Podcasts about National Comprehensive Cancer Network

What if our obsession with “dangerous” sun is killing us?If you (recklessly) leave your urban office for lunch, you are told to yank your hat down low. If you (again, recklessly) let your kids dash into the backyard, you are told to slather them in sunscreen—or learn to live with the guilt.And yes, sun avoidance undoubtedly prevents some skin cancers, including the deadliest type, melanomaBut a recent study suggests sunlight contributes to hundreds of thousands of deaths every year in the United States alone—orders of magnitude more than the estimated 8400 annual US melanoma deaths.In this episode, we discuss evidence linking sun avoidance toalmost a million annual deaths in the US and Europe alone, exceeding the number caused by global military conflictsbreast, pancreatic, colon, and lung cancers, as well as heart disease, high blood pressure, and stroketo INCREASED risk of death in those diagnosed with sun-induced melanoma.Yes, you read that right; some melanoma deaths may be related to too little sunlight.  (But do understand that this is complex--sunlight DOES cause melanoma. Well, some melanomas....)We also discuss why supplementing with vitamin D pills fails to remedy these terrible conditions, and what a thoughtful person can do instead, while staying safe.We hope you enjoy this episode, and that it helps you enjoy the sun again--thoughtfully, of course. References and further reading:  Sunlight: Time for a Rethink?Benefits of oral Polypodium leucotomas extract in MM high risk patients (This is an ingredient in Life Extension's Shade Factor, mentioned in this episode by Dr. Gordon). Uses of Polypodium leucotomos Extract in Oncodermatology  Calzari et alInsufficient Sun Exposure Has Become a Real Public Health Problem. Alfredsson L, Armstrong BK, Butterfield DA, et al. International Journal of Environmental Research and Public Health. 2020;17(14):E5014. doi:10.3390/ijerph17145014.Prospective Study of Ultraviolet Radiation Exposure and Risk of Cancer in the United States. Lin SW, Wheeler DC, Park Y, et al. International Journal of Cancer. 2012;131(6):E1015-23. doi:10.1002/ijc.27619.An Estimate of Premature Cancer Mortality in the U.S. Due to Inadequate Doses of Solar Ultraviolet-B Radiation. Grant WB. Cancer. 2002;94(6):1867-75. doi:10.1002/cncr.10427.Solar Ultraviolet-B Exposure and Cancer Incidence and Mortality in the United States, 1993-2002. Boscoe FP, Schymura MJ. BMC Cancer. 2006;6:264. doi:10.1186/1471-2407-6-264.Ecological Studies of the UVB-vitamin D-Cancer Hypothesis. Grant WB. Anticancer Research. 2012;32(1):223-36.Sunlight Exposure in Association With Risk of Lymphoid Malignancy: A Meta-Analysis of Observational Studies. Kim HB, Kim JH. Cancer Causes & Control : CCC. 2021;32(5):441-457. doi:10.1007/s10552-021-01404-6.Adulthood Residential Ultraviolet Radiation, Sun Sensitivity, Dietary Vitamin D, and Risk of Lymphoid Malignancies in the California Teachers Study. Chang ET, Canchola AJ, Cockburn M, et al. Blood. 2011;118(6):1591-9. doi:10.1182/blood-2011-02-336065.Is Prevention of Cancer by Sun Exposure More Than Just the Effect of Vitamin D? A Systematic Review of Epidemiological Studies. van der Rhee H, Coebergh JW, de Vries E. European Journal of Cancer (Oxford, England : 1990). 2013;49(6):1422-36. doi:10.1016/j.ejca.2012.11.001.An Ecologic Study of Cancer Mortality Rates in Spain With Respect to Indices of Solar UVB Irradiance and Smoking. Grant WB. International Journal of Cancer. 2007;120(5):1123-8. doi:10.1002/ijc.22386.Does Sunlight Prevent Cancer? A Systematic Review. van der Rhee HJ, de Vries E, Coebergh JW. European Journal of Cancer (Oxford, England : 1990). 2006;42(14):2222-32. doi:10.1016/j.ejca.2006.02.024.Heliovaccination: Solar mediated immunity against cancer. Uzoigwe CE. Experimental Dermatology. 2020;29(5):477-480. doi:10.1111/exd.14087.Beneficial Health Effects of Ultraviolet Radiation: Expert Review and Conference Report. Riedmann U, Dibben C, de Gruijl FR, et al. Photochemical & Photobiological Sciences : Official Journal of the European Photochemistry Association and the European Society for Photobiology. 2025;24(6):867-893. doi:10.1007/s43630-025-00743-6.A Blueprint for the Primary Prevention of Cancer: Targeting Established, Modifiable Risk Factors. Gapstur SM, Drope JM, Jacobs EJ, et al. CA: A Cancer Journal for Clinicians. 2018;68(6):446-470. doi:10.3322/caac.21496.Proportion and Number of Cancer Cases and Deaths Attributable to Potentially Modifiable Risk Factors in the United States, 2019. Islami F, Marlow EC, Thomson B, et al. CA: A Cancer Journal for Clinicians. 2024 Sep-Oct;74(5):405-432. doi:10.3322/caac.21858.Cutaneous Melanoma. Joshi UM, Kashani-Sabet M, Kirkwood JM. JAMA. 2025;334(23):2113-2125. doi:10.1001/jama.2025.13074.Sunlight, Vitamin D and the Prevention of Cancer: A Systematic Review of Epidemiological Studies. van der Rhee H, Coebergh JW, de Vries E. European Journal of Cancer Prevention : The Official Journal of the European Cancer Prevention Organisation (ECP). 2009;18(6):458-75. doi:10.1097/CEJ.0b013e32832f9bb1.Lessons Learned From Paleolithic Models and Evolution for Human Health: A Snap Shot on Beneficial Effects and Risks of Solar Radiation. Reichrath J. Advances in Experimental Medicine and Biology. 2020;1268:3-15. doi:10.1007/978-3-030-46227-7_1.PS-Vitamin D. American Academy of Dermatology (2022).American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity. Kushi LH, Byers T, Doyle C, et al. CA: A Cancer Journal for Clinicians. 2006;56(5):254-81; quiz 313-4. doi:10.3322/canjclin.56.5.254.Vitamin D, Sunlight and Cancer Connection. Holick MF. Anti-Cancer Agents in Medicinal Chemistry. 2013;13(1):70-82.Survivorship. National Comprehensive Cancer Network. Updated 2026-04-08.Keratinocyte Carcinoma. Wehner MR. JAMA. 2025;:2840731. doi:10.1001/jama.2025.18749.Public Awareness and Behaviour in Great Britain in the Context of Sunlight Exposure and Vitamin D: Results From the First Large-Scale and Representative Survey. Burchell K, Rhodes LE, Webb AR. International Journal of Environmental Research and Public Health. 2020;17(18):E6924. doi:10.3390/ijerph17186924.Behavioral Counseling to Prevent Skin Cancer: US Preventive Services Task Force Recommendation Statement. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. JAMA. 2018;319(11):1134-1142. doi:10.1001/jama.2018.1623.Lifetime Sunburn Trajectories and Associated Risks of Cutaneous Melanoma and Squamous Cell Carcinoma Among a Cohort of Norwegian Women. Lergenmuller S, Rueegg CS, Perrier F, et al. JAMA Dermatology. 2022;158(12):1367-1377. doi:10.1001/jamadermatol.2022.4053.Cancer Prevention and Early Detection Facts & Figures. Rick Alteri, Deana Baptiste, Emily Butler Bell, et al. American Cancer Society (2025). Skin Cancer, Irradiation, and Sunspots: The Solar Cycle Effect. Valachovic E, Zurbenko I. BioMed Research International. 2014;2014:538574. doi:10.1155/2014/538574.Intense Solar Activity Reduces UrinarDawn Lemanne, MD Oregon Integrative OncologyLeave no stone unturned.Deborah Gordon, MDNorthwest Wellness and Memory CenterBuilding Healthy Brains

In today's episode, we spoke with David O'Malley, MD. Dr O'Malley is a professor in the Department of Obstetrics and Gynecology at The Ohio State University College of Medicine and the director of the Division of Gynecologic Oncology at The Ohio State University Comprehensive Cancer Center–James in Columbus, Ohio. In our exclusive interview, Dr O'Malley discussed his approach to treatment selection and sequencing in platinum-resistant ovarian cancer, a disease setting he described as representing the highest unmet need in the field. He emphasized the central role of clinical trial enrollment and biomarker-driven decision-making, alongside practical patient-centered considerations, such as infusion schedule and quality of life.He highlighted the growing importance of antibody-drug conjugates (ADCs) in this setting, noting that folate receptor alpha and HER2 are the two biomarkers most relevant to current practice. Dr O'Malley outlined how National Comprehensive Cancer Network guidelines support treatment across a broader range of expression levels than initial approvals reflected, citing emerging data suggesting activity even at lower expression thresholds. He also addressed payload sequencing, explaining that outside of a clinical trial, he currently uses topoisomerase I–based ADCs and antimicrotubule-based ADCs each one time only, and remains open to targeting the same antigen again if the payload differs.The discussion also touched on combination strategies, resistance biology, and the evolving role of immunotherapy following the survival benefit observed with pembrolizumab (Keytruda) in the phase 3 KEYNOTE-B96 trial (NCT05116189). Dr O'Malley expressed enthusiasm for next-generation payloads, dual-target approaches, and the potential for bispecific antibodies and novel DNA damage response–targeting agents to define the post-ADC treatment landscape.Finally, Dr O'Malley underscored the need for more tumor biopsies to better characterize resistance mechanisms and called for expanded pharmaceutical investment in retreatment and cross-resistance studies to guide future sequencing decisions.

