Community Oncology Research Articles

The Impact of Survival Benefit and Study Design on FDA Approval for Anticancer Drugs Over the Past Decades.

Despite the tremendous effort in the oncology community, the success rate of anticancer development remained low at 30% to 40% from the Phase 3 study to the regulatory approval. The factors associated with the regulatory approval for market authorization have gained interest in the community to improve the success rate of drug development. Using the data from 208 Phase 3 studies for anticancer drugs, we explored the possible factors associated with the US Food and Drug Administration's (FDA's) approval by multivariate logistic regression analysis. The model incorporated 21 factors from therapeutic context, study design, and outcomes. The hazard ratio (HR) for overall survival (OS) showed a significant association with FDA approval (coefficient: -29.907, P <.001), and the age of control drugs in the market followed (coefficient: -2.581, P =.008). In the model, if the HR for OS changes from 0.75 to 0.85, the probability of FDA approval remarkably decreases from 79.6% to 16.4%. A 50% likelihood of FDA approval is predicted at HR 0.795 for OS. Furthermore, the P-value for the OS test and the width of the confidence interval on HR for OS showed a significant association with the probability of FDA approval. These findings consistently underscore the rigorous standard required for new anticancer drugs to obtain regulatory approval from the FDA.

Breadth and Depth of Patient and Caregiver Supportive Services in Community Oncology (WF-1803CD).

Providing supportive services to patients and their caregivers is essential to quality cancer care, yet the depth, availability, and infrastructure underlying these services remains unknown in community practice. We assessed these factors among practices within the National Cancer Institute Community Oncology Research Program (NCORP) to guide priorities for comprehensive supportive service(s) development and inform implementation of evidence-based interventions in clinical practice. Supportive care leaders at NCORP practices completed online surveys regarding availability of services to patients and caregivers within seven domains, service infrastructure (e.g., staffing, technology), and implementation recommendations for caregiver-specific services. Primary outcomes were the proportion of practices offering at least one service in each domain to both populations and the proportion offering caregiver training/education. Of the 103 participating practice groups, only 15.5% offered at least one service in each domain to both populations; 21.4% offered caregiver training/education. Psychological (83.5%) and spiritual/religious (75.7%) services were most widely available to both; health promotion (28.2%) services were least available to both. Services offered were largely available on-site with dedicated staff; caregiver-specific services were nearly always off-site and typically self-pay. Practices most often used the patient health portal to communicate with patients and caregivers (54.4%). Only 28.9% provided bilingual staff for services. Social workers (35.7%) and navigators (34.7%) were recommended to support caregiver services. To meet national recommendations for supportive service provision, practices should invest in caregiver education/training programs, expand health promotion programs, and increase interpretation services. Future interventions should leverage existing resources (e.g., recommended staff, patient portal).

Protecting Her Health: A Position Paper on Breast and Cervical Cancer

Abstract Breast cancer and cervical cancer are the two most prevalent cancers in women that screening programs can identify early. This study explores the epidemiology and screening of breast cancer, and cervical cancer from an Indian perspective, human papillomavirus (HPV) screening and artificial intelligence (AI) in cervical cancer screening, as discussed in the “Protecting her Health” session of the 6th Amrita International Public Health Conference. The conference was organized by the Department of Community Medicine, Public Health and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India, in collaboration with iTMO University and the Eurasian Federation of Oncology on December 1, 2023 and December 2, 2023 with the theme “Advancing Public Health Strategies for Cancer Control.” The following conclusions were suggested during discussions under the subtheme “Protecting her Health”: Even though mammography (MAM) is recommended by the World Health Organization (WHO) for screening breast cancer, clinical breast examination is a reasonable strategy in low- and middle-income countries with the lack of MAM-based screening.There should be a robust commitment from the Government to implement the WHO’s 90-70-90 elimination strategy into practice to eradicate cervical cancer. Scientific evidence from India reported the effectiveness of screening for cervical cancer through Visual Inspection with Acetic acid or HPV test.Adding HPV vaccination into the immunization program along with the screening activities can eradicate cervical cancer in the long run.With the least infrastructure, AI may be used to screen for cervical cancer in environments with limited resources.

Characterizing Oncologist Involvement in an Oncology Nurse-Led Primary Palliative Care Intervention (CONNECT).

