Oncology Experts Research Articles

Standardized surgical procedure for natural orifice specimen extraction surgery of precision functional sphincter-preserving surgery for ultra-low rectal cancer (NOSES-PPS) (2024 edition)

Natural orifice specimen extraction surgery of precision functional sphincter- preserving surgery for ultra-low rectal cancer (NOSES-PPS) is an innovative surgical technique that builds upon traditional laparoscopic surgery for low rectal cancer. This method utilizes a specially designed transparent screw-thread anal dilator and associated equipment to achieve precise tumor localization and resection through direct visualization via the anus. Digestive tract reconstruction is then accomplished using a combination of a precision circular stapler and manual suturing, thereby preserving sphincter function in patients with ultra-low rectal cancer. NOSES-PPS has been widely adopted across multiple provinces and cities in China, with over 500 cases successfully performed to date. The technique and its outcomes have been published in both national and international peer-reviewed journals, receiving significant recognition from the medical community. However, as a novel approach to rectal cancer surgery, there is currently a lack of authoritative clinical practice guidelines detailing the specific procedural steps of NOSES-PPS. To address this gap, the Colorectal Tumor Committee of the Chinese Medical Association, the Colorectal Cancer Committee of the Chinese Anti-cancer Association, and the China NOSES Collaborative Group have jointly led an effort to establish standardized guidelines for NOSES-PPS. This initiative involved the collaboration of experts in colorectal oncology from numerous large medical centers across China. Through multiple rounds of consultation and discussion, these experts have developed a comprehensive set of guidelines that detail the definition of NOSES-PPS, requirements for instrumentation, indications, key operative techniques, and the management of perioperative and postoperative complications. This guideline aims to promote the standardized implementation of NOSES-PPS in clinical practice.

Abstract B006: Qualitative research study on the use of minimal residual disease as an intermediate endpoint in multiple myeloma clinical trials in Saudi Arabia

Abstract Introduction: The U.S. Food and Drug Administration has recently considered minimal residual disease (MRD) as an acceptable accelerated approval endpoint in multiple myeloma (MM). Meta-analysis studies have shown the clinical benefit of MRD negativity in certain hematological cancers such as MM. Objectives: This qualitative research study, with a unique focus on the Saudi context, aims to assess the opinions and experiences of hematology and oncology specialists and consultants in Saudi Arabia. The study is particularly interested in their views on the use of MRD as an intermediate endpoint in early-phase clinical trials for fast-track drug approval by the Saudi Food and Drug Authority in the context of multiple myeloma. This includes assessing the use of MRD in both newly diagnosed and relapsed/refractory MM. The secondary objective is to gather information about the feasibility and availability of sensitive MRD detection methods in real-world medical practice and clinical trials in Saudi Arabia. Study Design: The study will involve interviewing 30 registered male or female physicians specialized in hematology and oncology in Saudi Arabia. The physicians will be included in the study using purposive sampling methods. The study will collect the physicians’ opinions and experiences about MRD. The interviews will be conducted through a single focus group and several face-to- face interviews or performed online, using ZOOM. Participants should have more than one year of experience post-residency or post-fellowship training. The predetermined set of semi- structured questions will cover topics such as the definition of MRD, its clinical and research significance, MRD detection thresholds, duration of MRD negativity, and its correlation with other clinical endpoints, such as progression-free survival and overall survival. The interviews will be conducted by scientific oncology and hematology evaluation experts at the Saudi Food and Drug Authority, who play a crucial role in this study. The study will consist of 5–10 semi- structured one-to-one interviews and focused group discussions of as few as four participants. Before starting any interview, participants will complete consent forms, including the study’s goals and who will conduct the study. Qualitative data will be prepared and analyzed by an expert in data analysis, ensuring the highest research standards. The results will be presented using descriptive and interpretive methods. Citation Format: Albandari A Alnasser, Tariq H Alqurayshah. Qualitative research study on the use of minimal residual disease as an intermediate endpoint in multiple myeloma clinical trials in Saudi Arabia [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B006.

