JCO Oncology Practice

The mechanisms underlying breast cancer brain metastasis (BCBM) development are complex, and its clinical presentation varies depending on the number, location, and size of brain metastases. Common symptoms include headache, neurologic deficits, and seizures. Diagnosis of BCBM typically relies on neuroimaging techniques, such as magnetic resonance imaging and computed tomography scans. Local therapies, such as surgery and stereotactic radiosurgery, can be used to control tumor growth and relieve symptoms. Whole-brain radiotherapy has been a mainstay of treatment for BCBM, but its use has been associated with cognitive decline. Systemic therapy with chemotherapy and targeted agents plays an increasingly important role in the management of BCBM. Novel agents, such as human epidermal growth factor receptor 2 (HER2)–targeted therapies and tyrosine kinase inhibitors, have shown promising results in improving survival for patients with HER2-positive and triple-negative BCBM. This comprehensive review synthesizes current knowledge, clinical insights, and evolving paradigms to provide a robust understanding and roadmap for optimizing the diagnosis and management of BCBM.

Akshara S. Raghavendra

Nuhad K. Ibrahim

Breast Cancer Brain Metastasis: A Comprehensive Review

321 Background: Hospitalization is a time of crisis for patients and caregivers. Subspeciality oncologists may bring more timely, effective support compared to a general oncologists. Attendings, fellows and advance practice providers (APPs) may benefit from focused expertise for consultative care and education. Methods: Subspeciality oncology consults launched July 2023, with consults staffed by 4 oncologists from: 1) breast 2) head and neck/thoracic 3) gastrointestinal and 4) genitourinary/melanoma. Previously, 3 oncologists staffed all patients, regardless of primary malignancy. Throughout the study period, oncologists were supported by at least 1 fellow or 1 APP. Using Epic and Tableau, we collected LOS, time to consult (TTC), ICU rate, hospice referral rate, 30-day readmission, 30-day emergency department (ED) visit data. Using Qualtrics, we collected fellow, attending, and APP satisfaction feedback pre- and post-intervention. Data was analyzed using R-4.40. Oncologists, fellows, and APPs completed Qualtrics surveys pre- and post-intervention regarding their experience. Results: Subspeciality oncology consults were associated with a significant decrease in LOS, TTC, and ICU rate. Median LOS decreased by 2.0 days (P&lt;0.001), with median TTC decreasing by 1.0 hour (P=0.003). ICU rate decreased from 27.5% to 16.4% (P&lt;0.001). There was no difference in hospice referrals or 30-day ED visits. A significant increase in 30-day readmission during post-intervention was observed (Table). Oncologists reported a high level of satisfaction with the program. Oncologist, fellow, and APP overall experience and educational rankings increased after the introduction of subspeciality consults. Inpatient productivity measured by wRVU increased by 30% following the intervention, without associated changes to outpatient productivity. Conclusions: Transition to a subspeciality oncology consult model improved inpatient quality of care, as well as clinician experience. Additionally, inpatient productivity increased without decrease in outpatient metrics. Subspeciality medical oncology consultation can improve inpatient quality of care, education, clinician satisfaction and productivity. Subspeciality oncology consult outcomes. General Consults (Baseline)* Subspeciality Consults (Intervention) P-value Median TTC (Hours) 4.0 (1.5-6.0)** 3.0 (0-5.0)** P=0.003 Median LOS (Days) 7.0 (4.0-13.0)** 5.0 (3.0-10.0)** P&lt;0.001 ICU Rate 148 (27.5%) 161 (16.4%) P&lt;0.001 Hospice Referral Rate 56 (10.4%) 95 (9.7%) 0.655 30-Day Readmission Rate 136 (25.3%) 301 (30.7%) 0.028 30-Day ED Rate 157 (29.2%) 315 (32.1%) 0.247 *Baseline data reflects outcomes for general oncology consult staffing, prior to initiation of subspeciality consult model (pre-intervention). **Interquartile Range (IQR).

Elizabeth Horn Prsic

Hari Anant Deshpande

Wei Wei

Michael Strait

Anne C. Chiang

General versus disease-specific medical oncology consults and impact on inpatient quality of care.

