bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncologist knowledge of cost of genetic testing.
Authors: Weiner Shayna , Austin Sarah , Carr Grant , Kidwell Kelley M. , Resnicow Ken , Stoffel Elena Martinez , Griggs Jennifer J.
Published: June 2022

10591

Background: Genetic testing allows patients and their families to identify hereditary cancer syndromes. Financial barriers to genetic testing are a major concern for patients offered genetic risk assessment. The cost of germline genetic testing has decreased substantially over the last several years. It is not clear, however, that oncologists are knowledgeable about the cost of genetic testing. The purpose of this study was to investigate oncologists’ knowledge of genetic testing costs. Methods: We deployed a survey to all oncologists who are members of the Michigan Oncology Quality Consortium, a physician-led quality improvement collaborative whose members represent 95% of the oncologists in Michigan. The modified Dillman method was used to achieve the maximum response rate. Responses were collected from December 2020 through May 2021. The responses to the question, “If a patient were to ask you how much it would cost for them to have clinical genetic testing for hereditary cancer syndromes, what would you tell them?” were independently coded by three investigators into one of three categories – correct and helpful, correct and not helpful, or incorrect and not helpful. We investigated associations between the number of years in practice and how important was cost as a barrier to genetic risk assessment. Results: The response rate to the survey was 61.2% (194/317). Only 25% of respondents provided an answer that was deemed to be both correct and helpful to a patient, for example “approximately $250 if out of pocket.” Nearly 40% of respondents gave an answer that was correct but was non-specific and would not help a patient decide about pursuing genetic testing. This category included responses such as deferring to a genetic counselor or that cost varies based on insurance. About 28% gave an incorrect response, such as “several thousand dollars” or responded, “I don’t know.” No associations were found between cost response category, number of years in practice, or reported responses that financial barriers play a role in referral patterns. Conclusions: The majority of oncologists in our statewide sample do not have an accurate understanding of the cost of germline genetic testing. Lack of precise information about the costs of testing may lead patients to believe that genetic testing is either not important or not within reach. Furthermore, providing incorrect information can have a downstream effect and prevent patients and their families from pursuing genetic counseling. Improving oncologists’ knowledge about the cost of testing may decrease barriers to uptake of genetic risk assessment. [Table: see text]
Predicting hyperglycemia among patients receiving alpelisib plus fulvestrant for metastatic breast cancer.
Authors: Ge Xuan , Behrendt Carolyn E. , Yost Susan Elaine , Patel Niki , Samoa Raynald , Stewart Daphne B. , Sedrak Mina S. , Lavasani Sayeh Moazami , Waisman James Ross , Yuan Yuan , Mortimer Joanne E.
Published: June 2022

1060

Background: Although hyperglycemia is recognized as a common adverse event (AE) on alpelisib (ALP), this AE has been little studied outside clinical trials. We report the frequency of ALP-associated hyperglycemia in a real-world setting and evaluate proposed risk factors. Methods: We retrospectively identified patients with PIK3CA-mutated, hormone receptor-positive, metastatic breast cancer who initiated treatment with ALP+fulvestrant (FUL) between August 2019 and December 2021. Five primary characteristics (diabetes, prediabetes, body mass index (BMI), age, Asian ancestry) were evaluated as independent risk factors for ALP-associated hyperglycemia using ordinal logistic regression that considered 3 glycemic levels: normoglycemia, grade 2, and grade 3-4 hyperglycemia. Overall risk of error from multiple hypothesis testing was kept below 5% using the False Discovery Rate method. Results: The study included n = 92 subjects, all but 1 female, mean age 59.9 (+11.9) years, 13.0% with Asian ancestry. One third (33.7%) of patients had pre-existing diabetes, another 9.8% had pre-diabetes only. One third (32.6%) were obese, another third (31.5%) were overweight. Hypertension and hyperlipidemia were present in 53.3% and 41.3%, respectively. On ALP+FUL, 59 (64.1%) current subjects developed hyperglycemia of grade 1-4, a rate no different than the 181/284 (63.7%) reported in the ALP+FUL arm of the SOLAR-1 trial. Among our subjects, risk of grade 2-4 hyperglycemia was independently increased by 4 of 5 hypothesized risk factors, specifically pre-existing diabetes (Odds Ratio 3.75, 95% Confidence Interval: 1.40-10.01), pre-diabetes (6.22, 1.12-34.47), Asian ancestry (7.10, 1.75-28.84), each unit of BMI above 20 (1.17, 1.07-1.28), but not by additional year of age (1.01, 0.97-1.05). Exploratory analysis detected no association with pre-existing hypertension or hyperlipidemia. Conclusions: These findings suggest that Asian ancestry merits further study as a predisposing factor for ALP-associated hyperglycemia. Our study of this AE also demonstrates that pre-existing hyperglycemia and greater BMI are independent risk factors; diabetes and pre-diabetes confer similar degrees of risk; risk from BMI begins after BMI 20 and rises incrementally; and age is not a contributing factor.
Effects of healthcare provider recommendation for genetic testing.
Authors: Delacroix Emerson , Hanson Erika , Austin Sarah , Carr Grant , Kidwell Kelley M. , Stoffel Elena Martinez , Resnicow Ken
Published: June 2022

