Cancer Experience Research Articles

The implication of the illness metaphors of In America: Mitigating negative effects of metaphors through illness narratives in the postpandemic era of COVID-19

Susan Sontag’s cancer experience made her realize the harm that the inappropriate use of illness metaphors might do to patients. After recovering from breast cancer, she wrote in Illness as Metaphor that illness has been romanticized and stigmatized. She also elaborated on some illness metaphors, such as the military metaphors for illness, which are still the subject of debate. Her novel In America could be regarded as an elaboration on the consequences of such metaphors. The phenomena she depicts in her novel are now visible twenty years later in the real world. Through analysing the personal experiences of the protagonists Maryna and Ryszard of In America, three levels of trauma caused by the illness metaphors used in negative ways are elucidated in this paper: the personal level, the social level, and the national level. Patients and their relations, health care workers, and even countries, such as China, have been hurt by these metaphors. Therefore, to avoid causing harm to more people, it is necessary to alleviate the negative effects of the inappropriate use of illness metaphors, especially in the postpandemic era of COVID-19. The illness narrative is a good way to mitigate the traumas caused by the inappropriate use of illness metaphors. This article attempts to explore the metaphorization of illness, the traumas caused by the inappropriate use of illness metaphors, and the occurrence of similar phenomena during and after COVID-19. The plot of In America is also explored as an illness narrative, and the illness narrative genre is examined as a way to mitigate the negative effects of the inappropriate use of illness metaphors.

Abstracts of the 39th Annual CAPO Conference-Building Hope: Integrating Sustainable, Innovative and Accessible Care in Psychosocial Oncology 6 to 7 June 2024.

On behalf of the Canadian Association of Psychosocial Oncology, we are pleased to present the Abstracts from the 2024 Annual Conference, titled "Building Hope: Integrating Sustainable, Innovative and Accessible Care in Psychosocial Oncology". The Conference was held in Calgary from 6 June 2024 to 7 June 2024. This conference brought together key stakeholders including multidisciplinary professionals from nursing, psychology, psychiatry, social work, spiritual care, nutrition, medicine, rehabilitation medicine, occupational health and radiation therapy for both adult and pediatric populations. Participants included clinicians, researchers, educators in cancer care, community-based organizations and patient representatives. Patients, caregivers and family members presented abstracts that speak to their role in managing cancer experiences and care. Over one hundred (150) abstracts were selected for presentation as symposia, 20 min oral presentations, 10 min oral presentations, 90 min workshops and poster presentations. We congratulate all the presenters on their research work and contribution.

PCR191 Patient-Centric Assessment of Treatment Experience in Breast Cancer: Development and Validation of a Patient Questionnaire

PCR191 Patient-Centric Assessment of Treatment Experience in Breast Cancer: Development and Validation of a Patient Questionnaire

Broken yet Brave: Arabic Women's Experience of a Breast Cancer Diagnosis.

Breast cancer is the most common cancer in Arabic women and is often diagnosed in advanced stages, resulting in an increased likelihood of requiring a mastectomy. Despite this, there is a lack of contemporary literature exploring Arabic women's experiences of breast cancer and its sequelae. Semi-structured interviews were conducted between 2019 and 2022 of Arabic women diagnosed with breast cancer. Data were analyzed using thematic analysis as described by Braun and Clark. Two main themes were identified: (a) Broken yet brave describes participants' experiences when diagnosed and (b) Making decisions about treatment and experiences of support detailing their lack of decision-making autonomy and perceptions of support. Arabic women believe in the concept of fate and faith, and their cultural conditioning is to prioritize family over themselves, often with limited support. They lack autonomy in decision-making due to the patriarchal society they live in.

Predictors of Moderate-High Posttraumatic Growth in Parents of Children With Cancer: A Cross-sectional Study.

Parents of children with cancer may experience posttraumatic growth (PTG). In clinical practice, this parental enhancement is more likely to be seen with a moderate-high PTG. The aim of this study was to determine the moderate-high PTG prevalence of parents of children diagnosed with cancer at least 6 months and to investigate its relationship with hope, social support, and patient-parent characteristics. This cross-sectional study was conducted with the parents of children with cancer admitted to the pediatric hematology-oncology unit using the Parent-Child Characteristic Questionnaire, Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support and Dispositional Hope Scale. Univariate and multivariate logistic regression analyses were performed to investigate the variables associated with moderate-high PTG. One hundred one parents were enrolled in this study, and the prevalence of the moderate-high PTG was 79.2%. There was a statistically significant difference between moderate-high PTG and children's age (P = .037). Multivariate logistic regression analysis showed that social support from significant others (odds ratio = 1.138, 95% confidence interval = 1.030-1.257, P = .011) was a predictor of moderate-high PTG. Moderate-high PTG is common among parents of children diagnosed with cancer. Perceived social support from healthcare professionals and other patient parents is a predictive factor. Interventions that encourage the support of health professionals and interaction with the parents of other patients, such as peer counseling, group-based interventions, and expanding the social support network, seem to be clinically promising in helping parents to improve from the cancer experience.

