bluuebunny/crossref_metadata_2025 huggingface dataset:
Workplace sexual harassment in academic oncology.
Authors: Yerramilli Divya , Williams Vonetta Michelle , Pandya Sankalp , Dandar Valerie M , Odei Bismarck , Chino Fumiko
Published: June 2023

11003

Background: Research has shown workplace sexual harassment (WSH) is a pervasive problem in academia, affecting recruitment, retention & career advancement of women faculty. This study examines WSH in academic oncology faculty in a national survey. Methods: We obtained data from the Association of American Medical Colleges StandPoint Faculty Engagement Survey between 2020-22 representing a national sample of academic faculty from 25 medical schools (overall response rate (RR) 58%). WSH was considered specific “unwanted behavior” by coworkers that occurred at least once in the past year. Reporting questions were asked on a 5-point Likert Scale from Strongly Disagree to Strongly Agree, with 6th option “I Don’t Know.” Responses were grouped as Agree/Strongly Agree vs all others. Chi-square tested for differences by gender and race/ethnicity. Results: 807/1,287 oncologists participated in the survey (RR 63%), and 91% (731) answered the WSH questions. Most self-identified as men (58%) and only 8% identified as underrepresented race/ethnicity (URiM). See Table for findings. In oncology, women experienced any WSH at higher rates than men (33.1% vs 10.3%, p=0.001). The most common was derogatory comments due to gender. Regardless of gender, most knew how to report WSH incidents, but men were more likely to feel safe reporting. While 64.9% of men felt confident that their medical school would resolve WSH incident(s) effectively, only 48.7% of women did. Positive perceptions of reporting decrease among those who reported harassment. URiM faculty (35.6% vs.18.5%, p=0.001) were more likely than non-URiM faculty to experience at least one of the five harassment behaviors, although this was limited by small sample. Conclusions: In academic oncology, women and URiM experience workplace sexual harassment more often than men and non-URiM. Less than half of women felt confident that reporting an incident would lead to effective resolution. Urgent intervention is needed to combat the negative force of sexual harassment on workforce equity. [Table: see text]
Actionability of comprehensive genomic profiling compared to the tissue-based and plasma-based assay in patients with metastatic breast cancer: A real-world study.
Authors: Tada Hiroshi , Yasuda Jun , Shirota Hidekazu , Miyashita Minoru , Harada-shoji Narumi , Hamanaka Yohei , Ebata Akiko , Sato Miku , Ishida Takanori
Published: June 2023

1101

Background: Comprehensive genomic profiling (CGP) was officially approved in August 2021 in Japan under the national health insurance system with three CGP tests in June 2019: FoundationOne CDx (F1CDx), OncoGuide NCC Oncopanel (NCC), which are tissue-based assay (TBA), and FoundationOne Liquid CDx (F1LCDx, starting in August 2021) which is plasma-based panel (PBA). The Center for Cancer Genomics and Advanced Therapeutics (C-CAT) has collected genomic and clinical data of 2,617 Japanese breast cancer patients as of October 2022. Here we assess these PBA and TBA to detect pathogenic or driver alterations informative for matched therapy in patients with metastatic breast cancer (mBC). Methods: We queried consecutive mBC patient clinical-genomic data through the C-CAT Research-Use Portal from June 2019 to October 2022 were categorized based on PBA or TBA. We used ClinVar to identify if the called somatic alterations were pathogenic or likely pathogenic, and BoostDM (https://www.intogen.org/boostdm/search) to identify potential driver mutations of breast cancer. The proposed rate of matched therapy was determined. The incidence rates were compared using the Pearson χ2 test. Results: Of 2,617 pts who underwent the CGP test, 2,259 (86%) received TBA (74% F1CDx and 12% NCC). The proportion of pts with ≥1 pathogenic variant with PBA and TBA was not significant (71.5%vs.72.7%; p=0.88), but the proportion of pts with ≥1 driver mutation was significantly higher with PBA than TBA (75.4% vs. 69.8%; p = 0.03). Regarding the proportion of pts who matched therapy or clinical trials presented among the pts for whom data were available, PBA was significantly lower than TBA (27.7% vs.38.5%, p < 0.001). Although data on post-treatment is still being collected, the proportion of tested patients that received matched therapies recommended by molecular tumor boards of each institute was significantly lower for PBA (4.2%vs. 8.3%; p = 0.007). Conclusions: This study is the first analysis of CGP for mBC in Japan using the C-CAT utilization program. Although significant alterations were well-detected in PBA, the proportion of pts who received matched-therapy post-testing was low for PBA. Possible causes include that PBA has fewer companion diagnoses than TBA in Japan and that PBA is more often used in later lines.
Addressing resiliency and burnout: A quantitative needs assessment of oncology physician assistants (PAs).
Authors: Tetzlaff Eric Daniel , Hylton Heather Marie , Ruth Karen J , Hasse Zachary , Hall Michael J.
Published: June 2023

