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1.
Cancer Prev Res (Phila) ; 15(8): 475-479, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35912410

RESUMO

Scientific advances in the late 19th century set the stage for progress in understanding and treating cancer, a disease that was previously considered almost hopeless. One hundred years later, cancer prevention is becoming an increasingly important focus for oncology research. New tools and ideas bring to the field some extremely promising molecular, organizational, social, and political approaches, which were a focus of the American Association for Cancer Research 2022 Annual Meeting and of the newly launched AACR Cancer Prevention Working Group (CPWG). We are moving toward precision prevention, better tools for early detection and for risk assessment, the use of a Precancer Atlas, unveiling of new biomarkers. Besides improving lifestyle, by avoiding risk factors such as tobacco use, excessive UV exposure, infectious agents, as well as poor dietary habits, lack of exercise, overweight, and obesity, many other factors can impact cancer risk, which is a warning to consider a multifaceted molecular but also social approach. Gender, ethnicity, geographic, and economic lines are associated with disparities in prevention, which we want to overcome. Here we summarize some challenges and priorities in cancer prevention emerging from the work of AACR and CPWG.


Assuntos
Oncologia , Neoplasias , Exercício Físico , Humanos , Estilo de Vida , Neoplasias/etiologia , Obesidade/complicações , Estados Unidos/epidemiologia
2.
Urologie ; 61(7): 777-780, 2022 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-35925250

Assuntos
Oncologia
3.
Curr Opin Support Palliat Care ; 16(3): 117-122, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35929558

RESUMO

PURPOSE OF REVIEW: The COVID-19 pandemic posed several challenges to cancer research including halting of trials, reduced recruitment and protocol violations related to inflexible processes followed in clinical trials. Researchers adopted innovative measures to mitigate these problems and continue studies without compromising their quality. This review collates these adaptations that could well continue after the pandemic. RECENT FINDINGS: The COVID-19 pandemic forced researchers globally to adopt innovative measures to overcome the challenges of the pandemic. These included protocol amendments to adjust to the pandemic and travel restrictions, and increased use of digital technologies. 'Virtual' clinical trials were conducted increasingly with adaptations in ethics and regulatory approvals, patient recruitment and consenting, study interventions and delivery of study medications, trial assessments, and monitoring. Many of these adaptations are safe and feasible, without compromising study quality and data integrity. Although these may not be universally applicable in all types of research, they bring many benefits including more diverse patient participation, less burden on patients for study procedures and reduced resources to conduct trials. SUMMARY: The COVID-19 pandemic has affected cancer research adversely; however, learnings from the pandemic and adaptations from researchers are likely to improve the efficiency of clinical research beyond the pandemic.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Humanos , Oncologia , SARS-CoV-2
5.
Value Health ; 25(7): 1081-1086, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35779938

RESUMO

OBJECTIVES: Asking "Was it worth it?" (WIWI) potentially captures the patient perception of a treatment's benefit weighed against its harms. This exploratory analysis evaluates the WIWI questionnaire as a metric of patients' perspectives on the worthwhileness of cancer treatment. METHODS: A 3-item WIWI questionnaire was assessed at end of treatment in patients with cancer on the COMET-2 trial (NCT01522443). WIWI items were evaluated to determine their association with quality of life (QOL), treatment duration, end-of-treatment reason, patient-reported adverse events (AEs), and disease response. RESULTS: A total of 65 patients completed the questionnaire; 40 (62%), 16 (25%), and 9 (14%) patients replied yes, uncertain, and no to "Was it worthwhile for you to receive the cancer treatment given in this study?" (item 1), respectively; 39 (60%), 12 (18%), and 14 (22%) to "If you had to do it over again, would you choose to have this cancer treatment?"; and 40 (62%), 14 (22%), and 11 (17%) to "Would you recommend this cancer treatment to others?" Patients responding yes to item 1 remained on treatment longer than those responding uncertain or no (mean 23.0 vs 11.3 weeks, P<.001). Patients responding uncertain/no to item 1 discontinued treatment because of AEs more frequently than those responding yes (36% vs 7.5%, P=.004) and demonstrated meaningful decline in QOL from baseline (-2.5 vs -0.2 mean change, P<.001). Associations between WIWI responses and most patient-reported AEs or treatment efficacy did not reach statistical significance. CONCLUSIONS: Patients who responded affirmatively on WIWI items remained on therapy longer, were less likely to stop treatment because of AEs, and demonstrated superior QOL. The WIWI may inform clinical practice, oncology research, and value frameworks.