Background and Objectives: Mixed success with primary palliative care delivery models may be related to inadequate communication between members of the care team. We sought to describe the previously unexamined role of oncologists in an oncology nurse-led primary palliative care intervention study. Design, Setting, and Subjects: We conducted a secondary analysis of data from Care Management by Oncology Nurses to Address Supportive Care Needs, a cluster-randomized controlled trial of a nurse-led primary palliative care intervention for adults with advanced cancer conducted at 17 community oncology clinics in Western Pennsylvania from 2016 to 2020. Nurses conducted three monthly study visits during which they developed care plans (CPs) with the patient and after which they updated the patient's oncologist. We characterized the level of oncologist involvement with the intervention. Results: Of the 336 patients randomized to receive primary palliative care, 266 completed at least one study visit and 233 (88%) had at least one visit where the oncologist was updated afterward. Across 674 total study visits, the oncologist was updated in 553 (82%) of the visits, signifying the oncologist awareness of the intervention. Of the times the nurse updated the oncologist, a CP was presented 29% of the time (163/553). Conclusion: In a large trial of oncology nurse-led primary palliative care, oncologists were often aware of but infrequently involved with the intervention. Future primary palliative care interventions should consider communication and engagement among team members.

Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care

Cancer and its care impose significant time commitments on patients and care partners. The oncology community has only recently conceptualized these commitments and the associated burden as the "time toxicity" of cancer care. As the concept gains traction, there is a critical need to fundamentally understand the perspectives of multiple stakeholders on the time burdens of cancer care. To explore time-consuming aspects of cancer care that were perceived as burdensome, identify the individuals most affected by time burdens of cancer care, and evaluate the consequences of these time burdens. Participants in this qualitative analysis were recruited from a National Cancer Institute-designated cancer center in Minnesota, where semistructured qualitative interviews were conducted from February 1 to October 31, 2023. Purposive and criterion sampling methods were used to recruit patients (adults with advanced stage gastrointestinal cancer receiving systemic cancer-directed treatment), care partners (patient-identified informal [unpaid] partners), and clinicians (physicians, physician assistants, nurse practitioners, nurses, social workers, and schedulers). Data were analyzed from February 2023 to February 2024. Thematic analysis was conducted with a hybrid (inductive and deductive methods) approach. Themes, subthemes, and illustrative quotations are presented. Interviews included 47 participants (16 patients [8 aged ≤60 years; 12 women (75.0%)], 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]). A total of 31 subthemes were identified that were grouped into 5 themes. Theme 1 captured time burdens due to health care outside the home (eg, travel, parking, and waiting time), while theme 2 identified the often invisible tasks performed at home (eg, handling insurance and medical bills, receiving formal home-based care). Theme 3 explored how care partners are affected alongside patients (eg, burdens extending to the wider network of family, friends, and community) and theme 4 represented the consequences of time burdens (eg, demoralization, seemingly short visits turned into all-day affairs). Finally, theme 5 referenced positive time spent in clinical interactions and hope for change (eg, patients value meaningful care, the "time toxicity" label is a spark for change). This qualitative analysis identifies key sources and effects of time toxicity, as well as the populations affected. The results of this study will guide the oncology community to map, measure, and address future time burdens.

Consensus Guidelines for the Use of Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors in the Management of Hormone Receptor Positive (HR+ve), Her2−ve Early Breast Cancer (EBC)

It is still not possible for all patients with early breast cancer to be cured. Even when they respond well to initial therapy, there exists a substantial risk for recurrence, sometimes after several years. With the availability of cyclin-dependent kinase (CDK) 4/6 inhibitors the role of adjuvant therapy has improved, and so has the chance of cure. These consensus guidelines will ensure that the community oncologist will be able to take the right decision for their patient. The expert committee shares their real-world experience as well as the consensus voting results. Patients eligible for adjuvant therapy with CDK4/6 inhibitors should start that treatment at the earliest. Based on current published data, abemaciclib is the preferred CDK4/6 inhibitor that should be used in eligible patients (unless contraindicated). To ensure optimal dose intensity and adherence to treatment schedule, use of literature and patient information material can improves compliance. Treatment modification requires early reporting of adverse effects, a responsibility of the patient and caregiver (relatives).

