Podcasts about National Comprehensive Cancer Network

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 

National Minority Quality Forum, in collaboration with the Alliance for Cancer Care Equity, invites you to hear from three experts in cancer patient navigation who will discuss what the new cancer patient navigation billing options mean for equity and community health partnerships. The Alliance for Cancer Care Equity is a partnership between the American Cancer Society Cancer Action Network, National Comprehensive Cancer Network®, and National Minority Quality Forum. Join us we discuss new payment through CMS; patient navigation across communities; collaboration between healthcare systems and community-based organizations; and more. Moderator Shonta Chambers, MSW Executive Vice President, Health Equity and Community Engagement Patient Advocate Foundation Shonta transitioned back to the non-profit sector in 2014 by joining PAF. She leads the development and execution of strategic initiatives to expand PAF's approach to achieve health equity through community and national level partnership engagement and mobilization. These initiatives are designed to link limited income communities to resources to abate financial, logistical and social access to care barriers. She brings to this role nearly 20 years of non-profit and public sector middle and senior level experience that spans public health, women's health and behavioral health. Panelists Bonny Morris, PhD, MSPH, RN Senior Director, Patient Navigation American Cancer Society Dr. Bonny Morris is leading the development and implementation of ACS CARES, the first national cancer navigation support program; ACS LION, a new nonclinical navigation credentialing program; and the enterprise strategy for patient navigation at the American Cancer Society. Darcie Green Executive Director Latinas Contra Cancer Darcie Green is the Executive Director of Latinas Contra Cancer and brings with her 20 years of community activism and public policy experience. Latinas Contra Cancer works to ensure just and equitable access to health and healthcare for the Latino community around issues of cancer. While working for a nonprofit health insurance and hospital system, Darcie led local efforts on health policy, often bringing together unlikely allies and resources to support improved health outcomes for uninsured or underinsured populations. Elizabeth F. Franklin, PhD, MSW Head, US Public Affairs and Patient Advocacy Oncology at Sanofi Dr. Elizabeth Franklin is an advocate for people impacted by cancer and is passionate about ensuring that patient voices are the north star in health care decision and policy making. She grew up in Kentucky where cancer, cancer mortality, and poverty rates routinely rank among the highest in the country, and as a result was drawn to social work and health equity by witnessing people being left behind and systems that resulted in inequitable care. These values have driven Dr. Franklin throughout her career in patient advocacy.

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

CME credits: 1.00 Valid until: 10-08-2024 Claim your CME credit at https://reachmd.com/programs/cme/hot-topics-in-blood-based-cancer-screening-key-information-on-multi-cancer-early-detection-from-2023-spring-oncology-meetings/15525/ Early detection of cancer is essential to reducing the significant burdens associated with it. When cancer is detected at earlier stages, treatments can be initiated sooner, resulting in improved outcomes, reduced morbidity and mortality, and better quality of life. While the implementation of current screening guidelines has resulted in an overall reduction in cancer deaths, only 25 percent of cancers are diagnosed using traditional screening modalities, leaving much room for improvement. Blood-based multi-cancer early detection, or MCED, tests that can screen from four to greater than 50 types of cancers have been developed to complement the population-based screening of asymptomatic individuals. At the spring 2023 American Association for Cancer Research, also known as AACR, American Society of Clinical Oncology, or ASCO, and National Comprehensive Cancer Network, orNCCN, annual conferences, a multitude of data was presented on MCEDs, including real-world data, clinical trial data, novel MCEDs in development, MCED accuracy, and the inherent health equity challenges that their implementation will face. This educational activity has two parts. Dr. Candace Westgate delivers an MCED Primer designed to build primary care clinicians' knowledge about the science of MCEDs and how to implement their use in primary care practice, followed by chapterized discussions between …=

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...

In alignment with the American Society of Breast Surgeons (ASBS) and National Comprehensive Cancer Network, the CommonSpirit Health Physician Enterprise will adopt an evidence-based approach to the diagnosis and management of Atypical Lobular Hyperplasia (ALH) and classical-type LCIS (cLCIS).Guest speakers:Peter Eby, MD, Chief of Breast Imaging Virginia Mason Medical CenterColleen O'Kelly Priddy, MD, FACS, Breast Surgical Oncologist and Medical Director, Mission Hope Breast CenterQuynh Le, DO, Breast Surgical Oncologist, Virginia Mason Medical Center

Host: Wui-Jin Koh, MD Listen in as Wui-Jin Koh, MD, Senior Vice President and Chief Medical Officer of the National Comprehensive Cancer Network, highlights the need for this important, new digital curriculum designed to support your care of patients across multiple solid tumor types.

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

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. --- 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. Both of our guests highlight the importance of focusing on patient outcomes and letting long term data prove efficacy. 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.  

NCCN Policy & Advocacy Priorities Supporting high quality cancer care through the NCCN Guidelines is a strategic pillar for the NCCN. Alyssa Schatz is the Senior Director of Policy & Advocacy at the National Comprehensive Cancer Network. She shares the current strategic priorities for her team in this week's episode.

Liquid biopsy has emerged as a novel diagnostic tool, enabling rapid, non-invasive molecular testing of thyroid cancers. This episode offers insight into some of the opportunities and challenges that are presented by liquid biopsy in this field. To answer questions on this topic, we have invited Professor Frederique Penault-Llorca to join us. She is Professor of Pathology at the University of Clermont-Ferrand and CEO of the Comprehensive Regional Cancer Institute Centre Jean Perrin in Clermont-Ferrand, France. Funding Information: This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty. Faculty Disclosures: Professor Frederique Penault-Llorca has disclosures are as follows: Advisory board: Roche, EliLilly, Illumina, Speaker: Roche, EliLilly, Illumina, References 1. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214 2. Albarel F, Conte-Devolx B, Oliver C. From nodule to differentiated thyroid carcinoma: Contributions of molecular analysis in 2012. Ann Endocrinol (Paris). 2012;73:155–164 3. Nylen C, Mechera R, Marechal-Ross I, et al. Molecular markers guiding thyroid cancer management. Cancers (Basel). 2020;12:2164 4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 2.2022. May 5, 2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf (accessed June 2022) 5. Pinchot SN, Al-Wagih H, Schaefer S, et al. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144:649–655 6. Bellevicine C, Sgariglia R, Nacchio M, et al. Molecular testing of thyroid fine-needle aspiration: local issues and solutions. An interventional cytopathologist perspective. J Mol Pathol. 2021;2:233–240 7. Kasraeian S, Allison DC, Ahlmann ER, et al. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468:2992–3002 8. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: Guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142:321–346 9. Pennell NA, Arcila ME, Gandara DR, et al. Biomarker testing for patients with advanced non-small cell lung cancer: Real-world issues and tough choices. Am Soc Clin Oncol Educ Book. 2019;39:531–542 10. Belli C, Penault-Llorca F, Ladanyi M, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021;32:337–350 11. Li MM, Datto M, Duncavage EJ, et al. Standards and guidelines for the interpretation and reporting of sequence variants in cancer: A joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists. J Mol Diagn. 2017;19:4–23

