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Sutherland R, Gross CP, Ma X, Jeong F, Seibert TM, Cooperberg MR, Catalona WJ, Ellis SD, Loeb S, Schulman‐Green D, Leapman MS. 'It Just Makes Sense to Me': A qualitative study exploring patient decision-making and experiences with prostate MRI during active surveillance for prostate cancer. BJUI COMPASS 2024; 5:593-601. [PMID: 38873351 PMCID: PMC11168777 DOI: 10.1002/bco2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Although prostate magnetic resonance imaging (MRI) is commonly used in the diagnosis, staging and active surveillance of prostate cancer, little is known about patient perspectives on MRI. Methods We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- and intermediate-risk prostate cancer managed with active surveillance. Interviews focused on experiences with and knowledge of prostate MRI and MRI-ultrasound fusion biopsy during active surveillance. We purposively sampled patients who received prostate MRI as part of their clinical care, conducted interviews until reaching thematic saturation and performed conventional content analysis to analyse data. Results Twenty patients aged 51-79 years (mean = 68 years) participated in the study. At diagnosis, 17 (85%) had a Gleason grade group 1, and three (15%) had a grade group 2 tumour. Overall, participants viewed prostate MRI as a valuable tool that accurately localizes and monitors prostate cancer over time, and they considered prostate MRI central to active surveillance monitoring. We identified five thematic categories related to MRI use: (1) the experiential aspects of undergoing an MRI scan; (2) the experience of visualizing one's own prostate and prostate cancer; (3) adequacy of provider explanations of MRI results; (4) confidence in prostate MRI in decision-making; and (5) the role of prostate MRI in longitudinal follow-up, including an interest in using MRI to modify the timing of, or replace, prostate biopsy. Conclusion Patients value prostate MRI as a tool that enhances their confidence in the initial diagnosis and monitoring of prostate cancer. This work can inform future studies to optimize patient experience, education and counselling during active surveillance for prostate cancer.
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Affiliation(s)
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Farah Jeong
- Yale School of Public HealthNew HavenConnecticutUSA
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Matthew R. Cooperberg
- Department of UrologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William J. Catalona
- Department of UrologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Shellie D. Ellis
- Department of Population Health Kansas University Medical CenterKansas CityKansasUSA
| | - Stacy Loeb
- Departments of Urology and Population HealthNew York University Langone HealthNew YorkUSA
- Manhattan Veterans Affairs Medical CenterNew YorkNew YorkUSA
| | | | - Michael S. Leapman
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of UrologyYale School of MedicineNew HavenConnecticutUSA
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Leapman MS, Sutherland R, Gross CP, Ma X, Seibert TM, Cooperberg MR, Catalona WJ, Loeb S, Schulman‐Green D. Patient experiences with tissue-based genomic testing during active surveillance for prostate cancer. BJUI COMPASS 2024; 5:142-149. [PMID: 38179031 PMCID: PMC10764160 DOI: 10.1002/bco2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 01/06/2024] Open
Abstract
Background Tissue-based gene expression (genomic) tests provide estimates of prostate cancer aggressiveness and are increasingly used for patients considering or engaged in active surveillance. However, little is known about patient experiences with genomic testing and its role in their decision-making. Methods We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- or favourable-intermediate-risk prostate cancer managed with active surveillance. We purposively sampled to include patients who received biopsy-based genomic testing as part of clinical care. The interview guide focused on experiences with genomic testing during patients' decision-making for prostate cancer management and understanding of genomic test results. We continued interviews until thematic saturation was reached, iteratively created a code key and used conventional content analysis to analyse data. Results Participants' (n = 20) mean age was 68 years (range 51-79). At initial biopsy, 17 (85%) had a Gleason grade group 1, and 3 (15%) had a grade group 2 prostate cancer. The decision to undergo genomic testing was driven by both participants and physicians' recommendations; however, some participants were unaware that testing had occurred. Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance. Participants had some misconceptions about the difference between tissue-based gene expression tests and germline genetic tests and commonly believed that tissue-based tests measured hereditary cancer risk. While some participants expressed satisfaction with their physicians' explanations, others felt that communication was limited and lacked sufficient detail. Conclusion Patients interact with and are influenced by the results of biopsy-based genomic testing during active surveillance for prostate cancer, despite gaps in understanding about test results. Our findings indicate areas for improvement in patient counselling in order to increase patient knowledge and comfort with genomic testing.
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Affiliation(s)
- Michael S. Leapman
- Department of UrologyYale School of MedicineNew HavenConnecticutUSA
- Yale Cancer OutcomesPublic Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | | | - Cary P. Gross
- Yale Cancer OutcomesPublic Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Xiaomei Ma
- Yale Cancer OutcomesPublic Policy, and Effectiveness Research CenterNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Matthew R. Cooperberg
- Department of UrologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William J. Catalona
- Department of UrologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Stacy Loeb
- Departments of Urology and Population HealthNew York University Langone HealthNew YorkNew YorkUSA
- Manhattan Veterans Affairs Medical CenterNew YorkNew YorkUSA
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Lalonde CS, Switchenko JM, Behera M, Bilen MA, Owonikoko TK, Kaufman JL, Nooka AK, Lewis CM, Hitron E, Collins H, Judson EC, Alese OB, Donald Harvey R, Carlisle JW. Shifting Sociodemographic Characteristics of a Phase I Clinical Trial Population at an NCI-Designated Comprehensive Cancer Center in the Southeast. Oncologist 2023; 28:1055-1063. [PMID: 37418599 PMCID: PMC10712723 DOI: 10.1093/oncolo/oyad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/09/2023] Open
Abstract
Racial and ethnic minority populations are consistently under-represented in oncology clinical trials despite comprising a disproportionate share of a cancer burden. Phase I oncology clinical trials pose a unique challenge and opportunity for minority inclusion. Here we compared the sociodemographic characteristics of patients participating in phase 1 clinical trials a National Cancer Institute ( NCI)-designated comprehensive center to all patients at the center, patients with new cancer diagnosis in metropolitan Atlanta and patients with new cancer diagnoses in the state of Georgia. From 2015 to 2020, 2325 patients (43.4% female, 56.6% male) consented to participate in a phase I trial. Grouped self-reported race distribution was 70.3% White, 26.2% Black, and 3.5% other. Of new patient registrations at Winship Cancer Institute (N = 107 497) (50% F, 50% M), grouped race distribution was 63.3% White, 32.0% Black, and 4.7% other. Patients with new cancer diagnoses in metro Atlanta from 2015 to 2016 (N = 31101) were 58.4% White, 37.2% Black, and 4.3% other. Race and sex distribution of phase I patients was significantly different than Winship patients (P < .001). Over time, percent of White patients decreased in both phase I and Winship groups (P = .009 and P < .001, respectively); percentage of females did not change in either group (P = .54 phase I, P = .063 Winship). Although phase I patients were more likely to be White, male, and privately ensured than the Winship cohort, from 2015 to 2020 the percentage of White patients in phase I trials and among all new patients treated at Winship decreased. The intent of characterizing existing disparities is to improve the representation of patients from racial and ethnic minority backgrounds in phase I clinical trials.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan L Kaufman
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ajay K Nooka
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Hannah Collins
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Emma C Judson
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Olatunji B Alese
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - R Donald Harvey
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Coleman CN, Wong R, Petereit DG, Maguire PD, Heron DE, Steinberg M, Bains Y, Vikram B, Angelis P, Livinski AA, Roach M, Govern FS. The National Cancer Institute's Cancer Disparities Research Partnership Program: a unique funding model 20 years later. J Natl Cancer Inst 2023; 115:1465-1474. [PMID: 37707545 PMCID: PMC10699796 DOI: 10.1093/jnci/djad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
The burden of cancer and access to effective treatment are not experienced equally by all in the United States. For underserved populations that often access the health-care system when their cancers are in advanced disease stages, radiation oncology services are essential. In 2001, the National Cancer Institute's (NCI's) Radiation Research Program created and implemented the Cancer Disparities Research Partnership Program (CDRP). CDRP was a pioneering funding model whose goal was to increase participation of medically underserved populations in NCI clinical trials. CDRP's Cooperative Agreement funding supported for awardees the planning, development, and conduct of radiation oncology clinical research in institutions not traditionally involved in NCI-sponsored research and cared for a disproportionate number of medically underserved, health-disparities populations. The awardee secured and provided support for mentorship from 1 of 2 NCI comprehensive cancer centers named in its application. Six CDRP awards were made over two 5-year funding periods ending in 2013, with the end-of-program accomplishments previously reported. With the current focus on addressing equity, diversity, and inclusion, the 6 principal investigators were surveyed, 5 of whom responded about the impact of CDRP on their institutions, communities, and personal career paths. The survey that was emailed included 10 questions on a 5-point Likert scale. It was not possible to collect patient data this long after completion of the program. This article provides a 20-year retrospective of the experiences and observations from those principal investigators that can inform those now planning, building, and implementing equity, diversity, and inclusion programs.