Abstract B007: A qualitative research study on hematology and oncology consultants’ experiences and opinions on using minimal residual disease (MRD) as a fast-track approval endpoint in early-phase clinical trials in multiple myeloma in Saudi Arabia

Abstract Introduction: The U.S. Food and Drug Administration recently considered the minimal residual disease (MRD) as an acceptable accelerated approval endpoint in multiple myeloma (MM). The data from the meta-analysis studies established the clinical benefit of MRD negativity in certain hematological cancers such as MM. Objectives: The primary objective of this qualitative research study is to assess hematology and oncology consultants’ opinions and experiences on the adequacy of using minimal residual disease (MRD) as an intermediate endpoint in early- phase clinical trials in multiple myeloma (MM) for fast-track approval of drugs and biological products in the Saudi Food and Drug Authority. That may include using MRD in MM in both settings: newly diagnosed and relapsed/refractory MM. The secondary objective is to gather information about the feasibility and availability of sensitive methods for detecting MRD in the context of real-world medical practice and clinical trials in Saudi Arabia. Study Design: The study design is a qualitative approach to interviewing 30 registered male, or female physicians specialized in hematology and oncology in Saudi Arabia. The interviews will be conducted in two ways: a single focus group and several face-to-face interviews. The participants should have more than 1 year of experience post-fellowship training. The participants will be invited for an interview via email or phone. A predetermined set of semi-structured questions is to be asked in the same order to each participant. The topic of questions will include the definition of MRD, clinical and research significance of MRD, MRD detection thresholds (e.g., 10^-5 vs. 10^-6), duration of MRD negativity at the complete response, correlation with other clinical endpoints such as progression-free survival (PFS) and overall survival (OS). The interviews will be conducted by scientific oncology and hematology evaluation experts at the Saudi Food and Drug Authority who have considerable experience in engaging in personal discussion. This qualitative study has about 5–10 semi-structured one-to-one interviews of hematology and oncology consultants performed at a convenient time for each doctor. Moreover, the discussions in focus groups can be as small as four participants. Qualitative data will be prepared and analyzed by an expert in data analysis. Citation Format: Tariq Hassan Alqurayshah, Albandari Alnasser, Tariq Alqurayshah. A qualitative research study on hematology and oncology consultants’ experiences and opinions on using minimal residual disease (MRD) as a fast-track approval endpoint in early-phase clinical trials in multiple myeloma in Saudi Arabia [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B007.

Current state of care for cancer patients with HIV in Russia: Data from an oncologist survey

Background. HIV infection and its consequences remain one of the dramatic problems of our time. Currently, for people receiving antiretroviral therapy, non-AIDS-related diseases are becoming relevant, among which malignant tumors are steadily coming to the fore. International data show that HIV-infected patients with cancer are significantly less likely to receive full anti-tumor treatment than patients without HIV. Aim. To obtain objective data on the incidence, clinical course, and effectiveness of the most common therapies for patients with malignancies and HIV in real-world practice in Russia. Materials and methods. The study was supported by the All-Russian National Union "Association of Oncologists of Russia." The questionnaire was sent to 1000 oncologists in all regions of the Russian Federation, of which 366 (36%) participated in the anonymous survey. The study did not imply any material award for the respondents. The questionnaire was developed with the direct collaboration of leading oncology experts in malignancies in HIV patients. It included questions about the frequency of follow-up of oncological patients with HIV, awareness of oncologists about the features of the malignancies in HIV patients, and treatment and supportive therapy of cancer patients with HIV infection. The key points of the analysis were the frequency and conditions of the standard anti-tumor treatment program for patients with cancer and HIV. Results. Lack of knowledge among oncologists, low oncological alertness among infectious disease doctors, and lack of specific guidelines for the management of this complex cohort of patients are the main reasons why patients with cancer and HIV fail to receive standard treatment for cancer in Russia. Conclusion. The urgency of the issue of treatment of patients with cancer and HIV warranted the study. This is due to the global trend of an increase in malignancies in HIV-infected people. Conducting educational activities, valid population studies, and creating a national register of these patients will form the basis for developing special clinical guidelines approved by the Ministry of Health of Russia.

