Treatment Summary Research Articles

Scaling up and implementing the digital Survivorship Passport tool in routine clinical care – The European multidisciplinary PanCareSurPass project

BackgroundChildhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1–6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7–9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11]. MethodsThe EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards. ResultsPanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe. ConclusionsPanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings.

Multiple Chronic Conditions and the Receipt of Cancer Survivorship Care Plans

Background: Most cancer survivors have multiple chronic conditions (MCC) that make it challenging to navigate disease management processes post cancer treatment. Objective: To examine associations between having MCC and receiving a survivorship care plan (SCP), which has potential benefits for improved follow-up care, among cancer survivors. Methods: Behavioral Risk Factor Surveillance System respondents with a self-reported history of cancer not actively receiving cancer treatment were included (N = 5449). SCP receipt was defined as being provided a written summary of cancer treatments received and instructions for follow-up care upon treatment completion. MCC was categorized as 0, 1, 2, or ≥3 based on a sum of 10 chronic conditions. Multivariable-adjusted logistic models were used to assess the association between MCC and SCP receipt. Results: Most cancer survivors were age 65 or older (59%) and female (58%). Sixty percent reported receiving an SCP and 50% had at least 2 chronic conditions. Compared to those with no chronic conditions, cancer survivors with 2 and 3 or more conditions were less likely to have received an SCP. Conclusions: Professional organizations recommend that cancer survivors receive SCPs; however, having MCC was inversely associated with SCP provision. Implications for Practice: The high necessity for SCPs among cancer survivors with MCC and the potential barriers associated with their delivery should be recognized by healthcare professionals. What is Foundational: This work highlights unmet survivorship care needs in cancer survivors with MCC. The findings emphasize the need to promote greater access to SCPs in healthcare settings that cater to cancer survivors with comorbid conditions.

The applications and prospects of intelligent services robots in medicine

With the rapid growth of the ageing population and the increasing demand for medical services, the medical market is facing great challenges and opportunities. Intelligent service robots can provide various medical services, such as patient monitoring, drug distribution, medical record management, etc., which can improve medical efficiency, reduce the burden of medical staff, and have the advantage of 24-hour uninterrupted service. However, the application of intelligent service robots in the medical field still faces some challenges, such as technical limitations, legal and ethical issues. In addition, there are also differences in patient acceptance and demand for intelligent service robots. Based on the summary of intelligent medical treatment, this paper will introduce the application of intelligent service robots, study the application and prospect of intelligent service robots in medical treatment and the innovation of intelligent service robots in business models. Through literature review, SWOT analysis and data, the paper explains the wide application of intelligent service robots and their future opportunities and challenges.

Racial disparities in receipt of survivorship care plans among female cancer survivors in Maryland

BackgroundWith the increasing number of cancer survivors in the US, survivorship care plans (SCP) have been promoted to improve survivorship outcomes for cancer patients. Few studies have assessed if the receipt of SCPs differs by race/ethnicity. This study evaluated if racial/ethnic disparities exist in SCP receipt among female cancer survivors living in Maryland.MethodsSurvey data were analyzed for 1,353 non-Hispanic white (NHW) and 280 non-Hispanic Black (NHB) women with a self-reported history of cancer living in Maryland who completed the Maryland Behavioral Risk Factor Surveillance Survey (BRFSS) between 2011 and 2020. Multivariable logistic regression models were used to estimate prevalence odds ratios (PORs) and 95% confidence intervals (CI) for SCP receipt by race/ethnicity. Models were further stratified by demographic, cancer-related, and lifestyle factors to examine effect modification.ResultsOn average, survivors were 66.8 years of age at time of BRFSS survey and 53.5 years of age at time of cancer diagnosis. Compared with NHW survivors, NHB survivors reported higher odds of receiving a summary of cancer treatments (POR = 3.81, 95% CI: 2.27, 6.39), instructions from a doctor for follow-up check-ups (POR = 2.10, 95% CI: 1.00, 4.39), and written or printed instructions (POR = 4.74, 95% CI: 2.12, 10.61). Age at survey (<65 years vs. ≥65 years) (p-interaction term = 0.01) and income level (≤50k vs. >50k) (p-interaction term = 0.04) significantly modified the relationship between race/ethnicity and receiving SCPs.ConclusionOur findings indicate that NHB female cancer survivors in Maryland are more likely to receive SCP information compared to NHW survivors and this association is significantly modified by age at survey and income level. More research is needed at the patient-provider level to gain a better understanding of the impact of SCP delivery to minority cancer populations.

