Oncology Guidelines Research Articles

Prognostic Relevance of the Proximal Resection Margin Distance in Distal Gastrectomy for Gastric Adenocarcinoma

BackgroundThe risk for recurrence in patients with distal gastric cancer can be reduced by surgical radicality. However, dispute exists about the value of the proposed minimum proximal margin distance (PMD). Here, we assess the prognostic value of the safety distance between the proximal resection margin and the tumor.Patients and MethodsThis is a single-center cohort study of patients undergoing distal gastrectomy for gastric adenocarcinoma (2001–2021). Cohorts were defined by adequacy of the PMD according to the European Society for Medical Oncology (ESMO) guidelines (≥ 5 cm for intestinal and ≥ 8 cm for diffuse Laurén’s subtypes). Overall survival (OS) and time to progression (TTP) were assessed by log-rank and multivariable Cox-regression analyses.ResultsOf 176 patients, 70 (39.8%) had a sufficient PMD. An adequate PMD was associated with cancer of the intestinal subtype (67% vs. 45%, p = 0.010). Estimated 5-year survival was 63% [95% confidence interval (CI) 51–78] and 62% (95% CI 53–73) for adequate and inadequate PMD, respectively. Overall, an adequate PMD was not prognostic for OS (HR 0.81, 95% CI 0.48–1.38) in the multivariable analysis. However, in patients with diffuse subtype, an adequate PMD was associated with improved oncological outcomes (median OS not reached versus 131 months, p = 0.038, median TTP not reached versus 88.0 months, p = 0.003).ConclusionPatients with diffuse gastric cancer are at greater risk to undergo resection with an inadequate PMD, which in those patients is associated with worse oncological outcomes. For the intestinal subtype, there was no prognostic association with PMD, indicating that a distal gastrectomy with partial preservation of the gastric function may also be feasible in the setting where an extensive PMD is not achievable.

Communicating Adolescent and Young Adult Oncology Treatment Guidelines in Practice: The Importance of Documentation for Ensuring Positive Impacts on Oncology Care.

Purpose: Improvements in outcomes for adolescent and young adult (AYA) oncology patients have lagged behind those of other age-specific cancer populations. Research has indicated that low availability of clinical trials, biological differences of this age-group, and several psychosocial factors including higher emotional distress impact outcomes. To improve care and survival rates for these patients, hospitals have implemented AYA oncology programs. The current study evaluated documentation of care in an AYA program housed in an academic medical center based on three areas emphasized in the National Comprehensive Cancer Network's Clinical Practice Guidelines in Oncology for AYAs: clinical trial enrollment, fertility, and psychosocial care. Methods: Retrospective chart reviews were conducted for 45 patients treated before the start of the AYA oncology program and 45 patients treated after program initiation. Patients aged 15-39 years with a diagnosis of a malignant tumor were included. Variables evaluated included documentation of clinical trial enrollment, fertility preservation and sexual health considerations, and behavioral health referrals. Results: Documentation of most clinical trial and fertility variables did not significantly improve from pre- to post-program, although a higher number of patients had these variables documented post-program. Behavioral health referrals increased significantly from 52.8% pre-program to 95.4% post-program. Conclusion: Access to behavioral health care improved the most following implementation of our AYA program, which is likely because of the integration of a dedicated psychologist for AYAs when the program began. The practice of guideline-based care for this population can be better assessed and improved with designated behavioral health providers and more systematic documentation processes.

Management of Fatigue in Adult Survivors of Cancer: American Society of Clinical Oncology - Society for Integrative Oncology (ASCO-SIO) Guideline Update Clinical Insights.

Management of Fatigue in Adult Survivors of Cancer: American Society of Clinical Oncology - Society for Integrative Oncology (ASCO-SIO) Guideline Update Clinical Insights.

Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology.

Breast cancer is treated with a multidisciplinary approach involving surgical oncology, radiation oncology, and medical oncology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget's disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of systemic therapy (preoperative and adjuvant) options for nonmetastatic breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.

Dosimetric comparison of nodal clinical target volume for locally advanced non‑small cell lung cancer: Options for geometric expansion vs. lymph node stations.

