American Society Of Clinical Oncology Guidelines Research Articles

From guidelines to radiology practice: navigating the 2023 ASCO guidelines for advanced gastroesophageal cancer and beyond.

The American Society of Clinical Oncology (ASCO) updated the guidelines for the treatment of advanced gastroesophageal (GE) cancer in 2023, signifying a major shift towards targeted therapeutics and precision medicine. This article serves as an imaging-based review of recent developments in the care of patients with GE cancer. We cover the epidemiology, the developing treatment paradigms, and the imaging assessment of GE malignancy. In addition, this review aims to familiarize radiologists with the unique adverse effects pertaining to therapeutics, surgeries, radiation therapies, and associated imaging corollaries. A case-based approach will be used to both explore the efficacy of modern treatments and demonstrate their adverse effects, such as chemotherapy-associated pneumonitis, radiation esophagitis, and anastomotic failure. With this comprehensive exploration of gastroesophageal cancer, radiologists will be equipped with the essential tools to inform the treatment decisions made by medical oncologists, radiation oncologists, and surgical oncologists in the new era of precision medicine.

OncoGPT: Enhancing oncological decision-making with ASCO guideline–trained AI.

e13607 Background: General-purpose language models like ChatGPT, while proficient in a wide array of topics, often lack the specialized knowledge and precision required for specific fields such as oncology. The American Society of Clinical Oncology (ASCO) guidelines offer a comprehensive resource for oncology professionals, yet sifting through extensive documents for specific information can be daunting. To bridge this gap, we introduce OncoGPT, a specialized GPT model, tailored to provide precise and guideline-adherent oncological advice. Methods: We leveraged GPT-4's advanced language understanding capabilities as the foundation for OncoGPT. This customization involved an extensive training regimen using the complete text of the ASCO clinical guidelines. The training process was meticulously designed to ensure that OncoGPT not only assimilates the detailed information within these guidelines but also understands the context and intricacies of oncological care. Additionally, we created disease-specific versions of OncoGPT, each fine-tuned with guideline subsets pertinent to particular oncological conditions. Further, the training was augmented with specific prompts to foster kind, sincere, and respectful interactions, especially for patient-oriented responses. The model was designed to discern whether the user is a healthcare professional or a patient and adjust the complexity of its responses accordingly. For patients, additional emphasis was placed on delivering information in a kind, responsible, and empathetic manner. Results: OncoGPT's performance was rigorously evaluated for accuracy and reasoning against real-world clinical scenarios. The responses generated by the model were meticulously reviewed by an experienced oncologist to confirm adherence to ASCO guidelines and clinical relevance. This assessment revealed a high level of precision and contextual understanding in OncoGPT's outputs, demonstrating its potential as a valuable tool for oncology practitioners. Importantly, it showed a remarkable ability to tailor its communication style based on the user's background, providing simplified explanations for patients and more detailed responses for professionals. An example of a specific OncoGPT: Breast Cancer OncoGPT: https://chat.openai.com/g/g-VcuECT3jg-oncogpt-breast-cancer Conclusions: OncoGPT represents a significant advancement in the application of AI for medical decision-making. By integrating the depth of ASCO guidelines into a responsive and accurate AI model, OncoGPT offers oncology professionals a powerful tool for accessible, guideline-compliant advice. This development marks a crucial step towards integrating AI more profoundly into specialized medical fields, enhancing both the efficiency and accuracy of clinical decision-making.