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient's goals and values. Hosts and discussants ·      Dr. Betelhem Yohannes, General surgery resident at the University of Washington ·      Dr. Griffen Allen, General surgery resident at the University of Washington  ·      Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington  ·      Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives ·      Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. ·      Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. ·      Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. ·      Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. ·      Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. ·      Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. ·      Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References  Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.  Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Dr. Deb Muth 00:02What if I told you that before a single drop of chemotherapy goes into a cancer patient’s body, we can take a blood sample, grow their actual living cancer cells in a lab, and test 70 different drugs against those cells, all outside the patient’s body, to find out which ones actually work. And what if I told you that the conventional oncology doesn’t routinely use this test? Well, today we’re going to talk about why that matters and we’re going to go through and I’m going to share a story that is very personal to me. It’s about a 38 year old man with a rare complex cancer diagnosis and the precision testing that is helping to keep that cancer from progressing. Stay with me. This is one that is going to change how you think about cancer treatment. Dr. Deb Muth 01:05You guys can put a little ad right in here before we start the next segment here. Hey everybody, welcome back to Let’s Talk Wellness Now. I’m Dr. Deb and today we’re going deep. I mean really deep. It’s some of the most cutting edge cancer testing I have ever seen in clinical practice. Now, normally I don’t talk about cancer. And I would not be sharing this story if it was anyone other than my own family. I do have permission to share and talk about this publicly. So I want to do this. I want to make sure that I share this message. And he is giving his blessing to share this story because we both believe that it can save lives. So his name is Cameron. He’s 38 years old. And he is my son-in-law. And two years ago, he came to me with a small lymph node underneath his arm and a bullseye rash. So of course, being the lime literate person that I am, my first inclination was to say, yeah, this makes sense. You have an enlarged lymph node because you have this bullseye rash. You got bit by the tick. Let’s keep an eye on it. If it doesn’t go away, let me know. So Fast forward a year and a half later, he comes to me and says, mom, what do you think about this? This thing is getting a little bit larger. And I said, yeah, it’s a little larger. Not sure. Let’s keep an eye on it. He wasn’t feeling anything. All his labs looked okay. And then one day he was out chopping wood and he started getting numbness in that arm and he felt it again. And it had exploded in size. And so after some evaluation with my daughter and him, we decided to do a ultrasound. And we thought what was going to come back was a fatty tumor. It felt like one looks like one responded to one. He’s 38 years old. He’s healthy. There’s nothing in our mind that’s ever thinking the result that we’re going to get back. Dr. Deb Muth 03:28Is a possible lymphoma. Needless to say, we were shocked by that ultrasound result. And we go fast forward, we have the biopsy. I requested a total excisional biopsy. I was told by the oncologist that that was old school. They don’t do that that way anymore. And I need to stay out of this. I need to let the experts take care of this because that’s what they do best. And this came from a breast surgeon here in Wisconsin. And so I stepped back for a moment. I let him do his biopsy and what came back was adenocarcinoma of an unknown origin. Had we excised the entire lymph node, we would have had more tissue to work with. I think we could have gotten a better diagnosis. So over the course of the next two and a half, three months, we have some more imaging done. We have some more testing done. They send a pathology out to Mayo Clinic. And what continues to come back is this incongruent test results. If anybody’s ever had this, it’s extremely frustrating. One test shows lymphoma. Now it shows breast cancer. Then the next week it shows estrogen receptor HER2 positive breast cancer. Two weeks later, another test comes back and it says, no, it’s not HER2, it’s triple negative breast cancer. And now it looks like it’s out of the lymph nodes. Now it looks like it’s in the lymph nodes. And we do a PET scan and they can’t find cancer anywhere except in this axilla area. But now we find a lymph node on the right side. So it must have spread.Let’s go ahead and do a biopsy on that. And so they biopsy the right side and the right side comes back with nothing other than tattoo ink. Now, all of this is kind of crazy. I am not a cancer specialist. I want to start by saying that I am not a cancer specialist. What I am sharing today is from a mother-in-law’s perspective, from a medical detective’s perspective, I do know how to do research. I do know how to find answers. And so what I’m going to share with you Dr. Deb Muth 05:54Is totally my opinion and totally my experience. And I’m not telling anybody to do anything different than what their doctors are telling them to do. But I am telling you to ask questions. So I go deep down the rabbit hole and find out that Tattoo Ink can appear like metastatic cancer on a PET scan. And we all know everybody gets tattoos today. They’re all over everyone. And yet we’re not thinking about how this tattoo ink can cause problems for us down the road, not to mention that there are heavy metals in them and it’s a toxin and it’s creating an inflammatory process in your body that your body’s constantly trying to get rid of. So the surgeon says to us, well, yes, that’s normal that that lymph nodes inflamed. It’s normal that there’s tattoo ink in it. The body’s doing what it’s supposed to do. It’s trying to get rid of a toxin. Okay. I will agree with that, but My son-in-law is covered with tattoos everywhere. And why didn’t we mention the tattoo ink that was found in the left axilla? We are only mentioning it in the right axilla. So there’s a lot of controversy, a lot of confusion. Many of you would never know any of this because A, you either don’t look at your lab results. And if you do, you don’t understand what you’re looking at. And that creates a problem for us, right? You don’t know what questions to ask. So we go into the doctor and the doctor tells us you have cancer and we’re going to swoop you in. And in the next two weeks, you’re going to be doing chemotherapy and radiation. And six months from now, we’re going to be doing surgery and there’s no time for questions and you’re scared shitless and you’re just doing what you can to survive. And I get that. And I totally understand that. And I appreciate that. But I’m telling you that If that is your choice, that is your choice. But as you’re doing that, take the time to ask the right questions. When this happened to us, there was a lot of challenging things with the oncology team. Nobody bothered to allow them to be a partner in their care. They dictated their care, but didn’t allow them to be a partner. So, Dr. Deb Muth 08:17Here’s what most oncologists do when patients get a cancer diagnosis. They look at the tumor type, they look at the stage, they look up the NCC guidelines, the National Comprehensive Cancer Network, and they follow the algorithm. Now, I have an enormous respect for conventional oncology. I really do. Working with cancer is probably one of the hardest things in medicine that anyone can do. The advances in this field over the last 10 years have been remarkable. But here’s my issue. Standard treatment assumes your cancer is the same as the cancer in the clinical trial that created the guidelines. It’s assuming that you and your cancer are the exact same as everyone else. You are the unique fingerprint, not the cancer. And this is the problem because your cancer is unique, just as unique as if you had your fingerprint taken, the mutations driving your tumor, the drugs your cancer cells are sensitive to, the metabolic vulnerabilities of your cancer. These are all different from the person sitting next to you in the chemo suite that has the same triple negative breast cancer or HER2 positive breast cancer or prostate cancer or colon cancer that you have. So what do do about that? Well, in my world, in the integrative medicine world, we test precisely, intelligently with the tools that most oncologists have never heard of. Or if they have, they haven’t incorporated it into their treatment modality for a variety of reasons. Either it’s not acceptable by the organization that they work for, they don’t understand it, They’re not going to be able to change their protocol anyway because they have to follow the NCCN protocol. So they don’t do it or they use a portion of it and they don’t do anything outside the protocol. So today I want to cover three things with you, three tools that we used that I think every cancer patient should be asking for when they start treatment or wherever you are in treatment at this point. Dr. Deb Muth 10:44you need to have these tests done. I don’t have any affiliation with any of these companies. I don’t get paid to tell you any of this. So let me just start by saying that I understand the chemistry behind these and how important it is to give you precision cancer treatment. And that’s why I’m talking about them today. The first one we’re going to talk about is the North Star response. This is your cancer surveillance score in the blood. How much cancer is circulating in the blood. The North Star Select, your cancer’s genomic blueprint from a blood draw. And the Datar Cancer Genetic Chemoscale, the live cell drug sensitivity test that tells us which drugs actually kill your cancer. So let’s go. Let’s dive into this. Let me just take a drink here. I’m going to cough a little bit. I apologize. I have this horrible tickle. It just never seems to go away, but that is not for today to discuss. So what is all of this? OK, the North Star response is a test that was developed by a company called Billion to One. And yes, that name is intentional because of the precision involved. It’s a next generation sequencing test, meaning it reads DNA at an incredibly detailed level. And it looks at something called methylated circulating tumor DNA or methylated CT DNA. Now let me break this down in plain English for you, because this can get a little overwhelming. When the cancer cells die or shed, they release tiny fragments of DNA into your bloodstream. We call this cell-free DNA or CFDNA, and it’s hidden within that cell-free DNA. And there are fragments that come from tumor cells. We call those CT DNA or circulating tumor DNA. Here’s what makes North Star’s response different. Rather than just looking for mutations in that tumor DNA, which is what most liquid biopsies do, and a liquid biopsy is just a blood test, Dr. Deb Muth 13:03This test looks at something called methylation patterns. Think of methylation like a dimmer switch on a gene. In healthy cells, certain genes are switched on and off in a very predictable way. In cancer cells, those dimmer switches go haywire. And cancer DNA has a characteristic hypermethylation, meaning switches are turning on and should be off or off and they should be on. And these patterns are essentially a cancer fingerprint in the blood. Now the North Star response scans more than 2000 locations in the genome for these cancer specific methylation patterns. And then it adds them all up into a single number called the tumor methylation score or TMS. So for Cameron, Cameron’s blood which was drawn on April 20th, 2026, his baseline tumor methylation score came back at 13. Now here’s the critical thing, to understand this was his baseline test, his starting point. And the real power of this test is in serial monitoring, meaning we run it again and again and again over time. And if that number goes up, the cancer activity is likely increasing. If it goes down, we’re likely suppressing the tumor activity. And if it stays flat or falls, that’s telling us that the disease is responding. So this is now in the blood. We have an actual fingerprint and every test from here forward will be compared to this number. Now let’s talk a little bit about this because I was not familiar with this test at all. I wasn’t sure what to expect. I wasn’t sure what to do with it. I did not order this test. He’s working with Inveda Medical and they are fabulous over there. I will tell you that from the beginning. This is coming from a practitioner and from a mother-in-law. They were absolutely wonderful to us. So when I saw this North Star, I didn’t know, should it be zero? Should it be a hundred? And when I talked to the doctor, he said, Dr. Deb Muth 15:29This number is actually really good. An average person walking around who’s never been diagnosed with cancer, who doesn’t have cancer, their number will be between 75 and 100. Cameron’s was 13. I think that’s fantastic. But what was the first question that went through my head? It’s probably the same question that you guys are doing. How can he have cancer with a number of 13 when it’s less than the normal average? And if we’re supposed to use this to track what’s happening with his cancer, how are we going to do that once we remove the cancer? Is this number going to go to zero? And it could possibly do that. And we may not be able to use this to track whether or not the disease is actually gone. But what we can do is use this to track over the course of his lifetime to see if the cancer cells are coming back long before we detect them on imaging. And that’s the huge part of this.So this is not a test that just anybody should go out and get because you’re worried about cancer. It is a test that should be done in somebody that is already diagnosed with cancer. So let’s start by making sure we explain that, okay? So imagine if every time your cancer cells are active and they’re shedding and they’re multiplying and they’re fighting back, they’re leaving a signature in your blood not just any signature, but a specific chemical tag that says, cancer’s here. That’s what the North Star Response Test reads. Those tags across thousands of locations and gives us a single score. So we track that score over time like a thermometer for your tumor. If it goes up, we get concerned. If it stays stable or goes down, we celebrate. And we can catch a change in the blood often months before it will show up on a scan. Pretty important when we’re talking about surveilling somebody for cancer returning, when we’re worried about it, and everybody knows the cancer patient is always worried after they get that clean bill health that something’s gonna come back, and most of the time they’re told that there is no way for them to determine that or know that from a blood test. And here is the blood test that can tell us, yes, it can. Dr. Deb Muth 17:51So I would really encourage you guys to talk to your oncologist about this. If you can’t find an oncologist that will do this, talk to an integrative cancer doctor. They will most likely be familiar with it. If not, ask them to find it for you and order it for you. So next, let’s talk about that genetic blueprint because North Star Select is a different test also by billion to one run on the same blood draw, but this one is doing something completely different. This is a comprehensive genomic liquid biopsy. Liquid biopsy just means blood tusks, meaning it’s looking for specific mutations in 84 cancer related genes, all from a blood sample, no biopsy needle, no surgery, just a blood draw. It looks for CNVS, single nucleotide variants, tiny one-letter typos in the DNA code. It looks for indels, small insertions or deletions in the DNA. It looks for copy number changes, the sections of the genomes that are duplicated or deleted. It looks at fusions. So when two genes incorrectly link together to create a dangerous hybrid, MSI status, micro satellite instability, which tells us whether immunotherapy is likely to work. And it has extraordinary sensitivity. It can detect a mutation that represents as little as 0.15 % of cell free DNA in the bloodstream. That is an almost impossibly small signal in the ocean of genetic noise. So what did this show for Cameron? This is where Cameron’s case gets clinically fascinating and where it tells the story of how his cancer is being held in check. Two major mutations were identified as actionable. One was called CRAS G12C. Dr. Deb Muth 20:11And it’s a variant-ELI fraction at 0.1%. Now, CRAS, if you’ve spent any time in integrative oncology, you’ve heard this name. CRAS is one of the most well-known oncogenes in cancer biology. Think of it like an accelerator pedal in the car. In a healthy cell, CRAS pushes the cell to grow when it receives the signal to do so. And then it stops. In cancer, crass gets stuck in the go position, like on the accelerator, foot on the accelerator, to the floor, going as fast as you can around that track, right? But it’s stuck there permanently. It doesn’t turn off and it’s supposed to be turning off. The G12C variant specifically is a mutation at a very precise location. Position 12 of the CRAS protein, where a glycine is replaced by cysteine. And this matters because CRAS G12C is now a drugable target. There are FDA approved drugs specifically designed to lock this mutation into its inactive state, essentially putting a foot on the brake. Now those are drugs like, and I’m gonna slaughter these names, Sordisib, a brand name is Lumacras, and Atacras, the brand name is Crastol. Neither is yet FDA approved for breast cancer, but they are approved for lung and colorectal cancer with CrasG2C. And Cameron’s tests identified 10 active clinical trials within a region that he could potentially qualify for with this mutation. The fact that his CRAS G12C is circulating at only 0.1%. That is a very low fraction. We call that a VAF, V-A-F, very low fraction. And it tells us something important. It means that this mutation is present in a small subclone of the tumor. It’s not the overall tumor burden. So either way, when we identify, we know it’s there. Dr. Deb Muth 22:37We can catch it and we can watch it. Now, here’s another interesting thing that we saw. His TP53 was at 0.23%. This is a tumor suppressor gene, the guardian of genome. And this gene is responsible for telling damaged cells to either repair themselves or self-destruct. And when it mutates as it is here in the position R196Q, that guardian goes off duty. The cell no longer has a reliable mechanism to prevent uncontrolled growth. So TP53 mutations are present in roughly 50 % of all human cancers. And there’s currently no FDA approved drug directly targeting the TP53 but there are clinical implications. TP53 mutant tumors may respond differently to chemotherapy and several investigational approaches, including TP53 vaccines and aurora kinase inhibitors are under active investigation. So we are seeing things happen in this part of cancer right now. Now there’s something called the VUS list and we are watching This is what we’re watching. beyond those two actionable mutations, NORSTAR Select identified what we call variants of an unknown significance, VUS, adenocarcinoma of an unknown significance, ACUP. These are mutations where we don’t yet have enough clinical evidence to determine whether they’re driving cancer or not, but we watch them. So on our mutation list was CDH1, a gene linked to hereditary gastric and lobular breast cancer, CDKN2A, a tumor suppressor cell cycle regulator, CDK12, involved in DNA repair, EGFR, ERBB, this is HER2 receptor, tyrosine kinases. Dr. Deb Muth 24:55I thought this one was pretty interesting since he had an IHC that showed a three plus HER2, but then when we confirmed it with FISH, FISH showed that was negative, but now we’re actually seeing genes expressing this HER2. So is there a HER2? Is there not a HER2? This is really important because if we don’t get these diagnoses right in cancer the first time, people will spend months and years treating the wrong type of cancer with the wrong type of medication. And this may be in part why some people do better than others. If we get it right out of the gate, they do good. If we don’t get it right out of the gate, they don’t do so good. Very important to have the actual genetic makeup of the tumor that’s growing in somebody. Now last, we have something called Notch C1, NRAS and RAF1. These are key pathway components. Now all of these were at very low baffs under 0.5%. These are just whispers, not shouts, but whispers that this cancer is excreting, but your body is listening. We have to be listening. We have to be able to watch these things and monitor these. Now here’s another note of clinical interest. It was an androgen receptor positive cancer. So also detected as a VUS.We know from tissue pathology that Cameron’s tumor was androgen receptor positive. So seeing this in circulation confirms that this AR expression of the cells are present in the bloodstream and that an anti-androgen approach remains worth considering. What that means is suppressing the testosterone. What all of you know I’m about ready to say is that I hate ever suppressing hormones, especially in a 38 year old male. That is not necessarily a good thing. So before we go suppressing hormones willy-nilly, we have to know that it’s the right thing to do. And we have to be able to combat all of the complications that are going to result of that. A 38-year-old male with no testosterone could lead to heart disease down the road, could lead to bone loss, could lead to dementia, Alzheimer’s. Not to mention the sexual side effects that are going to be present. And in a man that is very, very Dr. Deb Muth 27:20Difficult for someone to manage. So you have to be very specific and you want to be very, very diligent about what you’re doing in these cases like this. Now the MSI status was not detected. This tells us that cancer is not a microsatellite instability high, meaning that standard monotherapy may have a lower baseline response of probability and the strategic integration that we’re working with with in Vita could create an immunogenesis genicity becomes even more critical. So immunotherapy is going to be very critical in a cancer case like this and working with somebody that understands that and can carefully navigate that, especially if you have an autoimmune disease like Hashimoto’s or lupus, this is all very, very pristine and has to be looked at very carefully and done very diligently in order for somebody to do this without overstimulating that immune system and causing more problems. So when we looked at the blood and found this DNA fingerprint of the cancer cells circulating in the body, from that, what we see exactly is the genetic switches that are stuck on. They’re stuck on in the wrong position. This tells us which drugs were designed to fix exactly that problem. And it opens the door to clinical trials built for these specific mutations. It also gives us a list of things to watch for over time. And if one of those tiny little signals starts to grow, we know that cancer is gaining a ground in that area. And if it shrinks or disappears, we know we’re winning. This is like, I cannot tell you how exciting this is in the cancer world and the medical world because this is really pristine cancer therapy that we’re dealing with here. And to be able to have this is just so important to life saving events in treating cancer. So. Dr. Deb Muth 29:41Let’s talk about something called the Dittar Chemoscale. This is the battle before the battle. Okay, so I’ve saved the most remarkable test for last, and this is one from a company called Dittar Cancer Genetics. They’re based out of the UK. They are CAP and CLIA certified, which means it meets the rigorous standards required for clinical laboratory testing in the US. And this test is called the ChemoScale. And it is a live cell chemosensitivity assay. So let me explain exactly what that means because it sounds complex, but the concept is actually quite elegant. When we drew the blood from Cameron, the Dittar’s laboratory isolated what are called circulating tumor associated cells or CTACs. And these are actually living cancer cells and they’re associated cells that are traveling through his bloodstream. Excuse me. So let’s think about that for a moment. Real live cancer cells isolated from a blood draw. Those living cancer cells were placed into a lab environment and exposed to over 70 different drugs, both conventional chemotherapy agents and what we call repurposed drugs. I’ll talk more about those in a minute. The lab then measured how many of those cancer cells were killed by each drug expressed as a percentage of cell death. So the scale runs from zero to a hundred and below 25%, that drug doesn’t work well against any type of cancer in that person. Might work great in somebody else, but in that particular person’s cancer that they have, it’s not gonna work so great. Anything that’s 25 to 50 % is intermediate and above 50 % is a high response. And that’s really where Dr. Deb Muth 31:43we want to be. We want to see anything higher than 50 % because that’s a great medication that can be used to kill the cancer. This is not a theoretical test. This is not based on tumor’s genetic sequence and the computer algorithm that predicts the drug response. This is a HIS actual tumor cell being killed or not being killed in real time. That is the difference. So in traditional chemotherapy, we have our protocols. If you have triple negative breast cancer, if you have HER2 positive breast cancer, if you have prostate cancer, if you have colon cancer, here’s the protocol that you’re going to use because that’s the type of cancer you have. That’s what’s been studied. Now, the problem is most of these cancers have mutated over time, especially depending on how long they’ve been in your body, because that’s what they do to try to survive. They have to change so they can survive because your immune system’s constantly trying to kill them. And so this is a really important thing. And if we don’t take an individual into response or into our thought process when we’re creating these protocols, we may give a drug that doesn’t work at all towards that cancer and you just wasted seven cycles of chemotherapy with a drug that never would have worked in the first place or had such low resistance to it that it’s now just created side effects for you but did nothing to the cancer. And then we pull out another drug and we try that. And then we pull out another drug and we try that. Instead of us knowing precisely what we can use and what we can do. And this goes for both the conventional world and the alternative world. In the alternative world of cancer, we use things like IV vitamin C and tumeric and lately ivermectin and fenbendazole and mendendazole and all kinds of other things. And if we are not truly aware that this is going to do anything, we could be wasting somebody’s time and money. So I love that this test is available. I want to walk you through a little bit about what Dr. Deb Muth 34:01we are what we saw in our case, because I think this can make a big impact on people to ask the right questions. So this particular blood test looked at several different drugs. Cameron had sensitivity from 44 % up to 61 % on different medications. Now he was really lucky. The three main drugs that they would use to treat his cancer he had greater than a 50 % response to. So that was great. However, the drugs that were recommended for him to use out of the gate had less than 50 % activity. So he would have had one drug that was really good, one drug that was not so good. And we don’t know what the outcome would have been, right? So I think this is such an incredible, incredible test to have done. This is critical friends. I’m telling you if his oncologist had chosen the two drugs based on the general guidelines for his tumor, his cells would have largely not survived. But because we ran this test, we know. So we know to avoid the drugs that won’t work and we focus on the firepower where it really counts. So I want to also talk about this repurposed drug result because this is where it gets integrated for us. Now, this section is what I want everyone in our community, our Let’s Talk Wellness community, our members to understand. This is where conventional medicine and integrative medicine intersect in a peer-reviewed clinical validated way. So the Dittar test looks at live cancer cells against what they call repurposed drugs, meaning pharmaceuticals and natural compounds that were developed for the purposes, for other purposes, like it could be an antibiotic, it could be an herbal medicine, it could be all kinds of things, vitamins, whatever. But they have demonstrated anti-cancer activity in research. And when we’re talking about integrative medicine, this is a lot of where we get Dr. Deb Muth 36:26The integrative protocols from because these particular drug compounds are known for having anti-cancer benefits. And so that’s how integrative protocols get developed. But again, it could be just like medication, like cancer drugs. If your body doesn’t have a susceptibility to it, then you’re using a product that’s not necessarily going to work. And we all know we cannot take everything that somebody recommends just simply because it has an anti-benefit to whatever it is we’re treating. There’s only so many supplements you can take. There’s only so many things you can do before you get burnt out on taking it. We call it supplement fatigue. And so we want to be very precise with what we’re doing and target this very specific area. So one of the things that showed up really, really well for our case was artemisium, sweet wormwood. It’s an anti-malarial drug that has very potent anti-cancer effects. Now I found this extremely interesting in Cameron’s case because he does have a positive tick-borne illness called Babesia. And this is one of the things that we use to treat Babesia. The other thing I think is very interesting in this case is we are studying how parasites affect cancer these days. And that’s how Ivermectin, Fenbendazole, and Menbendazole have all gotten thrown into the treatment of cancer. And so for this drug or this herb to be sensitive to this type of cancer is really intriguing to me in the world of parasites and how parasites are truly decreasing the body’s immune system and causing cancer to grow. Another thing that worked, showed up really well for him was Valprolac acid. It’s an anti-seizure drug with HDAC inhibitor properties, and this disrupts cancer cell gene expression. There was a soy formula that showed up really well. Naltrexone, you guys have heard me talk about low dose naltrexone, LDN. This actually stimulates an endogenous opioid immune response feeling, and this drug actually showed up really well. Dr. Deb Muth 38:49Something as simple as quercetin. It’s an anti-inflammatory. This is a crass inhibitor in some studies. So this is really important. I’m sure most of you have heard about the benefits of green tea and green tea also actually has anti-angiogenic or anti-cancer benefits to it. Hydroxychloroquine, very popular drug. It’s another anti-malarial drug. So again, now we have two anti-malarial drugs that are susceptible to this type of cancer. And on top of it, he has a positive babesia test. So just saying, you got to connect the dots sometimes. You got to think outside the box sometimes. Metformin is very well known as a anti-proliferative in cancer. We use it to suppress the sugar because sugar feeds cancer. Nobody should be eating sugar if they have cancer. So this one showed up as well. And then CBD, we all know of the benefits of THC, the Rick Simpson oil, and CBD can be tested to see if that is beneficial to a particular cancer cell. This is different than THC. THC works very differently in cancer. CBD is your healthy component of it. It’s the part of the marijuana plant that does not make you high. So very important here. So now let me be very clear, because I always try to be very clear. This is not FDA approved. I’m going to repeat that. This is not FDA approved. This test is a laboratory developed test, not FDA cleared. These results represent in vitro testing, meaning in a lab, not inside the human body. And the results can differ in what we call in vivo, inside the body. And this is why I always say work with a qualified clinician who can interpret these results in full clinical context. But here’s why this matters. We now have evidence, live evidence of a cancer cell that shows sensitivities to compounds that are accessible, relatively safe, and some of which he may already be using, which some of them we were. Dr. Deb Muth 41:13We were already using some of them, which made us sit back and say, this cancer has been in there for two years. If it’s a triple negative breast cancer, it’s supposed to be an aggressive breast cancer that should have spread to a different organ already after two years. It is not, it has stayed in one spot. Also interesting in this case is that there is no breast tumor that they could find anywhere. This was all confined to the axilla into the lymph node. So to have this growing for this period of time with such a small tumor marker number, that 13 that we talked about in the North Star test originally, and to see some mutations, there’s a lot of questions to this particular case. And there are lots of questions to everybody’s cancer case. They are not all straightforward cancer cases. So this is what’s important to understand this fingerprint of these cancer cells so that you can identify exactly, exactly what’s going on and treat it exactly the correct way. Super important. So this kind of information gives us the direction in an integrative protocol. It’s not guessing. This is not eat more tumor, I can hope for the best. This is personalized tumor specific precision guided integrative oncology. It is very precise. There are several countries, several clinics like this around the country that offer this type of therapy. If it’s something that you’re interested in doing, I would encourage you to look at in Vita Medical. Hope for Cancer is another great facility. There are several great facilities around the country. Like I said, that could put together an integrative approach for you if this is something that you are thinking about doing. If you’re looking for answers, if you’re in stage four or stage three and you are not getting the results that you want to get, you want to look at a different approach. You want to do a combo approach of integrative medicine and traditional medicine and alternative medicine. Dr. Deb Muth 43:37I think this is so important to look at and have experts on your team. You know, in our case, Cameron’s cancer is very complex. It’s genomically aggressive in its presentation, yet it’s not progressing to distant areas, which is so wonderful. And I want to be careful here. I can’t tell you with certainty that this is any one thing. Biology is complex. Cancer is adaptive. It’s trying to survive. That’s what it is supposed to do. It is changing its shape. It’s changing its genetic structure. It’s changing everything to try to survive and try to hide against your immune system. Now we are not even close to the finish line in our journey, but what I can tell you is that what the integrative precision approach has done that standard care alone might not do. I can tell you that today and I will share our journey along the way for any of you that are going through this that want to look at a different approach as well because I think it’s important to have this information. So first of all, we know the tumor’s fingerprint. North Star response gives us that TMS score. so we can track it over time. And if the cancer tries to gain ground, we’ll see it in the blood before a scan, we’ll show it. We know the cancer’s genetic vulnerability. We know how to handle the DNA now. We know the watch list of things to look for. And when those signals start to grow, we have a roadmap of how to address it next, how to change it. We know which drugs will automatically work against the tumor cells. We’re not guessing based on a tumor type. We tested the cells. We know how many drugs in the commercial world and in the repurposed world will and will not work. And this is going to guide the treatment protocol that we walk forward with. So we’re not giving him drugs that won’t work or have a low response. Dr. Deb Muth 45:55We’re avoiding them completely and that matters because every ineffective drug is a dose of toxicity with no benefit. There is no lie to this. Chemotherapeutic drugs are toxic. That’s how they kill the cells, but they kill the good cells and the bad cells. And if we can avoid using a drug that’s not going to work, that is so important. And then we’re layering in those repurposed and natural compounds with proven activity against specific cells. This is not complementary fluff. This is biologically active tumor tested precision medicine. Very, very important. So here is what I need you all to know and what I want you to walk away with today. If you or someone you love is facing a cancer diagnosis before treatment starts, before the first infusion goes in, I want you to ask these questions so quick. Go grab something to write with. Pause this if you need to, because this is really, really important for you to do that. And we’re going to take a break for just a second while you guys go and do that. We’re going to give you a word from our sponsor, and then we’re going to come back. And I’m going to give you the four questions that I want you to ask specifically of your medical team so that you have the answers and the ammunition that you need to work with. So we’ll be right back. Dr. Deb Muth 47:29All right, everybody, welcome back. I hope you got your pencil, your paper, your pen, your phone, whatever you’re going to take notes with because this is important. So I’m to give you four questions that I want you to ask your medical team before you get started. Question one, can we do a chemo sensitivity test before we choose a chemotherapy regime? Ask specifically about DATAR, D-A-T-A-R. cancer genetics, Oncostat Plus, or a similar functional chemosensitivity platform. Very, very important to ask those specific things. All right, question two. Can we do a comprehensive liquid biopsy to identify actionable mutations and monitor tumor burden? Ask about North Star Select, Billion to One, Guardian 360, or Foundation One Liquid CDX? I’m gonna say those for you one more time, because I said them kind of fast. North Star Select by Billion to One, Guardian 360 or Foundation One Liquid CDX? Okay, question three. Can we establish a baseline tumor methylation score, TMS, so we have a surveillance marker to track over time? and ask specifically about the North Star Response Test. All right, question four. Is there an integrative oncology center that can layer precision guided natural compounds alongside conventional treatment? Research institutes like Inveda Medical Center, CTA CA Integrative Medicine, or Hope for Cancer, these people are doing integrative medical miracles. Let me tell you, I have researched every one of them. I have spoken to each of them individually before we made our decision of who we were going to work with. They are all fantastic. You want to work with an integrative nurse practitioner who understands oncology. And if you’re working with an integrative practitioner, you want to ask them these same questions about this test so that you can get the best outcome. Dr. Deb Muth 49:56For what you’re dealing with. You are allowed to ask these questions. You are allowed to want more information from that protocol that was designed for the average patient. You’re not average and your cancer is not average either. And your care doesn’t have to be. You do not have to settle for the same thing that the person sitting next to you in the IV suite is dealing with when you both have different cancers excreting different genetic material. This is so incredibly important. want to make sure you understand precision medicine is what changes the lives for people every single day, every single day. So I started this episode by telling you about a 38 year old man with a cancer that baffled conventional medicine and integrative medicine, an occult primary that was not found complex genetic genomic profile, a presentation that in many hands might have resulted in a one size fits all treatment protocol and a prayer. And instead we ran the tests, we mapped the fingerprint, we watched the cells, we guided the protocol, and we are still fighting with precision, with data, with intelligence. This is what Let’s Talk Wellness is all about not giving up. This is what not accepting we don’t know as a final answer and demanding the level of scrutiny and personalization that every cancer patient deserves. So if this episode resonates with you, please share it because somewhere out there, there is a person who is about to get the wrong chemotherapy because no one ran the right test. And maybe, just maybe, that This episode will be the reason someone asks the right question at the right moment. If you’re going through something like this, you need a group, you need somebody to connect with, please join our free Facebook group called Seen At Last. It is where we support one another, we share this information, we share knowledge, and we help people for free support and ask the right questions. Dr. Deb Muth 52:23And if you’re inclined in your heart to pray, pray for Cameron, we could use every ounce of prayer. If you are in a position where you can help support this journey financially, we do have a fund going in free funder. I can post the link below. Every little bit helps. If you have $5, $500, it doesn’t matter. We’re raising money for this treatment. And along the way, I am documenting every step of what we’re going through so I can provide more episodes like this for you guys to share the outcome and share what our journey is like so that it can help the next person along. I really always believe that whatever happens to us happens to us because we’re meant to share it. That’s why I’ve shared my personal journey. I’m sharing his personal journey and we want to help other people. So until next time, I’m Dr. Deb. Keep asking questions, keep advocating, and never ever accept being unseen.The post Episode 274 – Stop Guessing on Chemotherapy: The Live Cell Test Most Doctors Miss first appeared on Let's Talk Wellness Now.

Join the Behind the Knife Surgical Oncology Team as we discuss clinical challenges through case-based examples including the diagnosis, workup, and management of patients with cutaneous melanoma. Learning Objectives:In this episode, we review the workup and management of patients with cutaneous melanoma and both microscopic and macroscopic nodal disease. References used in the making of this episode: Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2 Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210   https://pubmed.ncbi.nlm.nih.gov/28591523/ National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cutaneous Melanoma. Version 1.2026. Accessed April 8, 2026. NCCN Guidelines PDF   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In today's episode, we spoke with Jacob Sands, MD. Dr Sands is the associate chief of the Lowe Center for Thoracic Oncology, Oncology Medical Director of the International Patient Center, and physician at Dana-Farber Cancer Institute, as well as an assistant professor at Harvard Medical School in Boston, Massachusetts. In our exclusive interview, Dr Sands discussed the rapidly evolving treatment landscape for small cell lung cancer (SCLC), emphasizing both the progress made with immunotherapy and the ongoing challenges associated with this aggressive disease. He noted that outcomes now vary widely, with some patients experiencing long-term durable disease control following checkpoint inhibitor therapy, while others continue to have limited benefit from currently available treatments.A major focus of the discussion centered on tarlatamab-dlle (Imdelltra), the DLL3-targeting bispecific T-cell engager approved for relapsed SCLC. Sands described tarlatamab as a “new paradigm” therapy, highlighting results from the phase 3 DeLLphi-304 trial (NCT05740566) showing superiority in progression-free survival, overall survival, symptom improvement, and toxicity outcomes vs chemotherapy in the second-line setting. He also reviewed the evolution of DLL3 as a therapeutic target, explaining how earlier efforts with rovalpituzumab tesirine (Rova-T) helped establish the foundation for newer, more effective DLL3-directed approaches. The conversation also explored the growing role of molecular subtyping in SCLC, including emerging data involving ASCL1, NEUROD1, and POU2F3 transcription factor subsets. Although Sands cautioned that these findings remain investigational, he noted that subtype-driven treatment selection may eventually help personalize therapy in SCLC.Sands also addressed real-world experience with tarlatamab, including higher observed rates of cytokine release syndrome and neurologic toxicities among patients who would not have qualified for clinical trials. Despite these risks, he emphasized that many heavily pretreated patients with poor performance status or brain metastases have still achieved meaningful and durable clinical benefit.Finally, the discussion covered recent updates to National Comprehensive Cancer Network guidelines, including the establishment of tarlatamab as a preferred second-line standard of care regardless of chemotherapy-free interval. Looking ahead, Sands highlighted the growing pipeline of investigational therapies in SCLC, including CAR T-cell therapies, antibody-drug conjugates, radioligand therapies, and additional T-cell engagers, stressing the importance of clinical trial referral and collaboration between academic and community oncology centers.

Dr Kruse discussed the evolving role of FES-PET/CT in breast cancer, particularly invasive lobular carcinoma. She explained that FES-PET/CT uses a radiotracer to map estrogen receptor–positive cancer sites, offering advantages over traditional imaging. FIndings from a study presented at the 2025 San Antonio Breast Cancer Symposium showed that many patients experienced treatment changes based on FES-PET/CT results. The National Comprehensive Cancer Network guidelines also now recommend FES-PET/CT for use in lobular breast cancer, enhancing its clinical utility. Dr Kruse concluded by emphasizing that future research is needed to explore its use in early-stage breast cancer and for monitoring endocrine therapy response.

"Because the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That's one of our biggest questions that we ask, usually every consult that we're seeing with solid tumor. 'Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?' And then also patients who have undergone organ transplants. Now, interestingly, this does include stem cell transplants," Kelsey Finch, PharmD, BCOP, oncology pharmacist practitioner at Columbus Regional Health in Indiana, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about checkpoint inhibitors. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 20, 2027. Kelsey Finch has disclosed a speakers bureau relationship with AstraZeneca. This financial relationship has been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to checkpoint inhibitors in the treatment of cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Pharmacology 101 series Episode 273: Updates in Chemotherapy and Immunotherapy Episode 174: Administer Pembrolizumab Immunotherapy With Confidence Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment ONS Voice articles: Here's Why Oncology Nurses Are Pivotal in Managing Immune-Related Adverse Events Make Subcutaneous Administration More Comfortable for Your Patients Nursing Considerations for ICI-Related Myocarditis Oncology Nurses Navigate the Changing Landscape of Immuno-Oncology Postdischarge ICI Patient Education Eliminates Hospital Readmissions Shorter Administration Times Still Require High-Acuity Care ONS Voice oncology drug reference sheets: Dostarlimab-Gxly Nivolumab and Hyaluronidase-Nvhy Nivolumab and Relatlimab-Rmbw Pembrolizumab and Berahyaluronidase Alfa-Pmph Retifanlimab-Dlwr Toripalimab-Tpzi ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Cancer Immunotherapy (second edition) ONS course: ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing articles: Immune Checkpoint Inhibitor–Related Myocarditis: Recognition, Surveillance, and Management Immune Checkpoint Inhibitor Therapy: Key Principles When Educating Patients Triple M Syndrome: Implications for Hematology-Oncology Advanced Practice Providers ONS Huddle Cards: Checkpoint Inhibitors Immunotherapy ONS Learning Libraries: Genomics and Precision Oncology Learning Library Immuno-Oncology Learning Library Drugs@FDA package inserts National Comprehensive Cancer Network homepage OncoLink: All About Immunotherapy To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Before immune checkpoint blockade, the two-year overall survival rate in metastatic melanoma was hovering around 10%. After these agents came to market, depending on the trial and the agents used, that number actually increased to about 50%–65%. So, five times the amount of patients were actually living at the two-year mark. Not surprisingly, studies then exploded across several tumor types, leading to approvals in all sorts of cancers, mostly in the solid tumor. But there are a couple hematologic as well. Lung cancer, kidney cancer, head and neck, Hodgkin lymphoma, hepatocellular, the list goes on. So, it's really just transforming the stage IV setting across all tumors, specifically from uniformly fatal prognosis to one where durable responses and long-term survival is also possible." TS 3:03 "There are four different mechanisms officially being used in therapies that are approved by the U.S. Food and Drug Administration (FDA). Those are cytotoxic T-lymphocyte–associated protein 4, programmed cell death protein 1, and programmed cell death ligand 1, which I'm counting as two different mechanisms, even though they somewhat work together. And lymphocyte-activation gene 3 is the fourth one that's in there. So, all these mechanisms impact the T cell in our immune system. The T cell is traditionally responsible for protecting our body from harmful things like bacteria, viruses, and cancer. When the tumor binds to cytotoxic T-lymphocyte–associated protein 4 receptors, that happens on the T cell itself. And that inhibits the activation of the T cells, essentially allowing that tumor to then live. So when developing medications that block this receptor, they noted an added benefit that it actually increased the T-cell proliferation as well as keeping that T cell active. So not only are we not blocking the T cells, we're making them more productive." TS 5:38  "If you have a chance of any sort of tissue rejection, specifically with allogeneic stem cell transplants or where we see that focusing on it, there's a little bit of controversy, mixed bag on opinions as far as autologous stem cell transplants. But it's best to at least exercise a little bit of caution. If they have a chance of organ rejection, is that worth the risk of the therapy that we're looking to give? And then, patients with HIV, any sort of immunologic concerns at baseline that we could potentially worsen." TS 14:37 "As a rule of thumb, with immune checkpoint blockade, regardless of what mechanism you're looking at, if something in your body can get inflamed, that can wind up as an adverse event. So, whenever I talk to my patients, the key word is anything ending in '-itis.' ... The most common adverse events that we end up seeing are dermatitis and hypothyroidism. Immune checkpoint blockade can cause both hyper- and hypothyroidism. Very often, we actually start in the hyper- and then end up, for lack of better words, burning out the thyroid, ultimately leading to a sustained hypothyroidism." TS 18:34 "The half-life of immune checkpoint inhibitors is usually around 30 days, meaning that once these agents are given, the drug will be in the patient's system for up to five months. Specifically, it will probably build month to month, so often we don't even see a lot of our adverse events until month three or four. Usually, when we're that far into treatment, we're not looking for new adverse events in things like chemotherapy. But these drugs do build over time." TS 24:28 "As far as safe handling is concerned, these agents are not chemotherapy. That makes drug compounding and administration pretty straightforward. When looking at the follow-up care, the most important thing, in my opinion, is to engage in meaningful dialogue with your patients. A lot of the side effects can be nonspecific. So, really listening to the patient and evaluating changes in their lifestyle, I think it'll get you far. We usually hark in on the new, worsening, or persistent whenever we're talking to patients because they'll be looking for things as well. So, just having a dialogue of how their life has changed can certainly help." TS 26:17

Why one expert argues that computers and other technology in the classroom are doing more harm than good for our students' education (at 13:54) --- Getting a cancer diagnosis is a life-changing event, but current and accurate information can make it less daunting... And that's where the National Comprehensive Cancer Network comes in (at 25:00) --- Former Ohio State football coach and current Lieutenant Governor Jim Tressel recently brought his statewide Fitness Challenge to Donnell Middle School... When the initiative launched this past summer, he joined us to explain what it's all about (at 46:17)

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lauren Madigan, MD, associate professor of dermatology at the University of Utah, for a focused exploration of mast cell disease, an often underrecognized but clinically significant group of disorders that dermatologists may encounter on the front lines. The conversation begins with mast cell biology, including their origin in the bone marrow, tissue-specific phenotypes, and roles beyond classic allergic disease. Dr Madigan explains how mast cells contribute to immune defense and wound healing, with Dr Del Rosso noting how infrequently they are discussed in routine dermatology training despite their relevance across multiple conditions. They then explore mastocytosis across the age spectrum, contrasting pediatric presentations (many of which remit by adolescence) with adult-onset disease, where cutaneous findings often signal systemic involvement. Dr Madigan reviews current National Comprehensive Cancer Network guidance, emphasizing that most adults presenting with cutaneous mastocytosis will have some degree of systemic disease and may warrant more detailed testing for accurate staging, prognostic differentiation, and management choices. The discussion highlights the heterogeneity of systemic mastocytosis, from indolent forms to advanced disease with organ involvement or associated hematologic neoplasms. The episode also covers practical diagnostic and workup considerations, including laboratory evaluation, KIT mutation testing, and biopsy considerations. Dr Madigan stresses the importance of experienced dermatopathology interpretation and thoughtful site selection to optimize diagnostic yield. Treatment strategies are discussed through a pragmatic lens, ranging from symptom-directed therapies to cytoreductive and targeted tyrosine kinase inhibitors, with an emphasis on individualized care based on disease subtype, symptomatology, and prognosis. The episode closes with resources to help dermatologists navigate diagnostic assistance and treatments via specialty centers and clinical trials. Listen to the episode to deepen your understanding of mast cell disease, sharpen your diagnostic approach, and gain practical guidance on evaluation, staging, and management strategies, both for real-world practice and for determining when referral to specialized care is warranted.

