bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-world outcomes of osimertinib (Osi) vs. afatinib or erlotinib in patients with classical vs. atypical EGFR-mutated metastatic non-small cell lung cancer (mNSCLC).
Authors: Barsouk Adam , Elghawy Omar , Heidlauf Alec , Yu Connie , Yang David , Kurian Martin , Goel Keshav , Rushkin Lynn , Huang Anran , Voruganti Teja , Sun Lova , Singh Aditi Puri , Cohen Roger B. , Aggarwal Charu , Marmarelis Melina Elpi , Langer Corey J.
Published: June 2024

8566

Background: Limited data are available on the efficacy of osi for mNSCLC with atypical EGFR mutations (AM) such as L861Q, G719X, S768I, and exon20 insertions. Afatinib is FDA approved for mNSCLC harboring L861Q, G719X, and S768I. Real-world analyses comparing osi to afatinib and erlotinib for AM have yielded mixed results. Methods: We performed a single-institution retrospective analysis of patients with EGFR-mutated mNSCLC treated from 2007-2023 with EGFRTKIs. Clinical trial patients were excluded. Patients with classical EGFRmutations (CM) were compared to those with AM. Baseline demographics, disease characteristics, treatment history, toxicity, and clinical outcomes were abstracted from the EMR. Median PFS and OS were estimated and compared via Kaplan-Meier log-rank analysis. Independent sample t-tests and chi-square analyses were used for univariate comparisons. P-values<0.05 were considered statistically significant. Results: Among 355 patients with 1L EGFR-mutated mNSCLC, 315 (90%) had CM (exon19 del [N=182; 51%] and L858R [N=119; 34%]), while 36 (10%) harbored AM in G719X (N=21; 6%), Exon 20 (N=11; 3%), L861Q (N=7; 2%), and S768I (N=4; 1%). Patients with CM vs AM had similar median age at diagnosis (63, p=0.406), gender (65% F; p=0.213), racial composition (p=0.653), and history of smoking (44%, p=0.167). At diagnosis, 45% vs 48% of patients had CNS involvement (p=0.434). 52% vs 41% received osi, 36% vs 20% patients received erlotinib, and 11% vs 37% received afatinib (p<0.001). Patients with CM had superior mPFS (29 vs 15m; p=0.021) and mOS (49 vs 13m; p<0.001) vs AM (Table). In AM patients (N=36), osi had superior mPFS (15m [7-23]) vs afatinib (11m [8-15]; p=0.005) or erlotinib (8m [6-10]; p=0.001). mOS was likewise superior for osi (29m [6-50]) vs afatinib (13m [9-17]; p<0.001) or erlotinib (14m [6-21]; p<0.001). 121 CM and 7 AM patients were rechallenged with a TKI; mPFS2 for AM was 13m for osi (N=4) vs 4m for afatinib (N=3; p=0.114). Dose-reduction due to AE was lower for osi (19%) vs afatinib (24%; p=0.003) or erlotinib (23%; p=0.002). Discontinuation due to AE was lower for osi vs afatinib (1% vs 2%; p<0.001) or erlotinib (2%; p=0.004). Conclusions: Retrospectively, AM were associated withinferior PFS and OS compared to CM. Osi demonstrated superior survival and tolerability compared to afatinib or erlotinib for AM. [Table: see text]
Genomic profiling of non-small cell lung cancer with rare aberrations in EGFR codon L858 and the survival outcome under real-world first-line EGFR tyrosine kinase inhibitor treatment compared to classic EGFRL858R.
Authors: Li Hengyuan , Zhang Jingying , Feng Zhi , Wu Wei , Zhao Xiaotian , Zhu Minyi , Xiao Yao , Pang Jiaohui , Ou Qiuxiang , Zhu Junfei , Qu Hao , Yuan Minchi , Xia Guojie , Shao Youyou , Liu Meng , Lin Peng
Published: June 2024