Abstract PO1-11-10: Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients

Abstract There is a steep linear increase in patients surviving a cancer diagnosis. Clinical solutions that address the high prevalence of cancer-related treatment effects (CRTE) are urgently needed. A stark example of this need is the dearth of screening and treatment programs for cancer related cognitive impairment (CRCI) (colloquially called “chemo-brain”). Up to 75% of cancer patients report neurocognitive changes that leave patients unable to cope with the expectations of employers, colleagues, families, and friends. The prevalence of neurological disorders is 275% higher among adult cancer patients, when compared to an adult cancer-free population. For many adolescent and young adult cancer patients, the onset of CRCI occurs during "cognitive prime time"; a time when individuals are pursuing education, careers, and raising families. To address a gap in CRTE we have implemented a virtual multi-disciplinary intervention to measure and treat CRCI. Our CRCI intervention follows National Comprehensive Cancer Network and American Society of Clinical Oncology (ASCO) guidelines for CRCI. These guidelines indicate a multi-disciplinary approach with emphasis on increasing physical activity levels, cognitive-behavioral therapy, memory adaptive training, mood management, and sleep optimization. Our approach also follows recent ASCO guidelines for nutrition counseling. Our CRCI program utilizes medical oncologists, physician assistants, mental health therapists, registered dietitians, and occupational therapists. A nationally validated patient reported outcome (PRO) measurement, analysis, and reporting platform informs clinical treatment pathways, monitors patient progress, guides clinical decision making, and improves patient/provider communication. Using health status measures for CRCI, and following American Cancer Society and ASCO guidelines, patients are risk-stratified into three personalized cancer survivor care pathways: 1) low-complexity patients; 2) medium-complexity patients; and 3) high-complexity patients. Low-complexity patients baseline PROs score in the normal range, medium-complexity patients are those who score below the norm (moderate to large effect size difference from normal), and high-complexity patients are those who score well below the norm (greater than larger effect size difference from normal). Low-complexity patients are enrolled into a self-management and continuation of care program. Medium-complexity patients are enrolled into a shared care program. High-complexity patients are enrolled into an acute care program. All three clinical pathways include continued risk-factor vital-sign surveillance. Nearly 100% (99%) of patients who enroll in our primary cancer survivor care program complete our PRO baseline (N=80). From a convenient sample of breast cancer patients (N=42), provisional results of patient-specific segmentation analyses reveal a nearly perfect bell-shaped curve, with 51% of the population classified within the definition of medium-complexity and even split of outliers (high-complexity 24% and low-complexity 24%). Additionally, of all patients in our primary cancer survivor care program who completed at least three measurement time points for health status measures of cognitive impartment (N=38), 92% had a positive experience, 71% had a clinically significant improvement in cognitive health, 21% had a no change in cognitive status, and only 8% had a decline in cognitive health. If these data, and PRO implementation approach hold true, this program could be scaled to national and international cancer survivor population suffering from CRCI. Citation Format: John Librett, Mark Kosinski, Gregory Litton. Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-10.

Hepatitis B serology testing in patients with cancer initiating anticancer therapy.

375 Background: The prevalence of hepatitis B virus (HBV) in the US is ~5%. Patients receiving anticancer therapy with a history of HBV infection are at risk for viral reactivation leading to hepatitis flare, liver failure, and death. The American Society of Clinical Oncology (ASCO) updated 2020 HBV screening and management guidelines recommending all patients have HBV serologies before anticancer therapy initiation. In August 2021, only 17% of patients initiating anticancer therapy at UConn Health had HBV serology screening before treatment. We aimed to increase the HBV screening rate by at least 50%, using HBV serologies before initiation of anticancer therapy. Methods: The plan-do-study-act method was used to conduct this quality improvement (QI) project. To increase the HBV screening rate, we provided education and a two-part HBV serology ordering process improvement. Education consisted of an e-mail to cancer center providers and nurses detailing updated ASCO HBV screening and recommendations. The ordering process improvement plan included 1) multidisciplinary team created HBV serology order, which could be ordered inside or outside of anticancer treatment plan and 2) best practice advisory (BPA) alert to providers when a new anticancer treatment plan was opened. Part 2 of the ordering process improvement plan included incorporation of HBV serology order set directly into anticancer treatment plans along with other baseline laboratory orders to reduce provider time and eliminate the need for BPA. A two-part retrospective chart review was conducted, using an electronic medical record report of patients initiating anticancer treatment plans between treatment periods (pre -intervention and post-intervention). Inclusion criteria included: patients > 18 years and treated with anticancer therapy for newly diagnosed cancer. Patients were excluded if they had known or suspected HBV infection; or were within the Department of Corrections. Results: During the post-implementation phase, 125 patients initiated a new anticancer treatment plan. Of these, 30 (24%) patients were excluded: 18 received prior treatment before HBV serology implementation, 6 received previous anticancer treatment, 5 did not receive anticancer treatment, and 1 was a Department of Correction patient. Out of 95 remaining eligible patients, 84 patients (88.5%) had HBV serologies performed before treatment initiation. Conclusions: Incorporating HBV serologies into anticancer treatment plans appears to be a reliable, acceptable, and valid means to increase adherence to ASCO guidelines related to HBV screening prior to initiation of anticancer therapy. We plan to initiate a follow-up analysis to identify reasons why HBV serologies were not obtained in 12% of patients to inform further QI interventions, and to ensure appropriate management of patients with positive HBV serology results.

