Cancer Program Research Articles

INTEGRATING AGE-FRIENDLY CARE INTO THE ONCOLOGY CONTINUUM

Abstract The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.

Bcl-2 expression in cell lines breast cancer and death program.

Breast cancer is a hormone-dependence and heterogenic disease. Drug resistance is the main reason for the failure of breast cancer treatment. Combinatory medications are methods for treatment but they are not sufficient in action. However, new approaches like molecular therapy reveal a new insight into cancer treatment. Studies show that Bcl-2 gene family inhibitors and ER blockers cause the improvement of recovery. Interfering molecules such as antisense ones can inhibit the expression of Bcl-2 and push the cancer cells to apoptosis. Our team designed a new Antisense Oligonucleotide (ASO) based on Antisense oligo G3139. MCF-7 and MDA-MB-231 cell lines were used to evaluate cellular proliferation. Liposomes and cationic nano-complex (Niosome) are used to increase the cellular delivery of ASO and Tamoxifen. We also investigated the cytotoxicity and apoptotic effects of Tamoxifen, naked ASO and Nano-packed ASO. The results indicated significant down-regulation of the Bcl-2 gene and inhibition of MCF-7 and MDA-MB-231 cellular proliferation. Flow-cytometry showed early apoptosis in all cell groups. The newly designed ASO reduced the expression of the Bcl-2 gene. It also had a synergistic effect with the Tamoxifen. The cationic nano-complex (Niosome) was more efficient than the liposome in delivering designed oligo antisense Bcl-2 in the cancer cells.

Commentary: PFKFB3 overexpression in monocytes of patients with colon but not rectal cancer programs pro-tumor macrophages and is indicative for higher risk of tumor relapse.

Commentary: PFKFB3 overexpression in monocytes of patients with colon but not rectal cancer programs pro-tumor macrophages and is indicative for higher risk of tumor relapse.

National enrollment of lung cancer clinical trials is disproportionate based on race and health care access

ObjectiveDespite declining lung cancer mortality in the United States, survival differences remain among racial and ethnic minorities in addition to those with limited health care access. Improvements in lung cancer treatment can be obtained through clinical trials, yet there are disparities in clinical trial enrollment of other cancer types. This study aims to evaluate disparities in lung cancer clinical trial enrollment to inform future enrollment initiatives. MethodsWe analyzed patients with non–small cell lung cancer from the National Cancer Database (2004-2018), categorizing them as enrolled or not enrolled in clinical trials based on “rx_summ_other” data element. Clinical, demographic, and institutional factors associated with trial enrollment were assessed using bivariate and multivariate analysis, adjusting for institutional-level clustering. ResultsA total of 1924 (0.12%) patients with lung cancer were enrolled in clinical trials. Enrolled patients were predominantly non-Hispanic White (82%), with greater socioeconomic status, treated at academic programs (67%), and had private insurance (42%) or Medicare (44%). They also traveled further for treatment compared with unenrolled patients (56 vs 27 miles, P < .001). After adjusting for demographic and clinical factors, lung cancer trial enrollment was significantly less likely among Black (odds ratio, 0.55; 95% confidence interval, 0.5-0.7, P < .001) and Hispanic (0.66; 95% confidence interval, 0.5-0.9, P = .01) patients. Patients with Medicaid or uninsured, in the lowest socioeconomic status group, and those treated at community-based cancer programs were the least likely to enroll. ConclusionsEnrollment in lung cancer trials disproportionally excludes minority patients, those in the lowest socioeconomic status, community cancer programs, and the underinsured. These disparities in demographic and access for trial participation show a need for improved enrollment strategies.

The Role of Transcription Factors in the Loss of Inter-Chromosomal Co-Expression for Breast Cancer Subtypes.

Breast cancer encompasses a diverse array of subtypes, each exhibiting distinct clinical characteristics and treatment responses. Unraveling the underlying regulatory mechanisms that govern gene expression patterns in these subtypes is essential for advancing our understanding of breast cancer biology. Gene co-expression networks (GCNs) help us identify groups of genes that work in coordination. Previous research has revealed a marked reduction in the interaction of genes located on different chromosomes within GCNs for breast cancer, as well as for lung, kidney, and hematopoietic cancers. However, the reasons behind why genes on the same chromosome often co-express remain unclear. In this study, we investigate the role of transcription factors in shaping gene co-expression networks within the four main breast cancer subtypes: Luminal A, Luminal B, HER2+, and Basal, along with normal breast tissue. We identify communities within each GCN and calculate the transcription factors that may regulate these communities, comparing the results across different phenotypes. Our findings indicate that, in general, regulatory behavior is to a large extent similar among breast cancer molecular subtypes and even in healthy networks. This suggests that transcription factor motif usage does not fully determine long-range co-expression patterns. Specific transcription factor motifs, such as CCGGAAG, appear frequently across all phenotypes, even involving multiple highly connected transcription factors. Additionally, certain transcription factors exhibit unique actions in specific subtypes but with limited influence. Our research demonstrates that the loss of inter-chromosomal co-expression is not solely attributable to transcription factor regulation. Although the exact mechanism responsible for this phenomenon remains elusive, this work contributes to a better understanding of gene expression regulatory programs in breast cancer.