11016

Background: Significant progress has been made in understanding the factors associated with oncology (onc) PA burnout. However, little is known about what PAs need to mitigate burnout, the availability of resources, and barriers to interventions. Methods: A national survey of onc PAs was conducted in 2022. PAs completed a quantitative needs assessment to determine the importance of and their perceived skills in topics of self-care, clinical care, and professional development. For importance, “high importance” included ratings of ‘Essential’ or ‘Very Important’; for perceived skill, “high skill” included ratings of ‘Excellent’ or ‘Good’. Engagement with employee assistance programs (EAPs) was examined. Resiliency & Burnout were assessed using the Connor-Davidson Resilience Scale & the Maslach Burnout Inventory. Results: PAs (n = 171) were mostly practicing in medical oncology (66%) and outpatient (66%). The high importance topics most often identified were dealing with difficult patients (93%), dealing with difficult providers (89%), delivering bad news (88%) and coping with death / patient suffering and personal grief (86%). Topics less often reported as high importance included opportunities to be a mentor (61%), professional coaching (59%) and mindfulness skills (53%). PAs frequently reported high skills in dealing with difficult patients (75%), delivering bad news (72%), and resiliency skills (59%). Fewer PAs reported high skills for debriefing following significant events (49%) and mindfulness skills (42%). Burnout (BO) rates were higher for those with lower perceived skills in resiliency (p = 0.03) and dealing with difficult providers and staff (p = 0.03) but did not differ based on importance of any topics. Resiliency significantly increased with increasing levels of reported importance for the mindfulness skills training, cognitive skills training, and debriefing after significant events topics. Resiliency significantly increased with increased levels of perceived skill for all topics explored. Common barriers to well-being EAP participation were lack of time (58%) and concerns about confidentiality and stigma (26%). For PAs with concerns about stigma, resiliency scores were lower (6.4 vs 7.0; p < 0.001) and BO rates were higher (73% vs 47%; p = 0.005). Conclusions: Perceived deficiencies in resiliency training and managing difficult work relationships correlate with higher rates of burnout in onc PAs. Barriers to participation in EAPs, which may help address these deficits, are common and when present are associated with an alarming rate of burnout and lower resiliency. Cultural change in medicine is needed to reduce perceived and experienced stigmatizing experiences to address burnout. These findings suggest that burnout interventions which focus on building resiliency and managing work relationships are crucial and may be best implemented outside of the workplace.
Characterizing imposter syndrome among oncologists on social media.
Authors: Teplinsky Eleonora , Beltran Ponce Sara , Dizon Don S. , Florez Narjust , Katz Matthew S. , McAlarnen Lindsey Allison , Moerdler Scott , Murphy Martina Cathryn , Saeed Hina , Barry Maura Meredith
Published: June 2023

11018

Background: Imposter syndrome (IS) is defined as an inability to believe that one’s success is deserved. It is commonly encountered by physicians, with cited statistics ranging from 22% to 98%, is associated with negative mental health impacts and can be harmful to one’s wellbeing. Given increasing SM use in hematology/oncology (H/O), we aimed to evaluate the effect of SM on IS among oncology trainees and oncologists. Methods: An anonymous online survey was distributed to oncology trainees and oncologists through SM platforms (Twitter, Facebook (FB), Instagram (IG)) and e-mail. Questions included demographics, current SM use, a novel scale for IS on SM (Table), Young Imposter Syndrome (YIS) Scale (a validated IS instrument) & assessment of mental health impacts of SM. Results: Out of 195 respondents, 103 answered all questions; median age 40y (27-65), 81% female. 21% were trainees and 36%, 30%, and 12% were early, mid and late-career faculty, respectively. Specialties included: adult H/O (72%), gynecologic oncology (11.3%), radiation oncology (10.5%), surgical oncology (4.1%), and pediatric H/O (1.5%). Twitter was the most commonly used SM platform (68%) followed by FB (36%) & IG (20%). 26% utilized professional SM 0-1 times/week while 28% did so daily. 97/157 (62%) noted positive mental health impacts from SM. 41% felt anxious, lonely or depressed due to SM. 19.7% have experienced SM harassment or cyberbullying. More than 50% of respondents met criteria on the YIS and IS scale; indeed, the YIS and IS on SM Scales were significantly correlated with each other (r = 0.57, p < 0.001, N = 103). The presence of IS on SM was associated with gender but not race/ethnicity or career stage. 59% of females versus 28% of males met criteria for IS (p = 0.02). The presence of IS on SM was significantly associated with self-perceived IS in professional settings (p < 0.001), but not in personal settings (p = 0.21). Conclusions: Many oncology professionals experienced IS while interacting on SM, but also note a positive mental health impact with SM use. The presence of IS on SM correlated with results on the YIS Scale, suggesting a novel assessment method, but further validation is needed. Future efforts to combat IS on SM while enhancing positive aspects of medical SM are warranted. [Table: see text]
Impact and engagement of a virtual platform to provide equitable oncology education globally.
Authors: Leyfman Yan , Pawar Shubhadarshini , Joshi Muskan , Balasubramanian Maduri , Wilkerson William B. , Menon Gayathri P. , Van de Kieft Alexandra , Jackewicz Sean , Abbas Rabab H. , Park Chandler H.
Published: June 2023