Decreasing the burden of febrile neutropenia through dynamic remote patient monitoring: The DEFeNDER program.

1535 Background: Ambulatory management of select patients with febrile neutropenia (FN) may substantially decrease patients’ burden of illness and improve their quality of life, and is recommended by American Society of Clinical Oncology (ASCO) guidelines. However, in the United States, inpatient management remains the universal standard. We hereby report the health care utilization associated with the DEFeNDR remote patient monitoring (RPM) program, which leverages technology and virtual centralized nurse monitoring to facilitate ambulatory management of FN as an alternative to hospital-based care. Methods: Adult patients with cancer hospitalized with FN were assessed daily for eligibility to participate in the DEFeNDR program. Eligibility criteria included MASCC score >21 (per ASCO guidelines), and clinical judgment of the attending provider. Patients receiving cellular therapy (CAR-T, BMT) in the prior 100 days were excluded. Eligible patients agreeing to participate in the 30-day program were provided a kit containing cellular-enabled, pre-connected devices to facilitate monitoring, including twice-daily vital signs and electronic symptom questionnaires. Data were EHR-integrated in real-time and embedded decision trees facilitated alerts for adverse trends. RPM nurses responded to alerts and escalated care as indicated by pre-specified care pathways. Program assessment was performed at 20 weeks after full implementation. The primary outcome was the mean proportion of evaluable days spent inpatient (mPEDI) within 30 days of eligibility compared between those who participated in the program vs. those who declined. Results: 35 patients were offered participation in the DEFeNDR program. Of these, 17 participated and 18 declined. Baseline characteristics are provided. Participating patients experienced mPEDI of 6.9% (Standard Error [SE], 3.7%), compared with 17.7% (SE, 3.6%) for patients who declined participation. Due to small sample size, this difference (10.8%) did not reach statistical significance (Wilcoxon Rank Sums p-value, 0.15). 30-day mortality did not differ between groups. Mean inpatient days were also lower for patients participating in the program. Additionally, when readmitted, patients participating in RPM experienced a trend toward shorter length of stay and lower rates of intensive care unit utilization. Conclusions: A trend towards decreased burden of inpatient care is evident among patients participating in the DEFeNDR program. Further studies are warranted to assess comparative effectiveness of this model vs usual care.[Table: see text]

Quality of cancer family history taking in pediatric solid tumor patients.

10045 Background: Approximately 10% of childhood solid tumors occur in individuals with a cancer genetic predisposition. Identifying cancer predisposition permits interventions for prevention and early detection of future cancers in the child and their affected family members and may have other important medical care implications. The American Society of Clinical Oncology (ASCO) guidelines recommend reviewing family history (FHx) to identify high-risk patients who should be offered genetic testing. To our knowledge, adherence to ASCO guidelines by pediatric oncology providers (POPs) has not been studied. Methods: Retrospective chart review of solid tumor patients <18 years of age referred for genetic counseling 1/1/2017-1/31/2019. POP and genetic counselor (GC) FHx documentation was assessed for adherence with the ASCO minimum quality metrics: 2 generation pedigree, patient ethnicity, cancer genetic testing results in relatives (GTRR), and cancer type, age at diagnosis, and lineage (maternal/paternal) for each relative with cancer (RWC). Comparisons of FHx quality between POPs and GCs were evaluated with 1-sided t-tests. Ethnicity was considered assessed if both maternal and paternal ethnicities were documented. GTRR was considered assessed if the results of all relatives who had undergone genetic testing were noted. Cancer type, age at diagnosis, and lineage were considered assessed if they were checked for all RWCs. Whether or not the child underwent genetic testing and their testing results were also documented. Results: Of 129 eligible patients, 102 underwent germline genetic testing. Twelve (12%) had pathogenic alterations in cancer predisposition genes. The POP failed to document FHx in 20 patients (16%), including 2 with pathogenic germline alterations. The POP missed first/second degree RWCs in 32 of 88 patients with RWCs (36%). GCs achieved >99% on each of the 6 ASCO quality metrics, whereas POPs performed significantly more poorly (Table). In patients with RWCs, GCs achieved all 6 metrics in more cases than POPs (99% vs. 3%, p<0.001). Conclusions: POPs performed significantly worse than GCs in documenting family history compliant with ASCO minimum family history guidelines, raising concern for missed genetic cancer predisposition syndrome diagnoses in those not referred to a GC. Routine referral of pediatric solid tumor patients to a GC for family history review and interventions to improve the quality of family history taking by POPs may improve germline cancer predisposition detection, improving care of both patients and their affected family members. [Table: see text]