Cancer stigma: the need for policy and programmatic action.

Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.

Family adjustment and resilience after a parental cancer diagnosis

PurposeTo explore the resources, parents with cancer and their partners draw upon to sustain their family resilience through the cancer experience.MethodsFifteen participants who were parents of children aged 8 to 25 years completed phone, audio-recorded, and semi-structured interviews. Of these participants, 11 were parents diagnosed with cancer, and four were partners of a parent diagnosed with cancer. Interview questions aimed to increase understanding about how families communicate, connect, and face challenges from the cancer experience. Interview data was analysed using inductive thematic analysis to provide scope to generate themes from parent’s experiences rather than to test pre-existing frameworks.ResultsThe thematic analysis of interview transcripts generated three key themes related to family resilience: (1) adaptability to changes in roles and routines, (2) open communication within the family, and (3) accepting support from others.ConclusionThis study found that parents’ ability to use personal resources when faced with significant challenges helped to improve the resilience of parents’ family system. Further research is needed to understand the factors that influence family resilience when a parent is diagnosed with cancer. Implications for the development of targeted interventions that provide support to not only the patient, but their whole family system will be discussed.

Medical students' views on oncology specialty: A cross-sectional study.

9038 Background: Understanding medical students’ views on oncology, including in jurisdictions where societal misperceptions and social stigma about oncology exist, could help foster higher interest in oncology field among future physicians. This study is conducted to identify factors associated with interest in oncology and likelihood of pursuing a career in an oncology-related field among medical students across various medical schools in the United Arab Emirates (UAE). Methods: A cross-sectional study involving students from 7 medical schools across UAE was conducted. Students’ demographics (n=5), oncology education (n=3) and prior exposure to oncology (n=6) were examined. Likert-type questions assessed students’ interest in oncology and likelihood of pursuing a career in oncology, students’ perspective on factors potentially affecting interest in oncology career (n=12) and the following constructed themes; i) general views about oncology (n=5), ii) confidence in skills related to challenging encounters (n=4), iii) oncology education (n=5) and iv) oncology support (n=4) in medical school. Pilot testing and validation was conducted with acceptable reliability (Cronbach’s alpha ≥ 0.70). A multivariable logistic regression model was employed to identify independent variables associated with study outcomes. Results: Of all completed responses (n=145), about half were from students in UAEU vs other schools and in pre-medical vs preclinical/clinical phase (46% vs 54% and 51% vs 49%, respectively). Most (63%) had family member diagnosed with cancer and approximately a third (33%) felt pessimistic about oncology. Approximately half agreed that cancer diagnosis is often associated with social stigma (56%) and misperceptions (55%). Overall, 52% and 30% were interested in oncology and likely to pursue a career in oncology, respectively. The highest student-ranked factors affecting interest in oncology career included feeling pessimistic/optimistic about cancer, personal/family experience in cancer, opportunities to participate in oncology research, and availability of mentorship and good local residency program. Interest in oncology and likelihood of pursuing a career in oncology were associated with family member diagnosed with cancer (OR 2.55; 1.07 - 6.28 and 4.67; 1.53 - 16.9, respectively), feeling pessimistic about cancer (0.35; 0.13 - 0.89 and 0.08; 0.01 - 0.35, respectively) and premedical vs preclinical/clinical phase (OR 0.21; 0.06 - 0.67 and 0.06; 0.01 - 0.30, respectively). Interest in oncology was also positively correlated with a composite score derived from all questions in the constructed themes (p = 0.014 Wilcoxon Test). Conclusions: Students interest in oncology, and pursuing a career in oncology, is associated with personal/family experience in cancer, pessimistic views about oncology, and availability of mentorship/research/residency, but not social stigma or societal misperceptions.

