Oncology Specialists Research Articles

Evaluation of an established oncology triage hotline in a model of emergency department avoidance: assessing the UKONS triage tool and call outcomes.

In response to a demonstrable need for 24/7, specialist oncology advice for patients undergoing systemic anti-cancer therapy, many healthcare institutions have adopted a telephone triage (TT) service. This is true of the Clatterbridge Cancer Centre which uses the UKONS framework to guide its decisions. This study aims to investigate the utilisation and outcomes of this TT service, with a focus on the most unwell call outcomes and factors leading to referrals to accident and emergency departments that could be mitigated with service development and modifications. A retrospective evaluation study was conducted of calls occurring between 1st September 2021 and 31st August 2022. A descriptive analysis of call UKONS grading, triage outcome and primary complaint was performed. The TT hotline received 23,766 calls of which only 9066 were for clinical advice. Of the clinical calls, 45.2% were UKONS red. The majority of red calls 53.3% were directed to AED. The proportion of red calls going to AED changed drastically depending on the timing of call and the corresponding services available at those times, with 38.3% of reds being sent to AED in hours but 72.3% out of hours. The profile of complaints also showed significant differences in hours versus out of hours. Significant use of the hotline supports a genuine demand for oncology TT services. In order to reduce referrals to AED, this study supports the creation of alternative destinations of emergency care, especially out of hours.

Scientific and technological connections between specialists in injectable oncology: a contribution to public health from the analysis of the Lattes database

Scientific and technological connections between specialists in injectable oncology: a contribution to public health from the analysis of the Lattes database

Developing a comprehensive education programme for doctors undertaking an oncology rotation at a specialist oncology centre

Developing a comprehensive education programme for doctors undertaking an oncology rotation at a specialist oncology centre

PredictONCO: a web tool supporting decision-making in precision oncology by extending the bioinformatics predictions with advanced computing and machine learning.

PredictONCO 1.0 is a unique web server that analyzes effects of mutations on proteins frequently altered in various cancer types. The server can assess the impact of mutations on the protein sequential and structural properties and apply a virtual screening to identify potential inhibitors that could be used as a highly individualized therapeutic approach, possibly based on the drug repurposing. PredictONCO integrates predictive algorithms and state-of-the-art computational tools combined with information from established databases. The user interface was carefully designed for the target specialists in precision oncology, molecular pathology, clinical genetics and clinical sciences. The tool summarizes the effect of the mutation on protein stability and function and currently covers 44 common oncological targets. The binding affinities of Food and Drug Administration/ European Medicines Agency -approved drugs with the wild-type and mutant proteins are calculated to facilitate treatment decisions. The reliability of predictions was confirmed against 108 clinically validated mutations. The server provides a fast and compact output, ideal for the often time-sensitive decision-making process in oncology. Three use cases of missense mutations, (i) K22A in cyclin-dependent kinase 4 identified in melanoma, (ii) E1197K mutation in anaplastic lymphoma kinase 4 identified in lung carcinoma and (iii) V765A mutation in epidermal growth factor receptor in a patient with congenital mismatch repair deficiency highlight how the tool can increase levels of confidence regarding the pathogenicity of the variants and identify the most effective inhibitors. The server is available at https://loschmidt.chemi.muni.cz/predictonco.

Can I Leave? Perspectives on Parental Leave and Parenthood in Medical Training Among Program Directors and Trainees in Oncologic Specialties.

Purpose: Peak fertility commonly occurs during medical training, and delaying parenthood can complicate pregnancies. Trainee parental leave policies are varied and lack transparency. Research on the impacts of parenthood on trainee education is limited. Methods: A Qualtrics-based survey was distributed via e-mail/social media to program directors (PDs) within oncologic specialties with a request to forward a parallel survey to trainees. Questions assessed awareness of parental leave policies, supportiveness of parenthood, and impacts on trainee education. Statistical analyses included descriptive frequencies and bivariable comparisons by key groups. Results: A total of 195 PDs and 286 trainees responded. Twelve percent and 29% of PDs were unsure of maternity/paternity leave options, respectively. PDs felt they were more supportive of trainee parenthood than trainees perceived they were. Thirty-nine percent of nonparent trainees (NPTs) would have children already if not in medicine, and >80% of women trainees were concerned about declining fertility. Perceived impacts of parenthood on trainee overall education and academic productivity were more negative for women trainees when rated by PDs and NPTs; however, men/women parents self-reported equal impacts. Leave burden was perceived as higher for women trainees. Conclusions: A significant portion of PDs lack awareness of parental leave policies, highlighting needs for increased transparency. Trainees' perception of PD support for parenthood is less than PD self-reported support. Alongside significant rates of delayed parenthood and fertility concerns, this poses a problem for trainees seeking to start a family, particularly women who are perceived more negatively. Further work is needed to create a supportive culture for trainee parenthood.