8596

Background: Rare genomic aberrations in EGFR codon L858 causing L858R (rare EGFRL858R) or non-L858R mutations have been reported, besides the predominant c.2573T>G genomic mutation leading to classic EGFRL858R. However, molecular features, survival benefit under EGFR tyrosine kinase inhibitors (TKIs), and resistance mechanisms of these rare mutations lack comprehensive investigation in non-small cell lung cancer (NSCLC). Methods: We retrospectively included 489 NSCLCs with treatment-naive tumor tissues/plasma biopsies harboring rare EGFRL858R (N=124), EGFRL858Q/M (N=17), or classic EGFRL858R mutations (N=348). Mutational landscapes, tumor mutation burden (TMB), and chromosome instability (CIN) scores, were investigated using tissue samples subject to a targeted next-generation sequencing panel covering 437 cancer-related genes. Advanced NSCLCs receiving EGFR TKIs as first-line therapy were sub-grouped to study survival benefit and resistance mechanisms. Results: NSCLCs with rare EGFRL858R had less-frequently mutated TP53 (59% vs. 72%, P=0.04) and lower CIN scores (0.29 vs. 0.23, P=0.02) than those with classic EGFRL858R, while age, sex, stage at diagnosis, histology subtype, and TMB were comparable. We also detected the cooccurrence of EGFRL858Q/M with EGFRL861Q ( P<0.01), particularly in patients carrying EGFRL858M (100%). Compared to 233 advanced NSCLCs harboring classic EGFRL858R, 58 patients with rare EGFRL858R exhibited superior first-line progression-free survival (PFS) [median: 13.0 vs. 10.0 months, hazard ratio (HR): 0. 57, 95% confidence interval (CI): 0.41–0.80], with a similar association observed in approximately 80% of included patients who received first-generation EGFR TKIs (median: 12.0 vs. 10.0 months, HR: 0.64, 95% CI: 0.45–0.92). After controlling for age, sex, histological subtype, EGFR TKI category, and anti-vascular therapy, rare EGFRL858R remained associated with improved PFS (adjusted HR: 0.55, 95% CI: 0.39–0.77). Patients with EGFRL858Q/M also had better PFS than those with classic EGFRL858R (adjusted HR: 0.26, 95% CI: 0.10–0.67). Of note, NSCLCs with combined EGFRL858M and EGFRL861Q appeared to have lower progression risks when receiving afatinib than using gefitinib/icotinib as first-line therapy. Furthermore, matched samples at baseline and progression revealed similar resistance mechanisms between NSCLCs with rare and classic EGFRL858R. Conclusions: NSCLCs carrying rare genomic aberrations in EGFR codon L858 were likely to get more survival benefits from first-line EGFR TKI treatment than those with classic EGFRL858R, giving scientific evidence supporting the clinical application of EGFR TKIs in these patients.
Prospective validation of in silico clinical trials prediction using an EGFR-mutated NSCLC mechanistic computational disease model.
Authors: Duruisseaux Michaël , Masson Perrine , Nativel Arnaud , Girard Nicolas , Cadranel Jacques , Swalduz Aurélie , Coudron Matthieu , Bouchard Guillaume , Kahoul Riad , Jacob Evgueni , Bosley Jim , Palgen Jean-Louis , L'Hostis Adèle , Monteiro Claudio
Published: June 2024

8614

Background: Advanced lung adenocarcinoma (aLUAD) is divided into multiple molecularly defined subsets, each with specific biological characteristics and responses to targeted therapy. Consequently, conducting practice-changing and cost-effective randomized trials is challenging. In silico clinical trials, utilizing mechanistic computational models, offer a potential solution, yet their ability to predict clinical trial results has not been proven. Methods: We updated a previously published version of the computational mechanistic model of EGFR-mutated aLUAD, notably by incorporating metastases. Disease model was integrated with physiologically based pharmacokinetic (PBPK) models of cisplatin, pemetrexed, and osimertinib, offering a more comprehensive understanding of the disease's dynamics. These models are founded on causal connections between biological entities and phenomena, establishing a link between the specific biological behaviors of EGFR-mutated aLUAD and the evolution of tumor size and progression over time. We have independently and prospectively simulated the outcomes of the FLAURA2 and MARIPOSA randomized trials dedicated to EGFR-mutated aLUAD. This was achieved by replicating the experimental protocols and generating cohorts of virtual twins of patients using publicly available data. Results: In silico results were released before the actual outcomes of the FLAURA2 and MARIPOSA trials were publicly available. The simulations yielded predictions with overlapping confidence intervals, similar hazard ratios, median survivals, and shapes of curves compared to the actual trial data. Bootstrapped weighted log-rank tests were used to compare the simulated and observed Kaplan-Meier curves for the two arms of FLAURA2 and for the osimertinib arm of MARIPOSA. Between 94 and 98% of the tests were statistically non-significant (α=0.05), confirming the accuracy of the predictions. Conclusions: This first-of-its-kind prediction of clinical trial outcomes demonstrates that in silico trials, when based on robust mechanistic models, can be a reliable tool for enhancing the design of actual trials, particularly for EGFR-mutated aLUAD. They offer a promising avenue for overcoming the challenges of comparator arms in single-arm trials and may serve as a new standard for formulating statistical hypotheses in future studies.
Real-world treatment patterns and outcomes in US patients (pts) with advanced non-small cell lung cancer (NSCLC) after platinum-based chemotherapy (PBC) and anti–PD-(L)1 treatment.
Authors: Velcheti Vamsidhar , Moore Julia , Wang Huifen , Zhu Xinmei , Samyshkin Yevgeniy , Ward Thomas , Christensen Alena , Solem Caitlyn
Published: June 2024

