Experienced Oncologist Research Articles

Impact of 18F-FES PET/CT on Clinical Decisions in the Management of Recurrent or Metastatic Breast Cancer.

The clinical impact of 16α-18F-fluoro-17β-estradiol (18F-FES) PET/CT on patient management has not been well investigated. The aim of this study was to assess the clinical impact of 18F-FES PET/CT on the management of patients with recurrent or metastatic breast cancer. Methods: Study subjects were identified retrospectively from a database of a prospective trial for postmarketing surveillance of 18F-FES between 2021 and 2023. Patients who were suspected or known to have recurrent or metastatic estrogen receptor-positive breast cancer based on a routine standard workup were included. Planned management before and actual management after 18F-FES PET/CT were assessed by 2 experienced medical oncologists via medical chart review. A 5-point questionnaire was provided to evaluate the value of 18F-FES PET/CT for management planning. The rate of intention-to-treat and interdisciplinary changes, and the impact of 18F-FES PET/CT according to PET/CT result or clinical indication, were examined. Results: Of the 344 included patients, 120 (35%) experienced a change in management after 18F-FES PET/CT. In 139 (40%) patients,18F-FES PET/CT supported the existing management decision without a change in management. Intention-to-treat and interdisciplinary changes accounted for 64% (77/120) and 68% (82/120) of all changes, respectively. A higher rate of change was observed when lesions were 18F-FES-negative (44% [36/81]) than 18F-FES-positive (30% [51/172]) or mixed 18F-FES-positive/negative (36% [33/91]). Regarding clinical indications, the highest rate of change was shown when evaluating the origins of metastasis of double primary cancers (64% [9/14]). Conclusion: 18F-FES PET/CT modified the management of recurrent or metastatic breast cancer, serving as an impactful imaging modality in clinical practice.

Empowering survivors, elevating care: The vital role of oncology primary care clinics.

362 Background: Due to increasing numbers of cancer survivors, there is a greater focus on the longitudinal management of treatment-related comorbidities. Cancer survivors have increased risk of cardiovascular (CV) disease, CV-related mortality, and second primary cancers (SPCs). Primary care providers (PCPs) are responsible for most of the care of long-term survivors, however, many report uncertainty around long-term effects and survivorship guidelines. While fostering strong primary care-oncology relationships is one approach to support those impacted by cancer, the development of oncology primary care clinics enhances patient outcomes and ensures patients receive comprehensive survivorship care. Despite this, few tertiary cancer care centers offer such clinics. Methods: In 2021, the University of Cincinnati Cancer Center established an oncology primary care clinic. Patients are eligible if they have a current or prior cancer diagnosis or cancer hereditary syndrome (CHS). The clinic is comprised of two-family medicine physicians, one with survivorship experience, and one fellowship-trained in palliative and hospice medicine. Clinical team members include an RN with oncology experience, medical assistants, a clinical service specialist, two oncology clinical pharmacists, and an oncology social worker. A clinical registry was developed to longitudinally measure patient outcomes. Electronic medical records of patients (n=683) seen between 1/2021 and 1/2024 were extracted and entered in REDCap. Data was summarized using SAS. Results: The mean age was 56 years (range 20-93), and 12% received a diagnosis in the pediatric/adolescent/young adult age range (0-39 years). The most common types included breast (23%),hematologic cancers (15%), and CHS (16%). Notably 43% of patients are on active treatment and 53% completed or are on maintenance treatment. Over 61% struggle with obesity, while 45% report being a current or former smoker. Comorbidities were common with 79% of patients having at least one CV diagnosis. Of 57% patients eligible for cardiomyopathy screening, 78% received recommended echocardiograms. Many patients received their recommended screenings including breast (79%), colon (43%), cervical (56%), prostate (46%), and lung (55%). Patients were referred to a variety of supportive services including physical therapy (42%), cancer exercise (18%) and psychiatry (14%). Conclusions: This model of care is a viable option for connecting cancer survivors with PCPs knowledgeable about survivorship care. CV-related comorbidities were common, and their management is a critical need during and after cancer. Survivors have increased risk of SPCs, and while the number of patients up to date on recommended cancer screenings is low, screenings are on the rise with ongoing efforts. Patient registries enable objective measurement of outcomes and can inform future research and care.