ACR-ARS Practice Parameter for Communication: Radiation Oncology.

This practice parameter was revised collaboratively by the American College of Radiology (ACR), and the American Radium Society (ARS). Timely, accurate, and effective communications are critical to quality and safety in contemporary medical practices. Radiation oncology incorporates the science and technology of complex, integrated treatment delivery and the art of providing care to individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey their knowledge and evaluation regarding patient care, clinical workup, and treatment provided to others in the management of the patient. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered. This practice parameter was developed and revised according to the process described under the heading "The Process for Developing ACR Practice Parameters and Technical Standards" on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. Both societies have reviewed and approved the document. This practice parameter addresses radiation oncology communications in general, including (a) medical record, (b) electronic, and (c) doctor-patient communications, as well as specific documentation for radiation oncology reports such as (a) consultation, (b) clinical treatment management notes (including inpatient communication), (c) treatment (completion) summary, and (d) follow-up visits. The radiation oncologist's participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with patients, caregivers, referring physician, and other members of the health care team. The ACR-ARS Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients.

Medical Insurance Coverage and Clinical Outcomes for Patients with Hematological Malignancies in a Rural State

Background Hematological malignancies, such as leukemia, lymphoma, and multiple myeloma, affect blood, bone marrow, and/or the lymphatic system. They can be difficult to treat and often require prolonged and expensive interventions such as chemotherapy, radiation therapy, stem cell transplant, and/or targeted immunotherapy. Due to the complexity and cost of treatment, they pose a significant financial burden on patients and their families. Medical insurance coverage plays a crucial role in providing access to these treatments. This is particularly important for individuals of lower socioeconomic status, and patients in rural states. Aim This retrospective study is focused at examining the relationship between various medical insurance coverage options and/or its absence in influencing the treatment regime and clinical outcomes of patients with hematological malignancies in a statewide cancer registry. Methods This is a retrospective cohort study, conducted by analyzing data in the cancer registry of patients with various hematological malignancies in a single rural state between 2015 and 2022. The patients were divided into study groups based on their insurance providers (Medicare, Medicaid, Private, Military, and Other). Demographic data, cancer treatment data as well as survival data was collected for all patients included in the study. Descriptive statistics were calculated for the overall sample and for each Insurance type subgroup. Due to normality violations, Kruskal Wallis tests (a non-parametric alternative to Analysis of Variance) were utilized to determine if there were statistically significant differences in age, number of treatments, and survival months between the Insurance type groups. To quantify the magnitude of the effect, epsilon-squared (2) was calculated for all between-group comparisons, as a recommended effect size for Kruskal-Wallis tests. Post-hoc group comparisons were conducted when necessary. All categorical variables were evaluated to determine if there were differences present between Insurance type groups using chi-square tests, with post-hoc group comparisons made when necessary. A log-rank test was utilized to compare the survival curves between the Insurance type groups. Univariable and multivariable Cox proportional-hazards regression analysis was used to examine the relationship between survival and Insurance type, when additionally accounting for demographics such as age, race, and sex. All analyses were conducted using R Version 4.3.1 with statistical significance defined as p<0.05. Results The study cohort included 2,472 patients from a single state cancer registry. The study groups differed significantly on age, race, current cancer status, overall treatment summary, chemotherapy, hormone treatment, immunotherapy, hematologic transplant and endocrine treatment, other/palliative treatment, number of treatments, survival length, and overall survival (Table 1). In addition, the survival curves significantly differed by insurance type (Figure 1). Independent predictors of death were age, sex, and insurance type. Multivariable analysis revealed only age and insurance were significant predictors of death with increased risk for older individuals relative to younger and increased risk of death for Medicare, Medicaid, and those that listed their insurance as ‘Other’ relative to those with Private insurance. All assumptions for Cox proportional-hazards regression were tenable. Conclusion There is a strong correlation between insurance types and the outcomes in cancer patients. It revealed that patients with private insurance were more likely to live longer and have more treatment options compared to patients without insurance or other types of coverage. This is reflected in the stratified insurance cohort which showed a 72.8% 5-year survival rate for patients with private insurance, as opposed to Medicare patients who ranked lowest at 49.3%. In addition, the study also highlighted racial disparities in insurance coverage. For instance, evidencing that black & white patients were more likely to be covered in equally by Medicare, while the white patients were over 50% more likely to be covered by other plans as compared to their black counterparts. Overall, the study thoroughly highlights the impact a patient's choice of insurance could portend in ensuring their longevity when battling hematological malignancies