Meaning of nutrition for cancer survivors: a photovoice study

BackgroundLittle is known about how cancer survivors perceive nutrition through the cancer experience and how those perceptions may influence their diet.AimsThis study aimed to capture the meaning of nutrition for...

Experiences of underrepresented adolescent and young adult (AYA) cancer survivors engaging in research-related activities.

10073 Background: Adolescent and young adult (AYA) cancer survivors are an age-defined cohort (15-39 years at diagnosis) confronting unique biopsychosocial needs throughout their cancer experience. Underrepresented (sexual and gender minority [SGM] and/or Black, Indigenous, and People of Color [BIPOC]) AYAs face additional challenges associated with discrimination, mistrust of providers, and culturally incongruent services. As a result, many underrepresented AYAs experience suboptimal oncological care and disparate outcomes when compared to cis-gendered heterosexual and/or white peers. This study explored the experiences of underrepresented AYA cancer survivors engaging in research-related activities. Methods: This study is part of a larger Patient Centered Outcomes Research Institute (PCORI)-funded project that is evaluating multilevel facilitators and barriers to oncological care and research for underrepresented AYA cancer survivors. With support from five academic cancer centers and five community-based organizations supporting AYAs across the US, we have assembled an intersectional community advisory panel (CAP) of 10 AYAs who identify as BIPOC and/or SGM. Together with the CAP, a semistructured interview guide was developed, and from January to February 2024, we conducted video interviews. Data were analyzed using thematic analysis of verbatim transcribed interview scripts. The CAP assisted the investigative team in the analyses and interpretation of data. Results: Of the 20 participants interviewed, roughly 70% identified as BIPOC, 40% as SGM, and 10% as both BIPOC and SGM. Participants included underrepresented AYA cancer survivors who, prior to this specific study, had or had not participated in cancer-related research. Three major themes affecting underrepresented AYAs and engagement in research-related activities were discovered, and included: 1) Layering of identities, culture, and stigma; 2) The role of trusted conduits in facilitating engagement; and 3) Beyond compensation: reasons of pursuance. Conclusions: The resultant themes illuminate multilevel facilitators and barriers to research engagement among underrepresented AYA cancer survivors. Findings will assist in guiding researchers, oncology care providers and program administrators both in academic and community settings in the design of inclusive and equitable cancer care delivery programs for underrepresented AYA cancer survivors.

Descriptive and content analysis of breast cancer vlogs on YouTube.

e21016 Background: Vlogs, or “video blogs,” are personally-created experiential videos based on wide-ranging topics, usually posted to YouTube. Many women with breast cancer (BC) document their cancer experiences in YouTube vlogs. These may have the potential to serve as peer-to-peer support and provide community. This study provides a descriptive and content analysis of vlogs by women with BC. Methods: YouTube was searched in incognito mode in 11/2023 using the search terms “breast cancer vlog.” A maximum of 10 videos/creator were included based on viewership and date created. Video characteristics collected included: title, length, number of views, likes, comments, and playlist inclusion. Videos were assessed for sponsorship, presence of explanation and discussion on BC, type of content, and themes. Creator characteristics included age, location, and engagement approaches. Descriptive and content analysis were performed to assess and analyze video content and potential areas where peer-to-peer support may be provided. Results: 90 vlogs by 13 creators were included, all originating from personal accounts. Mean video length, number of views, and number of comments were 21.4 minutes (SD 9.1), 266,780 (SD 534,465), and 1485 (SD 3422), respectively. 38.9% included hashtags. 12.2% included paid sponsorships. Most common filming location was at home (96.7%), followed by the hospital (31.1%), or in the car (21.1%). Home vlogs were most often set in the living room (44.3%), bedroom (33.0%), or kitchen (20.6%). 56.7% included visuals of treatment as well as physical findings. Creators addressed motivation for vlogging in 48.9%; the two most common reasons were wanting to build a community and helping others in a similar situation. In 46.7%, creators explicitly expressed emotion. Most common themes were treatment (85.6%), mental health (81.1%), side effects (72.2%), appearance (63.3%), and family relationships (36.7%). Subthemes included young age, finances, and the importance of online community support. Patient-directed advice was offered in 60.0%, mostly on treatment-related issues. In 56.7%, creators provided explicit treatment definitions. Chemotherapy was discussed in 70.0%; surgery in 57.8%, primarily mastectomy; radiation in 30.0%; general side effects in 71.1%. 24.4% were about a new diagnosis. When mentioned (44.4%), most common creator location was the USA. When mentioned (30.0%), most common age demographic was 20-29 years old. Conclusions: Vlogs by women with BC receive significant levels of engagement. The dedication to building community demonstrated by vlog creators, and the personal nature of their storytelling, advice, and suggestions, may make these vlogs a potential resource for peer-to-peer support.