A five-year, multi-institutional mentorship program in radiation oncology: the Society for Women in Radiation Oncology experience: Short running title: SWRO Mentorship Program

BackgroundMentorship in the field of radiation oncology (RO) promotes career development and satisfaction. Many individuals, however, do not have access to mentorship or are unsatisfied with their mentorship experience, potentially due to insufficient gender-concordant mentorship opportunities. To address this, the Society for Women in Radiation Oncology (SWRO) created the SWRO Mentorship Program for women, gender minorities, and those with intersecting marginalized identities at all stages of training for physicians and medical physicists. We present the five-year experience of the largest multi-institutional mentorship program, to our knowledge, in RO. MethodsPublicly available information and the SWRO mentorship sign-up form were used. Descriptive statistics and binomial tests compared to reference points were conducted. ResultsBetween January 2018 and June 2023, 296 individuals from 19 countries participated in the mentorship program, generating 225 mentee-mentor pairs. The majority were female (89.2%), based in the United States (US; 84.8%), and on the physician-track (96.6%). The remainder of the analysis focused on US-based, physician-track participants (n = 244), the majority of whom were female (96.7%) and trainees (58.2%). Among those who have completed RO residency, most accepted a first job in academia (82.1%) and remained in academia at the time of the analysis (76.3%). A significantly higher proportion of SWRO mentorship participants compared to the reference point took a first job in academia (82.1% vs 58.3%; p<0.0001). The most common disease sites of focus for the physician-track trainees who finished residency are breast (50.4%), central nervous system (32.7%), and gynecologic malignancies (30.1%), with 54% listing more than one. The most common expressed goals of mentorship are research (35.8%), leadership (24.5%), and building connections within a specific geography or institution (19.2%). ConclusionsThe SWRO experience demonstrates the feasibility of a large-scale, multi-institutional mentorship program in RO.

A Quality Approach to Blinatumomab Delivery in Pediatric Oncology: A Children's Oncology Group Study.

Background: Blinatumomab is a promising immunotherapy agent that has been shown to improve survival outcomes in children diagnosed with relapsed B-lineage acute lymphoblastic leukemia. Expanded use of blinatumomab in the treatment of childhood cancer is expected; however, clinician perspectives regarding administering this agent in healthcare and home settings have not been explored. Method: Semistructured interviews were conducted with clinicians (N = 13) from pediatric institutions across the United States and Canada. Qualitative data were analyzed using a constant comparative analysis three-stage method. Results: Participants were primarily nurses (92%), female (77%), and had greater than 10 years of pediatric oncology experience. The selective code and overarching theme identified was "A quality approach to blinatumomab delivery in pediatric oncology." Clinicians described detailed processes that were created and implemented to promote a common goal of safe blinatumomab administration across the continuum of care. Clinicians shared how they engaged in planning activities and considered a variety of factors prior to and during blinatumomab administration. Clinicians also expressed a need to reflect and evaluate on previous patient experiences to create new or revise existing processes and workflows. Communication was also central to clinicians' work. Clinicians provided recommendations to assist others with blinatumomab administration and offered suggestions for items that could help with implementing future clinical trials containing similar agents. Discussion: Findings suggest nurses are pivotal to establishing processes which support safe administration of immunotherapies, such as blinatumomab, while also considering patient-specific needs and promoting quality of life.

Virtual Waiting Room: The New Narrative of Waiting in Oncology Care.

This conceptual study introduces the "virtual waiting room," an innovative, interactive, web-based platform designed to enhance the waiting experience in oncology by providing personalized, educational, and supportive content. Central to our study is the implementation of the circular entry model, which allows for non-linear navigation of health information, empowering patients to access content based on their immediate needs and interests. This approach respects the individual journeys of patients, acknowledging the diverse pathways through which they seek understanding and manage their health. The virtual waiting room is designed not only to support patients but also to facilitate stronger communication and shared understanding between patients, caregivers, and families. By providing a shared digital space, the platform enables caregivers and family members to access the same information and resources, thereby promoting transparency and collective knowledge. This shared access is crucial in managing the emotional complexities of oncology care, where effective communication can significantly impact treatment outcomes and patient well-being. Furthermore, the study explores how the circular entry model within the virtual waiting room can enhance patient autonomy and engagement by offering customized interactions based on user feedback and preferences. This personalized approach aims to reduce anxiety, improve health literacy, and prepare patients more effectively for clinical interactions. By transforming passive waiting into active engagement, the virtual waiting room turns waiting time into a meaningful, informative period that supports both the psychological and informational needs of patients and their support networks.