The purpose of the present retrospective study was to evaluate whether dosimetric differences existed in nodal clinical target volume (CTV) using options for geometric expansion and lymph node (LN) stations based on the European Society for Radiotherapy and Oncology guideline for locally advanced non-small cell lung cancer (NSCLC). In the treatment planning computed tomographic images of 17 patients with cT4N2M0 NSCLC, nodal CTVs were contoured based on the guideline options of: i) Geometric expansion, with CTV including the nodal gross tumor volume plus 5 mm margin; and ii) LN stations, with CTV including the affected LN stations. Treatment planning of 60 Gy in 30 fractions was performed using volumetric modulated arc therapy; Dmean was the mean irradiated dose to the structure; and VnGy was the volume of the structure receiving ≥n Gy. Dose-volume parameters were compared between the two options. Consequently, the option of geometric expansion was associated with a significantly lower V60Gy and Dmean of the esophagus, V20Gy, V5Gy and Dmean of the lungs, and Dmean of the heart than the option of LN stations in all patients (P=0.017, P<0.001, P<0.001, P<0.001, P<0.001 and P=0.029, respectively). For the V20Gy of the lungs, the 8 patients (47%) with LN metastases in stations 2 or 3 had significantly larger differences in the values between the two options than the 9 patients (53%) without those metastases; the median values of the difference of V20Gy of the lungs between the two options were 2.8% (range, 0.2 to 9.6%) with LN metastases in stations 2 or 3 and 0.5% (range, -0.2 to 5.0%) without these metastases (P=0.027). In conclusion, using the option for geometric expansion might help reduce the V60Gy and Dmean of the esophagus, V20Gy, V5Gy and Dmean of the lungs, and Dmean of the heart in all patients, and the V20Gy of the lungs in patients with LN metastases in stations 2 or 3.

The Crucial Role of Hereditary Cancer Panel Testing in Unaffected Individuals with a Strong Family History of Cancer: A Retrospective Study of a Cohort of 103 Healthy Subjects.

Hereditary cancer syndromes caused by germline mutations account for 5-10% of all cancers. The finding of a genetic mutation could have far-reaching consequences for pharmaceutical therapy, personalized prevention strategies, and cascade testing. According to the National Comprehensive Cancer Network's (NCCN) and the Italian Association of Medical Oncology (AIOM) guidelines, unaffected family members should be tested only if the affected one is unavailable. This article explores whether germline genetic testing may be offered to high-risk families for hereditary cancer even if a living affected relative is missing. A retrospective study was carried out on 103 healthy subjects tested from 2017 to 2023. We enrolled all subjects with at least two first- or second-degree relatives affected by breast, ovarian, pancreatic, gastric, prostate, or colorectal cancer. All subjects were tested by Next Generation Sequencing (NGS) multi-gene panel of 27 cancer-associated genes. In the study population, 5 (about 5%) pathogenic/likely pathogenic variants (PVs/LPVs) were found, while 40 (42%) had a Variant of Uncertain Significance (VUS). This study highlights the importance of genetic testing for individuals with a strong family history of hereditary malignancies. This approach would allow women who tested positive to receive tailored treatment and prevention strategies based on their personal mutation status.

Less restrictions in daily life: a clinical practice guideline for children with cancer

PurposeIn current clinical practice, recommendations regarding restrictions in daily life for children with cancer are often lacking or not evidence-based. Critically reviewing the evidence and formulating recommendations are therefore of great importance as social restrictions (e.g., swimming, school attendance, sports) can impair the quality of life of these children severely. Therefore, our aim was to develop a clinical practice guideline for clinicians, children, and their parents regarding social restrictions in children with cancer.MethodsA comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members.ResultsSix studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation.ConclusionsIn this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.

Finding errors in the blink of AI: Use of an artificial intelligence tool to identify clinically important corrections to references cited by NCCN Guidelines for gynecologic malignancies.

