bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis disclosure to terminally ill cancer patients: A qualitative study among Japanese physicians.
Authors: Mori Masanori , Ogawa Miho , Nishimura Mashiho , Yamada Hirohide , Morita Tatsuya 
Published: March 2020

e20717 Background: Prognosis disclosure could facilitate end-of-life discussions and advance care planning in advanced cancer patients. However, many Japanese and Japanese American patients do not wish to know of their own prognosis, and physicians infrequently disclose terminal prognosis in Japan. We aimed to investigate Japanese physicians’ practice and emotion regarding prognosis disclosure. Methods: We adopted a qualitative design based on semi-structured interviews and content analysis. Attending physicians in a local cancer center were eligible if they had disclosed terminal prognosis to their cancer patients and/or families more than three times in the past year. The sample size was justified by recruiting participants through consistent comparison analysis until data saturation occurred. Results: We conducted 11 face-to-face interviews and detected the following categories; [practice in disclosure], [reasons for/against disclosure], and [emotion regarding disclosure]. [Practice] indicated that some physicians have almost always disclosed prognosis to their patients, while others have almost never done so. It included various skills such as “having families/nurses attend the meeting,” “asking families how much prognostic information physicians should provide to patients,” “asking patients why they want to know,” and “answering with a range of estimation.” [Reasons for disclosure] included “to help patients deal with unfinished business” and “to support realistic hope.” [Reasons against disclosure] included “uncertain prognosis,” “physicians’ concern about hurting patients,” “lack of time and staff support for physicians,” and “insufficient training in communication skills.” Lastly, many physicians felt “sad,” “nervous,” and “difficult,” while few felt “fulfilled” when disclosing prognosis. Conclusions: Practice patterns, reasons and emotional experiences vary widely in prognosis disclosure among Japanese physicians. Team approach, physician training in communication skills, and understanding of families’ as well as patients’ preferences may contribute to better-quality individualized cancer care based on patients’ goals, not on physicians’ personal preferences.
Elderly patients and ovarian epithelial cancer (OEC) or primary peritoneal carcinoma (PPC): A retrospective analysis.
Authors: Mane Joan Manel , Lopez de Argumedo Gonzalo , Marrodan Ines , Muñoz Alberto , Ruiz de Lobera Abigail , Azkona Eider , Iruarrizaga Eluska , Arruti Mikel , Condori Elizabeth , Buque Aitziber , Lopez Escola Cristina , Carrera Sergio , Lopez-Vivanco Guillermo 
Published: March 2020

e20718 Background: OEC frequency in elderly patients is increasing around the world and it’s expected to continue rising in the future. PPC is an entity with a similar behaviour. OEC is the most common cause of gynaecologic cancer-related death and it’s the fifth leading cause of cancer associated mortality among women; its relative risk is higher among elderly patients. In this study we try to identify clinical factors in elderly OEC and PPC patients in order to improve current medical management and to enhance clinical outcomes. Methods: From January 2007 to December 2011 a total of 53 elderly patients were included (≥65 years old). PPC: 11.3%; OEC: 88.7%. ECOG 0/1/2/3/4: 24.5/34/26.4/7.5/5.7%; 1.9% unknown. Stage at diagnosis: III (52.8%); IV (30.2%). Ca125 was increased in 79.2% of the cases; 64.2% of the patients underwent debulking surgery. The majority of patients (94.4%) received chemotherapy: monotherapy (13.2%) or polychemotherapy (86.8%). Results: Among 38 evaluable patients, partial response was observed in 45.4%, complete response in 27.2%, stable disease in 24.4% and progression in 3%; 18% of patients were retreated with the same schedule (platinum sensitivity) and 26.4% of the patients received more than one line of chemotherapy (range 2-5). Significant differences in overall survival (OS) were observed in multivariate analysis according to performance status (p=0.018). Median OS for all patients was 131 weeks. Conclusions: In our experience, results in elderly patients are comparable to those expected in younger patients. In this population, treatment options must be optimized.
CA184-240: A single-arm, open-label phase II study of vemurafenib followed by ipilimumab in patients with BRAF V600-mutated advanced melanoma (AM).
Authors: Hodi F. Stephen , Amin Asim , Saenger Yvonne M. , Pennock Gregory K. , Guthrie Troy H. , Salama April K. , Flaherty Lawrence E. , Koon Henry B. , Lawson David H. , Shaheen Montaser F. , Balogh Agnes , Konto Cyril , O'Day Steven 
Published: March 2020