普通与疾病特异性肿瘤内科会诊对住院患者护理质量的影响。

312 Background: Genetic evaluation and genetic testing for individuals with a significant personal and/or family cancer history is recommended by the National Comprehensive Cancer Network (NCCN) and other professional societies. The NCCN outlines criteria for germline testing for Lynch syndrome caused by mutations in MLH1, MSH2, MSH6, PMS2, and EPCAM based on personal and family history. There are subtypes of cancer patients that automatically qualify for Lynch syndrome genetic testing based on personal history including: colon or rectal cancer diagnosed &lt;51 and endometrial cancer diagnosed &lt;51. Actkins et al (2021) reported that genetic testing occurred in only 14.4% of their patients diagnosed with colon and endometrial cancer under 51. It is our hypothesis that the Texas Oncology community-based genetics program has evaluation and testing rates exceeding published reports. Methods: A retrospective cohort study of individuals diagnosed at all Texas Oncology sites between January 1, 2022, through December 31, 2022. Individuals with colon or rectal cancer diagnosed &lt; 51 years of age and individuals diagnosed with endometrial cancer &lt;51 years of age were included. Data was obtained from electronic medical records. The project was approved by the Texas Oncology Privacy Board. Results: A total of 869 patients were included in the study cohort. 417 (48%) underwent genetic testing without a formal genetics’ evaluation and 325 (37%) had a genetic evaluation in addition to genetic testing. 294/325 (90%) had their genetic evaluation at a Texas Oncology clinic. The most common reason for no genetic testing in this cohort was the physician not ordering the testing (79%). There was not a statistical difference in testing rates based on race, gender, or if the Texas Oncology site had a genetics provider in the clinic. Conclusions: 100% of our cohort qualified for genetic testing and only 48% received genetic testing. While this study proves that community-based oncology clinics can surpass published genetic testing rates, there are still quality improvement measures that can be implemented to increase genetic testing rates in this cohort. Colon or Rectal &lt;51 Uterine &lt;51 Had germline genetic testing 312 (51.4%) 105 (40%) Had genetic evaluation 234 (39%) 91 (35%) Genetic evaluation at TXO 213 (91%) 81 (89%) If seen at GREAT site, more likely to get tested? No (p=0.1969) No (p=0.9353)

Ann Bunnell

Lauren Reed

Kate Principe

Vanessa Torres

Genetic evaluations and testing results for hereditary colon and uterine cancer syndrome in a community oncology setting.

社区肿瘤学环境中遗传性结肠和子宫癌综合征的遗传评估和检测结果。

112 Background: Immune checkpoint inhibitors are unavailable or unaffordable to many patients in LMIC, including Mexico. Some proposed strategies to improve access include weight-based dosing, vial sharing, or using low-dose IO (immunotherapy) schedules. Despite the potential advantages of low-dose IO to increase access and improve outcomes, there is limited information regarding the use of low-dose IO in real-world clinical practice in LMICs. Methods: We conducted a cross-sectional online survey of medical oncologists and hematologists practicing in Mexico. The survey was distributed via email using databases from the Mexican Society of Oncology and the Mexican Society of Hematology, and through physician Whatsapp groups in April and May 2024. The primary objective was to examine the prevalence and reasons of low-dose IO use in real-world clinical practice across Mexico. The survey assessed provider characteristics, prevailing attitudes, and potential barriers to low-dose IO adoption. Results: A total of 154 specialists answered the online survey, of which 77 completed it. The median age was 41 years (range 30-73); forty-five (58.4%) were men, thirty-one were women (40.2%), and two were non-binary. Fifty-nine (77%) were medical oncologists and 18 (23%) were hematologists. Twenty-two (29.3%) worked in private practice, nine (12%) in public institutions, and forty-four (58.7%) practiced in both. Seventy-two percent of respondents reported barriers in acquiring IO and forty-eight percent reported utilizing low-dose IO. For low-dose IO users, nivolumab was the most frequently prescribed drug (76%), followed by pembrolizumab (43%). The most frequent reason for using low-dose IO was reducing treatment-related cost (83% of respondents). Common barriers to low-dose IO use included concerns regarding the efficacy and safety of lower doses and a lack of knowledge about dosing protocols. Fifty respondents (67%) reported complete or moderate confidence in the efficacy of low-dose IO for patients with advanced disease, while only 36 respondents (49%) reported confidence on its efficacy for patients with localized disease. Conclusions: Despite its potential benefits of low-dose IO and a need to improve access to treatment, there are concerns about the efficacy and safety of this strategy among Mexican cancer specialists. Addressing these barriers and identifying facilitators could improve the acceptability of prospective trials studying low-dose IO in Mexico.