Incidence of pre-neoplastic and neoplastic lesions of the cervix before and after the COVID-19 pandemic

ObjectiveThe COVID-19 pandemic had significant effects on healthcare systems worldwide, including the disruption of routine screening programs for cervical cancer. This study aimed to compare the incidence of cervical intra-epithelial...

Tailored support for preparing employees with cancer to return to work: Recognition and gaining new insights in an open atmosphere.

A considerable number of cancer survivors face difficulties in returning to work (RTW). More insight is needed on how to support employees shortly after cancer treatment and help them make the transition back to work. To gain an in-depth understanding of how and under what circumstances a Cancer & Work Support (CWS) program, which assists sick-listed employees with cancer in preparing their RTW, works. A qualitative design was used, inspired by Grounded Theory and Realist Evaluation components. Semi-structured interviews were conducted with RTW professionals (N = 8) and employees with cancer (N = 14). Interview themes covered experiences with CWS, active elements, and impeding and facilitating factors. Interviews were transcribed and analyzed by multiple researchers for contextual factors, active mechanisms, and the outcomes experienced. Respondents experienced the support as human centered, identifying two characteristics: 'Involvement' ('how' the support was offered), and 'Approach' ('what' was offered). Four themes were perceived as important active elements: 1) open connection and communication, 2) recognition and attention, 3) guiding awareness and reflection, and 4) providing strategies for coping with the situation. Variation in the experiences and RTW outcomes, appeared to be related to the personal, medical and environmental context. Both professionals and employees really appreciated the CWS because it contributed to RTW after cancer. This research shows that not only 'what' RTW professionals do, but also 'how' they do it, is important for meaningful RTW support. A good relationship in an open and understanding atmosphere can contribute to the receptiveness (of employees) for cancer support.

Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool.

National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6years of planning processes.

Cost-effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model-based analysis.

As Norway considers revising triage approaches following their first adolescent cohort with human papillomavirus (HPV) vaccination entering the cervical cancer screening program, we analyzed the health impact and cost-effectiveness of alternative primary HPV triage approaches for women initiating cervical cancer screening in 2023. We used a multimodeling approach that captured HPV transmission and cervical carcinogenesis to evaluate the health benefits, harms and cost-effectiveness of alternative extended genotyping and age-based triage strategies under five-yearly primary HPV testing (including the status-quo screening strategy in Norway) for women born in 1998 (ie, age 25 in 2023). We examined 35 strategies that varied alternative groupings of high-risk HPV genotypes ("high-risk" genotypes; "medium-risk" genotypes or "intermediate-risk" genotypes), number and types of HPV included in each group, management of HPV-positive women to direct colposcopy or active surveillance, wait time for re-testing and age at which the HPV triage algorithm switched from less to more intensive strategies. Given the range of benchmarks for severity-specific cost-effectiveness thresholds in Norway, we found that the preferred strategy for vaccinated women aged 25 years in 2023 involved an age-based switch from a less to more intensive follow-up algorithm at age 30 or 35 years with HPV-16/18 genotypes in the "high-risk" group. The two potentially cost-effective strategies could reduce the number of colposcopies compared to current guidelines and simultaneously improve health benefits. Using age to guide primary HPV triage, paired with selective HPV genotype and follow-up time for re-testing, could improve both the cervical cancer program effectiveness and efficiency.

