Academic Oncology Research Articles

Comparison of the effectiveness of integrative immunomodulatory treatments and conventional therapies on the survival of selected gastrointestinal cancer patients

In the last decade, the use of immunomodulating treatments (IMT) at integrative oncology providers (IOP) increased. IMTs are used to modulate the tumor microenvironment, which might lead to increased response-to-treatment, and the indication of immune checkpoint inhibitors might also be widened. The efficacy and safety of IMTs in advanced/metastatic gastrointestinal cancers were compared with conventional chemo(radio)therapy (CT). 21 colorectal– (CRC), 14 pancreatic– (PC), 5 cholangiocellular– (CCC), 5 gastric– (GC) and 4 esophageal cancer (EC) patients received IMT. IMT and CT were compared in CRC and PC. CT was administered at an academic oncology center. After the initiation of IMT, a median survival of ~ 20 (CRC, PC and EC) and ~ 10 months (CCC and GC) was observed. Of the IMTs, locoregional modulated electro-hyperthermia had the most positive effect on overall survival (HR: 0.3055; P = 0.0260), while fever-inducing interleukin-2, and low-dose ipilimumab showed a positive tendency. IMT was superior to CT in PC (HR: 0.1974; P = 0.0013), while modest effect was detected in CRC (HR: 0.7797; P = 0.4710). When the whole study population was analyzed, IMTs showed minimal effect on patient survival, still CT had the greatest effect if introduced as early as possible (HR: 0.0624; P < 0.0001). The integrative IMTs in the presented form have mild impact on gastrointestinal cancer patients’ survival, however, we observed its benefit in PC, which warrants further investigations.

Positive feelings of daily accomplishment, role clarity, and academic balance may protect against stress and burnout in oncology.

53 Background: Burnout and stress have negative effects on physician well-being, workforce retention, and patient outcomes. Work overload, lack of control, and value mismatch are known drivers of burnout, but protective factors remain unclear. Methods: National data from the Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey, conducted 2020-2022 (overall response rate 58%) was analyzed. Job satisfaction questions assessed faculty autonomy (“I am satisfied with my autonomy at work”), accomplishment (“My day-to-day activities give me a sense of accomplishment”), clear roles (“My role here is clear to me”), institutional alignment (“I feel personally driven to help this medical school succeed”), and academic balance (“My effort assigned to service, teaching, and research, accurately reflects how my time is actually spent in the workplace”) with “agree”/“strongly agree” considered positive. Burnout measures included: “I enjoy my work”, “I am under stress”, or self-reported (at least) “one or more symptoms of burnout”. Faculty demographics included gender, race/ethnicity, sexual orientation, and rank. Multivariate analysis (MVA) identified factors associated with physician stress and burnout. Results: Of 1306 academic oncologists surveyed, most were male (56%), White (65%), and identified as heterosexual (96%); 7% were considered underrepresented in medicine by race or ethnicity. Of 814 (62% of sample) who self-assessed job satisfaction, most endorsed positive autonomy (82%), accomplishment (82%), clear roles (79%), institutional alignment (80%), and academic balance (59%). Of assessed demographics, women had slightly less institutional alignment (76% vs 83% men, p=0.026) and academic balance (55% vs 62% men, p=0.032). Of 751 (58% of sample) who self-assessed burnout, only 25% enjoyed their work; the rest were either under stress (46%) or had at least one symptom of burnout (29%). Of assessed demographics, women were more likely to report burnout (34% vs 25% men, p=0.0013). On MVA, women (OR=1.6, 95%CI 1.1-2.4) were more likely to be either under stress or endorse burnout. Any faculty (regardless of gender) who reported feelings of job accomplishment (OR=0.36, 95%CI 0.14-0.96), clear roles (OR=0.31, 95%CI 0.13-0.78), and academic balance (OR=0.32, 95%CI 0.20-0.51) were less likely to report stress or burnout. Conclusions: In a large mid-pandemic national survey of academic oncologists, the vast majority were either under stress or had symptoms of burnout, with women being at highest risk. Faculty who endorsed a sense of accomplishment, reported they had clear roles, and whose academic effort was aligned with their actual time at work had one-third the risk of stress and burnout as those who did not. Implementing programs to improve these vital aspects of academic work should be part of essential burnout mitigation efforts.

Pilot study of remote electronic patient-reported outcomes (ePRO) symptom monitoring of palliative care needs among outpatients with advanced solid cancers.