Andres Meraz-Brenez

Enrique Soto Pérez de Celis

Roberta Demichelis

Leonardo Verduzco-Rodriguez

Arjun Gupta

Meera Vimala Ragavan

Fumiko Chino

Haydee Cristina Verduzco-Aguirre

Low-dose immunotherapy for patients with cancer in low- and middle-income countries (LMIC): A needs assessment.

低收入和中等收入国家（LMIC）癌症患者的低剂量免疫治疗：需求评估。

210 Background: Cancer survivors are increasingly older, with rising rates of functional impairment, comorbidity burden, and needs. Patients often require medical equipment, but administrative barriers and lack of payer coverage can limit access and increase cost sharing for patients. Prior work on financial burdens has largely focused on direct medical costs and costs of prescription drugs. We sought to characterize patterns of use and costs associated with medical equipment use among US cancer survivors. Methods: We used the US National Health Interview Survey (NHIS)—a nationally representative survey of the US population— to identify self-reported use of medical equipment (‘’such as a cane, a wheelchair, a special bed etc.’’) among cancer survivors from 1997-2018. We then used the Medical Expenditure Panel Survey (MEPS) — which includes additional data on health care costs and spending among people sampled from the NHIS— to evaluate out-of-pocket (OOP) and total spending on equipment (e.g., orthopedic items, prosthesis, bathroom aids, disposable supplies etc.) among cancer survivors from 2016-2020. We describe trends in prevalence of use, and compared OOP costs and percentage of cost sharing responsibility (OOP cost/total spending) for equipment relative to other medical care, such as prescription drugs. Results: We identified 55,625 cancer survivors in the NHIS, representing 19.1 million weighted individuals from 1997-2018. The weighted number of cancer survivors using medical equipment increased during the study period from 0.9 million in 1997 to 2.3 million 2018, a 2.4-fold increase. The number of survivors not requiring equipment increased by 1.7-fold during the same period. The adjusted prevalence of equipment use among survivors increased from 5.1% in 1999 to 7.9% in 2018, a 2.8 percentage-point increase (P &lt; .001 for trend). We identified 32,106 cancer survivors (56.6% women, 55.9% ≥65 years) in MEPS from 2016-2020. Among users, mean annual total spending on equipment was 1,205, and mean OOP costs for equipment were 672. For comparison, mean annual OOP costs for prescription drugs was $541. The cost sharing responsibility for equipment (56%) was higher than that for all other comparison groups: prescription drugs (10%), outpatient visits (11%), occupational/physical therapy (18%), emergency room visits (20%), and hospitalization (3%). Conclusions: The number of US cancer survivors who use medical equipment has more than doubled during the past 20 years. For these patients, OOP costs for equipment are greater than that for prescription drugs, with patients responsible for over half the total spending. These data are particularly notable given that patterns of use and spending reported here do not capture survivors unable to access necessary equipment due to administrative, financial, and/or other barriers. Interventions to assess need, ensure access, and decrease associated financial burden are urgently needed.

Faraz Jafri

Vishal R. Patel

S. M. Qasim Hussaini

Naveen Premnath

Helen M. Parsons

Anne Hudson Blaes

Use of and spending on medical equipment among cancer survivors.

癌症幸存者对医疗设备的使用和支出情况。

John W. Sweetenham

JCO Oncol Pract

Did I Mess Up Today?

我今天搞砸了吗？

Ovarian function suppression (OFS) with gonadotropin-releasing hormone agonists (GnRHas) is a standard of care for premenopausal patients with high-risk stage II/III hormone receptor-positive breast cancer (BC). Practical guidance on the optimal choice of GnRHa, timing, schedule, and monitoring is limited. Our aim was to determine how oncologists use OFS in routine care.

Catherine M. Kelly

Kathleen E. Bennett

Caitriona Cahir

Andrea Eisen

Lajos Pusztai

Clinical Management of Ovarian Function Suppression in Premenopausal Women With Breast Cancer: A Survey of Members of ASCO

乳腺癌患者围绝经期卵巢功能抑制的临床管理：美国临床肿瘤学会成员调查

In 2017, the National Cancer Institute (NCI) funded the Cancer Center Cessation Initiative (C3I) to implement and expand tobacco treatment programs in routine oncology care. Many C3I programs developed specialty care programs staffed by tobacco treatment specialists (TTSs) to deliver evidence-based treatment to adult patients who smoke. People involved in specialty tobacco treatment programs can help to identify implementation strategies and adaptations that may enhance tobacco treatment reach and effectiveness in cancer care and help more patients with cancer quit using tobacco.

