1
|
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.
Collapse
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
| |
Collapse
|
2
|
Nindra U, Shivasabesan G, Childs S, Yoon R, Haider S, Hong M, Cooper A, Roohullah A, Wilkinson K, Pal A, Chua W. Time toxicity associated with early phase clinical trial participation. ESMO Open 2023; 8:102046. [PMID: 37979324 PMCID: PMC10774969 DOI: 10.1016/j.esmoop.2023.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Early phase cancer clinical trials (EPCTs) involve experimental drugs being used for the first time in humans. These studies are designed for dose determination and safety, and represent the most time intensive of all clinical trials for both clinicians and patients. We sought to quantify the amount of patient time consumed through EPCT participation. PATIENTS AND METHODS A retrospective audit of patients treated in the EPCT unit at Liverpool Hospital, Sydney was carried out from 2013 to 2023. We defined 'time toxicity' (TT) as a composite measure where time-toxic days were considered days with any health care system contact, including clinic visits, infusions, procedures or blood work. RESULTS A total of 219 patients across 36 EPCTs were included. The median age was 65 years (range 31-81 years). Patients spent a median of 29% (range 4%-100%) of their days in direct contact with the health care system during their study. Protocol-specified visits accounted for the greatest contribution to total TT in 101 (46%) patients. In 7% (n = 16) of patients, unscheduled visits due to either adverse events or cancer-related symptoms accounted for the greatest TT. TT reduced as patients completed additional cycles of treatment. Patients who completed >10 cycles spent 14% of their days interacting with health care systems compared with 35% for those who completed ≤2 cycles. No statistically significant difference in TT was noted between dose-expansion and dose-escalation studies or trials focusing on immune-oncology versus targeted therapy. CONCLUSIONS Our study is the first to report TT in EPCTs with an extended follow-up. Clinicians should be aware of TT when discussing risks and benefits. TT also may not be the appropriate term when describing the time patients invest during EPCTs. Toxicity implies a negative impact, but for many patients, trial participation would be seen as positive. There should be efforts to streamline health care visits to limit TT in EPCTs.
Collapse
Affiliation(s)
- U Nindra
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney.
| | - G Shivasabesan
- Department of Medical Oncology, Liverpool Hospital, Liverpool
| | - S Childs
- Department of Medical Oncology, Liverpool Hospital, Liverpool
| | - R Yoon
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown
| | - S Haider
- Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Northern Cancer Service, Burnie
| | - M Hong
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Roohullah
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown
| | - K Wilkinson
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Pal
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Department of Medical Oncology, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - W Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| |
Collapse
|
3
|
Dang LE, Fong E, Tarp JM, Clemmensen KKB, Ravn H, Kvist K, Buse JB, van der Laan M, Petersen M. Case study of semaglutide and cardiovascular outcomes: An application of the C ausal Roadmap to a hybrid design for augmenting an RCT control arm with real-world data. J Clin Transl Sci 2023; 7:e231. [PMID: 38028337 PMCID: PMC10643919 DOI: 10.1017/cts.2023.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/09/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Increasing interest in real-world evidence has fueled the development of study designs incorporating real-world data (RWD). Using the Causal Roadmap, we specify three designs to evaluate the difference in risk of major adverse cardiovascular events (MACE) with oral semaglutide versus standard-of-care: (1) the actual sequence of non-inferiority and superiority randomized controlled trials (RCTs), (2) a single RCT, and (3) a hybrid randomized-external data study. Methods The hybrid design considers integration of the PIONEER 6 RCT with RWD controls using the experiment-selector cross-validated targeted maximum likelihood estimator. We evaluate 95% confidence interval coverage, power, and average patient time during which participants would be precluded from receiving a glucagon-like peptide-1 receptor agonist (GLP1-RA) for each design using simulations. Finally, we estimate the effect of oral semaglutide on MACE for the hybrid PIONEER 6-RWD analysis. Results In simulations, Designs 1 and 2 performed similarly. The tradeoff between decreased coverage and patient time without the possibility of a GLP1-RA for Designs 1 and 3 depended on the simulated bias. In real data analysis using Design 3, external controls were integrated in 84% of cross-validation folds, resulting in an estimated risk difference of -1.53%-points (95% CI -2.75%-points to -0.30%-points). Conclusions The Causal Roadmap helps investigators to minimize potential bias in studies using RWD and to quantify tradeoffs between study designs. The simulation results help to interpret the level of evidence provided by the real data analysis in support of the superiority of oral semaglutide versus standard-of-care for cardiovascular risk reduction.
Collapse
Affiliation(s)
- Lauren E. Dang
- Department of Biostatistics, University of California, Berkeley, CA, USA
| | | | | | | | | | | | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mark van der Laan
- Department of Biostatistics, University of California, Berkeley, CA, USA
| | - Maya Petersen
- Department of Biostatistics, University of California, Berkeley, CA, USA
| |
Collapse
|
4
|
Duenas JAC, Sanchez P N, Bonilla CE. Comparison of clinical outcomes among cancer patients treated in and out of clinical trials. BMC Cancer 2023; 23:786. [PMID: 37612602 PMCID: PMC10463452 DOI: 10.1186/s12885-023-11305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND It is unknown if participation in a cancer clinical trial confers clinical benefits to patients. There is not enough scientific evidence in this regard and the available publications are scarce and provide ambiguous and limited information. OBJECTIVE Compare overall and progression-free survival and response to treatment among those who met the eligibility criteria and accepted to participate and those who refused to participate in cancer clinical trials. METHODS An observational cross-sectional study with an analytical component was carried out, which included patients diagnosed with cancer who participated in phase III clinical trials and patients who, being eligible, refused to participate. The patients were cared for at the National Institute of Cancerology in Colombia between 2019 and 2022. Analysis of differences in proportions and means of sociodemographic and clinical variables was included; overall survival and progression-free survival time were described and the survival curves between groups were compared. Variables related to survival were determined using a Cox regression model and Hazard Ratios were calculated. RESULTS 62 women and 50 men were included. In the women group, we found a statistical association between clinical trial participation and non-serious events adverse and progression. The stable disease and complete response were higher in participants than in refusers. The median progression-free survival for refusers was 7,4 m meantime for participants the median was not reached and 74,1% remained without progression at 28 months. In the men group, we also found a statistical association between clinical trial participation and the occurrence of non-serious events adverse meanwhile there were no significant differences in overall response, progression, and death, even though the proportion of progression was minor in participants 20% vs. refusers 26% respectively. The median survival was not reached for any group, even though in the participants group 55,2% were still alive at month 20 and in the refusers group still alive at 56,8% at month 45. Covariables included for the multivariate Cox regression only age had a statistical association with overall survival in the women's group and the men group any covariables reached statistical association. CONCLUSION It can be considered that participation in clinical trials could give participants a better response to treatment, without increasing the probability of death and with the probability of decreasing the progression of the disease. Participation in trials could improve the outcomes of clinical response rates, no change in overall survival, and progression-free.
Collapse
Affiliation(s)
- Jose A Carreno Duenas
- Instituto Nacional de Cancerología - Colombia, Calle 1 # 9-85, Bogota, 110111, Colombia.
| | - Natalia Sanchez P
- Centro de tratamiento e investigación sobre cáncer (CTIC), Calle 168 # 14 -49, Bogota, 110131, Colombia
| | - Carlos E Bonilla
- Centro de tratamiento e investigación sobre cáncer (CTIC), Calle 168 # 14 -49, Bogota, 110131, Colombia
| |
Collapse
|
5
|
Ceelen W, Soreide K. Randomized controlled trials and alternative study designs in surgical oncology. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1331-1340. [PMID: 36964056 DOI: 10.1016/j.ejso.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Surgery is central to the cure of most solid cancers and an integral part of modern multimodal cancer management for early and advanced stage cancers. Decisions made by surgeons and multidisciplinary team members are based on best available knowledge for the defined clinical situation at hand. While surgery is both an art and a science, good decision-making requires data that are robust, valid, representative and, applicable to most if not all patients with a specific cancer. Such data largely comes from clinical observations and registries, and more preferably from trials conducted with the specific purpose of arriving at new answers. As part of the ESSO core curriculum development an increased focus has been put on the need to enhance research literacy among surgical candidates. As an expansion of the curriculum catalogue list and to enhance the educational value, we here present a set of principles and emerging concepts which applies to surgical oncologist for reading, understanding, planning and contributing to future surgeon-led cancer trials.