e13658 Background: Scientific articles are being retracted at higher rates for many reasons. Retractions or corrections may be unknown to authors citing these materials as primary sources, unwittingly perpetuating incorrect information. Our goal was to assess the utility of a scholarly artificial intelligence (AI) tool to identify errata to sources cited in NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for gynecologic cancers and to evaluate the clinical importance of identified errata. Methods: scite (scite Inc., Brooklyn, NY) is an AI tool that analyzes citations to generate a list of linked publications, display the context for each citation, and flag any published errata or retractions for each source. Using scite with references from NCCN Guidelines as of June 2023, we identified corrections to primary sources. Each author categorized errata as having major, minor, or no clinical relevance, with resolution of conflicts through discussion until consensus. To check whether scite missed errata, we assessed a random sample (20%) of unflagged references. Results: The guidelines cited 2,364 primary sources, and scite successfully linked to 1,984 (84%) of them . scite flagged 50 references (2.5%) as having corrections; all 50 did have errata (100% accuracy). scite identified 56 total errata, which were not always apparent on journal websites or PubMed. After review, 31 errors (55%) were classified as clinically relevant; 71% of those errors had major clinical importance and 29% were considered minor. Twenty errors (65%) had relevance to the guideline statements in which the source was cited, but only 1 (3%) error had potential to change current guideline text. Among the sample of sources scite did not flag, we identified none with published errata. Conclusions: We demonstrated use of an AI tool to accurately identify sources in clinical guidelines with published corrections. Sources with errata were uncommon, and our analysis did not reveal perpetuation of major errors in NCCN Guidelines. However, the proportion of corrections with major clinical relevance underscores the importance of awareness of errata when writing clinical guidelines or reviews. Compared to manual review of each source, AI tools can improve speed and accuracy in finding important errors. [Table: see text]

Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology.

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. Management of disseminated metastatic CRC involves various active drugs, either in combination or as single agents. The choice of therapy is based on consideration of the goals of therapy, the type and timing of prior therapy, the mutational profile of the tumor, and the differing toxicity profiles of the constituent drugs. This manuscript summarizes the data supporting the systemic therapy options recommended for metastatic CRC in the NCCN Guidelines for Colon Cancer.

Clinicians' perspectives of barriers and facilitators of suicide screening in head and neck cancer care.

e18023 Background: Patients with head and neck cancer (HNC) face a heightened risk of suicide, surpassing rates in other cancers and the general population. Unfortunately, there are currently no suicide-specific clinical guidelines in oncology, and it is unclear what barriers and facilitators impact suicide screening initiatives in HNC care. This qualitative study explored experiences, barriers and facilitators of suicide screening and management of mental health concerns in a diverse group of HNC clinicians. Methods: We conducted qualitative interviews with 16 HNC clinicians at a single healthcare system, including head and neck surgeons, radiation oncologists, medical oncologists, and nurses/nurse practitioners/physician assistants. Interviews covered topics such as clinicians’ perspective of the impact of HNC on patients’ mental health, experience with suicide risk assessment, existing protocols, and overall experiences related to managing mental health concerns in patients with HNC. Using rapid analysis techniques, we identified common challenges, facilitators, and training needs. Results: Our study uncovered distinct barriers faced by HNC clinicians. Key themes included the notable absence of formal suicide and mental health training among HNC clinicians; critical gaps in clinician education and the lack of established protocols for appraising and managing mental health concerns, particularly those related to suicide risk. Other barriers identified included clinicians’ uncertainties in recognizing and addressing suicidal thoughts, limited familiarity with available screening tools, and insufficient resources for patient support. Some key facilitators also emerged, including longer clinic visit times, mental health discussions in interdisciplinary conferences, and greater accessibility of mental health services for comprehensive patient support. Conclusions: In this qualitative study, we observed important barriers in mental health support and service delivery for HNC patients, especially gaps in clinician training, and lack of knowledge of existing suicide-related protocols. Given the suicide burden in HNC, it is important to address these challenges and begin developing initiatives for clinician training and formalized protocols to enhance mental health care for HNC patients.

Large language models for precision oncology: Clinical decision support through expert-guided learning.

