Solid Tumor Oncology Research Articles

BELZUTIFAN-INDUCED HYPERSENSITIVITY PNEUMONITIS

BELZUTIFAN-INDUCED HYPERSENSITIVITY PNEUMONITIS

Blood Transfusion is Associated With Adverse Outcomes in Pediatric Solid Tumor Oncology Patients Following Tumor Resection.

Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown. We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection. Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P =0.031). Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused. Level III.

Improving resident education on the inpatient solid tumor oncology rotation through development of an asynchronous video curriculum.

e23014 Background: As the oncology patient population grows, continued recruitment of talented individuals is essential. Meaningful and highly educational clinical exposures play a crucial role in a resident’s decision to pursue fellowship in oncology. Currently, the majority of oncology exposure occurs in the inpatient setting, where trainees are confronted with many competing clinical demands, leaving minimal time for teaching. Prior work has demonstrated that dedicated time for teaching supplemented with high-yield educational material improves trainee satisfaction and interest in a particular field. We hypothesize that implementing an asynchronous inpatient video oncology curriculum will improve resident clinical competency and satisfaction. Methods: This is an ongoing, single institution educational intervention using the Kern method for curriculum development in the Johns Hopkins Osler Internal Medicine Residency (IRB00307077). A targeted needs assessment has been developed to identify gaps in medical knowledge, assess preparedness in managing common solid tumor inpatient diagnoses, and explore satisfaction with prior educational experiences on this service. Based on these results, ten educational videos will be created by content experts and aligned with the learning objectives of the Osler residency program and ABIM blueprint. Trainees will have dedicated time to watch the videos during their solid tumor rotation. We plan to evaluate effectiveness of our curriculum by measuring completion rates and pre- and post-video multiple choice responses. We will also assess knowledge retention and resident satisfaction at three and six months post-rotation with online questionnaires. Results: Annual Osler program ACGME survey data review revealed a high level of resident dissatisfaction with the oncology clinical experience compared with other rotations. While 83.3% of residents rated their general internal medicine experience as “excellent,” only 52.4% rated their oncology experience as “excellent.” Needs assessment data collection has been delayed by the COVID-19 pandemic but is ongoing. Following topic selection, videos will be created in April 2022 with plans for video curriculum implementation in July 2022. Conclusions: In order to attract and retain trainees in the field of oncology, it is imperative that educational curricula adapts to meet learners’ needs. Efficient, evidence-based instructional strategies designed to promote clinical competency for internal medicine residents on an inpatient solid tumor service may foster engagement and rotation satisfaction. We are currently evaluating how an asynchronous video inpatient oncology curriculum may significantly improve the inpatient internal medicine trainee experience. If successful, this curriculum can be adapted for other trainees and practitioners new to the field of oncology.

Reducing oncology readmissions through a multidisciplinary discharge approach.

6561 Background: Hospital readmissions are associated with increased health care utilization and unfavorable patient outcomes. Oncology patients have an increased risk of hospital readmission compared to the general patient population. The 30-day readmission rate for cancer patients at our institution is 27.7% which is higher than the reported national average of 20.2%. We sought to reduce 30-day hospital readmission rates by 25% for solid tumor oncology patients through a prospective integrated multidisciplinary discharge approach. Methods: Hospital readmissions for adult patients with a known solid tumor cancer diagnosis admitted to the oncology service at UVA from Jan 2019 – Apr 2019 were identified. Baseline information on tumor type, reason for readmission, interventions, length of stay (LOS), and inpatient morbidity and mortality (including ICU admission and transition to hospice) were collected via retrospective review. Qualitative and quantitative tools including process maps, cause-and-effect diagrams, Pareto charts, and priority matrix were used to identify potential areas for intervention. Two PDSA cycles were implemented: daily multidisciplinary discharge rounds with physicians, nursing, social work, case management, and PT/OT (PDSA1), and a templated discharge email to patients’ primary oncology team including attending oncologist, mid-level providers, nurse coordinator, pharmacist, and urgent care team (PDSA2). An SPC chart with 3-σ limits and t-test of unequal variance with 2-sided p-value was used to evaluate impact on readmission rates from baseline to PDSA2. Results: Following PDSA1 (May 2019 – Oct 2019), the 30-day readmission was 25.7%; PDSA2 was postponed due to COVID-19, however the 30-day readmission rate remained stable during the pandemic. Following PDSA2 (Sept 2021 – Dec 2021), the 30-day readmission rate was 18.2% corresponding to an absolute decrease of 34.3% which was statistically significant (p≤0.05). This was associated with a trend towards increased LOS, rate of ICU admission, and case-mix severity index although not statistically significant. There was no significant difference in inpatient mortality or transition to hospice (Table). Conclusions: Implementation of multidisciplinary discharge rounds and templated discharge communication resulted in a significant decrease in rate of 30-day readmissions for solid tumor oncology patients. There was a trend towards increased LOS and ICU admissions without increased inpatient mortality. Improvement in discharge email compliance and implementation of an urgent symptom clinic may further reduce the 30-day readmission rate. [Table: see text]