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Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Rosemary Wong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Patrick D Maguire
- Coastal Carolina Radiation Oncology (Novant-New Hanover Regional Medical Center Radiation Oncology), Wilmington, NC, USA
| | | | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | | | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Patricia Angelis
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Mack Roach
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco, CA, USA
| | - Frank S Govern
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Freedland SJ, Hong A, El-Chaar N, Murty S, Ramaswamy K, Coutinho AD, Nimke D, Morgans AK. Prostate-specific antigen response and clinical progression-free survival in Black and White men with chemotherapy-naïve metastatic castration-resistant prostate cancer treated with enzalutamide in a real-world setting. Prostate Cancer Prostatic Dis 2023; 26:523-530. [PMID: 36517634 PMCID: PMC10449620 DOI: 10.1038/s41391-022-00622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the United States, Black men have a higher incidence of prostate cancer (PC)-related mortality than men of other races. Several real-world studies in advanced PC suggest, however, that Black men respond better to novel hormonal therapies than White men. Data on treatment responses to enzalutamide by race are limited. We assessed real-world prostate-specific antigen (PSA) response and clinical progression-free survival (cPFS) of Black vs. White men with chemotherapy-naïve PC treated with enzalutamide. METHODS This retrospective cohort study included patients with PC who initiated enzalutamide treatment from 2014 to 2018 in the IntrinsiQ Specialty Solutions™ database, a collection of electronic medical records from community urology practices. Index date was the date of the first prescription for enzalutamide, used as a proxy for metastatic castration-resistant PC (mCRPC). Patients who had undergone chemotherapy and/or abiraterone therapy were excluded. Kaplan-Meier and Cox models adjusted for baseline characteristics were used to estimate PSA response and cPFS by race. RESULTS The study included 214 Black and 1332 White men with chemotherapy-naïve PC presumed to have mCRPC based on the enzalutamide indication during the study period. Black men were younger and had higher baseline median PSA levels than White men. Enzalutamide therapy duration, follow-up time, and number of post-index PSA tests were similar between races. In multivariable analyses, the risk of patients achieving a ≥ 50% PSA decline was similar, whereas a numerically higher trend of ≥90% PSA decline was observed in Black men (HR 1.23; 95% CI 0.93-1.62 [P = 0.14]). In the multivariable analysis, Black men had significantly better cPFS (HR 0.82; 95% CI 0.68-0.98 [P = 0.03]). CONCLUSIONS Black and White men with presumed chemotherapy-naïve mCRPC had similar PSA responses when treated with enzalutamide, but Black men had better cPFS than White men. Further research is warranted to validate these findings.
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Affiliation(s)
- Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Durham VA Health Care System, Durham, NC, USA.
| | - Agnes Hong
- Astellas Pharma Inc., Northbrook, IL, USA
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Marima R, Mbeje M, Hull R, Demetriou D, Mtshali N, Dlamini Z. Prostate Cancer Disparities and Management in Southern Africa: Insights into Practices, Norms and Values. Cancer Manag Res 2022; 14:3567-3579. [PMID: 36597514 PMCID: PMC9805733 DOI: 10.2147/cmar.s382903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer (PCa) is a leading cause of mortality in men of African origin. While men of African descent in high-income countries (HICs) demonstrate poor prognosis compared to their European counterparts, African men on the African continent, particularly Southern Africa have shown even higher PCa mortality rates. Extrinsic factors such as the socioeconomic status, education level, income level, geographic location and race contribute to PCa patient outcome. These are further deepened by the African norms which are highly esteemed and may have detrimental effects on PCa patients' health. Insights into African cultures and social constructs have been identified as key elements towards improving men's health care seeking behaviour which will in turn improve PCa patients' outcome. Compared to Southern Africa, the Eastern, Western and Central African regions have lower PCa incidence rates but higher mortality rates. The availability of cancer medical equipment has also been reported to be disproportionate in Africa, with most cancer resources in Northern and Southern Africa. Even within Southern Africa, cancer management resources are unevenly available where one country must access PCa specialised care in the neighbouring countries. While PCa seems to be better managed in HICs, steps towards effective PCa management are urgently needed in Africa, as this continent represents a significant portion of low-middle-income countries (LMICs). Replacing African men in Africa with African American men may not optimally resolve PCa challenges in Africa. Adopting western PCa management practices can be optimised by integrating improved core-African norms. The aim of this review is to discuss PCa disparities in Africa, deliberate on the significance of integrating African norms around masculinity and discuss challenges and opportunities towards effective PCa care in Africa, particularly in Southern Africa.