Collapse
Affiliation(s)
- Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; SAFER Surgery, Surgical Research Unit, Stavanger University Hospital, Stavanger, Norway.
| |
Collapse
|
6
|
Søreide K. A formula for survival in surgery. Patient Saf Surg 2023; 17:13. [PMID: 37245020 DOI: 10.1186/s13037-023-00362-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
- SAFER Surgery, Stavanger University Hospital, Stavanger, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| |
Collapse
|
7
|
Kempf E, Vaterkowski M, Leprovost D, Griffon N, Ouagne D, Breant S, Serre P, Mouchet A, Rance B, Chatellier G, Bellamine A, Frank M, Guerin J, Tannier X, Livartowski A, Hilka M, Daniel C. How to Improve Cancer Patients ENrollment in Clinical Trials From rEal-Life Databases Using the Observational Medical Outcomes Partnership Oncology Extension: Results of the PENELOPE Initiative in Urologic Cancers. JCO Clin Cancer Inform 2023; 7:e2200179. [PMID: 37167578 DOI: 10.1200/cci.22.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To compare the computability of Observational Medical Outcomes Partnership (OMOP)-based queries related to prescreening of patients using two versions of the OMOP common data model (CDM; v5.3 and v5.4) and to assess the performance of the Greater Paris University Hospital (APHP) prescreening tool. MATERIALS AND METHODS We identified the prescreening information items being relevant for prescreening of patients with cancer. We randomly selected 15 academic and industry-sponsored urology phase I-IV clinical trials (CTs) launched at APHP between 2016 and 2021. The computability of the related prescreening criteria (PC) was defined by their translation rate in OMOP-compliant queries and by their execution rate on the APHP clinical data warehouse (CDW) containing data of 205,977 patients with cancer. The overall performance of the prescreening tool was assessed by the rate of true- and false-positive cases of three randomly selected CTs. RESULTS We defined a list of 15 minimal information items being relevant for patients' prescreening. We identified 83 PC of the 534 eligibility criteria from the 15 CTs. We translated 33 and 62 PC in queries on the basis of OMOP CDM v5.3 and v5.4, respectively (translation rates of 40% and 75%, respectively). Of the 33 PC translated in the v5.3 of the OMOP CDM, 19 could be executed on the APHP CDW (execution rate of 58%). Of 83 PC, the computability rate on the APHP CDW reached 23%. On the basis of three CTs, we identified 17, 32, and 63 patients as being potentially eligible for inclusion in those CTs, resulting in positive predictive values of 53%, 41%, and 21%, respectively. CONCLUSION We showed that PC could be formalized according to the OMOP CDM and that the oncology extension increased their translation rate through better representation of cancer natural history.
Collapse
Affiliation(s)
- Emmanuelle Kempf
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Department of Medical Oncology, Assistance Publique Hôpitaux de Paris, Henri Mondor Teaching Hospital, Créteil, France
| | - Morgan Vaterkowski
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
- EPITA School of Engineering and Computer Science, Paris, France
| | - Damien Leprovost
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Griffon
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - David Ouagne
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stéphane Breant
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Patricia Serre
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Mouchet
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Gilles Chatellier
- Department of Medical Informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Ali Bellamine
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Frank
- Department of Medical Information, Paris Saclay Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Xavier Tannier
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
| | | | - Martin Hilka
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christel Daniel
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
8
|
Bleinc A, Blin T, Legue S, Mankikian J, Plantier L, Marchand-Adam S. [Real-life survival of idiopathic pulmonary fibrosis with anti-fibrotic medication]. Rev Mal Respir 2023; 40:371-381. [PMID: 37117065 DOI: 10.1016/j.rmr.2023.03.004] [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: 03/13/2022] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is an irreversible fibrosing disease with median survival at diagnosis of 2-5 years. That said, pirfenidone and nintedanib slow down the gradual decline in respiratory function. Clinical trials have shown that while they are not curative, these drugs reduce mortality and increase survival time compared to placebo. This objective of this work was to compare the real-life survival of patients with IPF diagnosed at the Tours University Hospital depending on whether or not they took anti-fibrotic medication. METHODS This is a monocentric retrospective study involving 176 patients diagnosed with IPF starting from 1997. Out of these 176 patients, 100 were treated with anti-fibrotic agents and 76 did not receive any anti-fibrotic treatment. RESULTS Survival significantly increased in the group with anti-fibrotic medication, with median survival of 59 months [46-87] versus 39 months [29-65] (P=0.022). Predictive factors for death were neoplasia, IPF exacerbation and decreased DLCO. CONCLUSION Our study corroborates the beneficial result observed in clinical trials by showing longer survival in patients using anti-fibrotic agents.
Collapse
Affiliation(s)
- Alexandre Bleinc
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France.
| | - Timothée Blin
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
| | - Sylvie Legue
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Julie Mankikian
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Laurent Plantier
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
| |
Collapse
|
9
|
Peterson JS, Plana D, Bitterman DS, Johnson SB, Aerts HJWL, Kann BH. Growth in eligibility criteria content and failure to accrue among National Cancer Institute (NCI)-affiliated clinical trials. Cancer Med 2023; 12:4715-4724. [PMID: 36398619 PMCID: PMC9972031 DOI: 10.1002/cam4.5276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cancer trial accrual is a national priority, yet up to 20% of trials fail to accrue. Trial eligibility criteria growth may be associated with accrual failure. We sought to quantify eligibility criteria growth within National Cancer Institute (NCI)-affiliated trials and determine impact on accrual. METHODS Utilizing the Aggregated Analysis of ClinicalTrials.gov, we analyzed phase II/III interventional NCI-affiliated trials initiated between 2008 and 2018. Eligibility criteria growth was assessed via number of unique content words within combined inclusion and exclusion criteria. Association between unique word count and accrual failure was evaluated with multivariable logistic regression, adjusting for known predictors of failure. Medical terms associated with accrual failure were identified via natural language processing and categorized. RESULTS Of 1197 trials, 231 (19.3%) failed due to low accrual. Accrual failure rate increased with eligibility criteria growth, from 11.8% in the lowest decile (12-112 words) to 29.4% in the highest decile (445-750 words). Median eligibility criteria increased over time, from 214 (IQR [23, 282]) unique content words in 2008 to 417 (IQR [289, 514]) in 2018 (r2 = 0.73, P < 0.001). Eligibility criteria growth was independently associated with accrual failure (OR: 1.09 per decile, 95% CI [1.03-1.15], p = 0.004). Eighteen exclusion criteria categories were significantly associated with accrual failure, including renal, pulmonary, and diabetic, among others (Bonferroni-corrected p < 0.001). CONCLUSIONS Eligibility criteria content growth is increasing dramatically among NCI-affiliated trials and is strongly associated with accrual failure. These findings support national initiatives to simplify eligibility criteria and suggest that further efforts are warranted to improve cancer trial accrual.
Collapse
Affiliation(s)
- John S Peterson
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Danielle S Bitterman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Artificial Intelligence in Medicine (AIM) Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Skyler Bryce Johnson
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Hugo J W L Aerts
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Artificial Intelligence in Medicine (AIM) Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Radiology and Nuclear Medicine, Maastricht University, Maastricht, The Netherlands
| | - Benjamin Harris Kann
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Artificial Intelligence in Medicine (AIM) Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Flammia RS, Lavigne D, Tian Z, Saad F, Anceschi U, Gallucci M, Leonardo C, Preisser F, Mandel P, Chun FKH, Karakiewicz PI, Delouya G, Taussky D, Hoeh B. Trial Participation is Not Associated with Better Biochemical Recurrence-free Survival in a Large Cohort of External Beam Radiotherapy-Treated Intermediate- and High-Risk Prostate Cancer Patients. Clin Oncol (R Coll Radiol) 2023; 35:e77-e84. [PMID: 36115747 DOI: 10.1016/j.clon.2022.08.031] [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: 03/26/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
AIMS There is a widespread belief that outcomes of cancer patients treated within clinical trials might not be representative of the outcomes obtained within standard clinical settings. We sought to investigate the effect of trial participation on biochemical recurrence (BCR) in localised, D'Amico intermediate- and high-risk prostate cancer patients treated with external beam radiotherapy (EBRT). MATERIALS AND METHODS We relied on a study population treated with EBRT between January 2001 and January 2021 at a single tertiary care centre, stratified according to trial enrolment. Separate Kaplan-Meier and multivariable Cox regression models tested BCR-free survival at 60 months within intermediate- and high-risk EBRT patients, after adjustment for covariables. Additionally, the analyses were refitted after inverse probability treatment weighting was performed separately for both risk subgroups. RESULTS Of 932 eligible patients, 635 (68%) and 297 (32%) had intermediate- and high-risk prostate cancer, respectively. Overall, 53% of patients were trial participants. BCR rates were 11 versus 5% (P = 0.27) and 12 versus 14% (P = 0.08) in trial participants versus non-participants for intermediate- and high-risk subgroups, respectively. Differences in patient and clinical characteristics were recorded. Trial participation status failed to reach predictor status in multivariable Cox regression models for BCR in both intermediate-risk (hazard ratio 1.34; 95% confidence interval 0.71-2.49; P = 0.4) and high-risk patients (hazard ratio 1.03; 95% confidence interval 0.45-2.34; P = 0.9). Virtually the same results were recorded in inverse probability treatment weighting cohorts. CONCLUSIONS Relying on a large cohort of EBRT-treated intermediate- and high-risk patients, no BCR differences were recorded between trial participants and non-participants after accounting for confounders.
Collapse
Affiliation(s)
- R S Flammia
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - D Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| | - Z Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - F Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Department of Surgery, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - U Anceschi
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy; Department of Uro-oncology, National Cancer Institute, IRCCS "IFO-Reginal Elena", Rome, Italy
| | - M Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - C Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - F Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - P Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - F K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - G Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - D Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - B Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
11
|
Jorge S, Masshoor S, Gray HJ, Swisher EM, Doll KM. Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials. J Natl Compr Canc Netw 2023; 21:27-32.e2. [PMID: 36634612 DOI: 10.6004/jnccn.2022.7068] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. METHODS In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access-related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. RESULTS Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11-0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12-0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. CONCLUSIONS Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.
