differences. Our objective was to examine the role of patient-provider interactions to help explain the relationship between race/ethnicity and cancer-specific physical well-being (PWB) among women with breast cancer. METHODS The Pathways Study is a prospective cohort study of 4505 women diagnosed with breast cancer at Kaiser Permanente Northern California between 2006 and 2013. Our analysis included white, black, Hispanic, and Asian participants who completed baseline assessments of PWB, measured using the Functional Assessment of Cancer Therapy for Breast Cancer, and patient-provider interactions, measured by the Interpersonal Processes of Care Survey (IPC) (N = 4002). Using step-wise linear regression, we examined associations of race/ethnicity with PWB, and changes in associations when IPC domains were added. RESULTS We observed racial/ethnic differences in PWB, with minorities reporting lower scores than whites (beta, black: - 1.79; beta, Hispanic: - 1.92; beta, Asian: - 1.68; p < 0.0001 for all comparisons). With the addition of health and demographic covariates to the model, associations between race/ethnicity and PWB score became attenuated for blacks and Asians (beta: - 0.63, p = 0.06; beta: - 0.68, p = 0.02, respectively) and, to a lesser extent, for Hispanic women (beta: - 1.06, p = 0.0003). Adjusting for IPC domains did not affect Hispanic-white differences (beta: - 1.08, p = 0.0002), and slightly attenuated black-white differences (beta: - 0.51, p = 0.14). Asian-white differences narrowed substantially (beta: - 0.31, p = 0.28). CONCLUSIONS IPC domains, including those capturing perceived discrimination, respect, and clarity of communication, appeared to partly explain PWB differences for black and Asian women. Results highlight opportunities to improve providers' interactions with minority patients, and communication with minority patients about their supportive care needs.
Collapse
|
37
|
Coombs LA, Stephens C, Kolevska T, Max W. Nurse practitioner and physician assistant oncology workforce for older adults. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
38
|
Maio M, Lewis K, Demidov L, Mandalà M, Bondarenko I, Ascierto PA, Herbert C, Mackiewicz A, Rutkowski P, Guminski A, Goodman GR, Simmons B, Ye C, Yan Y, Schadendorf D, Cinat G, Fein LE, Brown M, Guminski A, Haydon A, Khattak A, McNeil C, Parente P, Power J, Roberts-Thomson R, Sandhu S, Underhill C, Varma S, Berger T, Awada A, Blockx N, Buyse V, Mebis J, Franke FA, Jobim de Azevedo S, Silva Lazaretti N, Jamal R, Mihalcioiu C, Petrella T, Savage K, Song X, Wong R, Dabelic N, Plestina S, Vojnovic Z, Arenberger P, Kocak I, Krajsova I, Kubala E, Melichar B, Vantuchova Y, Putnik K, Dreno B, Dutriaux C, Grob JJ, Joly P, Lacour JP, Meyer N, Mortier L, Thomas L, Fluck M, Gambichler T, Hassel J, Hauschild A, Schadendorf D, Donnellan P, McCaffrey J, Power D, Ariad S, Bar-Sela G, Hendler D, Ron I, Schachter J, Ascierto P, Berruti A, Bianchi L, Chiarion Sileni V, Cognetti F, Danielli R, Di Giacomo AM, Gianni L, Goldhirsch A, Guida M, Maio M, Mandalà M, Marchetti P, Queirolo P, Santoro A, Kapiteijn E, Mackiewicz A, Rutkowski P, Ferreira P, Demidov L, Gafton G, Makarova Y, Andric Z, Babovic N, Jovanovic D, Kandolf Sekulovic L, Cohen G, Dreosti L, Vorobiof D, Curiel Garcia MT, Diaz Beveridge R, Majem Tarruella M, Marquez Rodas I, Puliats Rodriguez JM, Rueda Dominguez A, Maroti M, Papworth K, Michielin O, Bondarenko I, Brown E, Corrie P, Harries M, Herbert C, Kumar S, Martin-Clavijo A, Middleton M, Patel P, Talbot T, Agarwala S, Chapman P, Conry R, Doolittle G, Gangadhar T, Hallmeyer S, Hamid O, Hernandez-Aya L, Johnson D, Kass F, Kolevska T, Lewis K, Lunin S, Salama A, Sikic B, Somer B, Spigel D, Whitman E. Adjuvant vemurafenib in resected, BRAF V600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial. Lancet Oncol 2018; 19:510-520. [DOI: 10.1016/s1470-2045(18)30106-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
|
39
|
Kubo A, Altschuler A, Kurtovich E, Hendlish S, Laurent CA, Kolevska T, Li Y, Avins A. A Pilot Mobile-based Mindfulness Intervention for Cancer Patients and their Informal Caregivers. Mindfulness (N Y) 2018; 9:1885-1894. [PMID: 30740187 DOI: 10.1007/s12671-018-0931-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
40
|
Harzstark AL, Kong M, Brinsko R, Mamtora K, Herrinton LJ, Liu L, Kumar S, Kolevska T, Baer DM, Dinesh M. K, St. Lezin M, Presti JC. Testicular Cancer Review Panel: Multidisciplinary specialist review of a rare cancer at Kaiser Permanente, Northern California. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