Racial/ethnic disparities in serious illness communication for patients with cancer.

6540 Background: Racial/ethnic disparities in serious illness communication exist between patients with cancer and their oncologists. Our prior work has shown that goals of care discussions are three minutes shorter with racial/ethnic minority patients. In this study, we sought to compare oncologist's use of serious illness communication skills, patient participatory behavior, and overall communication quality during encounters with patients with advanced cancer of different self-reported races/ethnicities. Methods: We analyzed baseline recordings from a two-arm multisite randomized controlled trial to test a coaching model of communication skills training for solid tumor oncologists and their newly diagnosed advanced cancer patients. We audio recorded post-imaging patient-oncologist encounters for patients receiving systemic cancer treatment and coded transcripts for oncologist's use of serious illness communication skills (coded as count/encounter): open-ended questions, reflections, empathic responses to patient empathic opportunities, empathic statements, “sorry” statements, and elicitation of questions. We also assessed global codes of oncologist communication (assessed on 5-point Likert scales): flow, concerns addressed, attention, warmth, and respect. Finally, we coded patient participatory behavior (coded as count/encounter): asking questions and assertive responses. We compared the skills and behaviors by race/ethnicity of the patient using the non-parametric Kruskal-Wallis test. Results: We included the 56 (38%) recordings with oncologists who did not receive the intervention. The patients in these encounters were 25 (45%) female; 32 (57%) over the age of 65; 23 (41%) White Non-Hispanic, 20 (36%) Black Non-Hispanic, and 11 (20%) Hispanic. Overall, oncologists responded empathically to patients’ emotions only 19% of the time. Oncologists used fewer reflective statements with Black Non-Hispanic patients (mean 0.3 statements/encounter) as compared to White Non-Hispanic patients (1.1) and Hispanic patients (1.1), p = 0.02. Furthermore, coders rated oncologists as being less likely to address concerns of Black Non-Hispanic patients (mean Likert scale 3.1) as compared to White Non-Hispanic (3.8) and Hispanic (3.4) patients, p = 0.04. Finally, coders rated oncologists as having less warmth with Black Non-Hispanic patients (mean Likert scale 2.9) as compared to White Non-Hispanic (3.8) and Hispanic (3.3) patients, p = 0.04. Conclusions: In this diverse sample of patients with advanced cancer, oncologists used fewer reflective statements, were less attentive to concerns, and expressed less warmth with Black Non-Hispanic patients. Interventions are needed to overcome these striking racial/ethnic disparities in serious illness communication for patients with cancer.

Patient specific factors associated with inpatient hospital length of stay for solid tumor oncology patients: a retrospective cohort study

Patient specific factors associated with inpatient hospital length of stay for solid tumor oncology patients: a retrospective cohort study

An appraisal of FDA approvals for adult solid tumours in 2017-2021: has the eagle landed?

In 2016, the then US President Barack Obama announced the Cancer Moonshot with a view to making 10 years' worth of progress in cancer prevention, diagnosis and treatment in only 5 years. This Perspective evaluates the FDA approvals of therapeutic agents for use in solid tumour oncology for the period 2017-2021 against the aspirations of the Cancer Moonshot. In the past 5 years, the FDA issued an unprecedented 161 new approvals of therapeutic agents for various indications in adult patients with solid tumours. However, less than a third (27%) of the newly approved medicines are supported by unequivocal evidence of an overall survival benefit; most are supported by positive signals from surrogate end points. Herein, the European Society for Medical Oncology Magnitude of Clinical Benefit Scale version 1.1 was used to evaluate the clinical value of the therapies granted FDA approval during the period 2017-2021. The results of this appraisal indicate a low level of clinical benefit for a substantial proportion (~20%) of the new indications, with most (~44%) providing intermediate benefit. The data suggest that, beyond increases in the sheer quantity of approvals, considerable improvement in the quality of the approved treatments is required to more confidently ensure that the clinical benefits are real and substantial enough to clearly justify the risks to patients.