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

This episode is sponsored by the Osteosarcoma Institute (OSI), a nonprofit organization led by osteosarcoma experts from top U.S. cancer centers who, together, are concentrating on the cure ® for osteosarcoma. The mission of the OSI is to dramatically increase treatment options and survival rates in osteosarcoma patients through identifying and funding the most promising and breakthrough osteosarcoma clinical trials and science. In addition to advancing research, OSI also provides a free resource called OSI Connect for osteosarcoma patients. Our osteosarcoma experts can discuss available treatments, possible side effects, and provide helpful advice for getting the most out of your visits with your treating physician. This resource is available in English and Spanish and aims to help patients and families find answers to their questions. Dr. John Healey, Chief, Orthopaedic Service; Stephen McDermott Chair in Surgery, is an orthopaedic surgeon who specializes in caring for people with sarcomas and noncancerous tumors of the bones and soft tissue. He has particular expertise in removing tumors while preserving limbs, as well as a special interest in treating children who have bone cancers, such as osteosarcoma and Ewing sarcoma. Dr. Healey has been with Memorial Sloan Kettering since 1984 and performs approximately 260 surgeries each year. In addition to his role as Chief of the Orthopaedic Service at MSK, he is a professor of orthopaedic surgery at Weill Cornell Medical College. Nationally, he has served as chair of the Children's Oncology Group Orthopaedics Section, president of the International Society of Limb Salvage, and president of the Association of Bone and Joint Surgeons, as well as on the boards of several musculoskeletal and orthopaedic organizations. Dr. Healey is also an advisor to the National Comprehensive Cancer Network. Brandon was diagnosed with Osteosarcoma in the left proximal Tibia in January 2019, between his first and second semesters of senior year at the University of Maryland. He completed the standard 9 month chemotherapy roadmap and received limb salvage surgery in April 2019, completing treatment in October 2019. He graduated with his class in May 2019 and ultimately moved to Manhattan where he now works for Citibank. He has been cancer free (knock on wood) for 2.5 years. What We Do at MIB Agents: PROGRAMS: ✨ End-of-Life MISSIONS ✨ Gamer Agents ✨ Agent Writers ✨ Prayer Agents ✨ Healing Hearts - Bereaved Parent Support ✨ Ambassador Agents - Peer Support ✨ Warrior Mail ✨ Young Adult Survivorship Support Group ✨ EDUCATION for physicians, researchers and families: ✨ OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma ✨ MIB Book: Osteosarcoma: From our Families to Yours ✨ RESEARCH: Annual MIB FACTOR Research Conference ✨ Funding $100,000 annually for OS research ✨ MIB Testing & Research Directory ✨ The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter.

Dr Pegram discusses treatment sequencing in metastatic HER2-positive breast cancer, recent updates to the National Comprehensive Cancer Network guidelines, and the influence of the DESTINY-Breast03 trial on the breast cancer treatment paradigm.

Andrea Wilson Woods is a writer who loves to tell stories, and a patient advocate who founded the nonprofit Blue Faery: The Adrienne Wilson Liver Cancer Association. Andrea is the CEO and co-founder of Cancer University, a for-profit, social-benefit, digital health company. With Cancer U, Andrea synergizes her talents of coaching, writing, teaching, and advocacy. For over ten years, Andrea worked in the education field as a teacher and professor for public and private schools as well as universities. Andrea obtained her master's degree in professional writing from the University of Southern California; her nonfiction writing has won national awards. Her new book, a medical memoir titled Better Off Bald: A Life in 147 Days, is a #1 Bestseller on Amazon in multiple categories.Andrea Bio:In 2002, Andrea founded Blue Faery: The Adrienne Wilson Liver Cancer Association after losing her 15-year-old sister Adrienne, whom she raised for seven years, to stage IV liver cancer. Blue Faery's mission is to prevent, treat, and cure primary liver cancer, specifically hepatocellular carcinoma (HCC), through research, education, and advocacy. Andrea established the articles of incorporation; wrote the bylaws, mission statement, and goals; and developed the organizational structure of the corporation. Currently, she attends board meetings, serves on committees, stays informed about liver cancer, and governs the organization. Andrea represents Blue Faery and its mission at conferences, seminars, and special events. Blue Faery has been honored for community service by U.S. Congressman Adam B. Schiff, California State Senator Jack Scott, and the County of Los Angeles, and was inducted into the Burbank Business Hall of Fame for receiving the Best of Burbank Charity Award from 2013 – 2017.Since serving on an HCC Patient Advisory Board for Eli Lilly in 2014, Andrea has received numerous scholarships to attend various conferences around the country to tell her story, increase her knowledge, advocate for more funding, and continue her professional development. Organizations that have granted scholarships/sponsorships include Academy Health, American Association for Cancer Research, American Society of Clinical Oncology, American Liver Foundation, Caring Ambassadors, Conquer Cancer Foundation, Global Liver Institute, National Comprehensive Cancer Network, National Viral Hepatitis Roundtable, and more.In 2017, Andrea won an e-Patient scholarship for Stanford Medicine X where she presented her talk, “How Euphemisms Help Us Deal With Death.” More recently, she spoke to more than 100 liver cancer researchers at the Hepatobiliary Cancers: Pathology and Translational Advances conference sponsored by Virginia Commonwealth University School of Medicine. Her presentation titled “Why We Need To Choose To Cure Liver Cancer” left the room speechless.As a patient advocate, Andrea serves on many committees and advisory boards including NCI Hepatobiliary Task Force, Target Pharma Solutions HCC Advisory Board, and ASCO's Systemic Therapy for Advanced Hepatocellular Carcinoma Guideline Panel. She is a patient advocate representative on the Mayo Clinic Hepatobiliary SPORE, which is devoted to improving the diagnosis and treatment of liver cancer and bile duct cancer. Andrea serves as a Consumer Reviewer on the Department of Defense's Peer-Reviewed Cancer Research Program. Andrea represents Blue Faery as a member of AASLD, ASCO, Deadliest Cancers Coalition, and GI Cancers Alliance. She was formerly a member and co-chair of the awareness group of the Liver Cancer Roundtable. Currently, Andrea is the only American serving on the Canadian Cancer Survivor Network's Liver Cancer Advisory Council. She is also a WEGO Health Expert and member of the International Coach Federation.