New research is transforming the outlook for cervical and uterine cancers -- two of the most serious gynecologic malignancies worldwide – and we'll be hearing from one of the people shaping that progress, Dr. Mary McCormack, on this episode of Raise the Line. From her perch as the senior clinical oncologist for gynecological cancer at University College London Hospitals, Dr. McCormack has been a driving force in clinical research in the field, most notably as leader of the influential INTERLACE study, which changed global practice in the treatment of locally advanced cervical cancer, a key reason she was named to Time Magazine's 2025 list of the 100 most influential people in health. “In general, the protocol has been well received and it was adopted into the National Comprehensive Cancer Network guidelines which is a really big deal because lots of centers, particularly in South and Central America and Southeast Asia, follow the NCCN's lead.”In this conversation with host Michael Carrese, you'll learn about how Dr. McCormack overcame recruitment and funding challenges, the need for greater access to and affordability of treatments, and what lies ahead for women's cancer treatment worldwide. Mentioned in this episode:INTERLACE Cervical Cancer Trial If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

"They [monoclonal antibodies] are able to cause tumor cell death by binding to and blocking to necessary growth factor signaling pathways for tumor cell survival. That's going to be dependent on the target of the antibody, but I'll give an example of epidermal growth factor, or EGFR. This is overexpressed in several different kinds of cancers where activation of this growth factor increases the amount of proliferation and migration of cancer cells. So, if we bind to it and block to it, then that would help halt these pathways and stop cancer cell growth," Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about monoclonal antibodies. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) (including 45 minutes of pharmacotherapeutic content) by listening to the full recording and completing an evaluation at courses.ons.org by December 26, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge in the history of, the mechanism of action of, and the use of monoclonal antibodies in the treatment of cancer.  Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 383: Pharmacology 101: Bispecific Antibodies Episode 375: Pharmacology 101: VEGF Inhibitors Episode 338: High-Volume Subcutaneous Injections: The Oncology Nurse's Role Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction Episode 275: Bispecific Monoclonal Antibodies in Hematologic Cancers and Solid Tumors ONS Voice articles: An Oncology Nursing Overview of Biosimilars Make Subcutaneous Administration More Comfortable for Your Patients Oncology Nurses' Role in Translating Biomarker Testing Results Reduce Chair Time by as Much as 16 Minutes by Priming IVs With Drug Shorter Administration Times Still Require High-Acuity Care The Names of Targeted Therapies Give Clues to How They Work ONS Voice drug reference sheets: Datopotamab deruxtecan-dlnk Enfortumab vedotin Margetuximab-cmkb Mirvetuximab soravtansine-gynx Nivolumab and hyaluronidase-nvhy Nivolumab and relatlimab-rmbw Pembrolizumab and berahyaluronidase alfa-pmph Retifanlimab-dlwr ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) ONS course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ Clinical Journal of Oncology Nursing articles: Bolusing IV Administration Sets With Monoclonal Antibodies Reduces Cost and Chair Time: A Randomized Controlled Trial Management of Immunotherapy Infusion Reactions Nurse-Led Grading of Antineoplastic Infusion-Related Reactions: A Call to Action Safety and Adverse Event Management of VEGFR-TKIs in Patients With Metastatic Renal Cell Carcinoma Oncology Nursing Forum articles: Administration of Subcutaneous Monoclonal Antibodies in Patients With Cancer Depressive Symptoms and Quality of Life Associated With the Use of Monoclonal Antibodies in Breast Cancer Treatment ONS huddle cards: Bispecifics Checkpoint Inhibitors Monoclonal Antibodies Other ONS resources: Biomarker Database Bispecific Antibodies video Patient Education Sheets Antibodies article: A Comprehensive Review About the Use of Monoclonal Antibodies in Cancer Therapy Cureus article:  A Comprehensive Review of Monoclonal Antibodies in Modern Medicine: Tracing the Evolution of a Revolutionary Therapeutic Approach Association of Cancer Care Centers (ACCC) homepage Cancer Immunology, Immunotherapy article: Therapeutic Antibodies in Oncology: An Immunopharmacological Overview Drugs@FDA package inserts Future Oncology article: Biosimilars: What the Oncologist Should Know Hematology/Oncology Pharmacy Association homepage National Comprehensive Cancer Network homepage Network for Collaborative Oncology Development and Advancement (NCODA) subcutaneous therapy article Oncolink: Side Effects of Immunotherapy World Health Organization: New International Nonproprietary Names (INN) Monoclonal Antibody Nomenclature Scheme To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Prior to monoclonal antibodies, all we really had were these toxic chemotherapies or toxic radiation, so it was recognized how great it would be if we could have a treatment that was much more specific to the tumor cells and have agents that have less toxicities. These advancements in monoclonal antibody production began in the 1980s. ... Eventually, we had the first monoclonal antibody that was approved by the U.S. Food and Drug Administration (FDA) for an oncologic indication, rituximab." TS 4:14  "Nowadays, we do have treatments that are also considered tumor-agnostic. This is when a patient has a certain biomarker, then that treatment can be given and FDA approval was given, regardless what type of tumor the patient has. We typically see these kinds of tumor-agnostic therapies more so in patients who have recurrent or advanced diseases in solid tumors. One monoclonal antibody example that comes to mind is dostarlimab. That's a checkpoint inhibitor that's approved for patients who are deficient in mismatch repair mechanism." TS 23:48 "Our immune system constantly has this surveillance system and it's able to recognize foreign pathogens, abnormal cells, and even precancerous cells. And they're able to eliminate them before they become cancerous. But on the flip side, one of the regulatory mechanisms that we have so our immune system doesn't attack itself is the presence of checkpoints. When these checkpoints bind to their ligands, this can then act as an off switch so that, again, our immune system is not going to attack itself. But then the tumor cells can take advantage of this and actually use this mechanism to evade the immune system. So, when we're giving a checkpoint inhibitor, now we're removing that off switch. As a consequence, common adverse effects can include things like immune mediated adverse events. These most commonly affect the skin, gastrointestinal tract, and liver. Essentially, this can cause any '-itis' you can think of." TS 26:36 "Looking at strategies to prevent infusion reactions, one example is the use of premedication. If premedication is recommended, this typically includes any combination of antipyretics, which is typically acetaminophen. Antihistamine, which is typically an H1 antagonist like diphenhydramine. Although, there could be cases where we want to substitute this agent because maybe the patient has been tolerating therapy okay, and they're having a lot of side effects. So, we might use a second-generation antihistamine in some cases. The premedication may be given with or without some kind of steroid, whether that's methylprednisolone, hydrocortisone, or dexamethasone." TS 29:53 "We tend to think of monoclonal antibody usage to be primary oncology, but that's not really the case. The first monoclonal antibodies that were developed were not for oncologic indications, they were for transplant indication for cardiac indication. So, they're really diversely utilized across all specialties and medicines. We have monoclonal antibodies for hyperlipidemia, for neurology, for rheumatology, so the uses are so very expansive across all specialties." TS 41:01

"I'll go back to the backpack analogy. When your kids come home with a backpack, all of a sudden their homework is not on the desk where it's supposed to be. It's in the kitchen; it kind of spreads all over the place, but it's still in the house. When we give antibody–drug conjugates (ADCs), the chemotherapy does go in, but then it can kind of permeate out of the cell membrane and something right next to it—another cancer cell that might not look exactly like the cancer cell that the chemotherapy was delivered into—is affected and the chemotherapy goes over to that cancer cell and kills it," ONS member Marisha Pasteris, OCN®, office practice nurse in the breast medicine service at Memorial Sloan Kettering Cancer Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ADCs in metastatic breast cancer. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  This podcast is sponsored by Gilead and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.  Episode Notes  This episode is not eligible for NCPD. ONS Podcast™ episodes: Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 378: Considerations for Adolescent and Young Adult Patients With Metastatic Breast Cancer Episode 368: Best Practices for Challenging Patient Conversations in Metastatic Breast Cancer Episode 350: Breast Cancer Treatment Considerations for Nurses Episode 303: Cancer Symptom Management Basics: Ocular Toxicities ONS Voice articles: An Oncology Nurse's Guide to Cancer-Related Ocular Toxicities Black Patients With Metastatic Breast Cancer Are Less Informed About Their Clinical Trial Options Communication Case Study: Talking to Patients About Progressive Metastatic Breast Cancer What Is HER2-Low Breast Cancer? ONS Voice drug reference sheets: Belantamab mafodotin-blmf Datopotamab deruxtecan-dlnk Enfortumab vedotin-ejfv Fam-trastuzumab deruxtecan-nxki ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Breast Care for Oncology Nurses Guide to Cancer Immunotherapy (second edition) ONS courses: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing article: Antibody–Drug Conjugates and Ocular Toxicity: Nursing, Patient, and Organizational Implications for Care The Association Between Hormone Receptor Status and End-of-Life Care Among Patients With Metastatic Breast Cancer Oncology Nursing Forum article: Impact of Race and Area Deprivation on Triple-Negative Metastatic Breast Cancer Outcomes ONS huddle cards: Altered Body Image Huddle Card Chemotherapy Huddle Card Targeted Therapy Huddle Card Foundations of Antibody–Drug Conjugate Use in Metastatic Breast Cancer: A Case Study ONS Biomarker Database (refine by breast cancer) ONS Breast Cancer Learning Library American Society of Clinical Oncology (ASCO) homepage Drugs@FDA package inserts National Comprehensive Cancer Network homepage Susan G. Komen metastatic breast cancer page To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "What an ADC is doing is taking the antibody and linking it to a cytotoxic chemotherapy with the idea of delivering it directly into the cell. How I explain this to new nurses or patients is a backpack analogy. If we think of it as a HER2 molecule wearing a chemo backpack, it's going to find the HER2 receptor attached to it and then drop the chemotherapy into the cell via the backpack. Similar to how we come home from work, we open the key to our door, we're carrying all of our items, and then we drop our own personal items in our house." TS 2:30 "The reason that so many patients with metastatic breast cancer are able to receive ADC therapy is because they are targeting two very common antibodies that we see in breast cancer. One is HER2 and the other is trophoblast cell surface antigen 2 (TROP2). These are seen across the board. We see these on triple-negative breast cancers, hormone receptor–positive cancers, and HER2-positive breast cancers. And now we have a new way to talk about HER2, which is a HER2-low. ... Recently, we have found that patients who express low levels of HER2 are able to receive ADC therapy, specifically fam-trastuzumab deruxtecan." TS 4:21 "Another [ADC] that has just been approved is datopotamab deruxtecan. This is another ADC that targets the TROP2 receptor on a cancer cell. This one carries a lot of side effects. I mentioned earlier that you need an ophthalmology clearance because there is a lot of ocular toxicity around this one. We see a lot of blepharitis, conjunctivitis, there can be blurred vision. Another thing we monitor on this one is mucositis. In the package insert, there's a recommendation for using ice chips while receiving the treatment. ... Then in the HER2-positive and HER2-low space is the big one, which is fam-trastuzumab deruxtecan. This was approved in 2019 for the HER2-positive patients, then more recently in the HER2-low [patients]. The big [side effect] with this one is interstitial lung disease." TS 10:11 "Interstitial lung disease is an inflammation or a little bit of fibrosis within the lung that causes an impaired exchange between the oxygen and carbon dioxide. This was seen in the clinical trials, specifically around fam-trastuzumab deruxtecan. During the trials, they had a very small percentage, I think it was 1%, that died due to interstitial lung disease. So, this is a very important side effect for us as nurses to be aware of. It typically presents in patients like a dyspnea. A lot of times, it's like, 'Well, I used to be able to walk my kid to the bus stop, but now when I walk there, I feel really short of breath.' Or 'I've had this dry cough for the past couple weeks and I've tried medications, but haven't had that relieved.' So, we really need to be aware of that because early intervention in interstitial lung disease is key." TS 12:57 "ADCs are toxic drugs. They have the benefit of being targeted, but we know that they carry a lot of side effects. ... Their specificity makes them so wonderful and we've seen amazing responses to these drugs. But also, we want patients to be safe. We want to give these drugs safely. So, we have to assess our patients and make sure that this is an appropriate patient to give this therapy to. I think that's an open conversation that clinicians need to have with patients regarding these drugs." TS 18:08

"Any time the patient hears the word 'cancer,' they shut down a little bit, right? They may not hear everything that the oncologist or urologist, or whoever is talking to them about their treatment options, is saying. The oncology nurse is a great person to sit down with the patient and go over the information with them at a level they can understand a little bit more. To go over all the treatment options presented by the physician, and again, make sure that we understand their goals of care," ONS member Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, manager of clinical education and clinical nurse specialist at Karmanos Cancer Institute in Detroit, MI, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about prostate cancer treatment considerations for nurses.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 21, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to the treatment of prostate cancer. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 387: Prostate Cancer Screening, Early Detection, and Disparities Episode 373: Biomarker Testing in Prostate Cancer Episode 324: Pharmacology 101: LHRH Antagonists and Agonists Episode 321: Pharmacology 101: CYP17 Inhibitors Episode 208: How to Have Fertility Preservation Conversations With Your Patients Episode 194: Sex Is a Component of Patient-Centered Care ONS Voice articles: Communication Models Help Nurses Confidently Address Sexual Concerns in Patients With Cancer Exercise Before ADT Treatment Reduces Rate of Side Effects Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer Nurses Are Key to Patients Navigating Genitourinary Cancers Sexual Considerations for Patients With Cancer The Case of the Genomics-Guided Care for Prostate Cancer ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition) Manual for Radiation Oncology Nursing Practice and Education (Fifth Edition) Clinical Journal of Oncology Nursing articles: Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers Physical Activity: A Feasibility Study on Exercise in Men Newly Diagnosed With Prostate Cancer The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population Oncology Nursing Forum articles: An Exploratory Study of Cognitive Function and Central Adiposity in Men Receiving Androgen Deprivation Therapy for Prostate Cancer ONS Guidelines™ for Cancer Treatment–Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer Other ONS resources: Biomarker Database (refine by prostate cancer) Biomarker Testing in Prostate Cancer: The Role of the Oncology Nurse Brachytherapy Huddle Card External Beam Radiation Huddle Card Hormone Therapy Huddle Card Luteinizing Hormone-Releasing Hormone Antagonist Huddle Card Sexuality Huddle Card American Cancer Society prostate cancer page National Comprehensive Cancer Network homepage To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org Highlights From This Episode "I think it's important to note that urologists are usually the ones that are doing the diagnosis of prostate cancer and really start that staging of prostate cancer. And the medical oncologists usually are not consulted until the patient is at a greater stage of prostate cancer. I find that it's important to state because a lot of our patients start with urologists, and by the time they've come to us, they're a lot further staged. But once a prostate cancer has been suspected, the patient needs to be staged for the extent of disease prior to that physician making any treatment recommendations. The staging includes doing a core biopsy of the prostate gland. During this core biopsy, they take multiple different cores at different areas throughout the prostate to really look to see what the cancer looks like." TS 1:46 "[For] the very low- and low-risk group, the most common [treatment] is active surveillance. ... Patients can be offered other options such as radiation therapy or surgery if they're not happy with active surveillance. ... The intermediate-risk group has favorable and unfavorable [status]. So, if they're a favorable, their Gleason score is usually a bit lower, things are not as advanced. These patients are offered active surveillance and then either radical prostatectomy with possible removal of lymph nodes or radiation—external beam or brachytherapy. If a patient has unfavorable intermediate risk, they are offered radical prostatectomy with removal of lymph nodes, external radiation therapy plus hormone therapy, or external radiation with brachytherapy. All three of these are offered to patients, although most frequently we see that our patients are taken in for radical prostatectomy. For the high- or very high-risk [group], patients are offered radiation therapy with hormone therapy, typically for one to three years. And then radical prostatectomy with removal of lymph nodes could also be offered for those patients." TS 7:55 "Radiation can play a role in any risk group depending on the patient's preference. ... The types of radiation that we use are external beam, brachytherapy, which is an internal therapy, and radiopharmaceuticals, [which are] more for advanced cancer, but we are seeing them used in prostate [cancer] as well. External beam radiation focuses on the tumor and any metastasis we may have with the tumor. It can be used in any risk [group] and for recurrence if radiation has not been done previously. If a patient has already been radiated to the pelvic area or to the prostate, radiation is usually not given again because we don't want to damage the patient any further. Brachytherapy is when we put radioactive pellets directly into the prostate. For early-stage prostate cancer, this can be given alone. And for patients who have a higher risk of the cancer growing outside the prostate, it can be given in combination with external beam radiation. It's important to note with brachytherapy, it cannot be used on patients who've had a transurethral resection of the prostate or any urinary problems. And if the patient has a large prostate, they may have to be on some hormone therapy prior to brachytherapy, just to shrink that prostate down a little bit to get the best effect. ... Radiopharmaceuticals treat the prostate-specific membrane antigen." TS 11:05 "The side effects of surgery are usually what deter the patient from wanting surgery. The first one is urinary incontinence. A lot of times, a patient has a lot of urinary incontinence after they have surgery. The other one is erectile dysfunction. A lot of patients may not want to have erectile dysfunction. Or, if having an erection is important to the patient, they may not want to have surgery to damage that. In this day and age, physicians have gotten a lot better at doing nerve-sparing surgeries. And so they really do try to do that so that the patient does not have any issues with erectile dysfunction after surgery. But [depending on] the extent of the cancer where it's growing around those nerves or there are other things going on, they may not be able to save those nerves." TS 15:26 "Luteinizing hormone-releasing hormone, or LHRH antagonists or analogs, lower the amount of testosterone made by the testicles. We're trying to stop those hormones from growing to prevent the cancer. ... When we lower the testosterone very quickly, there can be a lot more side effects. But if we lower it a little bit less, we can maybe help prevent some of them. The side effects are important. When I was writing this up, I was thinking, 'Okay, this is basically what women go through when they go through menopause.' We're decreasing the estrogen. We're now decreasing the testosterone. So, the patients can have reduced or absent sexual desire, they can have gynecomastia, hot flashes, osteopenia, anemia, decreased mental sharpness, loss of muscle mass, weight gain, and fatigue." TS 17:50 "What we all need to remember is that no patient is the same. They may not have the same goals for treatment as the physicians or the nurses want for the patient. We talked about surgery as the most common treatment modality that's presented to patients, but it's not necessarily the option that they want. It's really important for healthcare professionals to understand their biases before talking to the patients and the family. It's also important to remember that not all patients are in heterosexual relationships, so we need to explain recovery after treatment to meet the needs of our patients and their sexual relationships, which is sometimes hard for us. But remembering that—especially gay men—they may not have the same recovery period as a heterosexual male when it comes to sexual relationships. So, making sure that we have those frank conversations with our patients and really check our biases prior to going in and talking with them." TS 27:16

Osteosarcoma Webinar Series: Alanna Church, MD, Associate Director, Laboratory for Molecular Pediatric Pathology at Boston Children's Hospital, Assistant Professor of Pathology at Harvard Medical School, and Conference Cochair joins us on OsteoBites to discuss insights and higlights from the AACR Special Conference in Cancer Research: Discovery and Innovation in Pediatric Cancer—From Biology to Breakthrough Therapies, September 25-28 in Boston.Dr. Church is currently a Molecular and Pediatric Pathologist at Boston Children's Hospital, where she is a founder and associate medical director of the Laboratory for Molecular Pediatric Pathology (LaMPP). She is an Assistant Professor of Pathology at Harvard Medical School, the Program Director for the Harvard Molecular Genetic Pathology Fellowship, and the incoming Chair of Clinical Practice for the Association for Molecular Pathology. Her clinical and research work focuses on bringing molecular testing to the clinical care of children with cancer. Through institutional projects (the Profile study, GAIN consortium study), she has profiled thousands of children's tumors and has used these results to make real-time impacts on their diagnoses and treatments. She is involved in national initiatives to improve the quality and access to molecular testing for children with cancer, including the NCI-funded Count Me In Study (Dana Farber, Broad Institute), the National Comprehensive Cancer Network, the National Institutes of Health, and the Children's Oncology Group.

In today's episode, supported by Sumitomo, we spoke with Tanya B. Dorff, MD, about the use of androgen deprivation therapy (ADT) in patients with prostate cancer. Dr Dorff is section chief of the Genitourinary Disease Program, as well as a professor in the Department of Medical Oncology & Therapeutics Research at City of Hope in Duarte, California. In our conversation, Dr Dorff discussed the role of ADT in prostate cancer management, highlighting where this class of agents fits into National Comprehensive Cancer Network guidelines and how this class has evolved with the development of LHRH antagonists and agonists. She explained how the observational OPTYX study (NCT05467176), a registry of relugolix (Orgovyx) use, aims to address safety and efficacy in combination with androgen receptor pathway inhibitors in patients with advanced prostate cancer. She also noted how early data from OPTYX presented at the 2025 ASCO Annual Meeting showed relugolix's use in localized and metastatic settings. Dorff also talked through relugolix's safety profile, particularly regarding cardiovascular risk, as well as the quality-of-life effects associated with ADT. She also addressed strategies to mitigate financial toxicity, along with the potential for future ADT-sparing treatments.

Two Onc Docs, hosted by Samantha A. Armstrong, MD, and Karine Tawagi, MD, is a podcast dedicated to providing current and future oncologists and hematologists with the knowledge they need to ace their boards and deliver quality patient care. Dr Armstrong is a hematologist/oncologist and assistant professor of clinical medicine at Indiana University Health in Indianapolis. Dr Tawagi is a hematologist/oncologist and assistant professor of clinical medicine at the University of Illinois in Chicago. In this episode, OncLive On Air® partnered with Two Onc Docs to bring a discussion of key data from the phase 3 MATTERHORN trial (NCT04592913), which were presented at the 2025 ASCO Annual Meeting. MATTERHORN was a randomized, double-blind, multinational study evaluating the addition of durvalumab (Imfinzi) to FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel) in patients with previously untreated, resectable gastric or gastroesophageal junction adenocarcinoma. In the MATTERHORN trial, 948 patients were randomly assigned 1:1 to receive either durvalumab or placebo in combination with perioperative FLOT, followed by 10 cycles of durvalumab or placebo as adjuvant therapy. The primary end point was event-free survival (EFS); secondary end points included overall survival (OS) and pathological complete response (pCR). The trial met its primary end point. Durvalumab plus FLOT (n = 474) significantly improved EFS vs placebo plus FLOT (n = 474; HR, 0.71; 95% CI, 0.58-0.86; P < .001), representing a 29% reduction in risk of progression, recurrence, or death. The interim OS analysis showed a nonsignificant trend favoring durvalumab (HR, 0.78; 95% CI, 0.62-0.97; P = .025). The pCR rate was 19% (95% CI, 15.75%-23.04%) with durvalumab vs 7.2% (95% CI, 5.02%-9.88%) with placebo. Toxicity profiles were comparable between the 2 groups, though immune-related adverse effects were more frequent with durvalumab. Importantly, the addition of durvalumab did not delay surgery or initiation of adjuvant therapy. Although the MATTERHORN regimen is not yet FDA approved or included in the National Comprehensive Cancer Network guidelines, this trial demonstrates a promising EFS benefit and potential practice-changing implications, pending mature OS data and further molecular subgroup analyses, according to Armstrong and Tawagi.