2023 expert consensus on decision pathway of metastatic hormone-sensitive prostate cancer management in Taiwan

This short communication presents a consensus-based expert opinion from a multidisciplinary team of Taiwanese experts in urology, medical oncology, and radiation oncology regarding the management of metastatic hormone-sensitive prostate cancer (mHSPC). Through a comprehensive review of recent clinical trials examining the efficacy of novel hormonal agents (NHAs) and docetaxel, alongside updated guidelines for mHSPC management, the experts have deliberated on the practical implications from currently available literatures. The discussion focused on the combination of androgen deprivation therapy, NHAs, and docetaxel, as reported in the leading studies including ARASENS (ODM-201 in Addition to Standard ADT and Docetaxel in Metastatic Castration Sensitive Prostate Cancer), ENZAMET (Enzalutamide in First Line Androgen Deprivation Therapy for Metastatic Prostate Cancer), and PEACE-1 (A Phase III Study for Patients with Metastatic Hormone naive Prostate Cancer) trial. The risk-benefit ratio between prolonged overall survival and the incidence of major adverse events was thoroughly evaluated. This consensus underscores the recommendation that early initiation of intensified triplet therapy with docetaxel, NHA, and androgen deprivation therapy is beneficial for fit mHSPC patients with highly aggressive disease characteristics, effectively prolonging overall survival with manageable risk of adverse events.

Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology.

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology. · The various procedures in the field of interventional oncology (IO) are complex medical interventions that require not only the most advanced technical equipment but also adequate human resources, particularly specialized expertise in interventional radiology, diagnostic imaging, oncology, and radiation protection.. · This expertise is an integral part of the specialized medical training in radiology and is certified by professional societies such as the German Society for Interventional Radiology (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).. · Professional societies like DeGIR, CIRSE, and the American Society of Interventional Radiology (SIR) establish the necessary quality assurance framework for comprehensive, high-quality IO therapy through quality assurance (QA) registries, standard operating procedure (SOP) documents, and participation in guideline development.. · Currently, radiology is the only discipline that provides physicians with the theoretical and practical knowledge, skills, and competencies required to perform the demanding procedures in the field of IO through specialized training programs and tailored certification processes.. · Isfort P, Sommer CM, Bruners P et al. Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology. Fortschr Röntgenstr 2024; DOI 10.1055/a-2373-1013.

Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?

Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship-trained orthopaedic oncologists. We asked the following questions: (1) What are the diagnoses treated by US military fellowship-trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship-trained orthopaedic oncologists? We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS's Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship-trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated. Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures. Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies. Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.

Multi-Institutional Evaluation of Interrater Agreement of Biomarker-Drug Pair Rankings Based on the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) and Sources of Discordance.

The widespread use of next-generation sequencing in clinical practice has contributed to the accumulation of a large number of genomic findings associated with targeted therapy; therefore, the problem of ranking the detected findings has become acute. The European Society for Medical Oncology Scale of Clinical Actionability of molecular Targets (ESCAT) system was designed by the European Society for Medical Oncology to rank biomarkers into levels of evidence that reflect their potency and clinical significance based on published clinical data. However, the ESCAT system remains imperfect, as it is based on a subjective assessment of the levels of evidence. The objective of this study was to determine whether the ranking of LOE for biomarker-drug pairs based on the ESCAT system is dependent on the human factor, and to uncover potential issues associated with the use of the framework. To evaluate the inter-rater agreement, we created a dataset of a total of 154 biomarker-drug pairs for 18 unique tumor types. We aimed to include biomarker-drug pairs that could be considered standard of care as well as less common and under investigated pairs. Fourteen precision oncology experts were invited to assign an ESCAT level of evidence for biomarker-drug pairs. Statistical analysis was carried out using Cohen's kappa and the Kolmogorov-Smirnov test. The inter-rater agreement was low with some exceptions, and significant deviations from the consensus level of evidence were observed. For biomarker-drug associations, the deviations from the consensus were observed for more than 50% of the contributors' rankings. The most agreement between the contributors was observed for lung adenocarcinoma (p < 0.005), while the most disagreement was observed for esophageal cancer (p < 0.01) biomarker-drug pairs in our dataset. This study demonstrates noteworthy discordances between the precision oncology experts and may provide the directions for future developments in modifying the ESCAT framework and the overall applicability of the results of genomic profiling into clinical practice.