Collapse
Affiliation(s)
- Soledad Jorge
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | | | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| |
Collapse
|
12
|
Maliko N, Bijker N, Bos MEMM, Wouters MWJM, Vrancken Peeters MJTFD. Patterns of care over 10 years in young breast cancer patients in the Netherlands, a nationwide population-based study. Breast 2022; 66:285-292. [PMID: 36375390 PMCID: PMC9663518 DOI: 10.1016/j.breast.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Each year, around 600 young (<40 years) breast cancer (BC) patients are registered in the national NABON Breast Cancer Audit (NBCA). The aim of this study is to compare patient and treatment characteristics of young and older age BC patients over time with a focus on outcome of quality indicators (QIs). Furthermore, we analysed whether de-escalation trends of treatment can be recognized to the same degree in both patient groups. MATERIAL AND METHODS From October 2011 to October 2020 all patients treated for stage I-III invasive BC were included. Tumour characteristics, treatment variables and outcome of QIs of two age categories young (<40 years) and older patient (≥40 years) were analysed. RESULTS In total 114,700 patients were included: 4.6% young patients and 95.4% older patients. Young patients more often presented with a palpable mass, higher stage, and triple-negative BC. Overall, young patients more often started with neoadjuvant systemic treatment (NST) (54.3% vs. 18.6%) and a greater proportion of the young patients retained their breast contour after surgery (73.5% vs. 69.3%). De-escalation trends such as decrease in axillary lymph node dissections and in the use of boost were observed. The omission of radiation treatment after breast conserving surgery was only observed in older patients. CONCLUSION Although this study shows that young women more often present with unfavourable tumours, therapeutic procedures are performed with a higher adherence to the QIs than for older patients and young women do benefit from some de-escalation trends to the same extend as older patients.
Collapse
Affiliation(s)
- Nansi Maliko
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, AmsterdamUMC, Amsterdam, the Netherlands
| | - Monique EMM. Bos
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Michel WJM. Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marie-Jeanne TFD. Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands,Department of Surgery, AmsterdamUMC, Amsterdam, the Netherlands,Corresponding author. Department of Surgical oncology, Netherlands CancerInstitute/Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, the Netherlands.
| | | |
Collapse
|
13
|
Viljoen B, Hofman MS, Chambers SK, Dunn J, Dhillon HM, Davis ID, Ralph N. Experiences of participants in a clinical trial of a novel radioactive treatment for advanced prostate cancer: A nested, qualitative longitudinal study. PLoS One 2022; 17:e0276063. [PMID: 36350899 PMCID: PMC9645653 DOI: 10.1371/journal.pone.0276063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Qualitative studies nested within clinical trials can provide insight into the treatment experience, how this evolves over time and where improved supportive care is required. The purpose of this qualitative study is to describe the lived experiences of men with advanced prostate cancer participating in the TheraP trial; a randomised trial of 177Lu-PSMA-617 compared with cabazitaxel chemotherapy. Methods Fifteen men with advanced prostate cancer were recruited from the TheraP clinical trial with interviews conducted at three timepoints during the trial. An interpretative phenomenological approach was used, and interviews analysed using thematic analysis. This research paper reports the results from the mid-point, conclusion and follow up interviews, focusing specifically on participants’ experiences of trial participation. Results Three themes were identified representing the lived experiences of men with advanced prostate cancer participating in the TheraP trial: (1) facing limited options; (2) anticipating outcomes and (3) coping with health changes. Conclusions Men who enrol in clinical trial of anti-neoplastic treatments for prostate cancer need targeted psychological and supportive care that includes attention to unique aspects of the experience of having prostate cancer and being in a clinical trial. As part of their trial experience, men with advanced prostate cancer need to be regularly assessed for survivorship needs, fully informed, supported and referred to services for regular care and support across the trajectory of their disease. Trial registration NCT03392428. Registered on 8 January 2018 (ANZUP1603).
Collapse
Affiliation(s)
- Bianca Viljoen
- School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Michael S. Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Suzanne K. Chambers
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Jeff Dunn
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Victoria, Australia
| | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia
| | - Nicholas Ralph
- School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- * E-mail:
| |
Collapse
|
14
|
Elshami M, Hue JJ, Hoehn RS, Rothermel LD, Bajor D, Mohamed A, Selfridge JE, Chavin KD, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. A nationwide analysis of clinical trial participation for common hepato-pancreato-biliary malignancies demonstrates survival advantages for subsets of trial patients but disparities in and infrequency of enrollment. HPB (Oxford) 2022; 24:1280-1290. [PMID: 35063353 DOI: 10.1016/j.hpb.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND We describe factors associated with trial enrollment for patients with hepato-pancreato-biliary (HPB) malignancies. We analyzed the association and effect of trial enrollment on overall survival (OS). METHODS The National Cancer Database (2004-2017) was queried for common HPB malignancies (pancreatic adenocarcinoma [PDAC] & neuroendocrine tumors, hepatocellular carcinoma [HCC], biliary tract cancers [BTC]). Multivariable logistic regression was used to identify factors associated with trial enrollment. OS was analyzed by multivariable Cox regression. Inverse-probability-weighted Cox regression was utilized to determine the effect of trial enrollment on OS. RESULTS A total of 1573 (0.3%) of 511,639 patients were enrolled in trials; pancreatic malignancy: 1214 (0.4%); HCC: 217 (0.14%); BTC: 106 (0.15%). HCC and BTC were associated with lower likelihood of enrollment compared with pancreatic malignancy. Black and Hispanic patients were less likely to be enrolled compared to White patients. Treatment at academic facilities and metastatic disease were associated with higher likelihood of enrollment. Enrollment was associated with higher OS for PDAC, metastatic HCC, and metastatic BTC. Trial enrollment exhibited an OS advantage for PDAC and metastatic HCC. CONCLUSION Nationally, fewer than 1% of patients with HPB malignancies were enrolled in clinical trials. There are racial, sociodemographic, and facility-based disparities in trial enrollment.
Collapse
Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richard S Hoehn
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luke D Rothermel
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Bajor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mohamed
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer E Selfridge
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth D Chavin
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Division of Surgical Oncology, Department of Surgery University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| |
Collapse
|
15
|
Rotsides JM, Moses LE, Malloy KM, Brenner C, Fayson SM, Brown DJ, Spector ME. Disparities in access to translational research. Curr Probl Cancer 2022; 46:100894. [DOI: 10.1016/j.currproblcancer.2022.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
|
16
|
Melnick KF, Miller P, Carmichael E, McGrath K, Ghiaseddin A, Tran DD, Rahman M. The trial effect in patients with glioblastoma: effect of clinical trial enrollment on overall survival. J Neurooncol 2022; 159:479-484. [PMID: 35840786 DOI: 10.1007/s11060-022-04083-8] [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: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether participation in a clinical trial was associated with improved survival in patients with glioblastoma (GBM). METHODS Following IRB approval, patients were identified using CPT and ICD codes. Data was collected using retrospective review of electronic medical records. When necessary, death data was obtained from online obituaries. Inverse propensity score matching was utilized to transform the two cohorts to comparable sets. Survival was compared using Kaplan-Meyer curves and Wilcoxon Rank Sum Test. RESULTS In this cohort of 365 patients, 89 were enrolled in a clinical trial and 276 were not. Patients enrolled in clinical trials had a significantly higher mean baseline KPS score, higher proportion of surgical resections, and were more likely to receive temozolomide treatment than patients not enrolled in a clinical trial. After inverse propensity score matching, patients enrolled in a clinical trial lived significantly longer than those not enrolled (28.8 vs 22.2 months, p = 0.005). A potential confounder of this study is that patients not in a clinical trial had significantly fewer visits with neuro-oncologists than patients enrolled in a clinical trial (7 ± 8 vs 12 ± 9, p < 0. 0001). CONCLUSIONS Clinical trials enroll patients with the most favorable prognostic features. Even when correcting for this bias, clinical trial enrollment is an independent predictor of increased survival regardless of treatment arm.
Collapse
Affiliation(s)
- Kaitlyn F Melnick
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA.
| | - Patricia Miller
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Ethan Carmichael
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Kyle McGrath
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Ashley Ghiaseddin
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - David D Tran
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Maryam Rahman
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| |
Collapse
|
17
|
Silk AW, Barker CA, Bhatia S, Bollin KB, Chandra S, Eroglu Z, Gastman BR, Kendra KL, Kluger H, Lipson EJ, Madden K, Miller DM, Nghiem P, Pavlick AC, Puzanov I, Rabinowits G, Ruiz ES, Sondak VK, Tavss EA, Tetzlaff MT, Brownell I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer. J Immunother Cancer 2022; 10:e004434. [PMID: 35902131 PMCID: PMC9341183 DOI: 10.1136/jitc-2021-004434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/21/2022] Open
Abstract
Nonmelanoma skin cancers (NMSCs) are some of the most commonly diagnosed malignancies. In general, early-stage NMSCs have favorable outcomes; however, a small subset of patients develop resistant, advanced, or metastatic disease, or aggressive subtypes that are more challenging to treat successfully. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration (FDA) for the treatment of Merkel cell carcinoma (MCC), cutaneous squamous cell carcinoma (CSCC), and basal cell carcinoma (BCC). Although ICIs have demonstrated activity against NMSCs, the routine clinical use of these agents may be more challenging due to a number of factors including the lack of predictive biomarkers, the need to consider special patient populations, the management of toxicity, and the assessment of atypical responses. With the goal of improving patient care by providing expert guidance to the oncology community, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their own clinical experience to develop recommendations for healthcare professionals on important aspects of immunotherapeutic treatment for NMSCs, including staging, biomarker testing, patient selection, therapy selection, post-treatment response evaluation and surveillance, and patient quality of life (QOL) considerations, among others. The evidence- and consensus-based recommendations in this CPG are intended to provide guidance to cancer care professionals treating patients with NMSCs.