e13609 Background: Precision oncology revolutionized cancer treatment by identifying molecular biomarkers to guide personalized care. The ever-growing body of medical literature presents a challenge for oncologists researching targeted therapies. While recent studies investigated large language models (LLMs) to streamline this process, LLM reliance on general rather than medical knowledge limits clinical relevance and trustworthiness. To address these limitations, we developed a retrieval augmented generation (RAG) system that integrates PubMed clinical studies, trial databases and oncological guidelines with LLMs to support targeted treatment recommendations. The Molecular Tumor Board (MTB) at the Center of Personalized Medicine (ZPMTUM) guided and evaluated treatment options proposed by the LLM to assess their applicability for clinical decision support. Methods: We used 10 publicly accessible fictional patient cases with 7 tumor types and 59 distinct molecular alterations. Our LLM system MEREDITH (Medical Evidence Retrieval and Data Integration for Tailored Healthcare) consists of Google's Gemini Pro, enhanced with RAG and Chain-of-Thought (CoT) prompting. To establish a benchmark, clinical experts at ZPMTUM manually annotated the cases. Informed by MTB expert feedback, we iteratively improved our LLM system from a draft system relying on PubMed-indexed data to an enhanced system, which replicated expert annotation processes by incorporating oncology guidelines, drug availability and trial databases (ClinicalTrials.gov, QuickQueck.de). ZPMTUM assessed credibility and clinical relevance of manually annotated and LLM-generated recommendations. Patient-level data on (likely) pathogenic molecular alterations and recommended treatment options were summarized using median and interquartile range (IQR). Semantic similarity between LLM and clinician responses was assessed using cosine similarity of text vector embeddings; paired t-test evaluated significance. Results: The median of (likely) pathogenic molecular alterations per patient was 2.5 (IQR: 2-3). ZPMTUM identified a median of 2 treatment options per patient (IQR: 1-3), while the enhanced LLM identified a median of 4 (IQR: 3-5). MEREDITH proposed multiple relevant treatment suggestions, including therapies based on preclinical studies, and molecular interactions, for further assessment by the MTB. ZPMTUM prioritized the most suitable clinical option. The mean semantic textual similarity of LLM responses increased significantly from 0.69 in the draft system to 0.76 in the enhanced system (p &lt;0.001). Thus, feedback from ZPMTUM enhanced the model's ability to align its responses with clinician thought processes. Conclusions: Leveraging expert thought processes to instruct LLMs holds promise as a novel decision support tool for precision oncology.

Unfavourable carcinoma of unknown primary (CUP) with gastrointestinal profile: A retrospective study.

e16374 Background: According to European Society of Medical Oncology (ESMO) guidelines, CUP are classified in favorable and unfavorable subsets. Favorable CUPs (20% of pts) have clinical aspects and either pathology highly suggestive for specific site of origin or with amenable metastases for localized treatment with curative intent; they are treated with site-specific chemotherapy (CT). All other CUPs (80%) are defined unfavorable and are treated with empiric CT regimens. There is no data about the best CT regimen for unfavourable CUPs with GI profile, i.e., those CUPs that do not meet the criteria of favourable colon-like CUP (CK7-/CK20+/CDX2+) but have a morphological/immunohistochemical profile suggestive for the digestive system. Methods: We conducted a single-center retrospective study to describe outcomes and prognostic factors of pts with unfavourable CUPs with GI profile, referred to our center from Jan 2000 to Aug 2023, who received at least one cycle of first-line CT. The definition of GI profile was: a) negativity for GATA-3, PAX-8 and TTF-1 and b) CK7+/CK20-/anyCDX2 or CK7-/CK20+/CDX2- or CK7-/CK20-/CDX2+, or c) presence of an abundant mucinous component and/or a signet ring cell component. The primary endpoint was the progression free survival (PFS) of first line chemotherapy for advanced disease. Results: 43 pts were included (characteristics in table). After a median follow-up of 43.9 months, 33 deaths were registered and the mOS was 12.6 months (95% CI, 8.7-16.5). Forty PFS events were registered and the mPFS was 6.1 months (95% CI, 3.5-8.9). At univariate analysis, male pts (p=0.034), peritoneal metastases (p=0.0282), residual tumor after surgery (p=0.002), suspected biliopancreatic origin (p=0.033), PS ECOG &gt; 1 (p&lt;0.001) and CDX2- status (p=0.025) were associated with shorter PFS. No CT regimen was superior in terms of PFS at both univariate (p=0.282) and multivariable analysis after adjusting for peritoneal metastases, suspected origin, gender and baseline ECOG PS. Conclusions: Although limited by the small sample size, this study showed that all CT regimens were comparable in terms of PFS among patients with unfavorable CUP with gastrointestinal profile. Keywords (3/10): cancer of unknown primary; peritoneal metastases; chemotherapy. [Table: see text]

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

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

EROS: Engendering reproductive health within oncologic survivorship—ECOG-ACRIN E1Q11 paradoxical provision of reproductive health.