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Affiliation(s)
- Rahaba Marima
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Mandisa Mbeje
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa,Department of Medical Oncology, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Rodney Hull
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Demetra Demetriou
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa
| | - Nompumelelo Mtshali
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zodwa Dlamini
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Pretoria, South Africa,Correspondence: Zodwa Dlamini, Tel +27 12 319 2614, Email
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Eggly S, Senft N, Kim S, Heath EI, Jang H, Moore TF, Baidoun F, Manning MA, Penner LA, Albrecht TL, Carducci MA, Lansey D, Hamel LM. Addressing multilevel barriers to clinical trial participation among Black and White men with prostate cancer through the
PACCT
study. Cancer Med 2022; 12:8604-8613. [PMID: 36540051 PMCID: PMC10134336 DOI: 10.1002/cam4.5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer clinical trial participation is low and inequitable. Partnering Around Cancer Clinical Trials (PACCT) addressed systemic and interpersonal barriers through an observational study of eligibility and an intervention to improve patient-physician communication and trial invitation rates. METHODS Physicians at two comprehensive cancer centers and Black and White men with prostate cancer participated. Patients were followed for 2 years to determine whether they became potentially eligible for an available therapeutic trial. Potentially eligible patients were randomized to receive a trials-focused Question Prompt List or usual care. Patient-physician interactions were video-recorded. Outcomes included communication quality and trial invitation rates. Descriptive analyses assessed associations between sociodemographic characteristics and eligibility and effects of the intervention on outcomes. RESULTS Only 44 (22.1%) of participating patients (n = 199) became potentially eligible for an available clinical trial. Patients with higher incomes were more often eligible (>$80,000 vs. <$40,000, adjusted OR = 6.06 [SD, 1.97]; $40,000-$79,000 vs. <$40,000, adjusted OR = 4.40 [SD, 1.81]). Among eligible patients randomized to the intervention (n = 19) or usual care (n = 25), Black patients randomized to the intervention reported participating more actively than usual care patients, while White intervention patients reported participating less actively (difference, 0.41 vs. -0.34). Intervention patients received more trial invitations than usual care patients (73.7% vs. 60.0%); this effect was greater for Black (80.0% vs. 30.0%) than White patients (80.0% vs. 66.7%). CONCLUSIONS Findings suggest the greatest enrollment barrier is eligibility for an available trial, but a communication intervention can improve communication quality and trial invitation rates, especially for eligible Black patients.
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Affiliation(s)
- Susan Eggly
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Nicole Senft
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Seongho Kim
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Elisabeth I. Heath
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Hyejeong Jang
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Tanina F. Moore
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Fatmeh Baidoun
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Mark A. Manning
- Department of Psychology Oakland University Rochester Michigan USA
| | - Louis A. Penner
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Terrance L. Albrecht
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
| | - Michael A. Carducci
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Baltimore Maryland USA
| | - Dina Lansey
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Baltimore Maryland USA
| | - Lauren M. Hamel
- Department of Oncology Wayne State University/Karmanos Cancer Institute Detroit Michigan USA
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Kim J, Kester R, Blumenthal G. Clinical Trial Diversity in Oncology: FDA Takes Action with Post-Marketing Requirements or Commitments. Oncologist 2022; 27:993-997. [PMID: 36318222 PMCID: PMC9732216 DOI: 10.1093/oncolo/oyac228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
In recent years, there has been a renewed focus on promoting the inclusion of patients from racial and ethnic minority groups in oncology clinical trials. FDA Oncology has long pointed to the underrepresentation of racial minorities in registration trials leading to approval. US FDA's Guidance on diversity discusses how diversity could be handled within clinical trials, giving recommendations on broadening eligibility criteria, inclusive trial practices, and alternative trial designs. While there is no specific guidance from the FDA on cancer clinical trials, the recommendation is to include a representative population applicable to the US population. With the recent renewed focus on diversity in oncology clinical trials, FDA Oncology has recently asked for the completion of a Diversity Plan during drug development and has issued post-marketing commitments and requirements at the time of approval. As FDA has started to issue post-marketing requirements or commitments regarding diversity in 2020, we sought to analyze the post-marketing studies asking for a study of racial and ethnic minorities issued by the FDA's Office of Oncologic Diseases (OOD). The analysis demonstrated the need to increase the enrollment of a diverse patient population in cancer clinical trials.
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Affiliation(s)
- Janice Kim
- Corresponding author: Janice Kim, Merck & Co., Inc., Kenilworth, NJ, USA.
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Insights for Oncology Trials Garnered From the Rapid Development of an mRNA COVID-19 Vaccine. Cancer J 2022; 28:146-150. [PMID: 35333501 PMCID: PMC8974181 DOI: 10.1097/ppo.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The sudden emergence of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 stimulated unprecedented scientific initiatives to rapidly develop effective treatments and vaccines. One example was the development of vaccines based on messenger RNA platforms, which received emergency use authorization in the United States less than 1 year after the primary sequence of the severe acute respiratory syndrome coronavirus 2 virus was published. Novel practices arose from the collaborative efforts and inclusive clinical studies that facilitated the vaccines' rapid development and clinical testing. I describe insights gained from the experience of mRNA-1273 vaccine development that may be applied to or adapted for oncology research. These insights include clinical study design, diversity and inclusion initiatives, speed, and real-world evidence generation, as well as close partnership among regulatory agencies, government, and pharmaceutical companies.
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10
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Role of Precision Oncology in Type II Endometrial and Prostate Cancers in the African Population: Global Cancer Genomics Disparities. Int J Mol Sci 2022; 23:ijms23020628. [PMID: 35054814 PMCID: PMC8776204 DOI: 10.3390/ijms23020628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
Precision oncology can be defined as molecular profiling of tumors to identify targetable alterations. Emerging research reports the high mortality rates associated with type II endometrial cancer in black women and with prostate cancer in men of African ancestry. The lack of adequate genetic reference information from the African genome is one of the major obstacles in exploring the benefits of precision oncology in the African context. Whilst external factors such as the geography, environment, health-care access and socio-economic status may contribute greatly towards the disparities observed in type II endometrial and prostate cancers in black populations compared to Caucasians, the contribution of African ancestry to the contribution of genetics to the etiology of these cancers cannot be ignored. Non-coding RNAs (ncRNAs) continue to emerge as important regulators of gene expression and the key molecular pathways involved in tumorigenesis. Particular attention is focused on activated/repressed genes and associated pathways, while the redundant pathways (pathways that have the same outcome or activate the same downstream effectors) are often ignored. However, comprehensive evidence to understand the relationship between type II endometrial cancer, prostate cancer and African ancestry remains poorly understood. The sub-Saharan African (SSA) region has both the highest incidence and mortality of both type II endometrial and prostate cancers. Understanding how the entire transcriptomic landscape of these two reproductive cancers is regulated by ncRNAs in an African cohort may help elucidate the relationship between race and pathological disparities of these two diseases. This review focuses on global disparities in medicine, PCa and ECa. The role of precision oncology in PCa and ECa in the African population will also be discussed.