MRD: The Future Foundation of Solid Tumor Trials?

Inside Precision MedicineVol. 9, No. 2 MRD and Clinical TrialsMRD: The Future Foundation of Solid Tumor Trials?The terms minimal residual disease, measurable residual disease, and molecular residual disease, interchangeably referred to as MRD, denote what is left after cancer treatment with curative intent. Originally used to monitor patients with hematologic malignancies, MRD is becoming increasingly important in the field of solid tumor oncology because of its correlation with disease outcomes.Laura CowenLaura CowenLaura Cowen is a freelance medical journalist who has been covering healthcare news for over 10 years. Her main specialties are oncology and diabetes, but she has written about subjects ranging from cardiology to ophthalmology and is particularly interested in infectious diseases and public health.Search for more papers by this authorPublished Online:14 Apr 2022https://doi.org/10.1089/ipm.09.02.03AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 9Issue 2Apr 2022 InformationCopyright © GEN PublishingTo cite this article:Laura Cowen.MRD: The Future Foundation of Solid Tumor Trials?.Inside Precision Medicine.Apr 2022.12-13, 16.http://doi.org/10.1089/ipm.09.02.03Published in Volume: 9 Issue 2: April 14, 2022PDF download

Multidisciplinary Approach to Older Adults with Hematologic Malignancies—a Paradigm Shift

Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.

Epidemiologic and Clinical Analysis of Tumor Mutational Burden (TMB) in Acute Myeloid Leukemia (AML): Exome Sequencing Study of the Mayo Clinic AML Epidemiology Cohort (MCAEC)

