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Litt HK, Greenstreet-Akman E, Trejo E, Florez N, Velazquez AI. Quality and Accessibility of Liquid Biopsy Information. JAMA Netw Open 2024; 7:e2410171. [PMID: 38713467 PMCID: PMC11077385 DOI: 10.1001/jamanetworkopen.2024.10171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/05/2024] [Indexed: 05/08/2024] Open
Abstract
This cross-sectional study evaluates the information on a circulating tumor DNA test available to the public on popular internet resources.
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Affiliation(s)
- Henry K. Litt
- Department of Medicine, University of California, San Francisco, San Francisco
| | | | - Evelin Trejo
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Narjust Florez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ana I. Velazquez
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
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Litt HK, Kwon DH, Velazquez AI. FDG PET Scans in Cancer Care. JAMA Oncol 2023; 9:1304. [PMID: 37440237 DOI: 10.1001/jamaoncol.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
This JAMA Oncology Patient Page explains FDG PET scans and how they are used in cancer care.
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Perera ND, Bellomo TR, Schmidt WM, Litt HK, Shyu M, Stavins MA, Wang MM, Bell A, Saleki M, Wolf KI, Ionescu R, Tao JJ, Ji S, O’Keefe RM, Pun M, Takasugi JM, Steinberg JR, Go RS, Turner BE, Mahipal A. Analysis of Female Participant Representation in Registered Oncology Clinical Trials in the United States from 2008 to 2020. Oncologist 2023; 28:510-519. [PMID: 36848266 PMCID: PMC10243778 DOI: 10.1093/oncolo/oyad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Female underrepresentation in oncology clinical trials can result in outcome disparities. We evaluated female participant representation in US oncology trials by intervention type, cancer site, and funding. MATERIALS AND METHODS Data were extracted from the publicly available Aggregate Analysis of ClinicalTrials.gov database. Initially, 270,172 studies were identified. Following the exclusion of trials using Medical Subject Heading terms, manual review, those with incomplete status, non-US location, sex-specific organ cancers, or lacking participant sex data, 1650 trials consisting of 240,776 participants remained. The primary outcome was participation to prevalence ratio (PPR): percent females among trial participants divided by percent females in the disease population per US Surveillance, Epidemiology, and End Results Program data. PPRs of 0.8-1.2 reflect proportional female representation. RESULTS Females represented 46.9% of participants (95% CI, 45.4-48.4); mean PPR for all trials was 0.912. Females were underrepresented in surgical (PPR 0.74) and other invasive (PPR 0.69) oncology trials. Among cancer sites, females were underrepresented in bladder (odds ratio [OR] 0.48, 95% CI 0.26-0.91, P = .02), head/neck (OR 0.44, 95% CI 0.29-0.68, P < .01), stomach (OR 0.40, 95% CI 0.23-0.70, P < .01), and esophageal (OR 0.40 95% CI 0.22-0.74, P < .01) trials. Hematologic (OR 1.78, 95% CI 1.09-1.82, P < .01) and pancreatic (OR 2.18, 95% CI 1.46-3.26, P < .01) trials had higher odds of proportional female representation. Industry-funded trials had greater odds of proportional female representation (OR 1.41, 95% CI 1.09-1.82, P = .01) than US government and academic-funded trials. CONCLUSIONS Stakeholders should look to hematologic, pancreatic, and industry-funded cancer trials as exemplars of female participant representation and consider female representation when interpreting trial results.
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Affiliation(s)
| | - Tiffany R Bellomo
- Department of Vascular Surgery, Massachusetts General Hospital Harvard Medical Center, Boston, MA, USA
| | | | - Henry K Litt
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Shyu
- Department of Medicine, Mount Sinai, New York, NY, USA
| | | | - Max M Wang
- Feinberg School of Medicine, Northwestern, Chicago, IL, USA
| | - Alexander Bell
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Massoud Saleki
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Katherine I Wolf
- Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | | | - Jacqueline J Tao
- Department of Medicine, New York-Presbyterian Weill Cornell, New York, NY, USA
| | - Sunjong Ji
- Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Ryan M O’Keefe
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Pun
- Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | | | - Jecca R Steinberg
- Department of Obstetrics & Gynecology, Northwestern, Chicago, IL, USA
| | - Ronald S Go
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Brandon E Turner
- Department of Radiation Oncology, Dana Farber Cancer Institute Harvard Medical Center, Boston, MA, USA
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Oncology, University Hospitals, Case Western University, Cleveland, OH, USA
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Litt HK, Parks AL, Velazquez AI. Blood Clots, or Thrombosis, in Patients With Cancer. JAMA Oncol 2023; 9:876. [PMID: 37052914 DOI: 10.1001/jamaoncol.2022.6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
This JAMA Oncology Patient Page explains the risk, diagnosis, treatment, and prevention of thrombosis in patients with cancer.