11019

Background: Social media has emerged as a powerful outlet for the dissemination of medical information, especially in resource-limited regions, due to its mass global reach. However, misinformation has presented an unexpected detriment to public health on a global scale. To address this, MedNews Week (MNW), a free, virtual educational platform streamed on most social media platforms was developed to provide global oncology education through biweekly programming. Its leading show, Keynote Conference, features live virtual presentations from oncology’s premier global leaders discussing the latest developments in the field before a mainstream global audience. The aim of this study was to assess the worldwide reach and impact of this cost-free, virtual oncology education platform. Methods: From January 2022 to February 2023, MNW hosted 33 global leaders as Keynote Speakers discussing the latest developments in oncology. Viewership, impressions, and outreach data were collected from MNW’s social media accounts and Tweepmaps. Data was analyzed to assess MNW’s global reach and engagement and stratified based on engagement sentiment, gender, age group, and occupation. Results: During this period, MNW produced a healthcare social grasp score of 64% and generated over 64,000 Twitter impressions engaging 1.9 million viewers over 13 months in the US, UK, Ireland, India, France, and 16 lower socioeconomic (SE) countries and 99 cities. Most of the followers were from non-healthcare fields with more males than females (Table). Those who engaged conveyed positive sentiments (64%) contributing to a viewership increase from 47,589 (6 months) to 61,539 (1 year), where 60% of the audience was found to originate from lower SE regions globally. Conclusions: MNW has demonstrated an ability to attract and sustain a diverse, global, growing mainstream audience. Given MNW’s continued growth, it provides a proof-of-concept model to engage and disseminate medical information to mainstream audiences. The platform’s ability to showcase global leaders to mainstream audiences gratuitously, especially in lower SE regions that have been historically underserved, offers a practical approach to combat educational inequity. Consequently, such a platform has demonstrated great potential to positively impact global oncology education. Demographics of MedNews Week’s audience. [Table: see text]
Social determinants of health factors and palliative care services use among patients with metastatic breast cancer in Florida.
Authors: Giap Fantine , Hong Young-Rock , Bradley Julie Ann , Oladeru Oluwadamilola Temilade
Published: June 2023

1102

Background: ASCO recommends palliative care (PC) as an adjunct to the oncologic standard of care for patients with metastatic cancer. However, current evidence on PC utilization in patients with breast cancer and its relationship with area-level social determinants of health (SDoH) factors is limited. Therefore, we examined the associations between county-level factors and PC utilization among patients with metastatic breast cancer (mBC) in Florida. Methods: We extracted patient-level data (n = 23,539 patients diagnosed with mBC between 2012 and 2021) from the OneFlorida+ Data Trust and linked it to county-level data (67 Florida counties) from the AHRQ-SDoH Database. PC utilization since cancer diagnosis was identified using ICD-9 code V66.7 or ICD-10 code Z51.5. We assessed differences in PC utilization with county-level SDoH factors (e.g., poverty rate, transportation resource, provider supply, racial segregation) using bivariate analysis. Multivariable Poisson regression, including significant factors from bivariate analysis, was used to compare the PC utilization for the SDoH factors. Results: Our study population's overall prevalence of PC utilization was 16.1%. PC utilization was higher for patients with mBC residing in counties with a higher proportion of residents living in poverty and with a greater supply of advanced practice providers (APP: NP, PA), general surgeons, and nursing homes. Patients with mBC in counties with higher proportions of residents who identified as immigrants, with limited English proficiency, without personal transportation, and having higher racial segregation had lower PC utilization. In adjusted analysis, the supply of APP (coefficient:0.12) and nursing homes (coefficient:0.09) was associated with increased PC utilization. Conversely, racial segregation (White vs. non-White) was associated with decreased PC utilization (coefficient: -0.07). Conclusions: PC utilization among patients with mBC was associated with several SDoH at the county level. Notably, low PC utilization was associated with racial residential segregation and fewer APPs and nursing homes. Further research is needed to identify mediators in these relationships to improve PC effectiveness for patients with mBC in Florida.
The impact of physician gender on patient satisfaction in an academic hematology/oncology practice.
Authors: Turchi Alaina Marie , Khalid Ahmed Bilal , Nguyen Chi Mai , Su Jing , Ballinger Tarah Jean , Jalal Shadia Ibrahim
Published: June 2023