TMB is used to guide PD-1-directed immunotherapy in solid tumor Oncology. However, it has not been systematically studied in AML, where the focus has been on cytogenetic risk and individual driver gene mutations (GM's). TMB contribution to AML epidemiology is also uncertain. We therefore studied its association with epidemiologic risk factors; driver GM's and somatic mutations (SM's) in AML risk genes which we recently demonstrated (ABCB1; CYP1A1; CYP2B6; EPHX1; ERCC1,2,& 5; MEFV; MTRR; and TERT); clinical and cytogenetic features; and outcome after therapy in the MCAEC, a highly annotated clinical epidemiology cohort of consecutive AML pts [Finn, Cancer Epidemiol 39:1084, 2015].Methods:We obtained somatic leukemia DNA from remnant diagnostic cytogenetic pellets in 98 MCAEC patients (pts), as previously described [Foran, Blood (2017) 130:570a]. Whole exome sequencing (WES) was performed at depth of ~100 million paired end 100bp reads using Agilent SureSelectXT Human All Exon V5 + UTRs target enrichment kit. Reads were mapped to human genome build hg19 using BWA-MEM. Single nucleotide variants (SNVs) and small INDELs were identified using Mayo Clinic (MC) analytic pipeline GenomeGPS 4.0.1 following Broad GATK variant discovery best practices of alignment, realignment and recalibration, and multi-sample joint genotyping; and filtered using both germline whole exome and genome sequencing of ~1200 MC Biobank samples and public germline variant databases of 1000 genome project, 6500 individuals in exome sequencing project, and HapMap phase 3. Remaining variants were annotated using ANNOVAR, and functional variants of non-synonymous, truncating, frame-shift, and splice-sites were used in the statistical association analyses.TMB was defined as the number of functional mutations per Mb of coding region, heterozygous or homozygous. TMB associations with epidemiologic risk, clinical characteristics, and SM's in AML risk genes (listed above) or driver GM's (occurring in 5 or more pts: ASXL1, BCOR, CEBPA, DNMT3A, FLT3, IDH2, KRAS, MLL2-5, NF1, NPM1, NRAS, PHF6, RUNX1, SF3B1, STAG2, TET2, TP53, U2AF1) were evaluated using linear regression models; a rank transformation of TMB was utilized due to its skewed distribution. Multivariable analysis (MVA) models were adjusted for variables with p-value <0.05 in unadjusted analysis. Regression coefficients (“β”) were estimated, interpreted as change in mean TMB rank for specified variables or characteristic. Associations with outcomes were examined using logistic regression or Cox proportional hazards regression models. All statistical tests were two-sided (version 3.6.2; R Foundation for Statistical Computing, Vienna, Austria).ResultsMedian age at AML diagnosis was 70 yrs (Range: 19-94 yrs), and 67 pts were male. Cytogenetic risk group was favorable (7%), intermediate-normal (46%) or abnormal (20%), and poor risk (27%). 40/61 pts (66%) achieved complete remission (CR). With a median follow-up of 8.0 months (Range: 0.1 - 186), 80 pts (82%) died and 20 (20%) underwent allogeneic transplantation (AlloBMT).Median TMB was 18.2 (Range: 15.0-70.1). In MVA, significant associations with increased TMB were observed in pts with history of prior immunosuppressive therapy or solid organ transplantation (β=19.48, P=0.015), and with FLT3 (β=21.12, P=0.015), MLL2 (β=20.91, P=0.001), and MLL3 (β=11.31, P=0.031) GM's. A borderline association was observed for U2AF1 (β=16.14, P=0.057). TMB was also associated with SM's in TERT (β=25.13, P=0.028); a borderline association with SM's in ABCB1 was not confirmed in MVA (β=-17.98, P=0.069). Additionally, cytogenetic risk group was associated with TMB in MVA (P=0.005), being highest in intermediate-normal and lowest in poor risk groups. Body Mass Index was inversely associated with TMB (unadjusted β=-16.99, P=0.005), but unconfirmed in MVA (β=-8.29, P=0.12).There was no association with CR (OR=0.93, P=0.46), use of (HR=0.96, P=0.64) or relapse risk (HR=1.00, P=0.98) following AlloBMT, or survival (HR=0.97, P=0.56) (Figure).ConclusionsMeasurement of TMB is feasible in this AML epidemiologic cohort, and we observed important associations with AML risk factors, risk gene SM's, cytogenetic risk group, and driver GM's. We acknowledge the relatively small sample size and possibility of type II error, and therefore these observations require validation in a large prospective cohort which is planned. [Display omitted] DisclosuresForan: OncLive: Honoraria; certara: Honoraria; actinium: Research Funding; boehringer ingelheim: Research Funding; novartis: Honoraria; abbvie: Research Funding; servier: Honoraria; taiho: Honoraria; pfizer: Honoraria; revolution medicine: Honoraria; gamida: Honoraria; takeda: Research Funding; sanofi aventis: Honoraria; trillium: Research Funding; syros: Honoraria; aptose: Research Funding; bms: Honoraria; kura: Research Funding; h3bioscience: Research Funding; aprea: Research Funding; sellas: Research Funding; stemline: Research Funding. Murthy: CRISPR Therapeutics: Research Funding. Finn: Jazz: Consultancy, Speakers Bureau; BMS: Consultancy, Speakers Bureau; BeiGene: Consultancy, Speakers Bureau; ADC Therapeutics: Consultancy, Speakers Bureau. Badar: Pfizer Hematology-Oncology: Membership on an entity's Board of Directors or advisory committees. Cerhan: Celgene/BMS: Other: Connect Lymphoma Scientific Steering Committee, Research Funding; Genentech: Research Funding; NanoString: Research Funding; Regeneron Genetics Center: Other: Research Collaboration.

Emerging immunotherapeutic strategies for the treatment of breast cancer.

Immunotherapy has resulted in unprecedented gains in long-term outcomes for many cancer types and has revolutionized the treatment landscape of solid tumor oncology. Checkpoint inhibition in combination with chemotherapy has proven to be effective for the treatment of a subset of advanced triple-negative breast cancer in the first-line setting. This initial success is likely just the tip of the iceberg as there is much that remains unknown about how to best harness the immune system as a therapeutic strategy in all breast cancer subtypes. Therefore, numerous ongoing studies are currently underway to evaluate the safety and efficacy of immunotherapy in breast cancer. In this review, we will discuss emerging immunotherapeutic strategies for breast cancer treatment including the following: (1) Intratumoral therapies, (2) Anti-tumor vaccines, (3) B-specific T-cell engagers, and (4) Chimeric antigen receptor T-cell therapy, and (5) Emerging systemic immunotherapy strategies. For each topic, we will review the existing preclinical and clinical literature, discuss ongoing clinical trials, and highlight future directions in the field.

Malnutrition risk at solid tumor diagnosis: the malnutrition screening tool in a large US cancer institute.