10601

Background: This pilot study was conducted to elucidate the barriers and drivers for genetic testing by combining validated measures to inform the content of a clinical trial aimed at increasing uptake of clinically appropriate genetic testing amongst individuals with a personal history of cancer. Previous research shows that the rate of recommendation of genetic testing varies among Healthcare Providers (HCPs) despite national guidelines. Here we evaluate the rate and effect of HCP recommendation on the uptake of clinical cancer genetic testing. Methods: Data for these analyses were obtained from a cross-sectional survey completed by 794 adults (> 18 years) who were diagnosed with cancer in the past 10 years and were seen at an academic medical center within the past two years. Statistical analysis includes logistic regression and crosstabulation with SPSS and R statistical software. Results: Provider recommendation of genetic testing was found to be a very strong indicator of receiving genetic testing across all cancer types (OR = 146.4, p = <.001). HCPs more frequently recommended genetic testing to females (OR = 12.5, p = <.001), younger patients (OR = 1.05, p = <.001). While females are more likely to receive a recommendation, there were no significant differences on genetic testing uptake when a HCP recommended it for any gender. Conclusions: Without the recommendation of their provider, patients were significantly less likely to receive genetic testing that could affect their cancer treatment, surveillance, or family members. More aggressive patient health education is needed in cancer affected patients to decrease knowledge deficits and increase motivation for cancer genetic testing uptake. Education to providers regarding genetic testing recommendation guidelines could increase motivation to refer patients for genetic testing and counseling.
Outcomes of the BRCA quality improvement dissemination program in three health systems.
Authors: Bednar Erica M. , Chen Minxing , Walsh Michael T. , Eppolito Amanda L. , Teed Kelly B. , Klein Molly H. , Chao Han , Berg Jordan , Bowman Erin , Yobbi Cara S. , Krukenberg Rebekah C. , Jenkinson Sandra , Moore Jennifer , Garcia Cassie , Goedde Timothy , Morman Nichole A. , Bowdish Elizabeth C. , Wise Emaline , Rath Kellie S. , Lu Karen H.
Published: June 2022

10603

Background: The BRCA Quality Improvement Dissemination Program (BQIDP) was disseminated to 3 community-based health systems’ oncology clinics in 2017. The BQIDP occurred over 3 years and aimed to increase rates of guideline-recommended referral (ref), genetic counseling (GC), and germline genetic testing (GT) for patients diagnosed with invasive epithelial ovarian, fallopian tube, and primary peritoneal cancer (OC) and triple-negative breast cancer diagnosed at age 60 or younger (TNBC). The BQIDP applied virtual implementation facilitation to support sites’ development, implementation, and tracking of quality improvement (QI) interventions. Interventions were adapted from prior QI initiatives and published interventions. Methods: Baseline metrics (patients diagnosed 1/1/2015 to site’s BQIDP launch date Autumn 2017) were compared to metrics of patients diagnosed during BQIDP implementation (site launch dates Autumn 2017 to Autumn 2020). Two-sample test of proportions was used to assess for statistically significant change in rates pre and post BQIDP implementation at each site. QI interventions targeted provider and patient education, retrospective and prospective case finding with alerts to providers and patients, case finding by review of somatic test results and genetic counselor tumor board attendance, streamlined ref and scheduling processes, and infusion-suite based GC. Results: All clinics increased rates compared to baseline (Table). Statistically significant improvement was noted for patients with OC in receipt of GC at Site A, ref and receipt of GC at site B, and receipt of GC at site C. Statistically significant improvement was noted for patients with TNBC in ref and GT at sites A and B. Conclusions: Improved rates of ref, GC and GT for patients with OC and TNBC were observed at all 3 sites compared to baseline. Baseline ref, GC, and GT metrics for patients with TNBC were higher than for patients with OC at all sites. Tailored and facilitated QI efforts can promote patients’ receipt of guideline-recommended cancer genetics services in health system oncology clinics. [Table: see text]
Clinical characteristics of patients with PMS2 mutations.
Authors: Pandey Samiksha , Rangarajan Tara , Zakalik Dana
Published: June 2022

10610

Background: Lynch syndrome is a hereditary cancer predisposition syndrome caused by mutations in mismatch repair genes, MLH1, MSH2, MSH6, and PMS2. The cancer risks and clinical presentation of PMS2 associated Lynch syndrome is not well defined. This study outlines the characteristics of patients with PMS2 mutations identified in a large academic center. Methods: Patients with a pathogenic or likely pathogenic PMS2 variant identified between June 1, 2009 and Dec 31, 2021 were selected from a database at the Nancy and James Grosfeld Cancer Genetics Center at Beaumont Health. Data on demographics, cancer type and molecular testing were retrospectively analyzed. Results: A total of 92 patients from 61 families were found to carry a pathogenic or likely pathogenic variant in PMS2. The mean age at testing was 54 (19 to 95). A majority (50) of the family were Caucasian, while the rest were African American (2), Middle Eastern (2), Multiracial (8). The most common variant was c.137G > T (p.Ser46Ile), seen in twelve of 61 families. Forty-two patients (45.6%) had a personal history of cancer, with a mean age at diagnosis of 63. Of these forty-two patients, four had multiple malignancies, including one patient with six separate cancers. The most common malignancies were breast (16), colon (12), followed by uterine cancer (8), pancreatic (4), prostate (3) and other cancers. The mean age of diagnosis of breast cancer was 56 (41 to 78), colon cancers was 57 (32 to 75), uterine cancer 59 (50 to 72). Tumor IHC was performed in thirteen cases and 11 demonstrated loss of PMS2 protein expression. MSI was performed in 8 cases and 5 were unstable and 3 were stable. Conclusions: This study reveals the the clinical spectrum of cancers in PMS2 related Lynch syndrome. The most common cancers were breast, colon and uterine cancer, with older age of diagnosis. There was evidence of a more severe phenotype, exemplified by a patient with six cancers, suggesting higher penetrance. Further research is needed to better characterize the clinical presentation of PMS2 related Lynch syndrome.
Identifying genetic factors of response and resistance to CDK4/6 inhibitors in metastatic HR+/HER2-breast cancer using real-world data.
Authors: Agrawal Smita , Singh Neeraj , Narayanan Babu
Published: June 2022