Estimands in Real-World Evidence Studies

A Real-World Evidence (RWE) Scientific Working Group (SWG) of the American Statistical Association Biopharmaceutical Section (ASA BIOP) has been reviewing statistical considerations for the generation of RWE to support regulatory decision-making. As part of the effort, the working group is addressing estimands in RWE studies. Constructing the right estimand—the target of estimation—which reflects the research question and the study objective, is one of the key components in formulating a clinical study. ICH E9(R1) describes statistical principles for constructing estimands in clinical trials with a focus on five attributes—population, treatment, endpoints, intercurrent events, and population-level summary. However, defining estimands for clinical studies using real-world data (RWD), that is, RWE studies, requires additional considerations due to, for example, heterogeneity of study population, complexity of treatment regimes, different types and patterns of intercurrent events, and complexities in choosing study endpoints. This article reviews the essential components of estimands and causal inference framework, discusses considerations in constructing estimands for RWE studies, highlights similarities and differences in traditional clinical trial and RWE study estimands, and provides a roadmap for choosing appropriate estimands for RWE studies.

Status of survivorship care among young adult survivors of leukemia or lymphoma.

491 Background: Young adults (YA) have been identified by the American Society of Clinical Oncology as a special population having unmet needs during the transition into survivorship care (SC). These include concerns with financial/insurance status and care coordination, which are compounded further by racial, ethnic, gender, and socioeconomic disparities. The primary aim of this analysis was to describe the proportion of YA survivors, who had been diagnosed in childhood (<18 years) or young adulthood (≥ 18 years), engaging in SC after treatment for leukemia or lymphoma. Methods: The present analysis was part of a fully remote, multi-site, randomized effectiveness-implementation trial on financial distress, which closed to recruitment in April 2023. At trial entry, participants were aged 18- 39 years, ≥3 years post-diagnosis, and in remission. 45% were diagnosed in childhood; 55% as YA. At baseline, participants reported their current SC status. Operationally, SC was defined as care that addresses prevention, surveillance, intervention for the consequences of treatment, and care coordination; a treatment summary (TS) was defined as a document summarizing all cancer treatment received. Using chi-square tests participants were compared by receiving SC and having a TS versus not. Results: The cohort included 130 YA from 18 states who were a mean age of 30 years (SD=5), 60% female, 33% Hispanic, 22% non-Hispanic/non-White (NHNW), and 53% were ≥10 years from diagnosis.Being in SC and having a TS were each endorsed by 46% of participants. Those receiving SC were significantly more likely to be non-Hispanic White (NHW) or have at least a college education compared to those not receiving SC; there were no differences in age at diagnosis or insurance (see Table). There were no statistically significant differences by age group at diagnosis or other characteristics by whether they received a TS. Conclusions: Fewer than half of YA were in SC or had a TS. Providers should encourage long-term follow up care, especially with survivors at further risk based on health care disparities. Clinical trial information: NCT05620979 .[Table: see text]

Trends in prescription therapy for adolescents with depression in nine major areas of China during 2017–2021

