National Cancer Institute Cancer Research Articles

Abatement of the Survival Cliff in Older Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma in the United States.

Purpose: In 2018, a "survival cliff" in the United States was identified among older adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). This study reassessed the cliff and associated putative causes. Methods: Survival data were obtained using the U.S. Surveillance Research Program, National Cancer Institute (NCI) SEER 22 Registries. Accrual data on cancer treatment trials conducted by the NCI cooperative groups and NCI-designated cancer centers were obtained from the NCI Cancer Therapy Evaluation Program. Trend and average percent changes and statistical significances were identified with the NCI Joinpoint Regression Program. Results: A previous cliff-like decrement in the survival of 17- to 20-year-olds is no longer apparent, overall and in all racial and ethnic groups. The "survival cliff" age range was coincident with a clinical trial accrual cliff, and both diminished when more clinical trials were available to, and participated in by, young adult patients. Older AYA patients of ages 30-39 had minimal improvement in clinical trial accrual and least survival gain among the AYA age group. Conclusion: The survival cliff has abated, resulting in thousands of fewer premature deaths and tens of thousands of years of life saved-a remarkable achievement. The survival improvement may be attributed to improved clinical trial availability for and recruitment and participation of AYAs on treatment trials, application of pediatric-inspired ALL treatment regimens to AYAs, expanded national health insurance for -18 to 25 year olds, improved AYA cancer services, and a national focus on AYA oncology.

Abstract LB139: Disparities in oral precancerous lesion surveillance in the United States upper Midwest

Abstract Objective: To determine whether geographic representation and race of patients in a regional oral cancer surveillance program (University of Minnesota Cancer Active Surveillance Population (UMN CASP)) mirror characteristics in the corresponding National Cancer Institute (NCI) designated comprehensive cancer center catchment. Introduction: Oral cancer poses a significant public health concern that may be mitigated through lesion surveillance. Representation of patients for clinical trials throughout an NCI cancer center catchment area is a crucial goal to promote improved health outcomes. This study investigates the demographic landscape of patients with preneoplastic oral lesions seen at the CASP. Methods: Through the UMN Clinical and Translational Sciences Institute, we queried 30 International Classification of Disease (ICD) 9 and 10 codes corresponding to 120 unique mucosal oral precancerous lesion descriptors of CASP patients. Automated extraction of electronic medical record (EMR) data for 4,496 patients treated by the senior author between 2011 and 2023 identified 1,375 patients with preneoplastic lesions. The proportion of patients residing in three-digit zip code regions of Minnesota were compared to 2021 American Community Survey state population data. Additionally, race data were compared between CASP patients and the UMN Masonic Cancer Center (MCC) patient catchment data. Results: CASP patients were over-represented relative to state population distributions within the Minneapolis-St. Paul metropolitan area and surrounding suburbs (region 554 p<0.0001 and region 551 p<0.0001). Under-representation of CASP patients was observed in all western and southern border regions (regions 559 p<0.0001, 560 p<0.0001, 561 p<0.0001, 562 p=0.0037, 565 p<0.0001, and 567 p=0.0006) as well as portions of central (563 p<0.0001), northern (566 p=0.0015), and north-eastern (558 p<0.0001) Minnesota. Proportional representation was observed in several regions of central (553 and 564), eastern (550), and north-eastern (557 and 556) Minnesota. Comparisons of CASP race data revealed a higher proportion of black patients (CASP 8.59% [95% CI 7.17-10.27%] vs. MCC 7.16% [95% CI 7.14-7.17%]) and a lower proportion of Asian/Pacific Islander patients (CASP 3.74% [95% CI 2.82-4.94%] vs. MCC 5.32% [95% CI 5.30-5.34%]) relative to MCC catchment patients. White, American Indian/Alaskan Native, and mixed-race groups were proportionally represented in both data sets. Conclusions: These data show that system wide EMR searches can be implemented to identify patients in an NCI cancer center catchment area with precancerous or other at-risk conditions for cancer. Importantly, Native patients were proportionally represented in the screening program while several rural locations were under-represented. This information can instruct the expenditure of additional resources for under-represented groups and permit streamlined enrollment of patients for cancer prevention clinical trials. Citation Format: Alexander J. Dwyer, Lindsey Mortensen, Beverly R. Wuertz, Frank G. Ondrey. Disparities in oral precancerous lesion surveillance in the United States upper Midwest [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB139.