1064

Background: CDK4/6 inhibitors plus endocrine therapy are approved for treatment of HR+/HER2- metastatic breast cancer (MBC) and have shown to provide a significant progression free survival benefit over endocrine therapy alone. But not all patients benefit from this treatment and some develop resistance over time. The molecular mechanisms governing this resistance are poorly understood. We have developed a real world dataset that includes data elements from structured EMR tables as well as deeply curated unstructured data from BC patients (ConcertAI Genome360 BC Dataset) who have been treated with CDK4/6 inhibitors and have undergone DNA sequencing to identify somatic mutations. We have leveraged this linked clinical-genomics dataset to identify genetic drivers of resistance and response to CDK4/6 inhibitors. Methods: This retrospective study uses the Genome360 BC Dataset (N = 1249). The patient’s eligibility to be included in this study (N = 456) was HR+/HER2- MBC patients with age > 18 years treated with at least one of the CDK4/6 inhibitors and have response data based on RECIST criteria (responders = 231, non-responders = 225). For each patient in both cohorts, all pathogenic gene mutations and copy number changes were identified and enrichment analysis was performed. Biomarkers with Z value > 1.96 (p value < 0.05) were considered for further analysis. Pathway analysis was performed using these biomarkers and the CDK4/6 pathway to identify pathways and genes that can potentially be targeted to overcome resistance based on the mutational landscape of the patients receiving therapy. Results: We identified 7 potential segments (similar groups of genes) which predicted response or resistance to CDK4/6 inhibitors. Here we present data on 3 such segments which are closely related. Loss of function mutations in RB1 were enriched in the non-responder population (Z value = 2.33; p value = 0.026; N = 31). This is consistent with previously reported findings. In addition, amplifications and gain of function mutations in MYC and associated genes were also significantly enriched in the non-responder population (Z value = 2.71; P value = 0.01; N = 44). Interestingly, loss of function mutations in TSC1/2 genes which are downstream of MYC were predictors of good response to CDK4/6 inhibitors (Z value = 2.19; P value = 0.036; N = 30), strengthening the role of the parallel MYC signaling pathway in resistance to CDK4/6 inhibitors. Conclusions: Using our Genome360 BC Dataset, we have identified genetic markers affecting response to CDK4/6 inhibitors. In addition to the known role of RB1 in resistance to CDK4/6 inhibitors, the MYC signaling pathway emerged as a strong candidate. Based on these results, patients with mutations in these pathways may benefit from addition of mTOR or PKL1 inhibitors to CDK4/6 inhibitors to overcome resistance and prolong their effect.
Association of 27-gene IO score with outcome in a phase Ib trial of pembrolizumab (pembro) plus chemotherapy (CT) in metastatic triple-negative breast cancer (mTNBC).
Authors: Page David B. , Collins Krystle Louise , Rajamanickam Venkatesh , Moxon Nicole , Mellinger Staci L. , Conlin Alison Katherine , Seitz Robert , McGregor Kim , Nielsen Tyler J. , McArthur Heather L.
Published: June 2022