TPS9103 Background: Ipilimumab (Ipi), a fully human monoclonal antibody that binds to cytotoxic T-lymphocyte antigen-4 expressed on T cells, and vemurafenib (Vem), a small molecule inhibitor of BRAF V600-mutated kinase, are both approved treatments for AM. Ipi has shown improved overall survival (OS) in two randomized phase III trials of patients with previously treated (3 mg/kg monotherapy) and previously untreated (10 mg/kg plus dacarbazine) AM. Vem has shown improved OS in a randomized phase III trial of patients that harbor the BRAF V600E mutation. The most common drug-related adverse events (AEs) with Ipi monotherapy were immune-related GI tract and skin toxicities, which were generally manageable using treatment guidelines. The most common AEs with Vem were arthralgia, rash, and fatigue. Vem can induce rapid and substantial responses, and resistance mechanisms are a focus of current investigation. This study will evaluate the safety of Vem lead-in followed by Ipi (prior to resistance) in patients with BRAF V600-mutated AM. Methods: An estimated 45 patients will be enrolled. Eligible patients include those ≥18 years old with previously untreated AM, a BRAF V600 mutation, and an ECOG PS of 0 or 1. Major exclusion criteria are primary ocular melanoma, active brain metastases, and autoimmune disease. Patients will initially receive Vem for 6 weeks (960 mg twice daily). After a washout period of 3-10 days (per protocol), patients will be initiated on Ipi at 10 mg/kg (every 3 wk for 4 doses, then once every 12 wk beginning at week 24, until disease progression or unacceptable toxicity). Vem will be restarted at the time of disease progression on Ipi (no minimum time to restart) or unacceptable toxicity on Ipi (restart minimum of 1 mo after the last dose of Ipi). Vem will be restarted at the last dose level tolerated at the end of the lead-in phase. Patients will be followed every 12 weeks for toxicity and/or disease progression, and subsequently will be followed every 12 weeks for survival. The objectives of this study are to estimate the incidence of grade 3-4 drug-related AEs. Exploratory objectives include the evaluation of efficacy (OS). Clinical trial information: NCT01673854.
Open-label, multicenter, single-arm, phase I, dose-dscalation with efficacy tail extension study of vemurafenib in pediatric patients with surgically incurable and unresectable stage IIIc or IV melanoma harboring BRAFV600 mutations (NCT01519323).
Authors: Navid Fariba , Chisholm Julia C. , Ferrari Andrea , Herzog Cynthia E. , Rodriguez-Galindo Carlos , Hauschild Axel , Krishnan Kartik , Pappo Alberto S. 
Published: March 2020

TPS9104 Background: Although rare, melanoma is the most common form of skin cancer in children and the incidence is rising in the adolescent population. Similar to adults, the outcome for pediatric patients with advanced or recurrent melanoma is poor. Many adult studies of melanoma exclude patients under the age of 18 years. Approximately 50% of melanomas carry a mutation in the BRAF gene and the oral BRAF inhibitor vemurafenib (VEM) has demonstrated improved rates of overall and progression-free survival in adult melanoma patients who carry this mutation (Chapman et al; NEJM 2011). The current study is designed to determine the maximum tolerated dose (MTD)/recommended dose (RD), pharmacokinetics, safety, tolerability, and efficacy of VEM in pediatric patients with surgically incurable and unresectable stage IIIC/IV melanoma harboring BRAFV600mutations. Methods: Patients aged 12 through 17 years with newly diagnosed or previously treated measurable disease are eligible. Patients with radiographically stable, asymptomatic previously treated central nervous system lesions are also eligible. In the dose-escalation phase, patients will be enrolled sequentially to increasing dose cohorts of VEM following a 3+3 design. Dose-limiting toxicity will be assessed during the first cycle (defined as the first 28 days). The initial dose will be 720 mg BID (patients ≥45 kg) or 480 mg BID (patients <45 kg). Once the MTD/RD for the extension phase is defined based on the dose-escalation window, all patients will be eligible to receive the MTD/RD. The efficacy tail of the trial will enroll additional pediatric patients at the MTD/RD. Patients will receive VEM until disease progression, death, unacceptable tolerability, discontinuation from the study, or other protocol-specified criteria. The study aims to treat approximately 20 patients at the RD with 3-15 additional patients treated at other dose levels during the dose-escalation phase. This study is currently open at 18 sites in the USA, UK, Germany, Italy, and Australia. As of January 24, 2013, one patient has been enrolled. Clinical trial information: NCT01519323.
Multimodal therapy for the treatment of fatigue in patients with prostate cancer receiving androgen deprivation therapy and radiation.
Authors: Yennurajalingam Sriram , Carmack Cindy , Basen-Engquist Karen , Reuben James M. , Bruera Eduardo 
Published: March 2020