Relationship between cognitive and emotional domains of prognostic awareness with quality of life and psychological distress in patients with advanced cancer.

11106 Background: Prognostic awareness, a measure of patients’ cognitive and emotional perception of their illness and prognosis, allows individuals to align their medical decision-making with their goals and values. Prior studies have shown mixed findings regarding the relationship between prognostic awareness with better quality of life (QOL) and less psychological distress in patients with advanced cancer. However, studies have not investigated whether it is the cognitive or the emotional aspects of patients’ awareness of their prognosis that are associated with QOL and psychological distress in patients with advanced cancer. Methods: We conducted a cross-sectional study of patients with metastatic solid malignancies not being treated for curative intent at a single academic center from 11/2019-6/2022. We used the Prognostic Awareness Questionnaire (PAIS) to measure the cognitive (i.e., the capacity to understand one’s prognosis characterized by the accurate perception that a cancer is curable or not) and emotional coping with prognosis (i.e., the capacity to emotionally process prognostic uncertainty and terminal prognosis). We used the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression scale (HADS), and the Peace, Equanimity and Acceptance in the Cancer Experience (PEACE) scale to measure, QOL, psychological distress, and acceptance of illness, respectively. We used multivariate regression models controlling for age, gender, and cancer type to assess the relationship between the cognitive and emotional prognostic awareness domains and patient-reported outcomes. Results: Overall, 632 participants (age 65 years (SD=11.3), 51% female, 76% married or living with a partner) were enrolled in the study. In multivariate models, higher cognitive understanding of prognosis was not associated with QOL (b=-2.134; p=0.069), psychological distress (i.e., anxiety: b=0.331; p=0.232 and depression; b=0.233; p=0.368), or peaceful acceptance of terminal illness (b=-0.045; p=0.838). However, emotional coping of prognosis was associated with better QOL (b=1.981; p<0.001), less anxiety (b=-0.516; p<0.001) and depression (b=-0.370; p<0.001) symptoms, and more peaceful acceptance of terminal illness (b=0.438; p<0.001). Conclusions: Patients’ emotional coping with their prognosis, rather than their cognitive understanding of their terminal prognosis, was associated with their QOL, psychological distress, and acceptance of their illness. These findings underscore the importance of examining prognostic awareness and its association with patient-reported outcomes by domains. We also highlight the need to develop supportive care interventions to promote effective coping strategies for patients after prognostic disclosure.

Approaches to engaging participants in a national cancer genomics research network.

11022 Background: Although patient engagement is thought to improve the relevance and acceptability of research across diverse patient populations, a paucity of studies actively evaluate engagement activities to assess their impact. The NCI’s Participant Engagement and Cancer Genome Sequencing (PE-CGS) Network was established to advance cancer genomics for understudied cancers and among underserved populations by engaging patients and survivors as participants in research. We sought to characterize strategies for engaging and evaluating engagement among research centers within PE-CGS, and to describe factors impacting each center’s unique engagement strategies and evaluation methods. Methods: We used a multi-method approach to document centers’ engagement strategies and methods to evaluate engagement.We first completed a document review of centers’ study materials including protocols, specific aims, and publicly available information. We then conducted semi-structured key informant interviews with research center members to validate findings from the document review and to identify factors that influenced engagement strategies. The semi-structured interview guide was developed using the Health Equity Implementation Framework to ensure that we accounted for multi-level factors (societal, contextual, and clinical factors) relevant to engagement. Engagement strategies and evaluation methods were collated and analyzed descriptively. Information about factors that influenced their engagement strategies were analyzed using deductive thematic analysis. Results: Across the five PE-CGS research centers, we identified 9 engagement strategies including: convening at network meetings (n=5), use of advisory boards (n=5), brochures (n=3), newsletters (n=2), community outreach through advocacy organizations (n=1) and in-person events (n=2), and use of branded websites (n=4), social media (n=3), and health technology apps (n=1). Methods used for evaluating engagement included: surveys (n=4), interviews/focus groups (n=4), informal feedback from participants (n=2), randomized experiments (n=1), and N-of-1 studies (n=1). Multi-level factors that influenced engagement included those related to the language and culture of the patient population, availability of validated measures, timing of interactions with participants within their health journey, and patient burden imposed by the experienced cancer. Conclusions: Across a national research network with a priority to advance participant engagement in cancer genomics research, we observed a range of unique engagement strategies and evaluation methods. Notably evaluation approaches were not typically tied to specific engagement strategies, but rather sought to evaluate broader aspects of engagement in the respective research studies, such as their ability to engender inclusivity, collaboration, and trust among participants.