Globalization of precision medicine programs in lung cancer: a health system challenge

Globalization of precision medicine programs in lung cancer: a health system challenge

Abstract A023: Outcomes for breast cancer survivors with metastatic disease in a physical activity program for medically underserved cancer survivors

Abstract Background: Physical activity (PA) improves cancer survivors’ health outcomes including physical functioning, fatigue, and health-related quality of life (HRQOL), but the feasibility and effectiveness of PA programs for survivors with metastatic breast cancer (MBC) are still unclear. The purpose of this study was to examine the effects of the Active Living After Cancer (ALAC) program on breast cancer survivors with metastatic disease. ALAC is an evidence-based community program for underrepresented and medically underserved cancer survivors that aims to improve HRQOL and physical functioning through increasing PA. This presentation will analyze program effects on HRQOL and physical functioning as well as program satisfaction and retention among survivors with MBC compared to those with early stage breast cancer. Methods: This study is a secondary analysis of data from the ALAC program. ALAC is offered in the community in both English and Spanish and consists of 12 group sessions provided weekly. Among ALAC participants, we identified those with MBC (stage IV and with metastasis) and compared them to survivors with early stage breast cancer (stage I and II). The International Physical Activity Questionnaire (IPAQ), 30-second sit to stand test, and PROMIS Global Short Form-Physical and Mental Health T-scores were measured at baseline and follow-up. Program satisfaction and retention were assessed at the end of program. Repeated measure mixed models were used to compare changes in outcomes between patients with early stage breast cancer and MBC and Pearson’s chi-squared tests were used to examine differences in program satisfaction and attendance. Results: A total of 248 women (60 yr ±10.4), mostly Hispanic (50.6%) or non-Hispanic Black (19.7%), were included in the analyses (early stage: n=226; MBC: n=22). After the ALAC program, there were significant increases in PA (p&amp;lt;.001) and improvement of physical HRQOL (p=.011) and 30-second sit-to-stand (p&amp;lt;.001), but no significant between-group differences in these outcomes. Although session attendance was similar between groups, women with early stage breast cancer showed significantly higher program satisfaction compared to those with MBC (χ2=4.24, p=.039). Conclusions: The ALAC program effectively increases PA and improves physical HRQOL and physical functioning among breast cancer survivors with both metastatic and early stage disease. More research is needed to identify program changes needed to improve mental HRQOL and program satisfaction among women with MBC. Citation Format: Che Young Lee, Scherezade M. Mama, Yue Liao, Abenaa Brewster, Meagan Whisenant, Kylee Laffoon, Stacy J. Mitchell, Patricia V. Tracy, Giselle M Garza, Karen M. Basen-Engquist. Outcomes for breast cancer survivors with metastatic disease in a physical activity program for medically underserved cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A023.

Assessment of the Iraqi Breast Cancer Early Detection and Downstaging Program: Mammography Cancer Detection Rate

Background: In Iraq, early detection and downstaging of breast cancer programs were launched to control breast cancer (BC) in 2000. In the program model, mammography is conducted for normal and symptomatic women. The aim of this study is to assess the program’s model effectiveness in terms of mammography cancer detection rates and other screening determinates in the Iraqi Early Detection Program. Method: This is a retrospective study based on data attained from the Breast Disease Treatment Centre (BDTC) in Sulaimani, Iraq. From September 2016 to August 2021, 35,045 women visited the centre for BC screening and diagnosis of breast disorders. In BDTC, 16,186 mammograms and 1,289 biopsies were conducted, and 404 women were diagnosed with BC. This study measured the percentage of women who visited BDTC for screening, the women’s ages at diagnosis, the cancer detection rate (BC per 1,000 women visiting), mammography detection rate (BC per 1,000 mammograms) and the percentage of positive core biopsies. Results: The cancer detection rate (CDR) in 1,000 women was 11.53, the overall mammography detection rate was 24.96, and the highest rate was observed in 2018 (42.2). The overall percentage of positive core biopsies was 31.34%. The highest percentage biopsy rate was in 2017 (43.84%). From 2016 to 2021, the percentage of visits for screening increased gradually, rising from 9.5% to 28.6%. Conclusion: The early detection program in Iraq is considered to be effective in terms of high mammography cancer detection rates and the percentage of positive biopsy. Compared to the previous data, more women participated in the program for screening than for diagnosis.