561 Background: Testicular cancer is a rare disease; multidisciplinary management by experienced clinicians is recommended. Methods: Multidisciplinary specialized review of all new testicular cancer cases was established in a community setting by creating a twice monthly Testicular Cancer Review Panel, comprised of two subspecialized medical oncologists and two surgical urologic oncologists, at Kaiser Permanente in Northern California. An early ascertainment list of new testicular cancer diagnoses was obtained and review of the history, labs, pathology reports, and all relevant imaging was performed via a web-based conference. Urologic cancer fellowship trained pathologists and body fellowship trained radiologists were available for secondary review when requested. All recommendations were documented in patient charts. Results: From June 2016 to June 2017, 131 cases were reviewed. Review by the panel resulted in significant changes in care in 19 of 131 patients (14.5%). Pathology and radiology re-reviews were the most common sources of changes in treatment recommendations. Embryonal predominant T1 disease was referred for GU pathology review in 14 cases; in 8, lymphovascular invasion was identified, upstaging 6.1% of patients from 1A to 1B, changing treatment from observation to chemotherapy. Radiology re-review changed the stage and treatment in 11 patients (8.4%), identifying lymphadenopathy not previously noted in 7 patients and reassessing previously identified lymphadenopathy as a non-pathologic finding in 4 patients. The percentage of patients with stage I seminoma observed rather than undergoing adjuvant therapy increased from 11/15 (73.3%) over the first six months of the panel to 18/20 (90%) over the second six months. Convening the panel also resulted in dissemination of oncologic knowledge among treating physicians. Conclusions: Multidisciplinary specialized case review for a rare disease is feasible in the community setting and frequently alters care.
Collapse
|
41
|
Check D, Chawla N, Ergas IJ, Roh JM, Kolevska T, Kushi L, Kwan ML. Do differences in patient-provider relationships explain racial differences in side effect burden among women with breast cancer in the pathways study? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
48 Background: Prior research suggests that black patients with cancer report a greater burden of symptoms compared to white patients. Differences in patient-provider relationships may be an underlying and modifiable factor in these observed disparities. We examined differences in side effect burden by race/ethnicity and tested the hypothesis that patient-provider communication and trust may partly explain differences in symptom burden among women with breast cancer (BC). Methods: We conducted a cross-sectional analysis of data collected from 4,505 women diagnosed with BC from 2005-2013 at Kaiser Permanente Northern California. Women were asked two months post-diagnosis how much they were bothered by treatment side effects (FACT-B). Using modified Poisson regression, we assessed the association of race/ethnicity with side effect bother, adjusting for clinical characteristics, socioeconomic status (SES), and patient-provider communication and patients’ trust in providers in a step-wise fashion. Provider communication and trust were measured using the Interpersonal Processes of Care survey and a one-item assessment of patients’ trust in providers, respectively. Results: Before adjustment, Black, Hispanic, and Asian patients were at least 75% more likely than white patients to report high (vs. low) side effect bother (p < 0.0001). Bivariate associations of communication and trust with side effect bother and race/ethnicity were statistically significant. For example, patients with high (vs. low) scores for shared decision-making were more likely to be white than black (46% vs. 39%) and less likely to experience high vs. low side effect bother (10% vs. 14%, p < 0.0001 for both comparisons). However, after adjusting for clinical and SES characteristics in a multivariable analysis, the addition of patient-provider communication and trust to the model did not substantially alter disparity estimates. Conclusions: In our sample, patient-provider communication did not modify racial disparities in side effect bother. Further research is needed to explore additional modifiable factors underlying potential disparities in side effect management.