8627

Background: Effective treatment options for advanced or metastatic NSCLC are limited, especially for pts who progress after treatment with PBC and an anti–programmed cell death 1 protein (PD-1) or ligand 1 (PD-L1) regimen. Examining real-world treatment patterns and long-term outcomes, we report on progression-free survival (PFS) and overall survival (OS) in pts with NSCLC who previously received PBC and anti–PD-(L)1 regimens. Methods: This study used the nationwide Flatiron Health electronic health record–derived deidentified database. Pts included in the analysis were ≥18 years old with an initial diagnosis of advanced or metastatic NSCLC and an ECOG PS of 0 or 1 who had received prior PBC and anti–PD-(L)1 therapy in 1 (in combination) or 2 (in sequence) lines and had initiated ≥1 subsequent line of treatment between 2018 and 2023; the start date of subsequent treatment (defined as the index regimen) was the index date. Pts were followed up until death or last available data through Mar 31, 2023. Pt characteristics, treatment patterns, and outcomes were analyzed for the overall pt group and according to initial treatment cohort (cohort 1: first-line [1L] PBC plus anti–PD-(L)1; cohort 2a: 1L PBC and second-line [2L] anti–PD-(L)1; or cohort 2b: 1L anti-PD-(L)1 and 2L PBC). PFS and OS were estimated using Kaplan-Meier methods. Results: Of 1793 pts, most were in cohort 1 (73.5%), with fewer pts in cohorts 2a (22.5%) and 2b (4.1%). The majority of pts in cohort 2b had PD-L1 ≥50% (n = 57, 78.1%), while the percentage was lower in cohorts 1 (n = 262, 19.9%) and 2a (n = 72, 17.9%). Most pts (n = 1626, 90.7%) had stage IV disease. Median time from advanced diagnosis to index date was 10.5 months (range, 1.1-103.8); median follow-up from index date was 7.8 months (range, 0.0-65.0). A broad range of treatments were used after PBC and anti–PD-(L)1 regimens; among all pts, the most common were docetaxel + ramucirumab and docetaxel monotherapy. Among all pts, median PFS and OS from the time of starting these index regimens were 5.29 and 11.20 months, respectively; PFS and OS were similar across cohorts. Conclusions: A broad range of subsequent treatments were used following PBC and anti–PD-(L)1 regimens, most commonly docetaxel with or without ramucirumab. Short median PFS and OS underscore a significant unmet need among pts previously treated with PBC and anti–PD-(L)1. [Table: see text]
The role of pulmonary metastasectomy for non-primary lung cancer: Umbrella review of meta-analysis.
Authors: Woo Wongi , Park Brandon , Ahadi Awranoos , Chung Liam IL Young , Jung Chan Mi , Bharat Ankit , Chae Young Kwang
Published: June 2024

8639

Background: Lungs are the most common metastatic area for many cancers. Due to heterogeneous characteristics of primary cancers, the benefit of pulmonary metastasectomy (PM) has not been investigated other than colorectal cancers. Furthermore, well-designed trials in this field are difficult to undertake due to diverse clinical scenarios and therapy related to primary cancers. This study aims to investigate the clinical outcomes of PM for non-primary lung cancer by synthesizing existing literature. Methods: A systematic search for meta-analyses on PM for non-primary lung cancers was conducted, encompassing publications up to January 3, 2024. The analysis included eight primary cancer types: colorectal, renal cell, breast, adrenocortical, head and neck cancers, melanoma, and sarcoma. Primary outcomes, overall survival, and recurrence rates post-PM were assessed using random-effect models to account for study heterogeneity. Subgroup analysis categorized the survival rates based on primary cancer types, and a proportion meta-analysis was performed for comparison. Results: This study included 44 systematic-review articles and 157 individual studies, involving 23,694 patients who underwent PM for non-primary lung cancer. Patients had a mean age of 48.0 [95% CI 43.9-52.0] years, with 68.4% [95% CI 65.0-71.7] being male. About half of patients (47.1% [95% CI 40.8-53.5] had multiple metastatic lesions and 26.6% had bilateral involvement of lung. Sublobar resection was mostly performed (82%), and complete R0 resection was achieved in 87.2% [95% CI 83.0-90.8]. The pooled 5-year overall survival rate after PM was 41.2% [95% CI, 37.1-45.4%], with specific rates for each primary cancer type listed (Table). Patients with germ cell tumor demonstrated significantly higher survival rate than other cancers (p<0.05), while patients with melanoma had worst outcome (p<0.05). During follow-up, 57.6% [95% CI 46.4-68.1] had recurrence: 48% of them had intrathoracic only recurrence and 52% had extra-thoracic recurrence. Conclusions: The findings affirm that PM yields survival benefit. Overall survival rates following PM do not significantly differ based on primary cancer types, except for germ cell tumors and melanoma. Additionally, the recurrence rates are comparable to that of stage 4 advanced cancers other than germ cell tumor and is not significantly influenced by the primary cancer type. This highlights the importance of recognizing and incorporating PM in clinical practice when appropriate. [Table: see text]
Comparing rates of immune checkpoint inhibitor toxicity in different treatment settings (neoadjuvant, adjuvant, and palliative) in non-small cell lung cancer (NSCLC): A meta-analysis of phase III clinical trials.
Authors: Moloney Carolyn , Demir Tarik , Chung Liam IL Young , Oh Youjin , Chae Young Kwang
Published: June 2024