Disparities in Health Outcomes in Surgical Oncology.

Cancer health disparities refer to the unequal burden, treatment, and outcomes of cancer care experienced by specific populations. These disparities are systemic and often preventable, impacting diverse populations, including racial and ethnic minorities, medically underserved populations, populations in rural areas, individuals from the LGBT communities, disabled persons, extremes of age, and those living in persistent poverty. Addressing this topic is essential and timely to ensure equitable oncologic outcomes for all populations. Experts in surgical oncology and health disparities have collaborated to produce this seminar issue on Disparities in Surgical Oncology.

Distinctive presentation of pinna squamous cell carcinoma as devil cutaneous horn

Cutaneous horns are considered rare clinical elements defined by compact exophytic keratin growth typically resembling an animal’s horn. They are prone in the body’s sun-exposed areas, arising from various benign, malignant and premalignant conditions. Therefore, this paper reflects a reported case for the 75-year-old male diagnosed with cutaneous horn in his right pinna. The histopathological evaluation confirmed a squamous cell carcinoma (SCC). The case has equally stressed why histopathological assessment or examination is necessary to determine the condition’s nature and proper management. The patient was taken through a wide local excision with a comprehensive assessment and evaluation and the multidisciplinary discussion with an oncology and head expertise team. From the case, it is necessary to practice vigilance and caution in diagnosing and managing the condition from unusual places like the ear.

Improving goal-concordant care via a uniquely collaborative and multi-site PFAC model.

265 Background: Studies reveal a mismatch between the goals of care (GOC) of cancer patients and actual care received. The 10 members of the Alliance of Dedicated Cancer Centers (ADCC) convened the Improving Goal Concordant Care (IGCC) initiative to address system gaps. IGCC was led by palliative care and oncology experts, with guidance from patient and family advisors. Uniquely, the advisors were identified from patient family advisory councils (PFAC) at each center, forming a collaborative Advisory Group (AG) with the lived experience of each center and the knowledge of advocating for the patient/family voice locally. Methods: PFAC members were recruited from each site to serve on the AG. The 19 member AG met quarterly, with minutes shared with the IGCC oversight group, the Implementation Workgroup (IWG). In September 2023, all AG members were surveyed about perceptions of PFAC engagement and local impact of IGCC. In May 2024, 20 IWG members were surveyed about implementation successes and barriers, including items related to PFAC engagement. Results: AG evaluation and recommendations altered IGCC planned core implementation and evaluation actions meaningfully; for example in 1) selection of structured fields in electronic health record (EHR) and universally accessible GOC documentation and in 2) centering patients in the GOC measure set, including incorporating “Heard &amp; Understood” survey into IGCC evaluation. Other AG guidance around direct patient engagement readiness for GOC conversations and implementing patient GOC surveys was left to individual sites to consider with variable adoption. AG Survey: 63% response rate. 80% noted that the GOC program was discussed with their local PFAC and 92% experienced changed routine patient care after GOC implementation. IWG Survey: 100% response rate. 68% agreed that their center sought guidance from their PFAC during GOC implementation and that leadership presented to their PFAC about their GOC implementation. 26% indicated reporting data to their PFAC; of those that did, 80% agreed that this positively impacted their GOC implementation. Conclusions: While PFACs are occasionally included in quality interventions, this model centered the patient/family voice by supporting a PFAC stakeholder feedback loop working collaboratively and locally to support implementation and evaluation of IGCC objectives. While not all AG recommendations were formally integrated into IGCC, all were considered and many adopted at individual centers. Despite ongoing IGCC-level involvement, center-specific engagement of PFACs varied. Future efforts can track this during process evaluation as local PFAC engagement was highly valued. Consensus building for national best practice implementation and evaluation by recruiting local experts including PFAC members into national collaborative efforts is a successful model for local change.

Safe and supportive prescribing in transgender and non-binary patients with cancer.

