Issue Of Oncology Research Articles

Association of Financial Conflicts of Interest With Academic Productivity Among Junior Faculty in Hematology and Oncology

Financial conflicts of interest (COIs) represent a common and complex issue in hematology and oncology. However, little is known about the timing of when COIs begin to develop during a career trajectory. We evaluated self-reported COIs for junior faculty members at top cancer centers to determine how these financial relationships correlated with measures of academic career productivity. We analyzed data from 230 assistant professors at 10 academic cancer centers. Financial COIs were identified from the CMS Open Payments (Sunshine Act dollars) database. Self-reported COIs were obtained from American Society of Clinical Oncology (ASCO) and American Society of Hematology (ASH) disclosures, and from disclosures in recent publications. Number of publications and h-index (defined as the largest number of publications [h] such that h publications each have at least h citations) were used as measures of academic productivity. Scatter plots and Spearman correlation coefficients were used to assess the relationship between COIs or Sunshine Act dollars with number of publications and h-index. Linear regression modeling was used to analyze the relationships between COIs or Sunshine Act dollars with number of publications and h-index, adjusting for years of experience since completing fellowship (YSF). A total of 46% of junior faculty had at least 1 COI. Number of COIs reported to ASCO/ASH was positively correlated with total Sunshine Act dollars (Spearman correlation, 0.53; P <.01). The number of COIs and the number of Sunshine Act dollars increased with years in practice (Spearman correlation, 0.38 and 0.25, respectively; P <.01 for both). COIs and Sunshine Act dollars correlated with h-index (Spearman correlation, 0.41 and 0.37, respectively; both P <.01). After adjusting for YSF, linear regression demonstrated that log-transformed h-index and number of publications were associated with Sunshine Act dollars (both P <.01) and COIs (ASCO/ASH) (both P = .01). Financial COIs increased with number of YSF. Measures of academic productivity were positively correlated with COIs (ASCO/ASH) and Sunshine Act dollars. These data suggest that the cultivation of industry relationships is associated with the early academic productivity of junior faculty.

Gender Climate in Indian Oncology and Other Sectors

Cancer causes one of the highest numbers of cases related to non-communicable diseases (NCDs). According to GLOBOCAN 2020, India reported 1.32 million cancer cases in 2020.[1] It has been observed that cancer is affecting more women than men in India. However, the opposite trend is observed in other countries. As per the National Institute of Cancer Prevention and Research, one woman dies of cervical cancer every eight minutes in India and one of every two women newly diagnosed with breast cancer dies.[2] These contrasting results are being examined, and the reasons are being identified. Such gender disparity is observed not only in oncology but also across sectors. This paper highlights gender disparity issues in oncology and other sectors using findings of insurance-based health scheme, surveys among oncology professionals, and certain personal experiences to substantiate the argument.[3]

A Pandemic’s Silver Lining: Building a Collaborative Integrative Therapy Program

"A Pandemic’s Silver Lining: Building a Collaborative Integrative Therapy Program." Oncology Issues, 37(1), pp. 70–72

Методология литературного поиска на примере пациентов с опухолями околоушных слюнных желез с повреждением лицевого нерва после радикальных операций. Обзор литературы

The issue of a systematic full-fledged literary search in the study of narrow issues of oncology is of no small interest today. The collection of complete up-to-date information on the issue raised, in this case, the issue of radical treatment of primary tumors of the large parotid salivary glands, is very relevant, objectively reflecting the researcher’s ability to analyze the data obtained [1]. The purpose of this study was the need to systematize the methodology of literary search by the example of studying the issue of complications after radical surgery for neoplasms of the parotid salivary glands. The article examines the opinions of experts with the largest number of citations on this issue. Material and methods. The literature was searched in the databases Scopus, Web of Science. In particular, we consider the existing volume of literature related to facial nerve injuries after radical interventions, identifying the most active scientists, journals and relevant publications. Conclusions. The article analyzes the existing volume of literature in this field. The total number of articles in the «general» category is 2254 documents, and analyzing the chronological development of publications, we can conclude that this topic became widespread only in the 1980s. The number of publications devoted to this topic today is 51. Significant progress has been observed only after the 2010-s.