NCI Cancer Research Data Commons: Core Standards and Services.

The NCI Cancer Research Data Commons (CRDC) is a collection of data commons, analysis platforms, and tools that make existing cancer data more findable and accessible by the cancer research community. In practice, the two biggest hurdles to finding and using data for discovery are the wide variety of models and ontologies used to describe data, and the dispersed storage of that data. Here, we outline core CRDC services to aggregate descriptive information from multiple studies for findability via a single interface and to provide a single access method that spans multiple data commons. See related articles by Wang et al., p. 1388, Pot et al., p. 1396, and Kim et al., p. 1404.

NCI Cancer Research Data Commons: Resources to Share Key Cancer Data.

Since 2014, the NCI has launched a series of data commons as part of the Cancer Research Data Commons (CRDC) ecosystem housing genomic, proteomic, imaging, and clinical data to support cancer research and promote data sharing of NCI-funded studies. This review describes each data commons (Genomic Data Commons, Proteomic Data Commons, Integrated Canine Data Commons, Cancer Data Service, Imaging Data Commons, and Clinical and Translational Data Commons), including their unique and shared features, accomplishments, and challenges. Also discussed is how the CRDC data commons implement Findable, Accessible, Interoperable, Reusable (FAIR) principles and promote data sharing in support of the new NIH Data Management and Sharing Policy. See related articles by Brady et al., p. 1384, Pot et al., p. 1396, and Kim et al., p. 1404.

Abstract B036: Trends in disparities in clinical trial accrual: An analysis of National Cancer Institute (NCI)-sponsored early phase clinical trials over the last 22 years

Abstract Using the NCI Cancer Therapy Evaluation Program (CTEP)-sponsored early phase oncology clinical trials database, we evaluated trends in disparities in patient enrollment over the last 22 years. Counts and percentages of enrolled patients were calculated directly from the full population of patients enrolled to CTEP-sponsored Phase 1, 2, and 1/2 trials during 2000-22. Trends in enrollment were assessed based on single-year data, four-year periods, and using a three-year rolling average. Analyses of patient residential ZIP code were restricted to patients residing and enrolled at institutions within the United States. Geographical data corresponding to patient ZIP codes was obtained using the zipcodeR package, including geographical region and median household income corresponding to each ZIP, and distance between patient residential and enrolling institution ZIPs. A total of 14,877 patients were enrolled in CTEP-sponsored early phase trials evaluated during 2000-22, with 14,342 residing and enrolled within the US. The proportion of patients aged 40-64 at enrollment decreased from 59.8% in 2000-03 to 47.5% in 2020-22, with corresponding increases in ages 65-74 (24.2% to 32.9%) and 75-84 (5.9% to 12.3%). There were fluctuations in gender, most likely based on the specific agents being studied in clinical trials enrolling at a given time. In 2020-22, 72.9% of the population was non-Hispanic white when compared to 2000-03 when enrollment of non-Hispanic whites was 83.7%. Hispanic/Latino population enrollment increased from 4.2% in years 2000-03 to 6.9% in years 2020-22. Asian/Pacific Islander population increased from 2.5% in 2000-03 to 5.4% in 2020-22. Enrollment of non-Hispanic Black patients increased slightly over the last 20 years (6.3% to 7.1%), as did the proportion with unknown or unspecified race/ethnicity (3.3% to 7.6%). Trial enrollment trends by geographic regions revealed that enrollment in South and West overall increased (29.1% to 40.9%; 7.9% to 18.2%), Northeast representation remained static (23.9% to 20.8%) and Midwest representation decreased (24.4% to 19.4%) from 2000-03 to 2020-22. Most early phase participants in our database were from localities with a moderate median household income ($52,200 - $156,600; 51.9% to 59.4%), with an increase in representation from low-income localities (income < $52,000; 31.1% to 37.7%) over the last 22 years. We observed an overall increase in patients enrolling within a 50-mile radius of their residence over the 22-year period (46.5% to 64.5%) and an overall decrease in patients traveling over 200 miles to enroll in clinical trials (16.1% to 8.3%). We also examined trends in disparities during the COVID-19 pandemic and saw no significant differences in trial enrollment by race/ethnicity and gender when compared to pre-pandemic enrollment. Disparities in patients enrolled in early-phase clinical trials have marginally improved over the span of two decades, and outreach and inclusion efforts for enrollment of underrepresented patients should be continued to sustain these observed trends. Citation Format: Maria Farooq, Elad Sharon, Naoko Takebe, Ana F. Best, Shanda Finnigan. Trends in disparities in clinical trial accrual: An analysis of National Cancer Institute (NCI)-sponsored early phase clinical trials over the last 22 years [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B036.

