bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oncology fellows’ survivorship clinic: An opportunity for education and multidisciplinary care delivery.
Authors: Latif Hira , Graves Kristi D , Dilawari Asma Ali 
Published: May 2020

11023 Background: Cancer survivors in the U.S. are expected to exceed 20 million by 2026. Most fellows do not receive formal training in survivorship during oncology fellowship despite cancer survivorship comprising 2% of the American Board of Internal Medicine's Oncology examination and the recent accreditation standards related to survivorship care from the Commission on Cancer. Methods: We developed a survivorship curriculum and a multidisciplinary survivorship clinic staffed by a medical oncologist and physiatrist in September 2018. Oncology fellows rotated during their ambulatory block and completed surveys assessing skills and perceptions of competence at the beginning and end of the academic year. Results: 8 fellows completed the pre-survey and 6 of them completed the post-survey. While only a quarter had delivered a survivorship care plan/treatment summary prior to starting clinic, all fellows had delivered these (median=2, range=2-8) at the end of the year. Most fellows had seen survivors of breast, colorectal and hematologic malignancies prior to starting clinic; few had seen survivors with lung (12.5%), GU (0%) or head and neck (25%) cancer. These numbers increased, particularly with fellows’ seeing survivors of GU (50%) and head and neck cancers (100%) at the end of the year. Prior to the rotation less than half the fellows had assisted with managing cancer survivors’ treatment consequences or provided continuity of care through a multidisciplinary team. Similarly, only 25% had counseled cancer survivors with psychosocial concerns. On the post-survey, 100% of fellows reported practicing and feeling experienced in these domains. Post- survey showed improvement in self-reported competence levels in caring for cancer survivors (see Table). Conclusions: Participating in a survivorship clinic has a positive impact on oncology fellows’ experience and competence in caring for cancer survivors. Future directions are geared toward expansion of fellows’ skills to include areas related to cardiovascular and physical medicine. [Table: see text]
Just-in-Time Teaching (JiTT) screencasts for the resident inpatient oncology service: A pilot study evaluating feasibility and effectiveness.
Authors: Kuhlman Patrick , Williams Donna , Amornmarn Amy , Harbaugh Joshua , Lycan Thomas 
Published: May 2020

11025 Background: Just-in-Time Teaching (JiTT) screencasts have been viewed positively in some undergraduate and graduate medical settings. JiTT screencast effectiveness has not yet been evaluated for medical trainees in the inpatient adult hematology/oncology setting. Objectives: Our pilot study’s goal was to identify relevant learning objectives, to assess feasibility of screencast development, and to optimize screencast delivery. Methods: To identify key clinical topics, a mixed methods approach first utilized institutional retrospective data (6/1/2018-6/30/2019) to determine the most common inpatient medical problems followed by qualitative interviews of teaching faculty and senior residents. The following six topics were identified for inclusion: 1. Metastatic disease to spine 2. Brain metastases 3. Oncologic emergencies 4. Cancer associated venous thromboembolism 5. Hematologic emergencies 6. Sickle cell disease: inpatient management For each topic, a literature review was performed to develop teaching points which were then refined with input from clinician experts. Each screencast went through several rounds of edits by faculty and trainees prior to submission to the instructional design team for final editing. Screencast length ranged from 13 – 25 minutes (mean of 18 minutes). Qualitative and quantitative feedback was obtained from residents by structured focus group session and online surveys. Results: All residents reported that educational content was “just right.” The series of 6 screencasts was completed within 2 months of dedicated fellow research time. Preferred screencast length was 10-20 minutes and preferred viewing speed was 1.5x original speed (7/10). All residents reported that a screencast database would be a helpful resource for future clinical rotations. All residents (n = 10) reported that screencasts improved medical oncology knowledge base and will improve care provided to cancer patients. Conclusions: Creation of a screencast series was feasible for a hematology-oncology fellow. Systematic identification of key clinical topics led to materials which were confirmed by faculty and trainees to be important for internal medicine medical education on inpatient oncology services. This pilot data indicate that JiTT screencasts may be an effective educational intervention and directly informed a randomized educational research study which is currently enrolling participants.
GI oncology molecular tumor board: Fostering collaboration and clinical education for personalized therapy.
Authors: Grossman Joseph Elan , Bullock Andrea J. , Angarita Susana , Bockorny Bruno , Dayyani Farshid , Hurley Molly , McGregor Kimberly , Pectasides Eirini , Peters Mary Linton Bounetheau , Reddy Venkataprasanth P. , Schlechter Benjamin L. , Tavallai Mehrad , Zerillo Jessica A. 
Published: May 2020