Oncological issues of hormonal contraception and hormone replacement therapy

The article gives critical analysis of numerous epidemiological studies touching upon the problems of carcinogenesis while using hormonal contraception and hormonal replacement therapy and also the expediency of HRT as to oncologic patients after radical treatment.The materials presented testify to relative carcinogenous safety of hormonal contraceptives as to the majority of tumors and even considerable decrease of endometrial and ovarian cancer risk; but some investigations point to the increase о f breast cancer in case о f prolonged application о f hormonal preparations.The results оf the analysis show that HR Tmay be recommended among female population providing active screening, especially of mammary glands and endometrium. Besides that, hormonal preparations are not excluded for rehabilitation of some oncologic patients underthorough monitoring. Yet, there exists burning necessity of continuing cooperated scientific and clinical investigations forfurther studying oncologic aspects of hormonal contraception and HRT.

Exercise and Childhood Cancer-A Historical Review.

Simple SummaryChildhood cancer survivors are at risk of developing important adverse effects, but there is growing evidence that physical exercise could help in this regard. The present review summarizes the history of pediatric exercise oncology and the main milestones achieved along the way. Overall, physical exercise appears to be safe and beneficial even during the most aggressive phases of pediatric cancer treatment and can represent an effective coadjuvant therapy for attenuating cancer-related adverse effects.Childhood cancer survivors are at risk of developing important adverse effects, many of which persist for years after the end of treatment. The implementation of interventions aiming at attenuating tumor/treatment-associated adverse effects is therefore a major issue in pediatric oncology, and there is growing evidence that physical exercise could help in this regard. The present review aims to summarize the main milestones achieved in pediatric exercise oncology. For this purpose, we conducted a systematic review of relevant studies written in English in the electronic database PubMed (from inception to 14 August 2021). This review traces the field of pediatric exercise oncology throughout recent history based on three fundamental pillars: (i) exercise during childhood cancer treatment; (ii) exercise during/after hematopoietic stem cell transplantation; and (iii) exercise after childhood cancer treatment. Accumulating evidence––although still preliminary in many cases––supports the safety and potential benefits of regular exercise (with no major contraindications in general) in the childhood cancer continuum, even during the most aggressive phases of treatment. Exercise can indeed represent an effective coadjuvant therapy for attenuating cancer-related adverse effects.

Actual 3-Year Survival After Reduced-Port Laparoscopic Distal Gastrectomy for Gastric Cancer (RpLDG): a Propensity Score Matching Analysis

BackgroundTotal laparoscopic distal gastrectomy for early gastric cancer has been widely accepted; however, reduced-port laparoscopic distal gastrectomy has not gained the same popularity because of technical difficulties and oncologic safety issues. This study aimed to analyze the oncologic safety and short-term surgical outcomes of patients who underwent reduced-port laparoscopic distal gastrectomy (RpLDG) for gastric cancer. MethodsConsecutive patients who underwent surgical treatment between January 2016 and May 2018 were included in this study. Of the 833 patients enrolled, 158 underwent RpLDG and were propensity-matched with 158 patients who underwent conventional port laparoscopic distal gastrectomy (CpLDG). The groups were compared in terms of short-term outcomes and disease-free and overall survival rates. ResultsThe RpLDG group had shorter operation times (161.8 min vs. 189.0 min, p < 0.00) and shorter postoperative hospital stays (7.6 days vs. 9.1 days, p = 0.04) compared to the CpLDG group. Estimated blood loss was lower in the RpLDG group than in the CpLDG group (52.6 mL vs. 73.7 mL, p < 0.00), while hospital costs incurred by the RpLDG group were lower than those of the CpLDG group (10,033.7 vs. 11,016.8 USD, p < 0.00). No statistical differences were found regarding overall morbidity and occurrence of surgical complications of grade III or higher, as defined by the Clavien-Dindo classification. Furthermore, no significant differences between RpLDG and CpLDG were found in 3-year disease-free (99.4% vs. 98.1%; p = 0.42) and 3-year overall survival rates (98.7% vs. 96.8%; p = 0.25). ConclusionPatients who underwent RpLDG had better short-term surgical outcomes than those who underwent CpLDG in terms of operation time, estimated blood loss, duration of hospital stay, and hospital costs. The oncologic safety of RpLDG was satisfactory.