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Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R. Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2021; 80:428-439. [DOI: 10.1016/j.eururo.2020.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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12
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Fashoyin-Aje L, Beaver Md JA, Pazdur R. Promoting Inclusion of Members of Racial and Ethnic Minority Groups in Cancer Drug Development. JAMA Oncol 2021; 7:1445-1446. [PMID: 34264279 DOI: 10.1001/jamaoncol.2021.2137] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lola Fashoyin-Aje
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland
| | - Julia A Beaver Md
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Pazdur
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland
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13
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Ledet EM, Burgess EF, Sokolova AO, Jaeger EB, Hatton W, Moses M, Miller P, Cotogno P, Layton J, Barata P, Lewis BE, Nakazawa M, Zhu J, Dellinger B, Elrefai S, Nafissi NN, Egan JB, Shore N, McKay RR, Bryce AH, Cheng HH, Antonarakis ES, Sartor O. Comparison of germline mutations in African American and Caucasian men with metastatic prostate cancer. Prostate 2021; 81:433-439. [PMID: 33792945 PMCID: PMC8252583 DOI: 10.1002/pros.24123] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The goal of this study is to evaluate germline genetic variants in African American men with metastatic prostate cancer as compared to those in Caucasian men with metastatic prostate cancer in an effort to understand the role of genetic factors in these populations. METHODS African American and Caucasian men with metastatic prostate cancer who had germline testing using multigene panels were used to generate comparisons. Germline genetic results, clinical parameters, and family histories between the two populations were analyzed. RESULTS A total of 867 patients were included in this retrospective study, including 188 African American and 669 Caucasian patients. There was no significant difference in the likelihood of a pathogenic or likely-pathogenic variants (PV/LPVs) between African American and Caucasian patients (p = .09). African American patients were more likely to have a variant of unknown significance than Caucasians (odds ratio [OR] = 1.95; p < .0001). BRCA1 PV/LPVs were higher in African Americans (OR = 4.86; p = .04). African American patients were less likely to have a PV/LPV in non-BRCA DNA repair genes (OR = 0.30; p = .008). Family history of breast (OR = 2.09; p = .002) or ovarian cancer (OR = 2.33; p = .04) predicted PV/LPVs in Caucasians but not African-Americans. This underscores the limitations of family history in AA men and the importance of personal history to guide germline testing in AA men. CONCLUSIONS In metastatic prostate cancer patients, PV/LPVs of tested genes did not vary by race, BRCA1 PV/LPVs were more common in the African American subset. However, PV/LPVs in non-BRCA DNA repair genes were less likely to be encountered in African Americans. Family history associated with genetic testing results in Caucasians only.
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Affiliation(s)
- Elisa M. Ledet
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Earle F. Burgess
- Genitourinary Oncology SectionLevine Cancer Institute/Atrium HealthCharlotteNorth CarolinaUSA
| | - Alexandra O. Sokolova
- Division of Oncology, Department of MedicineUniversity of Washington Medical Center/Fred Hutchinson Cancer Research Center/VA Puget Sound HCSSeattleWashingtonUSA
| | - Ellen B. Jaeger
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Whitley Hatton
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Marcus Moses
- School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Patrick Miller
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Patrick Cotogno
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Jodi Layton
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Pedro Barata
- Deming Department of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Brian E. Lewis
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
| | - Mari Nakazawa
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Jason Zhu
- Genitourinary Oncology SectionLevine Cancer Institute/Atrium HealthCharlotteNorth CarolinaUSA
| | - Beth Dellinger
- Genitourinary Oncology SectionLevine Cancer Institute/Atrium HealthCharlotteNorth CarolinaUSA
| | - Sara Elrefai
- Genitourinary Oncology SectionLevine Cancer Institute/Atrium HealthCharlotteNorth CarolinaUSA
| | | | - Jan B. Egan
- Center for Individualized MedicineMayo ClinicScottsdaleArizonaUSA
| | - Neal Shore
- Carolina Urologic Research CenterAtlantic Urology ClinicsMyrtle BeachSouth CarolinaUSA
| | - Rana R. McKay
- Moores Cancer CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Alan H. Bryce
- Division of Hematology/Oncology, Mayo Clinic Cancer CenterMayo ClinicPhoenixArizonaUSA
| | - Heather H. Cheng
- Division of Oncology, Department of MedicineUniversity of Washington Medical Center/Fred Hutchinson Cancer Research Center/VA Puget Sound HCSSeattleWashingtonUSA
| | - Emmanuel S. Antonarakis
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Oliver Sartor
- Department of Medicine, Tulane Cancer CenterTulane UniversityNew OrleansLouisianaUSA
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14
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Stein JN, Charlot M, Cykert S. Building Toward Antiracist Cancer Research and Practice: The Case of Precision Medicine. JCO Oncol Pract 2021; 17:273-277. [PMID: 33974820 PMCID: PMC8257901 DOI: 10.1200/op.20.01070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jacob N. Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Samuel Cykert
- Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC
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15
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McKay RR, Gold T, Zarif JC, Chowdhury-Paulino IM, Friedant A, Gerke T, Grant M, Hawthorne K, Heath E, Huang FW, Jackson MD, Mahal B, Ogbeide O, Paich K, Ragin C, Rencsok EM, Simmons S, Yates C, Vinson J, Kantoff PW, George DJ, Mucci LA. Tackling Diversity in Prostate Cancer Clinical Trials: A Report From the Diversity Working Group of the IRONMAN Registry. JCO Glob Oncol 2021; 7:495-505. [PMID: 33835826 PMCID: PMC8162521 DOI: 10.1200/go.20.00571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer disproportionately affects racial and ethnic minority populations. Reasons for disparate outcomes among minority patients are multifaceted and complex, involving factors at the patient, provider, and system levels. Although advancements in our understanding of disease biology have led to novel therapeutics for men with advanced prostate cancer, including the introduction of biomarker-driven therapeutics, pivotal translational studies and clinical trials are underrepresented by minority populations. Despite attempts to bridge the disparities gap, there remains an unmet need to expand minority engagement and participation in clinical trials to better define the impact of therapy on efficacy outcomes, quality of life, and role of biomarkers in diverse patient populations. The IRONMAN registry (ClinicalTrials.gov identifier: NCT03151629), a global, prospective, population-based study, was borne from this unmet medical need to address persistent gaps in our knowledge of advanced prostate cancer. Through integrated collection of clinical outcomes, patient-reported outcomes, epidemiologic data, and biospecimens, IRONMAN has the goal of expanding our understanding of how and why prostate cancer outcomes differ by race and ethnicity. To this end, the Diversity Working Group of the IRONMAN registry has developed informed strategies for site selection, recruitment, engagement and retention, and trial design and eligibility criteria to ensure broad inclusion and needs awareness of minority participants. In concert with systematic strategies to tackle the complex levels of disparate care, our ultimate goal is to expand minority engagement in clinical research and bridge the disparities gap in prostate cancer care.