Interpretation of expert consensus on treatment for stage III non‐small cell lung cancer

Interpretation of expert consensus on treatment for stage III non‐small cell lung cancer

The 2021 ASCO guideline on the management of salivary gland malignancy endorses FNA biopsy and the risk stratification scheme proposed by the Milan System for Reporting Salivary Gland Cytopathology.

The 2021 American Society of Clinical Oncology (ASCO) guideline for the management of salivary gland cancer offers 47 evidence‐based recommendations on preoperative evaluations, diagnostic and therapeutic surgical procedures, radiotherapy, systemic therapy, follow‐up evaluations, and recurrent metastatic disease. The ASCO guideline provides a framework and the best current evidence for managing the care of patients with salivary gland malignancies from diagnosis to treatment, and it endorses fine‐needle aspiration biopsy and the new Milan System for Reporting Salivary Gland Cytopathology.

Levels of Evidence Supporting United States Guidelines in Pancreatic Adenocarcinoma Treatment.

Cancer guidelines are ideally based on high levels of evidence (LOE). We aim to evaluate the LOE supporting recommendations in United States (US) guidelines on pancreatic adenocarcinoma (PDAC) treatment and its evolution over time. We searched for current guidelines from the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) and their prior publicly available versions on societies' websites and/or MEDLINE. We recorded the LOE and class of recommendation (opinion of the writing panel) for each recommendation. We defined high LOE as: a "high" quality of evidence from the GRADE methodology (ASCO) and "Category 1" (NCCN). Our main outcome was the proportion of PDAC recommendations supported by high LOE. Proportions of high LOE recommendations were 5% (2/40) and 8% (12/153) in current ASCO and NCCN guidelines, respectively. Less than 10% of class I recommendations were based on high LOE. For NCCN guidelines, the proportion of high LOE recommendations did not improve over time and only three recommendations increased their LOE. We identified a small percentage of high LOE recommendations for PDAC treatment in US guidelines. However, guidelines authors can only deal with the available evidence. The current framework of evidence should be challenged with consideration of observational evidence.

Increasing the use of olanzapine in patients receiving chemotherapy in a community oncology practice.

12123 Background: The addition of olanzapine to high emetic risk chemotherapy regimens substantially improves nausea and vomiting within 24 hours and is recommended in the guidelines of both the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). However, the uptake of olanzapine has been low in national and institutional settings. The purpose of this project was to increase guideline-concordant prescribing of olanzapine in eligible patients in a community oncology practice. Methods: We developed a multiphase program to address the barriers to the use of olanzapine in a community oncology practice. Patients’ medical records (N = 423) were reviewed to collect baseline data. Motivational interviewing with prescribing clinicians elicited barriers to prescribing, reinforced clinical guidelines, and elicited and reinforced language that suggested a willingness to change prescribing patterns. Chemotherapy protocols were subsequently updated to include olanzapine for high emetic chemotherapy regimens, and prescriber and nurse education was provided by our pharmacists regarding the most recent ASCO and NCCN guidelines. A fellow-led educational session was provided to the infusion nursing team and care managers. At the end of a seven-month period, prescribing information was identified through a system-generated report followed by a medical record review for validation (N = 136) and was shared monthly with prescribing clinicians. Results: At baseline, the use of olanzapine was zero. Multiple barriers were identified regarding the use of olanzapine during motivational interviewing with clinicians, including lack of knowledge of the guidelines, belief that most patients do not require olanzapine, concerns about sedation with the previously recommended dose of 10 mg, and order sets that did not include olanzapine. After the interventions, there was a statistically significant increase in the use of olanzapine from 0% to 56% (p-value < 0.001). Conclusions: A combination of motivational interviewing, prescriber and nurse information support, and changes to the pre-populated order sets for chemotherapy antiemetics was highly successful in improving the uptake of guideline-concordant prescribing of antiemetics. This model of quality improvement, including motivation interview, may support quality improvement efforts across oncology.[Table: see text]

Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis

ObjectiveTo investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines.DesignEmpirical analysis.Data sourceGuidelines developed by the American College of Cardiology and...

Cardiac risk stratification of breast cancer patients in a cardio-oncology clinic.

The field of cardio-oncology aims to optimize the cardiac health of cancer patients. The goals of this study are to (1) describe the demographics of a cardio-oncology clinic and (2) apply the American Society of Clinical Oncology (ASCO) cardiac risk stratification guidelines among breast cancer patients to assess the development of cardiovascular events, primarily heart failure (HF). We performed a retrospective chart review on 203 consecutive cardio-oncology patients who were seen between January 2019 and March 2020. Mean follow-up for the cohort was 29.2 ± 3.1months (range 0-113). We applied the ASCO guidelines to the breast cancer subgroup. The plurality of patients 82/203 (40%) referred to clinic had breast cancer. The most common reason for referral was asymptomatic left ventricular (LV) dysfunction or HF (40%). Only 36/203 (18%) of patients were referred for a pre-chemotherapy evaluation. In breast cancer patients, there was a trend toward significance in up-titrating or initiating beta-blockers in the high vs. low risk ASCO groups [46/69 (67%) vs. 5/13 (38%), p = 0.054]. Approximately 13/82 (16%) of breast cancer patients required alterations to their anti-cancer therapy. HF events occurred in 1/36 (3%) of cancer treatment naïve patients and 14/167 (8%) of those with prior therapy, specifically 9% of the breast cancer subset. Our study provides insight into referral practices, interventions, and outcomes at a cardio-oncology clinic. Furthermore, breast cancer patients continue to have high rates of HF. These findings suggest a need to shift referral practices upstream for a pre-chemotherapy evaluation to optimize cardiovascular health.

Clinical management of chemotherapy for elderly gynecological cancer patients.

Since there are no established guidelines for the treatment of gynecological cancer in the elderly, medical treatment policy is currently decided by discussion with patients and their families based on doctors' experiences, referring to data from nonelderly patients and healthy elderly patients. The aim of this review was to clarify the current position of chemotherapy for elderly gynecological cancer patients and discuss the problems to be addressed in the future. Little evidence has been accumulated for anticancer drug treatment in elderly individuals with gynecological cancer. This review presents outlines and representative papers on general cancer chemotherapy for the elderly, and problems that need to be solved in gynecological cancer fields in the future are identified. In 2018, the American Society of Clinical Oncology (ASCO) published guidelines for "Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Summary". This guideline emphasizes that, when administering chemotherapy to patients over 65 years of age, vulnerabilities should be identified using geriatric assessment (GA). However, there have been no reports of clinical studies using GA in patients with cervical or uterine cancers, and only a few clinical studies using GA have been reported in patients with ovarian cancer. Scoring systems suitable for elderly Japanese patients remain lacking. A Japanese gynecological GA needs to be developed in cooperation with other disciplines.

Review of Bone Modifying Agents in Metastatic Breast Cancer.

Bone is the most common site for distant metastases in breast cancer and can cause significant morbidity and mortality. Bone modifying agents (BMAs) that include bisphosphonates (BPAs) and denosumab help in decreasing and delaying skeletal-related events (SREs) associated with metastatic breast cancer. BPAs approved for use by the Food and Drug Administration (FDA) in bone metastases (BM) in the United States are pamidronate and zolendronic acid, while clodronate and ibandronate are licensed for use in other countries. Current American Society of Clinical Oncology (ASCO) guidelines recommend denosumab 120 mg subcutaneously every four weeks, or zolendronic acid 4 mg every four weeks or every 12 weeks, or intravenous pamidronate 90 mg every four weeks. Current guidelines do not recommend one BMA over another, however, zolendronic acid and denosumab were the most commonly used BMAs in population-based studies. Side effects of BMAs include acute phase reactions, hypocalcemia, nephrotoxicity, osteonecrosis of jaw, etc. While other side effects are common with both BPAs and denosumab, the latter has less nephrotoxic potential and is preferred for use in patients with renal failure. Current ASCO guidelines recommend continuing BMAs indefinitely, however, in clinical practice, this decision needs to be individualized, especially since there is no data on the impact of long-term use of BMAs. Further studies would need to be developed to develop an algorithm of SRE risk assessment and to determine which patients would benefit from BMAs.