Актуальні питання радіаційної онкології в Україні

Огляд науково-практичної конференції Українського товариства радіаційних онкологів за участі міжнародних фахівців, 20–21 червня 2018 р., м. Вінниця, Україна

Impact of COVID-19 pandemic on oncologists’ professional and personal lives: A pre-vaccine study.

45 Background: The COVID-19 pandemic has adversely impacted healthcare workers globally, leading to high rates of burnout, especially among frontline workers. We conducted a study to assess the pandemic’s impact on community-based medical oncologists and hematologists (mO/H) in the U.S. before the widespread distribution of vaccines. Methods: Between October and December 2020, mO/H participated in a compensated, online survey addressing the impact of COVID-19 on oncologists’ professional and personal lives and other issues in oncology; demographic, clinical, and practice-based questions were also asked. Results are presented using descriptive statistics. Results: A total of 259 geographically diverse mO/H, with a median of 18 (1-42) years in practice, completed the survey. At the time of the study, local trends in COVID-19 cases were reported as increasing, stable, or decreasing by 29%, 51%, and 20%, respectively. The summative view of the pandemic was “proud of my work as a physician in the frontlines” (37%), “a challenge to get through” (35%), and “no significant impact” (23%). Over half reported a moderate to severe impact on their professional (60%) and personal lives (65). The top 3 factors adversely impacting professional life were: concern of transmitting COVID-19 to patients or staff (52%), difficulty providing patient care (45%), and loss of income (41%). The top 4 factors adversely impacting personal life were: concerns of safety for self and family (84%), a sense of anxiety (50%), loss of family income (24%), and a sense of depression/doom (22%). Fifty percent agreed or strongly agreed that they had increased burnout at work since the beginning of the pandemic. However, workload was assessed as stable (51%) or reduced (33%) during the pandemic. The top 3 factors contributing to burnout were: loss of face-to-face patient interaction (46%), financial loss by practice (42%), and reduced patient volume (35%). The factors thought to impact income were: use of virtual patients visits (38%), pay cuts from the employer (33%), and cancellation of elective procedures (31%). Overall, 41% reported receiving funds from government-based programs (e.g., CARES act) during the pandemic. While about half (52%) did not believe that the pandemic would impact their retirement, some felt that the pandemic would likely hasten (17%) or delay (17%) their plans to retire. Conclusions: This study confirms greater feelings of burnout among U.S. community-based mO/H in the wake of the pandemic and offers insight into drivers of professional and personal dissatisfaction. While mO/H have concerns about loss of income, notably, loss of in-person patient interaction is also a key factor impacting their professional satisfaction. Given the high baseline rate of burnout among mO/H, it is critical to prevent, mitigate and control additional risks imposed by pandemic-related factors.

Issues in Oncology: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner

Josh Epworth, ARNP, of University of Washington Medical Center, considers the findings of three important abstracts from the 2021 ASCO Annual Meeting and reflects on how advanced practitioners can improve access and care for their patients with cancer. Meeting coverage is provided by The ASCO Post.