Expansion of an Academic Molecular Tumor Board to Enhance Access to Biomarker-Driven Trials and Therapies in the Rural Southeastern United States.

Targeting tumor-specific molecular alterations has shown significant clinical benefit. Molecular tumor boards (MTBs) connect cancer patients with personalized treatments and clinical trials. However, rural cancer centers often have limited access to MTB expertise. We established an academic-community partnership expanding our academic MTB to affiliated rural community cancer centers. We developed a centralized molecular registry of tumors (MRT) to aggregate the comprehensive genomic profiling (CGP) results and facilitate multidisciplinary MTB review. Of the 151 patients included, 87 (58%) had actionable genomic biomarkers, 42 (28%) were eligible for a targeted off-label therapy, and 27 (18%) were matched to a clinical trial. Of those with a clinical trial match, only 1 of 27 (3%) was enrolled in the identified trial. One year into implementation, community oncology providers were anonymously surveyed on persistent barriers to precision treatment utilization. The primary barriers to clinical trial enrollment were the distance to the trial center (70%), lack of transportation (55%), and lack of local trials (50%). This study offers a framework to improve access to molecular expertise, but significant barriers to the equitable use of CGP and trial enrollment persist.

CTNI-24. WF-1801: SINGLE ARM PILOT STUDY OF RAMIPRIL FOR PREVENTION OF RADIATION-INDUCED COGNITIVE DECLINE IN GLIOBLASTOMA PATIENTS RECEIVING CHEMORADIOTHERAPY

Abstract BACKGROUND Patients with glioblastoma (GBM) experience cognitive decline after chemoradiation. Radiation therapy (RT) to the brain creates chronic inflammation believed to contribute to cognitive decline. Ramipril counteracts neuroinflammatory changes in pre-clinical models when given during RT. METHODS This prospective single arm study (WF-1801) coordinated by the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base assessed feasibility, tolerability, and potential efficacy of using ramipril in patients with GBM. Eligibility and treatment paradigms mirrored NRG/RTOG 0825 allowing for outcomes from the placebo arm to be used for comparison. Participants took ramipril during 6 weeks of chemoradiation with temozolomide and for 3 months after RT. Patients completed cognitive testing (HVLT-R, TMT, and COWA) and patient-reported outcomes at baseline, RT completion, and 1 and 4 months after RT. Co-primary endpoints were retention rate (compliance with 75% doses and completion of cognitive testing) and change in cognitive composite score 1 month after RT. RESULTS 75 participants were accrued between 3/25/2019 and 11/14/23: 65% were male, 89% White, median age 63 years. The NRG/RTOG 0825 placebo cohort (n=247) was younger (median 57, p&amp;lt;0.0001) with more White participants (95%, p=0.04). The overall retention rate in WF-1801 was 48% (one-sided 95% CI: 38%-100%); 61% completed &amp;gt;=75% of doses; 57% completed cognitive testing at all time points. The median (range) change in cognitive composite score 1 month after RT was 0.01 (-82.6, 13.0) reflecting an improvement from baseline. However, this was not significantly different from the NRG/RTOG 0825 placebo group median of 0.10 (-48.2, 8.6); p=0.49. CONCLUSION The overall retention rate fell short of our pre-specified endpoint of &amp;gt; 65%; however, medication compliance was high and well-tolerated in retained patients. Future investigations could identify patient subsets who may benefit more from concurrent ramipril. WF-1801 (NCT03475186) funded by UG1CA189824. NRG/RTOG-0825 (NCT00884741) funded by U10CA180868 and U10CA021661.

Identification of meaningful individual-level change thresholds for worsening on the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®).