Collapse
|
42
|
Lenz HJ, Philip P, Saunders M, Kolevska T, Mukherjee K, Samuel L, Bondarde S, Dobbs T, Tagliaferri M, Hoch U, Hannah AL, Berkowitz M. Randomized study of etirinotecan pegol versus irinotecan as second-line treatment for metastatic colorectal cancer. Cancer Chemother Pharmacol 2017; 80:1161-1169. [PMID: 29043412 DOI: 10.1007/s00280-017-3438-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Etirinotecan pegol (EP) is a long-acting topoisomerase-I inhibitor designed to provide sustained exposure to SN-38 (active metabolite of irinotecan). This phase II study compared EP versus irinotecan as second-line treatment for KRAS-mutant, irinotecan-naïve, metastatic colorectal cancer (mCRC). METHODS Patients were randomized to EP 145 mg/m2 or irinotecan 350 mg/m2 Q21d until disease progression/unacceptable toxicity. The primary endpoint was progression-free survival (PFS) with response determined by central radiologic review (RECIST version 1.1). RESULTS The study was terminated before completing accrual due to evolving standards of care. Eighty-three patients were randomized. Median PFS was longer with EP versus irinotecan (4.0 versus 2.8 months, respectively; HR 0.65; 95% CI 0.40-1.04; P = 0.07). Six-month PFS rates were 32.8 and 15.4%, respectively. Median OS was 9.6 and 8.4 months in EP and irinotecan arms, respectively (HR 0.91; 95% CI 0.56-1.49). ORRs were 10 and 5%, respectively (P = 0.676); median DOR was significantly longer in EP arm (7.9 versus 1.4 months; P = 0.018). The most common grade-3/4 adverse events for EP and irinotecan were diarrhea (21 vs 20%), neutropenia (10 vs 22%), abdominal pain (14 vs 5%), nausea (14 vs 2%), and vomiting (12 vs 7%), respectively. CONCLUSION EP is active and safe for second-line treatment of KRAS-mutant, irinotecan-naïve mCRC.
Collapse
|
43
|
Cubillo Gracian A, Dean A, Muñoz A, Hidalgo M, Pazo-Cid R, Martin M, Macarulla Mercade T, Lipton L, Harris M, Manzano-Mozo J, Maurel J, Guillen-Ponce C, Tebbutt N, Cooray P, Sohal D, Zalupski M, Kolevska T, Stagg R, Goldstein D. YOSEMITE: A 3 arm double-blind randomized phase 2 study of gemcitabine, paclitaxel protein-bound particles for injectable suspension, and placebo (GAP) versus gemcitabine, paclitaxel protein-bound particles for injectable suspension and either 1 or 2 truncated courses of demcizumab (GAD). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
44
|
Leonard JP, Kolibaba KS, Reeves JA, Tulpule A, Flinn IW, Kolevska T, Robles R, Flowers CR, Collins R, DiBella NJ, Papish SW, Venugopal P, Horodner A, Tabatabai A, Hajdenberg J, Park J, Neuwirth R, Mulligan G, Suryanarayan K, Esseltine DL, de Vos S. Randomized Phase II Study of R-CHOP With or Without Bortezomib in Previously Untreated Patients With Non-Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma. J Clin Oncol 2017; 35:3538-3546. [PMID: 28862883 DOI: 10.1200/jco.2017.73.2784] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the impact of the addition of bortezomib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) on outcomes in previously untreated patients with non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL). Patients and Methods After real-time determination of non-GCB DLBCL using the Hans immunohistochemistry algorithm, 206 patients were randomly assigned (1:1; stratified by International Prognostic Index [IPI] score) to six 21-day cycles of standard R-CHOP alone or R-CHOP plus bortezomib 1.3 mg/m2 intravenously on days 1 and 4 (VR-CHOP). The primary end point, progression-free survival (PFS), was evaluated in 183 patients with centrally confirmed non-GCB DLBCL who received one or more doses of study drug (91 R-CHOP, 92 VR-CHOP). Results After a median follow-up of 34 months, with 25% (R-CHOP) and 18% (VR-CHOP) of patients having