Development Of Cancer Care Research Articles

Assessing blood clot risk in venous catheter selection for patients with haematological cancers

Assessing blood clot risk in venous catheter selection for patients with haematological cancers Venous catheters enable patients with haematological cancers to receive vital chemotherapy. However, there is a risk of thrombosis. Consultant Haematologist Priya Sriskandarajah analysed a group of patients with haematological cancers to study the implications of catheter selection. Over the years, there have been major developments in cancer care, including novel chemotherapy regimens as well as stem cell transplantation. To support these advancements and enable efficient treatment administration, venous catheters (i.e. ‘lines’) are required. These are surgically inserted into a patient’s vein and allow direct delivery of these treatments into the bloodstream.

Abstract 4560: Assessing cancer drug combination efficacy across 900+ PRISM cell lines in a multiplexed screening assay

Abstract Combination therapies are crucial in cancer care, yet identifying which combination will benefit a specific patient is challenging. The vast array of clinical, investigational, and tool anticancer agents and diverse cancer contexts makes investigating many drug combinations over a large number of cell lines infeasible. Here, we describe a multiplexed screening approach using the PRISM assay, where drug combinations are screened on >900 DNA-barcoded cancer cell lines. We analyze cell viability data in drug combinations and single agents using established metrics to describe the combined effects such as additivity, synergy, and antagonism. Quantifying and classifying combined effects will help prioritize specific combinations for follow-up investigations and provide biological and mechanistic insights, thus enabling rationally designed combination therapies. We illustrate our methodology through data from three drug combinations that exemplify synergy and antagonism. In the first combination, temozolomide+O6-benzylguanine (alkylating agent + MGMT inhibitor), we found that cell lines expressing MGMT were sensitized to temozolomide in the presence of O6-benzylguanine, thus illustrating synergy. In the second combination, we screened two anti-apoptosis compounds A-1331852+AZD5991 (BCL-xL + MCL1 inhibitor) and found that BCL-xL and MCL1 inhibition were also synergistic. In the third combination, ML210+ferrostatin-1 (GPX4 inhibitor inducing ferroptosis + ferroptosis inhibitor), we found that ferrostatin-1 antagonized the effects of ML210. Our analysis also reveals the importance of appropriate dose selection and analytical metrics for reliably measuring combined effects. In conclusion, the PRISM platform's multiplexed cell line screening is a robust method for characterizing rationally designed drug combinations, offering a systematic approach to enhance the precision of combination therapy development in cancer care. Citation Format: Ashish Bino George, Shiker Nair, Mustafa Kocak, Ellen Nguyen, Alvin Kalathungal, Anthony Fazio, Cole Ponsi, Aydin Golabi, Melissa A. Ronan, Matthew G. Rees, Jennifer A. Roth. Assessing cancer drug combination efficacy across 900+ PRISM cell lines in a multiplexed screening assay [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4560.

Stem Cell Origin of Cancer: Clinical Implications beyond Immunotherapy for Drug versus Therapy Development in Cancer Care.

Although immunotherapy has revolutionized cancer care, there is still an urgent need to enhance its efficacy and ensure its safety. A correct cancer theory and proper scientific method empower pertinent cancer research and enable effective and efficient drug versus therapy development for patient care. In this perspective, we revisit the concept of immune privilege in a cancer cell versus normal cell, as well as in a cancer stem cell versus normal stem cell. We re-examine whether effective immunotherapies are efficacious due to their anti-cancer and/or immune modulatory mechanisms. We reassess why checkpoint inhibitors (CPIs) are not equal. We reconsider whether one can attribute the utility of immunotherapy to specific cancer subtypes and its futility to certain tumor/immune compartments, components, and microenvironments. We propose ways and means to advance immunotherapy beyond CPIs by combining anti-PD1/L1 with various other treatment modalities according to an appropriate scientific theory, e.g., stem cell origin of cancer, and based on available clinical evidence, e.g., randomized clinical trials. We predict that a stem cell theory of cancer will facilitate the design of better and safer immunotherapy with improved selection of its use for the right patient with the right cancer type at the right time to optimize clinical benefits and minimize potential toxic effects and complications.