President Biden Chooses Monica M. Bertagnolli, MD, to Lead the NIH

President Biden Chooses Monica M. Bertagnolli, MD, to Lead the NIH

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center.

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.

Impact of COVID-19 pandemic mitigation strategies on industry and NCI cancer treatment trials.

1565 Background: The onset of the COVID-19 pandemic resulted in major disruptions in enrollment and conduct of cancer clinical trials. In response, regulators allowed modifications to traditional trial processes to enable clinical research and care to continue. The American Society of Clinical Oncology and Friends of Cancer Research established a task force to evaluate how sponsors perceived the impact of these mitigation strategies on data quality and overall trial conduct. Methods: The study used a survey and live interviews of industry and National Cancer Institute (NCI) cooperative group sponsors of cancer treatment trials. Sponsors with trials active in the United States from January 2015-May 2022 were eligible. We assessed perceived impacts of the pandemic on protocol deviations, types of mitigation strategies, trial closures, dropouts, adverse events (AEs), and data integrity. Descriptive statistics were used for survey data summaries. Key findings from semi-structured interviews were described by theme. Results: Of forty-one eligible sponsors, 20 (49%; 15/36 industry and 5/5 cooperative group) completed the survey; eleven (55%; 7/15 industry and 4/5 cooperative group) were interviewed. Sixty percent of sponsors reported large portfolios (>10 trials) of phase II and/or phase III trials. The most widely adopted mitigation strategies were remote distribution of oral anticancer therapies (70%), remote consenting (65%), and remote symptom monitoring for AEs (65%). The proportion of sponsors reporting a “substantial” increase in protocol deviations compared to the pre-pandemic period dropped from 42% in the initial wave (March-April 2020) to 16% thereafter. Sponsors primarily reported “no change” in trial drop-out rates (77%), the number of trials closed due to low accrual (90%), or rates of AEs (81%) at any point during the pandemic. Overall, most (83%) respondents reported the pandemic had “minimal” (14) or “no” impact (1) on data integrity. In interviews, many sponsors reported persistent time delays in data entry related to labor shortages at sites. Conclusions: This study represents the first systematic evaluation of clinical trial sponsors about the impact of the COVID-19 pandemic on the conduct of cancer clinical trials. Remote clinical trial conduct mitigation strategies were broadly adopted. Despite an observed increase in protocol deviations, most sponsors reported the pandemic had minimal or no impact on data integrity. The COVID-19 pandemic impacted how cancer clinical trials were performed and has likely accelerated a trend towards greater flexibility in trial conduct that was already emerging, with potential benefits of reduced burden and improved access for patients and sites . Future work is planned to further quantify the impact of the pandemic and trial mitigation strategies on the quality of trial data both overall and for historically underrepresented patient groups.

