Role In Cancer Care Research Articles

Enhancing cancer care through addressing a neglected pillar: a narrative review on quality of life in Pakistani patients.

The current narrative review was planned to evaluate the quality of life of Pakistani cancer patients. Using relevant questionnaires and comparing global data over the last 2 decades, the review planned to explore artificial intelligence's role in cancer care, and to develop strategies for better outcomes. The review yielded poor results and exposed huge and neglected gaps in the overall approach towards the management of cancer patients based on different tumour types and categories. A few experimental interventions demonstrated promising results and echoed the need for further clinical and non-clinical experimentation for negating poor quality of life outcomes. Unsurprisingly, not a single study in the literature analysed, revealed a positive quality of life. A multi-pronged approach, therefore, must be brainstormed and safely implemented through experimentation of artificial intelligence and active coordination among healthcare bodies, finance/economic boards and welfare organisations that are active in countries like Pakistan to uplift the neglected quality of life domain among cancer patients, especially breast and oral cancers that have the highest incidences worldwide.

Geriatric assessment for the practicing clinician: The why, what, and how.

Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.

Early identification of people at high risk of oral cancer-A review of existing risk prediction models.

Prediction plays a ubiquitous role in cancer care. At every stage of the illness, the patient, the physician, and the family must make numerous decisions. Utilizing epidemiological, clinical, biological, lifestyle, and genetic factors, a cancer-specific risk assessment model calculates the likelihood of developing cancer. In India, oral cancer ranks as the fourth most common cancer, affecting nearly 3,000,00 individuals annually. Because it is in the premalignant stage, oral cancer is easily detectable in the oral cavity. Prompt identification of this lesion can result in better outcomes and a higher standard of living. Advanced statistical techniques have been used to develop prediction algorithms or risk scores that identify individuals with a high risk of developing oral cancer. With the aid of these risk assessment models, specific individuals can be screened to aid in the early detection of the disease, which may result in better outcomes and lifestyle modifications. Finding the best model among the current risk models for oral cancer may be aided by a thorough examination of all these models. Finding and assessing the risk model that primary care physicians can use and easily apply in clinical practice will be made easier with a succinct and straightforward comparison of the models. This review compares the current models to determine which has the best performance metrics, which could lead to a better understanding of the advantages and disadvantages of various risk prediction models of oral cancer.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Among 775,289 individuals diagnosed with cancer (median age: 68years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001). Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.

Communication between Caregivers of Adults with Cancer and Healthcare Professionals: a Review of Communication Experiences, Associated Factors, Outcomes, and Interventions.

Family/unpaid caregivers play an important role in cancer care. This review aims to summarize caregiver communication experiences with healthcare professionals (HCPs). The Caregiver-Centered Communication model defines five core functions that HCPs should achieve when interacting with caregivers, including fostering relationships, exchanging information, recognizing and responding to caregiver emotions, aiding in decision making, and assisting in patient care management. The literature shows that caregivers have both positive and negative communication experiences with HCPs with respect to these five core functions. Factors at the caregiver (e.g., demographic characteristics, information sources, caregiving duration, health status), patient (e.g., demographic and clinical characteristics), and HCP levels (e.g., time constraints in clinical settings, communication skills) are associated with caregiver-HCP communication quality. Studies further show that these communication experiences may affect caregiver outcomes, including quality of life, mental health, resilience, and satisfaction with cancer care. Moreover, poor quality caregiver-HCP communication is associated with patient readmission to the hospital and unmet care needs. Interventions for caregivers or patient-caregiver dyads have been shown to enhance caregiver confidence and increase their engagement in communication with HCPs. Interventions for HCPs have shown efficacy in improving their communication skills, particularly in involving caregivers in decision-making discussions. Given time constraints during medical visits, we suggest conducting a caregiver assessment by navigators prior to visits to understand their communication needs. Additionally, reimbursing HCPs for time spent communicating with caregivers during visits could be beneficial. More research is needed to better understand how to enhance caregiver-HCP communication quality.