11022

Background: Gender disparities continue to remain under addressed in medicine. While prevalent in many forms, patient bias and perceptions toward their healthcare team can impact patient compliance and care. Health systems often gauge patient satisfaction with physicians and post these ratings online. It is possible that gender biases affect patient satisfaction scores and evaluations. Here, we assess the impact of physician gender on patient satisfaction scores and comments in an academic hematology/oncology practice. Methods: A retrospective mixed-method analysis was conducted from patient satisfaction scores and comments obtained between January and June of 2021. Patients were asked a series of three questions about their care. Patients’ response to the question, “How likely would you be to recommend this providers office to friends and family?”, was analyzed on a score of 0-10, with 10 being extremely likely and 0 being not at all likely. Patients were then asked for the primary reason for their scoring, in an open-ended format. Mixed-gender codified data was quantified from de-identified, de-gendered patient comments. To identify the differences in patient perception between male and female physicians, we specifically examined the data of positive and negative impressions of variables including professional behaviors, expertise, kindness, compassion, and interactions with ancillary staff amongst providers. Results: Patient satisfaction scores from 199 unique patients were reviewed; 140 (70.4%) were about male-identifying physicians while 59 (29.6%) were related to female-identifying physicians. The mean satisfaction score was 9.95 ± 0.29 for female physicians and 9.64 ± 1.38 for male physicians (p = 0.011). Of patients responding, 76 (38%) were male and 123 (63%) were female. Female physicians scored higher than male physicians for both male and female patients (10.0 ± 0 versus 9.65 ± 1.37 (p = 0.011) and 9.77 ± 0.60 versus 9.62 ± 1.40 (p = 0.011), respectively). Kindness and compassion were mentioned in 36% and 42% of all female physician scores, respectively, and in 29% and 33% of all male physician scores; these did not reach statistical significance (p = 0.587 and p = 0.257). 21% of all male physician scores positively mentioned physician expertise, compared to 15% of female physician scores; this also did not reach statistical significance (p = 0.434). Conclusions: Female physicians had a higher mean satisfaction score in patient evaluations than their male counterparts by both male and female patients. Numerically, more patient comments about female physicians mentioned kindness or compassion, while fewer mentioned expertise. This early work will be expanded to a larger dataset of evaluations in addition to further exploration of how female and male oncology providers are perceived by patients in multiple other categories.
Bringing the teaching close to home: Implementation of a near-peer model for an introductory hematology-oncology fellowship lecture series.
Authors: Berry Jonathan L , Chase Matthew L , Drews Reed , Freed Jason , Patell Rushad , Rangachari Deepa
Published: June 2023

11025

Background: Hematology/oncology fellowship has a steep learning curve. Foundational knowledge at the start of fellowship is essential, given limited exposure to key disease-specific concepts in prior training. We have previously employed an expert faculty-led “introductory boot camp” during the first 2 months of fellowship training. Trainees provided feedback that this was not best meeting fellows’ needs. We hypothesized that a near-peer teaching model, led by senior fellows, would better align lecture content and scope with the needs of new fellows and improve senior fellows’ mastery of clinical knowledge and comfort with teaching skills. Methods: Using a constructivist theory of learning, we selected the most relevant topics from the curriculum and assigned each senior fellow 1-2 hour-long sessions on clinical areas of interest, paired with expert faculty. A one-hour workshop on lecturing techniques and instructional design was held for all senior fellows. Educational sessions led by senior fellows and expert faculty occurred July-September 2022 in a hybrid format. An IRB-exempt anonymous survey was sent to participating fellows and faculty regarding effectiveness of the educational sessions and the process of preparing to lead sessions. Results: 15 of 17 fellows (88%) and 12 of 15 faculty (80%) completed the survey. Overall, 71% (95% CI 33-82) of fellows and 75% (95% CI 43-95%) of faculty felt the new series was taught at an appropriate level for new fellows. All fellow respondents felt the approach was helpful for clinical practice and board preparation. All participating senior fellows felt equipped to teach and that the exercise improved confidence in the content and their teaching skills. No fellows proposed a return to the prior model, and 80% of faculty felt the near-peer approach should be continued in future years. Qualitative analysis of narrative responses identified several strengths, including emphasis on focused, introductory frameworks and the generation of living resources for future reference. Areas identified for future improvement include providing more guidance and structure for pre-lecture faculty-fellow preparations. Conclusions: A near-peer model of introductory lectures is feasible to implement, produces improved satisfaction with the curriculum, and can be a means of presenting foundational content in hematology and oncology concordant with the learners’ needs. This method has important implications for developing learner-concordant, expert-driven curricula in large and rapidly changing content areas within hematology/oncology.
Utility of a novel trainee-level hematology/oncology podcast in graduate medical education.
Authors: Mistry Ronak , Patel Vivek , Hausrath Daniel
Published: June 2023

11027

Background: Despite the popularity of podcasts in medical education, there are a limited number of trainee-level hematology/oncology (H/O) podcasts. We created & implemented a novel H/O podcast curriculum to address this barrier. Here, we evaluated the utility of this podcast for H/O fellows & internal medicine (IM) residents on H/O rotations. Methods: We included IM residents & H/O fellows at Vanderbilt University Medical Center in the 2022-2023 academic year. Each IM resident starting on a H/O inpatient rotation received an email prior to their rotation with list of recommended episodes. H/O fellows were encouraged to listen to episodes at their discretion. We developed anonymous surveys using a 5-point Likert scale (1, “strongly disagree” to 5, “strongly agree”) to understand how the podcast helped prepare them clinically & if H/O podcasts were effective educational tools. Results: A total of 20 trainees completed the survey including 7 residents (35%) & 13 fellows (65%). All post-graduate years were represented. Results of the survey are presented in the table. Most felt the podcast material helped with inpatient rotations & consults, was clinically relevant, & helped with clinical decision-making with a mean score of 4.76, 4.79, and 4.50, respectively. Respondents agreed the fundamentals of H/O are amenable to a podcast platform & are likely to continue to use podcasts as learning tools in H/O with a mean score of 4.68 and 4.40, respectively. When restricting to the fellow cohort, the majority felt that the podcast material helped them prepare for their clinic patients with a mean score of 4.62. Most found the podcast convenient & the most common activities while listing to our podcast were driving (70%), doing chores (35%), exercising (25%), and eating (25%). Conclusions: H/O fellows & IM residents found the trainee-level podcast curriculum clinically relevant and helped with clinical decision making. The respondents also all agreed or strongly agreed that podcasts are an effective medium to teach hematology/oncology. Our successfully piloted podcast curriculum can be adapted to other training programs to improve foundational knowledge in oncology. [Table: see text]
Efficacy of a hematology/oncology podcast curriculum at a community-based internal medicine program.
Authors: Fitzpatrick Madeline Campbell , Carter Jacob , Mistry Ronak , Hausrath Daniel , Patel Vivek
Published: June 2023