1082

Background: The IO score is a is a 27-gene signature developed to classify the tumor immune microenvironment derived from the 101-gene TNBCtype genomic classifications. The IO score predicts clinical outcome following immune checkpoint inhibitor therapy in NSCLC and bladder cancer, and recently was shown to predict benefit by pCR of atezolizumab plus CT over neoadjuvant CT alone in early stage TNBC (NeoTRIPaPDL1 trial). The IO score has not yet been evaluated in mTNBC or with pembro in breast cancer. Methods: We report preliminary associations of IO score with response from a phase Ib trial (NCT02734290). mTNBC subjects received 1st/2nd line pembro (200mg IV q3wk) plus investigator’s choice paclitaxel (80mg/m2 IV q1wk, n = 15) or capecitabine (2000mg PO BID x 7d, q2wk, n = 14). Baseline (n = 23) and on-treatment (at wk 6, n = 10) biopsies were analyzed for IO score and genomic subtype by RNA exome sequencing. Objective response rate (ORR, partial or complete response, 12 weeks) and survival was determined among response-evaluable subjects (n= 21). Tumor PD-L1 was assessed by IHC (combined positive score, CPS > 10%). The IO signature was analyzed as a binary classifier (IO+/IO-) and as a continuous variable (IO score). Results: 39% of evaluable subjects were IO+ (n =9/23). IO+ was associated with improved clinical outcome, including ORR (IO+ 43%, IO- 29%), median progression free survival (mPFS, IO+ 138d, IO- 79d), and median overall survival (mOS, IO+ 687d, IO- 305d). IO+/IO- classification and IO scores were stable across serial biopsies (Cohen’s kappa = 0.74, r = 0.84). IO score was not strongly correlated with PD-L1 CPS (r = 0.27) or sTILs (r =.09). PD-L1-/IO+ tumors constituted 31% (n = 5/16) of PD-L1- cases and exhibited favorable outcome (ORR 40%, mPFS 162d, mOS 556d). IO score and ORR varied across TNBCtype classifications (BL1 subtype: 50% ORR, 66% IO+; BL2 subtype: 0% ORR, 66% IO+; LAR subtype: 50% ORR, 0% IO+, MSL subtype: 33% ORR, 60% IO+). Conclusions: IO score is associated with favorable outcome following pembro + CT, and may identify PD-L1-negative cases that respond to pembro + CT. Further investigation in larger datasets is warranted to ascertain the clinical utility of IO score in this setting. Funding: Drug support and funding provided by Merck Sharpe & Dohme as part of the Merck Investigator Studies Program. Clinical trial information: NCT02734290.
Historical redlining and breast cancer survival in the United States: Evidence from the 2010-2017 SEER Medicare linked dataset.
Authors: Bikomeye Jean C. , Zhou Yuhong M. , McGinley Emily L. , Canales Bethany , Yen Tina W.F. , Beyer Kirsten M. M.
Published: June 2022

1095

Background: Cancer is the second leading cause of morbidity and mortality in the US. Systemic racism is a critical cause of health disparities and historically disadvantaged people experience poor outcomes including poor breast cancer (BC) survival. This study aims to investigate the impact of historical redlining on all-cause and BC-specific survival among older women in the US. Methods: Historic 1930’s Homeowner’s Loan Corporation (HOLC) boundaries and grades were linked to 2010 Census tracts and the 2010-2017 SEER Medicare BC cohort. Women were included if they were 66+ years old at diagnosis, diagnosed with invasive BC, enrolled in Medicare Part A and Part B for 12 months prior to diagnosis to calculate comorbidity, and a Census tract match for HOLC grade. The independent variable was HOLC grade in two categories: A and B(not redlined), and C and D(redlined). The outcomes were all-cause and BC-specific survival, determined by Kaplan Meier Survival curves and both unadjusted and adjusted Cox regression models. End point for censoring was 12/31/2019 (all-cause) and 12/31/2018 (BC-specific). The final models were stratified by age and tumor stage at diagnosis; and adjusted for comorbidity, race and ethnicity, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, and interaction term between comorbidity and race. Results: Among 10,113 women, 62.8% resided in historically redlined Census tracts. At a mean (+SD) follow-up time of 48.5 (+28.8) months, 28.9% were deceased; 41.6% of which died of BC. Women residing in historically redlined census tracts experienced poorer BC survival (49.8 +28.2 months) than those residing in non-redlined Census tracts (57.8 +30.7 months). After controlling for covariates, residing in a historically redlined Census tract remained an independent predictor of higher mortality: HR (95%CI) = 1.11 (1.02, 1.20) and 1.24 (1.011, 1.39) for all-cause mortality and BC-specific mortality, respectively. Conclusions: Residing in a formerly redlined Census tract at the time of BC diagnosis is associated with worse all-cause and BC-specific mortality, even after stratifying/adjusting for important patient and tumor characteristics. Public health and government agencies stakeholders should consider historical contexts when designing and implementing equity-focused community and clinical interventions targeted at mitigating and reducing BC disparities and improving health equity.
Medical student clinical cultural awareness in cancer care of sexual and gender minorities.
Authors: Au Cherry , Samuelson Annika , Schabath Matthew B. , Mitchell Edith P.
Published: June 2022

11003

Background: Health disparities in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+), or sexual and gender minorities (SGMs), patients are a known in health care. SGMs have higher cancer risk but lower rates of screenings, resulting in a higher likelihood of late-stage disease. Relevant gaps in medical school curricula regarding SGMs must be addressed to prevent these disparities. The purpose of this study is to evaluate medical students’ (MS) clinical cultural awareness in cancer care of SGM patients. Methods: This study was a cross-sectional survey distributed to medical degree students actively enrolled at a large urban academic center. This survey was adapted from a study by Schabath et. Al. The survey had 38 questions on demographics, attitudes, and knowledge of SGM topics. Questions were scored on a Likert scale from ‘strongly disagree’ to ‘strongly agree’ with ‘don’t know’ and ‘prefer not to answer’ as options. Results are reported using descriptive statistics. Results: There were 238 responses. Most respondents were white (63.9%), cis-gender female (57.6%), and heterosexual (78.6%). Distribution according to year are as follows: MS1 36.6%, MS2 14.7%, MS3 27.3%, and MS4 19.3%. Attitudes are listed in the table below. Four of the seven questions on knowledge had “Don’t Know” as the most common response. Notably, 47.1% of respondents did not know if screening gay/bisexual men with anal pap is associated with increased life expectancy. Students were interested in learning guidelines regarding SGM cancer screening and considerations for patients who are on hormone therapy. Conclusions: While most medical students are comfortable treating LGBTQ+ patients, most are not confident in their knowledge. This difference is most profound in knowledge of transgender patients. Schools must consider longitudinal education in SGM topics to improve student knowledge to produce confident and competent providers. Participants Responses to Attitude Items. [Table: see text]
Assessing the landscape in medical oncology medical education scholarship: A scoping study.
Authors: Jin Ruijia , Addison Sean McKay Fenlon , Kitchin Vanessa , Golden Daniel W. , Tam Vincent C. , Ingledew Paris-Ann
Published: June 2022