The Progress Tracker Breast Cancer Registry: Feasibility of a longitudinal patient-led, patient-reported outcomes (PROM) registry.

e23169 Background: A breast cancer diagnosis has the greatest disability-adjusted life years lost of all cancers and significant impact on physical, psychoemotional, social and overall global functioning. Directed by Breast Cancer Canada, a registered non-profit patient-led organization and data managed by the University of Calgary’s POET Program, PROgress Tracker uses a novel, peer-to-peer support model for recruitment, engagement and retention, and is the first national longitudinal and non-interventional PROMs registry. Our aim is to demonstrate the feasibility and potential of this registry in centering patient voice and lived experience to transform breast cancer management. Methods: PROgress Tracker, with 10-year enrollment goal of 50,000 Canadians with Stage 0-IV breast cancer, extends a series of validated PROMs (PROMIS, BREAST-Q, FACT-B, GAD, PHQ-9, COST-FACIT, ISI and ESASr-CA) via a digital platform every 3 months for up to 10 years. Dynamic customization of additional PROMs (PRO-CTCAE, BREAST-Q) based on patient and treatment-specific trigger questions assess evolving components of wellbeing, including financial stress, work life and adverse treatment effects. Results: Recruitment began in October 2023. 162 participants from all Canadian regions including remote/rural geographic areas have shared baseline demographic and clinical data including stage, genetic/molecular tumor markers, treatment type(s) and completed an initial series of PROMs. Comprehensive PROMs including sensitive topics (finances, sexuality, mental health) were completed with minimal missing data ( < 5%); 3-month follow-up surveys show a current retention rate of 57%. Preliminary analysis: median age of participants 54 yrs, 95% identify as Caucasian, and 57% are currently working. 46% reported financial stress (99% response rate); 63% reported ongoing symptoms requiring follow-up. 6% were BRCA+ and 19% triple negative, 7% experienced recurrence, 3% Stage IV, 75% received systemic and/or radiation therapy, 38% received targeted therapy. Conclusions: The lived experience of breast cancer is integral to patient-centred change in the era of precision/personalized medicine and is captured by PROgress Tracker using a diverse set of periodic PROMs to understand the evolution of global measures of wellbeing over time. Initial data indicates that this novel peer to peer model via digital administration of comprehensive and longitudinal PROMs is feasible. This initiative demonstrates attaining this scope of data is achievable, has interest and participation from the national breast cancer community and growing capacity to accrue important, real-time data to inform best practice and identify additional supports required for breast cancer care. While early feasibility is evident, further outreach and recruitment initiatives will ensure diversity of participants.

Tolerance and safety of adjuvant metronomic capecitabine in Indian patients with non-metastatic triple negative breast cancer (TNBC): An institutional experience.

e12530 Background: Triple-negative breast cancer (TNBC) subtype has a high risk of recurrence and overall poorer survival after standard treatment. SYSUCC-001 study presented in ASCO 2020 reported an increased disease-free survival after one year of metronomic capecitabine in operable TNBC patients after completion of local therapy. As per our clinical experience in metastatic breast cancer, many Indian patients are not able to tolerate capecitabine for longer duration. Hence, we wanted to assess the tolerance and safety of one year of daily dosing of capecitabine in our patients with Non-Metastatic TNBC. Methods: We performed a retrospective analysis of non-metastatic TNBC patients receiving adjuvant capecitabine 650 mg /m2 twice daily continuously for one year who took treatment from June 2020 to August 2022. The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Statistical analysis was conducted using SPSS, version 24. Results: We analyzed 90 patients, out of which majority (62%) were stage II. Median age of the cohort was 48 years. Germline data was available for 64 patients, out which 8 patients were BRCA 1 positive and 8 patients had a variant of undetermined significance. Median duration of capecitabine in our patients was 230 days (IQR: 10 - 360). Twenty-six (28.8%) patients underwent dose reduction and 15 (16.6%) had reported grade 3 toxicity. Mean dose of capecitabine received was 535 mg / m2 twice daily. Treatment was interrupted due to toxicity in 20 (22%) of patients. The most common capecitabine-induced toxicity was hand foot syndrome, which was also the most common reason for dose reduction and treatment interruption. Dihydropyrimidine dehydrogenase (DPD) mutation status was known for 38 patients out of which only one (2.6%) was found to have DPD deficiency. Incidence of grade 3 toxicity was observed to be less in patients with age less than 50 years, ECOG performance status 0-1 and absence of comorbidities. Two-year disease free survival (DFS) and overall survival (OS) was estimated to be 79.3% and 80% respectively. Most common site of metastases was reported to be brain followed by lung. Conclusions: Continuous metronomic dosing of adjuvant capecitabine for 1 year is fairly well tolerated in Indian patients with non-metastatic TNBC, but may still require dose reduction in some patients due to toxicity.