Dr. John Sweetenham, Dr. Larry Shulman, and Dr. Rebecca Maniago discuss the integration of clinical pathways and decision support tools into the cancer center workflow, challenges to implementation at the point of care, and the promise of AI to further unlock these tools for clinicians. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast. Over the last decade or so, there has been a great deal of work and a lot of discussion about the implementation of oncology clinical care pathways at the point of care, which are designed to reduce variability in care, reduce costs, and improve the quality of care and outcomes. Although clinical pathways aim to guide treatment decisions, current data suggests that the utilization of these pathways at the point of care is very low. There are many reasons for this, which we will get into on the episode today.   My guests today are Dr. Larry Shulman and Rebecca Maniago. Dr. Shulman is a professor of medicine at the University of Pennsylvania Abramson Cancer Center. He's also the immediate past chair of the Commission on Cancer and serves on the National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine. Rebecca Maniago is the director of clinical oncology at Flatiron Health, a technology platform that collects and analyzes real-world clinical data from electronic health records to facilitate decision making and research.  Our full disclosures are available in the transcript of this episode. Larry and Rebecca, welcome to the ASCO Daily News Podcast and many thanks for being here.  Dr. Larry Shulman: Thank you, John.  Rebecca Maniago: Thank you for having me.  Dr. John Sweetenham: Larry, I'm going to start out, if I may, with a question for you. You and I, in a previous podcast, have discussed some of these issues regarding pathway implementation before. But to start out with, it's certainly, I think, helpful for the listeners to remind us all of what are the benefits of oncology clinical pathways and why are we still talking about this 10 years or more on.  Dr. Larry Shulman: Yeah, and that's a great question, John. I think the good news is, and all of us who live in the oncology sphere know this, that there's been tremendous progress in cancer therapies over the last decade. But what that has entailed is the introduction of many new therapies. Their complexity is becoming really very tough for people to manage.  And so what we have are oncologists who are really trying to do their best to deliver care to patients that will give them the best chance for survival and quality of life. But it's really, really hard to keep up with everything that's happening in oncology in the context of what we all know is a very busy clinic schedule. Lots of patients coming through and decisions need to be made quickly. Pathways really could help us to guide us into recommending and delivering the best therapies for our patients for a particular disease. You know, cancer is complicated. There are many different types and there are many different therapies. It's just a lot to deal with without some assistance from pathways or pathway tools.  Dr. John Sweetenham: Thanks, Larry. So, knowing that's the case and knowing that these tools reduce variability, improve costs, improve quality of care as well. Starting with you again, Larry, if I may, why do you think it's been so difficult for so many oncologists to use these pathways effectively at the point of care?  Dr. Larry Shulman: So, I just wanted to step back a little bit. There are very extensive guidelines that tell us what the best therapies are for really all of the cancers. These guidelines come from the National Comprehensive Cancer Network or NCCN and the American Society of Clinical Oncology or ASCO and other professional organizations. And they're there. They're there, in free information off their websites.  But the problem is how to translate those pretty dense documents into something that will work in the clinic for a patient, for the physician who's working in the electronic health record. And the tools that are available, and there are a number of tools that can integrate with electronic health records, are expensive. You need to purchase them from the vendor and there are yearly fees.  And they're also difficult to implement. You need to work with the vendor to integrate them into your own rendition of your electronic health record. And there's a lot of customization that needs to be done. So, it's a financial challenge and it's also a time challenge for people to integrate these tools into their workflow, into their electronic health records.  Dr. John Sweetenham: Thanks, Larry. So speaking from my own past experience of pathway implementation, it certainly has been a major challenge for the reasons that you mentioned and also because of the, I think resistance may or may not be too strong a word, of many of the clinicians to use these for a number of reasons, part of which are the time it takes, part of which many of them feel that the pathways aren't really changing decisions that they might make anyway. So, you know, the uptake of pathway utilization, even in those centers which have been successful in getting something installed and plugged into their EHR, on the whole, hasn't been as good as it could have been. So maybe I'll turn to you, Rebecca, because I know that this is something that you've worked on a lot.  And it's a kind of double-barreled question. I think the first part of it is, you know, what do you think are the major roadblocks to high physician uptake in the use of these pathways platforms? And maybe you could talk a little bit about what the various software platforms do to make them more physician-friendly and to enhance utilization right on the front line.  Dr. Rebecca Maniago: Yeah, that's a great question. And so, you know, I've worked with a number of customers and physicians over the past five and a half years on implementing these pathways. And the number one pushback is really about the time it takes in the workflow. So, if I had a dollar for every time I heard “every click counts,” I'd be a rich person and it does come down to clicks. And so, you know, as a software vendor, we really have to focus on how do we reduce that friction?  How do we make sure that the clicks we are asking for are the ones that actually matter? And how do we continue to streamline that process? And so, you know, while there is a fine balance, because as part of a Pathways platform, at the end of the day, we do need to understand some data about that patient. You need to understand the clinical scenario so you can surface the right treatment recommendation, which means there is some amount of data capture that has to happen. In some circumstances, you know, we can pull some of that data in from the EHR.  But unfortunately, the reality is that a lot of that data is messy and it's sort of stuck in documents and unstructured places. And so it doesn't easily flow in, which means we rely on the provider to give us that information. And oftentimes they've already entered it other places. So what's more frustrating than entering data twice? But, you know, I do see a great opportunity here. And this is certainly where software companies are focused is with AI.  So, know, for, especially for this data aggregation, a lot of these AI tools can actually scan through the chart instead of relying on the physician to sort of manually skim through and aggregate and find all that pertinent information. That's what AI is really good at. And almost instantaneously, it can find the messy data that lives in those unstructured documents. And wouldn't it be nice if that was automatically populated within these applications so that really all we're asking of the clinician is to validate that that information is accurate. And then choose the treatment that cuts down on the number of clicks, it cuts down on frustration. You know, again, the physician will be the one that needs to make that decision. AI is not there to replace that, but it certainly has a great opportunity to reduce some of this manual documentation and the things that physicians find the most frustrating, especially as it relates to using these pathways tools.  Dr. John Sweetenham: One of the pretty common pushbacks that I heard during my time in a couple of institutions was, “Well, you know, I'm sitting here at the point of care with my patients and I already know what I want to do and how I'm going to treat that patient if it's not in the context of a clinical trial. So I don't need to go through, you know, X number of clicks to get me to where I know I'm going to be anyway.”  Does either of you have any thoughts about that? I think you've sort of partially answered it, but what do you think, Rebecca? Do you think that this is something that is more easily overcome-able, if that's even a word, than it was a few years back?  Rebecca Maniago: Yeah, I do. And I think this is where the customization comes into play. So while they may know what an appropriate treatment for their patient is, there are more options now than ever, which means at a local level, there may be multiple options that are clinically equivalent. And so when you think about things like payer pathways or drug margins as an organization, they have to drive some of that from within. But having the capability to do so can then start to sort of sell the value to the provider that, yes, you may know what you want to order for your patient, but would you consider something else if it was clinically equivalent, but it had other benefits to either the patient or the organization?  Dr. Larry Shulman: The other thing I would add to that, John, if I can jump in here is that the data is the data and the data shows us that guideline concordant care is not always prescribed to the US. And in fact, in some circumstances, the gaps between what should be prescribed and what is being prescribed are quite wide. So, you know, people feel like they're always doing the best job and making the best recommendations. And I think, you know, I think I am. But, you know, like many of my colleagues at academic cancer centers, I'm highly specialized. I only see patients with breast cancer. But many oncologists throughout the country are more generalists. They're seeing patients with multiple diseases. And it's harder for them to be completely on top of what the current recommendations are in any particular circumstance. Our diseases are complicated. They're getting more complicated all the time with molecular and genomic testing and subcategorizations of different cancers. So, I don't think that we can be too cocky about it, quite frankly. I think we ought to use technology that Rebecca describes for the tools and for AI to really help us. I think if we turn our backs on that, I think we're making a big mistake. You just got to look at the data. The data is pretty convincing.  Dr. John Sweetenham: You know ever since we started looking seriously at decision support through pathways a number of years ago, the word has always been around the payers role in this and the day will come where we are going to get reimbursed based on pathway and concordance and I'm not sure that that day has arrived. So I have a question for both of you in this regard actually. And the first of those is maybe I'll start with you for this part of it, Larry. Where do you think we are in that regard? And are you hearing more and more of payers starting to look at pathway compliance? And then on the other end of that, and maybe I'll ask Rebecca about this, is one of the other pushback issues that I used to experience from physicians I worked with was they may go through the pathways platform and come up with a treatment recommendation. The best example of this I can think might be that the recommendation might be a biosimilar. Let's just use that as an example. But the next stage in the process would be to find out whether the patient's insurance would actually cover that particular biosimilar, which opened up a whole new can of worms. So there are two kinds of payer aspects of that. Maybe Larry, I'll ask you to start off by talking about that kind of coverage issue. And then I'll ask Rebecca, if you have any thoughts about the flow the other way in terms of getting drugs approved and what we can do to help from an insurance perspective.  Dr. Larry Shulman: Sure, that's really an important point, John. Our current state of affairs with the payers and their attempt to be sure that we're providing responsible, guideline concordant care is the use of prior authorization processes, which are incredibly costly, both for the oncology practices and for the payers.  They have an army of nurses sitting at the phone talking to us in the oncology practices to decide whether they're going to pay for something. And frankly, generally, the payers will pay for things that are part of either the NCCN or ASCO or other professional organizations' guidelines. But you need to prove to them over the phone that in fact the patient qualifies for that.  We have actually had some experiments with some of the payers to prove that to them in different ways by auto transmission of data. And this would be a big savings for them and for us, it would take away some of the delays in therapy while we're waiting for prior authorizations to go through. And we shouldn't have to do this by phone.   The EHR and the pathway tools should aggregate the data, aggregate the potential treatment and be able to transmit those data to the payer. And if in fact it meets the appropriate criteria for guideline concordant care would be approved. Right now, it's a terrible, costly, timely manual process that they should be able to fix.  Dr. John Sweetenham: Thanks, Larry. And have you, you know, from a broader perspective, so not thinking necessarily about individual patients and specific issues around prior authorization, have you seen any movement among the payers to kind of get more aggressive about this and say, okay, you know, we are going to want to see your numbers, we want to know how many of your physicians are now using their pathways platform and so on. Are you seeing any word that that might be happening? Because certainly a few years back, that was the word on the street, as it were, that this day was coming.  Dr. Lawrence Shulman: And that's the proposal that we've made to several of our payers. Let us give you the aggregate data. If our guideline concordance is above a certain level, give us a gold card, give us a pass, and we won't need to do pre-authorizations. We've actually done that at my institution in radiology. Aggregate data gives individual physicians that pass if their guideline concordance was appropriate. I got to pass. So I don't need to go through those radiology pre-authorizations for my patients. And I think we can do the same thing with therapeutics. It's been a little bit more cumbersome to do it, and there's some detailed reasons why that is. But that's really what they want to know. And the payers want to know that patients are getting guideline concordant care, but they also realize it's not going be 100%. There are always a few outlier patients who require some variation from the guidelines. But if we get above 80% guideline concordant care, I think many of the payers would be happy to accept that as long as we continue to feed them the data. And that's the case in our radiology process with one of the payers is, you know, I get a gold card, but they continue to look at my data. And if I don't continue to perform well, they'll take that away.  Dr. John Sweetenham: Thanks, Larry. And Rebecca, just returning to you, this issue of prior authorization and facilitating life for the physician at the point of care in terms of knowing, you know, which specific treatment might be covered for a patient. Do you have any thoughts or maybe you could give us some insights on what software vendors are doing to facilitate that part of the process, the communication back to the payers to take some of that burden off the physician and the physician staff?  Rebecca Maniago: Yeah, absolutely. And this is a problem we've been trying to tackle for years. And it's not easy. We've tackled it in a couple ways. So first, we try to sort of link up to the payer portal where the information that was being attested to within the application could then be automatically sent. Because at the end of the day, the data points that are being collected to surface treatment recommendations ultimately are the same data points that the payer wants.  Unfortunately, there are a lot of data interoperability challenges within that space. So that was not something that was going to be sustainable. However, in current state, because as I mentioned, the customization is key for these products, focusing more on how can we allow practices to embed payer pathways within the application. So again, you kind of start with the backbone of your standard guidelines but then having the capability of adding in a payer pathway that will only show up as that preferred option for a patient who has that insurance, at least at the point of care, the provider sees what the insurer would then approve. So while it's not automatically assuring authorization, we are at least steering the decision in a direction where we think most likely this is going to be approved based upon the pathway that they have access to. So that sort of current state, I agree. We've been talking about this idea of gold carding for years.  Presumably the data is there today, right? Like we are able to capture structured data with every order placed to recognize concordance to Larry's point. All those reports are available to provide to payers. I just haven't seen a lot of practices have a lot of success when they tackle it on their own from that direction.  Dr. John Sweetenham: Right, thanks. Larry, you and I were at the NCCN annual meeting recently and I know that you've been quite heavily involved in the policy program and in the policy forums and so on at NCCN. Are you able to share anything from this year's meeting in terms of care pathways implementation and what you think might happen next in that regard?  Dr. Larry Shulman: NCCN, in my own opinion, has really led the way in defining what guideline concordant care is through their guidelines, which are very extensive, covering basically every cancer and every situation with every cancer. And it's really an astounding amount of amazing work that all of us use and the payers largely use as well. But they've increasingly understood that there's a gap between their guidelines and the implementation of their guidelines. And they are working on some things. They are working on the digitalization of their guidelines to make them more accessible, but also thinking about ways that they may, in fact, fit into the work processes that all of us have when we go to clinic.  They're acutely aware that the country is not where it needs to be in regard to a translation, if you will, of their guidelines in the practice. And I think we're all thinking really hard about whether there are things that we can team up to do, if you will, to try to close those gaps.  Dr. John Sweetenham: Great, thank you. Just switching gears a little bit back to you, if I can, Rebecca. I think you've said a little bit about this already. What do you think are the next steps that we need to take to more effectively implement these tools in the clinic? I think we've discussed a little bit some of the roadblocks to that. But where do you think we need to go next in terms of getting better use of these pathways?  Rebecca Maniago: Yeah, I will say one thing that we haven't really touched on is the pharmacy team. So the biggest blocker that I see is actually the pre-implementation. So there's a lot of focus on how do we get physicians to use this? How do we increase adoption? But often the first barrier is the regimen library. So no matter what the pathways platform is, the backbone of it will be those regimens. And so, really helping organizations and we partner with pharmacies, they're doing all the backend configuration. And so how can we make that piece of the technology easier for them to implement because that's really the lead up and there's a ton of cleanup and maintenance. You know, as a pharmacist, I empathize, but really that's where it all begins. And so I think, you know, continuing to focus on not only the front end user and the physician, but everybody that's going to be involved in order to make a pathway program successful needs to be, you know, at the table in the beginning, helping set up those processes and, and buying into the why this is important.  Dr. John Sweetenham: That's a great point.  Dr. Larry Shulman: So could I just jump in one quickly here, John? So pathways, as we've discussed, the tools are expensive. There is a person cost, as Rebecca is just describing, about customization and implementation. But there are very good data in the literature to show that when you follow pathways, care is less costly. Survival is better, which is obviously our primary goal, but also cost is less. And the payers can benefit from that. And the question is, can they figure out ways to use that to help to fund the purchase and maintenance of pathway products that will give their patients better care, but also less costly care? And so I think that is a potential solution. I've had that conversation with some payers as well. And it would be great to see that happen. I think that would be a huge step.  Rebecca Maniago: Yeah, we have some, if they're able to set it up in the right way and really optimize, you know, from the pharmacy perspective, we have practices who the application is more than, you know, paying for itself just by way of using it to the fullest potential that it has.  Dr. John Sweetenham: Yeah, that's a really great point. A couple of other more general questions. I'm going to start with you, Rebecca, and Larry ask you to respond as well. Are you hearing anything from patients around this issue? Are they aware or becoming more aware that pathways are being used in the clinic when they're seen by their physicians? And do they have a say, are there patient advocates involved in this part of the process? Rebecca, maybe you could start.  Rebecca Maniago: I haven't had as much exposure to that side of it. So, you know, I would love to hear what Larry thinks because most of my exposure is at the physician level, which of course they are the ones who are making the decision with the patient. So my assumption is that there is at least some level of understanding that there are options and that, you know, together let's decide on the best one for you. But again, I would love to hear what Larry has to say.  Dr. Larry Shulman: Yeah, so that's a really interesting question. I actually was discussing that at the cancer center last week, particularly around the utilization of AI in this process. And, you know, right now, as you know, if you submit a journal article or, you know, many other things, ask you whether you used AI to generate it. If in fact we use tools that include AI, we're not.  Are we obligated to tell the patient that you're making this recommendation together with computer assist, if you will, that helps you to make the recommendation you are making to them? Ultimately, I think it's the physician who's responsible for the choice, but should we disclose it? I have to tell you personally, I haven't thought about doing that. But I think it's a really, really good question is whether we should upfront tell the patients that we've had assistance in making the recommendations that we have.  Dr. John Sweetenham: Right, very interesting point. To close it out, one more question for both of you and again, it's the same one. Rebecca, to start with, we've all been, as I said right up front, talking and, you know, working on this issue for more than 10 years now. In 10 years from now, how would you like it to look and how do you think it might look?  Rebecca Maniago: Great question. I think we may get to where I would like to see it quicker than 10 years. I think AI provides a lot of opportunity and excitement. I'd love to turn a corner where physicians no longer see tools like this as a hindrance, rather they rely on them, they trust them, they help them get through their day. They continue to improve quality of care and reduce costs and patient burden. Obviously, that's the pipe dream, but I think we may get there before 10 years, given what I think AI is going to enable.  Dr. Larry Shulman: Yeah, I want to add to Rebecca's comments. One of the things that I worry about, and ASCO worries about a lot, is the oncology workforce, which is progressively strained in their attempts to care for all the cancer patients in the US. And for all of us who practice oncology, for many reasons, it's become more and more inefficient, whether it's use of the EHR, pre-authorization work, and so on.  And we really need to turn that around. We need to make practice not only better, which I think these tools can do, including AI, as Rebecca says, but make it much more efficient because that's going to allow us to both deliver more high-quality care to our patients, but also to care for more patients and have them benefit from our expertise and what we have to offer. So I think this is really an obligation on our part. I think it's an imperative that we move in this direction for both quality reasons and efficiency reasons.  Dr. John Sweetenham: Thanks, Larry. Well, I've really enjoyed the conversation today and I think, you know, it's been great to think about some of the challenges that we still have in this regard. But it's also great to hear what I'm sensing is quite a lot of optimism about how things may play out over the next few years. And it does sound as if there's a lot of hard work going on to bring us to a point where the clinical decision support tools are going to truly support what our oncologists are doing and no longer be seen as an obstruction. So, I want to thank you both for sharing your insights with us today on the ASCO Daily News Podcast.  Dr. Larry Shulman: Thank you so much, John.  Rebecca Maniago: Thank you so much.  Dr. John Sweetenham: And thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts.  Disclaimer:   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.   Find out more about today's speakers:  Dr. John Sweetenham  Dr. Lawrence Shulman  Rebecca Maniago  Follow ASCO on social media:  @ASCO on Twitter  @ASCO on Bluesky  ASCO on Facebook  ASCO on LinkedIn        Disclosures:  Dr. John Sweetenham:  No relationships to disclose    Dr. Lawrence Shulman:  Consulting or Advisory Role: Genetech     Rebecca Maniago:   No relationships to disclose.     

The International Psycho-Oncology Society (IPOS) deemed April 9th, 2025, the first-ever World Psycho-Oncology Day (WPOD). This day was meant to spread awareness of the importance of prioritizing psychosocial care for patients with all types of cancer as well as to honor Jimmie C. Holland, MD. Prior to WPOD, CancerNetwork® spoke with Cristiane Decat Bergerot, PhD, BS, MS, a psychologist and the head of supportive care at Grupo Oncoclinicas in Brazil, and a member of IPOS, about the importance of psychosocial care and the impact it has on patients with cancer. As stated by Bergerot and listed on the official IPOS website, the primary goals of WPOD are as follows: raise awareness, honor Jimmie Holland, engage stakeholders, promote action, and support fundraising efforts.1 These goals are geared towards paying homage to the history of psycho-oncology and pushing for a more advanced future. “We aim to empower patients, caregivers, and healthcare professionals, fostering a future where psychosocial support is an integral part of oncology worldwide,” Bergerot said.  Psycho-oncology has become more prevalent as a cancer care field since Jimmie C. Holland, MD, worked to help found it in the 1970s. Holland, a “pioneer” of psycho-oncology, was the first ever Chief of Psychiatry Services—a department that was the first of its kind anywhere in the world—at Memorial Sloan Kettering Cancer Center, and a founding member of IPOS.  Bergerot stated that, in her work, she sees that patients who receive psychological support exhibit improved pain management and quality of life. Trials now focus more on end points such as quality of life and patient-reported outcomes, and guidelines have emerged to create standards of care. The National Comprehensive Cancer Network and the American Society of Clinical Oncology each offer guidelines that detail how to manage patient distress as they progress through cancer therapy.2,3 Distress screenings and earlier recommendations for palliative care have also become more standard in treatment.  As for the future, Bergerot highlighted that psychosocial care needs to be more integrated into care as a necessary, rather than optional, component. New developments around the world, however, have created a landscape where telehealth and new research demonstrate the potential to help psycho-oncology grow rapidly.  References 1.        World Psycho-Oncology Day (WPOD). IPOS. Accessed April 2, 2025. https://tinyurl.com/43c9rr2c 2.        Distress during cancer care. NCCN. 2024. Accessed April 2, 2025. https://tinyurl.com/ycxxvnmt 3.        Andersen BL, Lacchetti C, Ashing K, et al. Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. J Clin Oncol. 2023;41(18):3426-3453. doi:10.1200/JCO.23.00293

This episode of Cancer Registry World features Dr. Wui-Jin Koh, Senior Vice President and Chief Medical Officer of the National Comprehensive Cancer Network (NCCN). Dr. Koh explores the vital role of cancer registry data in shaping treatment guidelines and how data-driven guidelines contribute to advancements in cancer management. Tune in to gain valuable insights from this important discussion.

Disclaimer: This podcast does not provide medical advice. The content of this podcast is provided for informational or educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health issue without consulting your doctor. Always seek medical advice before making any lifestyle changes. Dr. Dawn Mussallem is a distinguished consultant in the Division of Hematology Oncology at Mayo Clinic and an Assistant Professor of Medicine. As a board-certified lifestyle medicine breast specialist at The Robert and Monica Jacoby Center for Breast Health, she plays a vital role in advancing evidence-based, holistic breast cancer care. She also serves as Chair of Mayo Clinic Florida's Employee Well-being Committee, Medical Director for the Humanities in Medicine program & Councilor at Large for the Officers & Councilors of the Mayo Clinic staff. In 2015, Dr. Mussallem founded the Integrative Medicine & Breast Health Program at Mayo Clinic Florida, a patient-centered initiative that supports breast cancer patients during & after their diagnosis. The program emphasizes optimizing lifestyle practices alongside conventional cancer treatments. Her mission is to reframe cancer as a “teacher of life,” helping patients discover renewed vitality through healthier living. Currently, she leads Mayo Clinic's regenerative farm project which aims to provide nutrient-rich plant-based foods to patients, employees, learners, & food-insecure individuals in the community, demonstrating the interconnected benefits for human & planetary health. With more than 25 years of patient-centered clinical wellness experience, Dr. Mussallem is internationally recognized in cancer prevention, lifestyle medicine, integrative oncology, & cancer survivorship. Her personal journey—including a stage IV cancer diagnosis just three months into medical school and her experience as a heart transplant recipient in 2021 profoundly shapes her commitment to helping patients thrive during and after adversity. A sought-after international keynote and motivational speaker, Dr. Mussallem frequently appears on podcasts, webinars, radio, and television programs. She has authored numerous book chapters, journal articles, and abstracts, and serves as an editor for the Journal of the National Comprehensive Cancer Network, Wiley, and Mayo Clinic Proceedings. Her research focuses on exploring lifestyle's critical role in cancer prevention and management, particularly the impact of whole food, plant-based nutrition on the tumor microenvironment and cancer progression. She also investigates strategies to enhance quality of life for cancer survivors, examining the links between lifestyle modifications, longevity, and restorative well-being.

In this episode, we speak with Dr. Natalie Lui, Assistant Professor of Cardiothoracic Surgery at Stanford University, about lung cancer screening and the importance of early detection. Since lung cancer is often diagnosed in advanced stages, yearly low-dose computed tomography (LDCT) screening is crucial, especially for heavy smokers. We discuss risk factors, screening criteria from the U.S. Preventive Services Task Force, National Comprehensive Cancer Network, and the American Cancer Society, and why screening isn't universal despite its importance. Additionally, we explore current research, recent updates to guidelines, barriers to screening in underserved communities, and the potential of emerging technologies, such as AI, to enhance lung cancer screening in the future. Read Transcript CME Information: https://stanford.cloud-cme.com/medcastepisode92 Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=3122

In today's episode, supported by Taiho Pharmaceutical, we had the pleasure of speaking with Joleen Hubbard, MD, about practice-changing updates to the colorectal cancer (CRC) treatment paradigm. Dr Hubbard is a medical oncologist at Allina Health Cancer Institute in Minneapolis, Minnesota. In our exclusive interview, Dr Hubbard discussed key efficacy and safety findings from the phase 3 SUNLIGHT trial (NCT04737187) of trifluridine-tipiracil (Lonsurf) plus bevacizumab (Avastin) in patients with refractory metastatic CRC; quality of life outcomes from this trial; and the most practice-changing updates to the National Comprehensive Cancer Network guidelines for CRC.