High-quality expert annotations enhance artificial intelligence model accuracy for osteosarcoma X-ray diagnosis.

Primary malignant bone tumors, such as osteosarcoma, significantly affect the pediatric and young adult populations, necessitating early diagnosis for effective treatment. This study developed a high-performance artificial intelligence (AI) model to detect osteosarcoma from X-ray images using highly accurate annotated data to improve diagnostic accuracy at initial consultations. Traditional models trained on unannotated data have shown limited success, with sensitivities of approximately 60%-70%. In contrast, our model used a data-centric approach with annotations from an experienced oncologist, achieving a sensitivity of 95.52%, specificity of 96.21%, and an area under the curve of 0.989. The model was trained using 468 X-ray images from 31 osteosarcoma cases and 378 normal knee images with a strategy to maximize diversity in the training and validation sets. It was evaluated using an independent dataset of 268 osteosarcoma and 554 normal knee images to ensure generalizability. By applying the U-net architecture and advanced image processing techniques such as renormalization and affine transformations, our AI model outperforms existing models, reducing missed diagnoses and enhancing patient outcomes by facilitating earlier treatment. This study highlights the importance of high-quality training data and advocates a shift towards data-centric AI development in medical imaging. These insights can be extended to other rare cancers and diseases, underscoring the potential of AI in transforming diagnostic processes in oncology. The integration of this AI model into clinical workflows could support physicians in early osteosarcoma detection, thereby improving diagnostic accuracy and patient care.

Expert Opinions on Uveal Melanoma: Insights from the 58th Ophthalmic Oncology Group Meeting

Introduction Clear evidence for the best clinical management of uveal melanoma is lacking in some areas. Therefore, reports on expert opinions in the field can be valuable. Methods A questionnaire comprising 10 questions was distributed to potential participants of the 58th Ophthalmic Oncology Group Meeting in Stockholm, Sweden, in June 2024. Results Among 34 respondents, 13 (38%) had &amp;gt;20 years of post-residency experience in ophthalmic oncology. The maximum recommended tumor thickness for ruthenium-106 plaque brachytherapy was 5.7 mm (SD 1.1). Twenty-three respondents (68%) indicated that radiological surveillance for metastatic disease should be conducted irrespective of primary tumor characteristics. A majority (74%) would treat a lesion with a 6 mm diameter and 1.5 mm thickness without waiting for evidence of growth if sufficient risk factors were present. Most experts did not currently recommend sampling of circulating tumor DNA (ctDNA) or circulating tumor cells (CTCs). There were no significant differences in responses based on the experience of respondents (≤20 versus &amp;gt;20 years) or their annual volume of new cases (≤50 versus &amp;gt;50). Conclusion This article reports the opinions of 34 experts in ophthalmic oncology on various contemporary topics in uveal melanoma. The responses illustrate both agreements and differences in opinions among experts.

The Impact of a Pilot Oncology Summer Internship on Oncology Awareness Among Early Medical Students from Underrepresented Backgrounds: A Mixed-Methods Study.

Oncology is a field of medicine projected to face provider shortages as cancer prevalence rises. Moreover, the diversity of oncologists remains subpar compared to that of the general population despite initiatives to increase the number of students from underrepresented backgrounds (UIM). Thus, first-year UIM medical students interested in oncology were invited to participate in a 4-week oncology summer internship (OSI) to gain clinical exposure and mentorship experiences. The OSI connected students with oncologists for mentorship, provided tours of oncologic facilities, and coordinated shadowing opportunities. The impact of the OSI was assessed via a mixed-methods approach. Pre- and post-survey data were collected from eight of the nine OSI students. Quantitative data demonstrated improvement of students' understanding of oncology as a discipline, for example its training pathways (p = .02), and awareness of patient experiences in oncology, for example socioeconomic challenges (p = .008). Students reported an increased ability to identify with those in oncology and identify mentors in the field (p = .03 and p = .05, respectively). Qualitative data demonstrated continued interest in oncology with increased commentary on the patient experience and social determinants of health. Post-survey, students provided more commentary on the need for diversity in the field and possible increased professional connections in medicine. The OSI improved students' understanding of oncology and oncology patient experiences with potentially increased identification of and connection with others in the field. Further work will focus on assessing the impact of future OSIs on professional identity formation.

