bluuebunny/crossref_metadata_2025_split huggingface dataset:
SARS-CoV2 infection rate in patients and health care personnel in a chemoradiotherapy unit: A prospective cohort in Mexico.
Authors: Meneses Medina Mónica Isabel , Hernandez-Felix Jorge Humberto , Camargo Vanessa Rosas Rosas , Valenzuela Ana Karen , Cedro-Tanda Alberto , Martos Armendariz Edgar Omar , Anaya Sánchez Luis Guillermo , Torres Valdiviezo Lucero Itzel , Galindo Fraga Arturo , Herrera Montalvo Luis A. , Hidalgo Alfredo , Huitzil Melendez Fidel David 
Published: June 2021

e22521 Background: Cancer treatment during the COVID-19 pandemic represents a challenge. Increased hospital visits to receive treatment as well as interaction with healthcare personnel (HCP), represent a potential risk factor for acquiring COVID-19. Our objective was to analyze the SARS-CoV-2 infection rate in patients (pts) with cancer and HCP of a chemoradiotherapy unit localized in a center designated as a COVID-19 priority facility in Mexico City. Methods: We invited HCP and pts with solid tumors attending the chemoradiotherapy unit to participate in a prospective follow-up cohort to early detect asymptomatic COVID-19 infection. Only participants who gave informed consent were included. A RT-PCR test for SARS-COV-2 from nasopharyngeal swab samples was performed every 2 weeks, and daily electronic clinical questionnaires were sent. Recruitment started on June 12, 2020. Participants entered the study in different moments and they were followed until a positive test for COVID-19 was found, or pts finished treatment or, HCP changed work area or, withdrawal of inform consent, or follow up completion, which ever occurred first. The last day of follow up was September 30, 2020. The general infection rate during all the period of follow-up was calculated, as well as the infection rate per month. Results: We included 130 asymptomatic participants, 44.6% (n = 58) were HCP and 55.4% (n = 72) were cancer pts, 45.9% (n = 61) were men, and 54.1% (n = 72) were women. During a median follow-up of 85 days (IQR 48-103) we performed 634 nasopharyngeal swabs for SARS-CoV-2 RT-PCR, with a median number per participant of 5 (IQR 3-7). Within this period, 18 (13.5%) participants tested positive for SARS-CoV-2 infection. 12 were asymptomatic and 6 developed symptoms. None of them had a severe form of COVID-19 and we did not register any death associated to COVID-19. Table shows the infection rate per month. Conclusions: In our center, during the time period of follow up, the overall rate of COVID-19 infection was higher than that reported in a study from asymptomatic HCP and office workers in Mexico City (13.5 vs 8.4%). We also observed a monthly variation that was consistent with the months with the highest number of cases detected in Mexico City during the first wave. With careful implementation, it is feasible to continue to safely deliver systemic oncologic treatments during the COVID-19 pandemic.[Table: see text]
Confirmatory germline testing for presumed germline pathogenic variants using tumor-only testing.
Authors: Kondo Tomohiro , Yamada Takahiro , Yoshioka Masahiro , Nishigaki Masakazu , Yamamoto Yoshihiro , Kou Tadayuki , Matsubara Junichi , Kanai Masashi , Matsumoto Shigemi , Muto Manabu , Kosugi Shinji 
Published: June 2021

e22524 Background: Presumed germline pathogenic variants (PGPVs) can be detected in tumor tissues using comprehensive genomic profiling. Clinicians and patients can decide whether to conduct confirmatory germline testing or not. However, the promoting and obstructive factors for confirmatory germline testing are unclear. Methods: This single institutional retrospective study aimed to identify factors related to confirmatory germline testing in patients with PGPVs. Between April 2015 and April 2019, 270 consecutive patients with cancers of unknown primary site, rare tumors, or solid tumors refractory to standard chemotherapy, who underwent tumor-only comprehensive genomic profiling were reviewed. PGPVs were proposed to be disclosed as variants to the patients by our institutional molecular tumor board. Univariate logistic regression analysis was conducted to investigate the relationship between each patient’s characteristics and confirmatory germline testing. Factors showing a statistical relationship (p < 0.10 in univariate analyses) were included in multivariate logistic regression analysis with a backward selection of variables. Statistical significance was set at p < 0.05. Results: Of the 270 patients who underwent tumor-only comprehensive genomic profiling, 77 possessed PGPVs. The most common PGPVs were TP53 (n = 56), APC (n = 9), PTEN (n = 7), RB1 (n = 6), and BRCA2 (n = 6). Among the 77 patients, only 11 (14.3%) chose to undergo confirmatory germline testing. Multivariate logistic regression analysis revealed that the person disclosing the results (experienced oncologists with knowledge of cancer genome medicine vs. others, odds ratio [OR]: 27.7, 95% confidence interval [CI]: 4.60–167) and study period (OR: 0.110, 95% CI: 0.015–0.787) were independently and significantly associated with confirmatory germline testing. Conclusions: These findings indicate that fostering genomic competency in oncologists and collaborating with genetic experts would facilitate cancer patients and their families to receive genetic medical services in the process of cancer genomic profiling.
Real-world experience of pancreatic cancer molecular profiling in a tertiary center.
Authors: Sun Kai , Mylavarapu Charisma , Crenshaw Aubrey , Zhang Yuqi , Hsu Enshuo , Xu Jiaqiong , Niravath Marilyn , Nicolas Juan Carlos , Jones Stephen , Abdelrahim Maen 
Published: June 2021