Abstract PO4-08-08: Is it time for a European BRCA Mutation Registry? An Italian experience

Abstract Background: Knowledge of BRCA 1/2 mutation plays an important role in cancer care. The National Plan to improve BRCA detection in order to increase access to target agents and ameliorate the prevention strategy has several implementations in the Italian regions. Recent guidelines are considering extending genetic testing to a larger population, regardless of family history. We present our experience in Apulia Region on the detection of BRCA 1/2 and its clinical implication at the regional level, to underline the importance of spreading the extension of BRCA detection at the regional level and to propose the creation of a European register for BRCA patients, based on population-based BRCA 1/2 testing. Methods: This is an observational study conducted at a Familiar Cancer Service of the Lecce Hospital. Participants completed a questionnaire (socio-demographic epidemiology of cancer and lifestyle factors), genetic counseling and BRCA testing. Notably, genetic testing for BRCA mutations was carried out based on family cancer history since 2018, according to the Italian cancer guidelines (AIOM) and related updates in 2019 and 2023. A mutational analysis of exons and adjacent intronic regions of BRCA1/BRCA2 genes was performed by Sanger sequencing and MiSeq Illumina NGS platform. Results: Between 2014 and May 2023 a total of 4365 patients were enrolled in the study, of whom 2426 (56%) was evaluable for BRCA detection, 18% men (n=440) and 82% female (n=1986). Median age at diagnosis was 57 yrs. 65% of patients had a cancer diagnosis (n=1575) and 35% were healthy carriers (n=851). In particular, breast cancer (BC) was present in 63% of patients (n=1048), ovarian cancer (OC) in 21% (n=352), pancreatic cancer in 5% (n=85), prostate cancer in 4% (n=65), melanoma in 1% (n=13), and other cancers in 6% (n=92). The table 1 (uploaded) shows the results of patients with BC (n=1048) The presence of BRCA mutation is observed in 20.52% of BC patients (1:4.87). Conclusion These data confirm that BRCA mutation detection is an emerging need to improve prevention and early diagnosis according to the European Beating Cancer Plan. Therefore, it is crucial to improve this topic at regional level until the creation of a shared BRCA registry among European countries. Table. Citation Format: Elisabetta De Matteis, Mariangela Ciccarese, Paolo Tarantino, Tiziana Grassi, Francesco Bagordo, Emanuele Rizzo, Maria Rosaria Tumolo, Graziana Ronzino, Maria Rita De Giorgio, Salvatore Mauro, Nicola Di Renzo. Is it time for a European BRCA Mutation Registry? An Italian experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-08-08.

Bibliometric Analysis of Randomized Controlled Trials on Yoga Interventions for Cancer Patients: A Decade in Review.

This literature review presents a bibliometric analysis of the randomized controlled trials conducted between 2014 and 2023 on the potential benefits of yoga as a complementary therapy for cancer patients. To conduct this analysis, we searched medical and scientific databases, such as Scopus, Cochrane, and PubMed, using relevant keywords. Our search yielded 58 clinical trials involving 4,762 patients, which indicates a growing trend in this field of research. The studies we reviewed mainly focused on breast cancer patients and demonstrated the adaptability and versatility of yoga, offering a ray of hope and optimism. Among the various styles of yoga, Hatha yoga was the most frequently practiced style in these clinical trials. The analysis we conducted reveals that yoga interventions have a promising role in cancer care and can be a valuable complementary therapy for cancer patients. However, significant gaps and limitations still need to be addressed in this area of research. For instance, more rigorous and diverse investigations are needed to further establish the potential benefits of yoga interventions for cancer patients. Additionally, the standardization of yoga interventions is crucial to optimize therapeutic benefits. By addressing these gaps and limitations, we can further enhance the potential of yoga as a complementary therapy for cancer patients.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study.

