bluuebunny/crossref_metadata_2025 huggingface dataset:
Universal genetic testing versus guideline-directed testing for hereditary cancer syndromes among traditionally underrepresented patients in a community oncology program.
Authors: Jones Jeremy Clifton , Coston Tucker , Kunze Katie , Golafshar Michael A. , Rao Rohit , Wysokinska Ewa Maria , Johnson Elizabeth , Esplin Edward D. , Nussbaum Robert Luke , Heald Brandie , Klint Margaret , Barrus Kathleen , Bekaii-Saab Tanios S. , Dronca Roxana Stefania , Samadder Jewel
Published: June 2022

10588

Background: Detection of pathogenic germline variants (PGVs) has implications for cancer screening, prognostication, treatment selection, clinical trial enrollment and family testing. Published guidelines provide indications for PGV testing, determined by clinical and demographic factors, but these leave a significant number of cases missed by guideline-directed testing (incremental PGV). We have previously shown that 50% of patients with PVGs would not have been detected with guideline-based testing alone. In this project, we aimed to determine the feasibility and generalizability of this approach within a more racially/ethnically diverse cohort from a community cancer practice. Methods: We completed a prospective study of proactive germline genetic sequencing among patients with solid tumor malignancies at a community-based oncology practice in downtown Jacksonville, FL between June 2020, and September 2021. The patients were unselected for cancer type, stage, family history, race/ethnicity, and age. PGVs identified using an 84-gene NGS platform were stratified by penetrance. National Comprehensive Cancer Networks (NCCN) guidelines were used to determine incremental PGV rates. Results: 221 patients were enrolled, median age 63.0 years, 21.7% male. 56.6% of patients were white (non-Hispanic), 32.6% were black/African American, 5.4% were Hispanic. 39.8% of patients were commercially insured, 52.4% insured by Medicare/Medicaid and 2.7% uninsured. The cohort was comprised predominantly of breast cancer (61.5%), lung cancer (10.4%) and colon cancer (7.2%) patients. A total of 27 PGVs were identified in 23 patients. We found no significant difference in the rate of PGVs based on race/ethnicity. The overall rate of variants of uncertain significance (VUS) was numerically higher in black/African American patients (61.1%) compared with other ancestry (45%). 13 of 23 (56.5%) patients with detected PGVs did not meet NCCN guidelines for germline genetic screening (incremental PGVs). Conclusions: This prospective study found that universal multi-gene panel testing among patients from a racially/ethnically diverse cohort from a community cancer practice was associated with an increased detection of heritable variants with treatment implications over the predicted yield of targeted testing based on guidelines. This study is the first to evaluate this approach in an exclusively community-based practice. Clinical trial information: NCT04456140.
Germline screening rates and patterns for patients with pancreatic cancer at an academic medical center.
Authors: Coleman DeJuana , Thomas Martha , Le Tri Minh , Kunk Paul Raymond , Reilley Matthew
Published: June 2022

10590

Background: Current National Comprehensive Cancer Network guidelines recommend germline genetic testing for all pancreatic cancer patients irrespective of family history. Germline testing provides insight on inherited pathogenic variants that may influence care. Approximately 10% of pancreatic adenocarcinoma (PDAC) patients have pathogenic mutations which may have treatment implications and warrant the introduction of targeted therapy approaches. Patients with germline BRCA1/2 or PALB2 mutations have increased sensitivity to platinum chemotherapy and PARP-inhibitor therapies. Germline testing results may have important implications for patients’ family members for earlier targeted screening. A better understanding of the current state of testing is needed to develop systems to improve screening rates. We conducted a retrospective review of clinical practice patterns at an academic cancer center to assess the current uptake. Methods: Patients with pancreatic adenocarcinoma seen at the University of Virginia Health System within the 2021 calendar year were identified. Retrospective review of genetic counseling referral and germline genomic screening for individual patients was performed. Results: 210 patients with pancreatic adenocarcinoma were identified. 39 (19%) PDAC patients had a referral to genetic counseling placed in the electronic medical record and 44 (21%) completed germline screening. Of the patients referred to genetics, 17/39 patients (44%) met with a genetic counselor which led to germline screening, 3/39 (8%) patients were referred and saw genetics after receiving germline testing results. Among patients who completed germline screening, 27/44 (61%) had testing initially ordered by their oncologist with referral to genetic counseling based on testing results 3/27 (11%). Conclusions: Despite guideline recommendations, germline testing rates are low among this PDAC population. Genetic counselors are essential members of a multidisciplinary team and guide patient discussions and decision making with regards to germline testing. Typical practice has involved referral to meet with a genetics counselor prior to testing; however many patients elect not to schedule a visit and consequently do not obtain germline screening. Barriers may include costs associated with genetic counseling/testing, time constraints, and patient understanding of the relevance of testing for their cancer care. We observed that offering germline testing to PDAC patients with referral to genetic counseling based on results and patient preference is a viable practice pattern. Upfront clinician driven germline testing may offer an opportunity to improve access to germline screening. Prospective clinical trials are needed to increase rates of germline testing and genetic counseling for PDAC patients.
Risk-stratified FIT for urgent colonoscopy in Lynch syndrome: A clinical service throughout the COVID-19 pandemic.
Authors: Lincoln Anne G , Benton Sally C , Sasieni Peter , Monahan Kevin J
Published: June 2022