HOX gene regulation in glioma stem cells, mediators of resistance in breast cancer, and paradoxical therapeutic interventions

Therapy resistance remains a major challenge during the treatment of patients with advanced cancer. Due to the complex nature of the cellular and molecular mechanisms underlying therapy resistance, research efforts to tackle this challenge have focused on diverse aspects: from cancer stem cell (CSC) biology, therapy resistance-specific signatures to the development of new combinatorial therapeutic approaches. Among other articles, the August issue of Molecular Oncology includes several studies that directly or indirectly explore therapy resistance in patients with advanced cancer. In some cancers, therapeutic resistance has been linked to the presence of CSCs. In glioma, for example, glioma stem cells (GSCs) represent a tumor cell subpopulation underlying tumor relapse. Understanding the molecular mechanisms behind GSC gene expression may give new insights on tumorigenesis and tumor relapse. In their recent study, Le Boiteux et al. [[1]] analyzed six patient-derived GSC lines, as well as 70 primary adult diffuse glioma samples to map the mechanisms leading to deregulation of the HOX gene clusters, which have been previously implicated in the oncogenic potential of GSCs. The authors identified widespread reactivation of HOX genes in adult IDH wild-type (IDHwt) diffuse glioma samples and GSCs. HOX gene deregulation was associated with self- and cross-regulatory interactions between HOX transcription factors, but not with genomic rearrangements. Integrative analysis of high-throughput DNA methylation analysis, ChIPseq, and RNAseq data demonstrated that the absence of hypermethylation on canonical and alternative bivalent CpG islands in promoters, as well as loss of the H3K27me3 epigenetic mark, underlies aberrant gene expression of HOX clusters in IDHwt gliomas. Besides providing a comprehensive epigenetic analysis of HOX gene regulation in glioma, the study by Le Boiteux et al. highlights the complexity of HOX gene expression via alternative promoters in cancer. In a different setting, Mohammad Sultan and colleagues employed an in vivo genome-wide shRNA screen to identify potential mediators or biomarkers of paclitaxel resistance in patients with advanced breast cancer [[2]]. The transcriptional repressor BCL6 was identified among the top paclitaxel resistance hits, and BCL6 overexpression was detected in tumors of chemotherapy-resistant patients. To further test the role of BCL6 in paclitaxel resistance, the authors performed BCL6 knockdown and BCL6 inhibitor experiments both in vitro and in vivo, in a mouse model of triple-negative breast cancer. BCL6 targeting in preclinical models enhanced the efficacy of paclitaxel treatment. Thus, BCL6 may serve as a biomarker for drug resistance and may potentially be targeted for the treatment of patients with breast cancer that have developed paclitaxel resistance. In addition to chemotherapy, targeted therapies designed to block mitogenic signaling pathways are often used for the treatment of patients with cancer. However, drug resistance to these therapeutic agents represents a major challenge for the treatment of advanced cancer. In their perspective, Matheus Henrique Dias and Rene Bernards explore the prospects of a ‘paradoxical intervention’ strategy for the treatment of therapy-resistant cancers [[3]]. Such a strategy would involve overactivation, rather than inhibition, of mitotic signaling in cancer cells. In their view, such an approach would result in an overload of the stress response pathways and disruption of cancer cell homeostasis and viability. The authors review related data from several independent experimental models, discuss future perspectives, and explore the potential drawbacks of such a paradoxical intervention strategy for the treatment of patients with cancer.

The scientific publications of AIFM members in 2015-2019: A survey of the FutuRuS working group.