Recommendations about the Programming of Medical Activities in Medical Oncology of the Chilean Society of Medical Oncology

The objective of this publication is to expose the current situation and to establish recommendations for the scheduling of the medical activities in medical oncology considering the different types of care delivery and the necessary time for these to improve patient care while protecting the physician wellbeing. A review of the national and international literature was carried out regarding the scheduling of medical oncology care, and a web seminar was held with national medical specialists in oncology. We were able to show that there are no standard schedules, and there is a great dispersion in the number of patients treated in the different centers at the national level. The Chilean Society for Medical Oncology considers essential to standardize medical programming in the different oncology services, in order to assure the best care for cancer patients and to protect the medical personnel from work overload.

A multidisciplinary approach to adequate antibiotic use in a clinical oncology ward.

430 Background: Infectious complications are related to high morbidity and mortality among oncology patients. Despite prompt attention being given to its management, many times the prescription of antibiotics is inadequate or overuse, mainly in palliative care. A multidisciplinary team is essential to take care this complex patient and to support the best practice to antibiotic prescription. Methods: We established a multidisciplinary team with support of medical specialists in clinical oncology (physicians, nurses, pharmacies and residents) and infection control (physician and nurse) to evaluate the antibiotic use, indication and period of use based on local antibiotic stewardship guidelines. Antimicrobial consumption was assessed using Defined daily dose (DDD). A drive diagram was created, and the actions were implemented. The data were collected pre intervention (from January to October 2022) and post intervention (from November 2022 to May 2023). Results: The main therapeutic uses were identified as ceftriaxone (DDD = 134.26), piperacillin-tazobactam (DDD = 112.13), metronidazole (DDD = 134.26) meropenem (DDD= 27.14), and teicoplamine (DDD= 23.69). The final stages of life were the main offender based on our guideline. The average antimicrobial consumption during the final 72 hours of life was 41%. According to these data the following actions were taken: 1) improve the palliative risk identification system; 2) assess the pertinence of antimicrobial use in end-of-life care; 3) creation of the one protocol in this subgroup of patients 4) an applicative was created, allowing the insertion of the advice by the medical team and the follow-up by the pharmaceutical team. In post intervention period, with these multi modal strategies the average consumption in end-of-life care reduced to 18%. Conclusions: A creation of a multidisciplinary team in oncologic care with a particular focus in antibiotic stewardship improved the adherence antibiotics protocols and had an impact in patients end of life.

Pediatric Craniofacial Tumor Reconstruction

AbstractEffective management of pediatric craniofacial tumors requires coordinated input from medical, oncologic, and surgical specialties. Reconstructive algorithms must consider limitations in pediatric donor tissue and account for future growth and development. Immediate reconstruction is often focused on filling dead space, protecting underlying structures, and ensuring skeletal symmetry. Staged reconstruction occurs after the patient has reached skeletal maturity and is focused on restoring permanent dentition. Reconstructive options vary depending on the location, size, and composition of resected tissue. Virtual surgical planning (VSP) reduces the complexity of pediatric craniofacial reconstruction and ensures more predictable outcomes.

Assessment of emotional distress in palliative care: Edmonton Symptom Assessment System-revised (ESAS-r) vs Distress Thermometer.