The Choice of Anticoagulation Among Internal Medicine Residents to Treat/Prevent Venous Thromboembolism in Cancer Patients

Introduction: Venous thromboembolism (VTE) is the second most common cause of death in cancer patients next to disease progression. The patients with cancer are not only at increased risk to develop VTE but are also at increased risk of recurrence and bleeding complications from treatment. Hence, anticoagulation is of utmost importance in this population. The International Society of Thrombosis and Hemostasis (ISTH) and American Society of clinical oncology (ASCO) propose guidelines for treatment and prophylaxis of VTE in cancer patients frequently. We aimed to assess the choice and ease among internal medicine residents at different levels of postgraduate training in a teaching community hospital regarding the use of anticoagulation for the prevention and treatment of VTE in medical cancer patients. This study also determines the awareness of the 2019 guidelines of ISTH and ASCO among these residents. Methods: A Cross-sectional study including a web-based survey of five clinical scenarios was designed to determine the anticoagulation of choice as per the 2019 ASCO and ISTH guidelines. The scenarios consisted of non-gastrointestinal cancer patients with a diagnosis of VTE with and without normal kidney function, upper gastrointestinal cancer patents with recent VTE, and VTE prophylaxis in hospitalized and ambulatory cancer patients. Also, four questions were included to determine the ease of residents to start anticoagulation in cancer patients and to assess the difference in choices based on their postgraduate year (PGY) level making a total of nine questions. Results: 58 (77%) of the total residents (75) responded to the questionnaire who included, 18 PGY-1, 18 PGY-2, and 22 PGY-3. The average correct answers were 1.9 (Mean 39%; SD 21%) out of the five questions that were scored i.e the clinical scenario questions based on guidelines. In the scenario of VTE in non-gastrointestinal cancer, the majority of residents chose Lower Molecular Weight Heparin (LMWH) (60.34%), followed by rivaroxaban (24.14%). For a patient with impaired renal function, although a majority of residents preferred warfarin (41.38%), quite a few picked LMWH (29.31%). For upper gastrointestinal cancer, LMWH was the favored option (41.38%) and apixaban was second (31.03%). For VTE prophylaxis, LMWH had 63.16% of preference vs 35.09% of other options. In an ambulatory, fully functional patient with cancer, only 26% of residents believed anticoagulation is not required. 87.72% of the residents said they were unaware of the current guidelines and a total of 65.38% PGY-3 residents did not feel very comfortable starting anticoagulants on their patients without guidance. For the individual answers based on the PGY level see Figure 1. Conclusion: Most of the internal medicine residents preferred LMWH for cancer patients over direct oral anticoagulants. However, they picked the wrong choices in other common scenarios; such as one third preferred to start apixaban in a gastrointestinal cancer patient, or the majority would give prophylactic anticoagulation to ambulatory patients, which is not required per guidelines. These mistakes were supported by the majority of them saying that they were unaware of the treatment recommendations for VTE in cancer patients. Also more than half of the PGY-3 residents are not very comfortable initiating anticoagulants on their own. Based on the above study, we concluded that all residents should be educated on current VTE guidelines on cancer patients, and emphasis should be on including them in the Internal Medicine curriculum. This action will help the residents be more confident and highlight the importance of keeping up with new guidelines. Disclosures No relevant conflicts of interest to declare.

Diagnostic utility of high-risk human papillomavirus mRNA in situ hybridisation in squamous cell carcinoma of unknown primary in the head and neck and implementing American Society of Clinical Oncology guideline recommendations.