BackgroundIn cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST).MethodsA cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence.ResultsThe median age was 64 years (25–75 IQR, 55–72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%—most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5–2.4, p = < 0.001), cancer primary site (OR 1.6–5.7, p = < 0.001), stage IV disease (OR 1.8, 95% CI 1.4–2.2, p = < 0.001), low BMI (OR 4.2, 95% CI 2.5–6.9 p = < 0.001), and higher symptom scores were all independently associated with H-MST.ConclusionsTwenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06612-z.

Examining patient specific factors associated with inpatient hospital length of stay for solid tumor oncology patients from low socioeconomic communities in Milwaukee, WI.

232 Background: In a retrospective analysis at the Medical College of Wisconsin’s Cancer Center, we identified longer inpatient length of stay (LOS) for patients residing in low-socioeconomic (SES) ZIP Codes in Milwaukee County compared to their high-SES counterparts in 2020 (7.3 days compared to 7.1 days). Under the auspices of American Society of Clinical Oncology’ Quality Training Program (QTP) initiative, this study examined specific factors related to prolonged LOS for solid tumor oncology patients. Methods: This analysis includes initial CY20 LOS medical record data for select patient service areas. Supplemental data includes disease registry data, diagnostic data, and SES data determined by patient ZIP Code. We identified patients 18 years and older with a diagnosis of common oncologic malignancies from 1/1/2020-12/31/2020 (breast, gastrointestinal (GI), genitourinary (GU), gynecologic (GYN), head and neck (H&amp;N), and lung cancers). Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 1,637 patients with solid tumor diagnosis admitted to hematology and oncology units were identified. The LOSi did not vary significantly by race (range 0.95 – 1.07, p = 0.40) or primary payer (range 0.99 – 1.04, p = 0.59), but lower SES groups tended to have longer LOSi, with LOSi ratio above 1 compared to high SES (low SES: 1.16, p = 0.2; medium-low SES: 1.24, p = 0.06). Among patients with breast cancer diagnosis, Black (LOSi = 1.24, p = 0.01), medium-low SES (LOSi = 1.46, p = 0.02), Medicaid (LOSi = 1.40, p = 0.00), underweight (LOSi = 1.66, p = 0.00), and overweight (LOSi = 1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Among patients with H&amp;N cancer diagnosis, Black patients (LOSi = 0.77, p = 0.02) had slightly shorter LOSi, with LOSi ratio below 1. The LOSi did not vary significantly by other factors for patients with H&amp;N cancer diagnosis or the other common oncologic malignancies evaluated. Conclusions: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS. Healthcare systems may benefit by addressing patient-specific barriers and factors such as body mass index, SES and SDH, to reduce hospital LOS.

Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.

233 Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &amp;3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = &lt; 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.

Addressing the disparities and the factors related to prolonged inpatient length of stay for solid tumor oncology patients during the COVID-19 pandemic: A narrative review

Solid tumor oncology treatments are primarily performed in the outpatient setting. However, hospitalizations are inevitable due to complications of cancer and treatment-related toxicities. With rising health care spending, the length of hospital stay (LOS) is increasingly considered a proxy for healthcare costs. There are several ongoing eff orts to abbreviate the inpatient LOS and ensure a safe and timely discharge to the outpatient setting. In addition to the acute illness and the associated comorbidities, various factors aff ect the LOS: social determinants of health (SDOH), nutritional status in cancer patients, and end-of-life issues. Furthermore, it is unclear how the institutional policies on social distancing and visitation during the current coronavirus disease (COVID-19) pandemic may impact the LOS. The purpose of this article is to review various factors and barriers that lead to longer LOS for solid tumor patients during the COVID-19 pandemic, and identify the critical areas of quality improvement.

End-of-life transitions for family member on the solid tumour oncology ward: the 3 Wishes Project

ObjectivesAlthough death is not uncommon for hospitalised patients with cancer, there are few interventions in oncology that are designed to create a dignified, compassionate end-of-life (EOL) experience for patients and...

