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International Journal of Radiation... Jan 2021In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes...
PURPOSE
In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas.
METHODS AND MATERIALS
A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity.
RESULTS
Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm, intact node positive case was 409 cm, and intact node negative case was 342 cm. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached.
CONCLUSIONS
Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.
Topics: Consensus; Humans; Internationality; Lymph Nodes; Male; Oncologists; Organ Size; Pelvis; Prostatic Neoplasms
PubMed: 32861817
DOI: 10.1016/j.ijrobp.2020.08.034 -
ESMO Open Oct 2022Next-generation sequencing (NGS) of tumor cell-derived DNA/RNA to screen for targetable genomic alterations is now widely available and has become part of routine... (Review)
Review
Next-generation sequencing (NGS) of tumor cell-derived DNA/RNA to screen for targetable genomic alterations is now widely available and has become part of routine practice in oncology. NGS testing strategies depend on cancer type, disease stage and the impact of results on treatment selection. The European Society for Medical Oncology (ESMO) has recently published recommendations for the use of NGS in patients with advanced cancer. We complement the ESMO recommendations with a practical review of how oncologists should read and interpret NGS reports. A concise and straightforward NGS report contains details of the tumor sample, the technology used and highlights not only the most important and potentially actionable results, but also other pathogenic alterations detected. Variants of unknown significance should also be listed. Interpretation of NGS reports should be a joint effort between molecular pathologists, tumor biologists and clinicians. Rather than relying and acting on the information provided by the NGS report, oncologists need to obtain a basic level of understanding to read and interpret NGS results. Comprehensive annotated databases are available for clinicians to review the information detailed in the NGS report. Molecular tumor boards do not only stimulate debate and exchange, but may also help to interpret challenging reports and to ensure continuing medical education.
Topics: Humans; High-Throughput Nucleotide Sequencing; Oncologists; Neoplasms; Medical Oncology; RNA
PubMed: 36183443
DOI: 10.1016/j.esmoop.2022.100570 -
CA: a Cancer Journal For Clinicians Sep 2022Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity... (Review)
Review
Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.
Topics: Financial Stress; Humans; Medical Oncology; Neoplasms; Oncologists
PubMed: 35584404
DOI: 10.3322/caac.21730 -
JAMA Oncology Nov 2021Although geriatric assessment-driven intervention improves patient-centered outcomes, its influence on chemotherapy-related toxic effects remains unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Although geriatric assessment-driven intervention improves patient-centered outcomes, its influence on chemotherapy-related toxic effects remains unknown.
OBJECTIVE
To assess whether specific geriatric assessment-driven intervention (GAIN) can reduce chemotherapy-related toxic effects in older adults with cancer.
DESIGN, SETTING, AND PARTICIPANTS
A randomized clinical trial enrolled 613 participants from a National Cancer Institute-designated cancer center between 2015 and 2019. Patients were 65 years and older with a solid malignant neoplasm, were starting a new chemotherapy regimen, and completed a geriatric assessment. Patients were followed up until chemotherapy completion or 6 months after initiation, whichever occurred first. Data analysis was done by intention-to-treat principle.
INTERVENTIONS
Patients were randomized (2:1) to either the GAIN (intervention) or standard of care (SOC) arm. In the GAIN arm, a geriatrics-trained multidisciplinary team composed of an oncologist, nurse practitioner, social worker, physical/occupation therapist, nutritionist, and pharmacist reviewed geriatric assessment results and implemented interventions based on prespecified thresholds built into the geriatric assessment's domains. In the SOC arm, geriatric assessment results were sent to treating oncologists for consideration.
MAIN OUTCOMES AND MEASURES
The primary outcome was incidence of grade 3 or higher chemotherapy-related toxic effects (graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0). Secondary outcomes included advance directive completion, emergency department visits, unplanned hospitalizations, average length of stay, unplanned hospital readmissions, chemotherapy dose modifications, and early discontinuation. Overall survival analysis was performed up to 12 months after chemotherapy initiation.
RESULTS
Among the 605 eligible participants for analysis, median (range) age was 71 (65-91) years, 357 (59.0%) were women, and 432 (71.4%) had stage IV disease. Cancer types included gastrointestinal (202 [33.4%]), breast (136 [22.5%]), lung (97 [16.0%]), genitourinary (91 [15.0%]), gynecologic (54 [8.9%]), and other (25 [4.1%]). Incidence of grade 3 or higher chemotherapy-related toxic effects was 50.5% (95% CI, 45.6% to 55.4%) in the GAIN arm and 60.6% (95% CI, 53.9% to 67.3%) in the SOC arm, resulting in a significant 10.1% reduction (95% CI, -1.5 to -18.2%; P = .02). A significant absolute increase in advance directive completion of 28.4% with GAIN vs 13.3% with SOC (P < .001) was observed. No significant differences were observed in emergency department visits, unplanned hospitalizations, average length of stay, unplanned readmissions, chemotherapy dose modifications or discontinuations, or overall survival.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, integration of multidisciplinary GAIN significantly reduced grade 3 or higher chemotherapy-related toxic effects in older adults with cancer. Implementation of GAIN into oncology clinical practice should be considered among older adults receiving chemotherapy.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02517034.