Stem Cell Theory of Cancer: Clinical Implications of Epigenomic versus Genomic Biomarkers in Cancer Care

Biomarkers play a crucial role in the diagnosis, prognosis, and therapeutics of cancer. We use biomarkers to identify, image, monitor, and target cancer. In many respects, the discovery of pertinent biomarkers that distinguish fulminant from indolent neoplasms and sensitive from refractory malignancies would be a holy grail of cancer research and therapy. We propose that a stem cell versus genetic theory of cancer may not only enable us to track and trace the biological evolution of cancer but also empower us to attenuate its clinical course and optimize the clinical outcome of patients with cancer. Hence, a biomarker that identifies cancer stem cells (CSCs) and distinguishes them from non-CSCs may serve to elucidate inter-tumoral and intra-tumoral heterogeneity, elevate the values and utility of current prognostic and predictive tests, and enhance drug versus therapy development in cancer care. From this perspective, we focus on CSC biomarkers and discuss stemness or stem-like biomarkers in the context of a unified theory and a consideration of stem cell versus genetic origin. We review their role in primary and mixed tumors, in the elaboration of tumor subtypes, and in the imaging and monitoring of minimal residual diseases. We investigate how scientific theories influence the direction of scientific research and interpretation of experimental results, and how genomics and epigenomics affect the dynamics and trajectories of biomarkers in the conduct of cancer research and in the practice of cancer care.

3.D. Round table: Cancer Epidemiology and Prevention: which opportunities from the EU Cancer Mission?

Abstract While Europe accounts for a tenth of the world's population, it holds a quarter of the world's cancer cases. In the current scenario that see an increase in the proportion of elderly population in the EU, lives lost to cancer in the EU are set to increase by more than 24% by 2035, making it the leading cause of death in the EU. The overall economic impact of cancer in Europe is estimated to exceed €100 billion annually. Moreover, the COVID-19 pandemic has severely impacted cancer care, disrupting prevention and treatment, delaying diagnosis and vaccination, and affecting access to medicines. Since the pandemic began, the number of cancer diagnoses has decreased, foreshadowing a future increase in cases. In response to such challenges, the Europe's Beating Cancer Plan (EBPC) published in 2021 reflects a political commitment to leave no stone unturned to take action against cancer. In the EBPC, there is a renewed commitment to invest in cancer prevention, treatment and care that recognises the growing challenges, and opportunities to overcome them, including the developments in cancer care. In order to implement the EBPC the European Commission will use all the related funding instruments of the Horizon Europe Framework Programme for Research and Innovation (2021-2027) and it will be constantly guided from the experts of the Mission Board of Cancer. By establishing specific goals together with funding, the EU ensures the involvement of the Member States in tackling risk factors that are common to most non-communicable diseases. Simultaneously, there is a clear step towards health equity by collecting data stratified by equity-relevant attributes such as education or income. On another level, the focus on cancer might trigger new effective outcome-based payment models for personalised medicine, as well as better collection of data needed for a value-based approach on the effectiveness of health care. In the round table the panellists will discuss the opportunities and challenges of the EBCP implementation with the President of the Cancer Mission Board Walter Ricciardi, by addressing the epidemiological scenario of cancer disease in Europe and the related economic burden (Joao Vasco Santos), the role of the Comprehensive Cancer Control Networks and related Joint Action (Tit Albreht), and the readiness of the health services (Johan Hansen). Key messages • The implementation of the Europe's Beating Cancer Plan requires coordinated efforts among stakeholders with a clear leadership from Public Health Professionals. • Many externalities can be achieved through the EBCP as cancer has same determinants of most of the non-communicable diseases. Speakers/Panelists Walter Ricciardi Catholic University of the Sacred Heart Rome, Rome, Italy Tit Albreht National Institute of Public Health, Ljubljana, Slovenia João Vasco Santos EUPHA-ECO Johan Hansen EUPHA-HSR

Humanization in oncology care: A necessary change

Developments in cancer care, automation of care, rationing of time and fragmentation of the work process for institutional imperatives can often lead to the dehumanization of care. Although, it is indisputable that these interventions have significantly improved outcomes in oncology, they may have caused the emotional needs of patients, families, and health professionals to be considered secondary concerns. Therefore, humanized care can help dispel the negative emotions associated with cancer diagnosis and treatment and may even contribute to improve patient outcomes. This empathetic and respectful approach to patients leads to increase patient expectations of recovery, accountability, control over their own health, satisfaction, safer care, patient happiness and healthcare professional resilience, resulting in time and cost savings. The humanization of care has emerged as a response to the needs and concerns of patients and their families that go beyond the biological.

Exploring Health Care Professionals’ Perceptions Regarding Shared Clinical Decision-Making in Both Acute and Palliative Cancer Care

Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).

Development of Cancer Care in Northeast India.