250 Background: Early specialty palliative care for patients with advanced cancer is an evidence-based practice that improves health outcomes, yet patients do not receive timely referrals. ePRO symptom monitoring provides a ready care delivery platform to monitor patients for unmet palliative care needs and direct palliative care referral based on patient report. This study sought to obtain feasibility data for ePRO symptom monitoring of palliative care needs. Methods: We conducted a single-arm pilot study of longitudinal ePRO symptom monitoring of multidimensional palliative care needs among outpatients with advanced breast, gastrointestinal, and gynecologic cancers at an academic oncology practice. Adult patients on active treatment with a prognosis &gt; 6 months were approached consecutively. Patients completed baseline measures and enrolled on a third-party symptom monitoring platform for 12 weeks. Patients received weekly monitoring of 14 common symptoms using the National Cancer Institute's PRO version of the common terminology criteria for adverse events (PRO-CTCAEs). Patients received monthly monitoring of palliative needs using 11 PRO items from validated measures and a clinician-developed item for patient request for palliative care. Weekly symptom alerts and monthly palliative care PRO assessments were reported to the primary oncology team for interdisciplinary clinical management. Acceptability and appropriateness of the intervention were assessed using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM). Results: From May 2022 to April 2023, 29 of 37 eligible patients (78%) consented to the study, of which 25 completed baseline measures and enrolled on the platform (68% enrollment rate; most common reason for refusal was not enough time). Median age was 53 years (range 29-77), 18 (72%) female, 12 (48%) non-Hispanic White, 32% reported an ECOG-PRO score 2-3. 96% of patients met pre-defined ePRO adherence thresholds and 92% completed study end measures (1 patient censored for death). Completion of the palliative PRO items was &gt; 94% for 9 of 11 items. Two PRO items for spiritual distress screening were skipped most often. 80% of patients reported a severe score for at least one palliative PRO symptom during the study period. Mean AIM and IAM scores were 3.92 and 4.26, respectively (range 3.25 – 5; best possible total score 5). Conclusions: Expanding evidence-based ePRO symptom monitoring to include monthly palliative care needs assessment is highly feasible, acceptable, and appropriate to patients. Adherence to PRO items was high, and most patients had at least one area of need. Future work will refine the ePRO palliative assessment with attention to spiritual distress screening and determine severity thresholds to develop a PRO-directed referral system to specialty palliative care.

Alternative model to deliver germline genetic testing to patients with advanced prostate cancer (PCa).

123 Background: Genomic testing is now standard-of-care (SOC) for PCa patients with both therapeutic and hereditable consequences. National guidelines recommend germline testing in all high-risk and advanced PCa patients, regardless of age or family history. Yet, many systemic barriers prevent patients from receiving germline testing promptly, including the burden of appointments, comorbidities, transportation, provider knowledge of genetic testing, and insufficient genetics workforce that limits timely referral to genetic counselors. Methods: We developed a streamlined, alternative genetic care delivery model to improve rates of germline genetic testing for PCa patients. A multidisciplinary team (genitourinary medical oncologists, advanced practice RN, and genetic counselors) developed a tailored pre- and posttest counseling curriculum for PCa patients undergoing germline testing that was delivered by oncology providers. Pretest counseling was incorporated into SOC counseling for somatic tumor genomic testing performed to personalize therapeutics. Systematic posttest counseling was delivered by oncology providers, and men with germline pathogenic/likely pathogenic (P/LP) variants were referred to certified genetic counselors for formal genetic counseling. We retrospectively collected data on PCa patients treated at an academic oncology practice who underwent paired germline/somatic testing through a commercial lab accompanied by tailored pre/posttest counseling, including demographics, clinical characteristics, and germline test results. We performed quarterly audits to monitor quality metrics. Results: From September 2021 to May 2023, seventy-five PCa patients underwent paired germline/somatic tumor testing. The racial/ethnically diverse patient population (self-identified) included 81% Black, 13% Hispanic, and 6% non-Hispanic White men. At the time of analysis, 64 tests had resulted; 9.4% of patients (n=6) had a P/LP germline variant, and 31.2% of patients (n=20) tested negative. The majority of patients (59.4%, n=38) had a variant of unknown significance (VUS). Additional data will be available at the time of presentation. Conclusions: Providing paired germline/somatic tumor testing with tailored pre/posttest education delivered by oncology providers, and formal genetic counseling reserved for patients with P/LP germline variants, is an efficient way to provide guideline-directed genetic services for PCa patients. Given the frequency of VUS, education for pre/posttest counseling is essential, particularly in under-represented minority populations. The frequency of actionable mutations is reduced in underrepresented minority PCa patients compared with reports in the literature, reflecting limitations of current germline testing/bioinformatics platforms and the need for greater inclusion of diverse populations in future studies.