Preliminary efficacy and safety of total neoadjuvant therapy combined with PD-L1 blockade in pMMR/MSS locally advanced rectal cancer (ESTIMATE): A prospective, single-arm, phase II trial.

e15602 Background: Patients with locally advanced rectal cancer (LARC) experience benefits from total neoadjuvant therapy (TNT). This study aims to explore the efficacy and safety of combining TNT with immunotherapy for pMMR/MSS LARC patients. Methods: ESTIMATE is a prospective, single-center, phase II study (ChiCTR2400079718) enrolling pMMR/MSS LARC patients with tumors located 10cm away from the anal margin. Treatment involved induction chemotherapy with immunotherapy ([mFOLFOX6, days 1-2 + Envafolimab 200mg, ih, day 1]; q2w; 2 cycles), long-course concurrent chemoradiotherapy (LCRT) with immunotherapy ([IMRT, 50Gy/25f, 2Gy + Cape 825mg/m2, bid]; 5w + Envafolimab 200mg, ih, day 1; q2w; 3 cycles), consolidation chemotherapy with immunotherapy ([mFOLFOX6 + Envafolimab; 2 cycles), and then total mesorectal excision (TME) 3 weeks later or watch and wait (W&W). The primary endpoint is the pathological complete response (pCR) rate. Results: Until Nov. 16th, 2023, 35 patients were enrolled, with 28 completing the TNT regimen. The efficacy analysis revealed that out of 28 patients, 12 (42.9%) achieved clinical complete response (cCR), with 7 individuals choosing the W&W strategy. 21 patients underwent TME, yielding 8 with a tumor regression grade (TRG) of 0, 7 with TRG of 1, and 6 with TRG of 2. The rates of pCR, major pathological response (MPR), and complete response (CR) were 38.1% (8/21), 71.4% (15/21), and 53.6% (15/28), respectively. 25 (89.3%) patients experienced treatment-related adverse events (AEs) of any grade. Non-hematological AEs included decreased appetite, fatigue, nausea, and vomiting, while hematological AEs mainly comprised thrombocytopenia, anemia, and leukopenia or neutrophilia. Grade III AEs were primarily leukopenia or neutrophilia (2/28, 7.1%). Additionally, circulating tumor DNA (ctDNA) levels were measured in 7 patients who chose the W&W strategy after achieving cCR. Of these, 6 tested negative for minimal residual disease (MRD), while 1 had a positive MRD result (ctDNA: 0.56 MTM/ml). As of Jan. 26th, 2024, with a median follow-up of 5 months (range: 3-6), no recurrence was observed in any of the patients. Conclusions: The TNT approach, integrating LCRT with mFOLFOX6 and PD-L1 blockade, demonstrated a favorable CR rate and acceptable tolerability, offering a potential avenue for organ preservation in low rectal cancer patients with pMMR/MSS. Long-term benefits need validation through further follow-up. Clinical trial information: ChiCTR2400079718. [Table: see text]

SWOG S2107: Randomized phase II trial of encorafenib and cetuximab with or without nivolumab for patients with previously treated, microsatellite stable, BRAFV600E metastatic and/or unresectable colorectal cancer.