To evaluate the sensitivity and specificity of the Distress Thermometer (DT) as a screening tool for emotional distress in oncological palliative care patients and to compare the DT with the Edmonton Symptom Assessment System-revised (ESAS-r) and the gold standard to determine the most appropriate assessment method in palliative psychological care. Data were collected from psychological screening tests (ESAS-r and DT), and clinical interviews (gold standard) were conducted by a clinical psychologist specialist in palliative oncology from January 2021 to January 2022 in an oncology palliative care service. The sample consisted of 356 first-time patients with a diagnosis of advanced cancer in palliative care. The most frequently reported oncological diagnoses were gastrointestinal tract (49.3%) and breast (18.3%). Most patients were female (n=206; 57.9%), 60.4% were married/with a partner, 55.4% had between 6 and 9years of schooling, and a median age of 57 (range, 46-65) years. The cutoff of the DT was 5, with a sensitivity of 75.88% and specificity of 54.3%. Emotional problems (sadness and nervousness) had a greater area under the curve (AUC) when measured using the DT than the ESAS-r; however, only in the case of the comparative sadness and discouragement was the difference between the AUC marginally significant. The use of the DT as a screening tool in oncological palliative care is more effective in the evaluation of psychological needs than the ESAS-r. The DT, in addition to evaluation by an expert psychologist, allows for a more comprehensive identification of signs and symptoms to yield an accurate mental health diagnosis based on the International Classification of Diseases-11th Revision and/or Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.

Guidelines for pharmaceutical care of endocrine therapeutics for breast cancer(2023 edition)

Endocrine therapy is one of the primary treatment methods for hormone receptor-positive breast cancer patients. As of June 1 2023, the National Medical Product Administration has approved 56 drugs related to endocrine therapy in patients with HR+ /HER-2- breast cancer (including generic drugs that have passed the consistency evaluation), including 44 endocrine drugs which can be categorized according to their mechanisms of action into selective estrogen receptor modulators, selective estrogen receptor down-regulators, aromatase inhibitors, luteinizing hormone-releasing hormone analogs, and progestogens and 12 targeted drugs for combined with endocrine therapy, including CDK4/6 inhibitors, mTOR inhibitors, and HDAC inhibitors. The different pharmacological characteristics, mechanisms of action, and long-term medication factors of breast cancer endocrine therapy-related drugs can directly affect patients' medication adherence and medication safety. To standardize the pharmaceutical care of endocrine therapy drugs for breast cancer and promote rational use in clinical settings, the Oncology Specialty Pharmacist Subcommittee, in conjunction with multidisciplinary experts nationwide, has developed the "Guidelines for pharmaceutical care of endocrine therapy drugs for breast cancer (2023 edition)". The guidelines is based on clinical evidence-based evidence, relevant regulations of pharmaceutical management, and pharmaceutical care practices. The Delphi method and expert interviews were used to formulate the guidelines. The GRADE approach was used for assessing the certainty of evidence. This guideline mainly focuses on endocrine therapy for HR+ /HER-2- breast cancer patients. Due to space constraints, HER-2 positive targeted drugs were not included in the guideline. It covers 6 dimensions and 22 key problems of pharmaceutical care in the whole process of drug therapy, providing a scientific basis for pharmacists to carry out pharmaceutical care of such drugs.

Encuesta Nacional de la SEFH-2019: cartera de servicios, actividad asistencial, docencia e investigación en los Servicios de Farmacia Hospitalaria en España

ObjectiveTo report on the results obtained from the 2019 SEFH National Survey regarding the service portfolio, care activities, training programs and research work of Spanish hospital pharmacy departments. MethodIn March 2019, SEFH designed and distributed a questionnaire containing 77 questions grouped into 8 domains to its 368 affiliated hospital pharmacy departments. The questionnaire included an additional section on the activities carried out in 2017 and 2018. ResultsThe overall response rate was 54.3%. Sixty-nine percent of hospitals were public and 75% were general hospitals. A total of 88.6% of hospital pharmacy departments provided pharmaceutical care to inpatients, whereas 77.5% and 65% treated outpatients and ambulatory patients, respectively. Sterile formulations were prepared by 70.6% of pharmacy departments, while 12% measured drug levels in bodily fluids; 76.9% of hospitals with more than 1,000 beds prepared pharmacokinetic reports. In 2018, hospital pharmacies provided for a mean of 929 patients a month and 2,680 a year. The amount of formulations (sterile and non-sterile) prepared was 10,394,492, sterile formulations accounting for 62.6%. The average amount of clinical trials managed in hospitals with > 500 and > 1000 beds was of 186.2 and 421.8, respectively. The median of number of undergraduate tuition agreements between pharmacy departments and universities was 1 (IQR: 0-2); 21.5% of pharmacy departments had no agreements with any university. The mean number of undergraduate pharmacy students per hospital pharmacy was 4.12 (SD: 8,26). A total of 290 pharmacists were associate professors at some university. Fifteen percent of pharmacists held a certification from the Board of Pharmacy Specialties, 55.3% of them in the specialty of oncology. Hospital pharmacy departments employed a mean of 1.31(SD: 2,23) PhD holders. From those which reported the impact factor of their publications, 60% had an impact factor of zero while in 19.6% the impact factor was > 10. ConclusionsCare of out-patients and medication compounding are increasingly the main activities performed in Spanish hospital pharmacies, while there is still considerable room for improvement in the area of clinical pharmacokinetics. Pharmacy departments are generally committed to training as a key activity, while scientific output is still limited despite the increase in the number of PhD pharmacist.