8645

Background: Immunotherapy has created a paradigm shift in the treatment of NSCLC. There is growing interest in the utility of immunotherapy alone or in combination with chemotherapy for NSCLC in the peri-operative setting with practice changing results demonstrated in several pivotal phase III clinical trials. Nevertheless, immune related adverse events (irAEs) are the main barrier in the care of patients treated with immune checkpoint inhibitors (ICIs) with grade ≥ 3 irAEs seen in 10-15% of patients. The present meta-analysis aims to compare rates of irAEs across different treatment settings in NSCLC to aid in individual patient treatment decisions. Methods: We extracted data from selected published phase III clinical trials which have led to the approval of PD-1/PDL-1 ICIs in the neoadjuvant, adjuvant, peri-operative and in the palliative setting. We excluded trials which did not have supplemental data on irAEs included with published results and trials of CTLA-4 inhibitors. A sensitivity analysis was performed to assess whether number of cycles correlated with toxicity rates. Results: Pooled data from 15 published phase III NSCLC clinical trials including 5918 patients were included. This included 1 neoadjuvant, 2 peri-operative, 3 adjuvant, and 9 palliative studies. One of the peri-operative trials included data on irAEs which occurred during the neoadjuvant/surgery phase only and this data was pooled within the neoadjuvant group. The ICI drugs included nivolumab, pembrolizumab, atezolizumab, durvalumab, cemiplimab +/- chemotherapy. This included a total of 2523 stage 1B-3C and 3395 stage IV patients. We found a 9.5% rate of grade 3-5 and 35.8% rate of all grade irAEs in palliative trials (n=3395). In contrast, neoadjuvant ICI (n=572) had a 3.5% rate of grade 3-5 and 16.8% of all grades irAEs. Peri-operative ICI (n=797) had a 5.4% rate of grade 3-5 and 24.47% all grades irAEs. Adjuvant ICI (n=1550) had a 7% rate of grade 3-5 and 38.52% rate of all grade irAEs. The relative risk (RR) between the palliative and the neoadjuvant setting of a grade 3-5 irAE is 2.35 (95% CI:1.54 to 3.59; p = 0.0001) and the RR of any irAE is 2.03 (95% CI: 1.69 to 2.43; p=0.0001). The following median number of ICI cycles was seen: neoadjuvant = 3.5, adjuvant = 18, peri-operative = 18, palliative = 10. Lower number of cycles did correlate with lower toxicity in the neoadjuvant setting but this was not seen in other treatment settings. Conclusions: Neoadjuvant, peri-operative and adjuvant ICI’s are associated with a lower rate of irAEs than that seen in palliative trials. A neoadjuvant-only approach is associated with the lowest rates of irAEs and this may be due to the lower number of cycles received. These findings have implications for individual patient treatment decisions and support the use of neoadjuvant immunotherapy in NSCLC.
Assessing gender disparities in oncology: Less talk, more action.
Authors: Olazagasti Coral , Villa Celi Claudia , Velazquez Manana Ana I. , Sridhar Arthi , Horiguchi Miki , Mahtani Arun , Dizman Nazli , Gonzalez Nororis Mariana , Bernabe Carolina , Florez Narjust
Published: June 2024

9011

Background: 'Gender disparities' is a familiar term in medicine. Only 35.2% of oncologists in the U.S. self-identified as women in 2021. Women in medicine are undercompensated and underpromoted. Little is known of the experiences of non-U.S. female physicians in the U.S. We created the first cross-sectional study to assess gender disparities in IMGs and Puerto Rican medical graduates (PRMGs) in oncology in the U.S. Methods: An anonymous online survey was created and distributed via Survey Monkey. Eligible participants were non-U.S. IMGs and PRMGs who trained and/or practiced independently in the U.S. Participants were recruited through email and social media from Sept-Dec 2023. Bivariate association analyses were performed using the two-sample Wilcoxon test for ordered categorical variables and Fisher’s exact test for nominal categorical variables. Results: 97 IMGs and PRMGs in oncology completed the survey. As shown in the table, women were more likely to move to the U.S. for family (22.4% vs 6.2%, p=0.040), whereas men did more for financial gains (20.8% vs 6.1%, p=0.040). culture, particularly to the traditions (65.3% vs 43.8%;p=0.042) and dress code (44.9% vs 20.8%, p=0.017). Women experienced higher rates of gender discrimination during training (53.2% vs 4.5%, p <0.001) and independent practice (57.6% vs 3.6%, p<0.001) than men. Women were also more likely than men to face ethnic/racial discrimination during training (69.6% vs 38.1%; p=0.005). Despite lack of statistical significance, higher trends of ethnic/racial discrimination during independent practice were reported by women (table). More women reported no plans on returning home (68.8% vs 38.3%), whereas more men planned to return home at some point (38.3% vs 16.7%). 18.8% of men vs 0% of women elected leadership opportunities as the reason for returning to their home country (p=0.001). Conclusions: Our study reveals the unfortunate reality that many IMG and PRMG women face in oncology in the U.S. Despite national efforts to reduce the gap in gender disparities, minority women continue to experience racial/ethnic and gender discrimination at higher rates than men. To overcome inequities and achieve gender equity pay transparency, diversity in selection committees is necessary. Further, efforts should be across all settings, academia, private practice, and industry. The time for gender equity in oncology is now. [Table: see text]
Keeping health care professionals healthy: Systematic strategies for mitigation, wellness, and burnout prevention.
Authors: Kotwal Juee , Schnaitmann Natalie , Mooney Stefanie , Lemus Mejia Lucia , Luna Joanna , Mejia Daniela , Clark Karen L. , Loscalzo Matthew J. , Dale William
Published: June 2024