11036

Background: Medical podcasts have gained increasing popularity; however, there is limited evidence regarding their utility as an effective learning resource in Graduate Medical Education. Community-based internal medicine (IM) residents often have less exposure and education in hematology and oncology. To address this barrier, we developed a novel trainee-level hematology/oncology podcast curriculum to improve foundational knowledge for IM residents. Methods: A hematology/oncology podcast curriculum was implemented for IM residents at a community-based residency program in the 2022-2023 academic year. We developed ten episodes regarding workup and management of cytopenias, oncologic emergencies, and hematologic emergencies. We distributed anonymous pre- and post-intervention surveys to understand the impact of the podcast curriculum on a 5-point Likert scale on residents’ self-perception of their knowledge. Two sample paired t-test was used to compare mean differences in surveys. Results: A total of 17/27 residents (63%) completed the pre-intervention survey, and 9/27 residents (33%) completed the post survey. The pre-survey was more heavily weighted towards residents earlier in their training with 53% PGY1s, 29% PGY2s, and 18% PGY3s. With 5 being entirely comfortable, there was a statistically significant increase in mean comfort level in the workup and management of various cytopenias (2.65 to 4.0, p < 0.01) and the management of oncologic emergencies (2.29 to 4.2, p < 0.01). Comfort level in the management of hematologic emergencies numerically improved from 3.35 to 3.57 but was not statistically significant. Most residents (90%) agreed or strongly agreed that the fundamentals of hematology/oncology were amenable to a podcast platform. Many residents found this modality convenient and performed other activities while listening to the podcast including driving (82%) and exercising (55%). The majority of residents who completed the post-survey (64%) reported that they will continue to use podcasts to supplement their medical education. Conclusions: Community based IM residents’ comfort with the field of hematology/oncology improved following the medical podcast educational intervention. Residents found the learning platform amenable to the fundamentals of hematology/oncology and will continue to utilize medical podcasts to supplement their education. Our successfully piloted podcast curriculum can be adapted to other IM programs to improve foundational knowledge in hematology/oncology.
Effects of a focused one-day interactive session on oncology research on medical students’ interest in and understanding of oncology research.
Authors: Alrawabdeh Jawad , Alzubi Marah , Odeh Nada Wael , Hamadneh Yazan , Odeh Mahmoud , Khasawneh Enas Yousef , Al-Ani Abdallah , Hammouri Muhammad , Ahram Mamoun , Abbadi Abdalla
Published: June 2023

11037

Background: Literacy and proficiency in medical research are crucial for the development of modern-day physicians. The need to equip future doctors with sufficient research skills is particularly important in oncology research, as cancer is the second leading cause of death in Jordan and the first worldwide. With the support of the University of Jordan ASCO-OSIG, we explored the efficacy of an interactive research intervention in highlighting the foundations of cancer clinical, basic, and translational research among undergraduate medical students. Methods: We designed and implemented a one-day educational program about all types of cancer research: clinical, basic, and translational. To evaluate the impact of this ASCO-OSIG initiative, students were asked to voluntarily fill surveys before and after the event. Medical students in both their pre-clinical and clinical training were invited to attend the event. Prominent researchers and experts from multiple tertiary cancer centers in Jordan presented 50min lectures on the foundations of clinical, basic, and translational oncology research. Results: A total of 111 participants filled the pre and post surveys, of which ASCO-OSIG members comprised 28.8% of the sample. Approximately 51.4% of participants were pre-clinical students and 48.2% were in their clinical years. About half of our cohort (50.2%) have previously engaged in research projects with only 10.2% of participants have been involved in oncology research. The event was effective in promoting participants’ understanding and familiarity of the fundamentals of clinical (p-value < 0.001), translational (p-value < 0.001), and basic oncology research (p-value < 0.001). Most students were satisfied with the event; with 55% and 32.4% of students reporting being very satisfied and extremely satisfied with the event, respectively. Moreover, 83.8% of participants felt that oncology research was easier to get into after the event. About 96% of students reported that they would recommend this event to a colleague. Conclusions: We demonstrated that a focused one-day cancer research conference had improved medical students’ understanding towards oncology research. Due to its design simplicity, other global ASCO-OSIG coordinators could implement the model within their respective institutions. Future efforts should expand on the available research initiatives and include other medical schools worldwide.
Web-based patient educational material on chimeric antigen receptor T-cell therapy: Quantitative assessment of readability.
Authors: Thakur Rahul Kumar , Adhikari Anurag , Neupane Karun , Hammami M Bakri Bakri , Vegivinti Charan Thej Reddy , Al Hamed Rama , Atalla Eleftheria , Vikash Sindhu , Mehta Ansh , Kumar Abhishek
Published: June 2023