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Abstract
This quality improvement study characterizes surgical oncology trials, analyzes growth, identifies associations with early discontinuation or results reporting, and evaluates proportions of trials involving each neoplasm site.
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Affiliation(s)
| | | | - Jolie Z. Shen
- University of Washington School of Medicine, Seattle
| | - Brandon E. Turner
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Henry K. Litt
- Department of Medicine, University of California, San Francisco
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sherry M. Wren
- Department of Surgery, Stanford University, Stanford, California
- Palo Alto Veterans Health Care System, Palo Alto, California
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Perera ND, Bellomo TR, Litt HK, Fattahi S, Bell A, Stavins MA, Saleki M, Ionescu R, Shyu M, Wang MM, Tao J, Sarsour N, Ji S, O'Keefe RM, Pun M, Takasugi JM, Steinberg JR, King R, Mahipal A, Turner BE. Female participation in U.S. oncology clinical trials registered on ClinicalTrials.gov from 2008 to 2020. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
85 Background: Females are thought to be underrepresented in clinical trials, which may lead to care disparities. We characterized female enrollment trends in U.S. oncology trials registered on ClinicalTrials.gov and identified features associated with accurate representation. Methods: We employed a cross-sectional study design with descriptive, logistic regression, and cox regression analyses. We downloaded 270,172 studies registered on the Aggregate Analysis of the ClinicalTrials.gov database from October 1, 2008 to March 9, 2020, excluding non-interventional and reproductive organ specific trials. We then applied cancer/oncology specific Medical Subject Heading terms and manually reviewed the remaining 27,521 trials for true oncology content. Prevalence-corrected estimates for female participation were calculated as the percentage of females among trial participants divided by the percentage of females in the disease population per U.S. Surveillance, Epidemiology, and End Results Program (SEER) data (participation to prevalence ratio [PPR]), with a range between 0.8 and 1.2 reflecting accurate female representation in the trial. Results: Of 26,894 trials meeting eligibility criteria, 9,059 trials were completed in the U.S., 2,499 trials reported completed study status, and only 1,256 trials reported sex. Among 1,256 oncology trials and 229,056 participants, overall female representation was 46.9% (95% CI, 45.4-48.4%). 43% of trials were industry funded, 29% academic, and 28% U.S. government. Females were underrepresented compared to their disease burden in anal canal (PPR 0.21), thyroid (PPR 0.57), stomach (PPR 0.68), kidney (PPR 0.77), and bone (PPR 0.79) cancer trials. They were accurately represented in head and neck (PPR 0.80), lung (PPR 0.84), bladder (PPR 0.85), skin (PPR 0.88), pancreas (PPR 0.88), colon (PPR 0.90), hematologic (PPR 0.91), liver (PPR 1.01), CNS (PPR 1.03), soft tissue (PPR 1.05), and esophagus (PPR 1.05) cancer trials. Accurate representation was significantly associated with industry funding and pancreas cancer trial focus, but not associated with trial type (medical, surgical, radiation, other invasive, other) (Table). Conclusions: Females are underrepresented compared to their disease burden in many solid tumor clinical trials. Stakeholders can look to industry funded and pancreas cancer trials as models of improvement, but must increase female representation in clinical trials to improve cancer care. [Table: see text]
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Affiliation(s)
| | | | | | | | - Alexander Bell
- School of Medicine, University of California San Francisco, San Francisco, CA
| | | | - Massoud Saleki
- Department of Medicine, University of Vermont, Burlington, VT
| | | | - Margaret Shyu
- Department of Medicine, Mount Sinai Hospital, New York, NY
| | - Max M. Wang
- Medical Scientist Training Program, Northwestern University, Chicago, IL
| | - Jacqueline Tao
- Department of Medicine, New York-Presbyterian Weill Cornell, New York, NY
| | - Nadeen Sarsour
- School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Ryan M O'Keefe
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Matthew Pun
- School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jecca R. Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roderick King
- Department of Anesthesia, Mayo Clinic, Rochester, MN
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Brandon E. Turner
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