9013

Background: Health care professionals are deeply committed to the compassionate care of their patients. However, the same level of caring and compassion is not typically extended to colleagues, much less toward themselves. Escalating issues include: burnout, demoralization, personal conflicts, early retirement, and high turnover. Literature and training offer few suggestions to proactively address these complexities. There is a lack of attention to creating truly healthy work environments, with strategic infrastructure to enhance leadership, communication, and relationship among team members that directly impact wellness, engagement, and productivity. We will present the Staff Leadership Model (SLM) that integrates courageous and compassionate communication to foster healthier work environments, including how to implement and sustain the necessary infrastructure. Methods: In 4 large academic cancer settings, evolving iterations of the SLM were developed since 1995, focusing on maximizing inherent human capacities. In 2007, the Department of Supportive Care Medicine (DSCM), an interdisciplinary department at City of Hope (COH), systematically integrated the SLM. Specific processes, such as onboarding and skills training, regularly scheduled, open and honest communication, ways of working agreements, and performance evaluations that actively support value-driven behaviors, were implemented. Tailored interpersonal strategies were implemented, such as small group democratic meeting structure that equalizes all members, and problem-solving skills to deal with conflict. Clinicians received annual Press Ganey-administered surveys that measured clinician engagementas well as clinician resilience, measuring the ability to disconnect from work and ability to find meaning in their work, providing early warning indicators of burnout. Results: Sustained success has been demonstrated: 1) 5 years top tier clinician/staff engagement scores, with increase from 4.24 in 2022 to 4.32 in 2023 (+0.14 vs. overall COH) ; 2) 3.96 resilience index score vs. 3.80 overall COH in 2023 (3.23 decompression score vs. COH 2.94 and 4.69 activation score vs. COH 4.65); 3) Growth of the department from 25 professionals in 2007 to 170+ in 2024; 4) A clearly-defined clinical triage created through the expertise of the professionals; and 5) Staff creativity and leadership resulting in the creation and consistent growth of innovative, market-differentiating programs. Conclusions: Results support the relationship between the SLM and healthier work environments that increase engagement and decrease burnout, as reflected by the consistently high scores. The resilience index is a new survey measure with one year data. Cause-effect relation will continue to be evaluated. Overall, SLM creates a culture of health, wellness, support, and optimized individuals and teams.
Demographic trends and outcome measures found in randomized controlled trials of wellness interventions among medical trainees: A systematic review.
Authors: Hearn Andrew Irving , Chrabuszcz Daniella , Bao James , Hearn Kristen Elizabeth , Yaeger Lauren H , Stoll Carolyn RT , Colditz Graham A.
Published: June 2024

9014

Background: To our knowledge, there is no systematic review that identifies and characterizes the wellness interventions with high-quality evidence in the form of randomized controlled trials (RCTs) among medical education trainees (medical students, residents, and fellows). Methods: A medical librarian (YL) searched Embase, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), APA PsycINFO, and Clinicaltrials.gov from the earliest timepoint to March 2022. We included full text/ published studies that were prospective RCTs that included quantifiable measures related to mental health, wellness, or other measures of wellbeing. Medical students, residents, and/or fellows must be included in the intervention that is intended to improve wellbeing. We excluded studies that included only qualitative outcome measures, had no control group, or took place outside the USA. Results: Our search strategy resulted in 3,806 unique articles. 161 articles passed initial screening of titles and abstracts, and 46 studies met eligibility criteria with dates ranging from 1980 to 2022. A total of 8,016 participants were studied with the majority of studies (26) focusing on medical students, a minority of studies (20) focusing on residents, and no studies that included fellows. A minority (10) of studies were multi-institutional with the vast majority (36) being single-institutional. Outcome measures shared among two or more studies include variants of the Maslach Burnout Inventory (MBI) (5), Perceived Stress Scale (PSS) (5), PHQ-9 (5), Five-Facet Mindfulness Questionnaire (FFMQ) (5), State Trait Anxiety Inventory (STAI) (3), step count (3), Epworth Sleepiness Scale (ESS) (2), General Anxiety Disorder-7 (GAD-7) (2), Global Severity Index (GSI) (2), and Brief Symptom Index (BSI) (2). Interventions included in two or more studies center around mindfulness and/or meditation practices (15), cognitive behavioral therapy (CTB) (3), hypnosis (3), activity trackers (2), flexible work hours (2), and massage and/or manipulation (2). Conclusions: We conducted a systematic review to identify evidence-based wellness interventions and in the process potentially inform future research in regards to standardized outcome measures and highlighting the need for interventions targeting fellows, particularly in fields with a majority of physicians reporting burnout such as hematology/oncology.1 1. McKenna J. Medscape Physician Burnout & Depression Report 2024: “We Have Much Work to Do". Medscape. Published 2024. https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865.
Factors influencing career choices and post-fellowship perspectives in adult hematology/oncology fellows: A nationwide cross-sectional study.
Authors: Gonzalez Mosquera Luis , Balanchivadze Nino , Ali Faria , Meranda Matthew , Hinojosa Castro Oscar , Kuriakose Philip
Published: June 2024

9016

Background: The aim ofour study was to explore the characteristics, aspirations, and factors influencing career choices among adult Hematology/Oncology (HO) fellows, as well as their post-fellowship perspectives. Methods: An anonymous 25-question survey was distributed online to adult HO fellowship programs in the United States. The survey collected data on demographics, educational background, career plans, and specific factors influencing career choices. Results: Of the 56 fellows completing the survey, 54% identified as male, and 46% as female. The majority were White (40%), followed by Asian (34%), Middle Eastern (12%), Hispanic (7%), and Black (3%). Most fellows (79%) were aged 30-34 years, and 68% were MD graduates of US/Caribbean schools. A significant proportion expressed certainty (80%) during residency about pursuing adult HO as a career. Thirty eight percent of the respondents planned to practice both hematology and Oncology. While 39% hoped to work in an academic/university setting, 41% planned to stay within the community. Geographically, 45% preferred suburban, and 39% urban areas. Only 3% of respondents had plans to pursue a career in classical hematology. Factors influencing career choice included clinical interest in the field (98%), previous research experience in HO (54%), career mentorship (70%), lifestyle considerations (66%), and perceived job market (60%) (Table). Almost all respondents (97%) expressed a high likelihood of pursuing adult HO fellowship if they had to choose again. Fellows were confident about finding positions aligned with their interests, including clinical (72%), providing research opportunities (43%), and those offering intellectual stimulation (73%). While the majority were confident in achieving work-life balance (84%), 16% expressed some concerns. Conclusions: This study offers valuable insights into the factors influencing career choices among adult HO fellows. The findings emphasize the necessity of adjusting strategies to align with the evolving needs and aspirations of prospective fellows. Key initiatives could include fortifying career mentorship programs, providing increased support for those interested in classical hematology, fostering research experiences during residency training, and actively promoting a diverse and inclusive environment. Understanding these aspects and results is crucial for program directors, educators, and policymakers to optimize training programs and support the diverse needs of future practitioners in the field. [Table: see text]
Fortifying the workforce: A national survey of hematology/oncology fellowship program directors and training fellows for community-based careers.
Authors: Iacoviello Anthony , Agrawal Shubham , Berry Jonathan L , Widick Page , Roberts Daniel Aaron , Patell Rushad , Rangachari Deepa
Published: June 2024