We derived meaningful individual-level change thresholds for worsening in selected patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) items and their composite scores. We used two data sources, the PRO-TECT trial (Alliance AFT-39) that collected PRO-CTCAE data from adults with advanced cancer at 26 United States (U.S.) community oncology practices and the PRO-CTCAE validation study that collected PRO-CTCAE data from adults undergoing chemotherapy or radiation therapy at nine U.S. cancer centers or community oncology practices. Both studies administered selected PRO-CTCAE items and EORTC QLQ-C30 scales. Conceptually, relevant QLQ-C30 domains were used as anchors to estimate meaningful change thresholds for deterioration in corresponding PRO-CTCAE items and their composite scores. Items or composites with ǀρǀ ≥ 0.30 correlation with QLQ-C30 scales were included. Changes in PRO-CTCAE scores and composites were estimated for patients who met or exceeded a 10-point deterioration on the corresponding QLQ-C30 scale. Change scores were computed between baseline and the 3-month timepoint in PRO-TECT, and in the PRO-CTCAE validation study between baseline and a single follow-up visit that occurred between 1 and 7weeks later. For each PRO-CTCAE item, change scores could range from - 4 to 4; for a composite, change scores could range from - 3 to 3. Change scores in QLQ-C30 and PRO-CTCAE were available in 406 and 792 patients in PRO-TECT and the validation study, respectively. Across QLQ-C30 scales, the proportion of patients with a 10-point or greater worsening on QLQ-C30 ranged from 15 to 30% in the PRO-TECT data and 13% to 34% in the validation data. Across PRO-CTCAE items, anchor-based meaningful change estimates for deterioration ranged from 0.05 to 0.30 (mean 0.19) in the PRO-TECT data and from 0.19 to 0.53 (mean 0.36) in the validation data. For composites, they ranged from 0.06 to 0.27 (mean 0.17) in the PRO-TECT data and 0.22 to 0.51 (mean 0.37) in the validation data. In both datasets, the minimal meaningful individual-level change threshold for worsening was one point for all items and composite scores. gov: NCT03249090 (AFT-39), NCT02158637 (MC1091).

Trends in Real-World Characteristics and Outcomes of Patients with Diffuse Large B-Cell Lymphoma Treated in the US Community Oncology Setting Pre- and Post-CAR-T Approvals

Trends in Real-World Characteristics and Outcomes of Patients with Diffuse Large B-Cell Lymphoma Treated in the US Community Oncology Setting Pre- and Post-CAR-T Approvals

Advancing the Integration of CAR T-Cell Therapy in Community Oncology Centers: Key Findings from a Transformative Quality Improvement Initiative

Advancing the Integration of CAR T-Cell Therapy in Community Oncology Centers: Key Findings from a Transformative Quality Improvement Initiative

Real-World Patient Characteristics and Outcomes in Patients with Relapsed or Refractory Multiple Myeloma Receiving Teclistamab across Community Oncology Practices in the US

Real-World Patient Characteristics and Outcomes in Patients with Relapsed or Refractory Multiple Myeloma Receiving Teclistamab across Community Oncology Practices in the US

Real-World Baseline Characteristics and Preliminary Outcomes in Patients with Myelofibrosis Treated with Momelotinib in the US Community Oncology Practice Setting

Real-World Baseline Characteristics and Preliminary Outcomes in Patients with Myelofibrosis Treated with Momelotinib in the US Community Oncology Practice Setting

Radiation Therapist Education and Training: An International Survey.

This study reports on the current status of Radiation Therapist (RTT) education and training globally. RTTs are the health professionals responsible for the preparation and delivery of courses of radiation therapy, the latter being indicated in the management of 50%-60% of patients with cancer globally. Therefore, high standards of education of these professionals are paramount to safe and high-quality cancer care. In total, 195 responses were received to a survey sent via the International Atomic Energy Agency International Research Integration System to all member states. This represented 90 countries across all regions. The survey indicated a significant deficit in RTT education globally. Many regions report that limited radiation therapy-specific education is available and there is a paucity of assessed practice education. Radiation therapy-specific professional issues are the major barriers to curricula implementation globally. This survey highlights the considerable issues that prevail in the provision of high-quality education for RTTs globally. A collaborative global effort is required by the oncology community and other stakeholders to overcome this significant deficit.

Ayurvedic perspective of dietary risk factors of colorectal cancers - A hospital-based case control study