ObjectiveTo date, no national-scale drug usage survey for adolescents with depression has been conducted in China, and the purpose of this study was to examine the national trends in prescriptions in Chinese adolescent depression patients from 2017 to 2021.MethodsPrescribing data were extracted from the Hospital Prescription Analysis Cooperative Project. The average number of patients per year, the cost of treatment, and the prescription patterns (monotherapy vs. combination therapy) were analyzed, and subgroup analyses were conducted depending on age, sex, and drug class.ResultsThe study included 674,099 patients from 136 hospitals located in nine major areas of China. Of all patients, the proportion of adolescents increased from 1.63% in 2017 to 6.75% in 2021. Visits by adolescent depression patients increased from 1,973 in 2017 to 9,751 in 2021, and the corresponding cost increased from 607,598 Chinese Yuan in 2017 to 2,228,884 Chinese Yuan in 2021. The incidence of adolescent depression among female individuals was far beyond that among male individuals. Combination therapy was more frequent than monotherapy, and the most commonly prescribed drugs were antidepressants, antipsychotics, antiepileptics, and antianxietics. Despite the use of sertraline decreasing from 47.90 to 43.39%, it was the most frequently used drug.ConclusionIn summary, the prescriptions and cost of treatment for adolescent depression patients both increased rapidly. The widespread use of those drugs with weak clinical evidence reflects the current state of China, which should arouse our attention. The study can provide references for clinical treatment decisions and a basis for more efficient allocation of healthcare resources by the government.

P24 TB or not TB? A case of severe multi-organ erosive rheumatoid arthritis in a Ukrainian refugee

P24 TB or not TB? A case of severe multi-organ erosive rheumatoid arthritis in a Ukrainian refugee

Personalising care for patients: implementing a treatment summary folder following cytoreductive surgery.

A patient survey highlighted that patients treated with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) at one NHS trust lacked confidence with the transition of care between teams. A personalised folder of treatment information was designed and given to patients prior to discharge. To obtain patient feedback on the implementation and content of the folder. 30 consecutive patients were given the folder at discharge. Participants completed an online questionnaire to determine whether the information in the folder was appropriate, given at the right time in the pathway and enhanced confidence on discharge. 90% response rate was achieved. Of the respondents, 96% strongly agreed/agreed that the folder was helpful, 4% disagreed; 92% strongly agreed/agreed that the amount of information was right, 8% preferred more information, none less; 74% agreed/strongly agreed that the folder was provided at the right time; 96% said that the content met their expectations. Patients treated with CRS and HIPEC have specific needs related to their treatment. Implementation of the patient information folder at discharge increases patient confidence.

Survivorship Navigation for Young Women With Early-Stage Breast Cancer

BackgroundYoung women treated for breast cancer experience unique concerns in follow-up. We developed a program to direct young breast cancer survivors to a dedicated survivorship visit and evaluated their experience. Materials and MethodsEarly-stage breast cancer patients diagnosed under age 45 within 1 year of completing breast surgery, chemotherapy and/or radiation therapy were systematically referred for a survivorship visit. Patients completed a one-time, post-visit survey about their experience. ResultsSixty-nine out of 89 (78%) eligible patients attended a survivorship visit, and 40 of those 69 (58%) completed the post-visit survey. Most respondents learned about the survivorship clinic after completing treatment (30/40; 75%) and reported the survivorship visit occurred at an appropriate time in their follow-up care (26/40; 65%). Of the 34 respondents who reported receiving a treatment summary and survivorship care plan, 30 indicated it would be helpful when visiting their primary care provider (88.2%). Participants reported gaining valuable knowledge about cancer treatment (28/38; 73.7%), side effects (32/39; 82.1%), and cancer surveillance (30/40; 75%), and discussed emotional health (32/40; 80%), exercise (38/40; 95%), and ongoing cancer surveillance (32/37; 86.5%). Several reported intentions to make changes to their follow-up oncology care (8/20; 40%), exercise routines (16/30; 53.3%), and emotional health care (15/22; 68.2%). DiscussionSurvivorship visit navigation is feasible for young breast cancer patients. These visits can influence knowledge gained and intended future health plans and behaviors. Systematic approaches to survivorship care may improve the physical and mental health of cancer survivors. Future health care delivery research focused on survivorship is warranted.