Host Dr. John Sweetenham, associate director for Clinical Affairs at UT Southwestern Harold C. Simmons Comprehensive Center, and Dr. Robert Carlson, CEO of the National Comprehensive Cancer Network (NCCN), discuss novel therapies and compelling health equity research featured at the 2022 NCCN Annual Conference.   Transcript:   Dr. John Sweetenham: Hello, I'm John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News podcast.   Today, I'll be speaking with Dr. Robert Carlson, the chief executive officer of the National Comprehensive Cancer Network or NCCN. Dr. Carlson will be telling us about key advances in cancer care that were featured at the 2022 NCCN Annual Conference.   Our full disclosures are available in the show notes and disclosures of all guests on the podcast can be found on our transcripts at asco.org/podcasts.   Bob, I'm really pleased to have you on the podcast today, and personally very excited to serve in my new role as chair of the NCCN Board of Directors.   Dr. Robert Carlson: John, it's a pleasure to be with you this morning and all of us at NCCN look forward to working with you as chair of the NCCN Board of Directors.   Dr. John Sweetenham: Thank you! Bob, there was such a wide breadth of topics that were covered at the NCCN Annual Conference this year. Could you tell us about some of the key abstracts that you think will advance care for patients?   Dr. Robert Carlson: I'd be happy to! We had over 1,000 participants from 40 countries at this year's Annual Meeting. And there were a number of high-quality abstracts reporting on a spectrum of studies, including NCCN young investigators and a number of other investigators.   Three abstracts that I would like to single out include an abstract entitled, “Real-World Data and Independent Predictors of Clinical Outcomes with CDK Inhibitors in Metastatic Estrogen receptor-positive Breast Cancer Patients” which was presented by Priyanka Reddy and colleagues from Case Western Reserve. They assessed how the real-world experience with the CDK 4/6 inhibitors in hormone receptor-positive metastatic breast cancer compared with a clinical trial experience. They retrospectively identified 269 patients with hormone receptor-positive metastatic breast cancer in the first-line setting and assessed progression-free survival and overall survival in the cohort overall, and also in the subset with bone-only metastatic disease in those who had liver involvement.   In the overall cohort, the results demonstrated progression-free survival of 21 and a half months and overall survival of 57.6 months. In those with the bone-only disease, at 5 years, 84% of patients were alive compared with 42% in those with bone plus other visceral sites of disease.   They performed multivariate cox regression, and bone-only disease was an independent predictor of a favorable outcome with a hazard rate of 0.48 for progression-free survival, and 0.38 for overall survival, both highly statistically significant.   In those patients with liver disease, multivariable regression predicted an unfavorable outcome with a hazard ratio of 2.53 for progression-free survival and 2.24 for overall survival. So, the study found that the real-world experience with the CDK 4/6 inhibitors is very similar to that in clinical trials. And that bone-only disease continues to be a positive predictor of outcome and liver disease an unfavorable predictor of outcome.   Another important abstract was entitled, “Reuterin in the Healthy Gut Microbiome Suppresses Colorectal Cancer Growth through Altered Redox Balance,” and was presented by Joshua Goyert and colleagues from the University of Michigan.   This abstract reported on a series of findings related to alterations in the intestinal microbiome, especially related to reuterin, the metabolite from the lactobacillus reuteri.   The investigators found that the fecal metabolites from healthy subjects and wild-type mice suppress colorectal cancer, while metabolites from patients or mice with colorectal cancer do not.   Reuterin was found to be the most potent metabolite in suppressing colorectal cancer. And further study found that Reuterin was effective in inhibiting proliferation and inducing cell death of colorectal cancer, but also in cell lines of lymphoma, ovarian cancer, melanoma, and pancreatic cancer. Normal cells were not found to be at all affected. While early, this all suggests a novel strategy for treatment for translational investigation.   The final abstract to be highlighted was actually funded by the NCCN Oncology Research Program and is entitled “Phase 2 Trial Trifluridine/Tipiracil in Combination with Irinotecan in Advanced Biliary Cancers” and was presented by Sri Tella and colleagues from the Mayo Clinic Comprehensive Cancer Center.   Historically, biliary cancers have had very few and limited treatment options. This current study was an open-label phase two clinical trial in patients with biliary cancer and at least one prior systemic therapy to assess the activity of combination trifluridine/tipiracil plus Irinotecan. The subjects were treated with a regimen of trifluridine/tipiracil 25 milligrams per meter squared, orally, on days 1 through 5 on 14-day cycles, and Irinotecan, 180 milligrams per meter squared intravenously on day one of the 14-day cycles. The primary endpoint for success was 16-week progression-free survival. They enrolled 28 patients 27 of whom were available. And they found a 16-week progression-free survival of 37%, which exceeded their target rate of response of 30% or greater.   Overall survival was just over 1 year. While tolerated reasonably well, those reductions were common, and the investigators concluded that further evaluation in a randomized trial was needed.   Dr. John Sweetenham: Thanks, Bob. All very interesting abstracts. I think that makes important contributions. And in the spirit of interesting discussions at the NCCN, I must say that I personally felt that there were some very interesting and excellent sessions around health equity at the conference, including the plenary sessions.   I wonder if you could give us some key takeaways from those sessions looking at health equity, and also the one that specifically looked at access to cancer care, and equity in the context of access.   Dr. Robert Carlson: So, there were a number of sessions at the NCCN Annual Conference that related directly or indirectly to issues of access and equity of cancer care. I'd like to focus specifically on a plenary session that was devoted to equity in cancer care.   We all know that equities in cancer care are pervasive, and we can't just wish or decree away these disparities. We need to be willing to evaluate how each of us can change our own practice and how we can be an active part of larger systems change. And that is what this plenary session was all about—actively eliminating existing disparities in cancer care.   The session was moderated by Dr. Carmen E. Guerra of the University of Pennsylvania. It started with Thomas Farrington of the Prostate Health Education Network discussing the importance of cancer early detection and screening strategies that are designed to account for the differences in incidence and age distribution of cancers in different racial and ethnic groups.   Mr. Farrington used prostate cancer as an example of where Blacks have an especially high incidence, younger age distribution, and more aggressive prostate cancer than do other racial groups.   Liz Margolies of the National LGBT Cancer Network followed and stated that cancer doesn't discriminate, but the health care system certainly does. She talked about making welcoming spaces for sexual and gender minorities in cancer care settings, of truly learning and understanding the perspectives and needs of the LGBT communities, and gaining their trust. She concluded by saying that being well-intentioned is not enough—hard work is necessary.   Shonta Chambers of the Patient Advocate foundation described the importance of social determinants of health that included socioeconomic factors, physical environment, health behaviors, and health care access and quality. She emphasized the central importance of patient navigation in assuring appropriate access. She described using data and the social vulnerability index to target resources where they are needed the most.   Dr. Maria Garcia-Jimenez from UCLA outlined efforts to improve appropriate racial and ethnic representation across clinical trials, specifically by breaking down barriers to patient participation. Dr. Garcia-Jimenez described how these barriers exist at the health system level, with the provider, at the community level, which typically is through lack of trust, and at the patient level, through lack of trust, language, cultural differences, and lack of awareness.   Alyssa Schatz from the NCCN discussed the Elevating Cancer Equity initiative, which is a collaboration of NCCN, the American Cancer Society Cancer Action Network, and the National Minority Quality Forum, involving a number of additional representatives with expertise in disparities in cancer care. This initiative has developed a health equity report card, which includes 17 measures across 4 different domains, and that has been piloted currently at 5 NCCN member institutions to identify areas of racial access and equity needing improvement. The initiative also developed a series of policy priorities, primarily at the federal level that aimed at minimizing disparities.   The summary of this session is that talking about disparities is inadequate. It is crucial that we take positive and focused action to address existing disparities so that we can improve and facilitate equitable care for all patients. And that equity is everyone's responsibility.   Dr. John Sweetenham: That's great. Thanks, Bob. Yeah, there were 2 statements from that session, which really sort of struck home with me. I think, to your final point there, I know that one of the comments that were made was, 'It is great that there has been so much research in recent years, and so much emphasis in the literature on cancer care disparities. But doing research that demonstrates disparities doesn't actually help the patient. It's what we do about that, which is important. And it's sort of a statement of the obvious, but it's very impactful to me to think about that it's become an area of really quite extensive research, but we actually need some actionable conclusions from those research and to work really hard on that.   The other thing that was said that really struck home with me was the comment that “Cancer is a disease of the family.”' And certainly, the person who said that wasn't talking in the inherited sense, but really more of the impacts that cancer has on the family and the caregivers as a whole.   I thought they were both really impactful statements from what was a really excellent session. Bob, I really appreciate you sharing your insights with us today. Are there any other important messages you'd like to get across before we wrap up?   Dr. Robert Carlson: Well, the Annual Conference of the NCCN serves as a forum to discuss important and rapidly evolving NCCN clinical practice guidelines, to discuss best practices in administering cancer care, and to share the results of a wide range of research activities that relate to improving cancer care. We at NCCN invite the oncology community to next year's NCCN Annual Conference and review the endured materials that will be available sometime this June, from the conference that will be posted on the NCCN website.   Dr. John Sweetenham: Great, thank you! Thanks once again for spending time with us on the podcast today, and for the many contributions that NCCN has made, both nationally and globally, and indeed continues to make to advance quality, effective, equitable, and accessible care for all patients with cancer.   Dr. Robert Carlson: And thank you, John, we look forward to working with you as the chair of the NCCN Board of Directors to further extend all these efforts.   Dr. John Sweetenham: Thanks! Thanks also to our listeners for your time today. If you are enjoying the content on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness   Dr. Robert Carlson: Employment (immediate family member): Flatiron Health Patents, Royalties, Other Intellectual Property: Patents relating to inventions as an employee of NCCN Other Relationship: National Comprehensive Cancer Network   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 or service organization activity or therapy should not be construed as an ASCO endorsement.    