Health-related quality of life in patients with solid tumors receiving implantable venous access ports for chemotherapy: A prospective randomized controlled trial

PurposeImplantable venous access ports are widely used in patients receiving chemotherapy, but there is still scarce evidence about any patient-reported outcome measures. This prospective randomized controlled trial examined the impact on patients’ quality-of-life following the placement of an implantable port device for long-term chemotherapy treatment. MethodA total of 120 chemotherapy naïve adult outpatients scheduled to receive chemotherapy (duration ≥12 weeks) for solid tissue tumors in a single academic oncology unit were randomly allocated (n = 60 in each arm) between radiologically guided insertion of an implantable venous access port (PORT arm) or standard repeated peripheral venous access (Control arm). Health-related quality-of-life scores (HRQoL) were assessed with the EQ-5D-5L and the oncology-specific EORTC QLQ-C30 (version 3.0) questionnaires at baseline, 3- and 6-months post randomization. Non-parametric tests were applied and differences between medians (Δ) are reported because of skewed-left HRQoL data. ResultsBaseline clinical and demographic characteristics were well balanced between the two groups. There were no complications during insertion and no infection or device failure in the PORT subjects through the 6-month follow-up. The functional and symptom scales of the EORTC QLQ-C30 questionnaire were similar between both study arms at all time intervals. The EORTC QLQ-C30 global health status was significantly improved in the PORT subjects both at 3 months (Δ: 8.3 out of 100; P = 0.04) and 6 months follow-up (Δ: 16.7 out of 100; P = 0.003). Changes in EQ-5D-5L scores were significantly improved at 6 months in the PORT arm compared to control (Δ: 0.074 out of 1; P = 0.01). ConclusionsImplantable venous access ports may confer significantly improved patient-reported quality-of-life benefits in patients receiving chemotherapy for solid tissue tumors.

Models of Clinical Practice Integration in Academic Oncology Nursing.

Oncology nursing faculty at academic institutions help equip the next generation of cancer care professionals. In research- and teaching-focused nursing faculty roles, there are barriers to maintaining clinical oncology nursi.

Leveraging the Academic Artificial Intelligence Silecosystem to Advance the Community Oncology Enterprise.

Over the last 75 years, artificial intelligence has evolved from a theoretical concept and novel paradigm describing the role that computers might play in our society to a tool with which we daily engage. In this review, we describe AI in terms of its constituent elements, the synthesis of which we refer to as the AI Silecosystem. Herein, we provide an historical perspective of the evolution of the AI Silecosystem, conceptualized and summarized as a Kuhnian paradigm. This manuscript focuses on the role that the AI Silecosystem plays in oncology and its emerging importance in the care of the community oncology patient. We observe that this important role arises out of a unique alliance between the academic oncology enterprise and community oncology practices. We provide evidence of this alliance by illustrating the practical establishment of the AI Silecosystem at the City of Hope Comprehensive Cancer Center and its team utilization by community oncology providers.

Evaluation of Culture Conducive to Academic Success by Gender at a Comprehensive Cancer Center.

The primary objective of this study was to determine whether workplace culture in academic oncology differed by gender, during the COVID-19 pandemic. We used the Culture Conducive to Women's Academic Success (CCWAS), a validated survey tool, to investigate the academic climate at an NCI-designated Cancer Center. We adapted the CCWAS to be applicable to people of all genders. The full membership of the Cancer Center was surveyed (total faculty = 429). The questions in each of 4 CCWAS domains (equal access to opportunities, work-life balance, freedom from gender bias, and leadership support) were scored using a 5-point Likert scale. Median score and interquartile ranges for each domain were calculated. A total of 168 respondents (men = 58, women = 106, n = 4 not disclosed) submitted survey responses. The response rate was 39% overall and 70% among women faculty. We found significant differences in perceptions of workplace culture by gender, both in responses to individual questions and in the overall score in the following domains: equal access to opportunities, work-life balance, and leader support, and in the total score for the CCWAS. Our survey is the first of its kind completed during the COVID-19 pandemic at an NCI-designated Cancer Center, in which myriad factors contributed to burnout and workplace challenges. These results point to specific issues that detract from the success of women pursuing careers in academic oncology. Identifying these issues can be used to design and implement solutions to improve workforce culture, mitigate gender bias, and retain faculty.

Career development: A balance of opportunities and choices.