Effect of non-adherence to ARV therapy on 3-year life of HIV/AIDS patients: a cohort retrospective study

Background: Antiretroviral drug Therapy (ART) has dramatically reduced the morbidity and mortality of People Living with HIV/AIDS (PLWHA). However, adherence to antiretroviral therapy has become a challenge due to a lifetime of therapy. Adherence to antiretroviral therapy is one determining factor in the success of treatment. 
 Method: This study aimed to determine the influence of medication non-adherence on the 3-year survival of patients with HIV/AIDS. The study design used a retrospective cohort and calculated survival estimates using Cox regression. All HIV/AIDS patients in the RSPI-SS from 2010 – April 2012, totaling 164 patients, were obtained from medical records, a summary of treatment and ART (follow-up), pharmacy data, and ARV therapy monitoring books at the RSPI-SS. Data analysis using cox regression.
 Results: The cumulative survival probability of patients with HIV/AIDS at RSPI Prof. dr. Sulianti Saroso in the second year (24th month) was 95.6% and in the third year (in the 36th) was 91%. Multivariate analysis with Cox regression showed the factors that affected the 3-year survival of patients with HIV/AIDS are non-adherence to ART after being controlled by initial CD4 count (aHR = 7.608; 95% CI: 1.664 to 34.790) and non-compliance appointments after controlled by opportunistic infection, age and initial CD4 count (aHR = 2.456; 95% CI: 0.802 to 7.518). Among patients' non-adherence to ART, non-compliance appointments affected the 3-year survival of patients with HIV/AIDS after controlled by initial CD4 count, sex, CPT, modes of HIV transmission, WHO clinical stage, opportunistic infection, and age (aHR = 4.517; 95%CI: 0.729 to 27.987). 
 Conclusion: Non-adherence to ART may cause a failure to suppress HIV viral, thus increasing the possibility of HIV mutations that can lead to drug-resistant and ultimately increase the risk of death. Patients who do not adhere to medication and do not adhere to their medication appointments show a higher risk of dying than those who adhere to HIV/AIDS. Non-adherence to taking medication in the first year can be used as a marker to monitor medication adherence and the patient's health condition in the future. Therefore, it is essential to monitor adherence to taking the medication regularly through ARV therapy surveillance activities.

Overview of Cardiac Arrhythmias and Treatment Strategies.

Maintenance of normal cardiac rhythm requires coordinated activity of ion channels and transporters that allow well-ordered propagation of electrical impulses across the myocardium. Disruptions in this orderly process provoke cardiac arrhythmias that may be lethal in some patients. Risk of common acquired arrhythmias is increased markedly when structural heart disease caused by myocardial infarction (due to fibrotic scar formation) or left ventricular dysfunction is present. Genetic polymorphisms influence structure or excitability of the myocardial substrate, which increases vulnerability or risk of arrhythmias in patients. Similarly, genetic polymorphisms of drug-metabolizing enzymes give rise to distinct subgroups within the population that affect specific drug biotransformation reactions. Nonetheless, identification of triggers involved in initiation or maintenance of cardiac arrhythmias remains a major challenge. Herein, we provide an overview of knowledge regarding physiopathology of inherited and acquired cardiac arrhythmias along with a summary of treatments (pharmacologic or non-pharmacologic) used to limit their effect on morbidity and potential mortality. Improved understanding of molecular and cellular aspects of arrhythmogenesis and more epidemiologic studies (for a more accurate portrait of incidence and prevalence) are crucial for development of novel treatments and for management of cardiac arrhythmias and their consequences in patients, as their incidence is increasing worldwide.

Evaluating differences in cancer survivorship care plans experienced by cancer survivors with disabilities.