Assuntos
Neoplasias , Qualidade de Vida , Humanos , Oncologia , Neoplasias/terapia , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
BMC Health Serv Res ; 22(1): 881, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804359

RESUMO

BACKGROUND: Patient navigation is an evidence-based intervention for reducing delays in oncology care among underserved populations. In order to address the financial sustainability of this intervention, information is needed on the cost of implementing patient navigation in diverse healthcare settings. Because patient navigation programs and care settings are highly variable, this paucity of cost data creates difficulties in identifying best practices and decisions about the feasibility of implementing navigation programs within a health care system. One barrier to collecting these cost data is the lack of assessment tools available to support patient navigation programs. These tools must be relevant to the wide variety of navigation activities that exist in health care settings, and be flexible enough to collect cost data important to stakeholders in fee-for-service and value-based care environments. METHODS AND RESULTS: We present a novel approach and methods for assessing the cost of a patient navigation program implemented across six hospital systems to enhance timely entry and uptake of breast cancer care and treatment. These methods and tools were developed in partnership with breast oncology patient navigators and supervisors using principles of stakeholder engagement, with the goal of increasing usability and feasibility in the field. CONCLUSIONS: This methodology can be used to strengthen cost analysis and assessment tools for other navigation programs for improving care and treatment for patients with chronic conditions. TRIAL REGISTRATION: NCT03514433.


Assuntos
Neoplasias da Mama , Navegação de Pacientes , Neoplasias da Mama/terapia , Custos e Análise de Custo , Feminino , Humanos , Oncologia , Área Carente de Assistência Médica , Navegação de Pacientes/métodos
7.
Artigo em Inglês | MEDLINE | ID: mdl-35805361

RESUMO

Cancer is the leading cause of death in the Northern Territory (NT), Australia's most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT's diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT's Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients' need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.


Assuntos
Serviços de Saúde do Indígena , Neoplasias , Telemedicina , Pessoal de Saúde , Humanos , Oncologia , Neoplasias/terapia , Northern Territory , Cuidados Paliativos
9.
Pathol Oncol Res ; 28: 1610373, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35845921

RESUMO

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/patologia , Consenso , Feminino , Humanos , Hungria , Oncologia , Prognóstico
10.
J Natl Compr Canc Netw ; 20(7): 815-833, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35830886

RESUMO

Soft tissue sarcomas (STS) are rare malignancies of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as retroperitoneal/intra-abdominal STS, desmoid tumors, and rhabdomyosarcoma. This portion of the NCCN Guidelines discusses general principles for the diagnosis and treatment of retroperitoneal/intra-abdominal STS, outlines treatment recommendations, and reviews the evidence to support the guidelines recommendations.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Extremidades/patologia , Humanos , Oncologia , Sarcoma/tratamento farmacológico , Sarcoma/terapia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/terapia
11.
JCO Clin Cancer Inform ; 6: e2200011, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35839431

RESUMO

PURPOSE: Clinical trials of novel and targeted agents increasingly require biomarkers for eligibility. Precision oncology continues to evolve, but challenges hamper broad use of molecular profiling (MP) that could increase the number of patients benefiting from targeted therapy. We implemented an integrated clinical genomics program (CGP), including a virtual Molecular Tumor Board (MTB), and examined its impact on MP use and impact on clinical trial accrual in a multisite regional-based cancer system with an emphasis on effects for isolated clinicians. METHODS: We assessed MP and MTB use from 2010 to 2020 by practice location, physician experience, and patient characteristics. Use of MTB-recommended treatments was assessed. Clinical trial enrollment was evaluated for patients with MP versus MP and MTB review. RESULTS: After CGP implementation, the number of physicians using MP and the number of MP tests increased ≥ 10-fold. The proportion of Hispanic patients with MP was the same as that in the system (both 2%) with marginal differences observed in the proportion of African Americans tested compared with the system population (16% v 19%). Physicians followed MTB treatment recommendations in 74% of cases. Rapid clinical decline was the most common reason why physicians did not follow MTB recommendations. Clinical trial accrual was 15% (669 of 4,459) for patients with MP alone and 28% (94 of 334) with both MP and MTB review. Clinical trial availability and patient out-of-pocket costs affected MP use. CONCLUSION: Integrating CGP into clinical workflow with decision support tools, trial matching, and management of patient costs led to increased use of MP by physicians with all levels of experience, enhanced clinical trial accrual, and has the potential to reduce disparities in MP.