Career development: A balance of opportunities and choices.

Differential burnout by race, sex, and sexual orientation in academic oncology.

11000 Background: Burnout is a concern in medicine with negative effects on physician wellbeing, workforce retention, and patient outcomes. Research has shown that rising burnout can lead to medical errors, lower patient satisfaction, and decreased professional work effort. The presence of burnout in oncology is well documented, however it is unclear if burnout affects all groups equally in academic oncology. Methods: We obtained national faculty data from the Association of American Medical Colleges StandPoint Faculty Engagement Survey, conducted 2017-2020 (overall response rate 64%). Burnout was considered any response endorsing at least “one or more symptoms of burnout”. Self-reported workplace culture was assessed for key factors: collegiality, diversity, faculty wellness, and recruitment/retention of underrepresented in medicine (UiM) faculty. Faculty demographics included age, sex, race/ethnicity, sexual orientation (heterosexual, bisexual, lesbian/gay), rank, degree, and any department or institutional leadership role. Multivariate analysis (MVA) identified factors associated with faculty burnout. Results: A total of 724 academic oncologists were identified. Most were male (58%) and identified as heterosexual (95%). Race/ethnicity were mostly White (65%), with 29% Asian, 2% Black, and 3% Hispanic/Latino; 7% were considered UiM. Most (53%) were senior faculty; 37% had a leadership role. Overall, 22% reported burnout. Self-identified lesbian/gay/bisexual faculty had the highest rate of burnout (43% vs 21%, p = 0.0005) followed by female faculty (31% vs 16% men, p = &lt; 0.0001). Asian faculty had the lowest burnout rates (12%) followed by White and Hispanic (both 26%), Black (33%), and multi-racial physicians (50%, p = 0.003 for comparisons). Pooled UiM had numerically higher burnout but this was not statistically significant (30% vs 22%, p = NS). On MVA, lesbian/gay/bisexual (OR = 3.56, 95%CI 1.55-8.18, p = 0.003) and female (OR = 2.32, 95%CI 1.51-3.56, p &lt; 0.0001) faculty had increased odds of burnout. Most agreed that their institution cultivates collegiality (80%), diversity (73%), and faculty wellness (53%); men were more likely to endorse positive diversity (77% vs 68% women, p = 0.004). Most agreed their institution was successful in recruiting (63%) and retaining (58%) UiM faculty, however non-UiM were more likely to agree with this for recruitment (64% vs 46% UiM, p = 0.01) and retention (50% vs 42% UiM, p = 0.01). Conclusions: Nearly 1 in 4 oncologists report burnout with self-identified female and lesbian/gay/bisexual faculty at the highest risk. Additionally, in general, men and non-UiM faculty were more likely to feel their workplace culture was favorable. Urgent and tailored interventions at the institutional and departmental level will be critical to address both drivers of faculty burnout and the impact of burnout on attrition and career trajectory for marginalized and minoritized groups.

Should I stay, or should I go? Factors associated with intent to leave academic oncology.

11004 Background: Physicians who are female and/or belong to racial/ethnic groups underrepresented in medicine (UIM) face disparities in salary, promotion, and leadership opportunities in academic oncology. Also, growing rates of burnout, increasing burden of documentation/administrative tasks, and lack of adequate supportive staff represent threats to workforce retention, particularly for female and racial minority subgroups. We evaluated the prevalence and factors associated with likelihood of leaving their specific academic institution in a national sample. Methods: We obtained national faculty data from the AAMC’s StandPoint Faculty Engagement Survey, conducted between 2017-2020 with 25 U.S. medical schools. Chi-squared and Fisher’s exact tests were used to determine differences in likelihood of leaving their institution within 1-2 years by sex and UIM status. Multivariate analyses (MVA) examined the associations between likelihood of leaving their institution and self-reported sex, year born, sexual orientation, UIM race/ethnicity, degree, academic rank, and administrative role. Results: We identified 724 oncology faculty at academic institutions (overall response rate 64%). Slightly less than half of oncologists self-identified as female (42%, n = 303) and only 7% (n = 47) as UIM. When asked about the likelihood of leaving their current institution, 22% (n = 152/687) of oncologists reported being at least somewhat likely to leave within the next 1-2 years. Notably, 26% of female oncologists reported they were likely to leave, compared to 19% of males (p = 0.022); no differences were observed by UIM status (p = 0.714). MVA identified sex as associated with likelihood of leaving; females had 78% higher odds of leaving their institution within 1-2 years (aOR 1.78; 95% CI, 1.13–2.79). Among those likely to leave, 46% (n = 72/157) reported intent to leave academic medicine completely; rates were similar across sex and UIM groups (p = 0.746). When evaluating workplace experience, most oncologists (86%, n = 621) felt respected in their workplace. Among those reporting feelings of disrespect in the workplace, 16% of female oncology faculty felt disrespected due to their gender (n = 47), compared to 0% of male oncologists. A small number of faculty reported disrespect due to age (n = 26), race/ethnicity (n = 11), sexual orientation (n = 2), marital status (n = 10), or religion (n = 7). Females endorsed greater feelings of disrespect in all categories other than religion. Conclusions: Female oncologists are almost twice as likely to state they are likely to leave their academic institutions within 1-2 years; this aligns with published data on attrition of female faculty in academic medicine. Our findings confirm the persistence of these trends in the modern era and stress the urgency of improving workplace experience, culture, and supports in order to preserve and enhance the diversity of faculty in academic oncology.