10606

Background: Lynch syndrome (LS) is an inherited disorder characterized by pathogenic variants within mismatch repair genes resulting in an increased risk of colorectal cancer (CRC). In England, the fecal immunochemical test for Haemoglobin (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. Herein, we report results from a national emergency clinical service implemented during the COVID-19 pandemic which used FIT to prioritize colonoscopy in LS patients while endoscopy services were limited. Methods: Regional genetic and endoscopy services across England were invited to participate. Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 March 2021. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub’s Research Laboratory in Surrey. The Hub sent patients a FIT kit (OC-Sensor™ (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Lab reports with feecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥10µg of Haemoglobin (Hb)/g (µg/g) faeces: triaged for colonoscopy via an urgent two-week wait (2WW) pathway, (2) f-Hb ≤10µg/g: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits. Results: Fifteen centers across England participated in the clinical service from 9th June 2020 to 31st March 2021. An uptake rate of 64% was observed from this cohort (375/588 invites), though 21 cases were removed from analysis due to repeat FITs, insufficient sample, missing clinical data, or FIT completed after colonoscopy. Of the remaining 354 patients analyzed, 269 patients (76%) had a f-Hb of <6µg/g. 6% (n=23) of patients had a f-Hb that was at or between greater than the limit of detection of the assay (≥6µg/g) yet below 10µg/g.18% (n=62) had FIT results of ≥10µg/g and met criteria for urgent colonoscopy triage via the 2WW pathway. Of the 62 urgently triaged patients, 22 had detectable adenomas, 6 had advanced adenomas (AAs), and 4 were diagnosed with CRC (table). Conclusions: The utility of FIT during the pandemic has demonstrated clinical value for LS patients requiring CRC surveillance. Further longitudinal investigation on the efficacy of FIT in people with LS is warranted and will be examined as part of the multi-center prospective research study “FIT for Lynch Syndrome” (ISRCTN15740250) which is presently recruiting patients in the UK. [Table: see text]
Ribociclib-induced acute kidney injury: Uncover the MONALEESA’s dark face.
Authors: Hajir Maissoune , Abu-Hijlih Ramiz Ahmad , Abu Sheikha Areej , Alqasem Kholoud , Abdel-Razeq Hikmat
Published: June 2022

1063

Background: The phase-3 MONALEESA-2,-3 and -7 randomized trials showed improved progression-free survival (PFS) and overall survival (OS) with the addition of cyclin D-cyclin-dependent kinase 4/6 (CDK4/6) inhibitor ribociclib to endocrine therapy in women with advanced-stage breast cancer. However, ribociclib induced acute renal injury is not recognized in these studies. In this report, we explore ribociclib-induced acute kidney injury (AKI) in breast cancer patients receiving ribociclib. Methods: We performed a retrospective chart review of all breast cancer patients who received ribociclib at our institution between April 2019 and September 2021. Patients and disease characteristics were collected, details of creatinine kinetics in relation to administration of ribociclib and other nephrotoxic drugs were obtained. Acute kidney injury grades (AKI-KDIGO classification) were captured. Results: 145 females, median age 60.0 years, all with advanced-stage breast cancer treated with aromatase inhibitors (AI) or fulvestrant plus ribociclib were reviewed. A total of 26 (17.9%) patients developed AKI; 3 were grade-I, 21 grade-II and 2 were grade-III. Rate of AKI was significantly higher (n = 15, 48.4%) among 31 patients on other concomitant nephrotoxic drugs, compared to 11 (9.6%) of 114 other patients, p = 0.001. Nephrotoxic drugs include non-steroidal anti-inflammatory (38%), metformin (30%), angiotensin-II receptor blockers (26%), and angiotensin-converting enzyme inhibitors (11%). Median time to develop AKI was 54 (range, 21-168) days, while the median time for creatinine recovery was 5 (range, 4-7) days after holding the drugs. Average creatinine increment for affected patients was 2.28 times the baseline level. Time to AKI was shorter, but not statistically significant, among patients on nephrotoxic drugs and recovery was faster after stopping these drugs (Table). Conclusions: Ribociclib-induced AKI is not uncommon and not adequately addressed. Though reversable in majority of patients, some patients may develop grade-III AKI or require treatment interruption. Nephrotoxic medications seem to significantly enhance ribociclib-associated renal injury. Withhold these medications with periodical assessment by nephrologist is strongly recommended in these patients. Larger studies are warranted to validate our findings. [Table: see text]
Real-world outcomes of Black women versus non-Hispanic White women with advanced triple-negative breast cancer treated with immune checkpoint inhibitors at an urban cancer center.
Authors: Aldrich Jeffrey , Switchenko Jeffrey M. , Kalinsky Kevin , Bhave Manali A.
Published: June 2022