11123 Background: For the 10% of women diagnosed with cancer in the reproductive age, reproductive health (RH) is a critical component of oncologic survivorship. RH includes oncocontraception (OC), oncofertility (OF) and sexuality. Guidelines segregate these components resulting in fragmented reproductive health care management. Methods: The EROS trial is a clustered randomized trial performed at 17 NCI Community Oncology Research Program (NCORP) sites (including 8 NCORP sites and 9 Minority/Underserved NCORP sites) from 2016-2023. Eligible subjects included reproductively capable women aged 15-55 with new cancer diagnosis. Intervention included RH didactics and decision aids. Childbearing interest was dichotomous, not completed childbearing (including either pregnant or future childbearing interest) or completed childbearing. The objective of this study is to determine provision of OC and OF referral by providers at the baseline visit based on patient’s self-reported childbearing interest at study entry. Chi-square tests were used to compare distribution differences in the referral status (receipt: yes vs. no) between treatment arms. Results: The EROS study enrolled 420 subjects. Of the 63.6% (267/420) completed childbearing, 62.4% (58/93) in the intervention arm and 40.2% (70/174) in the non-intervention arm received an OC referral (p=0.0006), whereas 98.9% (92/93) in the intervention arm and 93.7% (163/174) in the non-intervention arm received an OF referral (p=0.0487). Of the 36.4% (153/420) not completed childbearing, 48.3% (28/58) in the intervention arm and 33.72% (32/95) in the non-intervention arm received an OC referral (p=0.0729), while 77.6% (45/58) in the intervention arm and 70.5% (67/95) in the non-intervention arm received an OF referral (p=0.3388). Conclusions: While the intervention increased the rates of provision of oncocontraception and oncofertility for patients with completed childbearing, our study shows provision of oncofertility referrals at a markedly higher rate than oncontraception. Referral patterns were inconsistent with patient need particularly in completed (receiving OF referral) or delayed childbearing (not receiving OC referral) interest of the patient. The bias favoring oncofertility referral may reflect oncology guidelines emphasizing this aspect of reproductive health despite comprehensive needs of patient.

Development and implementation of a geriatric oncology interprofessional case-based educational intervention for cancer care providers.

9020 Background: Geriatric assessment (GA) is recommended as part of the standard of care for older adults with cancer. However, the GA has not been fully adopted as part of routine practice in oncology in Mexico, mainly due to lack of qualified personnel and limited knowledge. We designed an interprofessional case-based educational intervention to address the main barriers for implementation of GA in oncology. Methods: We followed Kern’s six-step approach to design a continuing professional development (CPD) activity. Our targeted learners consisted of teams comprised of one oncologist and one geriatrician who practiced at the same site in Mexico. By the end of the intervention, participants would be able to perform GA in older adults with cancer, and to integrate information obtained through a GA in a cancer treatment plan through adequate interventions. We used Project ECHO’s model to create a CPD activity consisting of 12 weekly 75-minute online sessions via Zoom, with content selected from international geriatric oncology guidelines. At baseline, and at the end of the course, participants answered a 36-item multiple choice knowledge assessment (scale 0-100), a survey on self-perceived competence in GA skills (scale 0-10), and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, which assesses subjective performance of the GA (scale 0-4). Participants also completed a satisfaction questionnaire. We compared baseline and post-intervention scores through paired t tests; results from the satisfaction questionnaire are reported descriptively. Results: We included 56 participants (28 geriatricians and 28 oncologists). Median participant attendance was 10 sessions (IQR 9-11). Thirty-eight participants completed the satisfaction questionnaire: median satisfaction was 10/10 (range 8-10). There was no difference in satisfaction scores between oncologists and geriatricians. Mean baseline knowledge score was 59.5±12.8 and mean post-intervention knowledge score was 74.4±9.7 (p&lt;0.001, effect size 1.14). Mean baseline competence score was 6.42±2.5 and mean post-intervention competence score was 9.02±0.78 (p&lt;0.001, effect size 1.03). Mean baseline performance score was 2.58±0.65 and mean post-intervention knowledge score was 3.29±0.5 (p&lt;0.001, effect size 1.64). Increases in knowledge, competence, and performance scores were observed both in oncologists and in geriatricians separately. Conclusions: This interprofessional curriculum on GA in oncology was feasible and acceptable, and led to significant increases in knowledge, competence, and performance among participants. Project ECHO’s case-based learning model is adequate to provide interprofessional education, which is crucial in multidisciplinary areas such as geriatric oncology.