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Affiliation(s)
- Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Rana R. McKay, MD, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA 92023; e-mail:
| | - Theresa Gold
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | | | - Adam Friedant
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | - Marie Grant
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | | | | | - Maria D. Jackson
- University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | | | | | - Kellie Paich
- Movember Foundation, East Melbourne, Victoria, Australia
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, PA,African-Caribbean Cancer Consortium, Philadelphia, PA
| | | | | | - Clayton Yates
- Tuskegee University, Tuskegee, AL,Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL
| | - Jake Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY
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16
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Gill J, Prasad V. N of 1 Data Sharing: The Impact of Data Sharing within the Hematology-Oncology Drug Products Division of the US FDA. Trends Cancer 2021; 7:395-399. [PMID: 33431338 DOI: 10.1016/j.trecan.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
Despite both enthusiasm and concern regarding data sharing from clinical trials, few studies have documented the outputs of data sharing. The FDA has a considerable collection of raw data from drugs for their marketing authorization. An examination of data sharing with the FDA provides a snapshot into studies that this may facilitate.
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Affiliation(s)
- Jennifer Gill
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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17
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Lewis DD, Cropp CD. The Impact of African Ancestry on Prostate Cancer Disparities in the Era of Precision Medicine. Genes (Basel) 2020; 11:E1471. [PMID: 33302594 PMCID: PMC7762993 DOI: 10.3390/genes11121471] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer disproportionately affects men of African ancestry at nearly twice the rate of men of European ancestry despite the advancement of treatment strategies and prevention. In this review, we discuss the underlying causes of these disparities including genetics, environmental/behavioral, and social determinants of health while highlighting the implications and challenges that contribute to the stark underrepresentation of men of African ancestry in clinical trials and genetic research studies. Reducing prostate cancer disparities through the development of personalized medicine approaches based on genetics will require a holistic understanding of the complex interplay of non-genetic factors that disproportionately exacerbate the observed disparity between men of African and European ancestries.
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Affiliation(s)
- Deyana D. Lewis
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, Baltimore, MD 21224, USA
| | - Cheryl D. Cropp
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University McWhorter School of Pharmacy, Birmingham, AL 35229, USA;
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18
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Kadambi S, Loh KP, Dunne R, Magnuson A, Maggiore R, Zittel J, Flannery M, Inglis J, Gilmore N, Mohamed M, Ramsdale E, Mohile S. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 2020; 17:742-755. [PMID: 32879429 PMCID: PMC7851836 DOI: 10.1038/s41571-020-0421-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
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Affiliation(s)
- Sindhuja Kadambi
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
| | - Kah Poh Loh
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Richard Dunne
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Ronald Maggiore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Jason Zittel
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Marie Flannery
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Julia Inglis
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Nikesha Gilmore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Mostafa Mohamed
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Erika Ramsdale
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
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19
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Vernon LF. J. Marion Sims, MD: Why He and His Accomplishments Need to Continue to be Recognized a Commentary and Historical Review. J Natl Med Assoc 2019; 111:436-446. [PMID: 30851980 DOI: 10.1016/j.jnma.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
This review provides a fresh perspective on the work of J. Marion Sims, an Antebellum era physician who invented the vaginally speculum that bears his name. His accent to become the "Father of Modern Gynecology" was his groundbreaking development of the surgical techniques for the repair for vesicovaginal fistula. Recent scholarship, however, has pointed to the dark side of Sims in that his techniques were perfected through his use of Black slave women as his research subjects. In addition, he has been criticized for his failure to use anesthesia during his research operations. This article argues that Sims's work needs to be understood in a broader historical context and within the broader framework of other forms of human experimentation that took place in the nineteenth and twentieth centuries. There is a strong argument that recent attempts to remove Sims from history also have the unintended consequence of removing the contributions of not only the Black slave women who were his subjects in the development of modern obstetrical medicine, but the important role Blacks played in the development of other medical procedures.
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20
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Bentley C, Cressman S, van der Hoek K, Arts K, Dancey J, Peacock S. Conducting clinical trials-costs, impacts, and the value of clinical trials networks: A scoping review. Clin Trials 2019; 16:183-193. [PMID: 30628466 DOI: 10.1177/1740774518820060] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A significant barrier to conducting clinical trials is their high cost, which is driven primarily by the time and resources required to activate trials and reach accrual targets. The high cost of running trials has a substantial impact on their long-term feasibility and the type of clinical research undertaken. METHODS A scoping review of the empirical literature on the costs associated with conducting clinical trials was undertaken for the years 2001-2015. Five reference databases were consulted to elicit how trials costs are presented in the literature. A review instrument was developed to extract the content of in-scope papers. Findings were characterized by date and place of publication, clinical disease area, and network/cooperative group designation, when specified. Costs were captured and grouped by patient accrual and management, infrastructure, and the opportunity costs associated with industry funding for trials research. Cost impacts on translational research and health systems were also captured, as were recommendations to reduce trial expenditures. Since articles often cited multiple costs, multiple cost coding was used during data extraction to capture the range and frequency of costs. RESULTS A total of 288 empirical articles were included. The distribution of reported costs was: patient management and accrual costs (132 articles), infrastructure costs (118 articles) and the opportunity costs of industry sponsorship (72 articles). 221 articles reported on the impact of undertaking costly trials on translational research and health systems; of these, the most frequently reported consequences were to research integrity (52% of articles), research capacity (36% of articles) and running low-value trials (34% of articles). 254 articles provided recommendations to reduce trial costs; of these, the most frequently reported recommendations related to improvements in: operational efficiencies (33% of articles); patient accrual (24% of articles); funding for trials and transparency in trials reporting (18% of articles, each). CONCLUSION Key findings from the review are: 1) delayed trial activation has costs to budgets and research; 2) poor accrual leads to low-value trials and wasted resources; 3) the pharmaceutical industry can be a pragmatic, if problematic, partner in clinical research; 4) organizational know-how and successful research collaboration are benefits of network/cooperative groups; and 5) there are spillover benefits of clinical trials to healthcare systems, including better health outcomes, enhanced research capacity, and drug cost avoidance. There is a need for more economic evaluations of the benefits of clinical research, such as health system use (or avoidance) and health outcomes in cities and health authorities with institutions that conduct clinical research, to demonstrate the affordability of clinical trials, despite their high cost.