TPS9650 Background: Cancer-related fatigue (CRF) is the most frequently reported symptom associated with cancer and its treatment. Unfortunately, there are limited treatment options to alleviate this distressing symptom. Preliminary data suggest that the combination of exercise, cognitive behavioral therapy (CBT), and methylphenidate (that is, multimodality therapy [MMT]) can play an important role in reducing CRF. The project’s objective is to explore the effects and safety of this MMT on CRF in prostate cancer patients scheduled to receive radiotherapy with androgen deprivation therapy. We hypothesizethat the MMT is capable of reducing CRF as measured by the FACIT-F subscale in prostate cancer patients scheduled to receive radiotherapy. Specific Aims:(1) Our primary aim is to obtain preliminary estimates of the effects of various treatments (exercise, CBT, and methylphenidate) and their combinations in reducing CRF in prostate cancer patients receiving radiotherapy, as measured by the change in patients’ FACIT-F subscale scores taken at baseline and on day 57 and the secondary objective is to determine the effects of the treatments and their combinations on anxiety and depressed mood (both measured by the Hospital Anxiety Depression Scale [HADS]); on physical activity and function (measured by an accelerometer and a handgrip dynamometer, respectively); on levels of inflammatory cytokines (IL-1β, IL-6, TNF-α, and IL-10) in serum and induced monocytes, before and after treatment Methods: For this study, we will use a randomized factorial design to assess 3 treatments (exercise, CBT, and methylphenidate) and their placebos in 8 replications. A total of 32 patients will receive each primary treatment and 32 will not. Patients will be studied for a 57-day period, during which they are scheduled undergo daily radiation treatments with androgen deprivation therapy. Fatigue, anxiety and depressed mood, and inflammatory cytokines will be determined at baseline and at 3 subsequent post-intervention assessments. After successful initiation so far 19/64 patients were enrolled. Accrual continues. Clinical trial information: NCT01410942.
Humanism in global oncology curricula: An emerging priority.
Authors: Giuliani Meredith Elana , Martimianakis Maria Athina (Tina) , Papadakos Janet , Broadhurst Michaela , Driessen Erik , Frambach Janneke 
Published: March 2020

10505 Background: Training in humanism provides the skills to achieve shared decision making with patients and their families, to navigate systems level challenges and to function positively within the healthcare team. However, there is potentially a lack of attention to humanistic competencies in global oncology curricula due to the dominance of the biomedical model in curriculum design, the challenge of assessing humanistic competencies and global cultural considerations. The aims of this study were to explore to what extent humanistic competencies are included in global oncology curricula and the nature of the humanistic competencies included. Methods: Sixteen global oncology curricula identified in a prior systematic review were analysed. The curricula were coded using the Gold Foundation’s I.E.C.A.R.E.S (Integrity, Excellence, Collaboration & compassion, Altruism, Respect & Resilience, Empathy and Service) humanistic competency framework and the CanMEDS framework. Descriptive statistics were used to describe the proportion of items attributed to each aspect of the framework. Results: 7733 curricular items were identified in the 16 curricula and 729 (9%) aligned with the I.E.C.A.R.E.S framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%. The proportion of humanistic items has been increasing from the curricula published in 1980-1989 (3%) to the curricula published in 2010-2017 with a mean of 11% (4 to 25%). There was a higher proportion of humanistic competencies in curricula from the European region (9%) than in other regions. Of the humanistic items 35% were under respect, 31% under compassion, 24% under empathy, 5% were under integrity, 2% under excellence, 1% under altruism, and 1% under service. The majority of the humanistic items also aligned with the professional (35%), medical expert (31%) or communicator (26%) CanMEDS domains. Conclusions: The proportion of humanistic competencies has been increasing in global oncology curricula over time however the overall proportion remains low. Humanism is largely represented by competencies of respect, compassion and empathy and there exists a conflation between humanism and professionalism. Future global curricular efforts may benefit from attention to incorporating all aspects of humanistic competencies.
Innovation, education, and research: A multidisciplinary survivorship care model.
Authors: Latif Hira , Martone Patrick , Shaw James Edward , Wisotzky Eric , Dilawari Asma Ali 
Published: March 2020