To learn about colon cancer, we are joined by Gabrielle Shermanski. Gabrielle Shermanski completed her Master of Science in Human Genetics at Sarah Lawrence College in 2020. She is a licensed, board-certified Genetic Counselor at Geisinger with 4 years of clinical experience in adult oncology. Gabrielle's primary interests include helping patients with inherited breast cancer syndromes and inherited GI syndromes facilitate further care and communicate results to family members. Gabrielle has a strong interest in education, mentorship, and outreach opportunities. Her hobbies outside of work include cooking and hanging out with her puppy, RJ.   During the episode Gabrielle mentioned the National Comprehensive Cancer Network's colon cancer guidelines, which you can find here.    Stay tuned for the next new episode of “It Happened To Me”! In the meantime, you can listen to our previous episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “It Happened To Me”.    “It Happened To Me” is created and hosted by Cathy Gildenhorn and Beth Glassman. DNA Today's Kira Dineen is our executive producer and marketing lead. Amanda Andreoli is our associate producer. Ashlyn Enokian is our graphic designer.   See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, ItHappenedToMePod.com. Questions/inquiries can be sent to ItHappenedToMePod@gmail.com.

Today's guest is Renee' Herman. She has been a nurse for over 40 years and has spent the last 6 as a Nurse Navigator for breast cancer patients. She was also diagnosed with breast cancer this past December.We talk all about what nurse navigators do, how important they are during cancer care, and the blessing of their support and care at diagnosis, throughout the treatment journey, and also into survivorship. Renee' gave lots of resources throughout our conversation. Here are a few:National Cancer Institute: https://www.cancer.gov/American Cancer Society: https://www.cancer.org/https://www.breastcancer.org/Triage Cancer: https://triagecancer.org/National Comprehensive Cancer Network: https://www.nccn.org/Each state should have its own cancer coalition. Here is the link for the Colorado Cancer Coalition: https://www.coloradocancercoalition.org/ You can Google Cancer Coalition for your own stateThe book she gives to all her patients is The Breast Cancer Treatment Handbook by Judy Kneece. You can order it here: https://www.amazon.com/Breast-Cancer-Treatment-Handbook-10th/dp/1886665176You can reach Renee' at Please let me know any takeaways you've gotten from this episode or any other. I want to hear from you!! You can reach me on Instagram at https://www.instagram.com/melissagrosboll/, email me at drmelissgrosboll@gmail.com, or text me at 720-201-4292.

Throughout the history of cancer advocacy, there are the advocates who made us and the organizations who made us. And one such organization is the National Comprehensive Cancer Network, which is — for all intents and purposes — the “Good Housekeeping meets Consumer Reports” of all cancer standards of care, best practices, guidelines, and credibility consensus. Joining me on today's show to speak to all that is my friend Marcie Reeder, Executive Director of the NCCN Foundation, which is their patient-friendly arm that collaborates with scores of nonprofits to make sure their information is trickled down to the patient and caregiver community as a vital support resource. Marcie lost her father to esophageal cancer when she was young. Her public service to advance the narrative and the imperative of access, awareness, and survivorship is a testimony to her passion, character, and the very definition of cancer advocacy. NCCN is an incredible organization that does outstanding work on behalf of millions of people, and I hope this episode shines a light on their impact on the cancer community. Enjoy the show.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode of ASTCT Talks, Dr. Muhammad Salman Faisal is joined by Dr. Jens Hillengass. Dr. Hillengass discusses the latest advancements in CAR T cell therapy, focusing on its application in early-line settings following the results of the CAR-TITUDE 4 and KarMMa-3 trials. Tune in as he shares insights on the efficacy, patient selection and future directions of CAR-T cell therapy in multiple myeloma. This episode is supported by Johnson & Johnson. Don't miss out on this informative discussion with one of the leading experts in the field. About Dr. Jens Hillengass Jens Hillengass, MD, PhD, is Professor of Oncology and Chief of the Myeloma and Amyloidosis Service at Roswell Park Cancer Institute, Buffalo, NY. Previously, he was the head of the autologous stem cell transplant program and the deputy chief of the multiple myeloma section at the University Hospital of Heidelberg, Germany. He earned his medical degree, residency, and fellowship at Heidelberg University, and completed a research fellowship at the National Cancer Institute. Dr. Hillengass co-chairs the bone and imaging group of the International Myeloma Working Group and serves on the Multiple Myeloma guideline committee at the National Comprehensive Cancer Network. About Dr. Muhammad Salman Faisal Dr. Muhammad Salman Faisal is currently a fellow at Roswell Park Comprehensive Cancer Center, in his third year of training, with keen interest in myeloma, CAR-T and access to care.

Episode 319: Difficult Conversations About Pregnancy Testing in Cancer Care “For people diagnosed with cancer that are of childbearing potential, we have to consider how [pregnancy] testing could impact them. So we never know what someone has been through, and it's important to lead with empathy while providing education of the importance of this testing. So someone may find now that pregnancy testing is a dreaded experience instead of what they thought would be a joyous one,” Marissa Fors, LCSW, OSW-C, CCM, director of specialized programs at CancerCare in New York, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the psychosocial aspects of pregnancy testing in cancer care. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by July 5, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome:  Learners will report an increase in knowledge related to the patient experience of pregnancy testing during cancer treatment. Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes: Episode 311: Standardized Pregnancy Testing Processes in Cancer Care Episode 293: Access to Care: How to Manage Moral Dilemmas and Advocate for Your Patients  Episode 262: LGBTQ+ Inclusive Nursing Care Begins With Using Supportive Language Episode 217: Support Pregnant and Postpartum Patients During Cancer Diagnosis and Treatment Episode 211: Apply the LGBTQIA+ Lived Experience to Your Patient Interactions Episode 208: How to Have Fertility Preservation Conversations With Your Patients ONS Voice articles: Cultural Humility Is a Nursing Clinical Competency The Case of the Pregnancy Predicament Transgender Patient Populations: Inclusive Care Involves Listening and Communicating Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress Use Active Listening to Engage More Deeply in Patient Discussions ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition) Clinical Journal of Oncology Nursing articles: Pregnancy and Cancer Treatment: Developing a Standardized Testing Policy and Procedure Unintended Pregnancy: A Systematic Review of Contraception Use and Counseling in Women With Cancer ONS Congress® abstract: System Approach to Fertility Preservation and Pregnancy Status During Active Cancer Treatment ONS Huddle Cards: Fertility Preservation Sexuality ECHO Training Program (Enriching Communication Skills for Health Professionals in Oncofertility) Journal of the National Comprehensive Cancer Network article: Pregnancy Screening in Patients With Cancer To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “In everyday life, pregnancy testing is actually still really complex. It's more than just the positive pregnancy test and the happy parent we may see on commercials. For those that are hopeful for a positive test, there's still a lot of anxiety, worry, fear, maybe before, during, or after the results. And I think about how long this person has been trying to conceive and the financial impacts involved, change in family dynamics. What if that test comes back negative? Then I think about the potential disappointment or the heartbreak. I also consider the flipside—those that are scared of a positive result for fears of becoming pregnant for a range of different reasons.” TS 3:40 “I think it's important to always lead with empathy and kindness and an open mind. So you don't want to assume you know or understand how a person feels or may respond. Allow your patients to share with you how they're feeling in a nonjudgmental manner. This could be an incredibly vulnerable moment, and nurses can be a valuable source of support. Take a moment to just listen, normalize their feelings or let them ask questions. And I recognize it can be difficult to know what to say or do, but sometimes just being there for someone in those ways is incredibly meaningful and opens up more effective communication and trust.” TS 8:48 “For the patient that has been trying to conceive, taking another pregnancy test could be so daunting or triggering and bring back so many moments of grief. Seeing the results being negative could be heartbreaking all over again. Some people may find some relief knowing their fetus will be harmed and they won't have to make tough decisions. And then there may be guilt for feeling that way. There's no one way to feel or right or wrong way to feel. … Let them know their feelings are valid and anything they feel is okay and normal.” TS 13:40 “I think that a common misconception is that if a pregnancy test comes back positive, there are no options for treatment. Education and communication with your healthcare team can help clear up those options you may have and bring back the element of shared decision-making to make these decisions together with your healthcare team.” TS 31:03

“Chemotherapy exposure during the first trimester is contraindicated and increases the risk of spontaneous abortion, fetal death, and major congenital malformations. Second- and third-trimester exposure may affect some body systems still developing and can still result in fetal growth restriction, low birth weight, and preterm labor. Yet, I do want to stress that pregnancy can remain a possibility,” Kelsey Miller, MSN, RN, AGCNS-BC, OCN®, clinical nurse specialist in oncology and infusion therapy at Reading Hospital in West Reading, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about policies and procedures for pregnancy testing during cancer treatment. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by May 10, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to pregnancy screening procedures during cancer treatment. Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes: Episode 217: Support Pregnant and Postpartum Patients During Cancer Diagnosis and Treatment Episode 208: How to Have Fertility Preservation Conversations With Your Patients ONS Voice article: The Case of the Pregnancy Predicament ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition) Clinical Journal of Oncology Nursing articles: Pregnancy and Cancer Treatment: Developing a Standardized Testing Policy and Procedure Unintended Pregnancy: A Systematic Review of Contraception Use and Counseling in Women With Cancer ONS Huddle Cards Fertility Preservation Sexuality ONS Congress® abstract: System Approach to Fertility Preservation and Pregnancy Status During Active Cancer Treatment (by Kelsey Miller and Ainsley Hartman) ECHO program (Enriching Communication Skills for Health Professionals in Oncofertility) Journal of the National Comprehensive Cancer Network article: Pregnancy Screening in Patients With Cancer National Comprehensive Cancer Network Guidelines: Adolescent and Young Adult (AYA) Oncology To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “It's really crucial to identify [pregnancy] prior to treatment, as this should be considered a patient safety ‘never' event. We know that exposure to chemotherapy or radiation can cause mutagenic changes in reproductive cells and teratogenic effects in a developing fetus. Women of childbearing potential should have a documented pregnancy test prior to beginning cancer treatment due to the adverse effects of chemotherapy and radiation on a developing fetus.” TS 1:42 “We had a fertility risk checklist that was based off American Society of Clinical Oncology standards, that was not fully operationalized nor built into physician workflows. The checklist was a way of documenting that risks of infertility, fertility preservation, and contraception was discussed, as well as an attestation that referral to a reproductive endocrinologist was made if needed. I had a physician partner at the time who said the only way to get the providers to fill out this checklist is to make it a hard stop, so that's what we did. The fertility risk checklist is now a hard stop by means of an order validation that will pop up when the provider goes to sign the oncology treatment plan, and it will say, ‘Orders cannot be signed unless the fertility risk checklist is complete.'” TS 9:27 “Whenever I develop teams, I like to share a common vision. We're all here for patient safety, and we want to prevent harm by pregnancy screening these patients that could potentially become pregnant during cancer treatment.” TS 13:20 “There's a misconception that all cancer therapy will render patients infertile, and this is not the case. Even though chemotherapy and radiation reduce fertility and may cause premature ovarian failure, many patients still remain fertile. And we know from research that physical intimacy remains important during cancer treatment, and unintended pregnancies may occur.” TS 18:13

JCO PO author Dr. Christian Rolfo shares insights into his JCO PO article, “Liquid Biopsy of Lung Cancer Before Pathological Diagnosis Is Associated With Shorter Time to Treatment.” Host Dr. Rafeh Naqash and Dr. Rolfo discuss how early liquid biopsy in aNSCLC in parallel with path dx is associated with shorter time to treatment. TRANSCRIPT  Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCOPO articles. I'm your host, Dr. Rafeh Naqash, Social Media Editor for JCO Precision Oncology and Assistant Professor at the Stephenson Cancer Center, University of Oklahoma.   Today we are thrilled to be joined by Dr. Christian Rolfo, Associate Director of Clinical Research at the Center of Thoracic Oncology at the Tisch Cancer Institute at Mount Sinai Health System. He is also the lead author of the JCO Precision Oncology article entitled "Liquid Biopsy of Lung Cancer Before Pathological Diagnosis is Associated with Shorter Time to Treatment."  Our guest's disclosures will be linked in the transcript.  Christian, it's great to have you here. Welcome to our podcast and we are excited to learn about some of the interesting results from your study.  Dr. Christian Rolfo: Thank you very much, Rafeh. It's a pleasure to be here and discuss about liquid biopsy. Dr. Rafeh Naqash: You have a very important role in different liquid biopsy consortiums. This is an initiative that you have been leading and spearheading for quite a while, and it's nice to see that it is becoming something of a phenomenon now on a global scale where liquid biopsies are being implemented more and more in earlier stages, especially. For the sake of our audience, which revolves around academic oncologists, community oncologists, trainees, and patient advocates or patients themselves, could you tell us a little bit about the background of what liquid biopsies are? And currently, how do we utilize them in the management of lung cancer or cancers in general? Dr. Christian Rolfo: Liquid biopsy has been gaining importance over the years. We started to talk about liquid biopsy in 2009 when we started to see some correlations with EGFR mutations. In practicality, what we are doing is the most common or most applicable indication is to go for liquid biopsies from the blood, peripheral blood. So we are doing a blood draw and from there, what we are capturing is the DNA or fragments of DNA that are still in circulation. But the liquid biopsy definition is a little bit more broad and we can apply the concept of a minimally invasive approach to different fluids of the body, including pleural effusion, urine, and including CSF that is another indication, there, we are going to be a little bit more invasive than peripheral blood, but it is also an emerging tool that we will have to find specific indicators. In cancer, we started the history of liquid biopsy in advanced disease with the identification of biomarkers, and then from there, we are moving to other scenarios, including, nowadays, monitoring minimal residual disease and early detection. And that is applicable also for other tumors. Dr. Rafeh Naqash: Thank you, Christian, for that summary. Now, as you've rightly pointed out, we have come to implement liquid biopsies more and more, both in the academic setting and the community setting. And this has definitely led to faster turnaround time in some ways compared to tissue. In this study that you have authored with the help of many other collaborators and Foundation Medicine Flatiron Health data, the goal here, from what I understand, was to look at liquid biopsies that were done before, resulted before the pathological diagnosis. Could you tell us a little bit more about the premise of this study, why you thought about this question and how did you try to implement that idea to get to some of the interesting results that you see here? Dr. Christian Rolfo: Yeah, so what we are seeing generally in lung cancer and also in people with other tumors is that patients are having a journey and that they start seeing different doctors until they get a diagnosis. Generally, after the pathological diagnosis, if you don't have an in-house technology that is doing reflex testing, generally, oncologists need to request for testing and that is taking time. So if we are looking for comprehensive days until a patients are able to get a molecular profiling before we start the treatment is sometimes very long. We are talking, in some cases, about months. So, how we can speed the process, that was the main question. We tried to include liquid biopsy in the staging procedures that we generally were doing when we have a clinical diagnosis of lung cancer. It's either images that we are used to do, PET scans, MRIs, and other assessments, we want to include liquid biopsy there before the biopsy. And that's what we did. We were searching for this specific aim using the Flatiron Health Foundation Medicine electronic health records from 280 centers across the United States. We included a big number of patients in this analysis, more than 1000 patients for the first analysis. Dr. Rafeh Naqash: That's phenomenal that you had real-world data from 200+ centers across the US. Of course, when you have patients on a clinical trial versus patients in the real-world, we all know that there are differences in terms of approaching, overseeing, and managing these individuals. So this data set is an extension of what we could see in the real-world setting.  Could you tell us a little bit about the number of patients that you eventually identified that had liquid biopsies done before pathological diagnosis? I think you have different cohorts here, a group that was before and a group that was after, and you compared several important metrics treatment-wise from what I see. Could you highlight those for our listeners? Dr. Christian Rolfo: Yeah. So we were looking for patients who had a liquid biopsy CGP, comprehensive genomic profiling, ordered within 30 days pre diagnosis and post diagnosis. We focused on 5.2% of patients, which corresponded to 56 patients who ordered a liquid biopsy before diagnosis. The median time was eight days between the order and diagnosis and the range was between 1 to 28 days. And that was compared with 1020 patients who ordered a liquid biopsy after diagnosis. It is important to be clear that both cohorts had a similar stage and ctDNA tumor fraction. We can explain later what tumor fraction is, because it was done in addition with a paper that we just published last week. Liquid biopsy patients were consulted to have this CGP median one day after diagnosis, versus 25 days after for patients who had their diagnosis and their liquid biopsy later on. So, from these patients, the majority of the patients, 43% of LBx-Dx were positive for an National Comprehensive Cancer Network driver, and 32% had ctDNA TF >1% but were driver negative, so that is what we call presumed true negative. From here, maybe I can explain what is tumor fraction and, in general, how we use it.  Dr. Rafeh Naqash: I think that would be great for our listeners. We see this often in more and more liquid biopsy results nowadays, and I've tried to explain it to some of my fellows also. So, it would be nice if you explain for the sake of our listeners what tumor fraction is, what does it mean clinically, can you use it in a certain way, what biological relevance does it have. Dr. Christian Rolfo: So we are analyzing another paper that came out this week in cancer research on the concept of tumor fraction and it's a new definition. So what we are doing with tumor fraction is an algorithmic calculation or mathematical calculation on the amount of DNA of the cells also taking into consideration the math, the quantity of DNA present in the sample. So we are going very low in the sensitivity of this analysis and capturing there the real informative results of the ctDNA of the liquid biopsy. So in practicality, when you see a report that says the threshold that was established in this study was more than 1% or less than 1%, so patients who have a tumor fraction of more than 1%, we can really consider this liquid biopsy informative. And also in this next publication, we compared with tissue. In patients with a tumor fraction of more than 1%, were completely 100% correspondent with what we found in the reflected tumor tissue, the NGS. But what happened in patients with a tumor fraction of less than 1%, we can say that these patients are not informative. So we need to wait for the tissue biopsy result to come in because we were able to recuperate several patients that the liquid biopsy was negative with the tissue biopsy positive. This is an important concept because we are distinguishing not only the informativeness of liquid biopsy, but also we can distinguish between patients who are considered not shedder based on what is considered a shedder. And that was a problem until this kind of introduction was a problem before with the technology because the technology wasn't very fast to distinguish the sensitivity or high sensitivity. Now, the sensitivity is no longer a problem. Maybe, there is really value of information in what we have in liquid biopsy, and using this mathematical help, we can get these patients distinguished and help more people. So that would be really interesting. Dr. Rafeh Naqash: You touched on a few important concepts here, and one question I have, and I think there's no better person to answer this question. You're the right person to answer this question for our audience. Do you think when you have a liquid biopsy tumor fraction of less than 1%, and you have a tissue that is pending with an NGS, where tissue NGS has not resulted yet, but liquid biopsy results come in and tumor fraction is less than 1%. But let's say you have a non-smoker with a typical driver mutation and clinical characteristic positive individual in the clinic, and the tumor fraction is less than 1%. How much can you trust that liquid biopsy when the tumor fraction is less than 1%. Because do you think some of these driver mutations, like you mentioned, could be low shedders and you could miss a potentially actionable mutation on a liquid biopsy if the tumor fraction is less than 1%? Is that something that you've looked at or correlated or understood what would be the clinical meaning of that? Dr. Christian Rolfo: Absolutely. So there are two concepts here. A liquid biopsy could be non-informative, and that is what we saw in this paper. So you have patients that have a liquid biopsy negative, and that we see in the clinic, a liquid biopsy negative tissue biopsy positive. That could be because the liquid biopsy is not informative, but it could be also that the patient, for some biological reason, and we don't have an answer about that, they are not shedding the ctDNA in the bloodstream, ctDNA that we can capture. What we saw in different studies, including one of the papers that we presented also in ASCO last year with a MET amplification and  METex14, for example. In the study that was the VISION study using tepotinib, you see that patients who have a liquid biopsy negative are doing a better outcome compared to a patient who have a liquid biopsy positive. So I believe that we still have patients who are not shedders for some biological reason, that could be put in together with patients who have more bone metastasis than organ metastasis, or patients who have more in location, for example in the brain. These patients are difficult to capture in ctDNA due to some biological reasons. But also you have patients who are non-shedders. For the technicality of the parts of this tumor fraction analysis, it is really important to distinguish that and we will hear more and more. So, as you say, we have already some reports in some companies like Foundation are doing, but some others like to incorporate this tumor fraction. And several in-house technologies allow also to have this kind of mathematical calculation. So that is what we are facing now, to really understand better the power of liquid biopsy. Dr. Rafeh Naqash: Now, some of the other things that your project or paper that you published with JCO PO does not necessarily cover is the payer aspect of this. Now, we've had more and more discussions, obviously, and more and more information has been highlighted with the payers that this is an important test and needs to be reimbursed, even though if you do tissue NGS, liquid biopsies are complementary to tissue. So taking both together is probably a better view of the overall tumor or the mutational status of the tumor. But one of the biggest holes in this whole process, and this is my personal experience, I want to know what you think, is that we can't order these tests when the patient is admitted to the hospital, and 50% or more patients end up getting diagnosed in the hospital during an inpatient stay. The average hospitalization for someone with lung cancer is five to seven days on average, and then another one to two weeks to get into the clinic to see an oncologist. So what would your thoughts be there? How can we improve things there in terms of, can we try to do something different so that the payers agree that, yes, you can send a liquid biopsy when the patient is admitted, because there's that 14-day Medicare rule? Has your team, or have you in particular, tried to navigate some of those issues, and what are your thoughts on how we can try to improve some of those conversations?  Dr. Christian Rolfo: Yeah, that's a really good question, because here we are talking about inequities in access to the technology and the results and it's crucial. Several of our patients, specifically in lung cancer, they are coming to our consultations or to the emergency with a very bad situation so they need to be admitted immediately. And as you say, they can be there for one month waiting for results or for recovery or for stabilization of their general condition before we can start. Several of these patients will have some biomarkers that we can target with treatment. So in other words, I will say that this is a stupid rule because we cannot have in 2024 these kinds of limitations to access to treatment when we have on one side, the FDA is doing a terrific job to get drugs approved in a very short time, and on the other side we have payers who are not understanding the concept of molecular or precision oncology.  So what we are trying to do in these cases, to be honest, is to navigate with the vendors and try to get this done. I generally send the samples because I consider that personally that it is a very crucial information. And in several cases, we have started targeted therapies while the patient is still admitted. So I think it's something that we need to put in a better effort, because already we are not doing enough for our patients, if you look at the data of the MYLUNG Consortium that was presented in ASCO some years ago on the testing performance in the community practice, 50% of the patients with lung cancer were tested there were only some in minority groups, African Americans, 39%. So I think we need to do better in education, but also from the payer side, it's really crucial that they understand this concept.  Advocacy groups have a lot of say here. They are also doing an important job on that. We are now launching with ISLC, ISLB, Lung Cancer Europe, and Longevity in a survey that is to make also the patients aware what is the importance of molecular profiling, tissue or liquid biopsy, it's very important that you get something to treat the patient and select the right treatment. And even to say, there'll be a whole other work in your case so that is really important.  Dr. Rafeh Naqash: Absolutely, I completely agree. We have made a lot of strides, but there is still a lot of room for improvement in terms of equity, access, and reimbursement.   Now, one of the things that I noticed in your paper, and you could tell me a little bit more about this, when you looked at the pre-diagnosed liquid biopsies, meaning before tissue diagnosis, 56 individuals there suspected to have lung cancer, community-based testing was identified in 53 individuals versus academic being three. This is very encouraging when you see something like this happening in the community. Did you look at that? Did you try to understand why or how that was the case? Because in a general community setting, I would think that community practices have a more complicated system of reimbursement because they are dependent on direct reimbursement, whereas in bigger academic centers, there's some leeway here and there. So did you try to understand how they were able to order this before tissue, could you give us some insights there? Dr. Christian Rolfo: Yes, I think it was not big in this specific question, but it's a very interesting topic. Because we, generally, in academia, will believe that we are doing the things in advance and we are more, compared with the practical and the general practitioners or the general colleagues in the community practice, we have more resources. But sometimes, and it's true, obviously, we have more resources in terms of research and more opportunities in terms of clinical trials in some cases. But I think we understood with this minimal example that there is an important interest among general oncologists in the community practice to get this done. And this is something we need to emphasize, because sometimes we are putting the blame on our colleagues that are outside the academic centers on this lack of testing, and it's not really true sometimes. So this is a good point to start to work together and try to get more things done for our patients and try to get also the reality.   I think one of the problems we will have in the future that we can face right now is the lack of new figures in this molecular profiling. I am referring, for example, molecular nurses or personnel that is working and helping to get this done. We need to have more people that are working in this education for the patients in the access to treatment and access to the technology, but also to navigate better these problems with payers that sometimes in some patients that seem to be overwhelming. Because when you talk about the $100 that could be extra, it's hard for some patients. So we need to be very conscious about that. So having a new figure in the hospitals and the community practices could help to test more patients.  Dr. Rafeh Naqash: And I think at the end of the day, the payers or the reimbursement mechanisms need to understand that genomics is part of the diagnosis these days. It's not ancillary, it's not an addition, but it is part of the diagnosis. I'm pretty sure you have had similar instances where you get a confusing pathology result but then a genomic result points in a certain direction. You treat the patient in that direction, and then you see the patient benefiting in the tumor shrinking, which suggests that genomics is complementary to the path diagnosis. It's not necessarily a surrogate.You can't replace pathological diagnosis, but you can use genomics as a complementary diagnosis as part of the whole paradigm of treating the entire patient. So I think we definitely need more and more conversations like the ones that you're having or your liquid biopsy consortium is having and then more education from the FDA. Of course, more legislation, more advocacy.   Going back to the paper, I did notice another interesting thing, which is, again, very encouraging is patients with lung cancer with a performance status of 2 or about had a decent proportion of testing done. Which, again, points out to the important concept of avoiding these preconceived biases that, “Hey. If somebody is not a great performance status, testing and finding something in that individual could potentially change a lot for the individual.” Do you have any personal examples from patients you have treated or seen in the clinic for our listeners where you identified something and maybe they were not doing as great initially, and then you identified something in liquid biopsy, treated them and it changed the entire course of their illness and whole trajectory for them? Dr. Christian Rolfo: Being working in lung cancer for years, everyone has this kind of patient that we see that their performance state was very bad. Obviously, as a clinician, we need to identify why the performance is bad and is deteriorating. So we see some patients in lung cancer, some of them, they can have a very important comorbidity packet that is associated with lung cancer. So in patients who have a deterioration for lung cancer, and we find a driver help in some patients that were doing a kind of a weakness, and that is something that we see in several patients, specifically in patients living with leptomeningeal disease. In some cases, when we start to do drivers that have a big impact in the crossing the blood-brain barrier, I have a good response.  I have patients that had an important recovery. So this is something we need to distinguish and sometimes when the patients seem very bad they say, “Okay, we go directly to targeted care or supportive care.” We try to test these patients as well because these patients have an important impact on the quality of life that we are treating. We will not be able to cure patients in this setting with targeted therapies, but we can certainly make an impact in the quality of life and also in our form of survival.  Dr. Rafeh Naqash: One of the other questions that comes up often when you're in a multi display team, since most cancers these days are on the multi display decision making opportunities to treat the patient the best possible way is: Who orders the liquid biopsy? I remember from my fellowship several years back, our program director Paul Walker, who is, again, an amazing lung cancer thoracic oncologist, he had advocated that our endoscopic suite folks, the bronchoscopist, whether it was pulmonary, interventional pulmonology or CT surgeons, whoever did the bronchoscopy for the first time in the patient that they would send it whenever they see the patient from the bronchs. This was around six, seven years back. And I think Paul was a little ahead of his time and I didn't necessarily understand the implications that this would have.  And now, as I progress in my own little career, I can see the vision that he had, which I think a lot of other sectors have tried to do, and I'm pretty sure you have a certain process, too. Is that something we should try to talk more and more about? Because, of course, when you do the bronch, then you get a diagnosis and the patient sees the oncologist. This whole process takes anywhere from two to three weeks, maybe even more for smaller centers. So, is that something that you're doing or you see that you're having more conversations that, “Hey. Whoever sees the patient first should be able to order the liquid biopsy.” It's not necessarily the medical oncologists, it doesn't mean I love to order sequencing results or  sequential tests, but it could cause a delay in the patient care. So, could you tell us a little bit more of that?  Dr. Christian Rolfo: So it's really important, this part, because we need to create in our institution flows that will have this very well organized. And ideally, in the ideal world will be that we have reflex tests coming from the pathologist, but it's not happened in several places, because we don't have our NGS at home, or we are sending to vendors, and sometimes we are not sending to them. So that is one of the aspects.  The second aspect, and that I think is still a problem in some treatment, is that we still have 24:30 cytologists coming out in place of covariances. And in our institution, we were working very hard with our interventional pulmonologists and interventional radiologists to get this quality of tissue appropriate, and we have a very good rate of success and issues in a very minimal quantity of patients. Obviously, some patients are very difficult to get samples, and we need to refer still with cytology. But in some cases, where our surgeons or our pulmonologists have sent in samples for NGS, and I think this is we are coordinating. “I will see this patient next week. Can you please start to order?” And here, our nurse practitioner, our nurses in the team are also playing an important role for the reason I insist in the idea to have new figures that could be these molecular navigators we can call, or molecular nurses that helping coordinate this, not only the coordination, but also in the discussion of molecular tumor boards. We did an experience like that some years ago at Maryland University, and actually it was a very important opportunity to decrease the number of quantities of issues and get the results done very quickly. So I think it's important to come to have conversations with our colleagues, pulmonologists, radiation radiologists, interventional radiologists, pulmonologists and pathologists to get this done very quickly.  Dr. Rafeh Naqash: I love the idea of molecular navigators. And of course, everybody in the current day and age, we're having staffing issues, so getting a molecular navigator would be awesome, but I'm not necessarily sure how everybody would be able to implement it. But I think in the bigger picture, whether it's molecular navigators or multi disciplinary nurse navigators in general, liaisons in general, I think we all can do a better job in trying to coordinate some of these testings. And we have tried to do that through our thoracic oncology group and of course, there's a lot of progress that needs to be made, one step at a time. Dr. Christian Rolfo: If somebody is interested in this topic on the International Society of Liquid Biopsy, we started with a project that is called a Certificate for Advanced Studies in Precision Oncology. So we are educating the healthcare team for all this process and trying to get practical insights to have this career later. Because I think it will be something that's interesting for nurses or pharmacists to get this kind of career later or get another approach in their career.  Dr. Rafeh Naqash: Thank you so much, Christian.  Now, going to not the scientific part, which I think is the most interesting part of this conversation is to talk about you and your personal journey. Could you tell us a little bit about where you started, what your career has been like, how did you progress? Because you have a lot of junior faculty that listen to this and it's always good to take inspiration from people like yourself.  Dr. Christian Rolfo: Thank you. As you can hear my accent, it's not from here. So I was born in Argentina, I did my medical degree there. And then I had the opportunity to get a scholarship in Italy. I went to Italy and I stayed there for seven years. I did my fellowship there again, and I started to know there precision oncologists. My journey started in sarcoma. And actually I was working in the group of Dr. Casali's group, a very well known sarcoma expert. And at that time we were running phase I trials for imatinib, I remember, known as GIST. I saw this kind of response and awakening of patients that were really in very bad condition, with only through this imatinib. Very little to treat that disease at that moment, a median overall survival of two months. So I started to be interested in that. Then I moved from there to Spain and met Dr. Rafael Rossell, who was my mentor. In Italy, I have also a mentor in breast cancer, Dr. Luca Gianni, one of the pioneers in breast cancer treatment. So knowing all these people and having the support of them, was really crucial.  So I think this is the first advice for junior faculty: try to choose your mentor, even if your mentor is not in your center. Like the case, for example, Rafael Rossell was not in my hospital, but he was my mentor. So having this kind of discussion, I did my PhD in EGFR mutation, at that time was the fashion, not immunotherapy, of the moment. And then from there, after eight years in Spain, I moved to Belgium. I have a short period of completing my training at MD Anderson and I went to Belgium to Antwerp University and that was the opportunity to become the Director of the phase I program in the Early Clinical Trials Unit. It was really exciting to see growing a unit, and now they continue  at the center in Belgium. My colleagues that stayed there, they are doing a terrific job of continuing this idea. And from there I went to Baltimore, three years working at Maryland University being the Director of Thoracic Oncology and early clinical trials as well. Three years after, I moved to New York, and here doing this journey in clinical research, also being the Director of Clinical Research at the Center for Thoracic Oncology.  Life has put me in different places, different cultures, different opportunities. For me it was a really good journey to be in different countries, knowing different ways to see oncology as well, and immediately to work, because it was a shock coming from Belgium to the area of Baltimore where I had the reality to discuss peer to peer conversations and things that are not usually discussed in Europe. So it was really a very nice journey to learn, to have the capacity to adapt.  That is the other thing, my second advice, if I can give advice, but if you have the opportunity to go to some place, adaptation is the most important. So try to enjoy what you're doing and try to enjoy and learn from the patients, hopefully, and contribute your knowledge as well. Dr. Rafeh Naqash: Thank you so much, Christian. Two last questions. For all the places that you visited, what is your favorite place? And what is your favorite food? Dr. Christian Rolfo: My favorite place to live, I have Italy in my heart. Obviously, Argentina is my place, family. But Italy is in my heart. And then Spain, Spain gave me my wife and my son. So I have very good memories there and it's a very nice place. Obviously, I'm Argentinian, so for me it means meat in some places, Asado, that is a typical Argentinean one. But also, I am very eager to enjoy the pasta and paella, so we have several things. Anyway, here in New York, the pizza of New York is great. It is not Italian. This new way to make pizza from New York is fantastic.  Dr. Rafeh Naqash: I can try to see you're trying to keep everybody happy in a politically correct way. Dr. Christian Rolfo: I didn't mention Belgium, but we have chocolates there.  Dr. Rafeh Naqash: That is true. Every place is special and unique in different ways.  Christian, thank you so much. This was very entertaining and very informative for me and hopefully for the audience. Thank you so much for being a part of this conversation. And thank you so much for submitting your work to JCO PO. We hope you consider JCO PO for future research in this exciting area as well.  Dr. Christian Rolfo: Thank you. Thank you very much, Rafeh, for the opportunity. And JCO Precision Oncology is a really great forum to discuss precision medicine. Congratulations for all your work. The last, if you allow me to give an advertisement here. We have our Liquid Biopsy Congress, the ISLB, the annual conference will be in Denver from 20 to 25 November, so just before Thanksgiving day. So if you are able to go there, we will have a lot of discussion on liquid biopsy like we did today. Thank you very much.  Dr. Rafeh Naqash: Thank you so much for highlighting that, and hopefully, our listeners will try to register and be part of that meeting.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review. And be sure to subscribe so you never miss an episode. You can find all our shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