The American Society of Clinical Oncology (ASCO)-endorsed College of American Pathologists guideline recommends high-risk human papillomavirus (HPV) testing for metastatic squamous cell carcinoma (SCC) of lymph nodes level II/III of unknown primary. Herein, the performance of HPV-RNA in situ hybridisation (ISH) in detection of HPV-related SCC is evaluated implementing the ASCO guideline recommendations. Eighty head and neck (HN) SCC fine needle aspirations, which utilized HPV-RNA ISH/P16, were evaluated at Johns Hopkins Hospital (2015-2018) to investigate their performance and concordance with histology. The results were compared to a prior study of 59 HNSCCs, which HPV-DNA ISH. Of the 80 reviewed fine needle aspirations, 65 (50 male, 15 female) were included. The mean age was 63.2±14.0years. The most common site was neck lymph nodes (47, 72.3%). Fifty-five cases (84.6%) were accompanied by concurrent core biopsy, and 48 cases (59.4%) had surgical follow-ups. HPV-RNA ISH was positive in 44 (67.7%), and P16 was strongly positive in 46 (70.8%). The HPV-RNA ISH/ P16 concordance rate was 92.3% on cytology material. The cytology/surgical concordance rate for HPV-RNA ISH was 88.9% (16/18). There was a discordance between the results in five cases (7.7%; HPV-RNA ISH-/P16+). HPV-RNA ISH is a robust and reliable method for detecting HPV-related HNSCC on cytology material showing concordance rate of 92.3% between HPV-RNA ISH and P16, which is a sensitive but non-specific marker. Compared to HPV-DNA ISH, HPV-RNA ISH reproducibly identifies HPV-related HNSCC with fewer discrepancies between cytology and histology. The findings of this study are in agreement with the ASCO recommendations.

Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment. To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy. This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019. The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage. Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P < .001). Factors associated with reduced likelihood of fertility risk discussion included male sex (odds ratio [OR], 0.73; 95% CI, 0.60-0.90), increasing age (OR, 0.93; 95% CI, 0.92-0.94), private practice setting (OR, 0.70; 95% CI, 0.53-0.93), and lack of multidisciplinary team planning (OR, 0.54; 95% CI, 0.41-0.70). Factors associated with increased likelihood of fertility risk discussion included having breast cancer (OR, 1.39; 95% CI, 1.12-1.73) and lymphatic or hematopoietic cancers (OR, 1.79; 95% CI, 1.33-2.40), participating in each subsequent study year (OR, 1.16; 95% CI, 1.08-1.24), receiving care in an academic clinic (OR, 1.45; 95% CI, 1.05-2.01), and being a practice offering clinical trial enrollment (OR, 1.60; 95% CI, 1.13-2.29). States with legislatively mandated coverage of fertility preservation had significantly higher rates of fertility risk discussion compared with states without legislation (48.6% vs 39.6%, P < .001). The findings suggest that clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy. State laws mandating fertility preservation coverage may be associated with improved frequency of fertility counseling before chemotherapy. Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy.

Adherence to ASCO for Prophylaxis of Acute Chemotherapy- Induced Nausea and Vomiting in Iran.

Introduction:Chemotherapy-induced nausea and vomiting (CINV) is one of the scariest chemotherapy-induced adverse effects. We evaluated the adherence to the 2017 American Society of Clinical Oncology (ASCO), the latest guideline recommendations, for the management of acute CINV at our institute. Methods:During a 6-months cross-sectional study on outpatient’s cancer patients, we collected data from the prescription documents during temporary hospitalization and compared the results with ASCO guideline recommendations. Results:The most prescribed prophylactic regimens for the management of CINV were combination of aprepitant, granisetron, and dexamethasone and metoclopramide (51.8%). Regarding prescription compatibility in our center with ASCO guideline recommnedations, selection of different regimens for prophylaxis of acute CINV in our institute was compliant in 0 %, 22%, 4%, and 40% of high, moderate, low, and minimal emetogenic potential of chemotherapy regimen groupss, respectively. Conclusion:Although our hospital is a referral and university-affiliated center, adherence to the ASCO guideline recommendations for prophylaxis of CINV was poor.