Are National Cancer Centers Prepared to Deliver Climate-Smart, Resilient Healthcare? An Overview and Analysis of Organizations' Sustainability Plans

<h3>Purpose/Objective(s)</h3> Climate change will be the greatest global health threat of the 21st century. The impact on human health is well-documented and expected to increase if mitigation efforts remain inadequate. The health care sector and oncologists are on the front line of this crisis with vulnerable and marginalized patients bearing the burdens of a changing climate. Equally important, healthcare significantly contributes to greenhouse gas (GHG) emissions. In the U.S., healthcare is responsible for nearly 8.5% of GHG emissions and the loss of 388,000 disability-adjusted life-years annually. Cancer care encapsulates a significant portion of hospital resources. Therefore, it is imperative and urgent that cancer centers actively engage in transitioning to delivering climate-smart, resilient healthcare. Today, centers' engagement in sustainability planning remains largely unknown. This comprehensive review reports on the existence of publicly available sustainability plans at National Cancer Institute (NCI) Cancer Centers and their affiliations. <h3>Materials/Methods</h3> An online review of 64 NCI designated Comprehensive/Cancer Centers and affiliated hospitals/universities was performed using standardized search terms to identify organizations' publicly accessible sustainability plans. Quality of the plans was assessed based on the existence of U.S. Environmental Protection Agency (EPA) Scope 1, 2, 3 emissions. Key personnel and hospital leaders were identified and contacted to understand the centers' involvement in affiliated hospital/university plans. Independent t-tests were utilized to assess the relationship between state cancer incidence rates/per capita and the presence of a sustainability plan. <h3>Results</h3> Amongst the 64 Cancer Centers, only two centers (3%) had independent sustainability plans, although 7 (11%) centers mentioned sustainability on their homepage. A total of 55 of the affiliated hospitals/universities had publicly available sustainability plans (36 university, 12 hospital, and 7 joint hospital/university). A majority (77%) of hospitals with plans also had appointed sustainability leadership. In states where a hospital had a sustainability plan, there was a higher cancer incidence rate (p = 0.052), but there were no significant relationships with specific cancer disease sites (breast [p=0.090], colon [p=0.078], lung [p=0.088], prostate [p=0.696]). <h3>Conclusion</h3> Our findings highlight the critical gap in NCI Cancer Centers' involvement in transitioning to environmentally sustainable and resilient healthcare that will be necessary as cancer patients are affected by the imminent changes of climate. While most centers do not independently report on sustainability efforts, the majority (84%) of their affiliations have publicly accessible sustainability plans. Thus, highlighting the opportunity for centers to partner with their affiliated organizations, and together, ensure a future of climate-smart care for all patients and communities.

Abstract 2131: Curating cartography: Enabling the harmonisation, visualisation, and reuse of diverse multiplexed imaging data through the Human Tumor Atlas Network Data Coordinating Center