Abstract IA031: Equitable access to clinical trials: The role of community healthcare systems

Abstract Approximately 85% of US cancer care is delivered in community healthcare systems, most of which have no formal affiliation with academic programs and do not identify the research mission as a core responsibility. Therefore, most community-based cancer programs are research deserts. Yet there is strong evidence to support the oft-cited statement: 'the best treatment is a clinical trial.' In this age of rapid-fire discovery and clinical trials driven by deep knowledge of cancer biology and drug chemistry, coupled with close regulatory oversight, clinical trials carry much smaller risk for participants than ever before. In the end, clinical trials provide access to tomorrow's treatment, today. The socio-ecological model of healthcare recognizes that most problems and solutions reside at the levels of the individual, clinician, organization and social policy. As the number of actors sequentially diminishes from the individual to the social policy levels, the potential enduring impact of interventions sequentially rises. Interventions directly targeting the individual level are least efficient, those that target key social policies have the greatest enduring impact. So with the wicked challenge of inequitable clinical trials access. We will focus on the institutional level in my solutions-oriented discussion of equitable access to clinical trials. Using the NCI's Minority-Underserved NCORP progam and the Baptist Memorial Health Care Corporation as living examples, we will review intervention frameworks, objectively analyze the barriers to clinical trials access, and provide a pragmatic discussion of stakeholder-centered approaches to building clincial trials infrastructure in the places where people routinely seek care. We propose approaches to integrate clincal research as a core component of cancer care delivery in community healthcare systems and make the case that key external stakeholders, including patient advocacy groups, sponsors of research and healthcare policymakers must meet the target population where they reside. That connection can only happen by building clinical trials infrastructure and manpower within community healthcare systems. Citation Format: Ray U. Osarogiagbon. Equitable access to clinical trials: The role of community healthcare systems [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA031.

Abstract B048: Disparities in treatment course and outcomes in females diagnosed with non-metastatic inflammatory breast cancer

Abstract Background: Inflammatory breast cancer (IBC) is an uncommon, aggressive disease with a poor prognosis. National treatment guidelines recommend neoadjuvant chemotherapy followed by modified radical mastectomy (MRM) and radiation. Disparities in treatment may contribute to survival differences, and few studies have assessed factors contributing to such variation. We aimed to identify demographic and facility differences in treatment and survival among females with non-metastatic IBC. Methods: Secondary analysis of the National Cancer Database (2012-2016) on females diagnosed with non-metastatic IBC was performed. Demographics, treatment, and facility data were collected. Statistical analysis was performed with SAS. Results: A total of 5,438 patients met the inclusion criteria. Receiving surgical intervention was associated with age (p&amp;lt;0.0001), race (p&amp;lt;0.0001), and facility (p=0.03), with increased odds of surgery for younger, white, and comprehensive community cancer program patients. Receiving radiation therapy was associated with age (p &amp;lt;0.0001) and race (p&amp;lt;0.0001), with decreased odds of radiation for older, Black, and Hispanic patients. Receiving chemotherapy was associated with age (p &amp;lt;0.0001), with increased odds of chemotherapy for younger patients. Days from diagnosis to treatment initiation was associated with race (p&amp;lt;0.0001) and facility (p=0.0089), with increased time for Black, Hispanic, and academic facility patients. Survival time was associated with age (p&amp;lt;0.0001), race (p&amp;lt;0.0001), facility (p=0.0002), Charlson-Deyo (CD) score (p&amp;lt;0.0001), and surgery (p&amp;lt;0.0001), with decreased survival for older, Black, non-academic facility, higher CD score, and non-surgery patients. Conclusions: Treatment trends and survival of IBC patients are impacted by sociodemographic and facility-level variation, which, when addressed, may help to improve patient outcomes. Citation Format: Kirsten Lung, Young Sheng, Brandon George, Alliric Willis, Melissa Lazar. Disparities in treatment course and outcomes in females diagnosed with non-metastatic inflammatory breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B048.

Exploring Regional Challenges and Solutions to Appropriate and Equitable Care for Patients with Chronic Lymphocytic Leukemia