1074

Background: Black women (BW) are disproportionately diagnosed with metastatic triple negative breast cancer (mTNBC) compared to Non-Hispanic White women (NHW). Median overall survival (OS) in mTNBC remains poor at 12-18 months. While immune checkpoint inhibitors (ICIs) are a promising treatment strategy, BW were significantly underrepresented in pivotal clinical trials that led to the approval of ICIs in mTNBC. Therefore, the efficacy, safety, and optimal biomarkers of ICI response in BW remain unknown. We sought to compare baseline characteristics and outcomes between BW and NHW with mTNBC treated with an ICI and chemotherapy at an urban tertiary care institution. Methods: BW and NHW with advanced unresectable or mTNBC treated with an ICI plus chemotherapy at Emory University between 2019 and 2021 were retrospectively evaluated. Baseline characteristics, including next generation sequencing (NGS), as well as clinical outcomes between BW and NHW were compared using Kruskal-Wallis tests and Fisher’s exact tests. Progression free survival (PFS) and OS were analyzed with the Kaplan-Meir method. Results: Forty-one women with PDL-1 positive mTNBC treated with an ICI and chemotherapy were identified [BW, n = 26 (63%) and NHW, n = 15 (37%)]. A majority of patients had relapsed disease (73%); however BW were more likely to have de novo metastatic disease compared to NHW (38% vs 7%, p = 0.03). Twenty-seven (66%) patients received atezolizumab and 14 (34%) were treated with pembrolizumab. Of the 23 (56%) patients with NGS testing, alterations in TP53, PIK3CA, and BRCA were seen in 23 (100%), 5 (31%), and 1 (6%) patient, respectively. Median tumor mutational burden was similar between BW and NHW (5 vs 7, p = 0.8). BW had numerically lower median PDL-1 (SP142) compared to NHW (1% vs 2%, p = 0.5). Rates of immune and dose-limiting chemotherapy-related adverse events were similar between BW and NHW (Table). There were no differences in ICI response between groups, though BW had fewer complete responses and a shorter median PFS compared to NHW. Median OS was 12 months in BW compared to 28 months in NHW (p = 0.1). Conclusions: Our experience with real-world use of this regimen showed that BW had fewer complete responses and a trend towards worse OS compared to NHW. BW had numerically lower median PDL-1 expression compared to NHW, suggesting further investigation of biomarkers, potentially by Race, are needed to better identify responders to ICI in mTNBC. [Table: see text]
Lurbinectedin in patients with pretreated BRCA1/2-associated metastatic breast cancer: Results from a phase II basket study.
Authors: Boni Valentina , Pistilli Barbara , Brana Irene , Shapiro Geoffrey , Trigo Perez Jose Manuel Manuel , Moreno Victor , Castellano Daniel E. , Fernandez Cristian Marcelo , Kahatt Carmen Maria , Alfaro Vicente , Siguero Mariano , Zeaiter Ali Hassan , Longo Federico , Zaman Khalil , Antón Torres Antonio , Paredes Lario Alfredo , Huidobro Vence Gerardo , Subbiah Vivek
Published: June 2022

1092

Background: Lurbinectedin (L) is a selective inhibitor of oncogenic transcription that leads to cell apoptosis and shows antitumor activity against homologous recombination repair-deficient cell lines. A previous phase II study (Cruz et al. JCO 2018;36:3134-3143) demonstrated antitumor activity in patients (pts) with pretreated metastatic breast cancer (median of 1 prior advanced chemotherapy line) and BRCA1/2-mutated tumors with L 3.5 mg/m2 or 7.0 mg flat dose (equivalent to 4.0 mg/m2) every three weeks [q3wk]). This report focuses on the outcomes in the BRCA1/2-associated breast cancer cohort of a phase II Basket multitumor trial. Methods: This phase II study evaluated L 3.2 mg/m2 1-hour intravenous (i.v.) infusion q3wk in a cohort of 21 female pts with pretreated BRCA1/2-associated breast cancer. The primary efficacy endpoint was ORR according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), OS and safety. Results: Median age was 45 years (range, 29-73 years). Hormone receptor (HR)+ disease was observed in 76.2% of pts, triple negative disease in 19.0% and HER2+ in 9.5%. BRCA1 and BRCA2 were reported in 47.6% and 52.4% of pts, respectively. Median number of prior lines of chemotherapy for advanced disease was 2 (range, 0-3 lines). Prior poly(ADP-ribose) polymerase inhibitors and platinum compounds had been administered to 23.8% and 47.6% of pts, respectively. Confirmed partial response (PR) was observed in six pts (ORR = 28.6%; 95% CI, 11.3-52.2%). Lurbinectedin was active in both BRCA mutations: four PRs in 11 pts (36.4%) in BRCA2 and two PRs in 10 pts (20.0%) in BRCA1. Median DoR was 8.6 months, median PFS was 4.1 months and median OS was 16.1 months. Stable disease (SD) was observed in ten pts (47.6%), including three pts with unconfirmed response in a subsequent tumor assessment (ORR unconfirmed = 42.9% [95%CI, 21.8-66.0]). Clinical benefit rate (PR + SD≥4 months) was 76.2% (95% CI, 52.8-91.8%). The most common grade 3/4 toxicity was neutropenia (42.9%; grade 4, 23.8%; with no febrile neutropenia). Conclusions: This phase II study met its primary endpoint and confirmed the activity of L in pretreated BRCA1/2-associated breast cancer pts. L 3.2 mg/m2 1-hour i.v. infusion q3wk showed an acceptable, predictable and manageable safety profile. Considering the exploratory aim of this trial as well as previous results in other phase II study, further development of L in this indication is warranted. Clinical trial information: NCT02454972.
Subgroup analysis of patients with no prior chemotherapy in EMERALD: A phase 3 trial evaluating elacestrant, an oral selective estrogen receptor degrader (SERD), versus investigator’s choice of endocrine monotherapy for ER+/HER2-advanced/metastatic breast cancer (mBC).
Authors: Kaklamani Virginia G. , Bardia Aditya , Aftimos Philippe Georges , Cortes Javier , Lu Janice M. , Neven Patrick , Streich Guillermo , Montero Alberto J. , Forget Frederic , Mouret-Reynier Marie-Ange , Sohn Joohyuk , Taylor Donatienne , Harnden Kathleen Kiernan , Khong Hung T. , Kocsis Judit , Dalenc Florence , Dillon Patrick Michael , Tonini Giulia , Grzegorzewski Kris , Bidard François-Clement
Published: June 2022