Abstract The Human Tumor Atlas Network (HTAN) is a National Cancer Institute (NCI) Cancer Moonshot Initiative to generate three-dimensional molecular and spatial atlases of diverse human tumors and characterize crucial transitions in cancer progression and treatment. A series of manuscripts describing an extensive array of genomics, transcriptomics, proteomics, and imaging datasets are emerging but careful curation is required to maximize the data’s utility. HTAN centers have generated data from over 30 assay types including more than a dozen imaging methods (e.g., fluorescence microscopy, metal-tagged imaging, digital pathology, spatial transcriptomics, and electron microscopy). The HTAN Data Coordinating Center (DCC) develops infrastructure and tools to ingest, curate, explore, and share these data in a findable, accessible, interoperable, and reusable (FAIR) manner. As of November 2021 the DCC had ingested over 150 TB of data, including nearly 150,000 imaging data files. HTAN metadata schemas were developed through a community-driven Request for Comments process, including schemas for raw, processed and QC-checked imaging data, segmentation masks and feature arrays. This work led to a set of Minimum Information for Highly Multiplexed Tissue Imaging (MITI) guidelines, which are complemented by detailed metadata on participants and biospecimens. The Schematic python package is used to provide a user-friendly interface for defining data-model schemas, generate (meta)data submission spreadsheets, and asset-store interfaces on various cloud platforms. Across assay types, the HTAN schema currently encompasses over 700 attributes from 35 components. The DCC manages the HTAN Data Portal, which provides community access to the atlases and enables filtering of released atlas data based on metadata fields, and pointers to data availability. To enable visualization and exploration of imaging data directly from the portal, centers can submit Minerva stories, which provide guided storytelling of multiplexed tissue images. We provide methods to automatically generate default stories with visually appropriate overlays of sequential four-channel groups. We developed Miniature to generate unsupervised and interpretable multiplexed image thumbnails to provide rapid contextual information when browsing image collections. Dimensionality reduction is used to reduce a multiplexed image pyramid to three dimensions. Pixels are recolored according to their coordinates in low-dimensional space, where Pixels with similar marker expression are assigned similar colours. Public data sharing requires careful consideration of data egress costs and de-identification of images and their metadata. The DCC is working closely with NCI Cancer Research Data Commons to ensure long term-legacy and reuse of HTAN data. Citation Format: Adam J. Taylor, Milen Nikolov, Ino de Brujin, Jeremy Muhlich, Mialy De Felice, Artem Sokolov, Denis Schapiro, Peter Sorger, Julie Bletz, Nikolaus Schultz, Vésteinn Thorsson, James Eddy, Ethan Cerami. Curating cartography: Enabling the harmonisation, visualisation, and reuse of diverse multiplexed imaging data through the Human Tumor Atlas Network Data Coordinating Center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2131.

Exploring perceptions of gender bias in oncology: A survey study.

11056 Background: Gender inequalities contribute to burnout and have contributed to an ongoing exodus of women from academic oncology. Our aim was to explore the perceptions and experiences of oncology professionals regarding gender bias in the workplace with the hope of providing critical information to support equity initiatives. Methods: An anonymous, 22-question survey was sent via Survey Monkey to 1512 physicians with oncology-related specialties from National Cancer Institute (NCI) designated cancer centers whose emails were publicly available. Likert-scale questions (never-rarely-sometimes-often-very often) were analyzed with Kruskal-Wallis and Wilcoxon rank sum tests (percentages shown as frequency of having responded “sometimes-often-very often”). Chi-square test was used for categorical variables. Results: A total of 274 physicians completed the survey (response rate 18%): 152 (55.5%) self-identified as female (F); 112 (42%) as male (M); 7 (2.6%) as gender non-conforming or transgender; 3 (1.1%) chose not to answer. Most were White (59.9%), followed by Asian (20.4%), Middle Eastern (5.8 %), Multiracial (5.1%), Hispanic (3.6%), and Black (1.5%). The plurality (n = 103; 37.6%) were &lt; 40 years old. Primary fields of practice included 118 (43.1%) in adult oncology, 45 (16.4%) in combined hematology/oncology, 44 (16.1%) in radiation oncology, 44 (16.1%) in adult hematology, and 23 (8.4%) in other specialties. Female gender was associated with experiencing gender bias more often than male gender in the following areas: clinical practice (80.9% F vs 20.6% M), research activities (73.0% F vs 15.2% M), having difficulty balancing work and non-work responsibilities (95.4% F vs 78.6% M), being held to higher standards compared to physicians of other genders (73.1% F vs 14.2% M), being mistaken as a non-physician (78.9% F vs 6.3% M), and being scrutinized by others while tending to childcare needs (48.8% F vs 23.2% M) (all p &lt;.001). Female gender was associated with using techniques to navigate gender challenges more often than male gender, including wearing a white coat (55% F vs 7% M; p &lt;.001), ensuring that “Doctor” is written on identification (33% F vs 3% M; p =.002), emphasizing a professional look (53% F vs 10% M; p =.003) and working harder to establish expertise in the field (72% F vs 18% M; p =.003). When asked about strategies to address workplace gender-related bias, 63% would like policies on gender-related discrimination, (66.4% F vs 65.2% M; p =.93), 62% would like policies that prioritize leadership representation (74.3% F vs 51.8% M; p &lt;.001), and relatively few (37%) would prefer formal lectures/instruction for staff (38.2% F vs 37.5% M; p &gt;.99). Conclusions: Self-identified female academic oncologists at NCI Cancer Centers reported facing gender-related challenges in daily practice at much higher rates than men. There is a clear need to identify root causes and create initiatives to promote gender equity in the field of oncology.