Rearranged during transfection (RET) and tropomyosin receptor kinase (TRK) fusions are involved in various adult and paediatric cancers, including thyroid cancers. There is a high mortality rate for some of these cancers, partly due to the lack of efficient detection, diagnosis, and prognosis. The US and European guidelines recommend genomic testing as a part of standard diagnostic evaluations for some cancers to identify driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines presents challenges to practitioners, including coordination of sample handling, long turnaround times, test reimbursement (in applicable settings), access to targeted therapies, insufficient tissue, and patient harm from the repeat biopsies necessary if the tissue sample is insufficient. This episode offers some guidance around when and how to test for biomarkers of response to precision medicines. To answer our questions on the topic, we welcome the expertise of Professor Fernando López-Ríos. Professor López-Ríos is a pathologist at the ‘12 de Octubre' University Hospital in Spain. Funding Information: This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty. References 1. National Comprehensive Cancer Network. Thyroid Carcinoma. (Version 3.2021-October 15, 2021). Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed January 16, 2022. 2. Belli C, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021 Mar;32(3):337-350. 3. Marchiò C, et al. ESMO recommendations on the standard methods to detect NTRK fusions in daily practice and clinical research. Ann Oncol. 2019 Sep 1;30(9):1417-1427. 4. OncoKB: MSK's Precision Oncology Knowledge Base. Available at: https://www.oncokb.org/. Accessed March 15, 2022. 5. Mosele F, et al. Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group. Ann Oncol. 2020 Nov;31(11):1491-1505.

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.

Dr Hurvitz sheds light on shifts in practice patterns in HER2-positive breast cancer in light of data that emerged in 2021, remaining questions regarding treatment sequencing, the importance of updates to the National Comprehensive Cancer Network guidelines in metastatic HER2-positive breast cancer, and future directions to keep an eye on in 2022.

In today's episode, we're going to talk about how precision medicine fits into thyroid cancer treatment guidelines. To answer our questions on this topic, we welcome the expertise of Dr. Lori Wirth. Dr. Wirth is Medical Director of the Center for Head and Neck Cancers at the Massachusetts General Hospital, and an Associate Professor in Medicine at Harvard Medical School. Funding statement: This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education. References: Filetti S, Durante C, Hartl D, et al. Thyroid Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019; 30:1856-1883. National Comprehensive Cancer Network. Thyroid Carcinoma. (Version 3.2021-October 15, 2021). Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed January 16, 2022. Fleeman N, Houten R, Chaplin M, et al. A systematic review of lenvatinib and sorafenib for treating progressive, locally advanced or metastatic, differentiated thyroid cancer after treatment with radioactive iodine. BMC Cancer. 2019;19:1209. https://doi.org/10.1186/s12885-019-6369-7 Naoum GE, Morkos M, Kim B, Arafat W. Novel targeted therapies and immunotherapy for advanced thyroid cancers. Mol Cancer. 2018;17:51. Pekova B, Sykorova V, Mastnikova K, et al. NTRK fusion genes in thyroid carcinomas: Clinicopathological characteristics and their impacts on prognosis. Cancers.2021;13:1932. https://www.mdpi.com/2072-6694/13/8/1932 Pitoia F. Complete response to larotrectinib treatment in a patient with papillary thyroid cancer harboring an ETV6-NTRK3 gene fusion. Clin Case Rep. 2021;9:1905-1912. doi: 10.1002/ccr3.3900 VITRAKVI, Prescribing information. Bayer HealthCare Pharmaceuticals Inc. Revised: March 2021. ROZLYTREK, Prescribing information. Genentech USA, Inc. Revised: November 2021. Hong DS, DuBois SG, Kummar S, et al. Larotrectinib in patients with TRK fusion-positive solid tumours: a pooled analysis of three phase 1/2 clinical trials. Lancet Oncol. 2020;21:531-540. Chu YH, Dias-Santagata D, Farahani AA, et al. Clinicopathologic and molecular characterization of NTRK-rearranged thyroid carcinoma (NRTC). Mod Pathol. 2020;33:2186-2197. Doebele RC, Drilon A, Paz-Ares L, et al. Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1–2 trials. Lancet Oncol. 2020;21:271-282. RETEVMA, Prescribing information. Lilly USA, LLC. Initial US approval: 2020. GAVRETO, Prescribing information. Genentech USA, Inc. and Blueprint Medicines Corporation. Revised: April 2021. Krajewska J, Kukulska A, Oczko-Wojciechowska M, Jarzab B. Recent advances in precision medicine for the treatment of medullary thyroid cancer. Expert Review of Precision Medicine and Drug Development. 2021;6(5): 307-315. https://doi.org/10.1080/23808993.2021.1964952 European Medicines Agency. Retsevmo. December 11, 2020. Accessed January 18, 2022. https://www.ema.europa.eu/en/medicines/human/EPAR/retsevmo European Medicines Agency. Gavreto. September 17, 2021. Accessed January 18, 2022. https://www.ema.europa.eu/en/medicines/human/EPAR/gavreto

For new-to-practice oncology nurses, orientation serves as a foundation to understanding the specialized needs of their unique patient population. Join ONS member Christina Klein, MSN, RN, CRNI, OCN®, education coordinator at Temple University Hospital in Philadelphia, PA, and member of the Bucks Montgomery Counties ONS Chapter, and Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, as they discuss orientating new-to-practice nurses as they begin their careers in oncology and educational resources to build on their existing knowledge. 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) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by January 21, 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. Oncology Nursing Podcast Episode 125: Oncology Academy Orients Experienced RNs to Cancer Care Oncology Nursing Podcast Episode 160: Build Innovative Staff Education Tools and Resources ONS book: Core Curriculum for Oncology Nursing (sixth edition) ONS course bundle: Foundations of Oncology Nursing Practice ONS course: Oncologic Emergencies ONS course: Professional Practice—Oncology NP ONS Oncology Nurse Orientation Program Infusion Nurses Society education resources National Comprehensive Cancer Network guidelines 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.

Dr Bardia discusses the role of sacituzumab govitecan in the treatment of patients with metastatic triple-negative breast cancer, the influence of the National Comprehensive Cancer Network guidelines on treatment recommendations and sequencing in the second-line setting, and ongoing research with the agent in the neoadjuvant setting.