e18597 Background: Survivorship Care Plans (SCPs) are crucial elements for short- and long-term follow-up care among cancer survivors and have been endorsed by leading oncologic organizations. Yet, limited research exists about the receipt of SCPs among survivors with disabilities who may face additional barriers to access the health care services. Our study examines the association between the disability status and receipt of SCPs after completion of cancer treatment among US adult cancer survivors. Methods: This secondary analysis included cross-sectional, nationally representative, population-based data from the 2021 Behavioral Risk Factor Surveillance System. We included 2110 respondents (aged ≥ 18 years) who self-reported cancer history (other than skin cancer). Outcomes were self-reported receipt of cancer treatment summaries and follow-up care instructions after completion of the cancer treatment. The independent variable was disability status, comprised of six specific disability types (having serious difficulty with hearing, vision, cognition, mobility, self-care, and independent living). We combined disability status into four groups—as having 1) no disability; 2) one disability; 3) two disabilities; and 4) three or more disabilities. We applied recommended sample weights and conducted weighted descriptive statistics and multivariable logistic regression adjusting for self-reported individual-level factors (age, sex, race, marital status, education, health insurance, provider type who provided majority of the care). Results: Overall, 4.2% self-reported as Black, 19.5% Hispanic, 70.0% White, 59.5% women, and 54.5% aged 65+ years. A total of 20.8% of participants reported having one disability, 11.1% two disabilities, and 11.7% reported three or more disabilities. Mobility disability was the most prevalent disability type (27.0%), followed by cognition (14.8%), independent living (14.5%), hearing (12.7%), vision (9.2%), and self-care (6.5%). About 18.0% did not receive follow-up care instructions, and 41.7% did not receive treatment summaries. Overall, 52.8% of survivors reported receiving both follow-up care instructions and treatment summaries. Survivors with three or more disabilities were 0.40 (95% CI 0.27-0.88, p = 0.019) times significantly less likely to report receiving follow-up care instructions than survivors without disabilities. Survivors’ disability status was not significantly associated with reporting the receipt of cancer treatment summaries. Conclusions: Nearly half of the survivors did not receive SCP upon treatment completion, which may lead to poor treatment adherence and deterioration of health. Our findings suggest disparities in follow-up instructions based on disability status, especially for people with multiple disabilities. Effective strategies are necessary to build more equitable cancer survivorship care.

Survivorship care and breast and cervical cancer screening.

12075 Background: Studies suggest that despite their history, cancer survivors may be equally or less likely to be screened for various cancers. The impact of the components of survivorship care on post-treatment screening is unknown. We aim to gauge the association of receipt of treatment summaries, follow-up care instructions (including where to obtain “routine cancer check-ups”), and type of doctor providing survivorship care on breast cancer screening (BCS) and cervical cancer screening (CCS) in female cancer survivors. Methods: A cross-sectional, retrospective analysis using Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2016 and 2018 was conducted. BCS-eligible women were aged 40-74; CCS-eligible women were 30-64. BCS completion was defined as a mammogram within 2 years and CCS completion as a pap smear within 3 years or an HPV test within 5 years. Univariate analysis was conducted using chi-square. Multivariate logistic regression was used to determine which survivorship care factors were associated with BCS and CCS. Results: 4,533 BCS and 2,566 CCS-eligible survivors were identified. In the BCS-eligible group, 85.9% were aged ≥50, 89.7% were white, 62.5% had a degree beyond high school, 48.7% earned ≤$50,000, and 96.1% were insured. In the CCS-eligible group, 68.1% were aged ≥50, 87.9% were white, 63.7% had a degree beyond high school, 45.0% earned ≤$50,000, and 93.3% were insured. 82.0% were up-to-date (UTD) with BCS; 92.6% were UTD with CCS. BCS and CCS were higher for insured survivors (82.2% vs. 66.2%, p = 0.009; 93.8% vs. 83.3%, p = 0.013, respectively). 48.7% of BCS-eligible and 50.5% of CCS-eligible survivors received a treatment summary. 75% of BCS-eligible and 77% of CCS-eligible survivors received follow-up instructions. Among BCS-eligible survivors, recipients of treatment summaries and follow-up instructions were significantly more UTD with BCS than non-recipients (84.9% vs. 78.5% and 84.5% vs. 74.3%, respectively, p < 0.001). Among CCS-eligible survivors, recipients of follow-up instructions were significantly more UTD with CCS (94.5% vs. 88.9%, p = .021); there was no significant difference for recipients of treatment summaries (p = .201). In both groups, there was no significant difference in BCS or CCS based on the type of physician providing survivorship care (p = .732 and p = .098, respectively). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR 1.46; 95% CI: 1.05–2.03) and CCS (OR 2.57; 95% CI: 1.19–5.55). Conclusions: Follow-up instructions, which are part of the survivorship plan, have the greatest association with BCS and CCS among cancer survivors. Despite this, about 25% of BCS and CCS-eligible cancer survivors did not receive them. Additional research should focus on improving the practice of survivorship care, particularly follow-up instructions, as a method to increase uptake of BCS and CCS among cancer survivors.