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Affiliation(s)
- Colene Bentley
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Sonya Cressman
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Kim van der Hoek
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Karen Arts
- 3 Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Janet Dancey
- 3 Ontario Institute for Cancer Research, Toronto, ON, Canada.,4 Department of Oncology, School of Medicine, Queen's University, Kingston, ON, Canada.,5 The National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada
| | - Stuart Peacock
- 1 Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,2 Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada.,6 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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21
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Rogers CR, Rovito MJ, Hussein M, Obidike OJ, Pratt R, Alexander M, Berge JM, Dall'Era M, Nix JW, Warlick C. Attitudes Toward Genomic Testing and Prostate Cancer Research Among Black Men. Am J Prev Med 2018; 55:S103-S111. [PMID: 30670195 PMCID: PMC6352989 DOI: 10.1016/j.amepre.2018.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/18/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Black men are diagnosed with prostate cancer at nearly twice the rate of white men and are underrepresented in prostate cancer research, including validation studies of new clinical tools (e.g., genomic testing). Because healthcare system mistrust has contributed to these disparities for centuries, black men may be less inclined to pursue novel testing, and identification of facilitators to their participation in prostate cancer research studies remains warranted. METHODS A community-engaged approach involving a partnership with a community organization was used to conduct seven focus groups in Minnesota, Alabama, and California to explore black men's attitudes toward prostate cancer research participation and genomic testing for prostate cancer. Data were collected and analyzed from April 2015 to April 2017. RESULTS Identified genomic testing barriers included a lack of terminology understanding, healthcare system mistrust, reluctance to seek medical care, and unfavorable attitudes toward research. Facilitators included family history, value of prevention, and the desire for health education. Lack of prostate cancer knowledge, prostate-specific antigen testing confusion, healthcare system distrust, and misuse of personal health information were barriers to research study participation. Some black men were motivated to participate in research if it was seen as constructive and transparent. CONCLUSIONS Disparities for black men can both motivate and disincentivize participation depending upon a positive or negative view of research. Confusion over prostate cancer clinical care has fueled some mistrust among black men affecting both clinical care and research participation. With increased education, health literacy, and assurances of research integrity and transparency, black men may be more willing to participate in prostate cancer testing and research. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Charles R Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Michael J Rovito
- Department of Health Professions, University of Central Florida, Orlando, Florida
| | - Musse Hussein
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mark Alexander
- Health and Wellness Committee, 100 Black Men of America, Inc., Oakland, California
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Marc Dall'Era
- Department of Urology, University of California, Davis, Sacramento, California
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher Warlick
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
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22
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Ramamoorthy A, Knepper TC, Merenda C, Mendoza M, McLeod HL, Bull J, Zhang L, Pacanowski M. Demographic Composition of Select Oncologic New Molecular Entities Approved by the FDA Between 2008 and 2017. Clin Pharmacol Ther 2018; 104:940-948. [PMID: 30218447 PMCID: PMC6220929 DOI: 10.1002/cpt.1180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/06/2018] [Indexed: 01/13/2023]
Abstract
Race, ethnicity, sex, and age are demographic factors that can influence drug exposure and/or response, and can consequently affect treatment outcome. We evaluated demographic subgroup enrollment patterns in new therapeutic products approved by the US Food and Drug Administration (FDA) for the treatment of select cancers-breast, colorectal, lung, and prostate-that have comparative differences in morbidity and/or mortality among some demographic subgroups. In submissions of products approved between 2008 and 2013, participants (n = 22,481) were white (80%), from outside the United States (74%), between 17 and 64 years old (59%), and men (56% and 53%, including and excluding sex-specific indications, respectively). In pivotal trials of products approved between2014 and 2017, participants (n = 3,612) were white (71%), between 17 and 64 years old (61%), and men (48% and 63%, including and excluding sex-specific indications, respectively). The US-relevant minority populations were under-represented. A broader representation of patient subgroups in clinical trials may contribute to better understanding of exposure and/or response variability, and consequently help personalize drug therapy.
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Affiliation(s)
- Anuradha Ramamoorthy
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | | | - Christine Merenda
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
| | - Martin Mendoza
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
| | | | - Jonca Bull
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
- Pharmaceutical Product Development (PPD)LLCBethesdaMarylandUSA
| | - Lei Zhang
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
- Office of Research and StandardsOffice of Generic DrugsCDERFDASilver Spring, MarylandUSA
| | - Michael Pacanowski
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
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23
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Graham LF, Scott L, Lopeyok E, Douglas H, Gubrium A, Buchanan D. Outreach Strategies to Recruit Low-Income African American Men to Participate in Health Promotion Programs and Research: Lessons From the Men of Color Health Awareness (MOCHA) Project. Am J Mens Health 2018; 12:1307-1316. [PMID: 29695204 PMCID: PMC6142128 DOI: 10.1177/1557988318768602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 01/04/2023] Open
Abstract
African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs-especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease-has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we present data on the demographic and health characteristics of the population reached using these methods, which indicate that MOCHA has been highly effective in reaching this population of men.
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Affiliation(s)
- Louis F Graham
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Lamont Scott
- Department of Health and Human Services, Men of Color Health Awareness (MOCHA) Project, City of Springfield
| | - Erus Lopeyok
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Henry Douglas
- Department of Health and Human Services, Men of Color Health Awareness (MOCHA) Project, City of Springfield
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - David Buchanan
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Guerriero MK, Redman MW, Baker KK, Martins RG, Eaton K, Chow LQ, Santana-Davila R, Baik C, Goulart BH, Lee S, Rodriguez CP. Racial disparity in oncologic and quality-of-life outcomes in patients with locally advanced head and neck squamous cell carcinomas enrolled in a randomized phase 2 trial. Cancer 2018; 124:2841-2849. [DOI: 10.1002/cncr.31407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/26/2018] [Accepted: 03/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mary W. Redman
- Fred Hutchinson Cancer Research Center; Seattle Washington
| | | | | | - Keith Eaton
- University of Washington; Seattle Washington
| | | | | | | | | | - Sylvia Lee
- University of Washington; Seattle Washington
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25
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Chen A, Wright H, Itana H, Elahi M, Igun A, Soon G, Pariser AR, Fadiran EO. Representation of Women and Minorities in Clinical Trials for New Molecular Entities and Original Therapeutic Biologics Approved by FDA CDER from 2013 to 2015. J Womens Health (Larchmt) 2018; 27:418-429. [PMID: 29048983 PMCID: PMC7001461 DOI: 10.1089/jwh.2016.6272] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) has made efforts to encourage adequate assessment of women, racial/ethnic minorities, and geriatric participants in clinical trials through regulations and guidance documents. This study surveyed the demographics of clinical trial participants and the presence of efficacy and safety analyses by sex for new drugs approved between 2013 and 2015 by the FDA Center for Drug Evaluation and Research. METHODS New drug marketing applications submitted to FDA were surveyed for demographic data (sex, race, ethnicity, and age) and the presence of sex-based analyses for efficacy and safety. The Ratio of the Proportion of women in clinical trials for the indicated disease population relative to the estimated Proportion of women in the disease population (PPR) was calculated for new drug indications. RESULTS Of the 102 new drugs in this cohort (defined as new molecular entity drugs and original therapeutic biologics), sex was reported for >99.9% of trial participants, and women accounted for 40.4% of these participants. An estimated 77.2% of participants were White, 6.4% were Black/African American, and 29.1% were aged ≥65 years. Sex-based analyses for both efficacy and safety were conducted for 93.1% of applications. PPR was calculated for 82 new drugs for a total of 60 indications, of which 50 indications (83.3%) had a PPR ≥0.80. CONCLUSIONS Sex data are now collected for almost all study participants, and this study shows appropriate sex participation for most new drugs when estimated disease prevalence by sex (PPR) is considered. Therapeutic area and disease indication are important considerations when assessing the sex of participants because variation occurs depending on the disease under study. Some racial minorities, especially Blacks/African Americans, are still not well represented in most drug development programs and remain an area where improvement is needed.