Workplace sexual harassment in academic oncology.

11003 Background: Research has shown workplace sexual harassment (WSH) is a pervasive problem in academia, affecting recruitment, retention &amp; career advancement of women faculty. This study examines WSH in academic oncology faculty in a national survey. Methods: We obtained data from the Association of American Medical Colleges StandPoint Faculty Engagement Survey between 2020-22 representing a national sample of academic faculty from 25 medical schools (overall response rate (RR) 58%). WSH was considered specific “unwanted behavior” by coworkers that occurred at least once in the past year. Reporting questions were asked on a 5-point Likert Scale from Strongly Disagree to Strongly Agree, with 6th option “I Don’t Know.” Responses were grouped as Agree/Strongly Agree vs all others. Chi-square tested for differences by gender and race/ethnicity. Results: 807/1,287 oncologists participated in the survey (RR 63%), and 91% (731) answered the WSH questions. Most self-identified as men (58%) and only 8% identified as underrepresented race/ethnicity (URiM). See Table for findings. In oncology, women experienced any WSH at higher rates than men (33.1% vs 10.3%, p=0.001). The most common was derogatory comments due to gender. Regardless of gender, most knew how to report WSH incidents, but men were more likely to feel safe reporting. While 64.9% of men felt confident that their medical school would resolve WSH incident(s) effectively, only 48.7% of women did. Positive perceptions of reporting decrease among those who reported harassment. URiM faculty (35.6% vs.18.5%, p=0.001) were more likely than non-URiM faculty to experience at least one of the five harassment behaviors, although this was limited by small sample. Conclusions: In academic oncology, women and URiM experience workplace sexual harassment more often than men and non-URiM. Less than half of women felt confident that reporting an incident would lead to effective resolution. Urgent intervention is needed to combat the negative force of sexual harassment on workforce equity. [Table: see text]

Operational Challenges of an Asia-Pacific Academic Oncology Clinical Trial.

The Asia-Pacific (APAC) region is a major focus for multinational clinical trials, although its cultural, linguistic, economic, and regulatory diversity pose significant challenges for trial conduct, particularly for academic clinical trials. We describe our experience running the investigator-initiated phase III randomized, fully accrued, Aspirin for Dukes C and high-risk Dukes B Colorectal cancer trial (ASCOLT, ClinicalTrials.gov identifier: NCT00565708, N = 1,587), studying the benefit of aspirin in resected high-risk colorectal cancer. ASCOLT opened in 2008 and is the first large academic adjuvant trial fully conducted in the APAC region. Centrally coordinated by the Trial Management Team at the National Cancer Centre Singapore, it has involved 74 sites across 12 APAC countries/regions, including five middle-income countries. Challenges encountered included regulatory complexity, communication and logistical barriers, limited funding and resources, disparate experience and infrastructure across sites, recruitment holds because of changes in local laws, patient attrition, and disruptions caused by the COVID-19 pandemic. Over 100 contracts and 49 ethics board reviews were required, contributing to a lengthy prestudy preparation time of 2 years and start-up times of approximately 6 months per site. Some of the mitigating actions included engaging local cooperative groups (eg, the Australasian Gastro-Intestinal Trials Group in Australia and New Zealand) and seven contract research organizations to manage sites, regular communication with the central team, transition to electronic data management, and a centralized drug-dispensing system. To ensure an efficient and patient-centered clinical trials environment in the APAC region and sustained growth, we suggest coordinated approaches to harmonize regulatory processes, APAC academic oncology trials consortia to streamline processes and provide governance, and ongoing commitment from governments, funding agents, and industry.