Global prevalence rates for transgender individuals vary with estimates ranging from 0.3% to 1%, translating to a potential global population of 24.3 million to 81 million. It is estimated that one in two people will develop cancer in their lifetime. Gender-affirming hormone therapy (GAHT) is a common medical intervention for transgender and non-binary individuals. GAHT requires careful consideration for concurrent medical care due to potential drug interactions and physiological changes. A multi-disciplinary team with expertise in transgender health, oncology and pharmacy met to develop a document summarizing current knowledge on the topic for practical use. The team included trans and non-binary authors who shaped the document's language and focus. The document gives a status update on the current understanding of GAHT and how this may intersect with the safe prescribing of systemic anti-cancer therapies (SACT). The document underwent multiple review stages including internal review, review by the British Oncology Pharmacy Association (BOPA) EDI Subcommittee and, finally, BOPA Executive Committee review and final approval. Key recommendations of this document include the use of inclusive and effective communication, vigilant monitoring of kidney function and cardiovascular health, and considerations for hormone receptor-positive cancers. The document also recognizes the multidisciplinary nature of transgender healthcare and where this relates to social prescribing.

Optimización de la triple terapia en el tratamiento del cáncer de próstata hormonosensible metastásico

Triple therapy with docetaxel, androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has demonstrated survival benefits in patients with metastatic hormone-sensitive prostate cancer (mHSPC), especially in those with high-risk disease. However, once the use of ADT and docetaxel is established, guidelines do not clearly specify which ARPI is most appropriate. In this work, a literature review to identify phase III clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines on triple therapy in mHSPC was carried out. Evidence and recommendations were qualitatively reviewed to provide guidelines on the most suitable ARPI based on patient risk, disease volume, and nature of metastases (synchronous or metachronous). This review aims to update the previously published consensus on the optimal pharmacological treatment for mHSPC and to expose the opinions of hospital pharmacy, urology and medical and radiation oncology experts.

Optimizing triple therapy in patients with metastatic hormone-sensitive prostate cancer

Triple therapy with docetaxel, androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has demonstrated survival benefits in patients with metastatic hormone-sensitive prostate cancer (mHSPC), especially in those with high-risk disease. However, once the use of ADT and docetaxel is established, guidelines do not clearly specify which ARPI is most appropriate. In this work, a literature review to identify phase III clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines on triple therapy in mHSPC was carried out. Evidence and recommendations were qualitatively reviewed to provide guidelines on the most suitable ARPI based on patient risk, disease volume, and nature of metastases (synchronous or metachronous). This review aims to update the previously published consensus on the optimal pharmacological treatment for mHSPC and to expose the opinions of hospital pharmacy, urology and medical and radiation oncology experts.

Explaining the Current Status of General Medicine Curriculum from the Perspective of Cancer Education Based on SWOT Analysis

Introduction: Given the rapid advancements in the field of medicine, it is essential to review current status of curricula both quantitatively and qualitatively. The present study aims to determine the current status of general medical curriculum with a focus on cancer-related topics and education based on Strengths, weaknesses, opportunities and threats (SWOT)analysis. Methods: This qualitative phenomenological study was conducted during the academic year 2022-2023 at Babol University of Medical Sciences, Babol, Iran. The study population consisted of 12 experts specialized in higher education, medical education, basic sciences, preclinical education, general medicine internships, oncology, and medical education experts, whom were selected through purposive sampling. Data were collected through document reviews and expert panel discussions, and were analyzed using SWOT analysis. Results: The results indicated that the existence of a national curriculum was identified as a strength, while the absence of an independent syllabus for cancer education was recognized as a weakness. In terms of opportunities, the implementation of transformation and innovation programs in medical education and the possibility of localizing curricula by universities were positively evaluated. However, student dissatisfaction with the quality of clinical cancer education and the theoretical and practical knowledge deficiencies of graduates in this area were identified as threats. Conclusion: To enhance the effectiveness and foster innovation in policy-making, cancer education, and clinical care, and to prepare future professionals, academic specialists and medical education authorities must leverage evidence-based strategies and academic experiences to purposefully integrate interdisciplinary collaboration in teaching cancer-related educational content into the general medical curriculum.