had PFS events, the hazard ratio (HR) for PFS was 0.73 (90% CI, 0.43 to 1.24) with VR-CHOP ( P = .611). Two-year PFS rates were 77.6% with R-CHOP and 82.0% with VR-CHOP; they were 65.1% versus 72.4% in patients with high-intermediate/high IPI (HR, 0.67; 90% CI, 0.34 to 1.29), and 90.0% versus 88.9% (HR, 0.85; 90% CI, 0.35 to 2.10) in patients with low/low-intermediate IPI. Overall response rate with R-CHOP and VR-CHOP was 98% and 96%, respectively. The overall survival HR was 0.75 (90% CI, 0.38 to 1.45); 2-year survival rates were 88.4% and 93.0%, respectively. In the safety population (100 R-CHOP and 101 VR-CHOP patients), grade ≥ 3 adverse events included neutropenia (53% v 49%), thrombocytopenia (13% v 29%), anemia (7% v 15%), leukopenia (26% v 25%), and neuropathy (1% v 5%). Conclusion Outcomes for newly diagnosed, prospectively enrolled patients with non-GCB DLBCL were more favorable than expected with R-CHOP and were not significantly improved by adding bortezomib.
Collapse
|
45
|
Monk BJ, Brady MF, Aghajanian C, Lankes HA, Rizack T, Leach J, Fowler JM, Higgins R, Hanjani P, Morgan M, Edwards R, Bradley W, Kolevska T, Foukas P, Swisher EM, Anderson KS, Gottardo R, Bryan JK, Newkirk M, Manjarrez KL, Mannel RS, Hershberg RM, Coukos G. A phase 2, randomized, double-blind, placebo- controlled study of chemo-immunotherapy combination using motolimod with pegylated liposomal doxorubicin in recurrent or persistent ovarian cancer: a Gynecologic Oncology Group partners study. Ann Oncol 2017; 28:996-1004. [PMID: 28453702 PMCID: PMC5406764 DOI: 10.1093/annonc/mdx049] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A phase 2, randomized, placebo-controlled trial was conducted in women with recurrent epithelial ovarian carcinoma to evaluate the efficacy and safety of motolimod-a Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses-combined with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death. PATIENTS AND METHODS Women with ovarian, fallopian tube, or primary peritoneal carcinoma were randomized 1 : 1 to receive PLD in combination with blinded motolimod or placebo. Randomization was stratified by platinum-free interval (≤6 versus >6-12 months) and Gynecologic Oncology Group (GOG) performance status (0 versus 1). Treatment cycles were repeated every 28 days until disease progression. RESULTS The addition of motolimod to PLD did not significantly improve overall survival (OS; log rank one-sided P = 0.923, HR = 1.22) or progression-free survival (PFS; log rank one-sided P = 0.943, HR = 1.21). The combination was well tolerated, with no synergistic or unexpected serious toxicity. Most patients experienced adverse events of fatigue, anemia, nausea, decreased white blood cells, and constipation. In pre-specified subgroup analyses, motolimod-treated patients who experienced injection site reactions (ISR) had a lower risk of death compared with those who did not experience ISR. Additionally, pre-treatment in vitro responses of immune biomarkers to TLR8 stimulation predicted OS outcomes in patients receiving motolimod on study. Immune score (tumor infiltrating lymphocytes; TIL), TLR8 single-nucleotide polymorphisms, mutational status in BRCA and other DNA repair genes, and autoantibody biomarkers did not correlate with OS or PFS. CONCLUSIONS The addition of motolimod to PLD did not improve clinical outcomes compared with placebo. However, subset analyses identified statistically significant differences in the OS of motolimod-treated patients on the basis of ISR and in vitro immune responses. Collectively, these data may provide important clues for identifying patients for treatment with immunomodulatory agents in novel combinations and/or delivery approaches. TRIAL REGISTRATION Clinicaltrials.gov, NCT 01666444.