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Perera ND, Turner BE, Shen JZ, Wong BO, Litt HK, Stavins MA, Bellomo TR, Saleki M, Bell A, Ionescu R, Shyu M, Wang MM, Tao J, Sarsour N, O'Keefe RM, Takasugi JM, Steinberg JR, King R, Mahipal A, Wren SM. The surgical oncology clinical trial landscape: A cross-sectional analysis of ClinicalTrials.gov from 2008-2020. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1561 Background: Surgical interventions are studied less often than medical or radiation interventions in oncology clinical trials. We characterized surgical oncology trials registered on ClinicalTrials.gov, analyzed funding sources and identified features associated with early discontinuation and results reporting. Methods: We employed a cross-sectional study design with descriptive, logistic regression, cox regression, time series and survival analyses. We downloaded all 270,172 studies registered on the Aggregate Analysis of the ClinicalTrials.gov database from October 1, 2008 to March 9, 2020. After excluding non-interventional trials, applying cancer/oncology specific Medical Subject Heading terms to the remaining trials and excluding phase 1 trials, 27,915 trials were identified for manual review. Primary exposure variables were trial focus: neoplasia site and treatment modality (surgical interventions included investigations of outcomes from surgical resection or intra-operative/peri-operative changes), and funding: industry, U.S. government, academic. Results: 26,815 trials were found to have true oncology content; 1,661 (6.2%) involved surgical oncology, representing 311,789 patients. Funding sources were: 82.7% by academic institutions, 10.9% by industry, and 6.2% by U.S. government. The most studied neoplasia sites were colorectal (17.4% of trials), breast (10.7%), gastric (10.5%), hepatic (8.6%), lung (7.5%), brain/CNS (6.7%) and cervical (6.6%). U.S. government funded surgical oncology trials had the lowest risk of early discontinuation (adjusted HR 0.50, 95% CI: 0.26-0.99, p<0.047) and the highest odds of results reporting (adjusted OR 1.08, 95% CI: 0.55-2.11, p=0.83) (Table 1). Conclusions: There is a paucity of surgical oncology clinical trials compared to other treatment modalities, especially in context of surgery’s role in overall cancer care. From 2008-2020 only 6.2% of trials focused on surgical oncology, and U.S. government funded trials displayed the lowest hazard of early discontinuation and highest odds of results reporting. Stakeholders should look to government funded trials as models of improvement, but must increase representation and results dissemination of surgical oncology trials to guide treatment recommendations. Surgical oncology trial features and associated early discontinuation/results reporting. [Table: see text]
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Affiliation(s)
- Nirosha D. Perera
- School of Medicine, Stanford University, Stanford, CA, and Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brandon E. Turner
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - Jolie Z. Shen
- University of Washington School of Medicine, Seattle, WA
| | | | - Henry K. Litt
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | | | - Massoud Saleki
- School of Medicine, University of Washington, Seattle, WA
| | - Alexander Bell
- School of Medicine, University of California San Francisco, San Francisco, CA
| | | | - Margaret Shyu
- Department of Medicine, Mount Sinai Hospital, New York, NY
| | - Max M. Wang
- Medical Scientist Training Program, Northwestern University, Chicago, IL
| | - Jacqueline Tao
- School of Medicine, Stanford University, Stanford, CA, and Department of Medicine, New York-Presbyterian Weill Cornell, New York, NY
| | - Nadeen Sarsour
- School of Medicine, University of Michigan, Ann Arbor, MI
| | - Ryan M O'Keefe
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Jecca R. Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roderick King
- School of Medicine, Stanford University, Stanford, CA, and Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Sherry M. Wren
- Department of General Surgery, Stanford University and Palo Alto Veterans Affairs Health Care System, Stanford, CA
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Krasnow MR, Litt HK, Lehmann CJ, Lio J, Zhu M, Sherer R. Cancer, transplant, and immunocompromising conditions were not significantly associated with severe illness or death in hospitalized COVID-19 patients. J Clin Virol 2021; 140:104850. [PMID: 34022753 PMCID: PMC8106963 DOI: 10.1016/j.jcv.2021.104850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 12/24/2022]
Abstract