Collapse
Affiliation(s)
- Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn B Bollin
- Hematology and Medical Oncology, Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Sunandana Chandra
- Hematology Oncology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Brian R Gastman
- Melanoma and High-Risk Skin Cancer Program, Cleveland Clinic Cancer Center, Cleveland, Ohio, USA
| | - Kari L Kendra
- Division Of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Harriet Kluger
- Yale Cancer Center, Yale University, New Haven, Connecticut, USA
| | - Evan J Lipson
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Madden
- Melanoma/Cutaneous Oncology Program, New York University Langone Perlmutter Cancer Center, New York, New York, USA
| | - David M Miller
- Department of Medicine and Department of Dermatology, Massachusetts General Cancer Center, Boston, Massachusetts, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna C Pavlick
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Guilherme Rabinowits
- Department of Hematology/Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Emily S Ruiz
- Mohs and Dermatologic Surgery Center, Dana-Farber/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Michael T Tetzlaff
- Dermopathology Division, University of California San Francisco, San Francisco, California, USA
| | - Isaac Brownell
- Dermatology Branch, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
18
|
Hue JJ, Katayama ES, Markt SC, Elshami M, Saltzman J, Bajor D, Hosmer A, Mok S, Dumot J, Ammori JB, Rothermel LD, Hardacre JM, Winter JM, Ocuin LM. A nationwide analysis of pancreatic cancer trial enrollment reveals disparities and participation problems. Surgery 2022; 172:257-264. [PMID: 34839935 DOI: 10.1016/j.surg.2021.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/22/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Our research group recently surveyed the clinical trial landscape in pancreatic adenocarcinoma and identified 430 active trials. These represent an opportunity to expand treatment options for patients with pancreatic adenocarcinoma. Our primary objective was to detail clinical trial participation among patients with pancreatic adenocarcinoma. Our secondary objective was to evaluate survival. METHODS We queried the National Cancer Database (2004-2016) for patients with pancreatic adenocarcinoma. Patients were stratified by trial participation: clinical trial or non-trial. Multivariable logistic regression was used to identify variables associated with trial participation. The Kaplan-Meier method and multivariable Cox hazards regression were used to analyze survival. RESULTS In total, 261,483 patients were included: 1,110 (0.4%) were enrolled in a clinical trial. A total of 57 Black patients participated in a clinical trial (0.19% of Black patients). This was lower compared to White patients (n = 955, 0.49% of White patients, P < .001). After adjusting for demographic and clinical factors, Black patients were less likely to be enrolled in a clinical trial (odds ratio = 0.387, P < .001). Patients treated at nonacademic medical centers were less likely to be in a clinical trial. Trial participation was associated with an increased median survival relative to non-trial patients (stage IV: 9.0 vs 3.8 months, P < .001), and this association remained on multivariable regression (hazard ratio = 0.779, P < .001). CONCLUSION Fewer than 1% of patients with pancreatic adenocarcinoma participated in a clinical trial. There are racial and sociodemographic disparities in clinical trial enrollment. An association was observed between clinical trial participants and prolonged survival.
Collapse
Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | | | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Joel Saltzman
- Department of Medicine, Division of Medical Oncology, University Hospitals Cleveland Medical Center, OH
| | - David Bajor
- Department of Medicine, Division of Medical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Amy Hosmer
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - Shaffer Mok
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - John Dumot
- Department of Medicine, Division of Gastroenterology, University Hospitals Cleveland Medical Center, OH
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH.
| |
Collapse
|
19
|
Okado I, Pagano I, Cassel K, Su'esu'e A, Rhee J, Berenberg J, Holcombe RF. Clinical Research Professional Providing Care Coordination Support: A Study of Hawaii Minority/Underserved NCORP Community Site Trial Participants. JCO Oncol Pract 2022; 18:e1114-e1121. [PMID: 35294261 PMCID: PMC10530402 DOI: 10.1200/op.21.00655] [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: 09/08/2021] [Revised: 12/23/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although effective care coordination (CC) is recognized as a vital component of a patient-centered, high-quality cancer care delivery system, CC experiences of patients who enroll and receive treatment through clinical trials (CTs) are relatively unknown. Using mixed methods, we examined perceptions of CC among patients enrolled onto therapeutic CTs through the Hawaii Minority/Underserved National Cancer Institute Community Oncology Research Program. METHODS The Care Coordination Instrument, a validated instrument, was used to measure patients' perceptions of CC among CT participants (n = 45) and matched controls (n = 45). Paired t-tests were used to compare overall and three CC domain scores (Communication, Navigation, and Operational) between the groups. Semistructured focus group interviews were conducted virtually with 14 CT participants in 2020/2021. RESULTS CT participants reported significantly higher total CC scores than non-CT participants (P = .0008). Similar trends were found for Navigation and Operational domain scores (P = .007 and .001, respectively). Twenty-nine percent of CT participants reported receiving high-intensity CC assistance from their clinical research professionals (CRPs). Content analysis of focus group discussions revealed that nearly half of the focus group discussions centered on CRPs (47%), including CC support provided by CRPs (26%). Other key themes included general CT experiences (22%) and CRP involvement as an additional benefit to CT participation (15%). CONCLUSION Our results show that patients on CTs in this study had a more positive CC experience. This may be attributable in part to CC support provided by CRPs. These findings highlight both the improved experience of treatment for patients participating in a trial and the generally unrecognized yet integral role of CRPs as part of a cancer CT care team.
Collapse
Affiliation(s)
- Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI
| | - Kevin Cassel
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Jessica Rhee
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Randall F. Holcombe
- University of Hawaii Cancer Center, Honolulu, HI
- Current Affiliation: University of Vermont Cancer Center, Burlington, VT
| |
Collapse
|
20
|
Tini G, Trapani D, Duso BA, Beria P, Curigliano G, Pelicci PG, Mazzarella L. Quantifying geographical accessibility to cancer clinical trials in different income landscapes. ESMO Open 2022; 7:100515. [PMID: 35738201 PMCID: PMC9271515 DOI: 10.1016/j.esmoop.2022.100515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Clinical trials are increasingly perceived as a therapeutic opportunity for cancer patients. Favoring their concentration in few high-expertise academic centers maximizes quality of data collection but poses an issue of access equality. Analytical tools to quantify trial accessibility are needed to rationalize resources. Materials and methods We constructed a distance-based accessibility index (dAI) using publicly available data on demographics, cancer incidence and trials. Multiple strategies were applied to mitigate or quantify clear sources of bias: reporting biases by text mining multiple registries; reliability of simple geographical distance by comparison with high-quality travel cost data for Italy; index inflation due to highly heterogeneous cancer incidence by log-transformation. We studied inequalities by Gini index and time trend significance by Mann–Kendall test. We simulated different resource allocation models in representative countries and identified locations where new studies would maximally improve the national index. Results The dAI approximated well a more realistic but not widely applicable travel cost-based index. Accessibility was unevenly distributed across and within countries (Gini index ∼0.75), with maximal inequalities in high- and upper-middle-income countries (China, United States, Russian Federation). Over time, accessibility increased but less than the total number of trials, most evidently in upper-middle-income countries. Simulations in representative countries (Italy and Serbia) identified ideal locations able to maximally raise the national index. Conclusions Access to clinical trials is highly uneven across and within countries and is not mitigated by simple increase in the number of trials; a rational algorithmic approach can be used to mitigate inequalities. Accessibility to cancer clinical trials grew less than total number of trials over time in upper-middle-income countries. Accessibility is unevenly distributed, with maximal inequalities in high- and upper-middle-income countries. Simulation of resource allocation can identify ideal locations able to raise the national accessibility index.
Collapse
Affiliation(s)
- G Tini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - D Trapani
- Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - B A Duso
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - P Beria
- Department of Architecture and Urban Studies (DAStU), Politecnico of Milano, Milano, Italy
| | - G Curigliano
- Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - P G Pelicci
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - L Mazzarella
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy; Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy.
| |
Collapse
|
21
|
Presti D, Havas J, Soldato D, Lapidari P, Martin E, Pistilli B, Jouannaud C, Emile G, Rigal O, Fournier M, Soulie P, Mouret-Reynier MA, Tarpin C, Campone M, Guillermet S, Martin AL, Everhard S, Di Meglio A. Factors associated with enrolment in clinical trials among women with early-stage breast cancer. ESMO Open 2022; 7:100513. [PMID: 35724624 PMCID: PMC9271499 DOI: 10.1016/j.esmoop.2022.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer. Methods We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment. Results Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707). Conclusions In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment. The proportion of patients who access innovation through participation in clinical trials is generally limited. Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings. Clinical and geographical factors were associated to access to innovation in clinical trials. Enrolment in clinical trials is associated with better quality of life and clinical outcomes.