NUTRI-ONCOCARE: New integral nutrition care model to prevent and treat malnutrition in cancer patients

ObjectiveThe maximum expression of malnutrition in cancer patients is cancerous cachexia, always linked to an unfavorable prognosis. Given its evolutionary nature it is recommended to detect and act early in those patients with nutritional risk. The objective is to propose an action algorithm for the nutritional approach of patients with solid tumors. MethodThrough the nominal group technique, specialists in hospital pharmacy, nutrition and oncology who established a prioritization of issues related to nutritional status and its approach in patients with solid tumors were brought together. Their discussion and analysis allowed us to design a performance algorithm. ResultsThe algorithm differentiates two groups of patients according to the location of the tumor and its impact on nutritional status: high-risk tumors (group 1) include cancers of the head and neck, upper digestive tract and colorectal and low-risk tumors (group 2) include the rest of the neoplasms. Group 1 patients (with the exception of those with colorectal cancer) are directly assessed nutritionally in the first 3-5 days after their presentation in the Tumor Committee, starting the nutritional support required at that time. Patients in group 2 and those diagnosed with colorectal cancer are screened (through NUTRISCORE) after their presentation in the Committee, those with positive risk being referred to nutritional consultation to perform a complete evaluation and propose treatment options. Patients without nutritional risk are periodically re-evaluated. Follow-up is planned according to cancer therapy, with continuous monitoring in each treatment cycle or during the perioperative period. ConclusionsFrom the nominal group technique, agreements were reached to propose an algorithm of nutritional approach of the cancer patient. The adoption of the proposed algorithm could reduce variability in institutional clinical practice, promoting a timely and adequate nutritional approach in cancer patients.

Practice of Monitoring Cisplatin-Induced Ototoxicity by Audiology, ENT, and Oncology Specialists: A Survey-Based Study in a Single Italian Medical Center.

Ototoxic drugs can result in hearing loss and tinnitus. Early detection of the ototoxic process can help minimize or prevent these consequences. The American Speech-Language-Hearing Association has provided guidelines for monitoring ototoxicity, whereas Italy has not yet implemented a national monitoring protocol. This study aims to assess the current state of ototoxicity monitoring in patients receiving cisplatin therapy. A self-administered survey has been used to gather information from oncologists, audiologists, and ENT specialists. The research was conducted at Santa Maria della Misericordia hospital in Perugia. Two questionnaires were administered, one to ENT/audiology specialists and another to oncology specialists. Both questionnaires were used to collect information on awareness of chemotherapy-induced ototoxicity. A comprehensive understanding of cisplatin-induced ototoxicity has been widely established (100%). The most commonly reported audiological symptoms by patients were hearing loss (100%) and tinnitus (87.5%). The majority of ENT and audiologists (93.8%) and oncologists (92.9%) expressed the need for a specific ototoxic monitoring program. However, they noted the absence of a well-defined ototoxicity monitoring protocol. A well-established and efficient ototoxic monitoring system facilitates early detection of ototoxic hearing loss and subsequent rehabilitation of inevitable hearing impairment.

Diagnosis and treatment of subtentorial brain tumors in children 
 at the beginning of the XXI century