Within the Italian Association of Medical Physics and Health Physics (AIFM) working group "FutuRuS" we carried out a survey regarding the number of the peer-reviewed articles by AIFM members. We surveyed papers published in the years 2015-2019. Data extracted from Scopus included information regarding authors, title, journal, impact factor (IF), leading or standard authorship by AIFM members, keywords, type of collaboration (monocentric/multicentric/international), area of interest [radiation oncology (RO), radiology (RAD), nuclear medicine (NM), radioprotection (RP) and professional issue (PI)] and topics. We found 1210 papers published in peer-reviewed journals: 48%, 22%, 16%, 6%, 2 and 6% in RO, RAD, NM, RP, PI and other topics, respectively. Forty-seven percent of the papers involved monocentric teams, 31% multicentric and 22% international collaborations. Leading authorship of AIFM members was in 56% of papers, with a corresponding IF equal to 52% of the total IF (3342, IFmean=2.8, IFmax=35.4). The most represented journal was Physica Medica, with 15% of papers, while a relevant fraction of IF (54%) appeared in clinically oriented journals. The number of papers increased significantly between 2015 and 2016 and remained almost constant in 2017-2019. This survey led to the first quantitative assessment of the number and theme distribution of peer-reviewed scientific articles contributed by AIFM members. It constitutes a ground basis to support future AIFM strategies and promote working groups on scientific activity of medical physicists, and to build the basis for rational comparison with other countries, first of all within Europe.

SP2-2 COVID-19 impact on the oncology practice in the USA

Coronavirus disease 2019 (COVID-19) has changed our lives and how we approach cancer in the USA. Unfortunately, cancer incidence will not change despite COVID-19. Starting from March 2020, the US had a significant impact on how we care for our patients. Cancer screening, diagnosis, treatment, and posttreatment surveillance in uninfected patients during the pandemic is something that we continue to explore the most efficient way to provide the care without risking the patients from COVID-19 and not providing the inferior care. Further, we need to make sure that we protect our healthcare providers from the COVID-19. I will provide my talk from a medical oncology practitioner's perspective, approaches, and issues that I have noted in the USA.

Fertility Status Among Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled between 1971 and 1998 in the EORTC Children Leukemia Group Trials 58741, 58831/2 and 58881

BackgroundThe survival of childhood acute lymphoblastic leukemia (ALL) has improved significantly over the last decades, with recently reported overall survival rates in Europe of up to 85% in children (<14 years) and 62% in adolescents (15-19 years) (Trama, Lancet Oncol 2016). The increased number of long-term survivors has made the management of side effects an increasingly important issue in pediatric oncology. In this context, the impact on fertility caused by widely employed ALL treatments such as alkylating agents, cranial radiotherapy, total body irradiation and orchiectomy has been an emerging concern over the last years. The aim of this study was to assess fertility among long-term childhood ALL survivors.MethodsBetween 2012 and 2017, a follow-up study was performed among childhood ALL (and acute lymphoblastic lymphoma) survivors enrolled between 1971 and 1998 in EORTC studies (58741, 58831/2, 58881) in France and Belgium. Patients <18 years (yrs) at diagnosis and ≥18 yrs at the time of the follow-up were eligible to fill out a questionnaire that included information about their fertility. The following fertility-related outcomes were evaluated: having menstrual cycles for females, intention to have children, having children, use of reproductive techniques to become pregnant and occurrence of negative pregnancy outcomes (miscarriage, medical abortion, birth defects), separately for males and females.ResultsOut of 1429 eligible patients, 502 (35%) filled out the questionnaire, 862 (60%) were lost to follow-up, and 65 (5%) refused to participate. Disease characteristics and relapse occurrence within one yr after diagnosis were comparable between these 3 groups.Among respondents (275 females, 227 males), approximately 14% were aged 10-17 yrs at diagnosis and almost 30% belonged to the NCI high risk group (Table 1). Approximately 12% received cranial radiotherapy and 6% of females and 8% of males underwent hematopoietic stem cell transplantation. Relapse occurred in 12% and 14% of females and males, respectively. The median time between the diagnosis and the socioeconomic evaluation was 20 yrs (range: 13-42). The median age at follow-up was 25 yrs (range: 18-53).All but 6 females had ever had menstrual cycles. At the time of the fertility evaluation, 93% out of females younger than 45 yrs of age (N=270) either had menstrual cycles, were pregnant, gave breast feeding or continuously used contraceptives. Among females who had tried to become pregnant, 89% had been pregnant, 75% had children and 12% used medical help to become pregnant. One fifth of the ever pregnant females had ever had a miscarriage. The incidences of other negative pregnancy outcomes (e.g. birth defect, medical abortion) were low.The average number of children females had was 0.36 (95% CI: 0.27-0.44). The expected number of children in a population with the same distribution of country, age, and yr of birth of the mothers based on national population registries was 0.55. However, as 52% of the females had a bachelor or master degree and only 3% had no secondary school diploma, this difference could possibly be explained by an overrepresentation of females with a high level of education in our sample.Among males who had tried to have children, 83% made their partner pregnant, 72% had children and 7% used medical help to make their partner pregnant. The incidence of negative pregnancy outcomes other than miscarriage was low.ConclusionsIn this first disease-specific European cohort study, we evaluated fertility among adult survivors of childhood ALL enrolled in EORTC trials, with a median time from the diagnosis of 20 yrs.Most survivors who tried to have children, succeeded (75% of females, 72% of males). However, the average number of children per female seemed to be lower than in the general population. The incidences of birth defects, and medical abortions were low, both among female survivors and the partners of the male survivors.Despite the large number of potentially eligible patients, we could evaluate only 35% of long-term survivors. We were unable to study the effect of specific treatment exposures due to the large variety of treatments that patients received, the association between some treatments (protocol dependent) and age at the fertility evaluation, and the need to stratify the analyses by sex. Improvements in the follow-up of childhood cancer survivors are needed for a better evaluation of the long-term outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