Collapse
Affiliation(s)
- D Presti
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - J Havas
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - D Soldato
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - P Lapidari
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - E Martin
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - G Emile
- Centre François Baclesse, Caen, France
| | - O Rigal
- Centre Henri Becquerel, Rouen, France
| | | | - P Soulie
- Institut de Cancérologie de L'ouest -Paul Papin, Angers, France
| | | | - C Tarpin
- Institut Paoli Calmettes, Marseille, France
| | - M Campone
- Institut de Cancérologie de l'Ouest - Site de Nantes - Centre René Gauducheau, Nantes, France
| | | | | | | | - A Di Meglio
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.
| |
Collapse
|
22
|
Challenges of conducting value assessment for Comprehensive Genomic Profiling. Int J Technol Assess Health Care 2022; 38:e57. [PMID: 35674123 DOI: 10.1017/s026646232200040x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
23
|
Hasson Charles RM, Sosa E, Patel M, Erhunmwunsee L. Health Disparities in Recruitment and Enrollment in Research. Thorac Surg Clin 2022; 32:75-82. [PMID: 34801198 PMCID: PMC8611804 DOI: 10.1016/j.thorsurg.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite advances in thoracic oncology research, the benefits of new discoveries are not universally experienced. A lack of representation of racial/ethnic minorities and individuals of low socioeconomic status in clinical trials and thoracic research contributes to persistent health care disparities. It is critical that improved racial, ethnic, and socioeconomic diversity is achieved in our trials and research, if we are to attain generalizability of findings and reduction of health care disparities. Culturally tailored and community-based approaches can help improve recruitment and enrollment of marginalized groups in thoracic research, which is an essential step toward achieving health equity and advancing medical science.
Collapse
Affiliation(s)
- Rian M. Hasson Charles
- Dartmouth-Hitchcock Medical Center Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756
| | - Ernesto Sosa
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
| | - Meghna Patel
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
| | | |
Collapse
|
24
|
Hamm C, Cavallo-Medved D, Moudgil D, McGrath L, Huang J, Li Y, Stratton TW, Robinson T, Naccarato K, Sundquist S, Dancey J. Addressing the Barriers to Clinical Trials Accrual in Community Cancer Centres Using a National Clinical Trials Navigator:A Cross-Sectional Analysis. Cancer Control 2022; 29:10732748221130164. [PMID: 36165718 PMCID: PMC9520135 DOI: 10.1177/10732748221130164] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinical trials, although academically accepted as the most effective treatment available for cancer patients, poor accrual to clinical trials remains a significant problem. A clinical trials navigator (CTN) program was piloted where patients and/or their healthcare professionals could request a search and provide a list of potential cancer clinical trials in which a patient may be eligible based on their current status and disease. OBJECTIVES This study examined the outcomes of a pilot program to try to improve clinical trials accrual with a focus on patients at medium to small sized cancer programs. Outcomes examined included patient disposition (referral to and accrual to interventional trials), patient survival, sites of referral to the CTN program. METHODS One 0.5 FTE navigator was retained. Stakeholders referred to the CTN through the Canadian Cancer Clinical Trials Network. Demographic and outcomes data were recorded. RESULTS Between March 2019 and February 2020, 118 patients from across Canada used the program. Seven per cent of patients referred were enrolled onto treatment clinical trials. No available trial excluded 39% patients, and 28% had a decline in their health and died before they could be referred or enrolled onto a clinical trial. The median time from referral to death was 109 days in those that passed. CONCLUSION This novel navigator pilot has the potential to increase patient accrual to clinical trials. The CTN program services the gap in the clinical trials system, helping patients in medium and small sized cancer centres identify potential clinical trials at larger centres.
Collapse
Affiliation(s)
- Caroline Hamm
- 8637University of Windsor, Windsor, ON, Canada.,Western University, Windsor, ON, Canada.,Windsor Cancer Research Group, Windsor, ON, Canada.,WE-SPARK Health Institute, Windsor, ON, Canada
| | - Dora Cavallo-Medved
- 8637University of Windsor, Windsor, ON, Canada.,Windsor Cancer Research Group, Windsor, ON, Canada.,WE-SPARK Health Institute, Windsor, ON, Canada
| | - Devinder Moudgil
- 8637University of Windsor, Windsor, ON, Canada.,Western University, Windsor, ON, Canada.,WE-SPARK Health Institute, Windsor, ON, Canada
| | | | | | | | | | | | - Krista Naccarato
- 194075Windsor Regional Hospital, Windsor, ON, Canada.,Canadian Cancer Clinical Trials Network, Windsor, ON, Canada
| | | | - Janet Dancey
- Canadian Cancer Clinical Trials Network, Windsor, ON, Canada.,Queen's University, ON, Canada
| |
Collapse
|
25
|
Charlot M, Carolan K, Gawuga C, Freeman E, Sprague Martinez L. Patient powered research: an approach to building capacity for a hardly reached patient population to engage in cancer research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:74. [PMID: 34702359 PMCID: PMC8547568 DOI: 10.1186/s40900-021-00317-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Participating in clinical trials is a metric of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to be enrolled in clinical trials and experience a disproportionate burden of cancer mortality compared to Whites. Patient-engaged research is one potential strategy to address racial inequities in clinical trials, but little is known about best practices for engaging Black individuals and communities impacted by cancer in research partnerships. METHODS We used a community engaged research approach to establish a patient advisory council (PAC) representative of the patient population served by a safety net hospital cancer center. We outline the process of establishing the PAC and the lessons learned. RESULTS The inaugural PAC included 7 members representative of the cancer center's patient demographics. PAC members developed a patient centered vision, mission and action plan. PAC and community-academic research partners experienced the transformative power of centering the lived experiences of patients of color to promote health equity in cancer research. CONCLUSION Establishing a patient advisory council at a safety net hospital cancer care center provided a platform for engaging a hardly reached population in patient centered research.
Collapse
Affiliation(s)
- Marjory Charlot
- Division of Oncology, University of North Carolina School of Medicine, Houpt Physicians Office Building, 170 Manning Drive, 3rd Floor, Chapel Hill, NC, 27599, USA.
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Kelsi Carolan
- University of Connecticut School of Social Work, Hartford, CT, USA
- Boston University School of Social Work, Boston, MA, USA
| | - Cyrena Gawuga
- Macro Department, Boston University School of Social Work, Boston, MA, USA
| | - Elmer Freeman
- Center for Community Health Education Research and Service, Inc., Boston, MA, USA
| | | |
Collapse
|
26
|
Abel MK, Melisko ME, Rugo HS, Chien AJ, Diaz I, Levine JK, Griffin A, McGuire J, Esserman LJ, Borno HT, Mukhtar RA. Decreased enrollment in breast cancer trials by histologic subtype: does invasive lobular carcinoma resist RECIST? NPJ Breast Cancer 2021; 7:139. [PMID: 34697300 PMCID: PMC8547221 DOI: 10.1038/s41523-021-00348-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Enrollment in metastatic breast cancer trials usually requires measurable lesions, but patients with invasive lobular carcinoma (ILC) tend to form diffuse disease. We found that the proportion of patients with metastatic ILC enrolled in clinical trials at our institution was significantly lower than that of patients with invasive ductal carcinoma (IDC). Possible links between requiring measurable disease and decreased enrollment of ILC patients require further study to ensure equitable trial access.
Collapse
Affiliation(s)
- Mary Kathryn Abel
- University of California, San Francisco School of Medicine, San Francisco, CA, USA.,University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Michelle E Melisko
- University of California at San Francisco, Division of Hematology/Oncology, San Francisco, CA, USA
| | - Hope S Rugo
- University of California at San Francisco, Division of Hematology/Oncology, San Francisco, CA, USA
| | - A Jo Chien
- University of California at San Francisco, Division of Hematology/Oncology, San Francisco, CA, USA
| | - Italia Diaz
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | | | - Ann Griffin
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Joseph McGuire
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Laura J Esserman
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Hala T Borno
- University of California at San Francisco, Division of Hematology/Oncology, San Francisco, CA, USA
| | - Rita A Mukhtar
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA.
| |
Collapse
|
27
|
Eskander MF, Gil L, Beal EW, Li Y, Hamad A, Oppong B, Obeng-Gyasi S, Tsung A. Access Denied: Inequities in Clinical Trial Enrollment for Pancreatic Cancer. Ann Surg Oncol 2021; 29:1271-1277. [PMID: 34655352 DOI: 10.1245/s10434-021-10868-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The influence of social determinants of health (SDH) on participation in clinical trials for pancreatic cancer is not well understood. In this study, we describe trends and identify disparities in pancreatic cancer clinical trial enrollment. PATIENTS AND METHODS This is a retrospective study of stage I-IV pancreatic cancer patients in the 2004-2016 National Cancer Database. Cohort was stratified into those enrolled in clinical trials during first course of treatment versus not enrolled. Bivariate analysis and logistic regression were used to understand the relationship between SDH and clinical trial participation. RESULTS A total of 1127 patients (0.4%) enrolled in clinical trials versus 301,340 (99.6%) did not enroll. Enrollment increased over the study period (p < 0.001), but not for Black patients or patients on Medicaid. The majority enrolled had metastatic disease (65.8%). On multivariate analysis, in addition to year of diagnosis (p < 0.001), stage (p < 0.001), and Charlson score (p < 0.001), increasing age [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.96-0.97], non-white race (OR 0.54, CI 0.44-0.66), living in the South (OR 0.42, CI 0.35-0.51), and Medicaid, lack of insurance, or unknown insurance (0.41, CI 0.31-0.53) were predictors of lack of participation. Conversely, treatment at an academic center (OR 6.36, CI 5.4-7.4) and higher neighborhood education predicted enrollment (OR 2.0, CI 1.55-2.67 for < 7% with no high school degree versus > 21%). DISCUSSION Age, race, insurance, and geography are barriers to clinical trial enrollment for pancreatic cancer patients. While overall enrollment increased, Black patients and patients on Medicaid remain underrepresented. After adjusting for cancer-specific factors, SDH are still associated with clinical trial enrollment, suggesting need for targeted interventions.