1100

Background: EMERALD demonstrated significantly prolonged progression-free survival (PFS) and a manageable toxicity profile for elacestrant vs standard of care endocrine therapy (SOC) in patients with ER+/HER2- mBC following progression on prior endocrine and CDK4/6 inhibitor therapy. Benefit was observed in the overall study population and in patients with ESR1 mutations (mESR1). Here, we report a subgroup analysis from EMERALD in patients with no prior chemotherapy. Methods: EMERALD (NCT03778931) is a randomized, open-label, phase 3 trial that enrolled patients with ER+/HER2− mBC who had 1–2 lines of endocrine therapy, mandatory pretreatment with a CDK4/6 inhibitor, and ≤1 chemotherapy. Patients were randomized 1:1 to elacestrant (400 mg orally daily) or SOC (investigator’s choice of fulvestrant or aromatase inhibitor). Primary endpoints were PFS in all patients and patients with mESR1. In this analysis, we compared PFS between elacestrant and SOC in patients without prior chemotherapy. Results: Among the 477 patients enrolled in the trial, 77.8% (n = 371) had not received prior chemotherapy for mBC (median age = 64). Among patients without prior chemotherapy, treatment with elacestrant was associated with significantly prolonged PFS compared to SOC in both the overall population (hazard ratio [HR] = 0.68 [95% CI, 0.52-0.89] P = 0.004; median PFS 3.7 vs 2.0; 6-mo PFS 38% vs 23%; 12-mo PFS 27% vs 12%), and patients with mESR1 (HR = 0.54 [95% CI, 0.36-0.80] P = 0.002; median PFS 5.3 vs 1.9; 6-mo PFS 44% vs 24%; 12-mo PFS 31% vs 12%). Key treatment-related adverse events (AEs) in the no prior chemotherapy elacestrant group were nausea (25.9%), fatigue (12.7%), and hot flush (11.1%). There were no treatment-related deaths in either group. Conclusions: Among patients with ER+/HER2− mBC without prior chemotherapy, elacestrant significantly prolonged PFS compared to SOC endocrine therapy and showed favorable outcomes in this subgroup. Clinical trial information: NCT03778931.
Development and assessment of the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS training.
Authors: Schabath Matthew B. , Perez-Morales Jaileene , Hernandez Eryk N. , Miller Jarred D. , Seay Julia , Quinn Gwendolyn P.
Published: June 2022

11000

Background: Published studies report oncologists have limited knowledge about LGBT health and cancer needs but also report high interest in receiving education regarding the unique health needs of LGBT patients with cancer. As such, our group developed the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS), an interactive web-based LGBT cultural sensitivity training for oncologists that focused on focused on improving knowledge and communication skill-building. We report here on the results from two single-arm feasibility/acceptability trials and one randomized pragmatic trial (RPT) demonstrating effectiveness of the COLORS training. Methods: The first single-arm trial included 44 oncologists from three cancer centers in Florida and the second single-arm trial included 50 oncology fellows recruited through ASCO. The RPT included 225 oncologists randomly selected for equal distribution across the U.S., and participants were randomly assigned to either the COLORS training or a publicly available, web-based LGBT comparison training. Each of these studies included pre- and post-training assessments of LGBT-related knowledge, attitudes, and affirming practices. The RCT included a 3-month follow-up assessment to gauge retention of LGBT-affirming knowledge, attitudes, and practices over time. Results: Both single arm trials demonstrated that the COLORS training was feasible, acceptable, and results from the pre- and post-training assessments suggested the training improved knowledge, attitudes, and affirming practice behaviors. In the RPT, those randomized to COLORS demonstrated significant improvements in LGBT-related attitudes pre- to post-training (p < 0.01), and no significant changes in attitudes were observed among those randomized to the comparison training (p = 0.98). Both trainings yielded significant (p < 0.01) increases from pre- to post-training in LGBT-affirming practice behaviors. Likewise, both trainings yielded significant (p < 0.01) improvements in knowledge from pre- to post-training. Similar significant findings were observed when we analyzed the 3-month follow-up assessment. Conclusions: Results from the prior single-arm trials and the current RCT demonstrate that the COLORS training is effective in improving oncologist knowledge, attitudes, and affirming clinical practices related to the care of LGBT patients with cancer. Part of this work was funded by the Bristol Myers Squibb (BMS) Foundation and BMS Company.
Feasibility of virtual stress management and resiliency training (SMART) for oncology fellows during the COVID-19 pandemic.
Authors: Williams Colt , Chesak Sherry , Pachman Deirdre R. , Rhee Laura , Dierkhising Ross , Leventakos Konstantinos
Published: June 2022