PCN148 Community Oncologists' Experience and Perceptions of Cancer Survivorship

Improvements in cancer outcomes, attributable to advances in detection and therapy, have led to increased cancer survivorship in the United States (US). The number of cancer survivors is expected to continue to grow, from 16.9 million in 2019 to 22.1 million by 2030. In addition to risk of cancer recurrence and second malignancies, survivors can face long-term physical, emotional and psychological sequelae leading to financial burden on patients and increased overall healthcare expenditure. We sought to gain insight into oncologists’ experiences and perceptions of survivorship care, now considered an essential component of quality care in oncology. Between February and April 2020, a representative sample of 165 community hematologists/oncologists from across the US were surveyed via web-based survey and live interaction, regarding various clinical and practice issues in oncology including survivorship care. The vast majority of oncologists surveyed (87%) indicated that the number of survivors in their practice is greater today than 5 years ago. The most common concerns raised by cancer survivors were cancer recurrence (95%), side effects (49%), and ability to return to work/normal activity (46%). Over half of the oncologists (56%) felt well-prepared to manage the needs of cancer survivors, but 73% indicated need for additional training, especially with management of side effects (56%). While 78% provided their patients with a formal survivorship plan upon completion of treatment, only 50% utilized a formalized survivorship program or provider to deliver survivorship care. More than half expected to hire additional staff for survivorship care. Most (76%) viewed the ongoing management of cancer survivors’ chronic needs as the responsibility of both oncology and primary care practices. Most oncologists observed an increasing number of cancer survivors in their practices, and identified a need for addition training, staff and collaboration with primary care to deliver effective survivorship care.

EVALUATION OF THE TUMOR PROLIFERATIVE ACTIVITY INDEX PCNA IN A VARIETY OF ROUTES OF DELIVERY OF CHEMOTHERAPEUTIC DRUGS IN PATIENTS WITH LOCALLY ADVANCED BREAST CANCER