Collapse
|
46
|
Chiappori AA, Kolevska T, Spigel DR, Hager S, Rarick M, Gadgeel S, Blais N, Von Pawel J, Hart L, Reck M, Bassett E, Burington B, Schiller JH. A randomized phase II study of the telomerase inhibitor imetelstat as maintenance therapy for advanced non-small-cell lung cancer. Ann Oncol 2014; 26:354-62. [PMID: 25467017 DOI: 10.1093/annonc/mdu550] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Continuation or 'switch' maintenance therapy is commonly used in patients with advancd non-small-cell lung cancer (NSCLC). Here, we evaluated the efficacy of the telomerase inhibitor, imetelstat, as switch maintenance therapy in patients with advanced NSCLC. PATIENTS AND METHODS The primary end point of this open-label, randomized phase II study was progression-free survival (PFS). Patients with non-progressive, advanced NSCLC after platinum-based doublet (first-line) chemotherapy (with or without bevacizumab), any histology, with Eastern Cooperative Oncology Group performance status 0-1 were eligible. Randomization was 2 : 1 in favor of imetelstat, administered at 9.4 mg/kg on days 1 and 8 of a 21-day cycle, or observation. Telomere length (TL) biomarker exploratory analysis was carried out in tumor tissue by quantitative PCR (qPCR) and telomerase fluorescence in situ hybridization. RESULTS Of 116 patients enrolled, 114 were evaluable. Grade 3/4 neutropenia and thrombocytopenia were more frequent with imetelstat. Median PFS was 2.8 and 2.6 months for imetelstat-treated versus control [hazard ratio (HR) = 0.844; 95% CI 0.54-1.31; P = 0.446]. Median survival time favored imetelstat (14.3 versus 11.5 months), although not significantly (HR = 0.68; 95% CI 0.41-1.12; P = 0.129). Exploratory analysis demonstrated a trend toward longer median PFS (HR = 0.43; 95% CI 0.14-1.3; P = 0.124) and overall survival (OS; HR = 0.41; 95% CI 0.11-1.46; P = 0.155) in imetelstat-treated patients with short TL, but no improvement in median PFS and OS in patients with long TL (HR = 0.86; 95% CI 0.39-1.88; and HR = 0.51; 95% CI 0.2-1.28; P = 0.145). CONCLUSIONS Maintenance imetelstat failed to improve PFS in advanced NSCLC patients responding to first-line therapy. There was a trend toward a improvement in median PFS and OS in patients with short TL. Short TL as a predictive biomarker will require further investigation for the clinical development of imetelstat.
Collapse
|
47
|
Somkin CP, Ackerson L, Husson G, Gomez V, Kolevska T, Goldstein D, Fehrenbacher L. Effect of medical oncologists' attitudes on accrual to clinical trials in a community setting. J Oncol Pract 2013; 9:e275-83. [PMID: 24151327 PMCID: PMC5706122 DOI: 10.1200/jop.2013.001120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncology clinical trials (OCTs) are crucial in evaluating new cancer treatments, but only 2% to 3% of US adult patients with cancer enter OCTs. This study assessed barriers to participation in clinical trials among oncologists in a large integrated health care delivery system with an active clinical trials program. Although many studies have identified major physician barriers to enrollment, few have examined how these barriers affect actual trial accrual. METHODS Using information from a mailed survey, we examined the effect of oncologists' attitudes, beliefs, experiences, sociodemographic factors, and practice characteristics on clinical trial accrual in the 2 years following the survey. We identified relationships between these variables and subsequent clinical trial accrual using correlations and mixed effects models. RESULTS A construct combining questions that assessed oncologist attitudes, beliefs, and experiences substantially influenced OCT enrollment (r = .51; P < .0001). This construct included awareness of open clinical trials and specific eligible patients, as well as the practice of initiating a discussion about OCTs with most eligible patients. This broad concept of awareness had the greatest correlation with enrollment and mediated the effect on enrollment of other values and beliefs, such as welcoming a patient's initiation of a trial discussion and valuing the support of research nurses and coordinators. CONCLUSION Even in a health care setting with an active clinical trials program, substantial research personnel, infrastructure support, and widespread access to trials among oncologists and patients, oncologists' participation remains quite variable. Oncologist values, beliefs, and awareness of clinical trials play an important role in OCT accrual.