11016

Background: Stress Management and Resiliency Training (SMART) is a validated resilience training program designed to reduce stress, improve emotional resilience, and decrease burnout. The prevalence of burnout among practicing oncologists is as high as 40%, but unknown among oncology trainees. We implemented a virtual format of the SMART program to the Hematology/Oncology fellowship at Mayo Clinic to assess the feasibility of such a delivery, measure baseline rates of burnout in this group, and to investigate if a virtual method of delivery is as effective as in-person delivery as described in the literature. Methods: The SMART project was a mixed-methods, prospective, single arm clinical trial. Hematology/Oncology Fellows at Mayo Clinic were invited to participate. Four one-hour training sessions were conducted virtually. Fellows were given access to SMART online video modules and a book which supported the content covered during virtual training, a companion resilience mobile app, and a paperback mindfulness journal. Stress, burnout, and emotional resilience were measured at baseline and three months post-intervention using the Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Connor-Davidson Resilience Scale (CD-RISC2). Changes in mean scores on the PSS, MBI, and CD-RISC2 were assessed using the Wilcoxon signed-rank test. Program feedback and feasibility data were obtained during a virtual focus group. Audio transcripts from the focus group were codified for thematic analysis and verified by intercoder triangulation. A 6-month assessment will be due in March 2022. Results: 26 of 50 fellows invited participated in our study. At baseline, 24% of participants had measurable burnout and 92% had moderate to high stress. At 3-months, the number of participants with moderate to high stress decreased to 71%, while rates of burnout remained unchanged. The PSS demonstrated a decrease in mean stress (-10.9%, p = 0.005), while the MBI demonstrated decreased emotional exhaustion (MBI-EE -6.01%, p = 0.04), an improved sense of personal achievement (MBI-PA 28.1%, p < 0.001), but slightly worse feelings of depersonalization (MBI-DP 16.46%, p = 0.05). The CD-RISC2 suggested no change in global emotional resilience (-0.71%, p = 0.82). Thematic analysis of the focus group data revealed that participants overwhelmingly found the program beneficial (83% of all responses), 20% indicated improved stress, and 15% indicated improved work performance. Conclusions: Oncology fellows in this study had lower rates of burnout compared to practicing oncologists. Virtual implementation of the SMART program is feasible and resulted in improvements in stress and prevented worsened burnout. Outcomes were comparable to previously published studies conducted in-person. Focus group participants found the training beneficial, reported lower stress, and improved work performance.
A systemic look at professional burnout and well-being within an urban cancer center as a roadmap to recovery.
Authors: Moadel Alyson B. , Papalezova Katia , Milner Gabrielle , Gipson-Fine Amber , Kalnicki Shalom
Published: June 2022

11017

Background: As the U.S. health care system’s vulnerabilities have been laid bare by an unremitting pandemic, it behooves us to build in resiliency as we look towards recovery. The “burnout epidemic” facing oncology clinicians has been well documented prior to the pandemic. From a systemic perspective, however, data across the cancer service line is scant. In an effort to identify the stress points and strengths of an oncology service line, we present cross-sectional data from 2018 examining burnout, physical and emotional well-being, and self-care needs across all primary cancer center roles within a major urban cancer center in NYC. Methods: An anonymous online survey was completed by 310 of 646 (48%) cancer service providers comprised of physicians, nurses, clinical support staff, managers, and clerical staff. The abbreviated Maslach Burnout Inventory (MBI-9), the Mental Health Inventory (MHI), and the brief COPE were included. Results: Respondents ranged from nurses (15%) to clinical support staff (29%), with 79% identifying as female. In a snapshot view, 25% of the sample endorsed feeling burned out from work. Rates of emotional exhaustion were highest among nurses (41%) and lowest among physicians (14%), p < 0.06. Depersonalization rates ranged from 1% for physicians to 11% for nurses and clerical staff (p < 0.003). A breakdown of those who would not choose the same career over again: clerical (36%), management (28%), nurses/clinical support staff (23%) and physicians (11%), p < 0.053). Clinical levels of distress ranged from 20% (clerical staff) to 30% (nurses). Self-reported health (1-5) was lower among clerical staff and nurses (3.1) compared to physicians (3.9), p < 0.001. The majority of staff utilized adaptive coping strategies including positive reframing and planning, with religion and humor often endorsed. Interest in counseling and communication skills training ranged from 56%/57% among physicians to 84%/88% among clerical staff, respectively. Conclusions: This panoramic view of one cancer service line just prior to the pandemic points to particular systemic stresses in areas of emotional exhaustion, career choice questioning, and psychological and physical health. While levels of burnout fall within and below rates reported in the literature, it also points to fault lines affecting key service line positions, particularly nurses and clerical staff. At the same time, it highlights an underlying resiliency in coping and receptivity to self-care and development. In response to this internal needs assessment, our cancer center is working towards building a stronger foundation in which staff will not only survive the expected and unexpected stresses of working in health care but find meaning and joy in work. While we cannot predict the future, we can learn from the past. In this vein, a Well-Being Committee that includes representatives across the cancer service line was launched in 2022.
Characterization of industry relationships in oncology.
Authors: Harrison Rebecca A. , Majd Nazanin , Johnson Margaret O. , Urbauer Diana L. , Puduvalli Vinay K. , Khasraw Mustafa
Published: June 2022