11040

Background: Chimeric antigen receptor (CAR) T-cell therapy is another paradigm-shifting advancement for hematologic malignancies, creating unprecedented treatment options. However, there is still a lack of knowledge and understanding among patients regarding this novel therapy. Most patients turn to online resources, ranging from social media to federal websites, to gather health information to supplement decision-making. Given that the average American adult reads between the sixth- and eighth-grade levels, national organizations recommend that patient resources be written at the sixth-grade level or below. The purpose of this study was to evaluate web-based patient educational material on CAR -T cell therapy resources using measures of readability and compare it to national guidelines. Methods: Online patient information on CAR-T cell therapy from the top 20 U.S Cancer center as per US news ranking was collected. We analyzed the content by six of the most common readability tests- Flesch Reading Ease score (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, and the Automated Readability Index (ARI). The text from each article was carefully reviewed and analyzed using the software Readable, and the readability scores with standard deviation (SD) were obtained. Results: The mean score FRE score was 48.5 (SD: 6.7), which corresponds to college level and is difficult to read. The mean GF score was 8.7(SD: 1.5), which represents the writing of an 8th grader. The FKGL score was 8.6 (SD: 1.1), which represents a level of 8th grade or above. The mean CLI score was 11.5(SD: 1.3), which is the text level for high school juniors. The mean SMOG index was 10.9 (SD: 1), which is the level of a 12th grader. The ARI score was 7.8 (SD: 1.3), indicating a 7th-grade level. Conclusions: Overall, web-based CAR- T cell therapy patient educational materials scored poorly and does not meet the national recommendations. Authors of patient resources should incorporate readability criteria and prompt a revision or creation of new educational materials including videos and audio to support general patient understanding. By making CAR-T therapy information easily understandable, internet users can be better informed about their treatment decisions.
Clinicians’ experiences with patients with cancer or their families who endorse medical misinformation.
Authors: Palmer Amitabha , Gallagher Colleen M.
Published: June 2023

11042

Background: Medical misinformation causes delays in cancer care, forgoing of treatment, economic harms, potentially toxic effects, and harmful medical interactions with standard curative treatments. Previous literature has examined patients’ traits and beliefs. However, effectively caring for patients with cancer who endorse medical misinformation also requires better understanding the experiences, competencies, and concerns of the clinicians who treat them. We conducted an IRB approved study of physicians and advanced practice providers at a large cancer center. Methods: We surveyed clinicians about following themes: i) prevalence of misinformation, ii) attitudes towards patients endorsing misinformation, iii) strategies and competence, iv) resources to help them successfully address patients. Results: 87 clinicians responded to the survey. The median response was 15% of patients endorse claims that are false or misleading about standard-of-care cancer treatments and 20% endorse claims that overstate the benefits or understate the risks of unconventional treatments. The most common misinformation concerned herbs and supplements. Clinicians ranked provides hope and poor medical literacy as the top reasons for why their patients endorse medical misinformation followed by distrust in conventional medicine, cultural factors, and religiosity. The primary attitude clinicians project to patients when they request unconventional treatments was Openness/Equanimity (75.6%), Curiosity (43.9%), Skepticism (18.3%), Disdain/Disappointment (0, 0.0%), Other (6.1%). The primary internal attitude clinicians experienced in these situations was Openness/Equanimity (25.6%), Skepticism (57.3%), Curiosity (40.2%), Disdain/Disappointment (22.0%), Other (6, 7.3%). When asked if they’d be open to a patient using a harmless unconventional treatment that had no evidence of therapeutic benefit, 17.1% said yes, 17.1% said no, and 65.9% said it depends. Correcting misinformation is difficult: 38.2% report success rates below 60% for correcting misinformation and 68.5% report success rates below 80%. Several factors contributed to low success: Only 26% said that they have enough time to adequately address patients who endorse misinformation. Moreover, 46.9% report insufficient resources, 65% claim insufficient training, and 51.3% claim insufficient institutional support. Conclusions: Many cancer care providers feel insufficiently trained and supported to address patients who endorse medical misinformation. Cancer care institutions must develop training and resources to help clinicians effectively address patients who endorse misinformation about their care.
Association of pretreatment chest CT abnormalities with trastuzumab deruxtecan–associated pneumonitis.
Authors: Abelman Rachel Occhiogrosso , Hartley-Blossom Zachary , Fell Geoffrey G. , Ryan Phoebe , Nakajima Erika , Moy Beverly , Ellisen Leif W. , Bardia Aditya , Fintelmann Florian J. , Spring Laura
Published: June 2023