9028

Background: Most hematology/oncology (HO) care occurs in community settings. In a recent national survey of currently practicing community oncologists, we highlighted areas of unmet need regarding preparation for community-based (CB) careers during fellowship [Agrawal et al, JCO OP 2024]. Our study aims to explore attitudes of HO fellowship program directors (PDs) relating to CB HO training. Methods: We conducted a cross-sectional email survey of 185 HO fellowship PDs in the United States. The primary outcome was assessing PDs’ attitudes regarding inclusion of CB HO training during fellowship. Secondary outcomes included assessing whether programs currently have clinical and/or non-clinical training experiences specifically addressing skills relevant to community practice. Participants were also surveyed to assess PDs’ attitudes regarding what motivates fellows to choose careers in community practice. Demographics pertaining to program leadership and fellows were also obtained. Results: We received a total of 53 responses (29% response rate). The majority of respondents’ programs were in academic tertiary care hospitals (76%) with a plurality in the Northeast (32%), had a median of 5 trainees per class, and had roughly equal Male and Female (including transgender men and women) trainees (70%). The majority of PDs had been in clinical practice for ≥10 years (68%) and in their program leadership position for ≤10 years (83%). Almost all PDs (96%) reported having graduates who pursue careers in CB settings, with financial compensation cited most frequently in making this decision (98%). The majority of PDs (83%) agreed that training experiences in CB HO should be available for their trainees during fellowship. A multivariate regression analysis demonstrated that there were no significant factors associated with this outcome (p>.05). Training experiences relevant to community practice were not uniformly available amongst programs, with 74% of programs offering clinical experiences, but only 32% offering non-clinical experiences. The most cited clinical experience was the option to rotate in a CB setting (80%), and the most common non-clinical experience was exposure to training in quality improvement/patient safety (88%). Conclusions: While most HO training programs in the U.S. are embedded within academic centers, nearly all PDs indicated their programs train fellows who pursue careers in the community. PDs believe that experiences tailored to CB HO practice should be available to their fellows. Although many respondents’ programs offer CB clinical rotations, relevant extra-clinical skill development opportunities are lacking. Goal-concordant pathways for career development during HO fellowship can be optimized, particularly as they relate to training individuals for practice in CB settings, a growing need within the HO workforce.
Surveying oncologists' awareness and challenges in addressing social determinants of health: A national study.
Authors: Drew Heather , Beyer Michael , Kriz Chris , Colas Tomas , Vargas Stephany , Singer Ted
Published: June 2024

9030

Background: Ensuring that healthcare professionals are equipped to address disparities in healthcare access and outcomes is crucial for improving overall healthcare quality. Multiple studies have shown a clear causal link between social determinants of health (SDOH) and cancer. PeerView developed a research project to understand how well oncologists understand the impact of SDOH on the care and outcomes of patients with cancer and what they need to close gaps in knowledge and skills in order to deliver equitable care. Methods: PeerView developed and sent a series of seven surveys, each with 3-5 questions, to US medical oncologists and hematologist-oncologists from June 2023 to January 2024. Each set of surveys was sent to a different group of clinicians to ensure that responses were representative of the target group. Key Areas of Analysis: Overall awareness and understanding of SDOH; Perceived challenges in achieving health equity; Barriers to improving diversity in clinical trials; Clinician needs in addressing disparities; and Educational tactics and tool preferences for SDOH training. Results: 1,536 responses from US medical oncologists and hematologist-oncologists (37% working in an academic setting; 63% community-based) Representative findings: Approximately two-thirds (67%) needed to improve their understanding of SDOH and their effects on healthcare disparities; 60% were confident in their understanding of the effects of SDOH in cancer care in 4 key areas: care delivery and quality, screening, immunotherapy efficacy, and technology literacy; Most respondents felt confident or very confident caring for patients with cancer across ethnicities (81%), cultures (83%), socioeconomic statuses (78%), genders/gender identities (82%), and age (89%); 70% expressed confidence in their ability to identify patients at higher risk because of health disparities and SDOH; While the majority (61%) felt competent in connecting patients with resources and care to overcome SDOH-related barriers, community and academic providers differed significantly in their confidence; 70% selected the lack of resources in the healthcare system as the most or second greatest significant factor contributing to healthcare disparities; and 58%believed that partnering with pharmacists, community health workers, and community groups would help increase minority participation in oncology clinical trials. Conclusions: These results outlined deficiencies in knowledge and confidence of SDOH. By integrating these insights into development of continuing education (CE) activities and sharing them with the CE community, we can help clinicians overcome care-delivery barriers related to SDOH and develop inclusive care practices that empower patients to take charge of their health. Furthermore, insights from this research can shape policy decisions, curriculum development, and resource allocation on a larger scale.
Optimizing hematology/oncology (H/O) curricula for internal medicine (IM) residents: A two-institution Delphi survey.
Authors: Silverstein Jordyn , Huppert Laura Ann , Schwede Matthew , Goglin Sarah , Johnson Tyler Paul , Babik Jennifer , Brondfield Sam
Published: June 2024