Introduction. Breast cancer is one of the most live issue of the modern oncology, as it holds the leading position among the causes of female mortality and disability. A special place in the structure of this pathology is occupied by locally advanced forms of malignant tumor in which the effectiveness of the treatments used is unfortunately very low, therefore the prognosis is rather unfavorable. This determines there levance of them search for new methods of diagnosis and treatment in such patients. In the context of this research, we identified the role of neoadjuvant selective intra-arterial polychemotherapy in adverse primary inoperable forms of breast cancer. To determine and predict the effectiveness of this treatment, we used tumor proliferative activity. The research examined the expression of a PCNA nuclear proliferation marker for prognostic and diagnostic evaluation in the light of unsatisfactory literature on the subject in the context of determining similar parameters by other criteria. PCNA level was taken as the main dichotomous point of prognostic assessment of neoadjuvant therapy based on the results of retrospective analysis of the efficacy of preoperative treatment and determination of statistically significant difference between the results in the subgroups with lower and higher marker levels, which in our study were divided according to the median value of the immunohistochemical parameter level in the total sample of 25 %. Objective. Evaluation of the effectiveness of neoadjuvant treatment using systemic and selective intraarterial routes of chemotherapy administration in patients with locally advanced breast cancer using the tumor proliferative index based on the PCNA marker. Materials and methods. A retrospective analysis of the results of a comprehensive treatment of patients with initially inoperable locally advanced breast cancer based on selective and systemic routes of administration of chemotherapy was performed. The study included 63 patients. The sample was divided into 2groups depending on the selected type of neoadjuvant polychemotherapy: 1st group – control group were formed (based on systemic therapy) and 2nd group – study group (the selective intraarterial delivery route was used). The control group consisted of 22 patients, the study – 41 patients. All patients revealed stage IIIb of the disease. In accordance with the clinical manifestations, the patients were distributed as follows: control group include 12 patients with сT4bN1M0, 6 patients with сT4aN1M0 and 4 patients with сT4cN1M0; study group include 23 patients with сT4bN1M0, 7 patients with сT4aN1M0 and 11 patients with сT4cN1M0. All patients included in the study had luminal type B. In parallel with routine methods, the dynamics of proliferative activity of the tumor by the PCNA nuclear antigen was additionally studied in all patients. This study demonstrates the level of the PCNA marker at the start of treatment and after the completion of polychemotherapy (PCT). After PCT, all patients underwent surgical intervention. Taking into account the pathological examination, the patients were reassigned as follows: in the control group, 4 patients has pT4aN0M0, 2 patients – pT4aN1M0, 4 patients – pT4bN0M0, 8 patients – pT4bN1M0, 1 patient – pT4cN0M0 and 3 patients – pT4cN1M0; in the study group, 3 patients has PT4aN1M0, 4 patients – PT4aN0M0, 15 patients – PT4bN1M0, 8 patients – PT4bN0M0, 6 patients – PT4cN1M0 and 5 patients – PT4cN0M0. Since the patients belonged to the group with Luminal type of tumor, each of them received hormone therapy in an adjuvant regimen. Patients of reproductive age were treated with the group of estrogen antagonists, while postmenopausal patients received aromatase inhibitors. Targeted therapy was not used in the study. A statistical analysis was performed between the comparison groups; the median marker level in 25 % was taken as the critical value. Results. According to the degree of PCNA regression, it was determined that selective intra-arterial chemotherapy for breast cancer with a low proliferative activity index has a statistical advantage in overall survival and average life expectancy (p &lt; 0.05) compared with control group. Conclusions. Using the PCNA indicator, one can reliably evaluate the proliferative activity of the tumor, thus predicting the effect of neoadjuvant chemotherapy and choosing the optimal tactics of complex treatment. Keywords: locally advanced breast cancer, proliferative activity index, marker of nuclear antigen of proliferating cells, systemic polychemotherapy, selective intra-arterial polychemotherapy.