1106

Background: Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate approved for HER2+ metastatic breast cancer (MBC) and HER2-low (IHC 1+ or 2+ with FISH-) MBC . Pneumonitis with T-DXd has been observed in 13.6% of patients (pts) on DESTINY-Breast 01 (including 2.2% fatal events) and 12.1% in pts on DESTINY-BREAST 04 (including 0.8% fatal events). There is an unmet need to determine if pts with baseline lung abnormalities are at increased risk for development of pneumonitis from T-DXd. Methods: This retrospective cohort study included all pts treated with T-DXd for MBC at an academic institution from 1/2020 to 2/2023 for more than 1 cycle (>21 days). Outcomes were evaluated from treatment initiation until 2/1/2023. Two board-certified radiologists blinded to outcomes reviewed staging chest CTs performed before initiating T-DXd and graded each scan on 16 parenchymal abnormalities, including presence of interstitial lung abnormalities (ILA). Pneumonitis was retrospectively adjudicated by an independent oncologist using chart review and graded according to CTCAE v5.0 and compared to the treating physician’s assessment. The difference of proportions was analyzed with the Pearson Chi-Square test. Significance was declared at the 0.05 type I error threshold. Results: A total of 68 pts (median age 57.3 years) were included (30 = HER2+, 24 = HR+/HER2 low, 14 = TNBC/HER2 low). By independent assessment, 16 pts (23.5%) had grade 1 pneumonitis and 3 pts (4.4%) grade 2 pneumonitis. Median time from treatment initiation to pneumonitis was 83 days (range 35-266). By treating physician assessment, 5 pts (7.4%) developed grade 1 pneumonitis and 3 pts (4.4%) developed grade 2 pneumonitis. 16 of 68 pts (23.5%) had baseline ILA and 62 pts (91.2%) had at least one other parenchymal abnormality. As assessed by an independent oncologist, of pts with baseline ILA (N = 16), 12.5% developed T-DXd related pneumonitis, compared to 32.7% of pts without pre-existing ILA (N=52), p=0.16. There was no statistical difference in T-DXd related pneumonitis assessed by treating physician between pts with baseline ILA (2/16 patients, 12.5%) compared to pts without baseline ILA (7/52 pts, 13.5%), p=0.68. Conclusions: In this study, presence of baseline ILA was not associated with subsequent pneumonitis from T-DXd. Notably, the rate of independently assessed pneumonitis was higher than treatment-attributed pneumonitis as defined by the treating physician. Further research is needed to validate these findings and define predictors of treatment-associated pneumonitis. [Table: see text]
Distribution and outcomes of HER2-low and HER2-zero metastatic breast cancer in Black and younger women.
Authors: Zagami Paola , Abdou Yara , Wardell Alexis Caroline , Deal Allison Mary , Wheless Amy , Dees Elizabeth Claire , Carey Lisa A.
Published: June 2023

1109

Background: Black and younger patients with breast cancer (BC) have higher mortality. This racial disparity has been attributed to different BC biology, access to care, and treatment. With the advent of new antibody-drug conjugates (ADC) for metastatic BC (MBC), “HER2-negative” has been subdivided into HER2-low (IHC 1+ or 2+/ISH-negative) and HER2-0 (IHC 0). Little is known about these subcategories among Black and younger women with MBC. Methods: Clinical characteristics, treatment, and outcomes of patients diagnosed with HER2-negative MBC between 2011-2022 and with follow-up through a progression-free survival event on first-line therapy (PFS1) were retrieved from the UNC Metastatic Breast Cancer Database; hormone receptor (HR) and HER2 categories were by clinical criteria from the pathology report. Analyses were limited to HER2-negative BC and stratified/controlled by HR status. Fisher’s exact tests were used to compare HER2 status across race and age. The Kaplan Meier method and log-rank tests, as well as Cox proportional hazards models estimated PFS1. Results: The cohort included 772 MBC patients (56% HER2-low and 44% HER2-0), 22% Black women and 30% < 50 years old at MBC diagnosis. There were no differences in proportion with HER2-low by race or age (p>0.5). Patients with HER2-low had better observed median PFS1 compared to HER2-0, however, most of these differences were non-significant: overall (HR+ 12.2 vs 9.8m, p=0.11, HR- 4.3 v 3.3m, p=0.29) and within race and age categories (see table). In Cox modeling, Black women had worse PFS1 (p=0.03), that was no longer apparent after adjusting for HR status (p=0.1), there was no difference by age. Patients with HER2-0 had worse PFS1 (p=0.0005), which remained after adjusting for HR status (p=0.05). In a multivariable model comparing HER2-0 to HER2-low, adjusting for race and HR status, PFS1 remained shorter in the HER2-0 group (hazard ratio: 0.84, CI 0.692 – 1.015, p=0.07). Among those treated with uniform first-line therapy, better PFS1 was observed in HER2-low disease. This included 137 HR+ MBC treated with ET + CDK4/6i (mPFS1 14.3 v 10.3m, p=0.33) and 170 HR- MBC treated with chemotherapy (mPFS1 4.0 v 3.1m, p=0.22) with no variation by race or age. Conclusions: Within HER2-negative MBC, distribution of HER2-low and HER2-0 cancers does not differ by race and age. The clinical benefit of first-line therapy is strongly driven by HR status regardless of race and age, and is greater in HER2-low cancers although this cohort did not include HER2-directed ADCs. [Table: see text]
Imbalance in treatment discontinuation without progression between experimental and control arms among randomized trials in advanced breast cancer.
Authors: Tamimi Faris , Mittal Abhenil , Molto Consolacion , Malon Gimenez Diego , Nadler Michelle B. , Amir Eitan
Published: June 2023