9033

Background: Although H/O topics are essential for primary care physicians, internists and subspecialists, the H/O curriculum is not standardized across IM residency programs. We aimed to identify the most important H/O topics for IM residents to learn, according to IM generalists and H/O specialists. Methods: We used a modified Delphi approach to conduct a 2-round cross-sectional survey of IM generalists and H/O specialists at the University of California, San Francisco and Stanford University. Participants rated the importance of H/O curricular topics gathered from national H/O and IM organizations on a 1-5 scale (very unimportant to very important). Participants then viewed their own ratings compared to the group mean and standard deviation (SD) for each topic from round 1 and could change their ratings in round 2 if they wished. We used a content validity index (CVI, the percentage of respondents who rated the topic ≥4) of >75% to identify the most important topics. We compared the effect sizes of the differences between mean generalist and specialist ratings for each topic using Cohen’s d. Results: The survey included 239 topics (75 classical hematology, 52 malignant hematology, 112 solid oncology). The round 1 survey was sent to 132 clinicians (68 generalists, 64 H/O specialists), with 92 round 1 responses (response rate [RR] 69.7%) and 77 round 2 responses (RR 83.7%). The average variance decreased from round 1 to round 2 (1.00 to 0.86), indicating increasing agreement. Ninety-two topics met the CVI threshold: 41 from classical hematology, 15 from malignant hematology, and 36 from solid oncology. The Table shows the highest rated topics as examples. Most effect sizes were small (58.6%), indicating agreement between generalists and specialists across most topics. Conclusions: With input from both generalists and H/O specialists, we identified the most important H/O topics for IM residents, which can guide curriculum development for IM residency programs. [Table: see text]
Filling the gap in competency-based training for medical oncology with supervised online patient counseling: A qualitative study.
Authors: Iugai Sergei , Panchenko Daria , King Mary Caitlin , Kovalik Vladislav , Nikiforchin Andrei , Barakat Philipp , Ledakis Panayotis , Gushchin Vadim
Published: June 2024

9036

Background: The Higher School of Oncology (HSO) is a collaborative US-Russian postgraduate program that improves learning outcomes for young oncologists. Many HSO medical oncology (MO) residents/graduates are also engaged in online supervised patient counseling, known as ‘Just Ask.’ We aimed to explore the educational role of ‘Just Ask’ in shaping the competency-based learning outcomes of MO graduates, who have recently begun independent clinical practice. Methods: This qualitative study included 10 HSO alumni (2019-2023) who practice MO in Russia. All participants were current or prior ‘Just Ask’ consultants. Anonymous, online semi-structured in-depth interviews were conducted to explore interviewees reflection on competencies obtained at HSO and ‘Just Ask.’ The interview guide included 42 open-ended questions based on the American Accreditation Council for Graduate Medical Education (ACGME) list of competencies for MO physicians. All interviews were recorded and transcribed. Inductive-deductive coding with code categorization was followed by thematic analysis. Themes were mapped against the ACGME competencies. Results: Interviews, with a median duration of 69 (IQR: 54-80) minutes,involved participants with 0.5-3 years of practice. Six (60%) interviewees worked in hospitals, while 2 (20%) were in outpatient and another 2 (20%) were in mixed settings. We identified 85 codes and categorized them into 10 educational experience themes. Interviewees attributed learning an evidence-based approach, basic oncology knowledge, and patient communication skills through the HSO curriculum. Themes associated with learning from online counseling included integration into real-world practice, specific types of expertise (rare tumors), and advanced communication (explaining differences in management, written communication), which are less covered by HSO. This activity enhanced skills in patient navigation, advocacy, and the ability to detect care not supported by evidence. Safe-space learning provided by ‘Just Ask’ was a unique theme reflecting the ability of trainees to hone skills in a secure and resource-enriched environment with easy access to mentoring. The association of the selected 'Just Ask'-related themes with ACGME competencies is presented in the table. Conclusions: Supervised online counseling has emerged as a valuable educational tool aimed at supplementing competencies insufficiently covered by medical oncology postgraduate curriculum. [Table: see text]
Simian Episteme, circa 1200
Authors: Hong Jeehee
Published: June 2024

This article examines intersensory practices between seeing and hearing surrounding the medium of painting in middle-period China. Deviating from the better-known pictorial practice in which a mimetic image of a sound maker provides an entryway into a fictive soundscape, the central work discussed in this article depicts only a listener, and an unusual one at that: a seated monkey at the intersection of poetic, religious, and ecological boundaries. Attentive to the puzzling nonhuman form of the represented subject as an unlikely listener, it probes how the interplay between seeing and hearing gave rise to a complex sonic environment in pictorial medium. The unveiling of the mixed modality steers us toward an underrecognized role of painting in Chinese history as a material stimulus for multisensorial experiences, beyond the rhetoric of “soundless poetry” that has often stifled such dynamic potential of the medium.
What Noise Does a Psychotic Door Listen To? Information, Intermediality, and Guo Baochang's Peking Opera Film Dream of the Bridal Chamber
Authors: Lam Ling Hon
Published: June 2024