11029 Background: In recent years, genomic profiling has become standard of care for several gastrointestinal (GI) cancers. In addition to standard of care indications, comprehensive genomic profiling has led to novel and expanded applications of targeted therapy, chemotherapy, and immunotherapy and facilitated identification of potential clinical trials. A GI molecular tumor board (MTB) was developed with a goal of improving understanding of the biological effects of genomic alterations and their therapeutic implications to enhance personalized therapy. Methods: Foundation Medicine (FM) collaborated with physicians in the GI oncology group of an academic medical center to develop a GI MTB starting March 2019. As of December 2019, 27 GI oncology cases were presented where FoundationOneCDx testing was performed and a clinical question was posed. Cases were discussed by faculty, fellows, research staff, and a clinical genomic scientist and oncologist from FM. Impacted signaling pathways and biomarkers were discussed for each case alongside clinical content so that physicians could consider therapeutic options and clinical trials. Presenting faculty were asked to complete a questionnaire for each case presented to assess the impact of the MTB discussion on clinician knowledge and patient-level treatment recommendations. Results: Of 27 questionnaires sent to 7 providers, 17 (63%) were completed. Respondents indicated that as a result of the MTB, the treatment plan was changed in 2 cases (12%), reinforced in 9 cases (53%) and in 6 cases (35%) there was no effect. On a Likert scale of 1-4 where 1 is “rare/poorly” and 4 is “great” mean scores were as follows: Did this MTB help you understand the biological effects of the main genomic alteration(s) reported in the case presented? 3.3. Did this MTB help you understand the possible therapeutic implications of the main genomic alterations in the case presented? 3.3. Did this MTB improve your understanding of the role of next generation sequencing and comprehensive genomic profiling in making treatment decisions? 3.4. Conclusions: The results of our questionnaire indicate that treatment decisions were changed in a minority of cases based on the MTB. In most cases, clinical decision making was reinforced and understanding of the biological effects of genomic alterations and their therapeutic implications were improved. Based on this feedback we will continue to refine and integrate the GI MTB into clinical care for patients with GI malignancies, and share our experience locally with other disease groups.
Micro-learning: A new approach to upskilling and professional development on the management of patients on immunotherapy.
Authors: Winter Helen , Bal Jessica , Shaw Gemma , Leney Nick , Herbert Christopher 
Published: May 2020

11036 Background: Advances in cancer management are rapidly evolving . The introduction of immunotherapy across many tumour types and the potential of effector T cell therapies for patients requires upskilling in the wider health care team. This requires developing learning aimed at understanding the new mechanisms of action, potential side effects and how we educate and manage our patients receiving these therapies. Methods: Five stand alone micro-learning sessions on Immunotherapy were designed aimed at the acquisition of new skills and knowledge in a concise and targeted way. These sessions covered the key areas identified by the Systemic Therapy Day and Acute Oncology Units. These topics developed covered: What is Immunotherapy (IO) (its not chemo); How to interpret thyroid function for patients on IO; Get to know your Cortisol levels and adrenal insufficiency in patients with IO; Proactive management of IO Colitis; Liver function for patients on IO. These were delivered and evaluated during the working day in brief bite-sized sessions. Results: Attendance at formal training sessions - including annual study days and monthly study sessions are not keeping pace with the requirements for upskilling of staff. We present the evaluation of micro-learning delivered within the working day in short sessions. Conclusions: In the era of precision medicine, immunotherapy and effector T cell therapies a new approach to learning and upskilling in the wider health care team is needed. An integrated approach to learning on-the -job with short micro-learning sessions may embed the acquisition of new skills. More importantly, vocational education seeks to change habits, behaviour and culture. This needs to be accessible and flexible to adapt to the current patterns of work.
Developing South Asia’s first structured head and neck surgery multicenter fellowship initiative.
Authors: Chopra Shamit , Mandlik Dushyant , Balasubramanian Deepak , Kekatpure Vikram , Iyer Subramania , Dabholkar Jyoti , Patel Kaustubh 
Published: May 2020