Objective Patients with cancer, transplant, and other immunocompromising conditions are at uncertain risk of severe COVID-19 illness. This study aimed to clarify whether patients with immunocompromising conditions were more likely to develop severe COVID-19 illness in a single urban academic medical center. Methods A retrospective chart review and electronic data extraction of the first 401 patients at the University of Chicago Hospitals with SARS-CoV-2 infection was performed. Patients met criteria for severe COVID-19 illness if they required ICU level care, high flow oxygen, positive pressure support, helmet non-invasive ventilation, mechanical ventilation, or ECMO, developed ARDS, or died. Results The mean age was 60 years, 52% were women, 90% were African American, and mortality at 30 days post discharge was 13%. Severe COVID-19 illness was found in 168 (40%) patients. Of the 56 patients with past or current cancer, 25 (45%) had severe illness (p=0.76). Of the 55 patients with other immunocompromised conditions, 24 (44%) had severe illness (p=0.89) After controlling for age, sex, and race, neither cancer (p=0.73) nor immunocompromised conditions (p=0.64) were associated with severe illness. Conclusion No association was found between severe COVID-19 illness and cancer, transplant, and other immunocompromising conditions in a cohort of mostly African American patients.
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Affiliation(s)
- Maya R Krasnow
- University of Chicago Pritzker School of Medicine, 924 E 57 St. Suite 104, Chicago, IL 60637.
| | - Henry K Litt
- University of Chicago Pritzker School of Medicine, 924 E 57 St. Suite 104, Chicago, IL 60637.
| | - Christopher J Lehmann
- University of Chicago, Section of Infectious Disease and Global Health, Department of Medicine, 5841 S Maryland Ave, Chicago, IL 60637.
| | - Jonathan Lio
- University of Chicago, Section of Infectious Disease and Global Health, Department of Medicine, 5841 S Maryland Ave, Chicago, IL 60637.
| | - Mengqi Zhu
- University of Chicago, Section of General Internal Medicine, Department of Medicine, 5841 S Maryland Ave, Chicago, IL 60637.
| | - Renslow Sherer
- University of Chicago, Section of Infectious Disease and Global Health, Department of Medicine, 5841 S Maryland Ave, Chicago, IL 60637.
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Litt HK, Press VG, Hull A, Siros M, Luna V, Volerman A. Association between inhaler technique and confidence among hospitalized children with asthma. Respir Med 2020; 174:106191. [PMID: 33152551 DOI: 10.1016/j.rmed.2020.106191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Proper use of respiratory inhalers is crucial to asthma self-management and associated with improved outcomes. Previous studies conducted in outpatient and community settings show parents and children are overconfident in children's ability to use inhalers properly, which may lead healthcare providers to not teach or review inhaler technique. This study examined whether children and parents' confidence were associated with proper inhaler technique among children hospitalized with asthma. METHODS Children between 5 and 10 years old hospitalized with asthma at an urban academic medical center demonstrated inhaler technique using metered dose inhalers and spacers. Technique was scored based on a validated 12-step scale. Confidence was measured using three items assessing 1. Knowledge to use inhaler, 2. Skills to use inhaler, and 3. Ability to independently use inhaler. These items were five-point scales and analyzed as binary variables. Independent t-tests were used to measure associations between confidence and number of steps performed correctly. RESULTS None of the confidence items, when asked to parents or children (n = 70), were associated with the number of steps performed correctly. Further, while the majority of children and parents (59-70%) were confident based on each item, the mean number of steps correctly completed was 6.4 out of 12. CONCLUSIONS Children and parents' confidence in children's knowledge, skills, and ability to independently use an inhaler were all poor proxies for proper inhaler technique. Inpatient healthcare professionals should objectively evaluate technique and teach proper inhaler use to all children with asthma to optimize outcomes.
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Affiliation(s)
- Henry K Litt
- University of Chicago Pritzker School of Medicine, 924 E 57 St. Suite 104, Chicago, IL, 60637, USA.
| | - Valerie G Press
- University of Chicago Departments of Medicine and Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Ashley Hull
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Michelle Siros
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Viridiana Luna
- University of Chicago Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Anna Volerman
- University of Chicago Departments of Medicine and Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
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