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Affiliation(s)
- Alice Chen
- Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Hilary Wright
- Office of Women's Health, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland
| | - Hawi Itana
- Office of Women's Health, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland
| | - Merina Elahi
- Office of Women's Health, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland
| | - Ayomide Igun
- Office of Women's Health, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland
| | - Guoxing Soon
- Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Anne R. Pariser
- Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Emmanuel O. Fadiran
- Office of Women's Health, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland
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Affiliation(s)
- Jenna Lester
- Department of Dermatology, University of California-San Francisco, San Francisco
| | - Bruce Wintroub
- Department of Dermatology, University of California-San Francisco, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California-San Francisco, San Francisco
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27
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Eggly S, Hamel LM, Heath E, Manning MA, Albrecht TL, Barton E, Wojda M, Foster T, Carducci M, Lansey D, Wang T, Abdallah R, Abrahamian N, Kim S, Senft N, Penner LA. Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials. BMC Cancer 2017; 17:807. [PMID: 29197371 PMCID: PMC5712160 DOI: 10.1186/s12885-017-3804-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients' decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial. METHODS/DESIGN Data collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients' understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes. DISCUSSION PACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers. TRIAL REGISTRATION Clinical Trials.gov registration number: NCT02906241 (September 8, 2016).
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Mark A. Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Ellen Barton
- Department of English, Wayne State University, 5057 Woodward Suite 9408, Detroit, MI 48202 USA
| | - Mark Wojda
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Tanina Foster
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Michael Carducci
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 1M59 Bunting –Blaustein Cancer Research Building, 1650 Orleans Street, Baltimore, MD 21287 USA
| | - Dina Lansey
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Ting Wang
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Rehab Abdallah
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Narineh Abrahamian
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Seongho Kim
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
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Zeng X, Tao L, Zhang P, Qin C, Chen S, He W, Tan Y, Xia Liu H, Yang SY, Chen Z, Jiang YY, Chen YZ. HEROD: a human ethnic and regional specific omics database. Bioinformatics 2017; 33:3276-3282. [PMID: 28549078 DOI: 10.1093/bioinformatics/btx340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/25/2017] [Indexed: 02/05/2023] Open
Abstract
Motivation Genetic and gene expression variations within and between populations and across geographical regions have substantial effects on the biological phenotypes, diseases, and therapeutic response. The development of precision medicines can be facilitated by the OMICS studies of the patients of specific ethnicity and geographic region. However, there is an inadequate facility for broadly and conveniently accessing the ethnic and regional specific OMICS data. Results Here, we introduced a new free database, HEROD, a human ethnic and regional specific OMICS database. Its first version contains the gene expression data of 53 070 patients of 169 diseases in seven ethnic populations from 193 cities/regions in 49 nations curated from the Gene Expression Omnibus (GEO), the ArrayExpress Archive of Functional Genomics Data (ArrayExpress), the Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC). Geographic region information of curated patients was mainly manually extracted from referenced publications of each original study. These data can be accessed and downloaded via keyword search, World map search, and menu-bar search of disease name, the international classification of disease code, geographical region, location of sample collection, ethnic population, gender, age, sample source organ, patient type (patient or healthy), sample type (disease or normal tissue) and assay type on the web interface. Availability and implementation The HEROD database is freely accessible at http://bidd2.nus.edu.sg/herod/index.php. The database and web interface are implemented in MySQL, PHP and HTML with all major browsers supported. Contact phacyz@nus.edu.sg.
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Affiliation(s)
- Xian Zeng
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China.,Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Lin Tao
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China.,School of Medicine, Hangzhou Normal University, Hangzhou 311121, P. R. China
| | - Peng Zhang
- Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Chu Qin
- Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Shangying Chen
- Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Weidong He
- Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Ying Tan
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China.,Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
| | - Hong Xia Liu
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China
| | - Sheng Yong Yang
- State Key Laboratory of Biotherapy, Molecular Medicine Research Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zhe Chen
- Zhejiang Key Laboratory of Gastro-Intestinal Pathophysiology, Zhejiang Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yu Yang Jiang
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China
| | - Yu Zong Chen
- The State Key Laboratory Breeding Base-Shenzhen Key Laboratory of Chemical Biology, the Graduate School at Shenzhen, Tsinghua University, Shenzhen Kivita Innovative Drug Discovery Institute, Shenzhen 518055, P. R. China.,Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore 117543
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Chung JW, Bilimoria KY, Stulberg JJ, Quinn CM, Hedges LV. Estimation of Population Average Treatment Effects in the FIRST Trial: Application of a Propensity Score-Based Stratification Approach. Health Serv Res 2017; 53:2567-2590. [PMID: 28833067 DOI: 10.1111/1475-6773.12752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE/STUDY QUESTION To estimate and compare sample average treatment effects (SATE) and population average treatment effects (PATE) of a resident duty hour policy change on patient and resident outcomes using data from the Flexibility in Duty Hour Requirements for Surgical Trainees Trial ("FIRST Trial"). DATA SOURCES/STUDY SETTING Secondary data from the National Surgical Quality Improvement Program and the FIRST Trial (2014-2015). STUDY DESIGN The FIRST Trial was a cluster-randomized pragmatic noninferiority trial designed to evaluate the effects of a resident work hour policy change to permit greater flexibility in scheduling on patient and resident outcomes. We estimated hierarchical logistic regression models to estimate the SATE of a policy change on outcomes within an intent-to-treat framework. Propensity score-based poststratification was used to estimate PATE. DATA COLLECTION/EXTRACTION METHODS This study was a secondary analysis of previously collected data. PRINCIPAL FINDINGS Although SATE estimates suggested noninferiority of outcomes under flexible duty hour policy versus standard policy, the noninferiority of a policy change was inconclusively noninferior based on PATE estimates due to imprecision. CONCLUSIONS Propensity score-based poststratification can be valuable tools to address trial generalizability but may yield imprecise estimates of PATE when sparse strata exist.
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Affiliation(s)
- Jeanette W Chung
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jonah J Stulberg
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christopher M Quinn
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Larry V Hedges
- Department of Statistics, Department of Psychology, Department of Medical Social Sciences, School of Education and Social Policy, Institute for Policy Research, Northwestern University, Evanston, IL
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Cortés YI, Arcia A, Kearney J, Luchsinger J, Lucero RJ. Urban-Dwelling Community Members' Views on Biomedical Research Engagement. QUALITATIVE HEALTH RESEARCH 2017; 27:130-137. [PMID: 26825482 PMCID: PMC5166984 DOI: 10.1177/1049732315627650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study, we explore community members' overall understanding and experience with biomedical research engagement. We conducted a qualitative analysis to explore a concept that emerged but was not specifically addressed in a pre-existing dataset obtained using four focus group sessions with 30 urban-dwelling community members. Transcripts were read in an iterative process, and an emergent content analysis was performed. Five main themes were identified: (a) engaging in research to contribute to personal or greater good, (b) hierarchy of trust, (c) the importance of disclosure and transparency, (d) practical barriers to research engagement, and (e) fear of research procedures. Community members view research engagement as a collaborative process whereby community members and researchers are involved in all stages of the investigation. Focusing on research engagement, and not merely participation, may enhance community knowledge of the research process and advance scientific knowledge.