ONS member Deena Dell, MSN, APRN, AOCN®, nursing professional development specialist in oncology at the Sarasota Memorial Hospital Brian D. Jellison Cancer Institute in Florida, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss the history of surgical oncology, how it has evolved in recent years, and what we can expect in the future of the specialty. 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 December 10, 2023. 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. Oncology Nursing Podcast Episode 66: Updates in Surgical Oncology—ONS Congress ONS Voice article: Mortality Rates After Cancer Surgery Decrease, but Racial Disparities Remain ONS Voice article: Under the Knife: Supporting Patients' Needs Throughout Surgical Oncology Care Clinical Journal of Oncology Nursing article: Surgical Oncology: Evolution of Postoperative Fatigue and Factors Related to Its Severity ONS book: Core Curriculum for Oncology Nursing (sixth edition) ONS book: Surgical Oncology Nursing ONS course: Cancer Basics American Cancer Society guide to cancer surgery American College of Surgeons resources on cancer American Society of Clinical Oncology journal articles on cancer National Comprehensive Cancer Network guidelines National Institutes of Health surgical oncology team 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.

ONS member Amanda Sarafin, BSN, OCN®, MSN/Ed, nurse manager at Mount Sinai Health System in New York, NY, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss how oncology nurses and patients can find reputable educational resources during all stages of 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 November 26, 2023. 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. Oncology Nursing Podcast Episode 43: Sharing Patient, Provider, and Caregiver Resources ONS Voice articles on patient education ONS book: Cancer Basics (second edition) ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice ONS book: Fundamentals of Chemotherapy Immunotherapy Administration ONS book: Standards of Oncology Education: Patient/Significant Other & Public (fourth edition) ONS IVE Drug Education Sheets ONS Oral Chemotherapy Education Sheets ONS Safe Handling of Hazardous Drugs Learning Library ONS Survivorship Learning Library ONS videos for patient education American Cancer Institute resources on treatment and support Medscape oncology resources National Cancer Institute resources for patients National Comprehensive Cancer Network patient resources 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.

Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.   Case 1 - Learning Points: These are complex patients and multidisciplinary care should be provided with input from oncology.  A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients. Highly selected patients may benefit from surgery, namely those with a high performance status, a prognosis of months if the bowel obstruction was resolved, minimal carcinomatosis, and a single transition point. Diversion, bypass, or resection are all options, but a patient's capacity to heal related to recent systemic therapy needs to be taken into account.  Consent for surgery should focus on goals of care, quality of life, and achievable outcomes, and highlight the inherent risk in patients with advanced disease and a limited lifespan.  Case 2 - Learning Points: Colorectal malignancy is an exceedingly common cause of general surgical emergency and requires a thoughtful, systematic approach The role of stenting as a bridge to surgery in obstructing distal colon malignancy is somewhat controversial but can help to avoid permanent stomas; however there is some potential risk of perforation and possibly disease recurrence Treatment decisions should take place in the context of an informed discussion with the patient and consideration of both quantity and quality of life whenever possible Consistent involvement of a multidisciplinary team, including radiology, enterostomal therapy, and surgical oncology can be extremely useful in guiding complex decisions References: Shariff F, Bogach J, Guidolin K, Nadler A. Malignant Bowel Obstruction Management Over Time: Are We Doing Anything New? A Current Narrative Review. Ann Surg Oncol. 2021 Oct 18. doi: 10.1245/s10434-021-10922-1. Epub ahead of print. Ripamonti C, Gerdes H and Easson A. Management of malignant bowel obstruction. Eur J Cancer 2008 May;44(8):1105-15 Chen, T, Huang, Y. & Wang, G. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Onc 15, 164 (2017).  Olmsted C, Johnson A, Kaboli P, et al. Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration. JAMA Surg. 2014;149(11):1169–75. Dunn GP, Martensen R, Weissman D.  Surgical palliative care: a resident's guide. Essex: American College of Surgeons; 2009. Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83. National Comprehensive Cancer Network. https://www.nccn.org/. Accessed October 15, 2021. Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol. 2014 Nov;110(6):666-9. doi: 10.1002/jso.23707.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The National Comprehensive Cancer Network's 2021 Virtual Congress on Hematologic Malignancies took place from October 14 to October 16. The meeting focused on updates to the NCCN Guidelines; new, emerging, and novel therapeutic agents; advances in cancer care; and the practical management of patients with hematologic malignancies. This week, we hear from three presenters who participated in the conference.To listen to more podcasts from ASCO, visit asco.org/podcasts.

ONS member Kristi Orbaugh, RN, MSN, RNP, AOCN®, nurse practitioner for Community Hospital Oncology Physicians in Indianapolis, IN, and member of the Central Indiana ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss patient education prior to and during immunotherapy. This is a continued conversation from a previous episode that discussed findings from an ONS focus group that Orbaugh facilitated in August 2021; we've linked that in the episode notes. This podcast episode is supported by an educational grant from AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Episode Notes  Check out these resources from today's episode:   NCPD contact hours are not available for this episode.  Oncology Nursing Podcast Episode 172: Address Knowledge Gaps in Evidence-Based Precision Medicine Care  Previous Oncology Nursing Podcast episodes on immunotherapy  ONS Voice article: New Patient Education Formats Help Nurses Connect Patients to Individualized Resources  ONS Voice article: Patient Education Is Critical to Managing irAEs for Immune Checkpoint Inhibitors  ONS Voice article: Tailored Education Improves Patient Satisfaction and Comprehension  ONS course bundle: Immuno-Oncology for the Oncology Nurse Case Studies  Immuno-Oncology Learning Library  American Cancer Society patient education resources   ASCO patient education materials  National Comprehensive Cancer Network guidelines on managing immunotherapy-related toxicities  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. 

A rapid review of nonmelanoma skin cancer for the plastic surgery learner. In this episode we review:Basal cell carcinoma and squamous cell carcinomaRisk stratification of nonmelanoma skin cancersEvaluation and management of the nonmelanoma skin cancer patient Feedback is always appreciated. Comments, questions, suggestions, or corrections can be sent to jakemarksmd@gmail.comReferences:Zbar RIS, Canady JW. MOC-PSSM CME article: Nonmelanoma facial skin malignancy. Plast Reconstr Surg. 2008;121(1 Suppl):1-9.Connolly KL, Nehal KS, Disa JJ. Evidence-Based Medicine: Cutaneous Facial Malignancies: Nonmelanoma Skin Cancer. Plast Reconstr Surg. 2017;139(1):181e-190e.National Clinical Practice Guidelines in Oncology: Squamous Cell Skin Cancer (version 2.2021). National Comprehensive Cancer Network . 2021.National Clinical Practice Guidelines in Oncology: Basal cell Skin Cancer (version 2.2021). National Comprehensive Cancer Network. 2021.

ONS member Cindy Dionysus, MSN, RN, OCN®, infusion nurse at Riverwood Healthcare Center in Aitkin, MN, and nursing instructor at Central Lake College in Brainerd, MN, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss how oncology nurses can safely administer etoposide chemotherapy and manage its associated adverse events. This episode is part of an ongoing series about outpatient oncology drug infusion. The others are linked in the episode notes. The advertising messages in this episode are paid for by i3 Health.  Episode Notes  Check out these resources from today's episode:  NCPD contact hours are not available for this episode.  Previous Oncology Nursing Podcast episodes on outpatient oncology drug infusion  Oncology Nursing Podcast Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments  Oncology Nursing Podcast Episode 162: What Nurses Need to Know About Central Lines and Ports  Clinical Journal of Oncology Nursing article: Venous Flare Reactions: A Case Report of Reactions Following Etoposide Infusion  ONS course: Fundamentals of Chemotherapy Immunotherapy Administration  ONS course: ONS/ONCC Chemotherapy Immunotherapy Certificate Course  ONS position statement: Education of the Registered Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies American Cancer Society patient resources on chemotherapy treatment Etoposide package insert  National Cancer Institute information on etoposide National Comprehensive Cancer Network guidelines with evidence blocks National Institute for Occupational Safety and Health: Hazardous Drugs in Healthcare Settings  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.