Cerebral tumors are among the most menacing pathologies occurring in children. Of all the cerebral tumors, posterior cranial fossa tumors have been most widespread in children. The review of literature provides a detailed description of clinical pattern. The sources related about earlier occurrence of non-focal symptoms, rather than focal signs: lack of energy, nausea, vomiting and headache. The authors provided detailed description of cerebellum damage in case of tumors, and split the symptoms of the hemisphere and vermis injuries as ataxy and typical cerebellar gait are common to spot the malignant process in the vermis, whereas dyssynergia and hypomyotonia occur in case of hemisphere damage. The clinical picture of hydrocephalus in tumor pathology of posterior cranial fossa is discussed: rapidly growing child head circumference, separation of cranial sutures, bulging of fontanelle, child restless behavior, and other signs. The need for CT and MRI was substantiated as the most important diagnostic techniques; the benefits of each were also stated. Discussion was given to the clinical pattern of hydrocephalus in tumor pathology of the posterior cranial fossa, and the authors put special emphasis on the significance of presurgical correction of hydrocephalus. The authors mentioned the use of a neuronavigation system during surgical intervention and characterized the major accesses (access via the median aperture, transvermial, telovelar access) and methods of craniotomy, indications for resection and osteoplastic trepanation. This article discussed the basic principles of radio and chemotherapy used to achieve a sustained remission, approximate treatment patterns for various posterior cranial fossa tumors are described. In addition, the authors mentioned the need for MRI with contrast agent each 3 months, and subsequent visits to the specialist in oncology.

Provision of medical care to cancer patients in Ukraine during Russo-Ukrainian war: A survey of oncologists’ perceptions

ABSTRACT Background On February 24th, 2022, a full-scale armed conflict broke out in Ukraine, resulting in a significant impact on the healthcare system, as well as extensive damage to the country's infrastructure. The aim of this study was to assess the challenges faced by oncologists in providing cancer care to patients. Methods Data were collected through a structured self-administered questionnaire administered using the Google survey tool and distributed to all participants. Results This was a cross-sectional study that involved 111 oncology specialists. Physicians practising in regions that were partially or temporarily occupied by the Russian army (Chernihiv and Zaporizhzhia) reported a significantly higher decline in patient numbers compared to physicians in unoccupied regions (70.0% vs 20.9%; p < 0.0001). Most physicians from both occupied and unoccupied regions reported an increase in the number of patients with advanced disease (65.0% vs. 65.9%; p = 0.735). The majority of physicians from both occupied and unoccupied regions did not see loss of information, changes in cancer treatment phases, and self-medication as a concern. The majority were satisfied with the availability of medicines and equipment. Conclusion This needs-based assessment is crucial for improving the quality of cancer care as it provides valuable information for designing public health interventions.

Art for Advanced Radiation Oncology – Synchronizing the Past and the Future for a Better Patient Care

"Professor Maria Antonietta Gambacorta is a specialist in Radiation Oncology with a PhD in Brachytherapy. She is responsible for the Radiotherapy Oncology hospitalizations and the Interventional Oncology Center and the coordinator of the Multidisciplinary Group for the treatment of rectal tumors within the Comprehensive Cancer Centre of the Fondazione Policlinico Agostino Gemelli, Rome. Due to her level of expertise, she was elected member of the Board of Directors of the Italian Association of Radiation Oncology (AIRO); and member of the board for the drafting of the Guidelines on rectal cancer of the Italian Association of Medical Oncology. Professor Gambacorta is a member of European Society of Radiation Oncology (ESTRO) where she carries out teaching activities in international courses of the ESTRO school. She has published more than 170 scientific publications in peer-reviewed journals, including the International consensus guidelines for Clinical Target Volume delineation in rectal cancer. In this interview, Professor Gambacorta shares some insights about the Art for ART project, implemented in the Radiotherapy department of Policinico Agostino Gemelli, Rome."

Survey of ASCO Sponsored Oncology Interest Groups in the United States Assessing Medical Student Perceptions of Education in Radiation Oncology and Future Employment Prospects