Northeast India, a region of geographic, cultural, and ethnic diversity comprises ofAssam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Tripura, and Sikkim. Geographically, two-thirds of the area is hilly terrain. The North Eastern Region (NER) shows marked diversity in customs, cultures, cuisines, traditions, and languages. The Aizawl district of Mizoram (269.4) and the Papumpare district of Arunachal Pradesh (219.8) have the highest age-adjusted incidence rates (AAR) of cancer among males and females, respectively. Meghalaya has the highest relative proportion of cancers associated with tobacco use, with 70.4% in men and 46.5% in women. This correlates with the high prevalence of tobacco use. The Dr Bhubaneswar Borooah Cancer Institute, Guwahati, was inaugurated in 1973. The Institute currently conducts M.Ch. Surgical Oncology, Head and Neck Oncology and Gynaecologic Oncology, and DM courses in Medical Oncology and Onco-pathology. The year 2019 saw the creation of a high-dose radioisotope therapy ward. Allogenic Bone Marrow Transplantation (BMT) was started in 2021-2022. State Cancer Institute (SCI), Guwahati, houses a medical cyclotron, which is the only one in Northeast India. Assam Cancer Care Foundation (ACCF) is a joint venture between the Government of Assam and the Tata Trusts, with a three-level cancer grid. The Cachar Cancer Hospital and Research Centre (CCHRC) offers holistic, subsidised cancer care to over 4000 new patients every year. North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) offers endobronchial ultrasound (EBUS) and mediastinoscopy services, enabling accurate staging of lung cancers. While the cancer care facilities in NER have grown over the years, it is not commensurate with the high incidence of cancers in the region.

Programmatic development of cancer care in the Armed Forces of the Russian Federation

Programmatic development of cancer care in the Armed Forces of the Russian Federation

Current developments in cancer care: including the patients' perspective-3rd European Roundtable Meeting (ERTM) June 17, 2016, Berlin, Germany.

National Cancer Control Plans (NCCP) are necessary to improve cancer care and reduce mortality. We have reported previously on European institutional health structures and transformation of theoretical health care standards into a practical approach. For the latter consideration of the patients' perspective was considered as highly important and chosen as subject for this meeting. Several European organizations have realized deficits in this area. They promote equal and timely access to cancer care since current inequities lead to disparities in cancer survival across Europe. Patients' support working groups are focussing on employment issues, financial services, psychosocial screening and support, palliative care and rehabilitation. They also identified cancer research including patients' views as highly important. Workshops during the 3rd European Roundtable Meeting (ERTM) covered the issues transparency in patient care, implementation of new knowledge and decision making in partnership with the patient. It was concluded that patient views and perspectives have to be considered during the whole continuum of cancer care. Access to treatment, transparency and including patients into the development process are relevant aspects.

Current developments in cancer care: including the patient perspective

Current developments in cancer care: including the patient perspective

Oncology in Uzbekistan: achievements and perspectives

The article describes step by step formation and development of cancer care facilities in the Republic of Uzbekistan. It also presents the current status and perspectives for the development of cancer care for the population in Uzbekistan.

Surgery for epilepsy.

Surgery for epilepsy.

American Society of Clinical Oncology policy statement update: the critical role of phase I trials in cancer research and treatment.

The American Society of Clinical Oncology (ASCO) represents more than 35,000 oncologists and other health care professionals who care for people with cancer and conduct research to improve cancer treatment. ASCO approved a policy statement on the importance of phase I trials in cancer treatment in 1996 and published it in 1997.1 ASCO and its member clinicians have repeatedly used this statement as evidence that phase I trials have therapeutic intent (ie, potential to provide patients with clinical benefit) and to argue for insurance coverage of routine patient costs in these trials. Since the 1997 statement was published, there have been significant developments in cancer care and research. The Patient Protection and Affordable Care Act (ACA) of 20102 has led to enormous changes in the health care delivery system by increasing the number of individuals with health insurance and improving patients' access to many high-quality and preventive care services. The number of people diagnosed with cancer3 and surviving cancer4 is also rapidly increasing. Thus, there is an increase in the number of patients in need of cancer care, and these patients are more likely than in the past to have health insurance that covers the cost of their treatment. The ACA requires payers to cover routine patient costs in phase I to IV trials. Simultaneously, the biopharmaceutical industry has been investing in molecularly targeted agents and immunotherapies for cancer, leading to an increase in the number of promising new agents that need testing in phase I trials.5 Researchers are also exploring innovative trial designs, which may decrease patient risk, expose fewer patients to less-than-optimal drug doses, increase patients' potential for clinical benefit from trial participation, better identify subpopulations of patients likely to benefit from an agent, and reduce the chance of ineffective agents continuing through the development process.6–14 The result is that phase I trials in cancer have greater potential as a treatment option for many patients with cancer than they did in 1997. To address this changing landscape in cancer, ASCO convened a working group of the Cancer Research Committee to review and update the ASCO policy statement on phase I trials. This update reaffirms the critical importance of phase I trials in cancer research and treatment and emphasizes their therapeutic intent. The first section of the statement defines phase I trials in cancer and underscores the importance of trial design in the drug development process. Subsequent sections review the evidence that phase I trials provide patients with clinical benefit and make a series of recommendations on how to increase participation in these trials. The statement concludes with a section on special issues in pediatric phase I trials.