Collapse
Affiliation(s)
- Mariam F Eskander
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Lindsay Gil
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Eliza W Beal
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Yaming Li
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Ahmad Hamad
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Bridget Oppong
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Allan Tsung
- Division of Surgical Oncology, The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, USA.
| |
Collapse
|
28
|
Balyasny S, Lee SM, Desai AV, Volchenboum SL, Naranjo A, Park JR, London WB, Cohn SL, Applebaum MA. Association Between Participation in Clinical Trials and Overall Survival Among Children With Intermediate- or High-risk Neuroblastoma. JAMA Netw Open 2021; 4:e2116248. [PMID: 34236408 PMCID: PMC8267607 DOI: 10.1001/jamanetworkopen.2021.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Participants in clinical trials may experience benefits associated with new therapeutic strategies as well as tight adherence to best supportive care practices. OBJECTIVES To investigate whether participation in a clinical trial is associated with improved survival among children with neuroblastoma and investigate potential recruitment bias of patients in clinical trials. DESIGN, SETTING, AND PARTICIPANTS This cohort study included pediatric patients with intermediate- or high-risk neuroblastoma in North American studies who were included in the International Neuroblastoma Risk Group Data Commons and who received a diagnosis between January 1, 1991, and March 1, 2020. EXPOSURE Enrollment in a clinical trial. MAIN OUTCOMES AND MEASURES Event-free survival and overall survival (OS) of patients with intermediate- or high-risk neuroblastoma enrolled in an up-front Children's Oncology Group (COG) clinical trial vs a biology study alone were analyzed using log-rank tests and Cox proportional hazards regression models. The racial/ethnic composition and the demographic characteristics of the patients in both groups were compared. RESULTS The cohort included 3058 children with intermediate-risk neuroblastoma (1533 boys [50.1%]; mean [SD] age, 10.7 [14.7] months) and 6029 children with high-risk neuroblastoma (3493 boys [57.9%]; mean [SD] age, 45.8 [37.4] months) who were enrolled in a Children's Oncology Group or legacy group neuroblastoma biology study between 1991 and 2020. A total of 1513 patients with intermediate-risk neuroblastoma (49.5%) and 2473 patients with high-risk neuroblastoma (41.0%) were also enrolled in a clinical trial, for a cohort total of 3986 of 9087 children (43.9%) enrolled in a clinical trial. The prevalence of prognostic markers for the clinical trial and non-clinical trial cohorts differed, although representation of patients from racial/ethnic minority groups was similar in both cohorts. Among patients with intermediate-risk neuroblastoma, OS was higher among those who participated in a clinical trial compared with those enrolled only in a biology study (OS, 95% [95% CI, 94%-96%] vs 91% [95% CI, 89%-94%]; P = .01). Among patients with high-risk neuroblastoma, participation in a clinical trial was not associated with OS (OS, 38% [95% CI, 35%-41%] in the clinical trial group vs 41% [95% CI, 38%-44%] in the biology study group; P = .23). CONCLUSIONS AND RELEVANCE Approximately 44% of patients in this large cohort of patients with neuroblastoma were enrolled in up-front clinical trials. Compared with children not enrolled in clinical trials, a higher prevalence of favorable prognostic markers was identified among patients with intermediate-risk neuroblastoma enrolled in clinical trials, and unfavorable features were more prevalent among patients with high-risk neuroblastoma enrolled in clinical trials. No evidence of recruitment bias according to race/ethnicity was observed. Participation in a clinical trial was not associated with OS in this cohort, likely reflecting the common practice of treating nontrial participants with therapeutic and supportive care regimens used in a previous therapeutic trial.
Collapse
Affiliation(s)
- Skye Balyasny
- College of the Liberal Arts, Penn State University, University Park, Pennsylvania
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Ami V. Desai
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | | | - Arlene Naranjo
- Children’s Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington, Seattle
| | - Wendy B. London
- Boston Children’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Susan L. Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | | |
Collapse
|
29
|
Haller H, Voiß P, Cramer H, Paul A, Reinisch M, Appelbaum S, Dobos G, Sauer G, Kümmel S, Ostermann T. The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment. BMC Cancer 2021; 21:724. [PMID: 34162339 PMCID: PMC8220783 DOI: 10.1186/s12885-021-08468-2] [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: 04/30/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life. METHODS INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events. DISCUSSION This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer. TRIAL REGISTRATION German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.
Collapse
Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.
| | - Petra Voiß
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.,Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Anna Paul
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | | | - Sebastian Appelbaum
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Georg Sauer
- Department of Gynecology and Obstetrics, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sherko Kümmel
- Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany
| |
Collapse
|
30
|
Muthusamy A, Long D, Underhill CR. Improving recruitment to clinical trials for regional and rural cancer patients through a regionally based clinical trials network. Med J Aust 2021; 214:453-454.e1. [PMID: 33990964 DOI: 10.5694/mja2.51078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Donna Long
- Regional Trials Network Victoria, Albury, NSW
| | - Craig R Underhill
- Border Medical Oncology, Albury, NSW.,Rural Clinical School, UNSW, Albury, NSW
| |
Collapse
|
31
|
León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ Preservation in Patients With Advanced Laryngeal Tumours. Results of Induction Chemotherapy Versus Chemoradiotherapy in Actual Clinical Practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
32
|
Dieter J, Dominick F, Knurr A, Ahlbrandt J, Ückert F. Analysis of Not Structurable Oncological Study Eligibility Criteria for Improved Patient-Trial Matching. Methods Inf Med 2021; 60:9-20. [PMID: 33890270 PMCID: PMC8412998 DOI: 10.1055/s-0041-1724107] [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: 11/18/2022]
Abstract
Background
Higher enrolment rates of cancer patients into clinical trials are necessary to increase cancer survival. As a prerequisite, an improved semiautomated matching of patient characteristics with clinical trial eligibility criteria is needed. This is based on the computer interpretability, i.e., structurability of eligibility criteria texts. To increase structurability, the common content, phrasing, and structuring problems of oncological eligibility criteria need to be better understood.
Objectives
We aimed to identify oncological eligibility criteria that were not possible to be structured by our manual approach and categorize them by the underlying structuring problem. Our results shall contribute to improved criteria phrasing in the future as a prerequisite for increased structurability.
Methods
The inclusion and exclusion criteria of 159 oncological studies from the Clinical Trial Information System of the National Center for Tumor Diseases Heidelberg were manually structured and grouped into content-related subcategories. Criteria identified as not structurable were analyzed further and manually categorized by the underlying structuring problem.
Results
The structuring of criteria resulted in 4,742 smallest meaningful components (SMCs) distributed across seven main categories (Diagnosis, Therapy, Laboratory, Study, Findings, Demographics, and Lifestyle, Others). A proportion of 645 SMCs (13.60%) was not possible to be structured due to content- and structure-related issues. Of these, a subset of 415 SMCs (64.34%) was considered not remediable, as supplementary medical knowledge would have been needed or the linkage among the sentence components was too complex. The main category “Diagnosis and Study” contained these two subcategories to the largest parts and thus were the least structurable. In the inclusion criteria, reasons for lacking structurability varied, while missing supplementary medical knowledge was the largest factor within the exclusion criteria.
Conclusion
Our results suggest that further improvement of eligibility criterion phrasing only marginally contributes to increased structurability. Instead, physician-based confirmation of the matching results and the exclusion of factors harming the patient or biasing the study is needed.
Collapse
Affiliation(s)
- Julia Dieter
- Deparment of Medical Informatics for Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Friederike Dominick
- Deparment of Medical Informatics for Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Alexander Knurr
- Deparment of Medical Informatics for Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Janko Ahlbrandt
- Deparment of Medical Informatics for Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Frank Ückert
- Deparment of Medical Informatics for Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
33
|
Bible KC, Kebebew E, Brierley J, Brito JP, Cabanillas ME, Clark TJ, Di Cristofano A, Foote R, Giordano T, Kasperbauer J, Newbold K, Nikiforov YE, Randolph G, Rosenthal MS, Sawka AM, Shah M, Shaha A, Smallridge R, Wong-Clark CK. 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid 2021; 31:337-386. [PMID: 33728999 PMCID: PMC8349723 DOI: 10.1089/thy.2020.0944] [Citation(s) in RCA: 294] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Since the guidelines for the management of ATC by the American Thyroid Association were first published in 2012, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, and researchers on published evidence relating to the diagnosis and management of ATC. Methods: The specific clinical questions and topics addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of the Task Force members (authors of the guideline). Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, targeted/systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues, including end of life. The guidelines include 31 recommendations and 16 good practice statements. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of ATC. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with ATC.
Collapse
Affiliation(s)
- Keith C. Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Electron Kebebew
- Stanford University, School of Medicine, Stanford, California, USA
| | - James Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Juan P. Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Antonio Di Cristofano
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert Foote
- Department of Radiation Oncology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Thomas Giordano
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jan Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - M. Sara Rosenthal
- Program for Bioethics and Markey Cancer Center Oncology Ethics Program, Departments Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Anna M. Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| | - Manisha Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashok Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | |
Collapse
|
34
|
Abstract
This cross-sectional study uses data from the 2016 Behavioral Risk Factor Surveillance System data set to examine the association of age at cancer diagnosis with patients’ participation in clinical trials among cancer survivors.