11037 Background: Despite high head neck cancer incidence in South Asia, there exist few fellowship programs, which are limited by lack of structure, review processes and standard curricula. Our aim was a regionwide multicenter head and neck fellowship initiative to address the above limitations. Methods: A 10-member task force was constituted in January 2018 under the aegis of the Foundation for Head and Neck Oncology. First phase: Initial curriculum drafted by incorporating region-specific perspectives, aided by multiple source documents. Candidate eligibility criteria outlined, accommodating multiple pertinent disciplines and an international applicant base. Format for a structured entrance examination, and a mandatory/desirable rotation schedule were developed. Second Subcommittee(SC) phase: Creation of a web portal ( www.fhnofellowship.org ) by Outreach SC, approval of applicant centers by Accreditation SC, layout of exam structure by the Examination SC, and defining a rank order list-driven match process by the Match SC. Third phase: Development of standard documentation including suggested bibliography, log book format, recommended grand rounds topics, common minimum criteria for fellowship graduation. A common entrance exam was conducted in Feb 2019, which incorporated written screening, center-candidate interactions, objective interview, and the merit-based institution-fellow match. Results: Total number of applicants: 92, the majority Oral Maxillofacial Surgeons(83.7%). Seventeen fellows matched in the first cycle, the initial and 6-month program compliance 94.1% and 88.2% respectively. More eligible institutions accredited(36.8% increase) prior to the second cycle in Nov 2019, during which 19 fellows(11.8% increase) were matched. An interim review was done in Oct 2019, and periodic reviewing set at 6-month intervals. Planned fourth phase: Objective center/candidate feedback, surgical video repository, online training schedule, develop the fellowship exit examination, and expand outreach to other countries. Conclusions: Owing to high head neck cancer incidence in the subcontinent, anatomic complexity, need to balance outcomes/toxicities and requirement of expert multidisciplinary care; structured head neck fellowship training is imperative. Despite inherent challenges of concept and implementation in a diverse multicultural resource-limited setting, we foresee the application of region-relevant perspectives helping us achieve the objective of furthering subspecialty head neck training in South Asia.
Quality and reliability of online video information of breast cancer in Spanish.
Authors: Diaz Fernando Cristobal , Polo Perez Ismael Pavel , Corria Cedeno Dailis Barbara , LaPelusa Michael , Patel Dave , Rodrigo Hansapani Sarasepa 
Published: May 2020

11039 Background: Online health information is a central part of how patients learn about a cancer diagnosis. Involving patients in shared decision making is associated with better outcomes. Previous studies have identified a lack of high-quality, reliable online material related to cancer in English using validated tools. As the number of Spanish speaking people in the US, and globally, continues to grow, it is important that high-quality, reliable information is available in Spanish. No studies have evaluated online breast cancer informational videos in Spanish. Methods: A search using the phrase “cancer de mama” (translation: “breast cancer”) was conducted on YouTube. The first 200 video URLs were included for study with duplicates, non-Spanish, and non-informational videos excluded. The videos were characterized by several variables, including year of upload, country of origin, content discussed, views, likes, dislikes, and typology group (“Personal”, “Professional”, “Health Portal”, etc.). The quality and reliability of these videos were examined by measuring Global Quality Scale (GQS), a 5-point DISCERN score, and JAMA scores. Results: 173 videos met inclusion criteria in the study. The majority of the videos which discussed signs and symptoms were uploaded by a ‘commercial’ typology, risk factors mainly uploaded by ‘health portals’ (21%), and treatment options by ‘professionals’ (50%). Relatively few videos have discussed reconstruction, survivorship, and breast cancer in men. 57% of these videos were uploaded prior to 2017, 36% by different personnel followed by government/news agency (25%), and professionals (23%). There was no significant difference between number of views (p-value: 0.526) and likes (p-value: 0.122) among the five typology groups. Professional videos had the highest average GQS (2.55), DISCERN score (1.90), and JAMA score (2.05). Personal videos had the lowest average GQS (1.98) and DISCERN score (1.06). GQS, DISCERN, and JAMA scores were all statistically significantly different between each typology. Conclusions: The majority of online breast cancer videos in Spanish are older than 3 years and produced outside the US. They are generally of poor quality and reliability, although higher in professional videos. Given the lack of current, high-quality, and reliable informational videos available, needs assessments should be conducted to identify the most useful learning resources for Spanish-speaking patients. Specialists should consider uploading educational videos to improve the paucity of high-quality, reliable information online.
Long-term follow-up for duration of response (DoR) after weekly nab-sirolimus in patients with advanced malignant perivascular epithelioid cell tumors (PEComa): Results from a registrational open-label phase II trial, AMPECT.
Authors: Wagner Andrew J. , Ravi Vinod , Riedel Richard F. , Ganjoo Kristen N. , Van Tine Brian Andrew , Chugh Rashmi , Cranmer Lee D. , Gordon Erlinda Maria , Hornick Jason L. , Kwiatkowski David J. , Du Heng , Grigorian Berta , Schmid Anita N. , Hou Shihe , Harris Katherine , Desai Neil , Dickson Mark Andrew 
Published: May 2020