CancerNetwork® collaborated with OncLive® to speak with Edward S. Kim, MD, MBA, and Richard T. Lee, MD, about ongoing initiatives to expand integrative oncology for patients with cancer at City of Hope. Kim is the physician-in-chief and senior vice president at City of Hope Orange County as well as the Construction Industries Alliance City of Hope Orange County physician-in-chief chair. Lee is the Cherng Family Director's Chair of the Center for Integrative Oncology and a medical director of Supportive & Integrative Medicine in the Department of Supportive Care Medicine as well as a clinical professor of Supportive & Integrative Medicine at City of Hope. The discussion partly focused on how integrative oncology is practiced at City of Hope. The institution's style of integrative care derives inspiration from traditional Eastern medicine and encompasses modalities such as acupuncture, meditation, yoga, and massages to help treat patients with cancer more holistically. Lee cited updates in integrative therapy guidelines published by the Society for Integrative Oncology (SIO) in partnership with the American Society of Clinical Oncology (ASCO) to illustrate how integrative care can benefit patient quality of life.1 For example, he highlighted that there was strong evidence in support of implementing mindfulness-based interventions to help reduce anxiety and stress among patients. “These types of integrative therapies are a great way to complement many of the standard-of-care options that we have and provide even further benefit in controlling these symptoms and allowing patients to have a better quality of life as they go through treatment and as they head into survivorship,” Lee said. The conversation also pertained to the institution's efforts to expand the Cherng Family Center for Integrative Oncology, a first-of-its-kind national integrative oncology program, following receipt of a $100 million gift from Andrew and Peggy Cherng, co-founders and co-chief executive officers at Panda Express, supporting its creation.2 This initiative will include conducting rigorous research in a clinical program that may inform future integrative oncology guidelines, pursuing natural product drug development, and instituting educational programs that may train future integrative oncologists. "The only way we're going to be able to increase access to these important programs to more people is to do the rigorous, level 1 research that's needed in order to prove that there is a benefit of any particular area,” Kim said. “Because if we're rigorous and we show the results are positive, then we would expect them to be on the guidelines like the National Comprehensive Cancer Network, and then payers would then provide support to patients who want to have these services.” References 1.        Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2023;41(28):4562-4591. doi:10.1200/JCO.23.00857 2.        Logsdon Z. City of Hope receives $100 million gift to create first-of-its-kind national integrative oncology program. News release. City of Hope. September 12, 2023. Accessed March 13, 2024. https://tinyurl.com/26y3xj87

Drs. Meghan Berkenstock, Stella Kim, and Lauren Dalvin join the show again to teach us about immune checkpoint inhibitors: game changers in oncology, but with a host of ocular side effects. All eye providers will be seeing more patients on this class of medication, and our panel teaches us what to look for and how to manage it. Additional resources: the National Comprehensive Cancer Network offers a suite of clinical practice guidelines to help clinicians manage immunotherapy ocular adverse events. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Weighing the possible side effects of prostate cancer treatments while considering various treatment options can be a daunting challenge for men and their loved ones. We are excited to partner with BioProtect for this episode, with our distinguished guest, Dr. Jonathan Tward, a Radiation Oncologist and tenured professor in the Department of Radiation Oncology at the University of Utah Health. Dr. Tward will fill us in on a progressive new technology that aims to minimize both short and long-term side effects of radiation therapy for prostate cancer. Dr. Tward is a highly regarded authority and key opinion leader in the management of prostate cancer. He earned a Ph.D. in biochemistry at UCLA, a Medical Degree at Tufts University in Boston, and he completed his radiation oncology residency training at the University of Utah. He holds the Vincent P. and Janet Manzini Presidential Endowed Chair at Huntsman Cancer Institute in genitourinary malignancies. Dr. Tward specializes in delivering precisely targeted radiation therapy for numerous genitourinary malignancies, including prostate cancer. He utilizes various advanced technologies, including intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, and low and high-dose-rate brachytherapy. Dr. Tward has contributed to over 100 published peer-reviewed journal articles. He also actively serves on the National Comprehensive Cancer Network clinical practice guidelines committees for prostate, bladder, and penile cancers. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Links: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here. Connect with Dr. Tward Dr. Jonathan D. Tward BioProtect BioTech Balloon Spacer Procedure Video Symmetry, Visibility, and Control: The Advantages of the BioProtect Balloon in Prostate Cancer Treatment - Edward Soffen VideoAvailable Rectal Spacer Options for Patients With Prostate Cancer Undergoing Radiation Therapy Video Urology Times Video  

“The search for daunorubicin's sister really led to this discovery of doxorubicin, which is an analog with much greater activity. The discovery of doxorubicin can be coined kind of as, ‘one of the best drugs born in Milan, Italy.' And after that, a few analogs were developed and tested, and two that we currently use today, are idarubicin and epirubicin,” Puja Patel, PharmD, BCOP, clinical oncology pharmacist at the Delnor Hospital Northwestern Medicine Cancer Center in Geneva, IL, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about anthracyclines and other antitumor antibiotics. This episode is part of a series about drug classes, which we'll include a link to in the episode notes.  You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD), which may be applied to the nursing practice, oncology nursing practice, symptom management, palliative care, supportive care, or treatment ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by January 26, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge of anthracyclines and antitumor antibiotics.  Episode Notes  Complete this evaluation for free NCPD.   Oncology Nursing Podcast: Pharmacology 101 series  ONS Voice oncology drug reference sheets  IV Cancer Treatment Education Sheets  ONS Voice articles:  The Evidence Is Building for ACE Inhibitors in Anthracycline-Associated Cardiotoxicity  Outpatient Oncology Drug Series: Doxorubicin Is the Infamous Red Devil  Clinical Journal of Oncology Nursing articles:  Nursing Alchemy: Transforming R-CHOP Information Into Essentials  Dyspnea: Common Side Effect  Cardiac Toxicity: Using Angiotensin-Converting Enzyme Inhibitors to Prevent Anthracycline-Induced Left Ventricular Dysfunction and Cardiomyopathy  Oncology Nursing Forum article: Symptom Clusters in Lymphoma Survivors Before, During, and After Chemotherapy: A Prospective Study  ONS Huddle Card: Antitumor Antibiotics  Additional healthcare professional resources:  Blindspot: Hidden Biases of Good People  Harvard University Implicit Association Test  OncoPharm Podcast  ASCO Education Podcast  Additional patient resources:  National Comprehensive Cancer Network patient resources  National Comprehensive Cancer Network patient webinars  National Cancer Institute resources for patients   To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “Anthracyclines are kind of categorized as topoisomerase II inhibitors, and these agents are very powerful in that they have—it's really like three drugs in one—they have various mechanisms.” TS 3:55  “We need to create a stable environment, and so we actually cut one of the cords, and that's exactly what topoisomerase is doing. It's cutting one of the DNA strands. And in this case, it's cutting two strands, and that's why it's called topoisomerase II, so it's cutting both of the strands. It's cutting the DNA, releasing some of that tension, allowing for replication, and then rejoining that portion. So, it's a very important enzyme, and it'll go about doing this for the entire strand of DNA.” TS 4:50  “The other second mechanism is kind of the effect on DNA. So, you'll come across reading the term ‘DNA intercalation.' So, what does that word mean? When you take the word ‘intercalate,' the definition of it means ‘intrusive inserting of something in an existing series or sequence.' The analogy that I could think of here is simple: It's thinking about too many passengers squeezing in the backseat of your car. There could be safety issues, there's weight issues, there's instability maybe while driving. And that's what this doxorubicin is doing. It's sliding right in between the base pairs of the DNA double helix, destroying hydrogen bonds between those two bases, which then change the shape of that double helix. And by changing the shape, topoisomerase II, which we just talked about, can no longer go in and bind to DNA. It can't relax that super coil. And so, DNA synthesis doesn't happen.” TS 6:02  “So, the main toxicity that our listeners might be familiar with is cardiotoxicity. And also with cardiotoxicity, breaking it down a little bit, there's an onset that occurs during treatment or even years to decades, and that's kind of this delayed cardiotoxicity. Signs and symptoms of acute cardiotoxicity could vary from EKG changes present as tachycardia, tachyarrhythmia. Delayed cardiotoxicity is anything from heart failure to left ventricular ejection fraction decrease.” TS 9:41  “We're worried about heart failure in these patients. So, we might see EKG changes, we might see LVEF [left ventricular ejection fraction] changes, and we're kind of tracking these agents based on what is called cumulative dose tracking or lifetime dose. So, all of these agents have specific lifetime maximums that we need to be aware of.” TS 14:53  “So, smoking, hypertension, diabetes, dyslipidemia, obesity, or you're older in age, or perhaps you have a compromised cardiac function—you're at greater risk for developing these cardiotoxicities. An example that I've had in my clinic is I've identified some of these patients that have these risk factors, and we go into a little bit more aggressive monitoring for the echocardiogram or MUGA [multigated acquisition]. And when we put in those orders, we often get denials from insurance. We submit the guidelines in, kind of, appeals to help those patients kind of proactively realize if we're putting them in a greater cardiac risk.” TS 15:47  “One of the biggest things is for nurses to kind of look over their policies for administration for vesicants and specifically checking blood return for these agents, because many of them are given, you know, IV push. So, checking blood return every 2–5 ml is really important to make sure that you are in the right space. And then these agents, some of them can also be given continuously. So, you're thinking about, first of all, you should have a central line in for these agents because they're vesicants. But if it's being given continuous, there is something that's called anthracycline streaking, and it's not the same as an extravasation. So, I think being able to decipher the difference between the two is really, kind of, comes with experience.” TS 20:36  “I think awareness is really essential. And thankfully, you know, thankfully or not, I guess, you were with the patient for this entire time, right? Because you're pushing every 2–5 ml, you're checking. So, it's a very kind of intimate experience in and of itself. So, I think just being very vigilant is very important.” TS 22:24  “So, to talk about bleomycin here, for example, kinetically, two-thirds of this drug is eliminated renally. And so, we would think that there would need to be renal adjustments if there's renal changes. So, for creatinine clearance greater than 50, there are no renal dose adjustments. But after that, every 10 ml per minute decrease in GFR [glomerular filtration rate], there are dose reductions that are required. And this drug, in particular, has a lot of gradations in terms of renal dysfunction that I've seen.” TS 27:30  “Thinking about bleomycin, it's IV over 10 minutes, and you want to think about the lifetime maximum dose. So, when you are working up your patient, that's something to kind of think about. Dactinomycin is highly emetogenic, so making sure that there's antibiotics on board. It's also a vesicant, so thinking about vesicants precautions. Cold compresses is how you would help treat that if there is an extravasation.” TS 33:14   “I think trust is the foundation oncology really because we are asking our patients to do so many things outside of our infusion center, picking up medications, taking medications, calling us about signs and symptoms, going and getting all these imaging know. So, if there isn't that foundation of trust, having this perfect curative treatment plan may be more challenging to really be carried out.” TS 38:06  “We've developed these very powerful agents, and they're non–cell specific. So, I think the next step would be, how can we reformulate them to make them less toxic and provide more of a targeted approach? And so, perhaps an antibody-drug conjugate that is specifically attacking the lymphoma or the breast cell can deliver this chemotherapy with a cytotoxic payload is there in the horizon.” TS 39:07  “I think the misconception that ‘I will develop heart damage' is really important. Doxorubicin has the infamous name of the red devil, but I think it's important to let your patients know that heart failure increases with cumulative dosing. You know, talking to them about 300 mg/m2 is associated with a 1.5% heart failure risk. Whereas going all the way across to 500 mg/m2, now you're looking at 6%–20% probability of developing heart failure.” TS 42:30  “I think taking the time and understanding the literature. Typically, we don't start these agents with LVEF less than 50–55. There's some great review articles in JCO [Journal of Clinical Oncology] that kind of define what cardiomyopathy decrease looks like and decreases in LVEF over 10% to a value below the institutional limit of normal, I think, is a nice point to have as a value, a number to kind of work with.” TS 43:53  “Working with your nurse educator and leader to help achieve OCN®, oncology certified nurse, certification is really important. And I think live simulated experiences are really beneficial, maybe even looking at extravasations or having an infusion-related reaction, because here in the acute setting, we're really kind of in this like responsive mode. But if we practice, we can respond more deliberately and more calmly.” TS 45:05 

Margaret Tempero, MD, is an internationally renowned expert in pancreatic cancer, a Professor of Medicine and Director of the Pancreas Center at the UCSF Comprehensive Cancer Center. She organized the first Pancreas Cancer Think Tank in 1999 and chairs The Pancreatic Cancer Action Network's (PanCAN) Scientific and Medical Advisory Board. She was recently inducted into the prestigious Giants of Cancer Care. A thought leader in cancer, she is a former president of the American Society of Clinical Oncology and American Pancreatic Association and currently serves on the ASCO Conquer Cancer Foundation Board. She also serves as the Editor of Chief of Journal of National Comprehensive Cancer Network. “I remember asking a mentor of mine, ‘What does success mean?'” In her mind, Dr. Margaret Tempero expected an obvious answer: Some prestigious designation, a decorated award, maybe some groundbreaking research to her name; but when Dr. Ann Kessinger responded with the most fundamental truth of medicine, it revolutionized her medical philosophy to its core: “You're successful when you're improving the lives of your patients, plain and simple.” Join us for another episode of The Medicine Mentors as Dr. Margaret Tempero shares the true definition of success in medicine, teaches us how to improve the lives of our patients, and emphasizes getting to know the patient as a person before we know them by their disease. Pearls of Wisdom:   1. Success in medicine is found when you're improving the lives of your patients. Regardless of how you do it, the patient must be the first and center focus. 2. Get to know your patient as a person before you know them as a disease. It's as simple as asking them to tell you about themselves. Know the patient so you can help cater your discussion to a field that they understand. 3. Mentorship can be thought of like tennis; a bidirectional process where if your opponent is better, you do better. Mentees have to bring the full initiative to the mentor so they can play back.