Collapse
Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Héctor E. Alcalá
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| |
Collapse
|
35
|
Viljoen B, Chambers SK, Dunn J, Ralph N, March S. Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies. J Multidiscip Healthc 2020; 13:1257-1281. [PMID: 33149597 PMCID: PMC7603415 DOI: 10.2147/jmdh.s266281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.
Collapse
Affiliation(s)
- Bianca Viljoen
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Suzanne K Chambers
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeff Dunn
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Nicholas Ralph
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Sonja March
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Brisbane, Australia
| |
Collapse
|
36
|
Gopishetty S, Kota V, Guddati AK. Age and race distribution in patients in phase III oncology clinical trials. Am J Transl Res 2020; 12:5977-5983. [PMID: 33042473 PMCID: PMC7540092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
Background: Geriatric patients and minority patients are often under-represented in cancer clinical trials. The presence of multiple comorbidities makes geriatric patients ineligible for most clinical trials. Racial diversity may vary by geographical location and socio-economically backward areas may have a very different racial mix. The increase in cancer incidence in geriatric patients' raises the question of applicability of the results is such clinical trials. This study also explores the representation of different races in phase 3 clinical trials conducted in the past 10 years. Methods: Data about Phase III trials was extracted from the clinical trials.gov for 3 common solid organs and 3 hematological malignancies [breast, colon, lung, diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)]. The time period studied was for the past 10 years and included only adult patients (≥18 years). The age and race distribution of the patient population in these trials were extracted and analyzed. Results: Geriatric patients and minorities are under-represented in all phase III cancer clinical trials. The range of the proportion of geriatric patients varied from 10% to 40%. African American and Asian patients are under-represented in all phase III cancer clinical trials. Conclusions: The results of phase III clinical trials that are currently conducted on non-geriatric and Caucasian patient population may not meaningfully be applicable to geriatric patients and minorities. This study highlights the disparity of age and race for patients enrolled in clinical trials as against the patients seen in the real world.
Collapse
Affiliation(s)
- Swathi Gopishetty
- Medical Center of Central Georgia, Mercer UniversityMacon, GA 31201, The United States
| | - Vamsi Kota
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, The United States
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta UniversityAugusta, GA 30909, The United States
| |
Collapse
|
37
|
Smith AB, Niu AY, Descallar J, Delaney GP, Wu VS, Agar MR, Girgis A. Clinical trials knowledge and attitudes of Vietnamese- and Anglo-Australian cancer patients: A cross-sectional study. Asia Pac J Clin Oncol 2020; 16:e242-e251. [PMID: 32779349 DOI: 10.1111/ajco.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022]
Abstract
AIM Low participation in cancer clinical trials by culturally and linguistically diverse (CALD) patients limits access to cutting-edge treatments and generalizability of results. This is the first study exploring trials knowledge/attitudes and their association with trial participation in Vietnamese- and Anglo-Australian cancer patients. METHODS Eligible patients diagnosed with cancer in the past 10 years were invited to complete a self-report questionnaire comprising validated measures of: trials knowledge and attitudes, preferred information amount, preferred decision-making involvement, health literacy, and past and future (i.e. hypothetical) trial participation. Multivariable linear regression evaluated correlates of trials knowledge/attitudes. Multinomial logistic regression estimated the relationship between trials knowledge/attitudes and possible future trial participation. RESULTS Vietnamese-Australian participants (n = 50) had more negative attitudes regarding trials than Anglo-Australians (n = 100; B = -9.28; 95% confidence interval [CI], -17.60 to -0.97; P = 0.029), but similar knowledge (B = -0.91; 95% CI, -2.27 to 0.44; P = 0.18). Future trial participation was associated with positive attitudes (odds ratio [OR] = 1.08; 95% CI, 1.04-1.12; P < 0.001) and greater knowledge (OR = 1.30; 95% CI, 1.04-1.62; P = 0.02), but not Vietnamese background (OR = 0.95; 95% CI, 0.27-3.32; P = 0.93). CONCLUSION Despite poorer attitudes regarding trials in Vietnamese-Australians, Vietnamese background was not associated with less likely future trial participation, suggesting low trial participation by CALD patients may be more due to opportunity barriers. Improving knowledge and attitudes may increase trial participation generally.
Collapse
Affiliation(s)
- Allan B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Anita Y Niu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Verena S Wu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Meera R Agar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| |
Collapse
|
38
|
León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ preservation in patients with advanced laryngeal tumours. Results of induction chemotherapy versus chemoradiotherapy in actual clinical practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:143-151. [PMID: 32475610 DOI: 10.1016/j.otorri.2020.02.007] [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: 11/09/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES A high percentage of patients with locally advanced larynx carcinomas are candidates for inclusion in organ preservation protocols. The objective of this study is to compare the results of two schemes of preservation, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced larynx carcinomas in the context of actual clinical practice. METHODS Our retrospective study included 157 patients with locally advanced tumours of the larynx (T3-T4) treated with induction chemotherapy (n = 121) or chemoradiotherapy (n = 36). RESULTS From 121 patients who began treatment with induction chemotherapy, 6 died due to toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients received treatment with chemoradiotherapy. There were no significant differences in 5-year disease-specific survival between both treatments: 68.9% in induction chemotherapy versus 75.7% in chemoradiotherapy (p = 0.259). In 45.9% of patients the laryngeal function was preserved. Patients treated with chemoradiotherapy had a tendency to have better 5-year laryngeal dysfunction-free survival than patients treated with induction chemotherapy (55.6% versus 44.8%, p = 0.079). CONCLUSION Patients included in a protocol of organ preservation achieved a 5-year laryngeal dysfunction-free survival of 45.9%. There were no significant differences in disease-specific survival among patients treated with induction chemotherapy or chemoradiotherapy.
Collapse
Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Victoria Montoro
- Servicio de Otorrinolaringología, Hospital de Mollet, Mollet del Vallés, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Óscar Gallego
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Antonio López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
| |
Collapse
|
39
|
Dickens DS, Roth ME, Pollock BH, Langevin AM. Understanding the Barriers to Pediatric Oncologist Engagement and Accrual to Clinical Trials in National Cancer Institute-Designated Community Oncology Research Programs. JCO Oncol Pract 2020; 16:e1060-e1066. [PMID: 32396490 PMCID: PMC7564137 DOI: 10.1200/jop.19.00707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE: Clinical trial participation leads to progress in cancer care. Principal investigators (PIs) and clinical research associates (CRAs) play key roles in the provision and maintenance of clinical trial portfolios at their sites. Previous studies have evaluated the educational and resource needs of adult oncology providers, but nothing to date has focused on providers of pediatric oncology care. We aimed to identify the educational needs and clinical trial participation barriers at National Cancer Institute Community Oncology Research Program (NCORP) Children’s Oncology Group (COG) sites to improve the quality of site investigator engagement. METHODS: Quality improvement surveys of pediatric clinical research staff at NCORP sites were performed. The first was a web-based inquiry of NCORP COG PIs and lead CRAs to assess their general understanding of NCORP organizational structure and needs. The second survey of COG PIs was conducted by one-on-one telephone interviews aimed at identifying specific barriers to physician engagement and patient enrollment in clinical trial research. RESULTS: The majority of NCORP COG PIs and CRAs (63%) reported an incomplete understanding of NCORP structure, with approximately half expressing interest in developing stronger collaborations and engagement. Most NCORP COG PIs reported at least one shared barrier to clinical trial enrollment (78%), with inadequate protected time and research support (39% each) being the most frequently cited barriers. CONCLUSIONS: Contributions to pediatric cancer clinical research at COG NCORP sites could be enhanced through improved education, resources, and time allocation.
Collapse
Affiliation(s)
- David S Dickens
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Michael E Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brad H Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Comprehensive Cancer Center, Davis, CA
| | - Anne-Marie Langevin
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Health San Antonio, San Antonio, TX
| |
Collapse
|
40
|
Sittig MP, Luu M, Yoshida EJ, Scher K, Mita A, Shiao SL, Lu DJ, Mallen‐St. Clair J, Ho AS, Zumsteg ZS. Impact of insurance on survival in patients < 65 with head & neck cancer treated with radiotherapy. Clin Otolaryngol 2019; 45:63-72. [DOI: 10.1111/coa.13467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Mark P. Sittig
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Michael Luu
- Biostatistics and Bioinformatics Research Center Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Emi J. Yoshida
- Department of Radiation Oncology University of California San Francisco CA USA
| | - Kevin Scher
- Department of Medical Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Alain Mita
- Department of Medical Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Stephen L. Shiao
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Diana J. Lu
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Jon Mallen‐St. Clair
- Department of Surgery, Division of Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Allen S. Ho
- Department of Surgery, Division of Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles CA USA
| | - Zachary S. Zumsteg
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles CA USA
| |
Collapse
|
41
|
Close AG, Dreyzin A, Miller KD, Seynnaeve BKN, Rapkin LB. Adolescent and young adult oncology-past, present, and future. CA Cancer J Clin 2019; 69:485-496. [PMID: 31594027 DOI: 10.3322/caac.21585] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 06/26/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
There are nearly 70,000 new cancer diagnoses made annually in adolescents and young adults (AYAs) in the United States. Historically, AYA patients with cancer, aged 15 to 39 years, have not shown the same improved survival as older or younger cohorts. This article reviews the contemporary cancer incidence and survival data through 2015 for the AYA patient population based on the National Cancer Institute's Surveillance, Epidemiology, and End Results registry program and the North American Association of Central Cancer Registries. Mortality data through 2016 from the Centers for Disease Control and Prevention's National Center for Health Statistics are also described. Encouragingly, absolute and relative increases in 5-year survival for AYA cancers have paralleled those of childhood cancers since the year 2000. There has been increasing attention to these vulnerable patients and improved partnerships and collaboration between adult and pediatric oncology; however, obstacles to the care of this population still occur at multiple levels. These vulnerabilities fall into 3 significant categories: research efforts and trial enrollment directed toward AYA malignancies, access to care and insurance coverage, and AYA-specific psychosocial support. It is critical for providers and health care delivery systems to recognize that the AYA population remains vulnerable to provider and societal complacency.