e22526 Background: NCCN has recommended universal genetic testing of pancreatic cancer. Liquid biopsies have been approved by the FDA to facilitate detection of targetable mutations in various solid tumors. Methods: To investigate how oncologists follow NCCN guidelines and utilize liquid biopsies in pancreatic cancer, we retrospectively queried patient records from 7/2016 to 6/2020 in our institutional system. Those retrieved but with pancreatic cancer care from other 2 local institutions are also included. Demographics, cancer stage on diagnosis, year of diagnosis, molecular profiling (MP) and treatment setting (community vs academic) are recorded and analyzed. Results: A total of 500 pancreatic cancer patient records were identified. Of these, 234 patients were excluded due to incomplete records. Among the remaining 266 patients, 113 (42.5%) had MP performed. Younger patients and those treated at an academic setting were more likely to have MP (P= 0.0051 and 0.0010 respectively). The trend of increased utilization of MP over the years is also statistically significant (p< 0.0001). Gender, ethnicity or stage on diagnosis are not statistically significant between groups. (Table). Conclusions: MP is being increasingly utilized. However, more awareness is needed among oncologists, especially those who practice in the community setting.[Table: see text]
Addressing gaps in care for patients with rare cancers and blood disorders: The impact of a collaborative digital education initiative.
Authors: Turell Wendy , Ackbarali Tariqa , del Nido Elizabeth L. , Pucci Kathryn , O'Hara Randi , Kowalski Katie , Hopper John , Palma Jim 
Published: June 2021

e23005 Background: Clinicians are uniquely challenged to manage patients with rare cancers and blood disorders due to a lack of knowledge of diagnosis and management guidelines for these conditions. These conditions comprise a larger proportion of diagnosed cancers in minority populations, among whom a worse 5-year survival is realized in adults versus adolescents and children. Patients often experience delayed diagnoses, have limited treatment options, access to specialists, and limited clinical trials. Education surrounding rare cancers and blood disorders, diagnostic criteria, approved agents, and emerging novel agents is essential to improve treatment outcomes for patients with these rare malignancies. Methods: A 2-part CE and American Board of Internal Medicine (ABIM) Maintenance of Certification activity was launched live-online in October and November, 2020, and remains on-demand through November, 2021 at OMedLive.com, comprising 9 hours of virtual education. This first annual activity was launched in partnership with National Organization for Rare Disorders (NORD), and featured key opinion leaders with extensive expertise in rare cancers and blood disorders. Session components included case presentations, downloadable resources, live polling, and audience real-time Q&A. Knowledge and competence questions were administered pre- and immediate post-activity. Patient and clinical practice impact questions were also asked at 2-month follow-up. Data from these questions were analyzed to determine engagement, remaining gaps, and the unique challenges of managing rare cancers and blood disorders. Results: 996 clinicians have participated in the activity to date. All 28 CE test questions reflected improvements in knowledge and competence regarding symptom recognition, diagnosis, clinical trial data, guidelines, treatment options, and adverse event management. At 2-mos. follow up, 71% reported improvements in clinical practice and 67% reported improvements in patient impact (n = 66). Almost half (48%) indicated diagnosis as their most significant challenge, with other noted barriers including: limited access to molecular testing (29%) and limited knowledge of tests to order (17%). The top 3 reported treatment challenges were: a lack of clinical evidence (24%), limited treatment options (22%), and high treatment cost (16%). Updated and expanded data will be shared. Conclusions: Following the targeted collaborative educational initiative, clinicians demonstrated clear knowledge and competency improvements in critical areas such as recognition, diagnosis, and management, and reported significant improvements in patient outcomes and clinical practice. The results of the two-month impact survey demonstrated a need for further tailored education on diagnostic testing and clinical evidence on treatment options for rare malignancies.
Patient and provider education on HER2-positive metastatic breast cancer: Defining gaps in clinician practice, patient behaviors, patient-provider alignment, and clinical knowledge.
Authors: Turell Wendy , Ackbarali Tariqa 
Published: June 2021