KRC-APM: Key region cutting and artificial prior model for breast cancer recognition in ultrasound images

Computer-aided analysis of ultrasound images is important for the early detection of breast cancer, obtaining more treatment time and improving the likelihood of survival. Current methods are either limited by predefined Regions of Interest (ROIs), suffer from a low proportion and variable locations of tumors, or lack appropriate modeling of tumor characteristics in ultrasound images. This paper proposes a framework called Key Region Cutting and Artificial Prior Model (KRC-APM) for breast cancer recognition in ultrasound images. Firstly, to avoid the reliance on predefined ROIs, as well as to increase the proportion of tumor areas and eliminate abundant background, we propose a Key Region Cutting (KRC) method, which analyzes the confidence levels for tumor areas and tolerantly cuts high-confidence areas into key regions. Next, to model the characteristics of tumors in ultrasound images, we design three types of diagnosis-related Artificial Priors (APs) under the guidance of experienced oncologists: Shape Modeling, Margin Analysis, and Echogenicity Pattern Indication. Finally, to fuse the key region with the extracted APs, we propose an Artificial Prior Model (APM), which synthetically learns the pattern of breast cancer. The proposed KRC-APM is validated on two public datasets. The experimental results demonstrate that the key regions identified by the KRC method and the designed APs significantly enhance the performance of breast cancer recognition. Furthermore, the proposed KRC-APM framework outperforms current state-of-the-art (SOTA) methods.

Variations in the Five Facets of Mindfulness in Italian Oncology Nurses according to Sex, Work Experience in Oncology, and Shift Work.

Oncology nurses support cancer patients in meeting their self-care needs, often neglecting their own emotions and self-care needs. This study aims to investigate the variations in the five facets of holistic mindfulness among Italian oncology nurses based on gender, work experience in oncology, and shift work. A cross-sectional study was carried out in 2023 amongst all registered nurses who were employed in an oncology setting and working in Italy. There were no significant differences in all five facets of holistic mindfulness (p ≥ 0.05) according to gender, work experience in the oncology field, and shift work. Could holistic mindfulness be defined as an intrinsic individual characteristic? Surely, more insights will be necessary to better define the holistic trend in oncology nursing.

Automating the detection of treatment progression in patients with lung cancer using large language models.

e13620 Background: Accurate assessment of treatment response is fundamental to advancing cancer patient care, particularly in lung cancer, where treatment modalities are diverse and complex. The extraction of treatment response, particularly disease progression information, from Electronic Health Records (EHRs) is essential for several reasons: It facilitates generation of real-world evidence from real-world data, enables personalized treatment planning, and contributes to a broader understanding of cancer therapeutics. However, much of treatment response information is documented in free-text EHR notes and traditional methods of extracting such information from notes are labor-intensive, error-prone, and inefficient, presenting significant barriers to timely and accurate real-world evidence studies. The advancement of Natural Language Processing (NLP) technologies, especially Large Language Models (LLMs), presents a transformative opportunity to automate the extraction of treatment responses. Methods: We used a cohort of 1,953 primary lung cancer patients identified from UPMC Hillman Cancer Center cancer registry and retrieved ~113,000 clinical notes from UPMC clinical data warehouse. We focused on extracting disease progression information, following the RECIST guidelines which define progression as an increase in tumor size or cancer markers after therapy. We selected ~50 notes to perform manual annotations by an experienced oncologist and created a gold standard dataset to validate the NLP models. We fine-tuned a state-of-the-art open-source LLM named LLAMA-2 and compared against a traditional rule-based NLP system for the automated extraction of disease progression from notes. The process of fine-tuning involved adjusting the model's parameters specifically to improve its ability to recognize and classify instances of disease progression. Results: Our analysis demonstrated a significant enhancement in performance with the LLM compared to the traditional rule-based NLP system. LLM exhibited a remarkable increase in sensitivity by ~37%, indicating its superior ability to accurately identify disease progression. Additionally, the model maintained high specificity and PPV, achieving scores nearly comparable to the rule-based system but with a notable improvement in the F1-score by ~14%. Conclusions: Our research highlights the transformative potential of LLM-based NLP algorithms in automating the extraction of treatment responses from free-text EHRs. This methodology not only provides a scalable and efficient mechanism for processing large volumes of clinical text but also significantly enhances the accuracy of lung cancer treatment response assessments. [Table: see text]

How accurate is clinical prognostication by oncologists during routine practice in a general hospital and can it be improved by a specific prognosis training programme: a prospective interventional study

ObjectivesOncologists need competence in clinical prognostication to deliver appropriate care to patients with cancer. Most studies on prognostication have been restricted to patients in palliative care settings. This paper investigates...