11025

Background: Collaborative relationships between academic oncology and the pharmaceutical industry are essential for therapeutic development in oncology. Despite this, formal training and mentorship in developing productive industry collaborations are not routinely included in oncology training. Since little research has been done to characterize and optimize the efficiency of these relationships, we sought to better understand the nature of such collaborations in order to identify areas for optimization. Methods: An electronic survey was administered to 1000 randomly selected ASCO members. The survey included 23 questions eliciting demographic and practice information, and 26 questions eliciting respondents’ views around oncology-industry collaborations. Survey results were analyzed using descriptive statistics. Results: There were 225 survey respondents. Most were from the United States (70%), worked at an academic institution (60.1%), worked in medical oncology (81.2%), and had an active relationship with industry (85.8%). 26.7 % of respondents reported difficulty establishing a relationship with industry collaborators. Many relied on federal (39.5%) or departmental (30.2%) funding to supplement their research ventures. Partnerships were initiated by the respondents themselves (34.6%) or industry partners (31.9%) with similar frequency, whereas institutional affiliations (15.7%) and collaborative groups (5.8%) were reported as less common means for establishing collaborations. The majority (85.3%) of respondents stated these collaborations were of importance to their career. Inclusion in industry sponsored trials (71.1%) and commitment to research funding (66.3%) were considered early signs of a productive relationship, whereas lack of effective communication (86.1%) or little engagement by senior industry leadership (63.1%) were early red flags. Most respondents (75%) did not report having had mentorship in developing these relationships. Scientific integrity was generally thought to be preserved (92%) and there was little concern over the quality of the collaborative product (95%). Many shared concern over potential conflict of interest if a compensated relationship promoted an industry product for clinical care/research (60%), yet also stated these relationships did not shape their interactions with patients (67%). Conclusions: This study provides novel data characterizing the nature of collaborative industry-academia relationships in oncology. While respondents considered these collaborations an important part of clinical and academic oncology, formal education or mentorship around these relationships is rare. Further study exploring the structure of effective industry collaborations, optimizing methods to provide education in this area at all career stages, navigating conflict of interest issues in these relationships, and understanding industry perspectives is warranted.
Adapting a medical school cancer research education program to the virtual environment.
Authors: Vayani Omar , Klein Aviva , Hahn Olwen Mary , Pearson Alexander T. , Arora Vineet M , Olopade Olufunmilayo I. , Golden Daniel William
Published: June 2022

11029

Background: As the number of patients with a cancer diagnosis grows in the United States, there is an increasing need for physician scientists with oncology-related research training to develop new approaches to screening, diagnosis, therapy, and survivorship. A single US medical school developed the National Cancer Institute-funded Scholars in Oncology-Associated Research (SOAR) cancer research education program. Due to the COVID-19 pandemic, SOAR transitioned from fully in-person in 2019 to virtual in 2020 and hybrid in 2021. This study examines whether the in-person, virtual, or hybrid formats provide better educational experiences as rated by participants. Methods: SOAR includes a seminar series, an 11-week full-time cancer research experience, weekly research cluster group meetings, and tumor board and interprofessional shadowing experiences. In 2019 all program activities were in-person. In 2020 all activities were virtual with the shadowing suspended. In 2021, seminars and tumor boards were virtual, shadowing was in-person, and all other activities were hybrid. Pre- and post-surveys were collected from all participants to assess understanding of oncology and associated medical specialties. How participant understanding of oncology and related specialties changed within each year’s program was analyzed with a Wilcoxon rank-sum test. The Kruskal-Wallis test was used to examine change in understanding between the cohorts. Results: 37 students participated in SOAR (2019 n = 11, 2020 n = 14, 2021 n = 12). Self-reported understanding of oncology as a clinical (p < 0.01 for all) and research discipline (p < 0.01 for all) improved within all three cohorts. There was no significant difference between each cohort’s improvement in research understanding (p = 0.6158). However, there was a trend towards more of an improvement in the in-person cohort (p = 0.0796) for clinical understanding. There was no significant difference between each cohort’s improvement in understanding of oncology-related disciplines such as medical oncology, radiation oncology, pediatric oncology, surgical oncology, and survivorship as both clinical and research disciplines (p > 0.1 for all). Conclusions: A virtual cancer research education program can be as effective as an in-person or hybrid program for research education although it may be suboptimal for learning about clinical oncology. Given the ongoing challenges presented by the COVID-19 pandemic, flexibility is needed in delivering cancer research education programs such as SOAR. With modern research methodology and communications technology, cancer research is becoming increasingly diverse and flexible in terms of research environment. If program leaders are steadfast in their adaptation of research education programs to a virtual or hybrid environment, participant understanding of oncology as a clinical and research discipline remains robust.
The future of the oncology workforce: Presenters at an international trainee oncology conference.
Authors: Anampa-Guzmán Andrea , Loli Guevara Silvana Lucero , Nimboma Sanchez Luis Enrique , Gutierrez-Narvaez Cristian Antonio , Leon-Ferre Roberto Antonio
Published: June 2022