e23007 Background: Current breast cancer management is driven by inherent heterogeneity of disease. Therapeutic options for later lines of HER2 therapy have expanded, shifting practice patterns to incorporate the latest evidence and guidelines. Health care providers (HCPs) require education to synthesize new evidence in the context of clinical practice including three approved HER2-directed therapies between December 2019 and April 2020. Concurrent patient and caregiver education is imperative to improve collaborative treatment decisions for HER2+ metastatic breast cancer (MBC). Methods: Two, 1-hour online video-based programs were hosted in June, 2020 for HCPs and patients/caregivers, respectively. Practice and knowledge gaps among HCPs, and knowledge, communication and self-efficacy behaviors among patients were assessed. Each activity was interactive, consisting of slides, polling and live questions, and both remain on-demand (and on social media for patients/caregivers) for 12 months. Assessments were administered at 3 time points (pre-, immediate post-, and 2 mos. post-activity). Data from these questions, responses to live polling questions, and learner-submitted questions during live Q&A were analyzed to determine engagement, lessons learned, and continuing education gaps. Results: As of February 2021, 525 HCPs and 9,582 patients (9,449 Facebook Video; 133 CancerCoachLive.com) participated in the ongoing activities. Post education, HCP learners anticipated the education would positively impact practice behavior (77%) and patient clinical outcomes (73%). HCP improvements in pre/post knowledge and competence questions were realized in 3/4 of the questions. Of patients/caregivers, 34% more learners reported confidence in managing their condition post vs. pre-education. They listed “affording therapy” and “understanding treatment options” as their greatest challenges, and reported “self-care strategies” as their most sought information during the COVID-19 pandemic. At 2-mos. follow-up, 83% of patients reported improvements in communication with their HCPs, and 77% of HCPs reported improvements in their clinical practice. Updated data will be shared, including aligned HCP and patient questions pertaining to care challenges and communication goals. Conclusions: CME and patient education can yield gains in clinical practice behaviors, patient healthcare communication and confidence, and treatment knowledge of HER2-postive breast cancer. Together, aligned education directed to HCPs and patients can improve the ability to provide evidence-based treatment for patients.
CME curriculum improves clinician knowledge, competence, and confidence in managing patients with NF1-related tumors.
Authors: Worst Michelle Arielle , Caracio Rich , Lucero Katie , Cohen Jacob 
Published: June 2021

e23009 Background: Neurofibromatosis type 1 (NF1) is an uncommon complex autosomal dominant disorder caused by germline mutations in the NF1 tumor suppressor gene. Therapeutic options have historically been limited with surgical debulking being the preferred treatment modality. However, recent clinical data have shown improved outcomes with the use of MEK inhibitors. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of physician learners with respect to the treatment of NF1-related tumors. Methods: The educational series consisted of four online, CME-certified activities. For each activity, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities, stratified by learning theme, and evaluated by target specialty. A repeated pairs pre-/post-assessment study design was used and McNemar’s test or paired samples t-test (P < .05) assessed educational effect. The first activity in the series launched Dec. 2019 and the last launched June 2020; data were collected until Dec. 2020. Results: Overall significant improvements were seen after education for oncologists (N = 258, P < .001), neurologists (N = 474, P < .001), surgeons (N = 427, P < .001), neurosurgeons (N = 93, P < .05), and pediatricians (N = 56, P < .001), regardless of practice setting. A sub-analysis of community specialists also showed significant improvements after education: oncologists (N = 117, P < .01), neurologists (N = 188, P < .001), and surgeons (N = 206, P < .001). Outcomes assessed by learning themes and specialty showed relative percent increases, with the majority being statistically significant. Conclusions: This analysis demonstrates that oncologists’ and other specialists’ knowledge, competence, and confidence regarding the treatment of NF1-related tumors improved after education, as measured through a comprehensive analysis of CME outcomes data from a variety of activities designed to achieve these ends. These results have the ability to translate to improvements in clinical care. Despite the improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.
Online CME closes gaps in CSCC management revealed in a virtual patient simulation.
Authors: Dermer Shari , Betz Briana , Chatterjee-Shin Piyali , Patel Vishal , Khushalani Nikhil I. 
Published: June 2021