Over the last five years, applications to radiation oncology residency programs among graduates of medical schools in the United States (US) have declined by nearly 50% with a corresponding increase in unfilled positions in the National Resident Matching Program. This has led to ongoing concern regarding the future of the radiation oncology workforce and speculation regarding contributing factors. There are no published data substantiating medical student viewpoints on these issues. To better understand medical student perceptions of oncology specialties (medical oncology (MO), radiation oncology (RO), and surgical oncology/surgical subspecialties (SO)) and factors contributing to their career choices, we conducted a survey among oncology interest groups sponsored by the American Society of Clinical Oncology (ASCO). Survey content emphasized relative impressions of oncology specialties, exposure to these fields during medical school, and perceptions of future employment prospects. An IRB-approved thirty-item questionnaire was distributed electronically via SurveyMonkey to US medical student members of ASCO sponsored interest groups. Participation was optional at the institutional and individual level and responses anonymous. Chi square test or Fisher's exact test was used to compare categorical variables. Two-hundred seventy-nine students completed the survey (37% male, 62% female; 42% White, 40% Asian, 18% underrepresented minorities). Students report receiving less exposure to radiation oncology during medical school: 19% report RO is not included in their curriculum vs. 4% for MO (p<0.01); 77% report receiving lectures from MO faculty, 33% from RO, and 41% from SO (p <0.01); 41% were encouraged to consider RO as a specialty, compared to 62 % for MO and 42% for SO (p < 0.01); 45% report having a clear understanding of role of MO in oncology care vs. only 25% for RO and 38% for SO (p<0.01); 41% saw MO as leaders of the multidisciplinary cancer team, 1 % for RO, and 2% for SO, 47% felt all played equal roles (p<0.01). Students have more negative perceptions of future career prospects for RO: 81% feel that job prospects for MO are strong, 55% for RO and 73% for SO (p<0.01); 54% feel strongly that jobs are available in desirable geographic locations for MO, 36% for RO, 48% for SO (p<0.01); 27% of students report concerns about the future viability of RO, 10% for MO, and 11% for SO (p<0.01). Compared to other oncology specialties, students have less exposure to RO, less understanding of the role of RO in multidisciplinary cancer care, and more pessimism about the future job market/specialty viability. These are likely contributing factors to declining interest in RO among graduates of US medical schools. Current radiation oncologists should increase efforts to improve medical student interest and understanding of RO.

Enhancing Specialist Training in Radiation Oncology through the Implementation of Structured Radiotherapy Contouring Workshops

Contouring tumor volumes and organs at risk is a key component of Radiation Oncology specialist training. As trainees rotate through different tumor sites, they are expected to develop proficiency in contouring skills relevant to their year of training. These skills have historically been acquired in an unstructured manner during supervised clinical work. However, trainees often struggle to learn these skills due to variability in practice and approach amongst senior colleagues. Research has shown that contouring workshops improve the standardization of contouring and can be an effective way of enhancing the learning experience through interaction, instant feedback and reflection. We present our experience of implementing structured contouring workshops and the feedback received from the trainees. Eight contouring workshops were held in our institution over a period of 3 years between 2019 and 2022. These included Head & Neck (3), Prostate (1), SABR Lung (2), Breast (1), and Esophagus (1). Six were held in-person pre-COVID and two in a virtual format during the pandemic. Each workshop was 2 hours long and attended by trainees with varying levels of contouring experience. All the workshops were facilitated by a consultant radiation oncologist and a clinical tutor and followed a similar format consisting of a brief tutorial on the tumor site, followed by a contouring demonstration on an anonymized case on an Eclipse planning platform referencing published contouring atlases. Each of the trainees had access to a copy of the same case throughout the workshop and their contours were then reviewed both individually and collectively. A key component of the workshops was instant feedback, as trainees could compare their contours to that of the tutors and discuss any differences. Feedback on the contouring workshop was then collected through a post workshop questionnaire. The workshops were attended by an average of 12 trainees (range 10 to 14). Regardless of their year of training, all trainees rated the content and format of the workshops highly and stated they were relevant to their daily practice. Their subjective level of confidence in contouring in that specific tumor site improved significantly, going from an average of 5.6 out of 10 (range of 4 to 7) before the workshop to 8.7 (range of 8 to 9) after the 8 workshops. All the workshops were conducted at no extra cost as they were held using our existing planning software. The trainees indicated that the workshops were of definite educational benefit and strongly supported incorporating this approach to teaching contouring skills into the curriculum. Based on this feedback, these contouring workshops have been integrated into the recently revised higher specialist training curriculum on a more structured basis. This will ensure that trainees will continue to develop progressive expertise in contouring skills in keeping with best international practice as they advance through their training scheme.