Use of molecular NGS vs single gene testing differs by clinical setting and physician’s specialty in mNSCLC management.

e18547 Background: Genomic profiling is an important entrée to Precision Medicine (PM) therapies for treating metastatic non-small cell lung cancer (mNSCLC) with 16 new PM therapies approved since 2018, and 10 advancing from second (2L) to the first (1L) line. However, absent or suboptimal predictive biomarker testing leads to patients not benefiting from appropriate PM treatments (64% inappropriate; Sadik et al., 2022). Disparities in testing practices and perceptions remain when considering Next Generation Sequencing (NGS) versus Single Gene (SG) testing. We hypothesized that testing rates are associated with physician’s specialty/clinical setting, and assessed this in real-world data for USA mNSCLC patients. Methods: The DXRX database contains real-world claims and laboratory data covering 60% of USA mNSCLC population (Surveillance, Epidemiology, and Results program - SEER comparison). NGS and SG testing rates for newly diagnosed (1L) and 2L mNSCLC patients (~186K patients from 2018 to 2021) were evaluated by physician specialty and affiliation (self-populated on National Plan and Provider Enumeration System - NPPES). Oncologists and Pathologists referred 63% and 15% of the patients respectively. Results: Oncologists (ONCs) had higher NGS testing rates than pathologists (PATHs), with double the testing rates in 2L. NGS testing rates were higher in academic vs community settings, regardless of specialty. Conversely PATHs had higher SG testing rates than ONCs, particularly in community settings (Table). NGS testing rates were generally higher in 2L and SG testing higher in 1L. Conclusions: NGS is the optimal molecular testing modality for mNSCLC patients, however, there is a disparity of testing rates across physician specialties and treatment settings in decreasing order: academic ONCs &gt; community ONCs &gt; academic PATHs &gt; community PATHs, who favor SG testing. This could be influenced by turnaround time needs, reimbursement challenges, and/or technology diffusion rate. As most mNSCLC patients are treated in the community setting, efforts are needed to tackle disparities in appropriate testing. [Table: see text]

Temporal trends of atypical drug access at an academic oncology unit: The Verona University Hospital experience.

e13651 Background: In Italy, patient (pt) access to oncological drugs is almost exclusively provided by the NHS, following authorization by the European Medicines Agency (EMA) and negotiation with the Italian Medicines Agency (AIFA) for specific indications. However, regulatory delays (with respect to the availability of scientific evidence) and the need for rapid access to innovative drugs, particularly in the context of orphan and rare diseases, have prompted the utilization of atypical drug access pathways. In addition to enrollment in clinical trials, atypical drug access pathways are expected to be increasingly used in the context of a Precision Oncology practice. Methods: We explored trends in atypical drug access at the Oncology Section of the Verona University and Hospital Trust, by interrogating Oncology and Pharmacy databases and regional registries of rare diseases and reviewing AIFA registries records. Data on atypical drug access were also correlated with the use of NGS-based molecular profiling. Results: Between January 2016 and December 2022, a total of 355 atypical drug access requests for the treatment of cancer pts were recorded, with a peak in 2017 and no discernible temporal trend. Over this period, the two most common atypical access schemes were compassionate (including named patient and early access programs, 61%) and off-label (21%) use. The latter steadily increased over time (from 8% in 2017 to 39% in 2021). Overall, the type of drugs requested through atypical access were almost equally distributed between classical cytotoxic agents (CHT, 36%), immuno-oncology drugs (IO, 29%) and molecularly targeted agents (TT, 35%). Temporal trends in the usage of different classes of drugs are shown. Interestingly, TT requests decreased between 2016 and 2018 and stabilized at approximately 50% of total requests since 2019. Between 2019 and 2021, atypical drug access requests triggered by NGS-based extended molecular profiling significantly increased from 2.8% to 23.1% (p=0.0007). Conclusions: Although atypical drug access did not increase overall during the observation period, a trend towards increased off-label use of TT was identified, especially from 2019 onwards; figures for 2022 are being analyzed and will be presented at the Meeting. Since 2019, NGS-informed requests have significantly increased to constitute almost 1/4 of all atypical drug access requests, clearly identifying a trend towards implementation of Precision Oncology in routine clinical practice and evolving towards the implementation of Molecular Tumor Board case discussions. [Table: see text]

Use of positron emission tomography-computed tomography (PET-CT) scan in cancer patients: A single Canadian academic oncology center experience.