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps. To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals. Multiexplanatory qualitative case study. Community and hospital cancer clinics in Israel. Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants. Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care. Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Opportunities for interventional radiology in paediatric oncology

Interventional oncology (IO) has emerged as a pivotal field within interventional radiology (IR), gaining prominence in the past three decades. It has transcended its initial role in cancer care, expanding beyond biopsies and vascular access to offer a spectrum of percutaneous and transarterial procedures, transforming into a curative and palliative discipline. However, implementing IO in children presents distinctive challenges. While the technical aspects of IO procedures mirror those in adults, paediatric cases require specialised considerations. Radiologists must possess an in-depth understanding of the paediatric disease, tailor imaging modalities to the case, discern unique risks, and interpret disease markers specific to children. Notably, paediatric tumour biopsies demand significantly larger tissue samples for genetic sequencing, staging, and prognostication. Paediatric IO also confronts procedural disparities. Tumours in children may be larger relative to body size, necessitating precise radioembolisation dose calculations. The proximity of critical structures in small bodies amplifies the risk of collateral damage. When performing percutaneous ablation and endovascular therapies, these challenges must also be faced so that radiologists can navigate these complex clinical and technical considerations to ensure safe and effective interventions, all while prioritising the well-being of their young patients. This review summarises the current role and future opportunities for IO in paediatric cancer.

Current Perspectives on the Evolving Role of Radiation Therapists – Highlights from ESTRO23

Radiation therapists, also called Therapeutic Radiographers or Radiation therapy technologists (RTTs) are uniquely placed within the radiotherapy (RT) multidisciplinary team, as the use the technology and deliver the treatment but they are also patient focused. The implementation of technological advancements such as image-guided radiotherapy (IGRT), adaptive radiotherapy (ART), surface-guided radiotherapy (SGRT), and AI-based solutions necessitates acquiring new skills and competences. RTTs' daily involvement in patient's treatment allows the assessment of their needs and perspectives. Implementing a holistic approach to patients' comfort during RT, beyond positioning and immobilisation, reduces anxiety and increases compliance. The RTTs offer valuable feedback regarding potential challenges or improvements after new technology or new procedures’ implementation, essential for the enhancement of these innovations. Complex educational interventions focused on modern technology, communication and research competencies are required so that RTTs can optimally fulfil their essential role in cancer care.

Patients' and professionals’ experiences with advanced practice nursing in cancer care: A qualitative study

PurposeThe growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by advanced practice nurses (APN). MethodsPhenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness. ResultsInterviews were performed with 18 professionals and 11 patients, from high-complexity public hospitals between March–December 2021. The main themes that emerged were: Advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care. ConclusionAdvanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers.

Adult Hospitalists' Knowledge of Radiation Oncology in an Independent Nonacademic Healthcare System in Albuquerque, New Mexico.

Radiation oncology (RO) plays a crucial role in cancer care; cancer patients often undergo their initial diagnostic study by general physicians. However, studies have shown that most physicians are uncomfortable referring cancer patients to radiation therapy (RT). To assess the knowledge of RO among non-oncology physicians, we sent invitations to complete an online survey that required the responders to self-rate their understanding of RT and objective assessment. The survey was targeted at hospitalists and primary care physicians. Forty physicians responded to the survey, and 89.7% practiced primarily as hospitalists, with 67% being Internal Medicine graduates. Fifty percent of physicians have referred patients to RO before, although more than 90% have not done additional CME (continuing medical education) in Oncology. More than 50% of recent graduates (one to five years post-residency) self-rated themselves as "not knowledgeable" when it comes referral process to RO as well as general knowledge regarding RT. Factors, such as "type of cancer," "patients' wishes," and "life expectancy," are most cited as factors influencing the decision for a referral.

Functional Imaging of Hypoxia: PET and MRI.