11009

Background: Medical oncology and medical education have both expanded exponentially over the past 50 years; as such, it is important to understand the current status of postgraduate medical oncology education and develop ways to advance this field. This study undertakes a scoping review of medical education literature in medical oncology to inform future scholarship in this area. Methods: MEDLINE (Ovid), Embase (Ovid), ERIC (EBSCO), and Web of Science (UBC Core Collection) were searched to find peer-reviewed English language articles on Postgraduate Medical Education in Medical Oncology published between 2009 and 2020. The review was designed in accordance with updated methodological guidance for the conduct of scoping review. Articles were classified by learning specialty, learner training level, region of authorship, single or multi-institution, year of publication, whether the journal was an education journal, quantitative vs qualitative design, study methodology, and category or topic. A modified Kerns framework for curriculum development was used to assess the type of curriculum intervention, Boyer’s definition of scholarship was used to classify the type of scholarship, and the CanMEDS Framework was used to map the domains of physician competency each study aims to address. Results were interpreted using descriptive statistics and collated and summarized utilizing predetermined conceptual frameworks. Results: 2959 references were initially found across the 4 databases. After title and abstract screening, 305 articles remained; after full text review, a total of 144 articles were included in our final analysis. These data showed that postgraduate medical oncology graduate medical education scholarship is increasing and most commonly observed in the United States. Quantitative studies were most common with surveys used as the most popular study approach. In terms of CanMEDS framework, Professional and Medical Expert comprised the large majority of education focuses, while very few articles addressed Leader or Health Advocate. Curriculum development, professional development, and attitudinal skills (communication skills, ethics) were the dominant research themes, while no articles discussed teacher training. Conclusions: By investigating the body of current literature, this research identifies areas of highest priority in postgraduate medical oncology graduate medical education and opportunities for growth. Whereas areas like professionalism and attitudinal skills are well-studied, research is lacking in leadership, health advocacy and teaching training. This study provides guidance for future medical education scholarship in medical oncology and establishes a benchmark to examine changes in medical oncology educational scholarship over time.
Coupling gamified continuing education with confidence-based assessment to address knowledge gaps and assess attitudes towards liquid biopsy for cancer screening among primary care providers.
Authors: Scavone Jillian L , Robinson Katie , Scully Emily , Cooper Simon , Esgro Robert A. , Klein Eric A.
Published: June 2022

11012

Background: Blood-based liquid biopsy assays offer a simplified approach to detect cancer early, guide clinical decision making, and predict treatment success. Given their novelty, primary care providers need education to improve knowledge and confidence regarding their use. The use of gamification in continuing medical education (CME) has been shown to increase engagement and knowledge transfer, and confidence-based learning can improve the educational experience by identified areas in which learners lack comfort. Methods: We provided a gamified CME activity based on the principles of confidence-based learning designed to educate primary care providers (PCPs) on the latest advances regarding the use of liquid biopsy for cancer screening. The game coupled knowledge questions with self-assessment of confidence to gage awareness of these topics. Pre- and post-test was used to quantify the impact of the education. The CE activity was available for credit from March 31, 2021 to March 31, 2022. Results: As of January 2022, 389 PCPs have participated. Overall, participants scored an average 76% on gaming questions related to the rationale behind the use of cell free DNA (cfDNA) for cancer screening and the benefits of liquid biopsy over tissue biopsy, demonstrating relatively high baseline knowledge on these topics. Self-reported confidence among those who answered correctly, however, was only 3.4 out of 5.0, suggesting a lack of comfort with the concepts despite answering correctly. On topics related to specific studies that demonstrated the clinical utility of liquid biopsy, participants scored only 59% and confidence scored averaged 3.17 out of 5.0, demonstrating a lack of knowledge and comfort on these topics. Across all topics, providers scored a 61% on a pre-test. Post-learning, providers scored 89%, highlighting the impact of the education on knowledge gaps. Moreover, while 52% of participants had never ordered a liquid biopsy for cancer screening prior to the education, 69% report being likely or extremely likely to do so because of the education provided. Conclusions: Integration of gamified and confidence-based learning into CE activities is an impactful way to identify and address knowledge gaps while also informing the need for future education. In this study, while self-report of confidence generally correlated with knowledge scores, confidence scores were only average even among those who answered correctly, demonstrating the need for skills-based learning that may improve comfort with liquid biopsy in the clinical setting.
ASCO oral presenters five years later: Leaks in the pipeline?
Authors: Kwong Forrest , Lerner Kimberly , Tao Derrick L. , Patel Sarah , Prasad Vinay
Published: June 2022