Addressing the Disparities and the Factors Related to Prolonged Inpatient Length of Stay for Solid Tumor Oncology Patients during the COVID-19 Pandemic: A Narrative Review

Solid tumor oncology treatments are primarily performed in the outpatient setting. However, hospitalizations are inevitable due to complications of cancer and treatment-related toxicities. With rising health care spending, the length of hospital stay (LOS) is increasingly considered a proxy for healthcare costs. There are several ongoing efforts to abbreviate the inpatient LOS and ensure a safe and timely discharge to the outpatient setting. In addition to the acute illness and the associated comorbidities, various factors affect the LOS: social determinants of health, nutritional status in cancer patients, and endof- life issues. Furthermore, it is unclear how the institutional policies on social distancing and visitation during the current coronavirus disease (COVID-19) pandemic may impact the LOS. The purpose of this article is to review various factors and barriers that lead to longer LOS for solid tumor patients during the COVID 19 pandemic, and identify the critical areas of quality improvement.

Differential frequency in imaging-based outcome measurement: Bias in real-world oncology comparative-effectiveness studies.

BackgroundComparative‐effectiveness studies using real‐world data (RWD) can be susceptible to surveillance bias. In solid tumor oncology studies, analyses of endpoints such as progression‐free survival (PFS) are based on progression events detected by imaging assessments. This study aimed to evaluate the potential bias introduced by differential imaging assessment frequency when using electronic health record (EHR)‐derived data to investigate the comparative effectiveness of cancer therapies.MethodsUsing a nationwide de‐identified EHR‐derived database, we first analyzed imaging assessment frequency patterns in patients diagnosed with advanced non‐small cell lung cancer (aNSCLC). We used those RWD inputs to develop a discrete event simulation model of two treatments where disease progression was the outcome and PFS was the endpoint. Using this model, we induced bias with differential imaging assessment timing and quantified its effect on observed versus true treatment effectiveness. We assessed percent bias in the estimated hazard ratio (HR).ResultsThe frequency of assessments differed by cancer treatment types. In simulated comparative‐effectiveness studies, PFS HRs estimated using real‐world imaging assessment frequencies differed from the true HR by less than 10% in all scenarios (range: 0.4% to −9.6%). The greatest risk of biased effect estimates was found comparing treatments with widely different imaging frequencies, most exaggerated in disease settings where time to progression is very short.ConclusionsThis study provided evidence that the frequency of imaging assessments to detect disease progression can differ by treatment type in real‐world patients with cancer and may induce some bias in comparative‐effectiveness studies in some situations.

Systematic Review of Infectious Events in Prospective Trials of Ibrutinib

Systematic review of infectious events in prospective trials of IbrutinibIbrutinib is an oral small molecule inhibitor of Bruton tyrosine kinase (BTK). It is efficacious in the treatment of multiple B cell lineage disorders including chronic lymphocytic leukemia, mantle cell lymphoma and Waldenström macroglobulinemia. Use is expanding with ongoing clinical trials in solid tumor oncology as well as recent FDA approval for the treatment of chronic graft versus host disease (GVHD). As experience with newer targeted agents increases we are developing better appreciation and recognition of sometimes unanticipated toxicities. While the most common side effects with ibrutinib are rash and diarrhea, signals of concern have been seen with adverse effects related to hemorrhage, pneumonitis and recent attention to cardiac arrhythmias. Based on our own institutional experience, we updated a preliminary systematic review of infectious events in prospective trials of ibrutinib in the treatment of hematologic disorders.We reviewed the published literature and major conference abstracts using PubMed, Google Scholar and HemOnc.org. Publications through July 1, 2017 were included in the evaluation. All prospective trials of ibrutinib for the treatment of hematologic malignancies were included in the analysis. Those trials involving solid oncologic tumors, GVHD or following allogeneic stem cell transplant were excluded. Infectious events included pneumonia, sepsis, genitourinary and respiratory tract infections, sinusitis, cellulitis, infectious colitis or febrile neutropenia. Neutropenia without fever as well as inflammatory conditions (e.g., pneumonitis) without mention of infection were not included. Pneumonia was separately annotated and included bacterial, fungal, viral or other atypical causes if identified. Events were grouped by grade according to the Common Terminology Criteria for Adverse Events, version 4.03. In multi-arm trials only the ibrutinib-containing arms were included in the analysis and we generally restricted this on an intention-to-treat basis.From the updated literature review, 929 publications from PubMed, 772 from meeting abstracts and more than 11,000 from Google Scholar were identified. 33 peer reviewed publications and 106 abstracts reporting on 61 trials including more than 2300 patients were identified.Infectious adverse events of any grade were identified in over half of the patients for which data was available. Additionally, pneumonia accounted for half of the grade 3/4 infectious events and there were 33 grade 5 pneumonias identified among the studies. A number of significant infectious events were attributed to atypical organisms such as Aspergillus spp., Cryptococcus neoformans and Pneumocystis jirovecii . Somewhat counterintuitively, the rates of all events (infections, pneumonia or any grade 5 event) were consistently lower in the studies involving combination regimens. This finding may represent a gap in the data as many of these trials are incomplete and many are only reported in abstract format at the time of this analysis. Alternatively, this may be due to a more heavily pretreated population with relatively diminished performance status enrolled in the single agent trials.Among all studies grade 3/4 pneumonia was seen in 13% of patients on ibrutinib alone and 7.8% of patients on combination therapy. Grade 5 infections accounted for 25-33% of all grade 5 events. With increasing use of targeted therapies in patients previously not eligible for standard cytotoxic regimens, clinicians must be aware of unanticipated side effects. In one trial with a high rate of invasive aspergillosis, there was no correlation between patient CD4+ T cell counts and rates of this opportunistic infection. A separate investigation identified high rates of P. jirovecii in patients on single agent ibrutinib. Inhibition of BTK in non-malignant monocytes has been a proposed mechanism of increased susceptibility to invasive fungal disease. Antimicrobial prophylaxis with ibrutinib use is not currently standard practice in the management of hematologic diseases. Our findings of high rates of infectious events, particularly pneumonia often related to opportunistic pathogens, suggest that vigilance for infection is mandatory, and that risk factors for predisposition to infection, beyond CD4+ T cell counts and immunoglobulin levels, should be sought. [Display omitted] DisclosuresPauff:Abbvie: Employment.