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.

Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts.

Survey study. The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries. A survey of individual members of an international study group of spinal oncology surgeons was performed. Participants were provided a clinical vignette, pathologic diagnosis, and pre-operative imaging for three primary spinal oncology cases. Study participants provided a free text surgical plan for resection and were then presented an associated 3D printed model for each case and asked to re-evaluate their surgical plan. Ten spinal oncology surgeons participated in the study, representing nine institutions across five countries. Four of the surgeons (40%) made significant changes to their surgical plan after reviewing the 3D models, including sacrifice of an additional nerve root to obtain negative margins, sparing an SI joint that was originally planned for inclusion in the en bloc resection, adjusting the location of osteotomy cuts, changes to the number of surgical stages and/or staging order, and preservation of neurology that was originally planned for sacrifice. The overall impression of the 3D models was positive, with 90% of the participants stating they found the 3D model useful in developing a surgical plan. Surgical planning for resection of primary spinal column tumors is challenging and time intensive. 3D printed patient specific surgical models may be an additional tool that can augment surgical planning and execution by improving the chance of accomplishing surgical resection goals and minimizing morbidity.

Enhancing Nutritional Care in Cancer: Development and Face Validation of the Chemotherapy Dietary Adherence Scale

Background: Dietary adherence during chemotherapy is crucial for managing side effects and maintaining nutritional status. However, there is a lack of validated tools to measure dietary adherence in this context. The aim of this study was to develop and validate the Chemotherapy Dietary Adherence Scale (CDAS) for assessing dietary adherence among cancer patients undergoing chemotherapy. Methods: A cross-sectional study was conducted over 2 months. The CDAS was developed through a literature review and expert consultation. Face and content validation were performed with 25 experts in oncology, dietetics, and community medicine. The Content Validity Index (CVI) was calculated at both the item (I-CVI) and scale (S-CVI) levels. Results: The expert panel comprised diverse professionals (40% public health experts, 20% medical oncologists, and 20% dietitians). Face validation showed 85% agreement on grammar, clarity, and content. The I-CVI was 0.81, and the S-CVI was 0.83, indicating strong content validity. Conclusion: The CDAS demonstrated robust content validity and relevance for assessing dietary adherence in cancer chemotherapy patients. Further research is needed to evaluate its psychometric properties and clinical utility.

Leveraging Large Language Models for Precision Monitoring of Chemotherapy-Induced Toxicities: A Pilot Study with Expert Comparisons and Future Directions.

Large Language Models (LLMs), such as the GPT model family from OpenAI, have demonstrated transformative potential across various fields, especially in medicine. These models can understand and generate contextual text, adapting to new tasks without specific training. This versatility can revolutionize clinical practices by enhancing documentation, patient interaction, and decision-making processes. In oncology, LLMs offer the potential to significantly improve patient care through the continuous monitoring of chemotherapy-induced toxicities, which is a task that is often unmanageable for human resources alone. However, existing research has not sufficiently explored the accuracy of LLMs in identifying and assessing subjective toxicities based on patient descriptions. This study aims to fill this gap by evaluating the ability of LLMs to accurately classify these toxicities, facilitating personalized and continuous patient care. This comparative pilot study assessed the ability of an LLM to classify subjective toxicities from chemotherapy. Thirteen oncologists evaluated 30 fictitious cases created using expert knowledge and OpenAI's GPT-4. These evaluations, based on the CTCAE v.5 criteria, were compared to those of a contextualized LLM model. Metrics such as mode and mean of responses were used to gauge consensus. The accuracy of the LLM was analyzed in both general and specific toxicity categories, considering types of errors and false alarms. The study's results are intended to justify further research involving real patients. The study revealed significant variability in oncologists' evaluations due to the lack of interaction with fictitious patients. The LLM model achieved an accuracy of 85.7% in general categories and 64.6% in specific categories using mean evaluations with mild errors at 96.4% and severe errors at 3.6%. False alarms occurred in 3% of cases. When comparing the LLM's performance to that of expert oncologists, individual accuracy ranged from 66.7% to 89.2% for general categories and 57.0% to 76.0% for specific categories. The 95% confidence intervals for the median accuracy of oncologists were 81.9% to 86.9% for general categories and 67.6% to 75.6% for specific categories. These benchmarks highlight the LLM's potential to achieve expert-level performance in classifying chemotherapy-induced toxicities. The findings demonstrate that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM achieved 85.7% accuracy in general categories and 64.6% in specific categories. While the model's general category performance falls within expert ranges, specific category accuracy requires improvement. The study's limitations include the use of fictitious cases, lack of patient interaction, and reliance on audio transcriptions. Nevertheless, LLMs show significant potential for enhancing patient monitoring and reducing oncologists' workload. Future research should focus on the specific training of LLMs for medical tasks, conducting studies with real patients, implementing interactive evaluations, expanding sample sizes, and ensuring robustness and generalization in diverse clinical settings. This study concludes that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM's performance in general toxicity categories is within the expert range, but there is room for improvement in specific categories. LLMs have the potential to enhance patient monitoring, enable early interventions, and reduce severe complications, improving care quality and efficiency. Future research should involve specific training of LLMs, validation with real patients, and the incorporation of interactive capabilities for real-time patient interactions. Ethical considerations, including data accuracy, transparency, and privacy, are crucial for the safe integration of LLMs into clinical practice.