11019

Background: There is growing awareness of the challenges of retaining oncologists engaged in research, and this leaky academic pipeline is most notable for women in medicine. Studying academic oncologists is challenging due to their many affiliations, but with an estimated attendance of over 30,000 oncologists, the ASCO annual meeting is a highly sought-after stage for presenting new research. To better understand the continued research engagement of oncologists active in research, we used public data from ASCO annual meetings to follow a cohort of oral abstract presenters over 5 years. Methods: To define our initial cohort of oncologists engaged in research, we used the 2016 ASCO Annual Meeting Digital Program to identify first author oral abstract presenters. We tracked if each presenter was subsequently listed as an author of any research type (oral abstract session, poster session, education session, etc.) at the 2017, 2018, 2019, 2020 and 2021 ASCO conferences. We then filtered out researchers who were not listed as authors at ASCO in consecutive years to look at only those researchers who continued to have active ASCO involvement. To evaluate by gender, each presenter’s name was referenced with the publicly available Wiki-Gendersort tool for an unbiased assignment. Results: 209 first author oral abstract presenters were identified at the 2016 ASCO conference. We found that 67.9% of the initial 209 researchers were listed as authors at ASCO in 2017, 55.5% continued to be authors in 2018, 46.9% in 2019, 42.6% in 2020, and only 38.3% were still listed as authors 5 years later in 2021. When looking at sustained first authorship, 8.1% of the initial 209 research cohort continued to be listed as first authors for 5 consecutive years through 2021. We also looked at the breakdown of other types of ASCO presentations and found that 122 of the initial 209 research cohort presented posters in 2016. Of these 122 researchers, 60 (49.2%) remained authors of posters throughout the consecutive 5 years. This is significantly higher than the number of researchers who continued to author oral abstracts in 2021 49.2% vs. 3.8% (P < 0.0001). When evaluating the differences between gender, there were approximately twice as many men presenters as women (122 men vs 65 women; 22 names were unisex or unknown). The rate of retention was similar for men (47 of the initial 122 males, 38.5%) and women (25 of the initial 65 females, 38.5%) at 5 years (P = 1). Conclusions: We conducted a descriptive study evaluating the rate of sustained activity in academic oncology over 5 years. Our research suggests that about one-third of ASCO presenters will continue to have sustained yearly authorship at 5 years post-oral abstract presentation. Compared to men, the leaky academic pipeline is comparable for women in the 5 years following an oral abstract presentation at ASCO.
Evaluating the quality of clinical evidence in gastrointestinal cancers PubMed searches: How relevant are the results?
Authors: Riano Ivy , Pomares-Millan Hugo , Hammill Chet W. , Trikalinos Nikolaos
Published: June 2022

11037

Background: Bibliographic repositories have become increasingly important as clinical evidence is more accessible on the internet. Often, oncologists rely on published literature to guide patient care. However, with the proliferation of journals and increasing number of peer reviewed papers, current search strategies have the potential to retrieve large numbers of irrelevant or misleading articles. Moreover, access to current best evidence may require paid subscriptions. Here, we assessed the quality of retrieved medical literature pertaining to treatment of gastrointestinal cancers using the PubMed database. Methods: We interrogated 6 focused-therapy questions in 3 categories: medical oncology (MedOnc), surgical oncology (SurgOnc), and alternative medicine (AltMed). We extracted journal metrics of the first two pages (40 results) from each search. We defined the composite outcome “relevant result” as the product of removing results from 1) predatory journals (Beall’s list), 2) non-English language, and 3) no free access publications. As a sensitivity analysis, we defined 2007 as a cutoff for “relevant” publications and Impact Factor (IF) > 3 or H-index > 50. Results: Two hundred and forty results were retrieved (80 per search type). Forty-eight percent of the journals were European (n = 115), 40% US-based (n = 96), and 94% were in English (n = 225). Most journals (n = 170; 70.8%) had an IF between 1-10, followed by ̃21% with an IF > 10 (n = 51); yet ̃45% (n = 107) were in the Clarivate Analytics top quartile. Sixty percent (n = 139) of articles were free to access. The articles had a median H-index of 117 [IR 59, 168]. When modelling the multivariate association with “relevant result”, year of publication after 2007 had an OR = 1.07 (95% CI = 1.01-1.14; p< 0.02) and availability through GOLD Open Access by Clarivate Analytics had an OR = 1.09 (95% CI = 1.03-1.15; p< 0.0008). MedOnc retrieved more papers published in journals with IF > 10 (n = 31; 38.8%) than SurgOnc searches (n = 12; 15%; p< 0.001). Only the AltMed searches included non-peer reviewed publications (n = 4; 5%) and 4 results were from “predatory journals”, all in MedOnc. Conclusions: Articles had a 7% higher chance of being considered a “relevant result” if they were published after 2007 and a 9% higher chance if available under GOLD Open Access. Publications identified as “relevant results” with an IF or H-index above the established cutoffs, had a 6% higher chance to be in the top 40 PubMed search results. In the sensitivity analysis the results remain virtually unchanged. Importantly, nearly 40% of papers indexed in PubMed do not have free full-text articles, making them unavailable to oncologists without access to a medical library or paid subscription. These results highlight the imperative to deliver relevant, freely accessible information that can impact the care of the cancer patients.
Characterizing online engagement and academic impact of oncology research during the COVID-19 pandemic.
Authors: Muthiah Chandrasekar , Muthiah Arun , Wei Chapman , Khan Hina
Published: June 2022