TPS3640 Background: Patients with microsatellite stable (MSS), BRAFV600E metastatic colorectal cancer (mCRC) experience poor survival outcomes. Second-line treatment with the BRAF inhibitor encorafenib (E) and anti-EGFR antibody cetuximab (C) is an approved treatment combination, with overall response rate (ORR) of 20% and median progression-free survival (PFS) of 4.1 months. Anti-PD-1 antibodies like nivolumab (N) are ineffective as monotherapy for patients with MSS, BRAFV600E mCRC. In preclinical models of MSS, BRAFV600E CRC, inhibition of BRAF and EGFR induces loss of expression of mismatch repairs genes and promotes a microsatellite instability-high phenotype, which may prime these tumors for response to immunotherapy. In support of these findings, a single-institution clinical trial of E + C + N for 26 patients with MSS, BRAFV600E mCRC reported an ORR of 50% and median PFS of 7.2 months. We hypothesize that the addition of N to E + C will improve median PFS for patients with MSS, BRAFV600E mCRC. Methods: In this prospective phase II clinical trial (N=84), patients with previously treated MSS, BRAFV600E mCRC are randomized 2:1 into 2 arms, respectively: experimental treatment (E + C + N) or standard treatment (E + C). No prior BRAF, EGFR, or immunotherapy agents are allowed. All patients receive E (300 mg PO daily) and C (500 mg/m2 IV every 14 days), and patients in the experimental arm receive N (480 mg IV every 28 days). The primary endpoint is PFS. Secondary endpoints include overall survival, best overall response, duration of response, and safety/tolerability. Using a one-sided α= .10 and power 80%, we target an improvement in median PFS from 4.2 to 7.3 months (hazard ratio 0.57). Additional patient specimens will be collected for exploratory correlative research. As of 2/2024, 50 of 84 planned participants have been enrolled. Clinical trial information: NCT05308446 .

Understanding and comparing the views of specialty care providers and PCPs on addressing cancer survivorship needs via survivorship care plan portal.

e13799 Background: Individuals with colorectal cancer (CRC) experience persistent and disabling symptoms across the care trajectory. Consequently, Survivorship Care Plans (SCPs) have been developed to assist patients in navigating these experiences. However, there are mixed results regarding its effectiveness and implementation in helping cancer survivors. The purpose of this qualitative study is to explore and compare the attitudes of cancer specialists and PCPs on current practices for survivorship care coordination, and to identify potential barriers and facilitators to implementing a SCP-PHR tool. Methods: Semi-structured interviews were conducted with 22 providers involved in cancer care, including specialty care providers (n=16) and primary care providers (n=6). The interview guide was based upon the Consolidated Framework for Implementation Research (CFIR). The current analysis focused solely on the “tension for change” domain. Two researchers analyzed individual transcripts using a combined thematic approach (inductive and deductive) to identify common themes and important findings. Results: While multiple barriers were identified, care coordination/communication among different specialties emerged as a notable challenge. Providers indicated that a lack of well-defined responsibilities between various specialties led to challenges in providing proper follow-up care. Most providers had not routinely utilized SCPs in their practice. Several specialty care providers expressed uncertainty about who handles follow-up care (n=11; 68.7%) while others believed that PCPs or nurses should bear that responsibility (n=5; 31.2%). In contrast, many PCPs voiced that follow-up care responsibility should fall to oncologists (n= 5, 83.3%) due to provider burden and lack of familiarity with cancer symptomatology. As a result, providers noted that patients are not receiving adequate information about their care and are unaware of their treatment needs. Specialty care providers expressed concerns that areas of non-cancer symptom management and preventive care are not being adequately addressed alongside cancer-specific symptoms. Primary care providers echoed similar concerns and noted that care tools, like SCP-PHRs and warm hand-offs, could be implemented to address these concerns. Conclusions: Barriers surrounding survivorship care coordination underscore the need for creating a efficient SCP-PHRs, as providers seek support in providing care information to patients. Providers suggested a virtual platform should be structured in a concise format that delivers comprehensive information tailored to individual needs and addresses symptoms across all stages of their cancer continuum. Future studies may focus on understanding differences in perspectives among those who have actively engaged with SCPs in their care practices.

Impact of COVID-19 on referrals to outpatient palliative care for patients with advanced cancer in a safety-net health system.