Background: For patients with chronic lymphocytic leukemia (CLL)-the most common form of leukemia in older adults-equitable access to care is particularly challenging, as the disease is often diagnosed in community cancer centers encumbered by regional disparities. Therefore, identifying and understanding regional barriers to care is essential. In 2020, the Association of Community Cancer Centers (ACCC) developed a heat map detailing the incidence rate of CLL diagnoses across the country (Fig.1), overlayed with the locations of CLL “expert” providers, revealing the areas in the US most in need of additional CLL clinical expertise (Fig. 2). In 2022, these incidence rates were stratified by race, ethnicity, and metropolitan statistical area to identify disparities Building on these maps, ACCC set out to identify specific regional challenges to appropriate, equitable care for patients with CLL. Methods: As part of an independent education program, ACCC initiated conversations with providers about the regional barriers that patients with CLL face. Through 4 webinars in February 2023, participants from 4 regions-Northeast (New York and Maine), Northwest (Montana and Idaho), Midwest (Wisconsin, Illinois, and Iowa), and Southwest (Texas)-shared insights on challenges and exchanged ideas on strategies to improve care for patients with CLL. In addition, ACCC interviewed 3 regionally diverse cancer programs (from the US Northwest, South, and Southwest regions) that are effectively overcoming regional challenges to reach their patient populations and provide equitable care. These interviews highlighted barriers and challenges, showcased effective outreach campaigns, and explored how the outreach improved the patient journey. Findings: The following themes emerged as key challenges and potential solutions throughout all regions studied: (1) Comprehensive Diagnostic Work-up Before Treatment Initiation: A key component in caring for patients with CLL is identifying certain disease related criteria prior to formulating a treatment plan. This includes determining the disease burden, disease-related symptoms, and if the patient meets certain active disease criteria (eg, Binet Stage C or Rai Stage III or IV). Further, by utilizing genetic testing, such as the TP53 gene mutation and IGHV mutation tests, physicians can estimate time to treatment and choice of specific novel targeted therapies. (2) Understanding Patient Population Needs: Cancer programs must understand the needs of their unique patient populations to effectively address them. For example, in the Northwest, as mountainous passes can make travel dangerous at times, one local program utilizes near-campus housing/hotel space for patients for the duration of their intensive treatment. In the Southwest, addressing health insurance coverage, low health literacy, language barriers, patient-provider mistrust, and culturally competent care for undocumented individuals presents challenges to equitable care delivery. Therefore, cancer programs in this region have implemented protocols to utilize community and social services to help support these patients. (3) Developing Community Partnerships: As the median age of diagnosis with CLL is approximately 70 years old, barriers such as transportation availability, caregiver support and financial constraints could be magnified. Building trust, particularly among vulnerable communities, also presents a significant challenge. By partnering with community outreach organizations, programs can help address these issues through community resources such as ride share programs, transportation vouchers, and financial assistance programs. (4) Provider Education and Learning: Because many patients are diagnosed in community cancer programs and smaller practices where physicians do not often have experience with CLL, nationally available provider education on new developments in testing and treatments is key. Conclusions: ACCC identified regional challenges and solutions to appropriate and equitable care for patients with CLL, including the importance of comprehensive diagnostic work-up before treating, understanding the regional needs of patient populations (particularly underserved populations), building community partnerships, and engaging in targeted provider education.

Genomic analysis reveals HDAC1 regulates clinically relevant transcriptional programs in Pancreatic cancer

Novel strategies are needed to combat multidrug resistance in pancreatic ductal adenocarcinoma (PDAC). We applied genomic approaches to understand mechanisms of resistance in order to better inform treatment and precision medicine. Altered function of chromatin remodeling complexes contribute to chemoresistance. Our study generates and analyzes genomic and biochemical data from PDAC cells overexpressing HDAC1, a histone deacetylase involved in several chromatin remodeling complexes. We characterized the impact of overexpression on drug response, gene expression, HDAC1 binding, and chromatin structure using RNA-sequencing and ChIP-sequencing for HDAC1 and H3K27 acetylation. Integrative genomic analysis shows that HDAC1 overexpression promotes activation of key resistance pathways including epithelial to mesenchymal transition, cell cycle, and apoptosis through global chromatin remodeling. Target genes are similarly altered in patient tissues and show correlation with patient survival. We also demonstrate that direct targets of HDAC1 that also show altered chromatin are enriched near genes associated with altered GTPase activity. HDAC1 target genes identified using in vitro methods and observed in patient tissues were used to develop a clinically relevant nine-transcript signature associated with patient prognosis. Integration of multiple genomic and biochemical data types enables understanding of multidrug resistance and tumorigenesis in PDAC, a disease in desperate need of novel treatment strategies.

MAF and ERα Coordinately Drive Metastatic Programs in Breast Cancer.

MAF/ERα interactions activate prometastatic programs and chromatin remodeling in breast cancer.

Exploring Quality of Life Experiences and Concerns of Black Breast Cancer Survivors: a Narrative Approach.