Collapse
|
48
|
Harris JN, Liljestrand P, Alexander GL, Goddard KAB, Kauffman T, Kolevska T, McCarty C, O'Neill S, Pawloski P, Rahm A, Williams A, Somkin CP. Oncologists' attitudes toward KRAS testing: a multisite study. Cancer Med 2013; 2:881-8. [PMID: 24403261 PMCID: PMC3892392 DOI: 10.1002/cam4.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 01/18/2023] Open
Abstract
Recent discoveries promise increasingly to help oncologists individually tailor anticancer therapy to their patients’ molecular tumor characteristics. One such promising molecular diagnostic is Kirsten ras (KRAS) tumor mutation testing for metastatic colorectal cancer (mCRC) patients. In the current study, we examined how and why physicians adopt KRAS testing and how they subsequently utilize the information when discussing treatment strategies with patients. We conducted 34 semi-structured in-person or telephone interviews with oncologists from seven different health plans. Each interview was audiotaped, transcribed, and coded using qualitative research methods. Information and salient themes relating to the research questions were summarized for each interview. All of the oncologists in this study reported using the KRAS test at the time of the interview. Most appeared to have adopted the test rapidly, within 6 months of the publication of National Clinical Guidelines. Oncologists chose to administer the test at various time points, although the majority ordered the test at the time their patient was diagnosed with mCRC. While oncologists expressed a range of opinions about the KRAS test, there was a general consensus that the test was useful and provided benefits to mCRC patients. The rapid adoption and enthusiasm for KRAS suggests that these types of tests may be filling an important informational need for oncologists when making treatment decisions. Future research should focus on the informational needs of patients around this test and whether patients feel informed or confident with their physicians’ use of these tests to determine treatment access.
Collapse
|
49
|
Said JW, Reeves JA, Flinn I, Tulpule A, Robles RL, Flowers C, DiBella NJ, Kolibaba KS, Venugopal P, Kolevska T, De Vos S, Jaye DL, Esseltine D, Mulligan G, Corvez MM, Eckardt JR, Brockman B, Chico IM, Leonard J, Kussick S. Certification and role of local pathologists for diffuse large B-cell lymphoma (DLBCL) subtyping and eligibility determination in the phase II PYRAMID study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8559 Background: The role of local pathologists in promoting patient (pt) accrual and evaluating eligibility criteria involving a complicated immunohistochemical (IHC) algorithm has rarely been investigated. The phase II PYRAMID trial (NCT00931918) is assessing R-CHOP ± bortezomib for newly diagnosed pts with non-germinal-center B-cell (non-GCB) subtype DLBCL. In this trial, local pathologists were encouraged to perform DLBCL subtyping at the point of biopsy, identify suitable pts for the trial, and facilitate accrual. Methods: Determination of GCB vs non-GCB subtype is per the Hans method, an algorithm based on IHC for CD10, BCL-6, and IRF4/MUM1. In stage 1, pathologists demonstrated IHC subtyping proficiency by evaluating a tissue microarray (TMA) of 12 DLBCL cases; those with ≥80% of samples in agreement with central lab results were certified for determining trial eligibility. In stage 2, to broaden participation, pathologist certification occurred via teleconference outlining trial eligibility criteria, tissue subtyping requirements, and determining pathologists’ experience with the Hans method. Results: 182 pathologists have been certified for local subtyping, 50 via TMA and 132 by teleconference. 66/88 active study sites have ≥1 certified pathologist. Only 1 of the 10 top enrolling sites lacks a certified pathologist. 52% (84/162) of pts have been enrolled based on local pathologist subtyping prior to central lab confirmation. Discordance with central lab results occurred in 9/84 cases (11%). Enrollment rates pre- and post-local pathologist certification were 0.053 and 0.096 pts/site/month; an improvement of 81%. Trial accrual correlates with the presence of a certified local pathologist (p=0.0026). The rate of ineligible GCB cases sent for central lab testing was lower from sites with a certified pathologist (23% [69/299 cases] vs 38% [40/106 cases] for sites without). Conclusions: Engagement of local pathologists in trials requiring pathology selection can significantly improve accrual. This study demonstrates the effectiveness of various training modalities in improving selection by local pathologists using a complex IHC algorithm. Clinical trial information: NCT00931918.