ONS member Kristi Orbaugh, RN, MSN, RNP, AOCN®, nurse practitioner for Community Hospital Oncology Physicians in Indianapolis, IN, and member of the Central Indiana ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss knowledge gaps in clinical practice, particularly related to newer precision medicine approaches. Orbaugh is facilitating an ongoing ONS focus group on the topic. The latest session, which took place in August 2021, discussed immuno-oncology, precision oncology, and immune-related adverse events (irAEs). This podcast episode is supported by an educational grant from AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Episode Notes Check out these resources from today's episode: NCPD contact hours are not available for this episode. Oncology Nursing Podcast Episode 79: Nurses Need Biosimilars Education and Resources Oncology Nursing Podcast Episode 87: What Are the Biggest Barriers to Patient Education? Oncology Nursing Podcast Episode 125: Oncology Academy Orients Experienced RNs to Cancer Care Oncology Nursing Podcast Episode 160: Build Innovative Staff Education Tools and Resources ONS Voice article: Patient Education Is Critical to Managing irAEs for Immune Checkpoint Inhibitors ONS book: Guide to Cancer Immunotherapy ONS Genomics and Precision Oncology Learning Library ONS Putting Evidence Into Practice (PEP) resources ONS video: Balancing irAEs ONS webinar: Immuno-Oncology for the Oncology Nurse American Society of Clinical Oncology guidelines National Comprehensive Cancer Network guidelines 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.

Dr. Steve Pergam, associate professor of the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Research Center and the Infection Prevention Director at Seattle Cancer Care Alliance, discusses new guidance from the National Comprehensive Cancer Network's COVID-19 Vaccination Advisory Committee, regarding a third dose of the Pfizer-BioNTech or the Moderna COVID-19 vaccines for patients with cancer. 

ONS member Rebekah Flynn, DNP, APRN, AGCNS-BC, AOCNS®, CNE, OCN®, associate director of quality improvement and education at the Washington University Siteman Cancer Center in St. Louis, MO, and board president of the St. Louis ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss how to safely administer ifosfamide chemotherapy infusions. This episode is part of an ongoing series about outpatient oncology drug infusion. The others 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 July 16, 2023. 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 outpatient oncology drug infusion ONS Voice article: Nurses Advocate for Palliative Care, Drug Parity by Sharing Patient Experiences ONS Voice article: Manage Cancer Treatment-Related Skin Toxicities With ONS Guidelines™ ONS Voice article: Infection Prevention for Oncology Nurses ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice ONS Communities thread on ifosfamide toxicity ONS course: Fundamentals of Chemotherapy Immunotherapy Administration ONS course: Safe Handling Basics ONS/ONCC Chemotherapy Immunotherapy Certificate Course American Cancer Society information on approved and off-label indications for ifosfamide Chemocare information on ifosfamide Ifosfamide package insert National Comprehensive Cancer Network chemotherapy order templates National Institute for Occupational Safety and Health: Hazardous Drugs in Healthcare Settings 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.

ONS member Ilene Comeras Lattimer, BSN, RN, OCN®, CCRC, clinical research specialist at the James Cancer Hospital and Solove Research Institute in Columbus, OH, and director-at-large for the Columbus ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss how oncology nurses can navigate patients with metastatic colorectal cancer through treatment and survivorship. Lattimer also speaks about her own family history of cancer and her connection to Lynch syndrome. Pfizer provided support for this podcast episode through an educational grant. This podcast is part of a project, including two videos, two case studies, and other clinical practice resources that will be released in July 2021. 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 June 4, 2023. 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. Oncology Nursing Podcast Episode 153: Metastatic Colorectal Cancer Has More Treatment Options Than Ever Before ONS Voice article: Colorectal Cancer Prevention, Screening, Treatment, and Survivorship Recommendations ONS Voice article: Genetic Disorder Reference Sheet: Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) ONS Voice article: Nursing Considerations for Colorectal Cancer Survivorship Care ONS assessment tools ONS Guidelines™ for cancer-related constipation and skin toxicities ONS symptom interventions for chemotherapy-induced or immunotherapy-induced diarrhea ONS/ONCC Chemotherapy Immunotherapy Certificate Course American Cancer Society colorectal cancer survivorship care guidelines National Comprehensive Cancer Network distress thermometer and problem list 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. 

The combined clinical cell-cycle risk (CCR) score uses clinical and genetic factors to assess the risk of metastasis after radiation therapy in patients with prostate cancer. The CCR score has proven accurate in studies and can guide post-radiation treatment decisions in practice, according to Jonathan D. Tward, MD, PhD, of the University of Utah, Salt Lake City. Dr. Tward discusses the CCR score with host David Henry, MD, in this episode. About the score The CCR score combines the cell-cycle progression (CCP) score (available commercially as the Prolaris test) and the Cancer of the Prostate Risk Assessment (CAPRA) score to more precisely determine the postradiation risk for metastatic disease. Investigators identified a threshold for determining precise risk levels (2.112), which allows for personalized treatment decision-making based on more individual characteristics than standard risk-group categorizations, according to Dr. Tward. He noted that standard risk groups can include a broad range of actual risk even within a given category. Risk groups are “reasonably good at prognosticating who may or may not go on to have metastasis etc., but they’re not that good,” Dr. Tward said. CCR score proves effective Dr. Tward and colleagues evaluated the CCR score in a retrospective study published in Clinical Genitourinary Cancer (https://bit.ly/3vlgUwe). The study included 718 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy. Results showed that patients with CCR scores below the identified threshold (2.112) could safely forgo multimodality therapy. CCR score bests other scoring systems In another study, the CCR score proved more accurate than other scoring systems. Dr. Tward presented findings from this study at the 2021 Genitourinary Cancers Symposium (https://bit.ly/3eBvAjM). The study included 741 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy. The CCR score predicted metastasis (hazard ratio, 2.21; C-index, 0.78) and did so better than National Comprehensive Cancer Network risk groups (C-index, 0.70), the CAPRA score alone (C-index, 0.71), or the CCP score alone (C-index, 0.69). Dr. Tward said he has used the CCR score in his own practice for years and found it helpful. Show notes written by Sharon Worcester, a reporter for MDedge and Medscape. Disclosures Both studies were funded by Myriad Genetics, the company that developed the Prolaris test. Dr. Tward disclosed relationships with Myriad Genetics and other companies. Dr. Henry has no relevant disclosures. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd 

Guest: D. Ross Camidge, MD, PhD What are some of the clinical considerations for RET-rearranged non-small cell lung cancer? Dr. Ross Camidge, Director of the Thoracic Oncology Clinical and Clinical Research Programs at the University of Colorado, briefly discusses the guidelines and benefits of therapy recommended for non-small cell lung cancer by the National Comprehensive Cancer Network.