Black breast cancer survivors (BCS) in comparison with White BCS are more likely to experience suboptimal quality of life (QoL). QoL is a multi-dimensional concept that focuses on different aspects of well-being (e.g., emotional well-being). There is limited evidence on the perspectives and experiences of QoL (e.g., theinfluence of breast cancer on QoL) and the QoL concerns (e.g., negative perceptions of body appearance) among Black BCS. The purpose of this study was to explore the QoL experiences and QoL concerns ofBlack BCS. Primary data was collected in semi-structured interviews and analyzed using a thematic analysis. A narrative approach (detailed stories or life experiences of a small group of people) was used to better understand the research topic among the target group. Ferrell's Conceptual Framework on QoL in Breast Cancer was used to guide the development of the interview questions, codes, and themes. There were 10 Black BCS, averaging 58years of age. Two coders achieved a moderate level of agreement (i.e., Kappa) of 0.77. Five major themes were identified: defining QoL (what QoL means to them), behavioral changes (e.g., altering behaviors due to cancer), phases of cancer (e.g., breast cancer diagnosis), QoL experiences and factors affecting QoL, and impactful statements from cancer survivors (other meaningful information shared by the participants). The survivors reported multiple QoL concerns and body image issues. The study findings warrant cancer education interventions or programs to address the relevant survivorship issues of Black BCS.

Co-creation of human papillomavirus self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe: nominal group technique.

Human papillomavirus (HPV) self-sampling is recommended for cervical cancer screening, particularly among women who do not participate in or have access to current screening methods offered in Zimbabwe. Key stakeholder involvement is critical in co-creating acceptable delivery strategies for implementing HPV self-sampling to ensure demand and facilitate uptake by the target population. The main objective of this study was to engage key stakeholders in co-creating acceptable HPV self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe. We invited key stakeholders and employed a nominal group technique (NGT) for data collection. We employed the NGT to (1) identify barriers to access and utilisation of available cervical cancer screening services and (2) co-create delivery strategies for HPV self-sampling. The workshop included 8 participants (women n = 4, health workers n = 2 and policymakers n = 2). Quantitative data was gathered by ranking ideas and qualitative data were collected from participant group discussions and analysed thematically. The results of the ranking exercise were fed back to the participants for comments. The most significant barriers to accessing and utilising current cervical cancer screening services by women were: Inadequate information and education on cervical cancer, lack of resources and funding for cervical cancer programmes, long distances to nearest health facilities, and low perceived personal risk of cervical cancer. Key stakeholders recommended enhanced education and awareness, results notification, linkage to care, community-based self-sampling, and the choice of sampling devices as potential HPV self-sampling delivery strategies. Our study demonstrated the utility of the NGT for reaching a consensus. Using the NGT, we established priority delivery strategies for HPV self-sampling cervical cancer screening. Adequate education and awareness, early results notification, choice of sampling device and community-based self-sampling were crucial to HPV self-sampling screening in rural Zimbabwe. The proposed delivery strategies can guide the development of guidelines for designing and implementing an HPV self-sampling intervention. We recommend a study to determine women's most preferred HPV self-sampling delivery strategies before implementing the intervention.

Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer.

Despite recommendations for upfront total laryngectomy (TL), many patients with cT4a laryngeal cancer (LC) instead undergo definitive chemoradiation, which is associated with inferior survival. Sociodemographic and oncologic characteristics associated with TL utilization in this population are understudied. This retrospective cohort study utilized hospital registry data from the National Cancer Database to analyze patients diagnosed with cT4a LC from 2004 to 2017. Patients were stratified by receipt of TL, and patient and facility characteristics were compared between the two groups. Logistic regression analyses and Cox proportional hazards methodology were performed to determine variables associated with receipt of TL and with overall survival (OS), respectively. OS was estimated using the Kaplan-Meier method and compared between treatment groups using log-rank testing. TL usage over time was assessed. There were 11,149 patients identified. TL utilization increased from 36% in 2004 to 55% in 2017. Treatment at an academic/research program (OR 3.06) or integrated network cancer program (OR 1.50), male sex (OR 1.19), and Medicaid insurance (OR 1.31) were associated with increased likelihood of undergoing TL on multivariate analysis (MVA), whereas age > 61 (OR 0.81), Charlson-Deyo comorbidity score ≥ 3 (OR 0.74), and clinically positive regional nodes (OR 0.78 [cN1], OR 0.67 [cN2], OR 0.21 [cN3]) were associated with decreased likelihood. Those undergoing TL with post-operative radiotherapy (+/- chemotherapy) had better survival than those receiving chemoradiation (median OS 121 vs. 97 months; p = 0.003), and TL + PORT was associated with lower risk of death compared to chemoradiation on MVA (HR 0.72; p = 0.024). Usage of TL for cT4a LC is increasing over time but remains below 60%. Patients seeking care at academic/research centers are significantly more likely to undergo TL, highlighting the importance of decreasing barriers to accessing these centers. Increased focus should be placed on understanding and addressing the additional patient-, physician-, and system-level factors that lead to decreased utilization of surgery.