11043

Background: There is increasing use of social media as a platform to discuss research and educate. An article’s impact can be assessed through the Altmetric Attention score (AAS), which considers the volume of social media mentions (Twitter, Facebook, Wikipedia, policy, etc), and the PlumX Impact score, which incorporates interactions on these platforms and citations. COVID-19 has encouraged novel literature in oncology, and these metrics may holistically evaluate the immediate impact of articles in addition to gradual accrual of citations. We explored the relationship between traditionally used bibliometrics (citations, impact factor) and new bibliometrics (AAS, PlumX) of the top 100 trending articles on cancer and COVID-19. Methods: The 100 articles with highest AAS featuring keywords “cancer” and “COVID-19” between March 1, 2019 and January 15, 2022 were identified via Altmetric explorer. AAS, journal, social media mentions, open access status and other characteristics were collected. Scopus database was utilized to identify PlumX scores and citation count. Analysis included Spearman correlation coefficients and ANOVA. Results: Of the 100 articles, 64% were original investigations, 18% editorials/perspectives, 6% guidelines/consensus articles and remaining article types < 6% each. Original investigations comprised of 41% retrospective cohort, 33% cross-sectional, 20% prospective cohort, and remainder < 4% each. Most articles were open access (91%), from cancer-focused journals (77%), and based in North America (36%); 25% were in Europe, 24% multi-continental, and remainder < 8% each. Most publications were in 2020 (56%) and 2021 (40%). AAS and PlumX did not correlate with number of citations or impact factor. Open access publications were associated with greater PlumX (p = 0.033) compared to closed access; this was not seen with AAS. ANOVA showed greater AAS in Australian articles (p =.004) and greater PlumX in North American articles (p =.04). Article type or publication year did not impact AAS and PlumX. Conclusions: In our analysis, Altmetrics and PlumX did not correlate to traditional bibliometrics (citation count, impact factor) in cancer and COVID-19 articles. This suggests that these tools may be complimentary rather than predictive of citations. However, this may change given likely insufficient time for citations to accrue for 2021 studies. There were more editorials/perspective articles compared to similar studies in other specialties, suggesting greater impact of such articles in oncology during COVID-19; this is perhaps due to reliance on expert opinion given paucity of data. Additionally, we noted that PlumX benefits from open access status. Overall, as the use of social media for research dissemination grows, researchers and journal editors may employ alternative metrics to better understand ways to increase the influence of oncology literature during the pandemic.
Recent trends of “manels” and gender representation among panelists at the ASCO annual meeting.
Authors: Kamran Sophia C. , Yeap Beow Y. , Ghosh Anushka , Aldrighetti Christopher , Willers Henning , Vapiwala Neha
Published: June 2022

11053

Background: Gender disparities in academic medicine are a long-acknowledged concern. Efforts to recognize this imbalance and increase inclusivity continue, particularly in academic medical conferences. In June 2019, NIH Director Francis S. Collins MD, PhD publicly called for an end to all-male speaking panels (“manels”). It is unclear whether academic oncology conferences followed suit. We investigated the prevalence and longitudinal trends of manels and gender representation at the ASCO Annual Meeting during 2018-2021. Methods: Using ASCO online programs, 2018-2021 faculty information was obtained. Data collected included perceived or self-reported gender, medical specialty, panel role (chair vs. non-chair), type of session, and topic. Primary outcomes included percentage of manels and proportion of female panelists over time. Female representation among chairs, specialties, and topics were evaluated. Cochran-Armitage test was used to analyze time trends in the proportion of manels and female representation. Fisher’s exact test was used to compare each session type, topic, or specialty to other categories combined. P-values are based on a two-sided hypothesis. Results: During 2018-2021, there were 670 sessions total, 81 of which (12.1%) were manels. Among 2,475 faculty members, 1,181 (47.7%) were females. Over time, there was a significant decrease in the number of manels, from 17.4% in 2018 to 9.9% in 2021 (p = 0.030) and a corresponding increase in proportion of female panelists from 41.6% to 54.0% (p < 0.001). The largest decrease in manels occurred between 2018 (17.4%) and 2019 (10.5%). Among session type and topic, the highest proportion of manels was observed for leadership/special sessions (17.1%, p = 0.419) and translational/pre-clinical topics (19.6%, p = 0.024), respectively. The chair role was majority male (53.2%) in 2018 but increased to > 50% female representation in 2019-2021 (p = 0.157). The lowest proportion of female panelists were in pathology/radiology/dermatology specialties (combined 26.2%, p = 0.001). Female panelists were underrepresented for the topics of genitourinary cancers (38.6%, p = 0.029) and translational/pre-clinical sciences (36.7%, p < 0.001). Females were overrepresented in the topic of supportive oncology (70.3%, p < 0.001). There was a positive trend toward improved female representation among translational/pre-clinical sciences (27.4% in 2018 to 41.8% in 2021, p = 0.031), but with little improvement among genitourinary cancers (41.1% in 2018 to 40.7% in 2021, p = 0.969). Conclusions: The number of female ASCO panelists increased during the study period and surpassed 50% in 2021, with a corresponding decrease in the proportion of manels. Still, there are certain topics/specialties where female representation has remained stagnant. ASCO Annual Meeting organizers should continue to strive for diverse gender representation and the elimination of manels.
Optimal timing and interval of imaging for metastatic breast cancer.
Authors: Patel Shruti Rajesh , Itakura Haruka , Sledge George W.
Published: June 2022