Topics: Aged; Aged, 80 and over; Female; Geriatric Assessment; Hospitalization; Humans; National Cancer Institute (U.S.); Neoplasms; Oncologists; United States
PubMed: 34591080
DOI: 10.1001/jamaoncol.2021.4158 -
Journal For Immunotherapy of Cancer Jul 2021Expanding the US Food and Drug Administration-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and...
Expanding the US Food and Drug Administration-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and immune-related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1%-12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes development of evidence-based treatments and translational research. The objective of this study was to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. A working group of four neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the multidisciplinary Neuro irAE Disease Definition Panel including oncologists and irAE experts. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND/University of California Los Angeles (UCLA) Appropriateness Method with prespecified definitions. 27 panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for seven core disorders: irMeningitis, irEncephalitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, six descriptors of diagnostic components are used: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation, and presence or absence of concurrent irAE(s). These disease definitions standardize irAE-N classification. Diagnostic certainty is not always directly linked to certainty to treat as an irAE-N (ie, one might treat events in the probable or possible category). Given consensus on accuracy and usability from a representative panel group, we anticipate that the definitions will be used broadly across clinical and research settings.
Topics: Consensus; Drug-Related Side Effects and Adverse Reactions; Humans; Immune Checkpoint Inhibitors; Immunotherapy; Nervous System Diseases; Neurologists; Oncologists; Patient Care Team; Practice Guidelines as Topic
PubMed: 34281989
DOI: 10.1136/jitc-2021-002890 -
Oncology (Williston Park, N.Y.) Nov 2019Burnout is defined as an occupational-related syndrome characterized by physical and emotional exhaustion, cynicism/depersonalization, and low sense of professional... (Review)
Review
Burnout is defined as an occupational-related syndrome characterized by physical and emotional exhaustion, cynicism/depersonalization, and low sense of professional accomplishment. Multiple oncology-specific risk factors are associated with an increased susceptibility for the development of burnout. On a daily basis, oncologists are faced with life and death decisions and grieving much more frequently than are physicians in other specialties. Continuous exposure to fatal illnesses with limited success in curing them, exceedingly long work hours with more administrative time demands, limited autonomy over daily responsibilities, endless electronic documentation requirements, and a shifting medical landscape seem to be making oncologists more vulnerable to suffering from burnout. Evidence suggests that burnout can impact quality of care in a variety of ways and have potentially profound personal implications. In this review, the definition, prevalence, causes, and management of oncologist burnout are analyzed. Steps oncologists can take to promote personal well-being and professional satisfaction are also explored.
Topics: Burnout, Professional; Depression; Hospitals, University; Humans; Medical Oncology; Neoplasms; Oncologists; Quality of Life; Stress, Psychological; Surveys and Questionnaires; Workload
PubMed: 31769864
DOI: No ID Found -
CMAJ : Canadian Medical Association... Jul 2021
Topics: Adult; COVID-19; Child; Humans; Male; Oncologists; Pandemics; Siblings; Social Support; Swimming; Workload
PubMed: 34281976
DOI: 10.1503/cmaj.210514-f -
International Journal of Radiation... Jan 2023The goal of this article is to serve as a primer for the United States-based radiation oncologist who may be interested in learning more about radiopharmaceutical... (Review)
Review
The goal of this article is to serve as a primer for the United States-based radiation oncologist who may be interested in learning more about radiopharmaceutical therapy (RPT). Specifically, we define RPT, review the data behind its current and anticipated indications, and discuss important regulatory considerations for incorporating it into clinical practice. RPT represents an opportunity for radiation oncologists to leverage 2 key areas of expertise, namely therapeutic radiation therapy and oncology, and apply them in a distinct context in collaboration with nuclear medicine and medical oncology colleagues. Although not every radiation oncologist will incorporate RPT into their day-to-day practice, it is important to understand the role for this modality and how it can be appropriately used in select patients.
Topics: Humans; United States; Radiopharmaceuticals; Medical Oncology; Radiation Oncologists; Radionuclide Imaging
PubMed: 35970373
DOI: 10.1016/j.ijrobp.2022.08.010 -
The Oncologist Jul 2022Susan E. Bates reflects on the history of The Oncologist and articulates her vision for the future of the journal as she assumes the role of Editor-in-Chief.
Susan E. Bates reflects on the history of The Oncologist and articulates her vision for the future of the journal as she assumes the role of Editor-in-Chief.
Topics: Humans; Oncologists
PubMed: 35790115
DOI: 10.1093/oncolo/oyac125 -
Journal of Oncology Practice Oct 2019
Review
Topics: Disease Management; Humans; Medical Oncology; Oncologists; Physician's Role; Physician-Patient Relations; Psychotherapy
PubMed: 31483696
DOI: 10.1200/JOP.19.00237