11035

Background: In 2017, ASCO established the ASCO medical student and resident Abstract Forum. This study aimed to describe the characteristics of the ASCO medical student and resident abstract forum participants. Methods: We conducted a retrospective, observational study of Abstract Forum participants from 2017 to 2021. Descriptive statistics were used to summarize the participants' demographics by gender, stage of training, and institution location. We reported the publication rates and career paths of presenters. Results: The number of participants has more than tripled in the five years since the program's inception. Female participants are almost half of the total. In 2017, there was only one international participant. Over the subsequent five years, international members have steadily increased and represented nearly one-third of all participants in 2021. In the inaugural year, most forum participants were from institutions with ASCO Sponsored Oncology Student Interest Groups (OSIG), but in 2021 almost half were from institutions without OSIGs. The majority of participants were medical students, followed by internal medicine residents. Of a total of 179 abstracts presented between 2017 and 2021, 35 (19.55%) were subsequently published as full-text peer-reviewed manuscripts. Studies presented orally and studies presented by participants from the United States were significantly more frequently published as articles. 58.49% of medical student presenters that started residency chose Internal Medicine or Radiation Oncology. 50% of the student presenters that graduated internal medicine residency went to Hematology-Oncology fellowship. Most of the resident presenters that completed residency went to pursue careers in Hematology-Oncology (72.73%). Conclusions: The steady increase in participants since the program's creation demonstrates interest in the medical student and internal medicine resident community in these types of initiatives. The increase in international participants over the years highlights opportunities for ASCO to expand its global reach and efforts, particularly in low-income countries where trainees have the highest need for mentoring and organized support. Our study provides critical insights into the profile of participants of the Abstract Forum. Participation in this program should be encouraged, especially in countries with high cancer prevalence and mortality.
The impact of mentoring on early career faculty: Assessment of a virtual mentoring program.
Authors: Sharma Akanksha , Leeper Heather , Bang Soo , Molaie Donna , Porter Alyx B.
Published: June 2022

11039

Background: Participation in mentorship programs for early career physicians may be crucial to developing key skills and professional networks to navigate racial, ethnic and gender leadership disparities in medicine. A 6-month virtual facilitated peer mentorship program was developed and piloted through the Society for Neuro-Oncology (SNO) Women & Diversity Committee. The evaluation of the program’s feasibility to positively impact early career physicians, investigators and trainees is presented here. Methods: We designed and conducted a virtual mentoring program pilot open to SNO’s multidisciplinary members in residency, fellowship, or early career phase, leveraging peer-mentoring sessions with mid-to late-career physician mentors. A curriculum with online resources was provided recommending groups meet for 6 sessions: 3 involving the mentor and 3 dedicated to peer-mentoring. Group assignments were based on time-zones and interests. Pre- and post-participation surveys assessed mentee experience. Descriptive statistics were used to assess participant demographics and survey results. Results: Our call for participation was broad; all 20 mentee applicants participated in 5 groups. Mentees were 90% women and 60% were from diverse racial and ethnic backgrounds. Most were aged 31-40 (75%) and junior faculty (50%) in neuro-oncology (65%). The 5 senior mentors (3 men and 3 of diverse race and ethnic backgrounds) practiced either neuro-oncology (3), neurosurgery (1) or radiation oncology (1). The proportion who reporting having a signature lecture increased from 15% to 62% during the pilot. A large majority reported their participation was worthwhile (85%), that they would participate again (92%) and would recommend it to others (92%). Feedback themes included positive personal growth, peer support, networking and job opportunities, access to CV reviews, lack of and desire for late career female mentors, and virtual scheduling constraints. While the pilot was limited by several variables, it was timely to connect participants in Q3 of 2020 early in the COVID-19 global pandemic. The virtual meeting environment created a venue to share and discuss topics such as work-life balance, burnout, leading through change and social connection. Despite not achieving 100% professional concordance, participants found the experience worthwhile. The tools and curriculum of topics provided was implemented differently across groups, leading to varied experiences. Finally, we did not have 100% post pilot follow up despite multiple attempts limiting our complete understanding of the pilot. Conclusions: This virtual mentorship pilot program proved feasible and of value in development of early career women and diverse individuals. A resource toolkit has been designed to scale and diffuse.
Race- and sex-based variation in industry research and general payments to medical oncologists in the United States.
Authors: Jan Imraan , De Brian , Kwon Young Suk , Freeman Robert , Larkin Kelsey , Subramanian Shyamala , Pandu Prathyusha , Song Amy , Young Meredith , Sayan Mutlay , Ludmir Ethan B. , Haffty Bruce George , Mattes Malcolm David
Published: June 2022