Determinants of Hematology-Oncology Trainee's Post-Fellowship Career Pathways with a Focus on Non-Malignant Hematology

Background: Non-malignant hematologic conditions are extremely prevalent and contribute significantly to the global burden of disease. Most training programs in hematology are combined with training in medical oncology, and there is no longer a specific requirement for a certain amount or percentage of fellowship time to be dedicated to training in non-malignant hematology. As a result, our health care system may soon face a shortage of specialists in non-malignant hematology. We sought to identify factors that lead hematology-oncology fellows to pursue (or not to pursue) careers in non-malignant hematology.Methods: We conducted a cross-sectional web-based survey of our institution's hematology/oncology graduates from 1998 through 2016. Of 164 alumni, 151 had available contact information. We emailed all 151 alumni and received 2 “bounceback” emails indicating the email on file was no longer valid, leaving a total of 149 alumni who were emailed the questionnaire.Results: Of the 149 alumni emailed the questionnaire, 86 responded (response rate 57.7%). The median age of the responders was 44 years (range 33-63) and 62 (72.1%) were male. 59 (68.6%) of respondents practice at an academic medical center, 24 (27.9%) in a community center or private practice, and 3 (3.5%) are in other areas (industry, government, etc). Respondents reported spending a median of 65% of their time in clinical practice, 12.5% in research, 2.0% in education, and 5.0% in administration. Those in clinical practice reported spending a median of 60% of their time in solid tumor oncology, 20% in hematologic malignancies, and 5% in benign hematology. 46 (54.8%) of respondents indicated that they spent at least some time practicing non-malignant hematology, but only 1 respondent reported spending more than 50% of their time seeing patients with non-malignant hematologic conditions. Factors affecting choice of patient population are shown in the top component of the Table. For those who did not report practicing non-malignant hematology, the bottom component of the Table and the Figure show the degree to which respondents indicated that each of these factors could have positively influenced them to pursue a career in non-malignant hematology. Overall, respondents involved in clinical practice reported a median job satisfaction level of 85 on a scale of 1-100. Those who practice non-malignant hematology reported a slightly but non-significantly lower job satisfaction rate as compared to those who do not practice non-malignant hematology (median 81.5 versus 87.0, p=0.14), but there was no correlation between the percentage of time spent on non-malignant hematology and reported job satisfaction amongst those practicing non-malignant hematology (Spearman correlation = 0.05, p=0.75).Conclusions: Graduates of an academic hematology-oncology fellowship spend over 50% of their time in clinical practice, but only about half spend at least some time practicing non-malignant hematology and almost none practice non-malignant hematology for a majority of time. Factors most influencing graduates' career choices include clinical experience during fellowship, intellectual stimulation of the patient population/disease type, and a supportive mentor. Graduates report that the factor most likely to have led to spending more time in non-malignant hematology would be increased exposure to role models and mentors in this area. Overall, graduates report being satisfied with their careers. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.