Assuntos
Neoplasias , Ensaios Clínicos como Assunto , Genômica , Humanos , Oncologia , Neoplasias/tratamento farmacológico , Neoplasias/terapia , Medicina de Precisão , Populações Vulneráveis
12.
Am J Manag Care ; 28(7): 314-320, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35852880

RESUMO

OBJECTIVES: To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning. STUDY DESIGN: We conducted a cross-sectional survey of primary care providers (PCPs) and insured patients with cancer. METHODS: We asked PCPs about their method of oncologist referral; utilization of an oncologist selection tool that directs patients to high-quality, high-value oncologists; involvement in cancer care and value-based care; and when an advance directive should be established. We asked patients to reflect upon their personal experience when selecting their oncologist, utilization of an oncologist selection tool, and establishing an advance directive. RESULTS: PCPs tend to refer patients to oncologists who are part of their health system (67.9%). Most PCPs (79.2%) were not currently utilizing an oncologist selection tool; most (77.3%) expressed a willingness to use such a tool. Most PCPs (69.8%) believe the best time to talk about an advance directive is at the time of cancer diagnosis. Patients ranked a PCP referral (52.7%) as "very important" when selecting an oncologist. One-third of patients used a web-based oncologist selection tool; 65.2% responded that an oncologist selection tool would be "somewhat" or "very" important. Most (54.5%) patients had an advance directive. CONCLUSIONS: These results present a compelling rationale for developing a data-driven oncologist selection tool, optimizing patient and provider involvement in care, and expanding the portion of patients who have an advance directive at the start of their cancer care to optimize their cancer journey.


Assuntos
Neoplasias , Oncologistas , Estudos Transversais , Humanos , Oncologia , Neoplasias/terapia , Preferência do Paciente
13.
Transpl Int ; 35: 10640, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35859667

RESUMO

Artificial intelligence (AI) refers to computer algorithms used to complete tasks that usually require human intelligence. Typical examples include complex decision-making and- image or speech analysis. AI application in healthcare is rapidly evolving and it undoubtedly holds an enormous potential for the field of solid organ transplantation. In this review, we provide an overview of AI-based approaches in solid organ transplantation. Particularly, we identified four key areas of transplantation which could be facilitated by AI: organ allocation and donor-recipient pairing, transplant oncology, real-time immunosuppression regimes, and precision transplant pathology. The potential implementations are vast-from improved allocation algorithms, smart donor-recipient matching and dynamic adaptation of immunosuppression to automated analysis of transplant pathology. We are convinced that we are at the beginning of a new digital era in transplantation, and that AI has the potential to improve graft and patient survival. This manuscript provides a glimpse into how AI innovations could shape an exciting future for the transplantation community.


Assuntos
Inteligência Artificial , Transplante de Órgãos , Algoritmos , Previsões , Humanos , Oncologia
14.
JAMA Oncol ; 8(7): 969, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35861744

Assuntos
Oncologia , Humanos
15.
Recenti Prog Med ; 113(7): 451-459, 2022.
Artigo em Italiano | MEDLINE | ID: mdl-35852081

RESUMO

INTRODUCTION: Rare diseases have a high social and health impact. Since 2005, AIFA has been funding independent clinical research. The objective of this paper is to describe data on independent research on rare diseases financed by the Agency. METHODS: With reference to studies financed by AIFA between 2005-2018 the following data have been collected: financial characteristics, study design, therapeutic area, population included, completion status, availability of study results publications, publication characteristics and conclusions. Data have been analyzed in order to provide information on characteristics and scientific productivity of clinical studies on rare diseases. RESULTS: Between 2005 and 2018, AIFA published 9 Calls for Funding of Independent Research and financed 282 clinical studies, 111 (about 40%) of which were on a rare disease and/or a rare tumor for a total of € 43,455,438. Studies were interventistic in 93.6% (mainly phase II or III). The most represented therapeutic area was oncology (19.9%), followed by neurology (17.1%), and onco-hematology (16.2%). 28.8% of clinical studies enrolled fragile population (children, elderly, pregnant women). Fourty eight studies (43.2%) completed according to protocol, 8 (7.2%) completed with reduced sample size, 18 (16.2%) were prematurely terminated, while 37 of them are still ongoing. In the subgroup of 74 closed studies at least a scientific publication is available for 49 of them. A total of 81 papers are available including two publications related to ongoing studies (range 1-8; mean 1.5; median 1). Cumulative Impact Factor is 619.269 (range for single paper 0.17-34.492). DISCUSSION: A good percentage of clinical studies financed by AIFA were on rare diseases and/or rare tumors. Clinical trials were less likely to complete according to protocol than observational ones, in agreement with literature data; on the other hand once completed, clinical trials were more likely to publish research findings. Overall, 66.2% of closed studies has at least one publication; this percentage is higher if we consider the subgroup of clinical trials and if we consider clinical trials completed according to study protocol (95.3%).