Jennifer E. Bird

Jason S. Chladek

Heather D'Angelo

Mara Minion

Danielle Pauk

Robert T. Adsit

Karen L. Conner

Mark Zehner

Michael Fiore

Betsy Rolland

Danielle McCarthy

Specialty Tobacco Treatment Implementation in Oncology: A Qualitative Study

肿瘤学中的特色烟草治疗实施：一项定性研究

PURPOSE Limited health literacy—ability to obtain, process, and understand health information—can hinder communication, access to medical treatment, and identification and management of comorbidities. Older adults have high rates of poor health literacy, but its role in aging-related outcomes among older adults with cancer is understudied. METHODS We included 876 older adults age 60 years and older with cancer from the Cancer and Aging Resilience Evaluation Registry completing self-reported geriatric assessment, including health literacy, at first visit to medical oncology. The exposure was limited health literacy. Outcomes were frailty, physical/mental health-related quality of life (HRQOL), and health care utilization. We used modified Poisson regression to examine the association of exposure on outcomes adjusting for age, race-ethnicity, sex, and cancer type/stage. RESULTS Median age at enrollment was 68; 57.8% were male; 20.2% were non-Hispanic Black. The most prevalent cancers were advanced-stage (46.8% stage IV) colorectal (26.9%) and pancreatic (19.0%). Those with limited health literacy were older (70 v 68 years; P &lt; .001), male (63.0% v 55.1%; P = .026), non-Hispanic Black (28.8% v 16.1%; P &lt; .001), ≤high school educated (62.3% v 28.1%; P &lt; .001), and retired/disabled (86.3% v 71.2%; P &lt; .001). In multivariable analysis, limited health literacy was associated with higher prevalence of frailty (prevalence ratio [PR], 2.64 [95% CI, 2.15 to 3.26]), impaired physical (PR, 1.90 [95% CI, 1.59 to 2.27]) and mental (PR, 2.08 [95% CI, 1.76 to 2.47]) HRQOL, and hospitalization in the last year (PR, 1.28 [95% CI, 1.10 to 1.48]) versus adequate health literacy. CONCLUSION Older adults with cancer and limited health literacy had higher adjusted prevalence of frailty, impaired physical and mental HRQOL, and recent hospitalization. Interventions to address limited health literacy should be explored in this vulnerable and growing cancer population.

Srihitha Padamatinti

Mackenzie E. Fowler

Coryn Stephenson

Chen Dai

Smith Giri

Darryl Outlaw

Robert Hollis

Grant R. Williams

Association of Limited Health Literacy With Frailty, Health-Related Quality of Life, and Health Care Utilization Among Older Adults With Cancer: The Cancer and Aging Resilience Evaluation Registry

有限健康素养与癌症老年患者的衰弱、健康相关生活质量和医疗保健利用的关联：癌症与衰老弹性评估注册研究

Precision therapies and immunotherapies have revolutionized cancer care, with novel genomic biomarker-associated therapies being introduced into clinical practice rapidly, resulting in notable gains in patient survival. Despite this, there is significant variability in the utilization of tumor molecular profiling that spans the timing of test ordering, comprehensiveness of gene panels, and clinical decision support through therapy and trial recommendations.

Alexa K. Dowdell

Ryan C. Meng

Ann Vita

Bela Bapat

Douglas Hanes

Shu-Ching Chang

Lauren Harold

Cliff Wong

Hoifung Poon

Brock Schroeder

Roshanthi Weerasinghe

Rom Leidner

Walter J. Urba

Carlo B. Bifulco

Brian D. Piening

Widespread Adoption of Precision Anticancer Therapies After Implementation of Pathologist-Directed Comprehensive Genomic Profiling Across a Large US Health System

美国大型医疗系统中实施病理学家指导的综合基因组分析后精准抗癌疗法的广泛采用

短名	JCO. Oncol. Pract.
Journal Impact	4.64
国际分区	ONCOLOGY(Q1)
期刊索引	SCI Q2中科院 3 区

ISSN	2688-1527, 2688-1535
h-index	78
国内分区	医学(3区)医学肿瘤学(3区)

涉及主题	医学内科学生物遗传学病理癌症心理学政治学法学经济外科护理部家庭医学肿瘤科数学计算机科学精神科社会学
出版信息	出版商: Lippincott Williams and Wilkins Ltd.，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2020，原创研究文献占比: 90.27%，自引率:6.40%， Gold OA占比: 11.16%

JCO Oncology Practice

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