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

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

Virtual consultations: the experience of oncology and palliative care healthcare professionals

ObjectivesTo maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient-healthcare practitioner interactions. The aim of this study was to explore the views of oncology and palliative care healthcare professionals (HCPs) regarding the medium of VC.MethodA cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. This was undertaken in accordance with relevant guidelines and regulations.Results87 surveys were completed. Three master themes were identified. Personal, professional, and familial factors including patient age, illness and VC skillset all influenced practitioner’s experience of VC. Relationships and connection were highlighted by survey respondents as important influences, with a perception that VC could reduce usual relationships with patients, compared to previous face-to-face consults. There was a perceived loss in these domains with VC. Sharing bad news and having challenging conversations was seen as particularly difficult via VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a significant benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant worry, alongside the challenges faced with occasionally failing technology.ConclusionVC were felt to have a role for those patients who are already known to professionals, where there was an established relationship. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patient suitability prior to offering VC, with emphasis on the importance of patient choice, was seen as a priority in this new era of VC.

British Oncology Pharmacy Association Delphi consensus guidelines: Co-infusion of trometamol-containing calcium folinate (Leucovorin) with systemic anti-cancer treatments.

Drug stability and compatibility are critical factors influencing the cost and logistics of treatment delivery, therapeutic effectiveness, and patient safety. This is particularly significant in the realm of cancer chemotherapeutics, where stability and compatibility studies play a vital role in ensuring rational and safe medicine administration. Oxaliplatin, fluorouracil, and irinotecan, commonly used in various combinations for gastrointestinal cancers, are complemented by co-administration of folinic acid in certain protocols. Notably, some folinic acid preparations include trometamol as an excipient, potentially impacting the stability of the chemotherapeutic agents if infused concomitantly. This study seeks to establish guidelines for oncology multidisciplinary teams, addressing potential risks associated with the combination of trometamol-containing folinic acid and chemotherapeutics. To achieve this, a quantitative questionnaire was distributed to members of the British Oncology Pharmacy Association (BOPA) and non-BOPA members through an online survey. Nineteen healthcare professionals with oncology experience, comprising 18 pharmacists and one nurse, completed the questionnaires. Each participant rated the validity and clarity of statements on a 5-point scale. The Delphi process concluded after the fourth round, consolidating the findings and recommendations from the multidisciplinary team. Twelve recommendations for safe practice have been made.

How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group

PurposeIn clinical practice the assessment of the “vocal cord-arytenoid unit” (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. MethodsIn this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. ResultsTwenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. ConclusionsThe current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Abstract 3910: The Atlas of Blood Cancer Genomes: A resource for therapeutic and biomarker development

Abstract Developing a novel cancer therapy is an expensive, time-consuming, high-risk endeavor that involves identifying a molecular target as well as target indications. This process could be accelerated by a comprehensive interrogation of driver variants and gene expression profiles across cancer types. The Atlas of Blood Cancer Genomes (ABCG) project was initiated to elucidate the molecular basis of all leukemias and lymphomas, building on advances in genomic technologies, our capabilities for data analysis, and economies of scale. The ABCG project includes collaborators from 25 institutions worldwide who contributed samples from 10,512 patients comprising every type of blood cancer in the World Health Organization classifications. All cases were de-identified and their associated pathology and clinical information entered into a purpose-built web-based system. All cases underwent pathology and clinical data review by experienced hematopathologists and oncologists. Samples were subjected to whole exome DNA and RNA sequencing. We examined three classes of therapeutic targets with selected examples of application: 1. Surface markers: Surface markers are targets of many approved and experimental therapies in blood cancers (CAR-T cells, monoclonal and bispecific antibodies). We found that CD22, which has been evaluated as a target in diffuse large B-cell lymphoma (DLBCL), is also highly expressed in follicular lymphoma, adult ALL, mantle cell lymphoma, and high-grade B cell lymphoma, all areas of clinical need. We can evaluate the expression of virtually any marker or combination of markers across all blood cancers while noting areas of greatest clinical need within and across diseases, providing the basis to reclassify diseases by therapeutic target. 2. Genetic targets: Our work assesses the entire spectrum of genetic alterations including mutations and fusions. We found targetable alterations including BCR-ABL1 fusions, EZH2 Y641, IDH2 R140Q and BRAF V600E mutations in multiple cancers, albeit at low frequency, pointing to potential new indications for existing drugs in subsets of rare diseases. 3. Complex targets (immune or expression signatures or combinations of gene variants): Past work defined DLBCL immune and other signatures associated with response to avadomide, a novel cereblon inhibitor. We found that these signatures are also highly expressed in large subsets of peripheral T-cell lymphomas and acute myeloid leukemia, both areas of major unmet clinical need. Thus, we can interrogate immune and other signatures across the spectrum of cancers to uncover potential biomarkers of response. The ABCG project will enable the comprehensive study of genomic and clinicopathological features of all blood cancers. We anticipate that our data, approaches and results will provide a lasting resource for molecular classification and therapeutic development in all leukemias and lymphomas. Citation Format: Jennifer Shingleton, Raju Pillai, Sarah Ondrejka, Govind Bhagat, Amy Chadburn, Matthew McKinney, Jean Koff, Dina Soliman, Magdalena Czader, Abner Louissaint, Shaoying Li, Choon Kiat Ong, Amir Behdad, Andrew Evens, Yaso Natkunam, Mette Pedersen, Sirpa Leppa, Eric Tse, Jennifer Chapman, Catalina Amador-Ortiz, Yuri Fedoriw, Andrew Evans, Jiong Yan, Mina Xu, Kikkeri Naresh, Clay Parker, David Hsu, Sandeep Dave. The Atlas of Blood Cancer Genomes: A resource for therapeutic and biomarker development [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 3910.