Collapse
|
50
|
Chiappori A, Bassett E, Burington B, Kolevska T, Spigel DR, Hager S, Rarick M, Gadgeel S, Blais N, Von Pawel J, Hart L, Wang H, Eng K, Reck M, Schiller J. Abstract 2376: Improved progression-free survival (PFS) in patients with short tumor telomere length: Subgroup analysis from a randomized phase II study of the telomerase inhibitor imetelstat as maintenance therapy for advanced NSCLC . Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Tumor regrowth after chemotherapy may be driven by growth of tumor ‘stem cells’. Telomerase, required for indefinite replication, is upregulated both in putative ‘stem cells’ and bulk tumor cells. Imetelstat, a lipidated 13-mer oligonucleotide, is a potent and specific inhibitor of telomerase. A randomized phase II study was conducted to assess whether imetelstat, given as maintenance therapy, prolongs PFS in advanced NSCLC: results for the primary and secondary endpoints are reported separately.
NSCLC cell lines and other tumor cells with short telomeres appear to be more sensitive to imetelstat in vitro than those with long telomeres. A planned exploratory analysis to determine PFS as a function of tumor telomere length (TL) was performed. Tumor TL was assessed in archival tumor specimens from pts by quantitative PCR (qPCR).
TL data were available for 57 of the 116 pts accrued in the clinical trial. PFS was evaluated in patients grouped into the shortest 1/2, shortest 1/3 and shortest 1/4 of TL. In 19 pts with the shortest 1/3 TL measured by qPCR, imetelstat maintenance increased PFS with a HR in favor of the imetelstat arm of 0.32 (95% CI 0.1 to 1.0), p=0.042 (un-stratified log rank). Median PFS was 4.0 months for the imetelstat-treated short TL sub-group and 1.5 months for the control short TL sub-group. In the 38 pts with the longest 2/3 TL HR was 0.83 (95% CI 0.36 to 1.9). Results in the group with the shortest 1/4 of TL were similar to the shortest 1/3 TL group, and in the shortest 1/2 group, results were consistent but attenuated, indicating that a smaller subset may contain patients with the most potential to benefit. In the control arm, short TL was associated with shorter median PFS (1.48 months) compared to patients with long TL (2.7 months), suggesting that short TL has a negative prognostic value.
These findings suggest that imetelstat given as maintenance therapy prolongs PFS in pts with advanced NSCLC whose tumors have short telomeres as measured by qPCR. The data are consistent with the hypothesis that clinical benefit from telomerase inhibition is greater in patients with tumors possessing short telomeres. Prospective confirmation of these results in solid tumors and hematologic neoplasms is planned.
Citation Format: Alberto Chiappori, Ekaterina Bassett, Bart Burington, Tatjana Kolevska, David R. Spigel, Steven Hager, Mark Rarick, Shirish Gadgeel, Normand Blais, Joachim Von Pawel, Lowell Hart, Hui Wang, Kevin Eng, Martin Reck, Joan Schiller. Improved progression-free survival (PFS) in patients with short tumor telomere length: Subgroup analysis from a randomized phase II study of the telomerase inhibitor imetelstat as maintenance therapy for advanced NSCLC . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2376. doi:10.1158/1538-7445.AM2013-2376
Collapse
|