Join us in this heartfelt episode of Pets Are Family as we welcome Patricia J. Goldsmith, CEO of CancerCare, a visionary leader in the world of cancer support services. With an impressive background at the National Comprehensive Cancer Network and the Moffitt Cancer Center, Patricia brings a wealth of knowledge and compassion to the table.In our conversation, we delve into the groundbreaking program CancerCare offers, aimed at helping cancer patients keep their beloved pets at home during their treatment journey. Discover how this initiative provides essential support like pet food, financial aid, and transportation for veterinary appointments. It's more than a program; it's a lifeline for patients and their four-legged family members during some of life's most challenging moments.Patricia's insights shed light on the critical role of pets in providing comfort and normalcy to individuals battling cancer. This episode is not just a discussion; it's a tribute to the power of compassion and the unbreakable bond between pets and their owners. Don't miss this inspiring and touching conversation with one of the leading figures in cancer care and patient support.Key Topics:Patricia Goldsmith's impactful journey in cancer support services.How CancerCare is making a difference in the lives of cancer patients and their pets.The significance of pets in providing emotional support during cancer treatment.Innovative approaches to healthcare disparities and patient care.Follow us:Instagram - @petsarefamilypodcastFacebook - https://bit.ly/3PC9wbxTikTok - @petsarefamilypodcast#CancerCare #PatriciaGoldsmith #CancerSupport #PetCare #HealthcareHeroes #CancerTreatment #EmotionalSupportAnimalsSupport the show

The end of the year typically brings a number of FDA approvals, and 2023 is no different. Last week, the Food and Drug Administration approved a new drug, Augyro (repotrectinib) for the treatment of patients with ROS1-positive non-small cell lung cancer.  Also making oncology headlines this week, is an expert update on the cancer drug shortage, research about how the severity of diabetes can impact colorectal cancer outcomes and how vitamin D may be able to mitigate the severity of chemotherapy-induced peripheral neuropathy.   FDA Approves Augtyro for Patients With NSCLC Subset Another week, another FDA approval. This time, the agency approved Augtyro for the treatment of patients with locally advanced or metastatic ROS1-positive non-small cell lung cancer.  The drug works by targeting ROS1 oncogene fusions, which can be responsible for the growth of cancer. The approval was based off findings from the phase 1/2 TRIDENT-1 clinical trial, which showed that 79% of patients responded to therapy with the drug, including 6% who experienced a complete response, which is when all signs of cancer disappear.  Bristol Myers Squibb, the pharmaceutical company that manufacturers Augtyro, expects the drug to be available to patients in mid-December.  FDA Approves Keytruda plus Chemo for Advanced HER2-Negative Gastric, GEJ Cancers Also in FDA news last week, the agency approved the immunotherapy drug, Keytruda, in combination with chemotherapy for the treatment of patients with advanced unresectable or metastatic HER2-negative gastric or gastroesophageal junction adenocarcinoma.  The approval came after findings from the KEYNOTE-859 trial showed that the immunotherapy-chemo combination improved overall survival) that's time from treatment until death of any cause); progression-free survival (time from treatment until death or disease worsening) and response rate compared to a group that received placebo plus chemotherapy.  FDA Approves Truqap Plus Chemo for Some With HR-Positive, HER-Negative Breast Cancer Additionally, the FDA has approved Truqap with chemotherapy fulvestrant for the treatment of adults with HR-positive or HER2-negative locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN-alterations and who have progressed on at least one endocrine-based regimen in the metastatic setting or recurred at or within one year of completing adjuvant therapy. And now this approval was based on the results of the CAPItello-291 trial where among patients with these altered tumors, the median progression free survival was 7.3 months in the Truqap and chemotherapy cohort and 3.1 months in the placebo and chemotherapy cohort. FDA Approves Xtandi for High-Risk Prostate Cancer And the FDA approved Xtandi for the treatment of patients with non-metastatic castration-sensitive prostate cancer, with a high risk of biochemical recurrence, meaning a recurrence that is determined by rising prostate specific antigen levels. According to Pfizer, the manufacturer of the drug, and notably, this marks the first approval of an androgen receptor signaling inhibitor that is FDA approved for this patient population.  The approval is based on findings from the randomized phase 3 EMBARK clinical trial were five-year metastasis free survival, which is the time from treatment until metastatic disease was 87.3% in the Xtandi arm, compared with 71.4% and the leuprolide-only group and 80% in the monotherapy group, according to findings that were published in the New England Journal of Medicine.  Drug Shortages Continue to Be a ‘Serious Problem' in Oncology While the shortage of the chemotherapy drugs, cisplatin and carboplatin, seems to be improving, drug shortages, in general, are not a new problem and likely are not going anywhere soon, according to Corey McEwen, the director of oncology pharmacy services at Massachusetts General Hospital in Bostin.   McEwen explained that most of these drugs are manufactured outside of the United States. The FDA will approve certain locations to make the drugs, which then are shipped to the wholesaler, then the cancer treatment center or clinic and finally, to the patients. However, at no point during that process is there an obligation to be transparent about drugs that are in shortage or at risk to be in shortage.  Additionally, with increased demand and decreased supply, the price of these therapies can go up. At Mass. General, McEwen said that the institution will oftentimes take on the financial burden of the increased cost, because they are mainly focused on getting the drugs in the first place. However, that may not be the case in all cancer treatment centers, leading to more disparities and financial burdens from cancer care.  Diabetes Severity Associated With Poor Colorectal Cancer Survival Research published in the journal, Cancer, analyzed outcomes for patients with diabetes and colorectal cancer who underwent surgery for their cancer. Findings showed that patients with more severe diabetes tended to have poorer survival outcomes. This was particularly the case for patients who were female or in their earlier stages of cancer.  The researchers theorized that the relationship between diabetic severity and cancer prognosis may be explained by three mechanisms:  ·      Diabetes can lead to increased levels of insulin-like growth, which can accelerate tumor growth  ·      High blood sugar levels may result in poor response to chemotherapy  ·      The potential increased accumulation of genetic mutations that result from the high inflammatory burden caused by diabetes  Vitamin D May Help Prevent Chemo-Induced Neuropathy Once again, vitamin D made oncology headlines last week. This time, findings published in the Journal of the National Comprehensive Cancer Network found that patients who were deficient in vitamin D before starting treatment with paclitaxel had higher rates of chemotherapy-induced peripheral neuropathy than patients with sufficient vitamin D levels.  Peripheral neuropathy is a common side effect from certain types of chemotherapy drugs that presents as numbness, tingling or a stabbing feeling in the hands and/or feet. Eventually if the neuropathy gets so bad, patients can have a higher risk of falls or become unable to perform some essential everyday tasks, such as preparing food or getting dressed. There is currently no cure for the condition, so potential prevention or mitigation strategies — like getting enough vitamin D — are particularly important.  I spoke with study author Dr. Dan Hertz who said that while more research is needed in this space, it is worth it for patients to check their vitamin D levels and take a supplement, if needed. 

Drs. Shaalan Beg and Priyanka Kanth discuss the readiness, logistics, and barriers to implementing universal germline multigene panel testing for colorectal cancer (CRC) following new guidelines from the National Comprehensive Cancer Network that recommend genomic testing for all individuals with CRC younger than age 50. The experts also address other areas of unmet needs as new data emerge on moderate-risk genes and their association with CRC. TRANSCRIPT Dr. Shaalan Beg: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Shaalan Beg, your guest host of the podcast today. I'm the vice president of oncology at Science 37 and an adjunct associate professor at UT Southwestern Medical Center in Dallas. Last year, the National Comprehensive Cancer Network, or NCCN, updated its guidelines on colorectal cancer (CRC), recommending that all patients with colorectal cancer who receive a diagnosis before the age of 50 have multigene panel testing and that multigene testing should also be considered for patients 50 years of age and older with colorectal cancer, regardless of a personal or family history or other criteria. This represents a huge paradigm shift in the screening and care of patients with inherited cancers. And today, I'm joined by Dr. Priyanka Kanth, an associate professor of medicine and the director of the GI Cancer Prevention Program at MedStar Georgetown University Hospital in Washington, DC, to discuss new research that explores the readiness, logistics, and barriers associated with the implementation of universal germline testing in clinical practice.  You'll find our full disclosures in the transcript of this episode, and disclosures of all guests on the podcast are available at asco.org/DNpod. Dr. Kanth, it's great to have you on the podcast today. Dr. Priyanka Kanth: Thank you, Dr. Beg. It's wonderful to be here today and discuss this very exciting topic. Dr. Shaalan Beg: As a gastroenterologist who sees patients and families with a high risk for GI cancer, including medically underserved populations, can you comment on the significance of the expanded NCCN guidelines for colorectal cancer? Dr. Priyanka Kanth: Yes, absolutely. So this is, I would say, a big change from NCCN recommending pretty much every colorectal cancer patient can undergo multigene panel testing or universal. So everyone who's younger than age 50 and has colon cancer should get multigene panel testing. But we are also expanding it to pretty much anyone who may have colorectal cancer, and we can offer multigene panel testing. So, we are broadening the pool of patients who can get tested, and this will bring in more patients from very different demographics. So I think it will expand to every arena of patients with different insurance profiles, underserved, and, as more insurance companies and Medicare/Medicaid picks up, I think this will help a lot more patients in not only following on their genetic testing, but also their family members.  Dr. Shaalan Beg: Medical oncologists are very familiar with the challenges of implementing somatic molecular testing for people who have cancer. I can only imagine that implementing universal germline testing also has significant logistical challenges and barriers. You recently published a study in JCO Precision Oncology along with your colleagues and captured some interesting perspectives from clinicians on their practice of implementing universal genomic testing for colorectal cancer. Can you tell us more about this? Dr. Priyanka Kanth: Absolutely. So I would first like to thank the lead authors and senior authors of this study. They are Linda Rodgers-Fouche and Sanjeevani Arora and Rachel Hodan, who literally wrote the study and created and did all the legwork. And as you know how hard it is to do these big survey studies, so really thank them.  The study is a cross-sectional survey of the members of this Community Collaborative Group of America, IGC, which I would say comprises a lot of genetic counselors, gastroenterologists, oncologists, and colorectal surgeons who take care of these patients. So these are highly specialized groups that work in the field of GI genetics. Roughly 300 plus members were sent the survey to get their take on how they think [multigene panel testing] can be implemented for all colorectal cancer patients.   So to give you a synopsis of the study, the majority of members who participated, 70% or more, they supported this universal germline testing for colorectal cancer patients. But interestingly, more than 50% also thought that it will require a change in their practice or how this will be delivered. So that's the major takeaway, I would say. We are all supportive but how to really deliver to the patient would be the biggest challenge or barrier for us in the future.  Dr. Shaalan Beg: So, your study reported concerns on knowledge among non-genetics providers. I would assume that includes a lot of clinicians who are the first people to be in contact with potential patients who would require testing. How can the field mitigate this problem? And what are some alternate delivery service models for increasing awareness and making the process of ordering and following up on the results more efficient for practices? Dr. Priyanka Kanth: We all know the biggest barrier I would say is resources like who's going to deliver the added pool of patients that get genetic testing. So most of the current scenario, they're all seen by genetic counselors, but we have a limited number of genetic counselors and they cannot truly deal with this big influx. So how to educate non-genetic providers would be the biggest barrier. But also implementing in the system itself, like can we do pretest counseling as the first contact with the patient to deliver to discuss like you should undergo genetic testing. So that contact, can that be done with a non-genetic provider or even by other modes like telemedicine? Or can we do something like an online chat box or something which could just not only go over all the types of testing but opens the door for the patient to ask questions. So if there are alternate modes of delivery where the pretest is taken care of, that would be one big change required.   The other part is like when the test is done, who returns the results? So where does it go and who explains the results? So at that point, we surely need more genetic and even non-genetic providers if they are comfortable. So how to educate them would be the biggest barrier. At that point, I think, we are still figuring out the biggest change is in the system and requiring a take from all the stakeholders who are part of taking care of these patients. So not only genetic counselors, but oncologists, gastroenterologists, pathologists who are taking care of this patient to be on board and have a really clear-cut flow of how these are delivered, how these results are returned, and how they are explained to family members. Dr. Shaalan Beg: The workflows and the resources that you have in a high-risk GI clinic at a center like Georgetown's, I think it's safe to say, are much more than what typical resources a practicing provider will have in the clinic. How do you envision clinics resourcing for this type of test either through training or retraining their existing staff or by adding additional resources?  Dr. Shaalan Beg: At the community setting, it is really hard to educate essentially everyone as well. So, I feel like taking the load off the genetic counselor at the pretest level is the biggest implementation or change that can be done. And if we can remove that because not every patient is going to be positive for the gene mutation either; it does filter many patients who eventually will need returns. So at that place, how do you implement and where do you implement is the key and it is so system-based that I cannot even pinpoint. But I agree, bigger academic centers have better advantages and a knowledge base as compared to smaller community cancer centers or practices. Dr. Priyanka Kanth: Yeah, and I noticed that many of the respondents in your survey agreed with offering multigene panels, but there was variability by profession, and I was wondering if that resonated with you and that was an expected finding or not. Dr. Priyanka Kanth: Yes, and it was more so in terms of standardized multigene panel versus customized panel. So, this is fairly understandable because the genetic counselor is so well versed in offering which genes should be tested based on family history, but a non-genetic provider may not be fully equipped with the knowledge. So for example, myself, I do GI genetics, but if I have a patient with a lot of breast cancer in the family, I do defer them to a high-risk breast team. So there are nuances, too. The major difference here was also in standardized multigene panel, most of the gastroenterologists, oncologists were all for it compared to customized, which were more heavily leaned by the genetic counselor based on family history. And I can see why it's different because standardized, I would say, is much easier to implement and compared to customizing, which is based on family history or other cancer history and family. That's the major difference in the study. It comes down to education and experience and the follow-up based on what comes back from it.   Dr. Shaalan Beg: You've highlighted many factors, both from the pre-test, sort of preparing and selecting the right individuals, to ordering the right test based on the participant's risk factor profile and then optimal ways of following up on the results of these genomic tests. What are other areas of unmet needs when it comes to genomic testing for colorectal cancer? Dr. Priyanka Kanth: We know a lot about high-risk genes that are associated with colorectal cancer. We still are finding and learning about many genes, many moderate-risk genes, and their association with colorectal cancer. We don't have enough data or long-term cohort data to understand how they truly affect their lifetime risk for colorectal cancer and how do we truly surveil these patients. So that's one of the big barriers. Genetics still cannot explain all colorectal cancers. So as we get more data, we may discover more things and more genes that may be associated. But understanding these moderate-risk genes and their association with colorectal cancer would be, I think, one of the key areas to be looked into in the future. Dr. Shaalan Beg: And I would imagine as new biomarkers are identified, there will need to be a strategy to retest people who may have had genomic testing in the past. Dr. Priyanka Kanth: Absolutely. We are already encountering that in a practice. I have patients who have been tested maybe 10 years ago and just had Lynch mutation tested and were negative for that or so, and now we have so many other genes which are associated and also to understand family history changes. So, as family history changes, there might be clues to say that, “Okay, we should expand the panel or we should add these patients.” So it is a very dynamic situation. There could be a scenario in which we have a lot of patients who may need to be retested based on their current situation or even based on changing family history and the availability of genetic information. So, when I see a patient, I also tell them if we don't find anything or we are not doing anything major, we say, “Let's regroup in 3 to 5 years, let's see where we are,” or even with the risk mutation for some of the moderate-risk genes, we may change in a few years. So, revisiting that with these patients is highly useful. Dr. Shaalan Beg: So, is it safe to say that as of 2023, if we're seeing people in our clinic who have not had testing in the last 3 to 5 years, that they should have a discussion for repeat testing today? Dr. Priyanka Kanth: Yes, in terms of certain, I would say, newer polyposis genes in the GI world that have been included, some other moderate gene mutation which we have a little bit more sense of now and it has not been tested, I think that can be expanded. Five years is a safe bet. Last 2 to 3 years, maybe not so much, but you can revisit this. Also, some patients were tested for a smaller gene panel. So not 2 genes, but maybe 10 genes were included. That would probably still stand true. They may not need 70 gene panels, so it's still good to review that in the current scenario, and every few years, every 5 years, I would say.   Dr. Shaalan Beg: Whenever I think about any type of new test that has logistical challenges, has costs associated with it, and has operational demands of the clinic, I think about its disparate effect across different populations based on race, ethnicity, geography, demographics. Can you talk a little bit about how these guideline changes, what type of impact they may have, positive or not, for comprehensive genomic testing for colorectal cancer across different populations?  Dr. Priyanka Kanth: Yes, I think this is more positive than negative. This will include more patients and include more family members who were not being included, who were being missed. As we know that one of the reasons to do this multigene panel testing was the criteria, the family history criteria or the risk prediction models are not perfect. And the recent studies have shown that not every family member, every patient, is going to fit in these criteria. So we are getting more and more data in recent years that I think the much better, long-term option is to do a multi-chain panel and find it because we are missing patients. So it will increase the pool [of patients to be tested], and that will surely increase patients from all demographics. And as we do it more, there will be more buy-in from the payers and hopefully, this will decrease disparity. The problem, I think the negative part is how do we deliver it to everyone? If it is there but we are not able to deliver and that there is disparity on who gets the test and who does not, then that will create another disparity in a sense that it's there and we could have used it, but it's not being delivered. So the pros are we can include everyone, but how to include everyone is the big question. Dr. Shaalan Beg: So, Dr. Kanth, there are indeed challenges ahead in our pursuit for universal germline testing for colorectal cancer. I'd like to thank you for sharing your valuable insights with us today on the ASCO Daily News Podcast.   Dr. Priyanka Kanth: Thank you very much for having me here. It was great to talk to you, Dr. Beg. Dr. Shaalan Beg: And thank you to our listeners for your time today. Finally, if you value the insights that you hear on the podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer:  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers:   Dr. Shaalan Beg @ShaalanBeg   Dr. Priyanka Kanth @priyanka_kanth   Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook  ASCO on LinkedIn    Disclosures:   Dr. Shaalan Beg: Employment: Science 37 Consulting or Advisory Role: Ipsen, Array BioPharma, AstraZeneca/MedImmune, Cancer Commons, Legend Biotech, Foundation Medicine Research Funding (Inst.): Bristol-Myers Squibb, AstraZeneca/MedImmune, Merck Serono, Five Prime Therapeutics, MedImmune, Genentech, Immunesensor, Tolero Pharmaceuticals Dr. Priyanka Kanth:  Patents, Royalties, Other Intellectual Property: Methods and Compositions for Predicting a Colon Cancer Subtype

Dr. Shannon Westin, Dr. Stephanie Wheeler, and Dr. Caitlin Biddell discuss the paper "Economic Evaluation of a Non-Medical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer," a simultaneous publication, podcast, and presentation at the ASCO Quality Care Symposium. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get in-depth on manuscripts published in the Journal of Clinical Oncology. I'm your host, Shannon Westin, Social Media Editor of the JCO and GYN Oncologist. And I am so excited that today we have a simultaneous publication in JCO and presentation at the 2023 ASCO Quality Care Symposium here on 10/28/2023. And this is going to be the manuscript “Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer.” Very exciting work. And I'm thrilled to tell you I have two of the authors here with me today. First is Dr. Caitlin Biddell. She's a Health Services Researcher at Mathematica Policy Research.  Welcome, Caitlin.  Dr. Caitlin Biddell: Thank you. Happy to be here. Dr. Shannon Westin: And we also have Dr. Stephanie Wheeler. She is the Michael S. O'Malley Distinguished Professor in the Department of Health Policy and Management at the University of North Carolina, Chapel Hill, as well as being the Associate Director of Community Outreach and Engagement at UNC Lineberger Comprehensive Cancer Center.  Welcome. Dr. Stephanie Wheeler: Thank you. Happy to be here as well. Dr. Shannon Westin: Please note that our authors and participants have no conflicts of interest.  Let's get started. So first I would love to level set. Can you speak a little bit about what financial toxicity is and how common it is among patients with cancer?  Dr. Stephanie Wheeler: Sure, Shannon. I'm happy to take that one. This is Stephanie. So we know that financial hardship is often reported by patients and survivors who've experienced cancer. And as many as 50% of people with cancer have trouble with financial toxicity. There has been prior work that has conceptualized financial toxicity in three domains. So there's the material hardship, kind of the out-of-pocket material costs associated with cancer, which include both medical and nonmedical expenses. There is the stress and the psychosocial effects of that material hardship. And then there's coping behaviors that patients and their caregivers may employ to help deal with the high cost of cancer care. And as we've seen, cancer care increases in cost over time, and these expenditures really have very burdensome effects on patients and their families. We've been interested in looking at ways that we can try to mitigate that harm and really thinking about interventions in addition to the health policy changes that are needed to really ensure that this doesn't become a barrier to patients seeking and receiving the best quality care that they can. Dr. Shannon Westin: I think that kind of leads pretty nicely into my next question, which is really: How does this toxicity potentially impact equitable cancer care delivery?  Dr. Stephanie Wheeler: Yeah, I'm happy to talk about that a little bit as well. So we know from prior research, including some of our own, that patients of color, those from rural areas, and those who are uninsured or underinsured face the largest financial burdens associated with their cancer care. So to the extent that those financial hardships influence people's ability to seek and continue with and complete their cancer care that's been recommended, this actually is directly in the pathway and a mechanism through which patients are not able to get recommended treatment and therefore can contribute to differences in cancer outcomes. So there's direct health impacts in terms of their ability to receive and respond to cancer treatment.   In addition to that, we know that this financial hardship contributes to household-level harms both economic and psychosocial in nature. And in some other work, this financial hardship has translated to worse quality of life, worse economic outcomes, things like being able to stay employed and seeking changes in employment or remaining within a particular position because you don't want to lose your insurance—this is referred to as “job lock”—or can also contribute to higher mortality. So there's been some really important work showing that financial toxicity is directly linked with cancer mortality.  And so, as we think about ways that we need to address this, it's really key to ensuring cancer health equity that we are thoughtful about multiple solutions implemented at multiple levels that can deal with not only the contributors to high cancer costs but that can also start to affect both the nonmedical and the medical components of this cost burden. And by nonmedical, I mean things like the cost associated with transportation and seeking care, accommodations for people who need to receive radiation therapy multiple days in a row at a different healthcare facility than where they live, childcare costs. These things really start to add up in addition to the medical costs associated with cancer treatment. Dr. Shannon Westin: I really was intrigued by the intervention here that you all are studying around this Cancer Patient Assistance Fund. Can you tell me a little bit more about exactly what that was or is? Dr. Caitlin Biddell: Yeah, absolutely. So this is a program at the North Carolina Basnight Cancer Hospital, located within the Lineberger Comprehensive Cancer Center, and it started back in 2013, actually, and has really grown in size. But the main goal of this program is to ensure that patients do not face the nonmedical financial barriers to care that Dr. Wheeler was just talking about. So thinking about giving patients gas cards so that they are able to drive to and from treatment. Lineberger has a catchment area of the entire state, so many people are coming a long distance to come for cancer treatment. They also provide things like lodging and accommodations, as Stephanie mentioned, and then even paying patients' utility bills, things to keep them housed with electricity, the lights on, while they're undergoing cancer treatment. So just last year, in 2022, they distributed almost $350,000 to over 700 patients, and most of this is funded by philanthropic grants to ensure that patients can access the care they need. And it is a program that's really targeted to patients with low incomes. So they target patients with household incomes less than 250% of the federal poverty level. Dr. Shannon Westin: And how does a patient get connected to the fund? How do they find it and get hooked up?  Dr. Caitlin Biddell: Yeah, there's a couple different ways. So one path is through the outpatient social work team. So they often perform distress screening for new cancer patients. So they use the Distress Thermometer, which was developed by the National Comprehensive Cancer Network. And it measures a variety of different factors that may be contributing to distress, but that does include financial stress, job stress, and the expense of daily living stress. And so, when a patient scores a certain amount on that thermometer, a social worker will meet with them for a full assessment. And then part of the referral pathway from that assessment includes the Cancer Patient Assistance Fund. Patients who are in inpatient will often be screened with the Social Determinants of Health Module, which is housed in the electronic health record. And so that can also generate referrals for assistance. And then beyond the kind of standard pathways, there's also many other ways that a patient may express concerns to a nurse, a care coordinator, an oncologist, and then that provider can reach out directly to the Cancer Patient Assistance Fund. Dr. Shannon Westin: Your objective was to basically try to formally assess the impact of this fund on missed radiation or chemotherapy appointments. And so what was kind of your rationale for choosing this endpoint? And kind of take us through the design. Dr. Caitlin Biddell: Yeah, absolutely. So the idea for this study actually came about from the program coordinator of the Cancer Patient Assistance Fund several years back. We were just having a conversation about the program. I was commenting how important I thought it was, how interesting it was. And she was saying, “You know, I know anecdotally that this program makes a difference, but we've never really known how to quantify that.” And that's becoming increasingly important as they apply for philanthropic grants and really need to show that their program is having an impact. So that's what originally started our plan for evaluating the program.  And then, in thinking about endpoints, of course we imagined this program could have an impact on a range of different endpoints. So missed appointments is quite practicable. We also imagine it could influence patient health-related quality of life, patient symptoms associated with their cancer treatment, even potentially other long-term outcomes like mortality. But for the purposes of this evaluation, we needed to identify an endpoint that we believed could be measured, the association could be measured, in the data we had. And so we had electronic health record data. Missed appointments is something that is routinely captured in the electronic health record data because it's an endpoint that matters financially to health systems. So they are regularly tracking missed or no-show appointments. And it's also an outcome that matters financially to the health system, so they want to reduce this.  So we thought if we measure the impact of this program on missed appointments, there's potentially an opportunity to kind of align financial incentives so that if we show that the program has an impact on missed appointments, then that could be something that could get decision makers at the health system level to say, well, that's also an endpoint that we want to reduce, and so let's think about ways that we can align resources to reduce missed appointments through potentially the Cancer Patient Assistance Fund and other mechanisms. Dr. Shannon Westin: It's interesting because it definitely caught my eye because we give radiation, obviously, for gynecologic malignancies, and there's some pretty decent data that longer treatment duration for radiation has worse outcomes, with the implication that patients have missed appointments and so then, to finish their work, it takes longer, or to finish their treatment plan, it takes longer. So I definitely would be really intrigued to see the cancer-related outcomes. But I completely agree, like something practical, straightforward, and something easily obtained was the right way to start. I was just curious. So that's really interesting. So why don't you just walk us through the design of how you laid this out? Dr. Caitlin Biddell: Yeah, absolutely. So we conducted a retrospective evaluation between 2015 and 2019, and we chose that time point to end before the COVID-19 pandemic since we know that had many impacts on missed appointments. And we compared the proportion of missed appointments in the six months following treatment initiation between patients who were receiving Cancer Patient Assistance Fund assistance and then propensity-weighted comparators. And this is really just a method to make the pool of potential comparison patients look as similar to those receiving Cancer Patient Assistance Fund assistance as possible so that we can really tease apart that direct effect of the Cancer Patient Assistance Fund and separate it out from other characteristics that may be influencing missed appointments.  So we had stratified our analysis by treatment type. We looked at radiation therapy, and then we also looked at oncology infusion, so specifically immunotherapy and chemotherapy. And to evaluate these endpoints, we used a couple of different data sources that we linked together. So the first and the primary data source was the electronic health record. So at UNC, we have EHR data for research purposes stored in a data warehouse that we were able to pull from. And then we also linked in UNC Health's portion of the North Carolina Cancer Registry to get that really important information on cancer stage, cancer type, and treatment start date. And then, of course, we pulled in program records from the Cancer Patient Assistance Fund to identify which patients were receiving assistance, how much, and at what time points. And so, essentially, using that data and thinking about missed appointment outcomes in those six months following treatment initiation, we created a couple different models. So we looked at the high versus low no-show proportion using a logistic regression. And then we also looked at just the continuous no-show proportion in the sample to see if there was an effect on that as well. Dr. Shannon Westin: And what did you find? What was the impact of the fund's support on your outcomes? Dr. Caitlin Biddell: For radiation therapy, which I'll start with, the radiation therapy had a higher number of encounters, as we might expect, than immunotherapy/chemotherapy. There were a mean of 37 total radiation therapy encounters in the six-month follow-up period, and about 53% of the sample had one or more no shows. And so, then, when we looked at the impact the Cancer Patient Assistance Fund on radiation therapy missed appointments, we found that receipt of any assistance was associated with an eight-percentage-point decrease in the probability of having a no-show proportion in the highest quintile.  And then, when looking at continuous no-show proportion, we found it was associated with a 2.1-percentage-point decrease in the overall proportion of no shows, which corresponds to a 51% decrease in the overall mean no-show proportion. So a really substantial effect on radiation therapy missed appointments. And unsurprisingly, when we stratified the analysis by the amount of assistance received, we did see a greater impact of the program among patients receiving higher amounts of assistance.  Moving on to the oncology infusion cohort, this sample had a lower number of encounters in the follow-up period and less no shows, so only about 14% had one or more no shows. And so it potentially wasn't as surprising that we did not see an impact of the Cancer Patient Assistance Fund on infusion oncology missed appointments, though, of course, with the additional power and alternative analyses, it's not to say that there wasn't an effect, but in our population, we were not able to detect that. Dr. Shannon Westin: Yeah, and that makes a lot of sense. I mean, radiation is so much more time intensive and having to come back and forth. And when you were describing the fund and saying, like, housing assistance, I was like, “Oh, well, there you go.” Because that, I feel like, is one of the major issues. At MD Anderson, we also kind of take care of a very large catchment area, and it can be a huge burden for patients to have to come for that 15-minute appointment every day. So, yeah, when I saw your results, I thought that was likely what you were hypothesizing was the reason. And certainly, the impact on radiation is so impressive. It's just a hugely successful study and a hugely successful fund. So congratulations.  So, I guess, any other variables? You spoke a little bit about the amount of financial assistance received. Was there anything else that impacted the number of missed appointments in your study? Dr. Caitlin Biddell: Yeah, because of our propensity-weighting design, we really didn't focus as much on other patient-level contributors to missed appointments. So we attempted to control for all of those things through the waiting and then kind of didn't add those into the final model. So that was really the main focus, was looking at the impact of the Cancer Patient Assistance Fund and then, of course, looking by amount of assistance. That was a really important finding and also, of course, needs to be taken in the context that every patient has different needs and so the amount of assistance may differ for every patient. And so there's always a need to kind of really assess what a patient's needs are and base the amount of assistance on that. Dr. Stephanie Wheeler: It's probably worth saying again that the level at which we dichotomized these results was $180, which was sort of the median level of assistance provided. As you can imagine, there's a long tail, with some people receiving considerably more financial assistance. But I think it's really noteworthy that in the grand scheme of things, $180 per patient is a very small amount of money to provide to assist with things like housing support, transportation support, gas cards, and so forth. And the program does not have strict rules about how those funds are used. So, in our setting, where we've got a lot of rural patients potentially traveling hours across state in their own vehicles, gas cards are really important for them. But in other settings—more urban settings, for example—having flexibility in how those funds are used could be really helpful for people who need bus assistance or other public transportation beyond kind of having to drive a private vehicle to appointments.  Dr. Shannon Westin: It is a great point, and it is incredible how much you can do with a fairly little amount of money. And when we were talking about healthcare spending, obviously, that's a lot of money to an individual or a family. But in the grand scheme of what we spend on healthcare, that is a very, very small amount. So really, again, congratulations.  So I think the last question I'll ask is just kind of what are the next steps? And really should we be making sure that we have these programs everywhere? Do I need to go back and make sure that this kind of situation is set up in my institution? Dr. Stephanie Wheeler: Well, we also should share a little bit more about the economic evaluation results. Caitlin, why don't you describe that? Dr. Caitlin Biddell: Yeah, absolutely. And this speaks exactly to what you were talking about in terms of the amount of assistance that can go a really long way for a patient and is a drop in the bucket for a health system. So we did want to look at what the cost-effectiveness, or the cost consequence, of this program was from the health system perspective. And so we conducted a decision tree analysis, which is a method used in economic evaluation research, using kind of a hypothetical cohort of 350 patients, that mean number of radiation therapy encounters, 37 encounters over a six-month time horizon. And we did find that under the current funding of the model, which essentially is that philanthropy covers all of the financial assistance and then UNC Lineberger covers the cost of the staffing and the indirect cost of housing the program, we found that this program was estimated to save the health system $153 per missed appointment averted.  And then, in kind of an additional threshold analysis we conducted to see how much could the health system chip into this program in some way, whether it's through indirect cost or direct financial assistance, while still kind of breaking even from the perspective of no shows averted, and it was around $100 per patient. So, of course, that would be split across patients in different ways. Not everyone might receive that same amount. But there is opportunity here for health systems to make investments in reducing patient nonmedical barriers to care in a way that will come back in the form of saved revenue from averting missed appointments. Dr. Stephanie Wheeler: And the only thing I would add to that is this obviously was focused on those no-show appointments, but we anticipate that there's other financial benefits to the health system, like retention in care, patient satisfaction. There's a whole host of quality-of-life and clinical outcomes that are probably also benefited through use of this kind of nonmedical financial assistance program that we weren't able to measure. But I think part of our goal with this analysis is to start to make the case to hospitals and health systems that providing direct nonmedical financial assistance helps their bottom line as well. Dr. Shannon Westin: We, as clinicians and researchers, always want the benefit to the patients. But I agree, when you're dealing with administrators, we also need to show that. So I think that is super clever and a really nice part of the design.  So what's next steps for your research? Dr. Caitlin Biddell: Yeah, so I think we're currently kind of disseminating these findings within our own institution, so disseminating them back to the Cancer Patient Assistance Fund program so that they can use them in additional grant applications, but also really trying to get these findings in front of the health system administrators who might be able to make funding decisions surrounding this program. And then I think we are also thinking about ways to measure other endpoints beyond missed appointments. So we've kind of created this data set that involved some complicated linkages upfront, and now I do think there's opportunities to pull in other endpoints and even potentially some patient-reported endpoints as our electronic health records get better at collecting patient-reported data and even social determinant of health data, opportunities to really think about other impacts of this program.  And then I'll also add that there is talk among other groups at our institution about using this kind of approach to measure other similar programs. For example, we have a pretty large AYA program that does a lot of similar types of assistance and also psychosocial assistance. And so they're thinking about ways to use a similar methodology to evaluate some of their own work. So I think it's just kind of starting to open the door to thinking about how we can use the data we have within our institutions to really underscore the impacts that the programs that already exist are having on patients. Dr. Stephanie Wheeler: I would only add to Caitlin's fabulous answer that dissemination of this is really critical because we know that NCI-Designated Conference of Cancer Centers, the vast majority of them provide some kind of direct medical and nonmedical financial assistance, but many of them have restrictions on who can access those funds and eligibility criteria that preclude patients with certain cancers from accessing those funds or patients with still what we would consider to be relatively high financial vulnerability to not be able to access those funds. In addition to that, we know that community oncology practices less often have access to these kinds of financial support resources. And so what often happens—and this is an extremely fragmented space for patients and their caregivers to be navigating—is that when nonmedical financial needs present, people are left to their own devices to have to search out, seek out, and identify programs for which they're eligible in the community. And these are often funded by philanthropic organizations, really wonderful healthcare support organizations. But oftentimes these types of financial supports are not directly provided through the hospital, or if they are, they're in the form of “charity care provisions,” which are often opaque to patients and their caregivers to even find. And then the eligibility requirements for those programs, again, are often preventing access for a number of patients in need.   So what I would like to see, as a person who does a lot of research in this space around financial hardship, is for that burden to be shifting away from patients and caregivers and more towards the systems that are treating these patients and that are supporting the caregivers so that people can focus on what's important during their cancer care, which is getting treatment that's recommended, staying in treatment, and attaining the best possible health that they can. When patients and their families spend hours and hours and days and weeks trying to understand existing financial support programs in the community and then those disappear or evaporate, as they do when funding and contributions subside, that really has a very detrimental impact on the patient's entire care experience. And I think it's on us, as people who are part of the healthcare system, to ensure that that doesn't happen. And the financial case to hospitals is clear, I think, from this analysis, but the moral case to all of us, as providers, should be clear and should be compelling in itself.   Dr. Shannon Westin: On that note, I think that's a perfect way to end. Thank you so much. This was such an intriguing discussion, and I really hope people are listening that are making the decisions for their hospitals and will see how they can implement something like this in their institution.  Again, this was a discussion of “Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults with Cancer,” simultaneous publication in the JCO and presentation at the 2023 ASCO Quality Care Symposium on October 28th. It was great to have you all here. This was amazing, and I hope our listeners had a good time. And please do check out our other podcast offerings wherever you get your podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the Podcast do not express the opinions of ASCO. The mention of any product, service, organization, patient activity or therapy should not be construed as an ASCO endorsement.      