BackgroundThe rising prevalence of colorectal cancer (CRC) may be attributed to various nutritional and behavioural factors, making both factors as important topics for discussion to the layman and the oncology community. ObjectiveTo explore additional dietary risk factors, other than those already known, according to the Ayurvedic perspective in CRC patients. MethodsDetail dietary data was collected from 420 patients of CRC and 116 healthy volunteers registered at our institute with the help of a food frequency questionnaire. Descriptive analysis was done by plotting radar charts, whereas the logistic regression models were used to calculate the adjusted Odd Ratios (ORs) associated with consumption of green chilli, red chilli powder and curd, individually and in combinations. ResultsThe controls in the present study were younger, had more males, the majority of them belonged to middle- and lower-income groups and had a family history of cancer as compared with cohort of case studies. Green chilli consumption was found to be the maximum within the lower-income group (n = 18, 66.67%), while that of red chilli (n = 150, 48.23%), and curd (n = 107, 34.04%) within the middle class. Maximum consumption of green chillies (Males n = 48, 29.27%; Females n = 36, 21.95%), red chillies (Males n = 40, 29.85%; Females n = 16, 24.61%) and curd (Males n = 31, 28.97%) was observed in the age group 46 to 60 irrespective of sex. Tobacco was found to be the most common addiction in all groups. The maximum number of patients frequently consuming these three dietary items presented majorly with rectal cancer, and liver metastasis and were in advanced grade and stage of cancer. Curd and curd with red chilli powder had a significant association with the development of CRC with an OR of 2.7280 (95% CI 1.6346 to 4.5531) and 5.0806 (95% CI 2.4015 to 10.7485), respectively, which was highly significant (p < 0.0001). Green chilli was notably an associated risk with an OR of 2.0095 (95% CI 1.3258 to 3.0458), which was also statistically significant (p = 0.001). Red chilli powder and green chilli with curd had ORs as 1.6917 (95% CI 1.1105 to 2.5771) and 2.1778 (95% CI 1.1591 to 4.0918) with p = 0.0144 and 0.0156, respectively. ConclusionIn the present study, green chilli, red chilli, and curd are identified as additional dietary risk factors for colorectal cancers, owing to their ability to produce chronic inflammation leading to various inflammatory conditions including cancer.

Evaluation and Use of Natural Language Processing (NLP) Reasoning and Classification Models to Support Clinical Trial Patient Identification and Enrollment in the Community Oncology Setting

Clinical trial research in oncology relies heavily on clinical documentation within the electronic medical record (EMR) to ascertain patient eligibility in clinical trials based on inclusion and exclusion criteria. The structured data elements within the EMR serve as the primary information source for defining patient cohorts, with clinical cancer stage and performance status being two pivotal criteria determining trial eligibility. The challenge arises from the inconsistent availability of clinical stage and performance status data within the structured fields of the EMR despite their consistent presence in clinical notes. Additionally, there is a deficiency of standardization of this data that exists in the unstructured field. Hence, due to lack of structured data and standardization of said data, there are limitations in developing artificial intelligence (AI) models. To increase the comprehensiveness of clinical records, a clinical research team at a community oncology practice was consulted to identify requirements and extract essential clinical features from de-identified data. The methods outlined in this paper focused on eliminating false positives to allow future development of Large Language Models (LLM) using the outputted structured fields which resulted in an increase in patient record completeness with high accuracy. The accuracy ranged from 97.5-97.75% for the models that were developed. Out of the 60,000+ patients, the numerical staging, TNM (tumor, node, metastasis) staging, and Karnofsky performance score models added a structured field for 29.62%, 21.01%, and 40.64% patients respectively. Additionally, a semi-supervised NLP algorithm was applied on the performance status algorithm which achieved a mean absolute error (MAE) of 1.57. This work demonstrates the use case of natural language processing (NLP) in optimizing the clinical research enrollment process by providing an efficient and accurate method to detect key clinical values in unstructured patient data. Similar methodology with more advanced algorithms such as LLM can be employed to detect additional patient elements such as molecular biomarkers, imaging reports, postoperative surgical outcomes (i.e., clear margins etc.) and patient treatment outcomes using the extracted structured fields.

From Podium into Practice: Working Together to Revolutionise Cancer Care in the Real World

Cancer is on course to be the leading cause of death in the EU by 2035. Europe’s population is ageing rapidly, and obesity rates continue to climb; meanwhile, healthcare systems struggle with delayed diagnoses and unequal access to treatments. Despite these challenges, the oncology community has many reasons to be optimistic. Our increased understanding of cancer has enabled us to create potentially transformative treatments, which could deliver life-changing outcomes that were unimaginable 20 years ago. Much of this emerging science has been showcased at this year’s European Society for Medical Oncology (ESMO) Congress, leading to well-warranted excitement across the community. However, it will take more than early research and positive clinical trial data to transform cancer care. We must embed new technologies and approaches in real health systems, looking 10 or 20 years ahead, to truly redefine cancer care. Greg Rossi, Senior VP, Head of Oncology, Europe and Canada, AstraZeneca, shares his thoughts on the critical approaches and concrete steps needed for progress and the importance of collaboration to achieve these goals.