Continuity Unveiled: Evaluating Cytoreduction Outcomes for Advanced Ovarian Cancer Amidst the COVID-19 Era at an ESGO Designated Centre of Excellence.

The COVID-19 pandemic brought unprecedented global changes, necessitating adjustments to address public health challenges. The impact on advanced epithelial ovarian cancer (EOC) surgery, marked by increased perioperative risks, and changes in management plans was explored in this study based on promptly published British Gynaecologic Cancer Society (BGCS) and European Society of Gynaecologic Oncology (ESGO) guidelines. Retrospective data from 332 patients with advanced EOC who underwent cytoreductive surgery at a UK tertiary center were analyzed, and the outcomes were compared between pre-COVID-19 (2018-2019) (n=189) and COVID-19 era (2020-2021) (n=143) cohorts, covering the same timeframe (March to December). Primary outcomes included residual disease (RD) and progression-free survival (PFS), while secondary outcomes were the ESGO quality indicators (QIs) for advanced EOC surgery. Kaplan-Meier curves were produced to illustrate PFS. Complete cytoreduction rates remained comparable at 74.07% and 72.03% for pre-COVID-19 and COVID-19 groups, respectively. Differences were observed in ECOG performance status (p=0.015), Intensive Care Unit (ICU) admissions (p=0.039) with less interval debulking surgeries (p=0.03), lower surgical complexity scores (p=0.02), and longer operative times in the COVID-19 group (p=0.01) compared to the pre-COVID-19 group. The median PFS rates were 37 months and 34 months in the pre-COVID-19 and COVID-19 groups, respectively (p=0.08). The surgical QIs 1-3 remained uncompromised during the COVID-19 era. Management modifications prompted by the COVID-19 pandemic did not adversely impact cytoreduction rates or PFS.

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment.

No studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival. First course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson's chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment. Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90). The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

Seeing the Trees From the Forest: Challenges in Subgroup Analysis-Based Guidelines in Oncology

As clinical trials in oncology require substantial efforts, maximizing the insights gained from them by conducting subgroup analyses is often attempted. The goal of these analyses is to identify subgroups of patients who are likely to benefit, as well as the subgroups of patients who are unlikely to benefit from the studied intervention. International guidelines occasionally include or exclude novel medications and technologies for specific subpopulations based on such analyses of pivotal trials without requiring confirmatory trials. This Perspective discusses the importance of providing a complete dataset of clinical information when reporting subgroup analyses and explains why such transparency is key for better clinical interpretation of the results and the appropriate application to clinical care, by providing examples of transparent reporting of clinical studies and examples of incomplete reporting of clinical studies.

The Evolving Role of Genomic Testing in Early Breast Cancer: Implications for Diagnosis, Prognosis, and Therapy.

Multigene prognostic genomic assays have become indispensable in managing early breast cancer (EBC), offering crucial information for risk stratification and guiding adjuvant treatment strategies in conjunction with traditional clinicopathological parameters. The American Society of Clinical Oncology (ASCO) guidelines endorse these assays, though some clinical contexts still lack definitive recommendations. The dynamic landscape of EBC management demands further refinement and optimization of genomic assays to streamline their incorporation into clinical practice. The breast cancer community is poised at the brink of transformative advances in enhancing the clinical utility of genomic assays, aiming to significantly improve the precision and effectiveness of both diagnosis and treatment for women with EBC. This article methodically examines the testing methodologies, clinical validity and utility, costs, diagnostic frameworks, and methodologies of the established genomic tests, including the Oncotype Dx Breast Recurrence Score®, MammaPrint, Prosigna®, EndoPredict®, and Breast Cancer Index (BCI). Among these tests, Prosigna and EndoPredict® have at present been validated only on a prognostic level, while Oncotype Dx, MammaPrint, and BCI hold both a prognostic and predictive role. Oncologists and pathologists engaged in the management of EBC will find in this review a thorough comparison of available genomic assays, as well as strategies to optimize the utilization of the information derived from them.

GPT-4 for Information Retrieval and Comparison of Medical Oncology Guidelines

GPT-4 for Information Retrieval and Comparison of Medical Oncology Guidelines