11516 Background: Malignant PEComa is a rare, aggressive sarcoma, with no approved medical treatment. Cytotoxic chemotherapies have limited benefit for patients with advanced disease. The AMPECT trial measured the effects of nab-sirolimus (ABI-009) and is the first prospective study in advanced malignant PEComa. nab-Sirolimus is a nanoparticle albumin-bound mTOR inhibitor with significantly higher intratumoral drug levels, mTOR target suppression, and anti-tumor activity in animal models versus other mTOR inhibitors. This report presents long-term follow-up of DoR after the primary analysis. Methods: Patients (N=34) received nab-sirolimus (100mg/m2 IV, weekly, 2/3 weeks) until progression or unacceptable toxicity. Primary endpoint: ORR by IRR. Key secondary endpoints included DoR, PFS6, OS, and safety. Exploratory endpoints included correlation of tumor genotype and outcome. The sample size of 30 efficacy-evaluable patients was based on an estimated ORR of 30% and the lower bound of the 95%CI of ORR to exclude values less than 14.7%. The primary analysis was conducted when all patients were treated ≥6 months (May 22, 2019). This report updates the primary response analysis and DoR with an additional 8.5-month of follow-up. Results: As of Feb 06, 2020, of the 31 efficacy-evaluable patients, the confirmed ORR by IRR was 39% (12/31, 95%CI: 21.8, 57.8), with 1 complete response (CR) and 11 partial responses (PR), 52% stable disease (SD, 16/31, with 10/16 SD ≥12 weeks), and 10% progressive disease (3/31); the disease control rate (CR+PR+SD ≥12 weeks) was 71%. PFS6 was 71% (95%CI: 47.7, 85.1). The majority of responses (67%) were reached at the first post-baseline scan at week 6, with a median time to response of 1.4 months (95%CI: 1.3 to 2.8). The median DoR by IRR was not yet reached (range 5.6-38.7+ months; calculated median 22.2+ months) with 8/12 (67%) responders still on treatment for >1 year and 5/12 (42%) >2 years. Mutational analysis available for 25 patients identified that TSC2 loss-of-function mutations significantly correlated with response; 8/9 (89%) patients with TSC2 had a confirmed response. Conclusions: Responses of advanced malignant PEComa to nab-sirolimus were highly durable and occurred in 39% of patients based on independent review. The high disease control rate with manageable toxicities suggest that nab-sirolimus is effective and represents an important new treatment option for these patients. NCT02494570. Clinical trial information: NCT02494570 .
Correlation of response with progression-free (PFS) and overall (OS) survival in relapsed/refractory Ewing sarcoma (RR-ES): Results from the rEECur trial.
Authors: Wheatley Keith , Kadir Bryar , Khan Maria , Fenwick Nicola , Gaspar Nathalie , Kanerva Jukka , Kuehne Thomas , Longhi Alessandra , Mata Cristina , Phillips Marianne , Hall Kirsten , Safwat Akmal , Valverde Morales Claudia , Westwood Andrew J. , Winstanley Mark , Evans Abigail , Strauss Sandra J , Dirksen Uta , Whelan Jeremy , McCabe Martin G. 
Published: May 2020