Cross-sectional study on the current status of county-level cancer prevention and treatment capabilities in the four southwestern provinces of China.

184 Background: Lung cancer (LC) stands out as the most prevalent form of cancer in China, and it is also the primary cause of cancer-related mortality. Notably, 42.3% of newly diagnosed cancer patients are identified at the grassroots level each year. In response, the Chinese government is actively promoting tiered diagnosis and treatment approaches. This study aims to evaluate the current state of county-level cancer prevention and treatment capabilities in China, offering suggestion for policy and the standardized pathway development. Methods: A cross-sectional study was conducted in 470 district and county (city) hospitals across four provinces in southwest China: Sichuan, Yunnan, Guangxi, and Guizhou, from December 2023 to March 2024. The study was initiated by 13 hospitals, and all participating physicians signed informed consent forms. All analyses were conducted by SPSS 22.0. Results: Of the 470 county-level hospitals in China, 151 have a permanent population of over 500,000. 146 counties (198 hospitals) have established cancer specialties. There are 74 medical linear accelerators and 33 cobalt-60 treatment machines. Among them, 63.6% are tertiary hospitals, and 94.9% are public hospitals. 37.4% of hospitals have linear accelerators, and 16.7% have cobalt-60 treatment machines. 89.8% perform TNM staging, 79.1% perform radical surgery, 96.4% perform chemotherapy, 83.2% perform endocrine therapy, 97.5% perform targeted therapy, 87.3% perform immunotherapy, 54.8% perform interventional therapy, and 34.0% perform radiotherapy. Additionally, 56.8% conduct multidisciplinary diagnosis and treatment (MDT), and 37.0% provide palliative care. 83% hospitals have pathology departments, and 46.0% have established cancer centers. 79% hospitals can perform routine pathological diagnosis, and 17.0% can perform genetic testing in-hospital. Imaging departments have conducted CT plain scans in 96.4% of cases, CT enhancements in 87.7%, MRI plain scans in 84.1%, and MRI enhancements in 72.3%. Fibro-bronchoscopy was carried out in 87.2% of cases, and gastrointestinal endoscopy in 84.2%. Morphine injection was accessible in 84.8% of cases, oxycodone in 64.5%, and tramadol in 86.8%. Non-steroidal analgesics were accessible in 88.3% of cases. Conclusions: In the southwestern areas of China, the penetration rate of oncology expertise is 31.1%. Most medical institutions offering oncology specialties are tertiary public hospitals. The average number of radiotherapy machines per county or district is 0.16. The development of surgery, oncology, and the imaging is well. Radiotherapy is still in developing, and the genetic testing capacity in-hospital is insufficient. The application of TNM staging is satisfactory. Accessibility to analgesic and anti-inflammatory drugs is well, but the construction of county cancer centers still needs improvement.