E-learning portal for professional development in cancer care

Purpose – Cancer care is complex and an integrated cancer pathway involves many health professionals in a variety of care settings using many skills. The widely distributed and heterogeneous nature of the cancer workforce raises significant challenges with respect to professional development. Cancer Learning is a government-funded initiative designed to provide access to a wide range of quality online learning resources for all health care professionals involved in the care of cancer patients and their families. The purpose of this paper is to discuss these issues. Design/methodology/approach – A multi-phase project, led by a consortium of national stakeholders in cancer care, informed the design, build, and deployment of Cancer Learning; an online, evidence based, information and learning portal to support professional development of health professionals across the continuum of cancer care in Australia. An action research approach allowed for an iterative process of ongoing dynamic evaluation and improvement of this workforce improvement resource. Findings – The National Government Agency, Cancer Australia's Cancer Learning online hub has been supporting the professional development requirements of cancer care professionals since the site deployment in 2007. Since launch, site usage continues to grow and evaluations have been positive. Time constraints of health professionals continue to be a major barrier to sustained online learning participation. Originality/value – This research recount of the development and implementation of an Australia first national online learning initiative highlights the rigorous approach undertaken for the delivery of a quality evidence-based resource for the professional development of all health professionals involved in the delivery of cancer care.

Coaching intervention as a strategy for minority recruitment to cancer clinical trials.

Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer. Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed. Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression. Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.

Caring for cancer patients on non-specialist wards

As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.

Coaching intervention as a strategy for enhancing accrual to phase I/II clinical trials

6580 Background: Lack of both trust and rapport with health care providers has been identified as possible causes for under- representation of minorities within clinical trials. Our study used a “Peer Coach” (PC) to promote trust among minority patients with advanced cancer. Methods: Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a PC or “Usual Care” (UC). Patients completed baseline and 6-month telephone interviews to assess demographics, trust in healthcare providers, attitudes toward clinical trials, and quality of life. Patients randomized to the coaching intervention were assigned a coach, trained in health communications, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomized to UC received no further intervention. Results: Over 21 months, we screened 268 patients and enrolled 73 African Americans and 2 Asians (56 women and 19 men) including 38, 18, 13, and 6 patients with breast, colorectal, lung and prostate cancers, respectively. Patients were randomly assigned to PC (38) and UC (37), with no baseline differences. Longitudinal data analysis was conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was slightly higher in the PC group but was found to be non-significant (p=0.226). Trust in doctor (p=0.053), absence of depressed mood (p=0.032) and higher quality of life (p=0.052) predicted enrollment. Adherence to care was unrelated to the assigned group and, in the PC group, to the number of coach contacts. Baseline depression was associated with missed physician appointments (p=0.039). There was no difference between the PC and UC groups on attitudes towards clinical trials, perceptions of racism, trust in doctor, medical mistrust, depression, or quality of life. Conclusions: Psychosocial elements of trust in doctor, depression and quality of life were found to predict trial enrollment, regardless of assignment to PC or UC. Future studies should include a more structured approach to clinical trial promotion, follow patients over a longer period, and consider treatment of depression given its association with trial enrollment and adherence. No significant financial relationships to disclose.

Patients’ involvement in improving cancer care: experiences in three years of collaboration between members of patient associations and health care professionals

Objective The aim of this study was to explore how members of patient associations (PACPs) and health care professionals (HCPs) experience collaboration in a network initiated by the health care system and aimed at improving cancer care. Methods The participants were asked to describe, after 1 and 3 years, their experiences of collaboration. Data collected were in the form of a written answer to a single, open-ended question, and the answers were analysed using inductive content analysis. Results The analysis revealed four themes: the impact of processes that occur within the network, the impact of learning, the impact of innovation and development in cancer care, and the impact of PACP members’ personal cancer experience. Statements about the impact of the processes that occur within the network dominated at both occasions. Conclusion This study of experiences of collaboration provides new data on the importance ascribed to such efforts between patients in an organised association and HCPs. Practice implications We suggest that differences in perceptions and expectations should be taken into account in future collaborations between representatives of patient associations and of health care systems in order to reach out and to influence developments in cancer care.

Nurse lecturer Dion Smyth scans the nursing and medical journals for the latest developments in cancer care

Nurse lecturer Dion Smyth scans the nursing and medical journals for the latest developments in cancer care