Patterns of Cancer Treatment among People with HIV in the Mountain West

People with HIV (PWH) are more likely to get cancer than the general population, and cancer is a large and growing cause of morbidity and mortality in PWH. Cancer survival is significantly worse in PWH compared with uninfected people, due in part to lower rates of cancer treatment. There is a lack of high-quality data assessing treatment patterns for cancers diagnosed in PWH in the Mountain West region of the United States, which is underrepresented in HIV malignancy research funding and cancer clinical trial enrollment specific to this population. As such, the current project examined cancer data for two Mountain West states: Utah (UT) and Nevada (NV). In UT, the majority of PWH are treated in the XXX healthcare system, therefore institutional data from 1992 - 2019 was used to identify cases of cancer among PWH in UT. In NV, cancer registry data linked with HIV registry data was anonymized and obtained from 1985 - 2017. Clinical and demographic features, as well as patterns of cancer treatment, are described in both cohorts. We did not pool data or make direct statistical comparisons between the cohorts given the incompatibility of data sources between the two states. Of the 1,089 cases included in the study, 105 were identified in UT and 984 in NV. In both states, most cancer patients with HIV were White (68% UT, 75% NV) and male (78% UT, 86% NV). 23% of patients in Utah were uninsured or had unknown insurance, while 42% of patients in NV were uninsured/unknown. In UT, the most common cancers among PWH were hematologic (22%), gastrointestinal (16%), and genitourinary (13%). In NV, the most common cancers were gastrointestinal (23%), hematologic (20%), and skin (18%). Stage I was more common in UT (44%, 21% NV), while stage IV was more common in NV (35%, 29% UT). Overall, cancer treatment rates for PWH were numerically higher in UT (75%) compared to NV (55%). In UT, 48% of PWH received surgery, 36% received chemotherapy, and 12% received radiotherapy. In NV, 38% had surgery, 43% had chemotherapy, and 15% had radiation. The study identified differences in PWH and cancer diagnosed in UT and NV, although direct statistical comparisons were not made. The number of PWH diagnosed with cancer in NV was higher, cancer stage was more advanced, and treatment rates were lower. These findings reflect higher HIV prevalence, with HIV rates 3x higher in NV vs. UT. Lower utilization of surgery in NV may reflect later stage at diagnosis. Treatment rates in both states were lower than typical for the general population, which may reflect limited access to tertiary medical centers with HIV and oncology specialists for rural patients in the Mountain West. Given lower cancer treatment infrastructure in NV and availability of clinical trials for PWH in UT, community engagement and collaboration between the two states may yield opportunities to improve access to cancer treatment and outcomes for PWH in the Mountain West.

Evaluation of Peer Review Practice in Radiation Oncology Treatment Planning: Single Institution Experience

Pretreatment Peer review meeting at our radiation oncology department is a weekly meeting, where the initial radiation treatment (RT) planning process for every patient is discussed including: Computed Tomography (CT) simulation and treatment planning. In this study, we are aiming to evaluate our peer review process and to report the compliance to the suggested modifications. All RT plans for all patients indicated for radiotherapy accepted by the primary radiation oncology team then presented in our weekly peer review meeting for final approval. A minimum of two radiation oncologists reviewed each plan and their suggestions documented then suggested modifications are classified as changes in: field arrangement, clinical target volume (CTV), dose and fractionation. Compliance to suggested modification also recorded as: applied and not applied with or without documented justification. Atotal of 1779 radiation treatment plans were discussed in our regular weekly peer review meetings for a period of 3 years. 67.5% of them were treated with radical intent while 32.5% treated with palliative intent. The most common technique used was three-dimensional conformal (3DCRT) followed by intensity modulated RT (IMRT) (70.6% and 29.4%, respectively). The most frequently reviewed sites were: breast (38%), Gastrointestinal (11.9%) and head and neck (9.3%).1592 plans (89.48%) were labeled as: approved, 162 (9.1%) labeled as: modified and only 25 (1.4%) plans labeled as: hold. The frequency of modifications was significantly greater in breast (39.5%) than Gastrointestinal (17.9%) followed by gynecological cancers (14.2%) (P value <0.001). Modifications were more predominant with radical plans (64.2%) than palliative ones (35.8%) (P value <0.001) and statistically greater using 3DCRT (64.2%) than IMRT (35.8%) (P value <0.001). CTV recorded as the most frequent variable suggested for modifications (34.6%), followed by dose and fractionation (24.7%) (P value = 0.035). 72.2% of recommended modifications were applied by the consultant of primary team and 22.2% of non-applied modifications were justified and documented. There was 100% compliance rate to all plans labeled as hold. The practiceof peer review in radiation oncology specialty is very challenging. Its role in quality assurance of the radiotherapy process is highly accepted by radiation oncologists at our radiation oncology department. It is reflected in their high compliance rate to the suggested modifications. We recommend its implementation routinely at any radiation oncology department to enhance the quality of RT plans.