Amy Jones, MD, is the Program Director of  Hematology-Oncology Fellowship Program at UT Southwestern Medical Center. She also serves as the Medical Director of the Inpatient Hematology-Oncology Unit for the Parkland Health & Hospital System. She is a founding Co-Chair of the Parkland Cancer Improvement Committee and a recipient of the Niarchos Grant for Quality Improvement through ASCO. She serves on the Cancer in People with HIV/Kaposi Sarcoma Panel of the National Comprehensive Cancer Network. Dr. Jones has delivered a number of invited lectures and published numerous academic articles, and she serves as a course director for medical education at the fellowship and medical student levels. “You can be a mom and hang out with your kids, have a husband who loves smoking meat, and still be a complete boss at work.” Between brisket and directing the Hematology-Oncology Fellowship Program at UT Southwestern, Dr. Amy Jones teaches us a thing or two about keeping our hearts and minds full. Join us in this motivating episode with Dr. Jones, as she takes us through her earliest inspirations and how they've instilled in her a sense of service while making sure she has time to fill her own cup. Tune in as we talk about recharging our batteries and leaning on mentors, learning how to take charge as a mentee keeping your torch lit, and why it's crucial to be able to tell your story. Pearls of Wisdom:   1. A good mentee is one that is honest about what they want and can take their goals across the finish line. Drive the relationship even when it's uncomfortable because that's what it takes for success. 2. When looking to the future, ask yourself what you dream of in a job and what your day-to-day life might look like. Write a letter that starts with who you are and what you've done, ending with where you're going and how you'll get there. 3. Balance is key for a long career. Because you have an ability to give back you also have the responsibility to serve, but in order to serve you have to be able to care for yourself, too.

While next-generation sequencing is recommended by the National Comprehensive Cancer Network for biomarker testing for all patients with advanced non-small cell lung cancer (NSCLC), uptake among community oncology programs and practices is suboptimal. To standardize comprehensive biomarker testing in patients with NSCLC, Oncology Hematology Care, Inc., developed and implemented a 1-year quality improvement (QI) project that included custom data reports and monitoring dashboards to ensure practice-wide adoption and sustainability across multiple clinic sites. After increasing biomarker testing rates from 68% to 92.7%, this QI project is now being scaled across the country through the US Oncology Network, McKesson as a best-practice initiative. Guest: Molly Mendenhall, RN, BSN Director of Quality and Compliance Oncology Hematology Care, Inc. (OHC) Cincinnati, Ohio   “[On average] biomarking testing for patients with cancer is less than 50%. But with a shift towards personalized medicine, if we can implement and standardize this testing across the nation, we could provide targeted therapies, which have been shown to improve overall survival and quality of life.”   This podcast is part of a special series with the 2023 ACCC Innovator Award winners. For a deeper dive into this and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 40th National Oncology Conference, Oct. 4-6, in Austin Texas.   Resources: [Video] Optimizing Advanced NSCLC Biomarker Testing, Treatment, and Management Virtual Summit Biomarker Testing in Patients with Non-Small Cell Lung Cancer NSCLC Biomarker Testing Roadmap Infographic [Video] Optimizing Biomarker Testing through Precision Medicine Stewardship A Financial Advocate's Guide to Biomarker Testing Paying for Biomarker Testing [Podcast] Financial Barriers to Biomarker Testing [Podcast] Biomarker Testing Advocacy

The National Comprehensive Cancer Network, or NCCN, held its annual meeting recently in Orlando. On this week's episode of The ASCO Post podcast, we'll hear from two presenters who discussed quality of life issues in individuals with cancer.To listen to more podcasts from ASCO, visit asco.org/podcasts.

The National Comprehensive Cancer Network, or NCCN, held its annual meeting recently in Orlando. On this week's episode, we'll hear from two of the presenters who discussed NCCN Clinical Practice Guidelines Updates in chronic lymphocytic leukemia/small lymphocytic lymphoma and CNS cancers in adults. We'll also hear about a third presentation on the molecular landscape of metastatic colorectal cancer and its treatment.To listen to more podcasts from ASCO, visit asco.org/podcasts.

Jamil Rivers is a powerhouse. Diagnosed at 39 with Stage IV de novo metastatic breast cancer (MBC), she is a CEO, devoted mama, wife and passionate advocate. Since diagnosis, Jamil has become an advocate using her cancer experiences to advance legislative policy, medical research and customize support to better meet the needs of individuals impacted by breast cancer, particularly metastatic and African-American patients. She launched The Chrysalis Initiative which provides mentoring, resource navigation, and outreach for African-American women. In this episode Jamil reads her essay “Fighting for Equality in an Unequal Society” from Wildfire Magazine's 2022 “Legacy Stories” issue. Her essay is about using one's story to advocate for deep change within a system that has been broken and biased for a long time. April and Jamil will discuss the meaning behind The Chrysalis Initiative name, how cancer revealed Jamil as a leader to help others, and creating an equitable healthcare space in a landscape of discrimination and substandard support. Jamil gives advice for others living with MBC that want to start new projects, and talks about when she knew her advocacy work was impacting lives.More about Jamil: https://www.instagram.com/truejamilkali/More on The Chrysalis Initiative:1 (800) 929-4979https://thechrysalisinitiative.org/https://www.instagram.com/chrysalisinitiative/https://www.facebook.com/chrysalisinitiative/https://twitter.com/chrysalisinithttps://www.linkedin.com/company/chrysalis-initiativehttps://www.youtube.com/channel/UCs-NCZTCIXspPb3Q44XFzxQMore about BC Navi: https://www.bcnavi.com/s/National Comprehensive Cancer Network: https://www.nccn.org/business-policy/business/academyPurchase a print or digital copy of the “Legacy Stories” issue of Wildfire Magazine: https://www.wildfirecommunity.org/shop/mbc22Get the free Wildfire email newsletter: https://www.wildfirecommunity.orgLearn about Wildfire writing workshops: https://www.wildfirecommunity.org/workshopsShop Wildfire merch & more: https://www.wildfirecommunity.org/shopSend your voice recording testimonial to editor@wildfirecommunity.org*Free* The Burn Writing Companion: Guided Prompt Journal (Vol. 1): https://www.wildfirecommunity.org/the-burnBuy the Wildfire book “Igniting the Fire Within: Stories of Healing, Hope & Humor, Inside Today's Young...

We are kicking off 2023 with the fabulous cancer survivor, healthcare entrepreneur and thought leader, Jennifer Hinkel. As a survivor of Stage III Hodgkin Lymphoma, Jennifer has a special interest in oncology innovation as a cancer survivor. She is passionate about using data to improve the lives of cancer patients, and also making sure that patients are aware and compensated for the use of their data. Key highlights: 1. What advice would adult Jennifer give to her 17-year-old self about being diagnosed with cancer? 2. The importance and value of patient data 3. Building the bank for patient data 4. Henrietta Lacks' cell line and its incredible impact on science relate to digital patient data today About our guest: Jennifer Hinkel is an oncology market access and health economics leader with experience in consulting, global pharma and biotech, health policy, and health care startups. She has held management and executive roles at companies including National Comprehensive Cancer Network, Roche UK, Roche Argentina, Genentech, and Caris Life Sciences. She is a Managing Director of The Data Economics Company where she leads commercialization of the Lydion Engine in life sciences and healthcare applications and is a Founding Partner at Sigla Sciences, a market access firm.  Key Moments: 7 mins 22 secs: Walking through a portal. One of the things I recall most strongly is this feeling that I walked through a door, a portal to a different world. No one around me had seen that world. They didn't even know that that world existed. And it is not a super pleasant world, it's a world full of a lot of scary things. Although it's also a world full of like a lot of really smart people and people who are out there trying to be helpful and to make the experience better for people. I think that the most important thing to say would be: you might feel like you're the only one that's gone through this, but there are actually other people out there going through the same thing. 18 minutes 37 seconds: Getting compensated of your data I philosophically believe that this is data that is generated by you, a patient. Yes, you plus an X-ray machine or you plus a doctor. Most of us don't walk around just spouting genetic sequences out of the air, but there has to be some science applied. But really that data is yours. It's pretty unique to you, and that should belong to you. And if other people are using it, especially if they're using it for a business purpose, I think you should get to share in that. 27 minutes 27 seconds: Story of Henrietta Lacks.  This woman Henrietta Lacks, who had cells taken. And her cell line has become a mainstay of biotech research for decades and decades. Only recently it was recognized, that this woman was never really compensated for the contribution that her genetic material made to science.  I think that we will start to have that same idea on the digital data. Just because it's in a digitized format, I think doesn't make it any less personal or unique to us really. This data is just the output of your medical procedure or what your body produced.  Subscribe to our newsletter | Free resources | Nutrition Program | Cancer Coaching | Stay organized with the Manta Planner  | Visit the Manta Cares website Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

In this crossover episode between BackTable VI and BackTable Innovation, Dr. Chris Beck interviews Dr. Riad Salem (Chief of Interventional Radiology at Northwestern University) and Peter Pattison (President of Interventional Oncology at Boston Scientific) about how TheraSpheres for Y90 radioembolization became a mainstay in the IR toolkit for HCC and where the technology is heading next. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/PvWJlD --- SHOW NOTES To begin, Peter outlines how the original concept of TheraSpheres began at the University of Missouri, as a collaboration between Drs. Delbert Day and Gary Ehrhardt, who combined their ceramic and nuclear chemistry expertises to create radioactive glass beads and published a paper in 1987. After animal and human testing, the product was licensed to the company Nordion, where Peter worked. The product was given a humanitarian device exemption (HDE) from the FDA, which allowed TheraSpheres to be used for investigational purposes. In the late 1990s, Dr. Salem was in his early interventional oncology career and heard about TheraSpheres. He recognized the enormous potential that this technology had to ensure known amounts of radioactive doses were delivered to the tumor and minimize adverse effects. In fact, he noticed that his Y90 patients had less pain, post-embolization syndrome, and hospitalization than his transarterial chemoembolization (TACE) patients. In the mid 2000s, he collected and submitted data to various conferences and journals, but he was met with criticism from the IR world, which was more comfortable with TACE, since it was the current standard of care. In 2011, Nordion decided to run a clinical trial, EPOCH, which eventually showed that the addition of TARE to systemic therapy for colorectal metastases to the liver led to longer progression free survival. Dr. Riad has focused his efforts on training more IRs on the methodology of Y90, since this was an important step to increasing adoption and minimizing missteps with the new technology. He believes that the advent of Y90 has resulted in better angiography, since IRs are more cognizant of off-target embolization. Dr. Salem also petitioned at the US Nuclear Regulatory Committee to allow IRs to become the authorized users for Y90 injection and advocated to add TARE to the National Comprehensive Cancer Network guidelines for liver cancer. Both of these developments allowed TARE to become more widely adopted. Finally, Peter discusses the competition that TheraSpheres has faced from TACE and SIRSpheres (resin-based radioembolization). He shares exciting new developments that have occurred since acquisition by Boston Scientific. These include exploration for the extra-hepatic use of TheraSpheres in glioblastoma and prostate cancer. --- RESOURCES BackTable Ep. 223- Portal Vein Recan #ReCanDoIt with Dr. Riad Salem: https://www.backtable.com/shows/vi/podcasts/223/portal-vein-recan-recandoit Therapeutic Use of 90Y Microspheres: https://pubmed.ncbi.nlm.nih.gov/3667306/ A phase I dose escalation trial of yttrium-90 microspheres in the treatment of primary hepatocellular carcinoma: https://pubmed.ncbi.nlm.nih.gov/1327493/ Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up: https://pubmed.ncbi.nlm.nih.gov/7931662/ Humanitarian Device Exemption: https://www.fda.gov/medical-devices/premarket-submissions-selecting-and-preparing-correct-submission/humanitarian-device-exemption EPOCH Trial: https://ascopubs.org/doi/full/10.1200/JCO.21.01839 Radioembolization with 90Yttrium Microspheres: A State-of-the-Art Brachytherapy Treatment for Primary and Secondary Liver Malignancies: https://www.jvir.org/article/S1051-0443(07)60901-4/fulltext

Season 3 Episode 15- Myeloproliferative Neoplasms, Pankit Vachhani, MDOn the Season 3 finale we sit down with Dr. Pankit Vachhani to discuss myeloproliferative neoplasms and specifically myelofibrosis. Dr. Vachhani is an Assistant Professor of Medicine at the University of Alabama at Birmingham (UAB) and Associate Scientist of Experimental Therapeutics. A graduate of Weill Cornell Medical College in Qatar in 2012, Dr. Vachhani went on to complete his internal medicine residency at Virginia Commonwealth University, followed by a fellowship in hematology/oncology at Roswell Park Comprehensive Cancer Center in Buffalo, NY.                                             At UAB, he is involved in various clinical trials as a principal investigator.  He leads the Leukemia/BMT working group and serves as the Medical Director of the Clinical Research Unit (CRU). His primary research interest is in hematological malignancies, particularly myeloproliferative neoplasms and AML, where he focuses on experimental therapeutics. He also serves as a panelist helping create the AML and MPN Treatment Guidelines for the National Comprehensive Cancer Network.

This episode is hosted by Pooja Dharwadkar, M.D, assistant professor at the University of California San Francisco, and features a discussion between Carol Burke, M.D, codirector of the Hereditary Cancer Clinic at the Cleveland Clinic; Robert Hüneburg, M.D, gastroenterologist at the National Center for Hereditary Tumor Syndromes at University Hospital Bonn in Bonn, Germany; and Bryson Katona, M.D, director of the GI Cancer Genetics and Cancer Risk Evaluation programs at the Hospital of the University of Pennsylvania in Philadelphia, PA. They discuss the benefits of upper GI cancer surveillance in Lynch syndrome – specifically as it applies to gastric cancer – and the studies that have contributed to recent updates in the National Comprehensive Cancer Network screening and surveillance guidelines for individuals with Lynch syndrome.  This episode references the following articles:  “Upper endoscopic surveillance in Lynch syndrome detects gastric and duodenal adenocarcinomas,” found here: https://pubmed.ncbi.nlm.nih.gov/32859614/ “Value of upper gastrointestinal endoscopy for gastric cancer surveillance in patients with Lynch syndrome,” found here: https://pubmed.ncbi.nlm.nih.gov/32930401/ “Clinically actionable findings on surveillance EGD in asymptomatic patients with Lynch syndrome,” found here: https://pubmed.ncbi.nlm.nih.gov/34252420/ This episode was recorded on July 9th, 2022 and reflects expert opinion at the time of the recording.  

In this episode of Black Power Moves, part of the Ebony Covering Black America Podcast Network, we're speaking to Donna Cryer, Founder, President & Chief Executive Officer of Global Liver Institute. https://www.globalliver.org/ GLI is the premier patient-driven liver health nonprofit operating across the globe. Moved by her own experience as a liver transplant recipient, Donna has become a powerful force in liver health, health policy, and patient advocacy. At GLI, she has raised more than $10 million for liver health initiatives. She has been featured by and worked with Congress and the White House to advance equitable healthcare in both organ procurement and information technology. Donna is a frequent speaker on patient centricity in research and healthcare delivery and patient engagement in healthcare transformation at meetings of Biotechnology Innovation Organization, Pharmaceutical Research and Manufacturers of America, America's Health Insurance Plans, National Quality Forum, National Comprehensive Cancer Network®, and the National Academy of Medicine.  She frequents the stage of national platforms, including The Washington Post Live, SXSW, and The Atlantic's People v. Cancer. Learn more about your ad choices. Visit megaphone.fm/adchoices

Cardiac tamponade typically presents gradually over time, and it can happen multiple times throughout a patient's cancer care journey. Oncology nurses must stay cognizant of the warning signs and management approaches. ONS member Roberta Kaplow, RN, PhD, CCRN, AOCNS®, clinical nurse specialist at Emory University Hospital in Atlanta, GA, and member of the Metro Atlanta ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss the latest nursing management and prevention strategies for cardiac tamponade. This episode is part of a series about oncologic emergencies; the previous ones are linked in the episode notes. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by March 18, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies Clinical Journal of Oncology Nursing article: Cardiac Toxicity Related to Cancer Treatment Oncology Nursing Forum article: Cardiovascular Emergencies: Pericardial Effusion and Cardiac Tamponade ONS book: Cardiac Complications of Cancer Therapy ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies ONS course: Treatment and Symptom Management—Oncology RN ONS Huddle Cards™ American College of Cardiology information on water bottle heart National Comprehensive Cancer Network guidelines for patients To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.