Oncologists’ views on Expanded Access and Right-to-Try: The need for education and shared decision-making.

e13603 Background: Over half of Americans report favoring access to experimental treatments even if they have yet to be proven either safe or effective, yet only 3-5% are enrolled in clinical trials and a fraction of a percent in expanded access. The Expanded Access (EA) program (aka “compassionate use”) and Right-to-Try (RTT) are parallel federal mechanisms that offer qualifying patients access to off-trial experimental treatments. Our study aimed to capture the views and experiences of oncologists on obtaining eligible medicine using the FDA’s EA and is the first to report findings on physician attitudes toward RTT. Methods: We conducted 21 semi-structured interviews and qualitative analysis of oncologists at a major cancer center with 3 main sites across the U.S. Participants were purposely selected to have experience with EA. Results: Oncologists’ considerations for offering EA options to patients were based on a sound scientific rationale, reasonable risk-benefit ratio, functional status of the patient, and patient motivation. Although oncologists’ experience positively correlated with level of ease in navigating EA, most remained largely unfamiliar with RTT. Only 4 oncologists had experience discussing RTT with patients and none had obtained an experimental therapeutic under this pathway. When informed about RTT, oncologists articulated 3 sets of concerns including limited safety and oversight, unclear structure and lack of requirements to collect and report data, and the potential for inflating patient expectations. Published work by others have shown that patients desire experimental options to be offered and report that physicians do not always offer experimental medicine taking into account factors, such as, reimbursement. Given that oncologists may factor in variables such as patient motivation, and potentially affordability or health literacy, when considering whether experimental medicine is appropriate to offer their patient, there may be a need to develop a conversation aid so that clinically relevant options are presented to patients equitably and patient choice is enhanced. Conclusions: Further research to better understand patient perspectives and potential discordant views between patients and oncologists is needed in order to design shared decision-making tools to inform oncologists about off-trial preapproval pathways and help both oncologists and patients navigate the thorny issues of experimental oncology.

Implementing a Transportation Hub: A holistic approach to a systemic problem

Editor's Note: In this edition of Oncology Issues, 2021‐2022 Association of Community Cancer Centers President Krista Nelson, MSW, LCSW, OSW‐C, FAOSW, announced her President's Theme: “Real‐World L...

Carrie's TOUCH: Supporting Black Women with Breast Cancer

Editor's Note: In this edition of Oncology Issues, 2021‐2022 Association of Community Cancer Centers President Krista Nelson, MSW, LCSW, OSW‐C, FAOSW, announced her President's Theme: “Real‐World L...

Oncological issues in staging mediastinal lymph node metastasis for left lung cancer

ObjectiveWe aimed to discuss the underlying oncological issues in staging of mediastinal lymph node metastasis in patients with left lung cancer who underwent extended radical lymphadenectomy (ERL). MethodsThis multi-institutional retrospective study analyzed 116 patients with left non-small-cell lung cancer who underwent bilateral paratracheal lymph node dissection (ERL) via median sternotomy. The clinicopathological records of patients with mediastinal lymph node metastasis were examined for prognostic factors, including age, sex, histology, tumor size, cN number, preoperative data, metastatic stations (number and distribution), pT, and adjuvant chemotherapy. ResultsMediastinal lymph node metastases were found in 43 patients, and right paratracheal lymph node metastases (pN3) were found in 13 patients. The 5-year overall survival rate was 25.2% in patients with pN3 tumors (n = 13) and 23.1% in patients with pN2 tumors (n = 30). The prognosis did not differ between patients with pN3 and pN2. Univariate analyses showed that histology, cN, and adjuvant chemotherapy were significant prognostic factors in patients with mediastinal lymph node metastasis. In these 43 patients, cN and adjuvant chemotherapy were significant independent prognostic factors in multivariate analysis. ConclusionsThe prognostic factors for left lung cancer with mediastinal lymph node metastasis were cN status and adjuvant chemotherapy, and not pN status (pN2 or pN3). We hope that the study results, which suggest that there may be no difference in prognosis between pN2 and pN3, would broaden the discussion of oncological issues in the staging of mediastinal lymph node metastasis of left lung cancer.