Burnout and Resiliency Among Advanced Practice Providers in Oncology Care.

Occupational exhaustion, or burnout, is characterized with three components: emotional exhaustion, depersonalization, and sense of decreased personal accomplishment. Advanced practice providers (APPs) in oncology care are at particular risk for burnout. This was a prospective, comparative, descriptive study utilizing a convenience sample of oncology APPs who completed the Advanced Practice Provider Oncology Web Education Resource (AP-POWER; formerly Oncology Nurse Practitioner Web Education Resource, or ONc-PoWER), developed to provide educational content for new oncology APPs. The study purpose was to utilize the AP-POWER alumni to describe the level of burnout (Maslach Burnout Inventory) as well as resilience (Brief Resilience Scale) after at least 1 year in oncology practice, and to compare these scores according to the number of APP oncology practice years. Of the 133 questionnaires emailed, 30 were returned (22.6% response) and 27 completed (20.3%). Within the Maslach Burnout Inventory, the mean score of the emotional exhaustion subscale was 25.19 (standard deviation [SD] 12.74; high degree of occupational exhaustion), depersonalization 7.74 (SD 5.98; moderate degree), and personal achievement 31.85 (SD 6.20; low degree). The resilience scores had a mean of 22.52 (SD 3.37; normal range). Resiliency was positively associated with personal accomplishment. There was no difference in burnout among newer (< 3 years) and more experienced (> 3 years) oncology APPs. Oncology APPs report key indications of burnout, including a high degree of emotional exhaustion and moderate depersonalization, which was not mitigated through resiliency. The results are worrisome. Burnout scores for oncology APPs are high. Resiliency is present but is not protective for burnout. Strategies must be developed institutionally to support these key cancer care providers.

The Use of Granulocyte Colony-Stimulating Factor as Primary Prophylaxis in Patients Undergoing Chemotherapy: An Experience of Moroccan Oncologists.

Febrile neutropenia (FN) is a frequent and serious emergency for oncologic patients undergoing chemotherapy. Using granulocyte colony-stimulating factor (G-CSF) as primary prophylaxis of febrile neutropenia is an integral part of the management of cancer patients. Our study aims to identify the challenges that prevent Moroccan oncologists from prescribing G-CSF for primary prevention. Seventy doctors participated in our study, with a participation rate of 35.35%. Twenty-two participants had at least five years of experience in oncology. Most participants were medical oncologists (82.9%), and two-thirds of them practiced in teaching hospitals. Regarding the use of G-CSF in primary prevention, all participants complied with the recommendations for FN risk assessment and the prescription of G-CSF for prophylaxis in patients at high risk of FN (>20%). However, their use in intermediate-risk patients remains limited mainly by the cost of these drugs (45.7% of participants). FN remains a dreadful complication in oncology. Since the introduction of G-CSF into standard oncology practice, particularly in primary prevention, the management of certain patients has improved considerably. Nevertheless, the indications for G-CSF in our context, essentially in intermediate-risk patients, are uncertain.

Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India.

The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.