The Chinese opera film criticism of the late 1950s coincided with the introduction of cybernetics to China. Echoing cybernetics’ emphasis on the homeostasis of an artificial or living machine archived by filtering noise from information in the environment, film critics aimed no less at maintaining the steady states of Chinese culture (epitomized by traditional opera) when taking on the treacherous milieu called modernization (in the form of cinema). The whole problematic of opera films—in which one is forced to choose filtering out formulaic operatic gestures or realistic cinematic mise-en-scène as noise to maintain a self-cohesive cultural system—follows from the mistake of essentializing media specificities as prior to the contingent encounter among different mediums. However, an alternative approach lies in treating noise not as interference that must be eliminated but as surplus information that introduces system errors, triggers phase shifts, and brings about random changes for genuine self-organization, allowing us to confront control with the noise in its own channels. A revamping of cybernetics in this regard opens up new possibilities of understanding opera films through the peculiar prism of Guo Baochang's 2005 opera film Chungui meng 春閨夢 (Dream of the Bridal Chamber). And that prism particularly takes the form of a series of moon gates (yueliang men 月亮門), an architectural trope invoked throughout the film signifying the cybernetic circuit of gateways that at once exerts control over and yet is disturbed and reshaped by the noisy signals arising from the mutual interferences among opera, film, and, ultimately, television.
Founder mutations and rare disease in the Arab world
Authors: Marafi Dana
Published: June 2024

Founder mutations are disease-causing variants that occur frequently in geographically or culturally isolated groups whose shared ancestor(s) carried the pathogenic variant. While some disease alleles may vanish from the genetic pool due to natural selection, variants with weaker effects may survive for a long time, thereby enhancing the prevalence of some rare diseases. These are predominantly autosomal recessive diseases but can also be autosomal dominant traits with late-onset or mild phenotypes. Cultural practices, such as endogamy and consanguinity, in these isolated groups lead to higher prevalence of such rare diseases compared to the rest of the population and worldwide. In this Perspective, we define population isolates and the underlying genetic mechanisms for accumulating founder mutations. We also discuss the current and potential scientific, clinical and public-health implications of studying founder mutations in population isolates around the world, with a particular focus on the Arab population.
Public Information Is an Incentive for Politicians: Experimental Evidence from Delhi Elections
Authors: Banerjee Abhijit , Enevoldsen Nils , Pande Rohini , Walton Michael
Published: June 2024

Two years prior to elections, two-thirds of Delhi municipal councillors learned they had been randomly chosen for a preelection newspaper report card. Treated councillors in high-slum areas increased pro-poor spending, relative both to control counterparts and treated counterparts from low-slum areas. Treated incumbents ineligible to rerun in home wards because of randomly assigned gender quotas were substantially likelier to run elsewhere only if their report card showed a strong pro-poor spending record. Parties also benefited electorally from councillors’ high pro-poor spending. In contrast, in a cross-cut experiment, councillors did not react to actionable information that was not publicly disclosed. (JEL D72, D83, H75, J16, O15, O17, O18)
Adaptation and validation of a quarter-of-life crisis questionnaire – The Developmental Crisis Questionnaire (DCQ-12)
Authors: Kulik Agnieszka , Dacka Monika , Jurek Krzysztof , Mazur Natalia
Published: June 2024

Cel pracy

Celem artykułu jest przedstawienie polskiej adaptacji Kwestionariusza Kryzysu Rozwojowego (DCQ-12). W Polsce obecnie brakuje narzędzia do pomiaru kryzysu ćwierć życia, co utrudnia empiryczne badania i zrozumienie tego zjawiska. Kwestionariusz DCQ-12, opracowany przez Petrova i współpracowników służy jako niezależne narzędzie do badania kryzysu rozwojowego u dorosłych.

Metoda

Badanie przeprowadzono online przez zewnętrzną firmę specjalizującą się w panelach badawczych. Próba obejmowała łącznie 1176 osób. W celu oceny właściwości psychometrycznych skali przeprowadzono analizy struktury wewnętrznej, w tym analizy czynnikowe eksploracyjne i konfirmacyjne oraz ocenę trafności.

Wyniki

Analizy statystyczne wskazują, że polska adaptacja DCQ-12 jest wiarygodnym narzędziem do badania nasilenia kryzysu ćwierć życia i jego komponentów. Uzyskane wyniki potwierdzają strukturę narzędzia, a właściwości psychometryczne w polskim badaniu są porównywalne do danych pierwotnych; wartość alfa Cronbacha dla całej skali wyniosła 0,78, co sugeruje, że rzetelność narzędzia jest zadowalająca i akceptowalna.

Wnioski

Polska wersja Kwestionariusza Kryzysu Rozwojowego wykazuje dobre właściwości psychometryczne. Jej wykorzystanie w praktyce terapeutycznej może być szczególnie korzystne dla lepszego poznania różnych aspektów kryzysu ćwierć życia.
The Politics of Sport: John Day's The Isle of Gulls
Authors: Finn-Atkins Alexandra
Published: June 2024

This article explores three scenes in John Day’s understudied satiric drama The Isle of Gulls, reading the royal hunt, game of bowls, and double jest as examples of a cultural phenomenon that disguises politics as recreation.
Harry R. McCarthy. Performing Early Modern Drama Beyond Shakespeare: Edward’s Boys. Cambridge: Cambridge University Press, 2020.
Authors: Barker Roberta
Published: June 2024

This review considers Harry R. McCarthy's Performing Early Modern Drama Beyond Shakespeare: Edward’s Boys.