e18691 Background: PET-CT scan is key tool in the diagnosis and follow up of cancer patients. In 2017, a governmental study demonstrated that the use of PET-CT scans in the province of Quebec, Canada was two times more elevated than other Canadian provinces, and similar to the United States (507 vs 510 PET-CT scans per 100,000 persons, respectively). In Quebec, the governmental agency Institut national d’excellence en santé et en services sociaux (INESSS) published recommendations for judicious use of PET-CT scans, derived from evidence-based literature and publications from international oncology societies . We sought to evaluate the use of PET-CT scans in our institution with regards to INESSS guidelines. Methods: A total of 1561 PET-CT scans were performed for oncologic purposes at the CHUM between September 1st and November 30th 2019. TEP-CT scans from patients under 18 years of age or who were not followed at our center were excluded. 975 PET-CT scans respected our criteria. We reviewed disease and clinical characteristics of patients, adherence to 2017 INESSS guidelines, imaging indication (staging, response to treatment, or follow up), and type of specialties requesting the exam. Results: Oncologic PET-CT scans were most frequently prescribed by surgeons (39%), followed by oncologists (29%) and radiation-oncologists (12%). 530 (54%) PET-CT scans followed guidelines, 377 (39%) did not, and 68 (7%) were not included in INESSS guidelines. Adherence to guidelines was similar between oncologists and surgeons (54% and 53%, respectively). PET-CT scans ordered by radiation-oncologists followed guidelines in 67% of cases. Lung (29%), breast (19%), and gastro-intestinal cancers (16%) were the sites for which the exam was most requested. Whereas 77% of PET-CT scans requested for lung cancer followed guidelines, only 17% of breast cancer PET-CT scans did. Misuse of this imaging tool was also observed in the investigation of cancer of unknown origin, where only 17% of ordered PET-CT scans followed guidelines. Conclusions: In our institution, 39% of PET-CT scans prescription did not follow guidelines. Variability in adherence to guidelines was significantly more noticeable between primary cancer sites compared to types of specialties requesting the exam. To avoid wasting of resources, we advocate for respecting guidelines and discussing in tumor-boards the off-label use of PET-CT scans. Judicious use of PET-CT scans is particularly important in a public health system for appropriate allocation of resources.

Characterization of industry relationships in oncology.

Collaborative relationships between academic oncology and industry (pharmaceutical, biotechnology, "omic," and medical device companies) are essential for therapeutic development in oncology; however, limited research on engagement in and perceptions of these relationships has been done. Survey questions were developed to evaluate relationships between academic oncology and industry. An electronic survey was delivered to 1000 randomly selected members of the American Society of Clinical Oncology, a professional organization for oncologists, eliciting respondents' views around oncology-industry collaborations. The responses were analyzed according to prespecified plans. There were 225 survey respondents. Most were from the United States (70.0%), worked at an academic institution (60.1%), worked in medical oncology (81.2%), and had an active relationship with industry (85.8%). One quarter (26.7%) of respondents reported difficulty establishing a relationship with industry collaborators, and most respondents (75%) did not report having had mentorship in developing these relationships. The majority (85.3%) of respondents considered these collaborations important to their careers. Respondents generally thought that scientific integrity was preserved (92%), and most respondents (95%) had little concern over the quality of the collaborative product. Many (60%) shared concerns over potential conflict of interest if an individual with a compensated relationship promoted an industry product for clinical care/research, yet most respondents (67%) stated these relationships did not shape their interactions with patients. This study provides novel data characterizing the nature of collaborative relationships between clinicians, researchers, and industry in oncology. Although respondents considered these collaborations an important part of clinical and academic oncology, formal education or mentorship around these relationships was rare. Conflicting findings around conflict of interest highlight the importance of more dedicated research in this area. Business enterprises in health care play a central role in cancer research and care, driving the development of new medical testing, drugs, and devices. Effective working relationships among clinicians, researchers, and these industry partners can promote innovative research and enhance patient care. Study of these collaborations has been limited to date. Through distribution of a questionnaire to cancer clinicians and researchers, we found that most participants consider these relationships valuable, though they find establishing such relationships challenging partly because of gaps in educational programs in this area. Our findings also highlight the need for further policy around the potential bias these relationships can introduce.