Assuntos
Neoplasias , Doenças Raras , Idoso , Criança , Feminino , Humanos , Itália/epidemiologia , Oncologia , Gravidez , Projetos de Pesquisa
16.
Curr Oncol ; 29(7): 4827-4841, 2022 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-35877243

RESUMO

Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels throughout the breast cancer continuum, highlighting the lack of translation from research into practice. In addition, discerning how exercise can be tailored to address breast cancer-related impairments, so that individuals are able to participate safely and effectively, has also not been studied extensively. Thus, we propose that implementing exercise screening, triage, and referral pathways across the breast cancer continuum may allow for increased accessibility and adoption among those living with and beyond breast cancer. This paper provides an overview of exercise prescription tailoring for common breast cancer and treatment-related impairments, proposes a simplified screening tool for identifying physical activity and movement-related impairments, and considers how best to channel evidence into practice via proposed implementation pathways that may better connect individuals living with and beyond breast cancer with exercise oncology resources through screening, triage, and referral.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/terapia , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Oncologia , Encaminhamento e Consulta
17.
Am J Manag Care ; 28(5 Spec No.): SP223-SP290, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35877810

RESUMO

The annual special issue of Evidence-Based Oncology™, a publication of The American Journal of Managed Care® (AJMC), features coverage of the 2022 Annual Meeting of the American Society of Clinical Oncology, held June 3-7, 2022, in Chicago, Illinois. Clinical trials presented during the meeting and summarized in the issue include DESTINY-Breast04, DETERMINATION, SHINE, and ECHELON-1. The issue features coverage from sessions addressing current issues in health policy and cancer care delivery, such as improving diversity in clinical trials and managing financial toxicity. Sections of the special issue include Advancing Health Equity, Breast Cancer, Solid Tumors, Blood Cancers, and Health Policy & Delivery. A final section features clinical findings presented by scientists affiliated with Strategic Alliance Partners of AJMC. Each issue section includes an interview with a key opinion leader participating in the meeting.


Assuntos
Medicina Baseada em Evidências , Neoplasias , Congressos como Assunto , Humanos , Oncologia , Neoplasias/tratamento farmacológico , Sociedades Médicas , Estados Unidos
18.
BMJ ; 378: o1785, 2022 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-35878889
19.
PLoS One ; 17(7): e0270651, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35881586

RESUMO

PURPOSE: The COVID-19 pandemic upended nearly all aspects of daily life and of medical care, placing a double burden of professional and personal concerns on those who provide medical care. We set out to assess the burden of the pandemic on provider outlook and understand how cancer survivorship providers experienced rapid changes to practice. METHODS: We distributed a survey through the American College of Surgeons Commission on Cancer (CoC) to its accredited organizations in mid-October 2020. We included questions on provider characteristics, changes in patient care practices resulting from the pandemic, worry about COVID-19, and concern about impact on cancer survivors. RESULTS: Of the n = 607 participants, three-quarters were female and three-quarters were White. Only 2.1% of participants reported having had COVID-19, but 43% reported anxiety about getting COVID-19 and over a quarter experienced sadness or depression, anxiety about the future, changes to sleep, difficulty concentrating, or social isolation. Approximately half of providers also expressed significant concern about progression of cancer in patients who experienced care delays or were afraid of accessing in-person care. In terms of changes to survivorship care, respondents reported changes to visitor policies, delays or cancellations, and efforts to reduce in-person visits. CONCLUSIONS: COVID-19 has taken a significant toll on front-line healthcare professionals, including oncologists and cancer care allied health professionals. Findings support proactive mental health support of healthcare professionals as well as emergency preparedness to manage delays to care for cancer patients in the event of future unexpected pandemics.


Assuntos
COVID-19 , Neoplasias , Oncologistas , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Oncologia , Neoplasias/epidemiologia , Neoplasias/terapia , Oncologistas/psicologia , Pandemias , SARS-CoV-2
20.
Pathol Oncol Res ; 28: 1610383, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35898593

RESUMO

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified based on the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The professional guideline primarily reflects the resolutions and recommendations of the current ESMO, NCCN and ABC5, as well as that of the St. Gallen Consensus Conference statements. The recommendations cover classical prognostic factors and certain multigene tests, which play an important role in therapeutic decision-making. From a didactic point of view, the text first addresses early and then locally advanced breast cancer, followed by locoregionally recurrent and metastatic breast cancer. Within these, we discuss each group according to the available therapeutic options. At the end of the recommendations, we summarize the criteria for treatment in certain rare clinical situations.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Oncologia
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