The Prevalence of Dissemination and Implementation Research and Training Grants at National Cancer Institute–Designated Cancer Centers

BackgroundDissemination and implementation (D&I) research is a key factor in the uptake and use of evidence-based cancer control interventions. National Cancer Institute (NCI)–designated cancer centers are ideal settings in which to further D&I knowledge. The purpose of this study was to summarize the characteristics of NCI-funded D&I science grants in the nation’s cancer centers to understand the nature, extent, and opportunity for this key type of translational work.MethodsWe used the National Institutes of Health Research Portfolio Online Reporting Tool to identify active NCI-funded grants in D&I science at NCI clinical cancer centers (n = 13) and comprehensive cancer centers (n = 51) as well as their academic affiliates. Active projects were eligible for inclusion if they 1) were awarded directly to an NCI cancer center or an academic or research affiliate, and 2) identified D&I content in the abstract. Portfolio data were collected in February 2021.ResultsWe identified 104 active NCI-funded D&I research or training grants across the 64 cancer centers; 57.8% of cancer centers had at least 1 NCI-funded D&I grant. Most awards (71.1%) were for research grants. Training grants constituted 29.1% of D&I-focused grants. Overall, 50.0% of grants (n = 52) concentrated on specific cancers. Almost two-thirds of grants (n = 68, 65.4%) had a stated health equity focus.ConclusionsMore than one-half of NCI-designated cancer centers have active funding in D&I science, reflecting a substantial investment by NCI. There remains considerable room for further development, which would further support NCI’s translational mission.

Abstract IACC0601: Radiopharmaceuticals and their future in cancer care

Abstract Radiopharmaceutical agents have been an appealing treatment approach since the use of 131I to treat thyroid malignancies. Advances in cancer radiobiology and radiochemistry have brought radiopharmaceuticals forward to the cutting edge of oncology clinical research. The National Cancer Institute (NCI) and its partnering academic and clinical research networks monitor radiopharmaceutical discoveries that might be incorporated into cancer treatment strategies for patients with unmet therapeutic needs. Such endeavors happen through leveraged partnerships between NCI's Cancer Therapy Evaluation Program (CTEP), its Radiation Research Program (RRP), and academic institutions in the Experimental Therapeutics Clinical Trials Network (ETCTN). If innovative discoveries are made, NCI supports clinician scientists to plan new and original radiopharmaceutical phase I and II monotherapy or combination trials. The clinical trial infrastructure needs, such as radiopharmaceutical dosimetry and treatment planning, are now available in government workflow and regulatory oversight. This presentation introduces a modern approach to the clinical development of radiopharmaceutical agents in an era of molecular targets and personalized cancer therapeutics. Citation Format: Charles A. Kunos. Radiopharmaceuticals and their future in cancer care [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr IACC0601.

Improving Cancer Survivorship Care for Latino Adolescent, Young Adult Survivors through Community-Partnered Participatory Research.