Molecular Targets of Plant-Derived Bioactive Compounds in Oral Squamous Cell Carcinoma.

With a significant increase in both incidence and mortality, oral cancer-particularly oral squamous cell carcinoma (OSCC)-is one of the main causes of death in developing countries. Even though there is evidence of advances in surgery, chemotherapy, and radiotherapy, the overall survival rate for patients with OSCC has improved, but by a small percentage. This may be due, on the one hand, to the fact that the disease is diagnosed when it is at a too-advanced stage, when metastases are already present. This review explores the therapeutic potential of natural herbal products and their use as adjuvant therapies in the treatment of oral cancer from online sources in databases (PubMed, Web of Science, Google Scholar, Research Gate, Scopus, Elsevier). Even if classic therapies are known to be effective, they often produce many serious side effects and can create resistance. Certain natural plant compounds may offer a complementary approach by inducing apoptosis, suppressing tumor growth, and improving chemotherapy effectiveness. The integration of these compounds with conventional treatments to obtain remarkable synergistic effects represents a major point of interest to many authors. This review highlights the study of molecular mechanisms and their efficiency in in vitro and in vivo models, as well as the strategic ways in which drugs can be administered to optimize their use in real contexts. This review may have a significant impact on the oncology community, creating new inspirations for the development of more effective, safer cancer therapies with less toxic potential.

Mesenchymal tumors of the mediastinum: analysis of the clinical case

Mediastinal tumors include a wide range of benign and malignant neoplasms. The latter in the early stages are characterized by a long latent course and carry a significant threat of com pression and / or invasion of vital organs of the mediastinum. The complexity of their diagnosis is complemented by a mixed clinical picture, similar to other somatic diseases. Considering all of the above, mediastinal tumors are an urgent problem for the modem oncological community, they require improving knowledge and gaining experience in their surgical and conservative treatment. Mesenchym al tumors of the mediastinum make up a small part of tumors of the mediastinal space, and the low incidence of neoplasm s of this anatomical localization dictates the need for an interdisciplinary approach to the diagnosis and treatment of mesenchym al tumors of the mediastinal space. A clinical case of the disease is considered, an effective and radical surgical treatment method is demonstrated. The asymptomatic course of the early stages of the disease, as w ell as the relatively low effectiveness of surgical intervention in the late period of oncogenesis, dictates the need to search for new approaches in the diagnosis and treatment of mediastinal tumors.

Challenges in implementation of molecular classification in early stage endometrial cancer-An NRG Oncology cooperative group mixed-methods study.

Professional guidelines recommend molecular profiling for mismatch repair (MMR), p53, and polymerase epsilon (POLE) status in endometrial cancer (EC). However, adoption in the United States has not been documented, and barriers to the implementation of testing have not been described. In this mixed-methods study, implementation science frameworks were used to develop a quantitative survey. Gynecologic oncologists, medical oncologists, radiation oncologists, and pathologists affiliated with NRG Oncology programs were contacted through snowball sampling and were surveyed during 2022-2023. A subset of respondents was interviewed. Statistical and thematic analyses were performed. At least 403 NRG Oncology-affiliated providers were contacted for the survey, and 107 (26.6%) responded. Greater than 90% of respondents perceived POLE, MMR, and p53 status as important for clinical care. MMR and p53 tests were perceived as easy to obtain, but only 24.2% of respondents reported that POLE testing was moderately or very easy to obtain. Respondents from academic sites reported better access to molecular classification and perceived greater importance of molecular classification compared with respondents from community sites. In thematic analysis of 13 qualitative interviews, cost concerns were reported as large barriers to testing. Interviewees reported a desire for prospective data to guide treatment selection based on classification results. Although integrating molecular classification into standard pathologic reporting is recommended, and clinicians perceive molecular profiling in early stage EC as important, survey respondents noted significant implementation barriers. Implementation challenges that differ between community oncology and academic practice settings were identified. Strategies to improve equitable access to molecular classification of early stage EC are needed.