ONS member Randy Jones, PhD, RN, FAAN, professor at the University of Virginia School of Nursing in Charlottesville and member of the Blue Ridge of Virginia ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss racial and other health disparities in patients with metastatic castration-sensitive prostate cancer. Astellas provided support for this podcast episode through an educational grant. 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 April 2, 2023. The planners and faculty for this episode have no conflicts to disclose, and the episode has no commercial support. 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.  ONS Voice article: Prostate Cancer Clinical Trials Don't Reflect Racial Diversity—And It's Getting Worse Over Time  ONS Voice article: U.S. Sees Another Record-Breaking Decrease in Cancer Deaths, but Disparities Remain  Oncology Nursing Forum article: Hidden Patients, Hidden Partners: Prostate Cancer Care for Gay and Bisexual Men  Jones discusses the decision-making tool he developed for patients with prostate cancer.  American Cancer Society information on prostate cancer  Centers for Disease Control and Prevention information on the Tuskegee study  National Cancer Institute information on prostate cancer for providers  National Comprehensive Cancer Network clinical practice guidelines on prostate cancer  Prostate Cancer Foundation  Zero Prostate Cancer Summit 

On today's episode meet Lee Schwartzberg, MD, FACP. Dr. Schwartzberg is a medical oncologist and the Medical Director of West Cancer Center. He is also the Chief Medical Officer at OneOncology, an organization that invests in and collaborates with practices to deliver comprehensive cancer care in communities. A renowned expert in the study and treatment of breast cancer, precision medicine and supportive care, Dr. Schwartzberg served on the Board of Directors for the National Comprehensive Cancer Network and is the founding editor-in-chief of the journal Community Oncology. Today we are talking about bringing precision medicine to community oncology practices.

In this episode of Avalere Health Essential Voice, experts from our Market Access practice discuss major takeaways from the 2021 National Comprehensive Cancer Network annual conference.

Throughout the history of cancer advocacy, there 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 and 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 in the cancer community. Enjoy the show.

Dr. Ruth O'Regan is the Division Head of Hematology and Oncology in the Department of Medicine at the University of Wisconsin School of Medicine and is an associate director of the University of Wisconsin Carbone Cancer Center. Dr. O'Regan specializes as a breast cancer physician and researcher. She is ranked by Newsweek/Castle Connolly Medical as one of the top oncologists in the nation. She received her MD from University College in Dublin, Ireland. She completed her internal medicine residency at Northwestern University and the Medical College of Wisconsin. She completed fellowships in Oncology from Mater Hospital in Dublin and Northwestern University. Dr. O'Regan is the Chief Scientific Officer of the Big Ten Cancer Research Consortium. She is the Vice-Chair of the Wisconsin Association of Hematology and Oncology, and is on the Executive Committee for the National Comprehensive Cancer Network. Prior to the University of Wisconsin, Dr. O'Regan was the chair and medical director of breast cancer research at Emory University, and the director of breast cancer research at the Winship Cancer Institute. Tune in to hear about breast cancer: causes, symptoms, treatments, and much more.

Lisa Richardson, MD, MPH, director of the Centers for Disease Control and Prevention's (CDC's) Division of Cancer Prevention and Control, joins Lisa Kennedy Sheldon, PhD, APRN, AOCNP®, FAAN, ONS's clinical and scientific affairs liaison, to discuss CDC's initiatives for cancer prevention and screening during the COVID-19 coronavirus and flu season. The conversation also covers how oncology nurses can help improve declining screening rates and access a new database of cancer incidence and biomarkers. The advertising messages in this episode are sponsored by Coherus BioSciences.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Episode Notes Check out these resources from today's episode: Oncology Nursing Podcast Episode 96: The COVID-19 Coronavirus and Cancer Care Oncology Nursing Podcast Episode 97: COVID-19 Cancer Care Lessons From Seattle and New York ONS Voice article: How Can ONS Support Members in Today's Practice Changes? ONS Voice article: COVID-19 Fact Sheet and Implications for Patients With Cancer ONS Voice COVID-19 topic page ONS Information on the Coronavirus (COVID-19) ONS Advocacy During COVID-19 Pandemic ONS Recommendations for Oncology Staff Assignments During the COVID-19 Pandemic Dr. Lisa Richardson's biography Talk to Someone, virtual simulation with cancer survivor Linda Staying Well While Staying at Home Best Remedy for COVID-19 Is Prevention Cancer, the Flu, and You The National Comprehensive Cancer Network (NCCN) makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hematopoietic Growth Factors. V.2.2020. © National Comprehensive Cancer Network, Inc., 2020. All rights reserved. Accessed July 10, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org.

El Dr. Alan Burguete-Torres, oncólogo médico junto con el Dr. Carlos Rodríguez Montalvo, cirujano hepatobiliar, ambos del Centro Médico Zambrano Hellion, TecSalud en Monterrey, Nuevo León, México, nos comentan sobre el manejo multidisciplinario del carcinoma hepatocelular. El carcinoma hepatocelular es la sexta enfermedad oncológica más frecuente a nivel mundial, se estima que en los próximos 20 años el número de casos aumente hasta casi duplicarse alrededor de un millón y medio de casos de forma anual. (1) Las guías internacionales de tratamiento sugieren que las recomendaciones terapéuticas sean propuestas por un equipo multidisciplinario local, basados en la experiencia individual de cada especialista en el equipo y las características del paciente. Las guías NCCN proponen la evaluación multidisciplinaria como el factor principal previo al algoritmo del diagnóstico. Además de resaltar la importancia para la toma de decisiones de nuevos esquemas de tratamiento como la combinación de inmunoterapia más antiangiogénicos como primera línea. (2-3) El Dr. Carlos Rodríguez Montalvo, comenta que en el 90% de los casos, el hepatocarcinoma está relacionado con una enfermedad hepática crónica, de tal manera que es fundamental contar con un equipo que colabore de manera integral con el paciente. El doctor destaca que hoy en día existen diversas herramientas de detección como los estudios de imagen y programas de detección temprana que hacen posible el identificar esta enfermedad de forma anticipada, incrementando la posibilidad de curación. (4) De acuerdo con su experiencia, el trasplante hepático es una indicación claramente establecida para el tratamiento con intención de curación, sin embargo, no todos los pacientes son aptos para este procedimiento, aunado a esto, la aplicación de terapias quirúrgicas como una alternativa, pueden ofrecer tratamientos con intención de recuperación y control a largo plazo de la enfermedad. Así mismo, la importancia de la biopsia es fundamental para tomar en cuenta la biología tumoral, ya que esto permitirá seleccionar de una mejor manera a los pacientes que recibirán tratamiento en cualquier etapa de su enfermedad. En conclusión, es fundamental el trabajo multidisciplinario para el manejo de pacientes con hepatocarcinoma ya que se puede llegar al mejor tratamiento dependiendo de la situación específica del paciente, incrementando la tasa de supervivencia y mejorando la calidad de vida. (4) Referencias: World Health Organization. Cancer today, global cancer observatory. 2018, International Agency for Research on Cancer. Vogel A., Cervantes A., Chau I., y cols. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2018. ESMO. iv238–iv255. National Comprehensive Cancer Network. NCCN Guidelines Hepatocellular Carcinoma Version 4.2020. 2020. NCCN. Agarwal P., Philips P., Hillman L., y cols. Multidisciplinary Management of Hepatocellular Carcinoma Improves Access to Therapy and Patient Survival. 2017. Clinical Gastroenterology. 10.1097/MCG.0000000000000825 Gracias al apoyo educativo de Roche México

SSO Secretary, Kelly Hunt, MD interviews Mehra Golshan, MD, and Eleftherios (Terry) Mamounas, MD, about their involvement with the manuscript, “COVID-19 Pandemic Breast Cancer Consortium’s Considerations for Re-Entry.” Dr. Golshan and Dr. Mamounas were appointed as SSO representatives to a consortium consisting of experts from The American Society of Breast Surgeons, the National Accreditation Program for Breast Centers, the National Comprehensive Cancer Network, the American College of Surgeons Commission on Cancer, the American College of Radiology and the American Society of Clinical Oncology.