Minority adolescent and young adult (AYA) cancer survivors experience disparities in receipt of survivorship care. This study describes the infrastructure of a community-partnered participatory research (CPPR) project between a community-based organization and a National Cancer Institute (NCI)-designated cancer center to develop culturally-tailored interventions to improve Latino AYA cancer survivor knowledge regarding their need for survivorship care. Research team participants included the community organization and NCI cancer center directors, a research coordinator, a community liaison, and cross-training program interns. Through use of Jones's theoretical framework, additional stakeholders from academic and community settings were identified and invited to participate in the research team. A process evaluation and qualitative interviews were conducted to assess equal partnership between community and academic stakeholders and determine if the infrastructure followed the five core principles of CPPR. A grounded theory approach was used to analyze qualitative data. CPPR between an NCI-designated cancer center and a community-based organization is a new research model for conducting minority AYA cancer survivor outreach. Open communication was critical in engaging the Latino community to discuss their survivorship needs. Community stakeholders were key to infrastructure success through fostering a cohesive partnership with and acting as the voice of the Latino community. Implementing a cross-training program promoted continued engagement of community members with academic partners. Proper infrastructure development is critical to building successful research partnerships in order to develop culturally-tailored interventions to improve survivorship care knowledge.

Has oncofertility information for male patients improved? Objective assessment of internet-based fertility preservation resources at NCI cancer centers from 2015 to 2020.

Fertility preservation is a critical patient counseling component following cancer diagnosis. The aim of this study was to compare change and quality of fertility preservation information available to patients on the websites of National Cancer Institute (NCI)-designated cancer centers over 5years (2015 to 2020) for both women and men. All NCI-designated cancer center websites were queried for information on oncofertility in 2020 publicly available to patients using the methodology and rubric previously employed in 2015. Data was evaluated based on each center's city, county, and state by demographic data obtained from the US Census. Additionally, the yearly number of in vitro fertilization (IVF) cycles performed in the city, county, and state of each NCICC was included using websites of clinics reporting data to the Society for Assisted Reproductive Technology. Significantly NCICCshave a standalone pages for fertility preservation in 2020 compared with 2015 (p = 0.004). There is a statistically significant association between discussion of male fertility and the number of fertility centers in the county and state of the NCICC (p = 0.04 and p = 0.001).NCICCs in counties in the highest quartile of per capita income were significantly more likely to address male fertility (p = 0.03). Oncofertility information on NCICC websites has improved between 2015 and 2020. The impact of cancer treatment on male fertility, while improved, is still limited, particularly in counties with lower per capita income.

Evaluation of Radioactivity in Patient Specimens Received in the Core Laboratory at a National Cancer Institute (NCI) Designated Cancer Center.

Biological specimens from patients who have received radiopharmaceuticals are often collected for diagnostic testing and sent to clinical laboratories. Residual radiation has long been assumed to be minimal. However, literature is sparse and may not represent the specimen volumes or spectrum of radionuclides currently seen at National Cancer Institute (NCI)-designated cancer centers. This study examined the radiopharmaceuticals associated with patient specimens received in the hospital core laboratory and assessed the potential risk of external radiation exposure to laboratory personnel. The types and amounts of radiopharmaceuticals administered in a large metropolitan hospital system were retrospectively examined over a 20-month study period. The associated biological specimens sent to the largest core laboratory in the system for testing were evaluated. In addition, manual survey meter assessment of random clinical specimens and weekly wipe tests were performed for 44 weeks, and wearable and environmental dosimeters were placed for 6 months. Over 11 000 specimens, collected within 5 physical half-lives of radiopharmaceutical administration, were processed by our laboratory. Manual survey meter assessment of random clinical specimens routinely identified radioactive specimens. If held in a closed palm for >2 min, many samples could potentially deliver a 0.02 mSv effective dose of radiation. The laboratory regularly receives radioactive patient specimens without radioactive labels. Although the vast majority of these are blood specimens associated with low-dose diagnostic radiopharmaceuticals, some samples may be capable of delivering a significant amount of radiation. Recommendations for laboratories associated with NCI cancer centers are given.

National Cancer Institute support for targeted alpha-emitter therapy.