11524 Background: Survival for RR-ES at 5 years remains < 15%, so novel treatments are needed. Almost all Phase II trials for RR-ES use response as the primary outcome measure. It is unclear whether response is a valid surrogate for survival outcomes. Methods: Patients (pts) were eligible if they had RR-ES and were evaluable for imaging response (primary outcome) if they had measurable disease by RECIST 1.1. The randomization was initially between four chemotherapy regimens: topotecan-cyclophosphamide, irinotecan-temozolomide, gemcitabine-docetaxel (GD), high-dose ifosfamide. Response was assessed after 2, 4 (primary) and 6 cycles of therapy and was classified as complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD). PFS and OS were secondary outcomes. Survival from each assessment point by response status was analyzed, by Cox models, with hazard ratios (HR) given for PR v. SD and CR+PR v. SD. Results: From 2015-19, 241 pts with response data were entered. The relationship between response status and PFS and OS is shown in the table (HR < 1.0 indicates better outcome for PR or CR+PR than SD). Both PFS and OS were similar for pts with PR or CR+PR compared to those with SD. OS was inferior for patients with PD (all p < 0.01) (PFS is by definition zero for patients with PD at that timepoint). Small numbers mean CR results are not reliable. Results were consistent across all treatments and between refractory and relapsed disease. At the first interim assessment the GD arm was dropped, with risk ratios for response compared to the other three arms (blinded as still open) of 0.3, 0.5 and 0.5. If a new outcome – disease control (CR+PR+SD) – is defined, the risk ratios are 0.7, 0.8 and 0.7; i.e. still inferior for GD, but less so. Conclusions: Response does not correlate with survival outcomes in RR-ES, so considering PR, or even CR, a success and SD a failure when evaluating treatments may be misleading. We propose PFS as a better primary outcome for future trials and it will be introduced as such in the rEECur trial. Clinical trial information: ISRCTN36453794 . [Table: see text]
Increased pathological complete response rate with neoadjuvant denosumab in locally advanced giant cell tumor.
Authors: Taveira Gabriela Monte Tenorio , Marinho Felipe Da Silva , Souza Antonio Marcelo Gonçalves de , Carneiro Wagner cabral Gomes 
Published: May 2020

11528 Background: Giant cell bone tumor corresponds to 5% of bone tumors, has an osteolytic pattern and mainly affects long bone epiphyses in young adults. Despite being considered benign, it can metastasize and is treated as a locally destructive tumor, since it causes pain, limited joint movement and impaired function, with a risk of pathological fractures. The use of denosumab for surgical downstaging and reduction of recurrence is being studied, but the standard of treatment is still surgical. Methods: 15-year experience in monitoring 40 patients at the Cancer Hospital of Pernambuco-BR, who used neoadjuvant denosumab. They received Denosumab 120mg on D1, D8 and D15 as attack phase and subsequent maintenance with 120mg monthly. Results: The 40 patients made an average of 10 doses of neoadjuvant denosumab. Mostly located in the femur (41%) and tibia (23%), but with rare disorders in talus or orbit. Metastasis occurred in 6%, with site in lung and bones. Most were women (62%) around 21-40 years old, with Capanacci III classification at 72%. In this group, 28 had locally advanced disease and 12 had unresectable or metastatic disease. After using neoadjuvant denosumab, 75% have already had a biopsy, of which 63% (19/30) had a complete pathological response in biopsy. Of the patients with no post-denosumab neoplasia, 26% (5/19) had recurrence after medication and surgical procedure. Neoadjuvant treatment with denosumab, a monoclonal antibody that binds to RANKL, has been shown to benefit from histological response and surgical downstaging. We found 63% of complete pathological response in the 30 patients who underwent biopsy after medication, with bone sclerosis and hypocellular fibrous tissue as the main finding. Of these, 26% had disease recurrence after surgery. These data follow the international standard of disease recurrence rate, which is around 30%. Conclusions: We hope that the use of neoadjuvant desonumab will be more widespread and that it will be able to perform surgical downstaging, allowing less invasive and morbid procedures. Thus achieving greater joint preservation at the expense of a disease recurrence rate similar or less than standard surgical treatment.