e24071 Background: Medically underserved adults with cancer experience challenges with access to care and tend to present at later disease stage. Amidst the complex needs of safety-net patients, the value of early palliative care (PC) services can go unrecognized. Few studies have examined PC referral patterns in the outpatient setting among advanced cancer patients within a safety-net system, and none has studied how or whether referrals have evolved since the most acute stages of the COVID-19 pandemic. This study examined PC referrals for cancer patients seen as outpatients in the urban safety-net primary provider of cancer care for uninsured individuals in Dallas, TX, and assessed changes from before to after the acute pandemic phase. Methods: We used tumor registry records linked to outpatient PC referral data from the safety-net health system’s electronic health record from January 1, 2018 to July 31, 2023. The primary outcome was a binary indicator for receipt of PC referral among patients diagnosed with advanced-stage solid tumor cancer. Using a multivariate logistic regression model, we evaluated whether our independent variable – a binary indicator for pre-pandemic (January 1, 2018 to February 28, 2020) and post-pandemic (March 1, 2020 to July 31, 2023) time periods – was associated with PC referrals. We included age, sex, race/ethnicity, cancer type, preferred language, and insurance as covariates. Results: Among 1,590 eligible patients (mean age 58.1, range: 21-94), 44% were female and 75% were non-White. Diagnoses included lung (20%), gastrointestinal (17%), colorectal (14%), breast (9%), prostate (9%), head/neck (9%), pancreatic (8%), gynecologic (6%), and other (8%) cancers. Across both time periods, a total of 785 (49%) of patients received a PC referral. Whereas 53% of the 754 patients in the pre-pandemic cohort received a PC referral, 46% of the 836 in the post-pandemic cohort received a referral. In the adjusted regression model, pre-pandemic patients were 1.26 times more likely to have a PC referral than post-pandemic patients (95% CI, 1.02-1.56). Referrals varied by cancer type across both time periods – compared to breast cancer patients, gynecologic cancer patients had lower odds of PC referral (aOR, 0.19; 95% CI, 0.10-0.36) and pancreatic cancer patients had higher odds of PC referral (aOR, 2.93; 95% CI, 1.71-5.00). Conclusions: Our analysis showed that referrals declined during the COVID-19 pandemic and revealed differing underlying patterns of PC referral along disease groups. Understanding pre-existing referral patterns and lasting practice changes post-pandemic can support clinicians to integrate PC and improve cancer outcomes. Findings can be used to develop interventions, such as clinical triggers, to improve PC delivery for underserved cancer patients.

Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (OPBC-03/SAKK 23/16/IBCSG 57-18/ABCSG-53/GBG-101-TAXIS).

TPS611 Background: Axillary lymph node dissection (ALND) is standard of care for most patients with clinically node-positive breast cancer (cN+BC), either in the adjuvant setting or in case of residual nodal disease after neoadjuvant chemotherapy (NACT). At least one quarter of patients with breast cancer experience long term morbidity after ALND. The TAXIS trial was designed to investigate if axillary radiotherapy (ART) can replace ALND in patients with cN+ BC who underwent tailored axillary surgery (TAS), which is recognized as one of the most important uncertainties and controversies in axillary management of patients with breast cancer. Methods: To test the remaining indications for ALND in clinical practice, we designed the international, multicenter, phase-III, non-inferiority, randomized controlled TAXIS trial to be pragmatic (average PRECIS-2 score of 4.44). Accordingly, most study domains follow usual care conditions, including eligibility (following routine indications for ALND in clinical practice), surgical skills and techniques, and follow up. The radiation oncology protocol included detailed recommendations and an extensive quality assurance program, which was developed to address the limitations of prior landmark trials and increase acceptability among recruiters. The main objective of the trial is to demonstrate that treatment with TAS and ART is non-inferior to TAS and ALND in terms of disease-free survival (DFS) of patients with cN+ BC detected by imaging or palpation in the upfront surgery setting or in case of residual disease after NACT. Randomization at a 1:1 ratio is mainly performed intraoperatively to either use TAS followed by ALND and regional nodal irradiation excluding the dissected axilla as a target volume (arm A) or to use TAS followed by regional nodal irradiation including the full axilla (arm B). The sample size is based on the primary endpoint DFS. With a type I error of 5% and a power of 80%, 385 events will be needed to show non-inferiority of TAS and axillary RT in comparison to ALND with a non-inferiority hazard ratio of 1.289 (corresponding to a DFS at 5 years of 80% in the ALND arm and 75% in the TAS and axillary RT arm). The sample size was calculated to be 1500 patients (750 per arm). Enrolment started in July 2018 and will stop after reaching 1500 patients, which is expected to be completed by Q4/2025. With currently 51 active sites from Europe, Canada and Korea within the network of the Oncoplastic Breast Consortium (OPBC), >950 patients were randomized by January 2024. Another 14 sites in Europe, USA, and South America will join the trial in 2024. The interim analysis (after 20% of the required events) is expected for Q4/2024 and will be reviewed by the IDMC. The primary endpoint analysis is planned in Q4/2030. Clinical trial information: NCT03513614 .