11050

Background: Industry partnerships offer financial incentives, prestige, and can facilitate career advancement in oncology. However, not all physicians may have equal access to these opportunities. We hypothesized that physicians who are underrepresented in the medical oncology workforce based on race, ethnicity, and gender receive less industry funding. Methods: All US medical oncologists (MOs) who received ≥1 industry research payment between 2016 and 2020 according to the Open Payments database were included in this retrospective study. Information extracted from Open Payments included MO’s name, institution, research payments (i.e. funding for a research project where the physician is a Principle Investigator), and general payments (i.e. fees not associated with research, such as consulting and travel fees). Additional web searches were conducted using institutional websites, NPPES NPI registry, LinkedIn, Doximity, Scopus, and NIH RePORTER to determine each MO’s race, ethnicity, sex, academic rank, degrees, h-index, institutional NIH research funding rank, and individual receipt of NIH funding. Log-linear regression was performed to identify associations of both industry and general payment data. Results: Of 7,542 physicians meeting inclusion criteria, 69% were male, 65% White, 29% Asian, 2% Black, and 4% Hispanic, which is comparable to the American Medical Association Physician Masterfile figures for MO. The median sum research payment and general payment was $134,857 and $11,537 per physician respectively. Significantly higher mean research payments were associated with an MS (+72%; P = 0.003) or PhD degree (+30%; P = 0.009), h-index (+3%; P < 0.001), top 50 institution rank by NIH funding (+44%; P < 0.001), and associate professor rank (+95%; P < 0.001). Significantly lower mean research payment were observed for Black physicians (-36%; P = 0.022) and those with non-academic affiliation (-47%; P < 0.001). No significant association was observed between sex and research payment. Significantly higher mean general payments were associated with male sex (+46%; P < 0.001), MS degree (+171%; P < 0.001), h-index (+2%; P < 0.001), and Asian race (+72%; P < 0.001). Significantly lower mean general payments were associated with an affiliation with a non-academic practice (-31%; P = 0.012). Conclusions: Black physicians received smaller sums of industry research payments compared to White physicians. Female sex was associated with decreased general payments compared to male sex. Further exploring the underlying mechanisms determining access to industry payments may help facilitate greater equity and inclusivity in oncology.
Self-identification of gender and race/ethnicity in hematology and oncology journal editorial boards: What is the state of diversity?
Authors: Riano Ivy , Patel Shruti Rajesh , Abuali Inas , Ai Angela , Geiger Gabriella , Pimienta Jacqueline , Ramirez Roggio Adriana , Dhawan Natasha , Dizman Nazli , Salinas Alexandra Lizette , Duma Narjust
Published: June 2022

11058

Background: Underrepresentation of women and minorities persists in many aspects of the scholarly publication process as demonstrated by our initial findings presented at ASCO21. Having a gender-balanced and diverse editorial team promotes collaborative work and decreases the publication bias against women. In our initial study, gender and race/ethnicity were determined based on publicly available data. We aimed to add to our study by asking editors to self-report their gender and race to assess the diversity of editors at leading hematology and oncology journals by self-reporting. Methods: We identified 60 journals in oncology, hematology, radiation oncology, and surgical oncology with the highest impact factors. Editors-In-Chief (EiC) and Second-In-Command (SiC) editors (such as deputy, senior and associated editors) were included in the analysis. A demographic survey assessing gender, race/ethnicity, age, and job characteristics was sent to 793 participants via email. Data were analyzed with R software. Results: A total of 66 out of 793 editorial board members responded to the survey. Gender breakdown of respondents was 36 (54.5%) men and 30 (45.8%) women. Most respondents were between the ages of 40 and 60 (69.7%). Thirty-eight (57.6%) of the editors had ≤5 years of editorial experience. Of the 66 respondents, 44 (66.7%) self-identified as non-Hispanic white, followed by 14 (21.2%) as Asian and 3 (4.5%) as Hispanic. Only 1/66 (1.5%) editors self-identified as Black or Native Hawaiian/Other Pacific Islander, and 1/66 (1.5%) did not identify themselves with a racial group. Conclusions: Underrepresented groups in medicine (URM) and women occupied a minority of leadership roles on editorial boards in high-impact hematology and oncology journals. Notably, this study provides new insights into editorial board diversity by using self-reporting as a primary methodology. Limitations of the cross-sectional study is that URM and women are more likely to respond to surveys on diversity, equity, and inclusion potentially skewing the results. Diversity in editorial boards not only can enhance scientific discovery by encouraging submissions from researchers with diverse backgrounds but also promotes career advancement for women and URM.[Table: see text]