Review of Current Systemic Therapy and Novel Systemic Therapy for Pancreatic Ductal Adenocarcinoma.

This review aims to describe the systemic treatment options for pancreatic ductal adenocarcinoma and includes a summary of the current treatments as well as the ongoing clinical trials which may be efficacious in the treatment of this aggressive malignancy. A literature review was performed using MEDLINE/PubMed between August 1996 and February 2023. The reviewed studies are categorized into these categories: current standard of care treatments, targeted therapies, immunotherapy and clinical trials. The current treatment modality for the treatment of advanced pancreatic cancer is mainly systemic chemotherapy. The introduction of polychemotherapy regimens including gemcitabine/nab-paclitaxel and FOLFIRINOX (oxaliplatin, irinotecan, folinic acid and fluorouracil) has improved the clinical outcome of advanced pancreatic cancer. For further improvement in clinical outcomes, several novel approaches have been extensively studied in pancreatic cancer. The review discusses the current standard chemotherapy regimen and the novel treatment options in the field. While there are novel treatments being explored for metastatic pancreatic, it remains a debilitating and aggressive disease with high mortality that warrants continued efforts to advance therapeutic options.

PRIMARY VAGINAL MELANOMA: ABOUT TWO CASES TREATED BY RADIOTHERAPY

Vaginal melanomas are extremely rare gynaecological malignancy and very aggressive tumor. There is no standardized treatment owing to the extreme rarity of the disease. The prognosis of vaginal primary melanoma is very poor despite treatment modality, because most of the cases are diagnosed at advanced stage. This paper details the clinical course of 2 patients with primary vaginal melanoma treated by definitive radiation therapy, this report includes also a summary of available treatments of this uncommon disease, with focus on the role of radiotherapy.

Care plan for breast cancer survivors: translation and validation

Objective: To translate, cross-culturally adapt and validate the content of the Treatment Summary and Survivorship Care Plan (TSSCP-S) for Brazilian breast cancer survivors. Methods: Methodological, quantitative study performed according to the steps of translation, compatibility and back-translation, construction of consensus of opinions in a group of experts for content validation, according to the Delphi technique and user evaluation. Results: The translated and cross-culturally adapted plan was evaluated by ten professionals, including nurses, physicians, psychologists, nutritionists and physical therapists with a degree, scientific production, knowledge and time working on the subject. Consensus was obtained in two rounds. The instrument presented a content validity coefficient of 83.3% in the second round of Delphi. In the evaluation of content, clarity, usefulness, cultural and socioecological responsiveness domains, agreement was 93.3%. The sociodemographic and clinical profile of users was heterogeneous, contributing to the necessary cultural adjustments, with a final consensus of 93.9%. Conclusion: The care plan was translated into Brazilian Portuguese, cross-culturally adapted and its contents were validated considering national health policies.

Molecular Mechanisms of Gastrointestinal Stromal Tumors and Their Impact on Systemic Therapy Decision.

Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that mostly derive from Cajal cell precursors. They are by far the most common soft tissue sarcomas. Clinically, they present as gastrointestinal malignancies, most often with bleeding, pain, or intestinal obstruction. They are identified using characteristic immunohistochemical staining for CD117 and DOG1. Improved understanding of the molecular biology of these tumors and identification of oncogenic drivers have altered the systemic treatment of primarily disseminated disease, which is becoming increasingly complex. Gain-of-function mutations in KIT or PDGFRA genes represent the driving mutations in more than 90% of all GISTs. These patients exhibit good responses to targeted therapy with tyrosine kinase inhibitors (TKIs). Gastrointestinal stromal tumors lacking the KIT/PDGFRA mutations, however, represent distinct clinico-pathological entities with diverse molecular mechanisms of oncogenesis. In these patients, therapy with TKIs is hardly ever as effective as for KIT/PDGFRA-mutated GISTs. This review provides an outline of current diagnostics aimed at identifying clinically relevant driver alterations and a comprehensive summary of current treatments with targeted therapies for patients with GISTs in both adjuvant and metastatic settings. The role of molecular testing and the selection of the optimal targeted therapy according to the identified oncogenic driver are reviewed and some future directions are proposed.