10519 Background: Advances in early detection, therapeutics, and an aging population are expected to lead to an increase in the number of cancer survivors in the United States to 20 million by year 2026. The Institute of Medicine and Commission on Cancer recommends delivery of survivorship care plans on completion of curative treatment. While models exist for high-quality survivorship care, institutions encounter barriers such as lack of resources and limited training in survivorship. Our institution piloted a unique model combining fellows’ education with guideline-driven recommendations from a multidisciplinary team to provide consolidated survivorship care. Methods: A survey for self-reported competence and experience was conducted amongst the hematology and oncology fellows at the MedStar Washington Hospital Center. A bimonthly clinic staffed by a medical oncologist, oncology fellow and a cancer rehabilitation fellow was initiated in September 2018. Didactic lectures, curriculum syllabus and recommended assessments were established. Screening tools for distress, patients’ confidence in knowledge about survivorship and physical function via PROMIS 20a were administered; clinical assessments including the “6-minute walk test” were used to assess cardiovascular health. Results: Most fellows had not encountered a survivor of lung (16%), GU (0%) and head and neck cancer (33%). Majority of the fellows had never delivered a survivorship care plan. Scores were low in competence and experience in survivorship. By December 2018, 15 patients with 17 diagnoses of cancer were referred to the clinic. 10 were survivors of hematologic malignancies while 7 were of solid tumors. The no-show rate was 40%. Fellows conducted the assessments and were supervised by an oncology attending. Of the 9 patients seen, 4 were referred for physical therapy; additional referrals for psychology and cardiology were frequent. Conclusions: A comprehensive multidisciplinary survivorship clinic focusing on fellows’ education is a feasible model for delivery of survivorship care and aims to bridge the gap in experience and competence of fellows. Future goals include re-assessment of patient-reported outcomes, physical function, and competence of fellows.
Training of oncologists: Results of a global survey.
Authors: Jalan Divyanshi , Rubagumya Fidel , Hopman Wilma M. , Vanderpuye Verna D. , Lopes Gilberto , Seruga Bostjan , Booth Christopher M. , Berry Scott R. , Hammad Nazik 
Published: March 2020

10526 Background: While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. Methods: An online survey was distributed through a snowball method via national oncology societies and a pre-existing network of contacts to cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs) based on World Bank criteria. Results: 273 physicians who trained in 57 different countries responded to the survey; 33% (90/273), 32% (87/273), and 35% (96/273) in LMICs, UMICs and HICs respectively. 60% of respondents were practicing physicians and 40% were in training. The proportion of trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; P = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; P < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs (abstract: 37/72 (51%) from HICs, 18/66 (27%) from UMICs, 24/65 (37%) from LMICs, P = 0.014; poster: (42/72 (58%) from HICs, 28/66 (42%) from UMICs, 13/65 (20%) from LMICs, P < 0.001; publication: 43/72 (60%) from HICs, 32/66 (49%) from UMICs, 24/65 (37%) from LMICs, P = 0.029). Respondents identified several barriers to effective training including skewed service to education ratio and burnout. With regards to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice, and understanding of healthcare systems irrespective of country grouping. Conclusions: Investment in training by the public sector would be vital to decreasing the prevalence of self-funding in LMIC. Gaps in research training and enhancement of competencies in research dissemination in LMIC require attention. Instruction on cancer care systems and leadership need to be incorporated in training curricula in both LMICs and HICs.
Targeting B-cell malignancies: Impact of an educational curriculum on BTK inhibitors.
Authors: Willis Lauren , Tanzola Mindy , Caracio Richard , Lucero Katie S. , Shah Bijal D. , Woyach Jennifer Ann , Furman Richard R. , Wang Michael , Brown Jennifer R. 
Published: March 2020