Health System Recruitment and Retention Strategies: A Plenary Session

Recruitment and retention in healthcare were uniquely impacted by the COVID-19 pandemic. An existing workforce shortage was significantly exacerbated by high attrition, early retirements, and people leaving healthcare altogether because of burnout and exhaustion. Since the pandemic crisis has eased, individuals have shown the desire for healthier work–life balance and opportunities for remote or hybrid work environments with clearly defined career paths. Recognizing this shift and aligning with the current environment are imperative to recruiting and retaining employees in healthcare. At the NCCN 2023 Annual Conference, a panel of experts from 5 major academic oncology centers shared their struggles with recruitment and retention (both before and after the COVID-19 pandemic) and offered valuable insight into some of the systems and processes they’ve since implemented to attract desirable candidates, make them feel heard and appreciated, and retain them in the long run.

A prospective study evaluating perioperative quality metrics of cancer surgery: Experience from a tertiary care cancer centre in India.

Well-defined quality metrics were studied at this high-volume tertiary care academic oncology centre to evaluate surgical quality and outcomes. A prospective cohort of 691 patients undergoing major surgeries for all cancers was observed between 1 September 2018 and 30 August 2019 and predefined quality indicators in three categories: namely, optimal hospital resource utilisation, quality of surgery and perioperative outcomes were recorded during their admission period. Surgical procedures were divided into group I versus group II involving simple/moderate complexity versus high complexity procedures for analysis done using appropriate tests in STATA v14.0. There were 373 versus 318 patients in group I versus group II with a mean of 48 years of age and 459 (66.43%) being females. Mean BMI was 24.58 kg/m2 , haemoglobin 12.12 g/dL and mean serum albumin of 4.25 g (SD ± 0.6). A total of 667(96.53%) patients had an Eastern Co-Operative Oncology Group performance score of 1 with 271 (39.22%) having comorbidities and 195 (28.22%) having tobacco/alcohol addictions. A total of 393 (56.87%) patients underwent prehabilitation. 83% of patients belonged to lower-middle socioeconomic status and 32% of patients had some prior surgical intervention. Neoadjuvant therapy was administered in 44.5% versus 37.42%, mean preoperative hospital stay was 3.65 versus 6.16 days whereas postoperative was 2.6 versus 6.09 days with total stay being 6.27 versus 12.21 days, mean surgical duration was 132 versus 268 min with mean blood loss of 100 versus 245 mL (group I vs. group II, respectively). Intraoperative events, namely, unexpected bleeding and hypotension occurred in 144 (20.84%) patients while packed red blood cells and/or fresh frozen plasma transfusion was required in 56 (8.1%) patients. 40% of patients needed intensive care unit care postoperatively with 45 (6.51%) patients having some event (hypotension, sepsis, acute kidney injury, etc.). A total of 29 (<4%) patients had ≥grade 3 surgical complications while ≥grade 2 medical complications occurred in 6.43% versus 12.58% of patients (group I vs. group II). A total of 90 (13.02%) patients were readmitted, 15 (2.17%) re-explored and 5 (0.72%) patients died. Optimal surgical outcomes in this study compared to international standards underpin the need for well-defined multidisciplinary perioperative pathways to be followed for each organ system and this framework can be adopted by other cancer centres in LMIC to achieve good surgical outcomes.

The SERENITY study: online Mindfulness-Based Cancer Recovery (e-MBCR) program for women living with breast and gynecological cancer—protocol for a pilot effectiveness-implementation randomized trial

ABSTRACT Background: Mindfulness-Based Interventions (MBIs) have been shown to improve mental and physical health as well as biological processes of patients living with cancer. More research is needed to inform on the determinants that might facilitate or hinder their implementation in hospitals. The primary objective of this study was to explore the feasibility and implementation of an online Mindfulness-Based Cancer Recovery program (e-MBCR) for women with breast and gynecological cancer treated at two academic oncology centers in Switzerland. The secondary objective was to explore the psychological and biological effects of the program. Methods: The SERENITY study is a pilot hybrid effectiveness-implementation trial using a randomized waitlist-controlled design, including a mixed methods approach. The intervention groups receive treatment as usual and the e-MBCR program, whereas the control groups are on a wait-list to receive an online Mindfulness-Based Stress Reduction program at the end of the study. Four e-MBCR programs are delivered consecutively, with 12 patients in each group. Participants' attendance to the sessions is the primary outcome. Implementation outcomes of interest are feasibility, acceptability, appropriateness, fidelity, costs, and early sustainability. Implementation determinants will be described, and an exploratory analysis of psychological outcomes and cancer-related biomarkers will be performed at three time points (baseline, postintervention, and 3 months of follow-up). Discussion: The results of this study will inform a future large trial and adjustments needed for a real-world implementation of the program. The translational part of this study will contribute to the collective effort to better understand how MBIs affect important cancer-related biomarkers.