1110

Background: In Randomized Controlled Trials (RCT), treatment discontinuation (TD) can result in censoring. Imbalanced frequency of TD between arms could impact interpretation of results. Here, we quantify TD between the experimental and control arms among RCT supporting registration of drugs for advanced breast cancer. Methods: We identified RCT supporting US Food and Drug Administration's approval of drugs for advanced breast cancer between 2013 and 2023. We extracted data for the number of participants with TD for reasons other than disease progression (PD), death, or completion of treatment. Odds ratio (OR) for TD comparing experimental to control arms were determined for each trial. To assess progression-free survival (PFS) translation into an overall survival (OS) benefit, we calculated hazard ratio (HR) for PFS/OS. Then we assessed whether there was quantitative association between the OR for TD and the ratio of HR for PFS/OS. Quantitative significance was defined according to the criteria of Burnand. Results: Analysis included 22 RCT comprising 13853 participants and supporting approval for 18 distinct drugs. TD was reported in 2212 (16.0%) participants. Among these participants, the leading causes of TD were withdrawal of consent (27.8%), site termination (20.7%), adverse events (17.2%), and loss of follow-up (10.9%). There was a statistically significant imbalance in the experimental arm in 4 RCT (18%) (Table), which was observed for everolimus, ribociclib (with fulvestrant), alpelisib, and neratinib. The OR for TD showed quantitative, but not statistically significant negative association with the ratio of the HR for PFS/OS (Beta -0.393; p=0.18). Conclusions: TD without PD, death, or completion of treatment occurs in a substantial proportion of participants of several RCT supporting approval of drugs for advanced breast cancer. all the statistically significant imbalanced TD in the RCT were in experimental arms. Quantitative association between imbalanced TD and the ratio of HR for PFS/OS suggests imbalanced TD may impact ability to translate improvements in PFS to OS. Results of RCT with imbalance in TD should be interpreted cautiously. [Table: see text]
Efficacy of combination lurbinectedin (LURBI) + doxorubicin (DOX) from the phase 1B soft-tissue sarcoma (STS) lead-in to a randomized phase 2 trial in leiomyosarcoma (LMS).
Authors: Cote Gregory Michael , Haddox Candace L. , Choy Edwin , Merriam Priscilla , Mazzola Emanuele , Wagner Andrew J. , Siontis Brittany L. , Attia Steven , Seetharam Mahesh , Demetri George D. , George Suzanne
Published: June 2023

11507

Background: Single agent or combination chemotherapy, typically Dox- or gemcitabine-based, are standard 1st- and 2nd-line therapies in patients (pts) with metastatic LMS; however, objective response rates (ORR), progression-free, and overall survival (PFS/OS) remain inadequate. Lurbi (PharmaMar S.A. / Jazz Pharmaceuticals) binds to DNA inhibiting transcription and inducing double strand breaks leading to apoptosis and delaying S/G2 progression. In a prior pilot study, we showed Lurbi+Dox is well-tolerated, with signs of activity, particularly in LMS. We designed this phase 1b to optimize dosing to lead into a randomized (1:1) phase 2 trial of Dox+/-Lurbi in anthracycline-naïve LMS. Herein we provide updated efficacy and tolerability data for this Phase 1b cohort. Methods: Pts > 18 yrs with locally advanced/metastatic, unresectable non-GIST STS (Phase 1b only) w/o prior anthracycline or Lurbi/trabectedin, ECOG PS < 3, RECIST 1.1 measurable, and normal organ function were eligible. The phase 1b followed a 3+3 design. Dosing included fixed Lurbi (3.2 mg/m2 d1) with two Dox dose levels (DL; DL1: 25 mg/m2 d1; DL2 25 mg/m2 d1+8). All pts received GCSF prophylaxis. Tumor assessments were every 2 cycles. DL1 was chosen as RP2D and the phase 2 trial began accrual in Aug 2022 aiming to enroll 50 LMS pts randomized 1:1 (stratified by uterine LMS [uLMS]] v. other LMS) with PFS as primary endpoint. Pts progressing on Dox are allowed to cross to Lurbi monotherapy. Results: 10 patients were enrolled in Phase 1b. Histologies included 5 LMS (4 uLMS) and 1 each of myxofibrosarcoma (myxFS), undifferentiated pleomorphic sarcoma (UPS), dedifferentiated liposarcoma (DDLPS), endometrial stromal sarcoma (ESS), and solitary fibrous tumor (SFT). With a median follow-up of 344 days, 5/10 pts remain on treatment with median PFS of 357 days (95%CI 175-ND). 6 pts demonstrated partial response (PR; 5 confirmed), 3 with stable disease (SD), and 1 with progressive disease (PD, Table). Median time to PR was 81 days (range 46-207). Duration of response was over 132 days in all responders with 3 still on treatment. Treatment-related AEs were typical for Dox/Lurbi, including nausea, fatigue, and reversible LFT elevations/cytopenias. Updated safety and response data will be provided at the time of the meeting. Conclusions: Lurbi+Dox is well-tolerated with efficacy in STS including 6/10 pts achieving PR, 9/10 pts staying on treatment for >120d, and 6/10 pts >200d. The randomized phase 2 study is currently enrolling. Clinical trial information: NCT05099666 . [Table: see text]