1106

Background: Breast cancer is a family of diseases with varying disease trajectories based on intrinsic biology of the tumor. The time of progression varies across & within subtypes, and with increasing rates of drug resistance depending on prior therapeutic exposure. There is no strong consensus about optimal surveillance and routine imaging in patients with metastatic breast cancer (mBC), but many oncologists report that monitoring strategies are based on strategies used in clinical trials. Methods: We reviewed 17 prior Phase III studies that led to FDA approval in mBC. We reviewed 8 studies for ER+ mBC, 5 studies for HER2+ mBC, 2 studies for triple negative (TNBC) mBC, and 2 studies for BRCA+ mBC. We calculated rates of progression or death (POD) per month for the first year on therapy using data from survival analysis tables and compared them across the different types and lines of therapy. Results: Risk of progression in mBC varies based on receptor status and line of therapy (Table). There was a significant difference in POD rates between ER+ therapies compared with all other disease types (HER2+, TNBC, BRCA) (p = 0.012). Patients with TNBC or receiving PARP inhibitors or later line HER2 therapies had higher POD rates than those with ER+ breast cancer or receiving first line HER2 therapy (6.9% vs 4.1% per month; p = 0.0004). No significant difference was seen in the monitoring frequency between ER+ and HER2+ disease (p = 0.39). Conclusions: These data suggest that shorter interval imaging should be performed for patients with TNBC or receiving PARP inhibitors or later line HER2 therapies. Surveillance imaging for patients with mBC should be based on disease biology, number of prior regimens, time since initiation of therapy, and regimen efficacy. Current imaging recommendations are not data-based and do not adjust for new agents that have been approved. Oncologists should integrate these into individualized estimates to determine optimum frequency of imaging in clinical practice and research. [Table: see text]
Outcomes following preoperative chemoradiation +/- pazopanib in non-rhabdomyosarcoma soft tissue sarcoma (NRSTS): A report from Children's Oncology Group (COG) and NRG Oncology.
Authors: Weiss Aaron R. , Chen Yen-Lin , Scharschmidt Thomas , Xue Wei , Gao Zhengya , Black Jennifer O. , Fanburg-Smith Julie , Zambrano Eduardo , Choy Edwin , Davis Jessica L. , Kayton Mark , Million Lynn , Okuno Scott H. , Ostrenga Andrew , Randall R. Lor , Terezakis Stephanie , Venkatramani Rajkumar , Wang Dian , Hawkins Douglas S. , Spunt Sheri L.
Published: June 2022

11504

Background: Pazopanib is a multi-targeted tyrosine kinase inhibitor (TKI) with activity in advanced soft tissue sarcoma. ARST1321 was a phase II study designed to compare the near complete pathologic response rate (≥ 90% necrosis) following preoperative chemoradiation +/- pazopanib in children and adults with intermediate/high risk chemotherapy-sensitive body wall/extremity NRSTS. Enrollment was stopped early following a predetermined interim analysis that found the rate of near complete pathologic response to be significantly greater with the addition of pazopanib. As a planned secondary analysis of the study, we now report the outcome data for this cohort. Methods: ARST1321 was a jointly designed COG and NRG Oncology study open to enrollment July 2014-October 2018. Eligible adult (≥18 years) and pediatric (< 18 years) patients with newly-diagnosed unresected body wall/extremity NRSTS were enrolled into the Chemotherapy Cohort (> 5 cm, FNCLCC grade 2/3, protocol-designated chemotherapy-sensitive histology). Following a dose-finding phase, patients were randomized to receive (Regimen A) or not receive (Regimen B) pazopanib (< 18 years: 350 mg/m2/day; ≥ 18 years: 600 mg/day) in combination with ifosfamide (7.5 gm/m2/cycle) and doxorubicin (75 mg/m2/cycle) + 45 Gy preoperative RT followed by primary resection at week 13, then further chemotherapy to week 25. Results: Eighty-five eligible patients were enrolled in the Chemotherapy Cohort and randomized to receive or not receive pazopanib. Median age 22.1 years (range: 5.7-64.2 years); 30 patients < 18 years. Most common histologies were synovial sarcoma (n = 42) and undifferentiated pleomorphic sarcoma (n = 19). As of December 31, 2021, at a median survivor follow-up of 3.3 years (range: 0.1 – 5.8 years), the 3-year event-free survival (EFS) for all patients in the intent-to-treat analysis was 52.5% (95% CI: 34.8%-70.2%) for Regimen A and 50.6% (32%-69.2%) for Regimen B (p = 0.8677); 3-year overall survival (OS) was 75.7% (59.7%-91.7%) for Regimen A and 65.4% (48.1%-82.7%) for Regimen B (p = 0.1919). Conclusions: Although the rate of near complete pathologic response was significantly greater with the addition of pazopanib to preoperative chemoradiation in children and adults with intermediate/high risk body wall/extremity NRSTS, outcomes were not statistically significantly different between the two regimens. Pathologic response could be a TKI-related phenomenon and may not be a good surrogate marker of outcome in future studies. Clinical trial information: NCT02180867.