Collapse
Affiliation(s)
- Allison G Close
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra Dreyzin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Brittani K N Seynnaeve
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Louis B Rapkin
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
42
|
A Cost-effectiveness Analysis of Systemic Therapy for Metastatic Hormone-sensitive Prostate Cancer. Eur Urol Oncol 2019; 2:649-655. [DOI: 10.1016/j.euo.2019.01.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/28/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022]
|
43
|
Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019. [PMID: 31251394 DOI: 10.1002/cncr.32360.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| |
Collapse
|
44
|
Mohamed HH, Ibrahim Sokkar M, Afifi AM, Saad AM, Albarouki S, Al-Husseini MJ. Does a history of malignancy impact the survival of a subsequent endometrial adenocarcinoma? Should clinical trials eligibility criteria be revisited? J OBSTET GYNAECOL 2019; 40:233-239. [PMID: 31352852 DOI: 10.1080/01443615.2019.1621808] [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] [Indexed: 12/30/2022]
Abstract
We aimed at finding the impact of prior malignancies on the survival of patients with endometrial adenocarcinoma using SEER database (from 1973 to 2014). We identified 127,988 patients who were diagnosed with endometrial adenocarcinoma (6485 had a prior malignancy), and we compared the overall and cancer-specific survival based on the presence or absence of a prior malignancy and the latency period between the two diagnoses using Kaplan-Meier test and Cox models. Adjusted cox models showed that a history of a prior malignancy neither affected the overall survival nor the cancer-specific survival of stage IV cases in all latency groups except the one diagnosed within 1 year of the first cancer. Therefore, there is no rational explanation for excluding stage IV endometrial adenocarcinoma patients with a prior malignancy from clinical trials except for the group that was diagnosed with endometrial adenocarcinoma within 1 year from the first cancer.Impact statementWhat is already known on this subject? Not enough evidence is found on the impact of prior malignancies on the survival of patients with subsequent endometrial adenocarcinoma.What do the results of this study add? History of a prior malignancy neither affects the overall survival of stage IV endometrial adenocarcinoma nor the cancer-specific survival. Only patients who had their second malignancy diagnosed within one year of the first malignancy should be excluded from clinical trials, while patients diagnosed within one to five years of the first cancer should be encouraged to enrol in clinical trials as they have an enhanced survival than patients without a history of malignancy.What are the implications of these findings for clinical practice and/or further research? We recommend that future researchers should consider including the aforementioned group of patients in their trials to achieve more accurate results and in order not to strip the patients of potential therapeutic benefits of enrolling in clinical trials.
Collapse
Affiliation(s)
- Hadeer H Mohamed
- Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mai Ibrahim Sokkar
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed M Afifi
- Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anas M Saad
- Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sali Albarouki
- Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
45
|
Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019; 125:3488-3493. [PMID: 31251394 DOI: 10.1002/cncr.32360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| |
Collapse
|
46
|
Reitsma M, Fox J, Borre PV, Cavanaugh M, Chudnovsky Y, Erlich RL, Gribbin TE, Anhorn R. Effect of a Collaboration Between a Health Plan, Oncology Practice, and Comprehensive Genomic Profiling Company from the Payer Perspective. J Manag Care Spec Pharm 2019; 25:601-611. [PMID: 30632889 PMCID: PMC10398083 DOI: 10.18553/jmcp.2019.18309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Comprehensive genomic profiling (CGP) is a next-generation sequencing-based methodology that detects 4 classes of genomic alterations, as well as gene signature biomarkers such as microsatellite instability and tumor mutational burden. In the context of precision oncology, CGP can help to direct treatment to genomically matched therapies. OBJECTIVE To describe the results of a 3-year observational analysis of patients undergoing testing with CGP assays (either FoundationOne or FoundationOne Heme) at a community oncology practice after a regional health plan implemented a medical policy that enabled coverage of CGP. METHODS A retrospective analysis of medical records was completed at the oncology practice from November 2013 to January 2017; this date range was chosen to coincide with the regional health plan's medical policy implementation of CGP. The medical policy provided coverage of CGP for patients with advanced solid and hematologic cancers. A medical record review assessed all previous and current molecular test results, matched therapy or clinical trial enrollment, and clinical outcomes (clinical benefit or disease progression). The potential cost diversion, from payer to study sponsor, for patients who enrolled in clinical trials was explored. RESULTS There were 96 patients in the community oncology practice who received CGP over the 3-year period, 86 of whom had clinically relevant genomic alterations. Of the 86, 15 patients were treated with genomically matched therapy, and 6 patients enrolled in clinical trials based on CGP results. In a subset of 32 patients who previously underwent conventional testing, most (84%) had clinically relevant genomic alterations detected by CGP that conventional testing did not identify, and a portion of these patients subsequently received treatment based on the CGP results. In the separate cost diversion analysis of 20 patients who enrolled in phase 1 clinical trials, an estimated $25,000 per-patient cost-benefit may have been accrued to the payer. CONCLUSIONS This observational analysis characterized the use of CGP in a large community oncology practice among a group of patients insured by a regional health plan. Clinical trial enrollment was facilitated by CGP use in the community setting and may have contributed to cost diversion from the payer to study sponsors. DISCLOSURES No separate study-related funding was provided by or to Priority Health, Foundation Medicine, and Cancer and Hematology Centers of West Michigan. Data analysis by Reitsma was conducted as part of an internship funded by Priority Health. Reitsma and Fox are employed by Priority Health. Anhorn, Vanden Borre, Cavanaugh, Chudnovsky, and Erlich are employed by Foundation Medicine.
Collapse
Affiliation(s)
- Mitchell Reitsma
- Priority Health, Grand Rapids, Michigan, and Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - John Fox
- Priority Health, Grand Rapids, Michigan
| | | | | | | | | | | | | |
Collapse
|
47
|
Han JJ, Kim JW, Suh KJ, Kim JW, Kim SH, Kim YJ, Kim JH, Lee JS, Lee KW. Clinical characteristics and outcomes of patients enrolled in clinical trials compared with those of patients outside clinical trials in advanced gastric cancer. Asia Pac J Clin Oncol 2019; 15:158-165. [PMID: 30848562 DOI: 10.1111/ajco.13145] [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: 02/11/2018] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
AIMS Participating in clinical trials could give cancer patients potential benefits such as experimental treatment, meticulous follow-up, and management of toxicities. We hypothesized that patients participating in clinical trials would achieve better survival outcomes than those not enrolled in trials. We assessed whether the trial effect can improve survival for patients with advanced gastric cancer. METHODS We retrospectively enrolled metastatic or recurrent gastric cancer patients who received palliative chemotherapy from January 2010 to December 2012. All patients in this study received fluoropyrimidine and platinum as the first-line palliative chemotherapy. Patients participating in clinical trials were matched 1:1 with patients not enrolled in trial based on propensity-score. RESULTS A total of 229 patients were identified, 83 (36.2%) among them participated in 14 clinical trials for advanced gastric cancer. The number of patients enrolled in phase I, II and III trials were 10, 54 and 19, respectively. The median overall survival of the total study patients was 13.0 months (95% confidence interval, 10.7-15.3 months). In the propensity-score matched population, a total of 78 matched pairs of patients were generated. The median overall survival of the 78 patients who participated in the clinical trials was 6 months longer than that of patients not enrolled in trials, although this benefit was marginally significant (15 months vs 9 months, hazard ratio, 0.709; p = 0.068). Participation in clinical trials was a significant factor to predict better overall survival in multivariate analysis (hazard ratio, 0.533, p = 0.001). CONCLUSION Trial effect may contribute to prolongation of overall survival in patients who participate in clinical trials for advanced gastric cancer. Physicians may discuss trial effect to encourage participation in clinical trials.
Collapse
Affiliation(s)
- Jae Joon Han
- Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
48
|
Backhus LM, Fann BE, Hui DS, Cooke DT, Berfield KS, Moffatt-Bruce SD. Culture of Safety and Gender Inclusion in Cardiothoracic Surgery. Ann Thorac Surg 2018; 106:951-958. [DOI: 10.1016/j.athoracsur.2018.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/31/2023]
|
49
|
Chang AC. Centralizing Esophagectomy to Improve Outcomes and Enhance Clinical Research: Invited Expert Review. Ann Thorac Surg 2018; 106:916-923. [DOI: 10.1016/j.athoracsur.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/01/2018] [Indexed: 12/19/2022]
|
50
|
|