Abstract B056: Assessing knowledge of genetic testing for inherited cancer among registry-based young black breast cancer survivors and predominantly non-Hispanic white clinic-based patients

Abstract Introduction: Practice guidelines put forth through the American Society of Clinical Oncology (ASCO) evolved to encompass a new method of testing whereby multiple genes are tested in parallel (i.e., multi-gene panel testing) and racial disparities in genetic testing rates persist. To measure and compare knowledge of inherited cancer predisposition and multi-gene panel testing across racially diverse patient groups, we administered a newly developed and validated knowledge scale aligned with the 2016 ASCO guidelines. Methods: Online survey data inclusive of 14 knowledge questions was collected among Black women diagnosed with breast cancer at or below age 50 recruited through the Tennessee and Florida state cancer registries (“Registry group”; N=39) and an insured, predominately non-Hispanic White patient population referred for cancer genetic risk assessment at the Vanderbilt Hereditary Cancer Clinic (“Clinic group”; N= 55). Demographic and clinical information were compared using Chi-Square and Fisher’s Exact tests. Mean knowledge scores were calculated and compared using multiple regression analysis. Results: Rates of cancer among the Registry and Clinic groups were 100% and 49% (p&amp;lt;.0001), and rates of previous genetic testing were 69% and 13% (p&amp;lt;.0001). Mean knowledge scores were 6.10 and 6.75. When controlling for race, cancer history, and previous genetic testing, knowledge was not significantly different between the two groups (p=0.507). The lowest scoring knowledge questions among the Registry and Clinic groups included: 1) understanding of a variant of uncertain significance (15% and 11%); 2) knowledge of impact of genetic test results on supplemental insurance (21% and 11%); and 3) the types of possible test results (15% and 18%). Conclusion: These findings demonstrate similar knowledge of inherited cancer predisposition between a predominantly non-Hispanic White clinic-based population and a registry-based population of young Black breast cancer survivors; however, additional analyses should be performed as sample size increases. Knowledge about the possible results of genetic testing and the lack of protection against discrimination by supplemental insurers (e.g., life and disability insurance) was low across both groups; thus, should be a focus for improvement given that it could have real-world implications for decision-making. It remains important to assess knowledge of inherited cancer across diverse patient groups to develop effective strategies and interventions to increase knowledge across populations, including those with recognized disparities. Citation Format: Sydney Cadiz, Sonya Reid, Brenda Zuniga, Ann Tezak, Anne Weidner, Tuya Pal. Assessing knowledge of genetic testing for inherited cancer among registry-based young black breast cancer survivors and predominantly non-Hispanic white clinic-based patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B056.

Early referral to palliative care: Where are we in Brazil?

e24118 Background: The American Society of Clinical Oncology (ASCO) recommends that patients with advanced cancer receive dedicated palliative care services concurrently with active treatment within 8 weeks of diagnosis and maintaining follow up for at least 12 weeks. The adherence to these standards in Brazil is unknown. Objective: To evaluate adherence to ASCO recommendations of early referral to a palliative care team at a multicentric outpatient oncological clinic in Brazil using the following indicators: (i) whether patients were enrolled in palliative care services within 8 weeks of diagnosis and (ii) whether patients were followed up for a minimum of 12 weeks. Methods: All palliative care physicians within a network of 15 outpatient oncology clinics (Oncoclinicas Group) prospectively recorded time to care post-diagnosis with advanced cancer by ASCO guidelines and duration of follow up time throughout the 1-year duration of the study. The number of patients enrolled in care within 8 weeks of diagnosis and followed for at least 12 weeks was recorded. An initial goal of adherence was set at 50% for each indicator. Results: Of 1016 patients, we studied 579 data numbers. 26% of patients were referred within 8 weeks of their advanced cancer diagnosis and 23% were followed for 12 weeks or more. Conclusions: These data indicate that even with a recognition of ASCO recommendations for timely palliative care referral, patients in Brazil are often seeing palliative care teams too late. The possible main causes of this late referral in Brazil are: (i) lack of adequate knowledge about the real meaning of palliative care and (ii) a lack of understanding of how a multidisciplinary team acts positively in the patient's experience. We believe that the best way to change this reality is through continuing education about Palliative Care, reinforcing the intention of continuous care: strengthening bonds, facilitating communication, reaching better symptoms control and practicing patient-centered care.