Radiopharmaceutical targeted therapy (RPT) has been studied for decades; however, recent clinical trials demonstrating efficacy have helped renewed interest in the modality. This article reviews National Cancer Institute (NCI)'s support of RPT through communication via workshops and interest groups, through funding extramural programs in academia and small business, and through intramural research, including preclinical and clinical studies. NCI has co-organized workshops and organized interest groups on RPT and RPT dosimetry to encourage the community and facilitate rigorous preclinical and clinical studies. NCI has been supporting RPT research through various mechanisms. Research has been funded through peer-reviewed NCI Research and Program Grants (RPG) and NCI Small Business Innovation Research (SBIR) Development Center, which funds small business-initiated projects, some of which have led to clinical trials. The NCI Cancer Therapy Evaluation Program (CTEP)'s Radiopharmaceutical Development Initiative supports RPT in NCI-funded clinical trials, including Imaging and Radiation Oncology Core (IROC) expertise in imaging QA and dosimetry procedures. Preclinical targeted a-emitter therapy (TAT) research at the NCI's intramural program is ongoing, building on foundational work dating back to the 1980s. Ongoing "bench-to-bedside" efforts leverage the unique infrastructure of the National Institutes of Health's (NIH) Clinical Center. Given the great potential of RPT, our goal is to continue to encourage its development that will generate the high-quality evidence needed to bring this multidisciplinary treatment to patients.

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance. To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals. This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute's national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019. Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community. Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge. The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge. In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed.

Assessment of oncofertility content on reproductive endocrinology and infertility clinic websites

<h3>Objectives:</h3> As the age of first pregnancy increases in the United States, young individuals with a cancer diagnosis are often challenged with time-sensitive issues surrounding fertility preservation and cancer treatment. Oncofertility has become increasingly important in the care of these individuals. The purpose of this study is to assess oncofertility content on fertility clinic websites as indicated by relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and fertility clinic characteristics, including: private vs academic, size (cycles/year), state-mandated fertility insurance coverage, type of National Cancer Institute (NCI) designated cancer center, and distance from a NCI designated cancer center. <h3>Methods:</h3> In the Fall of 2020, websites of 381 fertility clinics that are members of the Society for Associated Reproductive Technology (SART) were surveyed. Each clinic website was reviewed systematically by two authors (K.S. and R.M) and discrepancies adjudicated by a third author (V.M). Extracted data included: clinic location, practice type (private vs academic), size (small ≤ 500 cycles/year, medium 501-1,000 cycles/year, and large >1000 cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and the distance from an NCI cancer as determined by Google Maps. Additionally, we documented whether the clinic was located in a state that mandated reproductive & infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine. The primary outcome was mention of keywords referring to oncofertility, including: oncofertility, fertility preservation, cancer, chemotherapy, ovarian suppression/shielding/preservation/transposition. Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate. <h3>Results:</h3> Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one keyword regarding oncofertility. Most frequently used terms included cancer (79%), fertility preservation (78%), ovarian preservation (69%), chemotherapy (63%); while less used terms included oncofertility (24%), transposition (12%), suppression (9.4%), shielding (5.0%). There was an association between practice size and inclusion of onocofertility content (<i>p</i><.01). Practices that did ≥501 cycles per year were more likely to mention one of the oncofertility keywords (RR 1.2; 95% CI 1.1-1.3). The association of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI designated cancer center were not statistically significant. <h3>Conclusions:</h3> Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer.

NCI Imaging Data Commons.

The National Cancer Institute (NCI) Cancer Research Data Commons (CRDC) aims to establish a national cloud-based data science infrastructure. Imaging Data Commons (IDC) is a new component of CRDC supported by the Cancer Moonshot. The goal of IDC is to enable a broad spectrum of cancer researchers, with and without imaging expertise, to easily access and explore the value of deidentified imaging data and to support integrated analyses with nonimaging data. We achieve this goal by colocating versatile imaging collections with cloud-based computing resources and data exploration, visualization, and analysis tools. The IDC pilot was released in October 2020 and is being continuously populated with radiology and histopathology collections. IDC provides access to curated imaging collections, accompanied by documentation, a user forum, and a growing number of analysis use cases that aim to demonstrate the value of a data commons framework applied to cancer imaging research. SIGNIFICANCE: This study introduces NCI Imaging Data Commons, a new repository of the NCI Cancer Research Data Commons, which will support cancer imaging research on the cloud.