Molecular and functional imaging have critical roles in cancer care. Existing evidence suggests that noninvasive detection of hypoxia within a particular type of cancer can provide new information regarding the relationship between hypoxia, cancer aggressiveness and altered therapeutic responses. Following the identification of hypoxia inducible factor (HIF), significant progress in understanding the regulation of hypoxia-induced genes has been made. These advances have provided the ability to therapeutically target HIF and tumor-associated hypoxia. Therefore, by utilizing the molecular basis of hypoxia, hypoxia-based theranostic strategies are in the process of being developed which will further personalize care for cancer patients. The aim of this review is to provide an overview of the significance of tumor hypoxia and its relevance in cancer management as well as to lay out the role of imaging in detecting hypoxia within the context of cancer.

A Precise Review: Cancer Diagnosis, Detection, and Treatment in Light of Informatics

Background: Cancer, recognized as one of the most lethal diseases of the 21st century, poses a grave threat to human lives. Scientists are persistently engaged in a quest to find effective treatments for this disease. Cancer informatics offers a fresh perspective by focusing on the comprehensive and efficient acquisition, storage, and utilization of cancer-related information. It aims to enhance our understanding and management of cancer by optimizing the processes involved in accessing and analyzing cancer data. Aim: We explore technological advancements that leverage the potential of cancer informatics to achieve rapid diagnosis and successful treatment of these life-threatening illnesses. Specifically, we delve into the utilization of artificial neural networking, which employs statistical, probabilistic, and optimization techniques to enable machines to learn from past instances. This enables them to identify intricate trends that may be challenging to discern within extensive, chaotic, or complex datasets. Bioinformatics: OMICS technologies exhibit high-throughput interfaces that enable the comprehensive exploration of the genome, epigenome, transcriptome, proteome, and metabolome in an unbiased manner on a global scale. Furthermore, we examined the concept of Precision medicine (PM), which disruptively takes into account both individual variations and population characteristics to deliver customized treatment approaches. Additionally, Nanotechnology holds tremendous promise in transforming medicine to become more personalized, predictive, and preemptive. Lastly, Radiotherapy (RT) plays a crucial role in cancer care, benefiting approximately 50% of all patients, and is an indispensable component of their treatment plans. Conclusion: While we delve into these modern techniques, it is important to acknowledge that every technology has its limitations, which we have also addressed in this review. However, amidst these limitations, we have explored the specific types of cancer for which each technique holds the most promise and benefits. This discussion offers a silver lining by highlighting the potential areas where these techniques can be particularly advantageous.

Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers.

Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.

Abstract 3361: Clinical and genomic correlates of liquid biopsy (LB) derived variant allele frequency (VAF) in advanced NSCLC patients