10531 Background: We sought to determine if a curriculum of online continuing medical education (CME) activities could improve hematologists/oncologists (hem/onc) knowledge and competence related to clinical decision making in the use of BTKi in patients with B-cell lymphomas. Methods: An expert panel identified knowledge/competence gaps related to the use of Bruton's tyrosine kinase inhibitors (BTKi) in B-cell lymphomas. A clinical practice assessment (CPA) survey was launched May 2018 to further assess baseline educational needs. Based on the needs identified, 7 activities were posted online between May-Dec 2018. Multiple-choice questions were asked before and after participation in each activity and were grouped into learning topics. Mean knowledge/competence was calculated for the CPA and across all 7 activities. The impact of education was examined using a pre/post design. Statistical significance was assessed using a chi-square statistic ( P < .05 level). Results: For all topics except foundational/differentiating BTKi, the audiences participating in the baseline CPA and the other 7 activities, were similar or lower at pre-test, suggesting that learning needs continued until our education addressed them. All changes from pre-to-post-test were significant ( P < .001). The largest relative percent change from pre- to post-test was seen with knowledge of resistance mechanisms for BTKi as well as knowledge/competence managing AE of BTKi. Post-test there was a high level of knowledge about the selectivity seen with 2nd generation BTKi. Conclusions: This analysis shows that online CME, utilizing many different formats (video, text, panel discussions) can significantly improve the knowledge and competence of hem/oncs in multiple areas surrounding the use of BTKi for the treatment of B-cell lymphomas. Results also suggest the following areas warrant further education: awareness of clinical trial safety and efficacy data for BTKi and mechanisms for resistance to BTKi. [Table: see text]
Online education about immunotherapy for melanoma: Outcomes over time.
Authors: Parikh Kinjal , Lucero Katie S. , Repetto Patti , Kadkhoda Haleh , Warren Charlotte , Gearhart Jacqueline , Weber Jeffrey S. 
Published: March 2020

10533 Background: The indications and use of immune checkpoint inhibitors (ICIs) for the treatment of melanoma have grown since the first drug approval in 2011. The expanding evidence base and number of indications challenges clinicians to stay up to date with how best to integrate these agents into treatment pathways. The objective of this study was to assess trends over time in oncologists’ knowledge, competence, and confidence using ICIs in the treatment of melanoma. Methods: A series of online continuing medical education (CME) activities about the role of ICIs in the treatment of melanoma was launched in April 2014; 18 included multiple-choice knowledge/competence questions and a confidence question assessed on a 5-point Likert-type scale before and immediately after the activity. Activities that had at least 30 oncologists participate pre/post are included in this analysis. A pre-/post-assessment study design was used, and educational effect was assessed with Chi-square tests. Analyses were conducted to examine trends in knowledge, competence, and confidence over four years on a quarterly basis. Weighted averages in each of the outcomes were calculated by quarter. Results: A total of 92,373 learners participated from April 2014-March 2018, including 57,432 physicians, of whom 11,922 were oncologists. The average increases from pre- to post-test for knowledge- (12 activities), competence- (11 activities), and confidence-based (9 activities) questions were 21%, 15%, and 6%, respectively (P < 0.01 for all comparisons). The absolute increase in knowledge from pre-test in 2014 (48%) to post-test in 2018 (78%) was 30 percentage points; and for competence, 6% (from 62% in 2014 to 68% in 2018). The mean confidence rating pre-test in 2015 was 2.51 versus 3.37 post-test in 2018. Conclusions: Online CME improves oncologists’ knowledge, competence, and confidence using ICIs in the treatment of melanoma. As new data emerge and indications expand, new educational activities are necessary to reinforce existing knowledge, close persistent gaps, and increase oncologists’ confidence using ICIs in this clinical setting.