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Affiliation(s)
| | | | - Joan Kearney
- Yale School of Nursing, West Haven, Connecticut, USA
| | | | - Robert J Lucero
- University of Florida, Gainesville, Florida, USA
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, Gainesville, Florida, USA
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31
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Oren O, Oren M, Beach D. On the generalizability of prostate cancer studies: why race matters. Ann Oncol 2016; 27:2146-2148. [PMID: 27573566 DOI: 10.1093/annonc/mdw409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Oren
- Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA;
| | - M Oren
- Internal Medicine, Wolfson Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - D Beach
- Hematology and Oncology Division, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA
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Ahaghotu C, Tyler R, Sartor O. African American Participation in Oncology Clinical Trials--Focus on Prostate Cancer: Implications, Barriers, and Potential Solutions. Clin Genitourin Cancer 2015; 14:105-16. [PMID: 26786562 DOI: 10.1016/j.clgc.2015.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022]
Abstract
In the United States, the incidence and mortality rates of many cancers, especially prostate cancer, are disproportionately high among African American men compared with Caucasian men. Recently, mortality rates for prostate cancer have declined more rapidly in African American versus Caucasian men, but prostate cancer is still the most common cancer and the second leading cause of cancer deaths in African American men in the United States. Compared with Caucasian men, prostate cancer occurs at younger ages, has a higher stage at diagnosis, and is more likely to progress after definitive treatments in African American men. Reasons for racial discrepancies in cancer are multifactorial and potentially include socioeconomic, cultural, nutritional, and biologic elements. In addition to improving access to novel therapies, clinical trial participation is essential to adequately establish the risks and benefits of treatments in African American populations. Considering the disproportionately high mortality rates noted in these groups, our understanding of the natural history and responses to therapies is limited. This review will explore African American underrepresentation in clinical trials with a focus on prostate cancer, and potentially effective strategies to engage African American communities in prostate cancer research. Solutions targeting physicians, investigators, the community, and health care systems are identified. Improvement of African American participation in prostate cancer clinical trials will benefit all stakeholders.
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Affiliation(s)
- Chiledum Ahaghotu
- Department of Urology, College of Medicine, Howard University, Washington, DC.
| | | | - Oliver Sartor
- Departments of Urology and Medicine, Tulane University School of Medicine, New Orleans, LA
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Frew PM, Omer SB, Parker K, Bolton M, Schamel J, Shapiro E, Owens L, Saint-Victor D, Boggavarapu S, Braxton N, Archibald M, Kalokhe AS, Horton T, Root CM, Fenimore VL, Anderson AM. Delivering a "dose of hope": a faith-based program to increase older african americans' participation in clinical trials. JMIR Res Protoc 2015; 4:e64. [PMID: 26036841 PMCID: PMC4526899 DOI: 10.2196/resprot.4072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Underrepresentation of older-age racial and ethnic minorities in clinical research is a significant barrier to health in the United States, as it impedes medical research advancement of effective preventive and therapeutic strategies. OBJECTIVE The objective of the study was to develop and test the feasibility of a community-developed faith-based intervention and evaluate its potential to increase the number of older African Americans in clinical research. METHODS Using a cluster-randomized design, we worked with six matched churches to enroll at least 210 persons. We provided those in the intervention group churches with three educational sessions on the role of clinical trials in addressing health disparity topics, and those in the comparison group completed surveys at the same timepoints. All persons enrolled in the study received ongoing information via newsletters and direct outreach on an array of clinical studies seeking participants. We evaluated the short-, mid-, and longer-term effects of the interventional program on clinical trial-related outcomes (ie, screening and enrollment). RESULTS From 2012 to 2013, we enrolled a balanced cohort of 221 persons in the program. At a 3-month follow-up, mean intention to seek information about clinical trials was higher than baseline in both treatment (mu=7.5/10; sigma=3.1) and control arms (mu=6.6/10; sigma=3.3), with the difference more pronounced in the treatment arm. The program demonstrated strong retention at 3-month (95.4%, 211/221) and 6-month timepoints (94.1%, 208/221). CONCLUSIONS The "Dose of Hope" program addressed an unmet need to reach an often overlooked audience of older African Americans who are members of churches and stimulate their interest in clinical trial participation. The program demonstrated its appeal in the delivery of effective messages and information about health disparities, and the role of clinical research in addressing these challenges.
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Affiliation(s)
- Paula M Frew
- Emory University, Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Decatur, GA, United States.
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Burchard EG, Oh SS, Foreman MG, Celedón JC. Moving toward true inclusion of racial/ethnic minorities in federally funded studies. A key step for achieving respiratory health equality in the United States. Am J Respir Crit Care Med 2015; 191:514-21. [PMID: 25584658 DOI: 10.1164/rccm.201410-1944pp] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A key objective of the 1993 National Institutes of Health (NIH) Revitalization Act was to ensure inclusion of minorities in clinical research. We conducted a literature search for the period from 1993 to 2013 to examine whether racial/ethnic minorities are adequately represented in published research studies of pulmonary diseases, particularly NIH-funded studies. We found a marked underrepresentation of minorities in published clinical research on pulmonary diseases. Over the last 20 years, inclusion of members of racial or ethnic minority groups was reported (in MeSH terms, journal titles, and MEDLINE fields) in less than 5% of all NIH-funded published studies of respiratory diseases. Although a secondary analysis revealed that a larger proportion of NIH-funded studies included any minorities, this proportional increment mostly resulted from studies including relatively small numbers of minorities (which precludes robust race- or ethnic-specific analyses). Underrepresentation or exclusion of minorities from NIH-funded studies is likely due to multiple reasons, including insufficient education and training on designing and implementing population-based studies of minorities, inadequate motivation or incentives to overcome challenges in the recruitment and retention of sufficient numbers of members of racial/ethnic minorities, underrepresentation of minorities among respiratory scientists in academic medical centers, and a dearth of successful partnerships between academic medical centers and underrepresented communities. This problem could be remedied by implementing short-, medium-, and long-term strategies, such as creating incentives to conduct minority research, ensuring fair review of grant applications focusing on minorities, developing the careers of minority scientists, and facilitating and valuing research on minorities by investigators of all backgrounds.
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Affiliation(s)
- Esteban G Burchard
- 1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California
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35
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Spratt DE, Osborne JR. Disparities in castration-resistant prostate cancer trials. J Clin Oncol 2015; 33:1101-3. [PMID: 25691679 DOI: 10.1200/jco.2014.58.1751] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Galsky MD, Oh WK. Mind the gap: Efficacy versus effectiveness and pivotal prostate cancer clinical trial demographics. Cancer 2014; 120:2944-5. [DOI: 10.1002/cncr.28808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/07/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew D. Galsky
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute; Icahn School of Medicine at Mount Sinai; New York New York
| | - William K. Oh
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute; Icahn School of Medicine at Mount Sinai; New York New York
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