Abstract Background: Initially developed as an alternative to tissue-based molecular assessment, LB is expanding its role in cancer care, with quantitative measure of blood ctDNA being tested for response prediction, response assessment and minimal residual disease detection. Its use for molecular classification has been extensively validated, but little is known about determinants of shedding parameters such as VAF. While it is correlated with tumor burden, characteristics of the tumor such as site of metastasis or particular mutations may have a role. Scope of this study is to elucidate these factors. Methods: Data from advanced NSCLC patients included in two prospective cohorts who received a LB with 36-genes InVisionFirst-Lung (INI) and the 324-gene FoundationOne Liquid CDx (FMI) assays were reviewed and patients with available 18F FDG positron emission tomography scan (PET) performed within 30 days from LB were included. Total Metabolic Tumor Volume was calculated for each PET with a 42% SUVmax threshold. The higher VAF (mVAF) was calculated for each LB, excluding germline mutations and clonal hematopoiesis-related variants. Patients should be either untreated or with progressive disease at the time of LB. Regression analysis was performed according to a rank-based estimation model. Results: Overall 301 LB were included, 119 with InVisionFirst-Lung and 182 with FoundationOne Liquid CDx. LB were contributive in 154 (85%) FMI and 102 (86%) INI. MaxVAF was correlated with tMTV in FMI ( rho 0.3571, p 0.0004) and IVI (rho 0.3387, p = 0.0003) cohort. In FMI cohort, median mVAF was higher for TP53 mutant vs wt (n= 111, mVAF 21.1 % vs 8.0%, p &amp;lt; 0.0001), RB1 mutant (n = 11, mVAF 26.3% vs 4.7%, p 0.0103) and in those with liver metastasis ( p 0.0089). LDH was correlated to mVAF (rho 0.280, p = 0.0037). In multivariate model, tMTV (p &amp;lt; 0.0001), TP53 mutation ( p 0.0039), RB1 mutation (p 0.0003) and liver metastasis ( p 0.0371) remained significantly associated with mVAF. When LDH was added to the model (LDH available for 119 pts), tMTV lost its significance (p 0.561). In INI cohort, median mVAF was also higher in patients with TP53 mutation ( 7.1% vs 3%, p 0.0038), in patients with liver metastasis ( 10.1% vs 4.6%, p 0.0299), and it was correlated with tMTV (rho 0.502, p &amp;lt; 0.0001). It was confirmed in a multivariate model (p &amp;lt; 0.0001 for tMTV and 0.0049 for TP53). Correlation between mVAF and LDH was also seen (LDH available for 54 pts, rho 0.591, p &amp;lt; 0.0001). Among patients with liver metastasis, mVAF was correlated with MTV of liver lesions in FMI (n = 30, rho = 0.212, p = 0.0069) and INI cohort (n= 26, rho 0.204, p 0.0313). Overall, in patients with LDH &amp;lt; ULN, 18/103 were non contributive, vs 4/70 in those with LDH &amp;gt; ULN. Conclusion: In patients with aNSCLC, mVAF depends on disease burden, on the molecular characteristics of the disease and on the presence and extent of liver disease. LDH levels above ULN predict the presence of ctDNA and percentage of mVAF. Citation Format: Filippo Gustavo Dall'Olio, Damien Vasseur, Camilo Garcia, Arianna Marinello, Mihaela Aldea, Laura Mezquita, Jordi Remon, Anas Gazzah, Marco Tagliamento, Kristi Beshiri, Pernelle Lavaud, Maud Ngocamus, David Planchard, Etienne Rouleau, Antoine Italiano, Benjamin Besse. Clinical and genomic correlates of liquid biopsy (LB) derived variant allele frequency (VAF) in advanced NSCLC patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3361.

What is the role of the children's community nurse in childhood cancer care?

Aim: To highlight the experiences of children's community nurses (CCNs) within cancer care and to identify their day-to-day roles and responsibilities. Method: Questionnaires were completed by 12 CCNs and oncology specialist nurses within London, these were analysed using a coding software. Findings: Children and their families perceive CCNs as knowledgeable, happy and friendly professionals, essential in reducing hospital admissions and who have a positive impact on a child and their family's well-being. The CCN has a varied role in cancer care, however, currently in the UK there is no framework specific to caring for a child at home with cancer. In response to the findings, one has been written to identify care needs and to emphasise service expectations. Conclusion: Specific training for caring for a child with cancer should be prioritised for all staff working within a CCN team and to ensure best practice, the framework should be implemented once reviewed and services re-evaluated.

Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care.

This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.

The Ketogenic Diet: Considerations for Cancer Survivorship.

This article aims to evaluate the current practice of the ketogenic diet (KD) in oncology by discussing feasibility, impact on quality of life, and implications for dietetic practice. Articles discussed were selected based on an adult oncology population with emphasis on publications from the last 5years. There is a paucity of randomized prospective trials and articles reviewed were heterogeneous in nature, limiting the ability to draw conclusions about the KDs role in cancer care and survivorship. Despite the lack of evidence, patients with cancer are interested in KD. The authors highlight barriers to supporting implementation of KD and recommend the inclusion of a registered dietitian with experience in KD to ensure safety and support the nutrition goals of patients with cancer. Thorough, well-designed randomized control trials are needed to elucidate the potential advantages of this diet therapy in cancer care and survivorship.

Temporal trends in Black-White disparities in cancer surgery and cancer-specific survival in the United States between 2007 and 2015.

The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015. Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.