e23013 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer type. Although highly curable in its early stages, advanced or metastatic CSCC has been associated with mortality rates as high as 70%. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists on the assessment and management of CSCC. Methods: The educational series consisted of 4 online, CME-certified activities in multiple delivery formats, including an initial virtual patient simulation, followed by a clinical practice assessment (CPA) and 2 video discussions with synchronized slides. For the video discussions, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test ( P <.05) assessed educational effect. The first activity launched June 2019 and the last launched August 2020; data were collected until December 2020. Results: Following education oncologists had significant improvements in knowledge and competence compared with responses from the CPA. Improvement in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes identified in the virtual patient simulation are reported: Identifying patients who are not candidates for surgical intervention: 9% increase (56% CPA/ 77% pre/ 84% post; n=123-314; P <.05). Tailoring treatment: 30% increase (41% CPA/ 56% pre/ 73% post; n=119-314; P <.05). Tailoring treatment–cemiplimab: 22% increase (32% CPA/ 55% pre/ 67% post; n=123-314; P <.05). Tailoring treatment–cetuximab: 16% increase (15% CPA/ 37% pre/ 43% post; n=123-314; P <.05). New and emerging immunotherapies for CSCC: 47% increase (28% CPA/ 30% pre/ 44% post; n=119-314; P <.05). Conclusions: These results demonstrate the effectiveness of curriculum-based education for oncologists to address specific gaps in care as identified in a virtual patient simulation. This series of CME-certified online educational activities resulted in significant improvements in knowledge and competence in the assessment and treatment of patients with CSCC.
Secret sauce in collaborative tumor boards: Team-based characteristics that optimize tumor board functionality.
Authors: Oureilidis-DeVivo Barbara 
Published: June 2021

e23015 Background: Interdisciplinary teams are an indispensable characteristic of modern organizations, particularly in healthcare settings that require specialists to work together to solve multifaceted patient care problems. Multidisciplinary tumor boards (TBs) aim to coordinate multidisciplinary perspectives to help the oncology team devise the best treatment program for the patient. Yet, while this is their purpose, studies have found that TBs do not always achieve that goal effectively. Why are some tumor board (TB) teams more effective than others? This study shed light on key characteristics found among highly effective TBs. It provides a theoretical explanation of their organizational behaviors and structures and their effect on cancer treatment decision-making. The research is grounded in organizational behavior theories that have historical prominence in group decision-making, social hierarchy, and interdisciplinary collaboration, and are used to explain the phenomenon under investigation best. Methods: Qualitative research was used in the study. Data from 44 different TB observations and 18 interviews were gathered over four years at seven research hospitals in the United States and United Kingdom. The data were then coded, analyzed and synthesized with organizational behavior theory to explain the social phenomena under investigation. Results: The study revealed that certain TBs practice strong collaboration displaying high levels of partnership, cooperation, equality, and interdependency, which was incorporated explicitly into their meeting systems to achieve their common goal. Team-based characteristics such as members’ consistent shared preferences and identity, coordinated interactions, a collective learning process, and shared power and partnership are key markers found within these teams that positively influenced treatment decision-making processes and outcomes, earmarking best practices in TB groups. Conclusions: Organizational theory that suggests that for a collaborative process to be effective, team-based mechanisms need to be adopted in which each member respects, trusts, and acknowledges the skills and expertise of other disciplines in the organization, shares team values, decision-making processes, responsibilities, and planning, relies mutually upon other team members, and works outside normal professional boundaries openly and willingly. In an egalitarian structure like that of the TBs reviewed in this study, where preferences and identities are consistent and groups are collaborative, treatment decisions are less biased and incorporate multidisciplinary perspectives. Thus, this study suggests that by possessing both team- and task-based characteristics and practices, TBs engage in best practices, and thereby optimize their functionality.
Methylation of MMP2 and MMP9 in patients with localized and generalized forms of Ewing's sarcoma.
Authors: Petrusenko Natalia A. , Gvaldin Dmitry Yu. , Yurchenko Darya Yu. , Kuznetsov Sergey A. , Burtsev Dmitriy V. , Kit Oleg I. 
Published: June 2021

e23503 Background: MMPs play a critical role in tumor growth and progression, metastatic development, angiogenesis, and tumor invasion. Epigenetic regulation of MMP2 and MMP9 levels is often disrupted in cancer and is considered as potential biomarkers. In this study, we tried to assess the methylation of the MMP2 and MMP9 genes in patients with localized and generalized forms of Ewing's sarcoma (ES). Methods: As a material used DNA from FFPE of primary tumor of 20 patients with localized forms ES and 20 patients with generalized forms ES. After bisulfite conversion of total DNA and PCR, the level of CpG methylation was assessed by sequencing on a Genetic Analyzer Applied Biosystems 3500. Results: The analysis showed the presence of hypomethylation of the MMP2 in the group with generalized forms (100%) 1.25 times more often than in the group with localized forms (80%), and hypermethylation was observed only in the group with localized forms–20% of cases (χ2 = 4.234, p = 0.040). On the other hand, hypermethylation was 1.9 times more common in the group with localized forms of ES (90%) (χ2 = 8.313, p = 0.004). Differences in the methylation status of the MMP2 and MMP9 indicate that the presence of hypomethylation at two loci increases the risk of developing generalized ES by 22 times (OR = 22.2, p < 0.05; CI95% 2.460-20.769). Conclusions: Specific methylation of the matrix metalloproteinases genes MMP2 and MMP9 identified in the groups of localized and generalized Ewing's sarcoma. At the same time, the group with generalized forms of ES was characterized by gene hypomethylation.