In this second episode of our new podcast series, Dr Tom Lynch, who began his position as director of the Fred Hutchinson Cancer Research Center as Seattle became the first epicenter of the COVID-19 pandemic in the United States, comments on the current status of oncology research and data soon to be presented from a Phase III trial evaluating the EGFR TKI osimertinib as adjuvant therapy for patients with non-small cell lung cancer and EGFR tumor mutations. Additional resources: * Lynch TJ et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004;350(21):2129-39. Abstract (https://pubmed.ncbi.nlm.nih.gov/15118073/) * AstraZeneca. [Osimertinib] Phase III ADAURA trial will be unblinded early after overwhelming efficacy in the adjuvant treatment of patients with EGFR-mutated lung cancer [press release (https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2020/tagrisso-phase-iii-adaura-trial-will-be-unblinded-early-after-overwhelming-efficacy-in-the-adjuvant-treatment-of-patients-with-egfr-mutated-lung-cancer.html)]. April 10, 2020. * National Comprehensive Cancer Network. Short-term recommendations for non-small cell lung cancer management during the COVID-19 pandemic. COVID-19 NCCN guidelines (https://www.nccn.org/covid-19/pdf/COVID_NSCLC.pdf).

In this podcast, Thomas Farrington, founder of the Prostate Health Network, speaks with WCG President of Patient Advocacy Steve Smith.Mr. Farrington discusses his experience with the healthcare system, coupled with his own research on prostate cancer, which led him to become a vocal advocate for prostate cancer patients and survivors. His advocacy spans a wide range of approaches from educational seminars, a frequently-visited website, a theater production called Daddy’s Boy that is now on tour, and visits to legislators on Capitol Hill to help shape public policy for the benefit of people with this unmet medical need.Mr. Farrington also serves as a trustee of the Dana Farber Cancer Institute and as an advisor to a number of other healthcare organizations and programs, and he is on the National Comprehensive Cancer Network’s prostate cancer treatment guidelines panel and their prostate cancer early-detection guidelines panel.

Guest: Jason Day Guest: Dening Day Biomarker testing is a critical step in any mNSCLC patient’s treatment journey, as PGA champion Jason Day found out when his mother, Dening, was diagnosed with the disease.1-3 In this video, Jason and Dening tell their story about how biomarker testing helped Dening get on a therapy that can target the driver of her disease. Jason and Dening’s story may help your newly diagnosed mNSCLC patients understand the importance of testing their lung cancer, knowing the full molecular results, and treating based on those results. Share this video and more with your patients by visiting TestLungCancer.com. References: Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for NSCLC V.3.2020. ©National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed February 11, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. Brahmer JR, Govindan R, Anders RA, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). J ...

Guest: Jason Day Guest: Dening Day Biomarker testing is a critical step in any mNSCLC patient’s treatment journey, as PGA champion Jason Day found out when his mother, Dening, was diagnosed with the disease.1-3 In this video, Jason and Dening tell their story about how biomarker testing helped Dening get on a therapy that can target the driver of her disease. Jason and Dening’s story may help your newly diagnosed mNSCLC patients understand the importance of testing their lung cancer, knowing the full molecular results, and treating based on those results. Share this video and more with your patients by visiting TestLungCancer.com. References: Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for NSCLC V.3.2020. ©National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed February 11, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. Brahmer JR, Govindan R, Anders RA, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). J ...

This week we answer a few questions: the first is from Patreon backer, Harry Hong, on Kaplan-Meier curves. The second is from a student at Mount Sinai Medical School who reached out with some ethical questions they had after the ASH annual meeting on the obligations and responsibilities of peer reviewers. Finally, we end the episode with an interview with Dr. Bishal Gyawali of Queens University in Kingston, Ontario, Canada on his new paper out today in the Journal of the National Comprehensive Cancer Network titled "Response Rates and Durations of Response for Biomarker-Based Cancer Drugs in Nonrandomized Versus Randomized Trials". Durations of Response: doi.org/10.6004/jnccn.2019.7345 Vinay's new book, Malignant: www.amazon.com/Malignant-Policy-…cer/dp/1421437635 Back us on Patreon! www.patreon.com/plenarysession

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. Monika Sharda: Hi, I'm Monica Sharda, an editor on the Cancer.Net team and your host for today's podcast. In this episode, we're going to discuss 2 studies on patient experiences with clinical trials that will be presented at ASCO's 2019 Quality Care Symposium. This annual meeting brings together health care experts to share strategies for cancer care issues and integrate these methods into patient care. I have with me 2 oncology experts who will help us understand these studies and why they're important. Our first guest, Dr. Merry-Jennifer Markham is a hematologist at the University of Florida in Gainesville. Welcome, Dr. Markham. Dr. Markham: Hi, hi. Thanks for having me. Monika Sharda: And we also have with us Dr. Neeraj Agarwal, who is a medical oncologist at the University of Utah's Huntsman Cancer Institute. Thanks for being with us, Dr. Agarwal. Dr. Agarwal: A pleasure. Thank you. Monika Sharda: So before we delve into the studies, I want to make sure we explain what clinical trials mean for any listeners who may not be familiar with the term. Can you provide a brief explanation of what a clinical trial is and how they're used in cancer care? Dr. Agarwal: Yeah, of course. So if we look at the definition of National Cancer Institute, how the clinical trial is defined that is a type of research study that test how well new medical approaches work in our patients. And these studies test new methods of screening, prevention, diagnosis, or treatment of a disease. These are often called as prospective clinical studies, but I make it simple for my patients. I tell them that to me the definition of a clinical trial is how to get cutting edge technology, which can be a treatment or a device, to my patients 5 years before FDA approval of that drug or a device. How to expedite availability of those cutting-edge technology to my patients is the definition I use for clinical trials. Monika Sharda: Thanks. That's a great way to put it. So let's start by discussing the study that comes out of Seattle, Washington where researchers looked at whether participating in a clinical trial helped people with metastatic non-small cell lung cancer live longer. Can you tell us a little bit about how the study was conducted, Dr. Agarwal? Dr. Agarwal: Yes, and this study, as you mentioned, was conducted in Seattle Cancer Alliance consisting of University of Washington and Fred Hutchinson Cancer Research Center, both based in Seattle, Washington. What the researchers did, they looked back at the records of patients with non-small cell lung cancer or simply advanced lung cancer who were treated in their institutions between January 2007 and December 2015. And they included 371 patients.  One-third of those patients, almost 30% of patients were enrolled on 1 or more clinical trials. And other patients were not enrolled in the clinical trials. And they compared, basically, those patients. They looked at the survival of patients who were able to get on a clinical trial versus who did not. And very interestingly, patients who were enrolled on a clinical trial, their median survival was twice as much as those who did not get to enroll on a clinical trial. The overall survival in patients who were on clinical triasl who got to get treated on a clinical trial—at least one clinical trial—was 838 days compared to patients who did not go on a clinical trial who only lived for 454 days. This is even more interesting is because the researchers compared the patient's disease characteristics, demographic characteristics, and they made sure that patients were evenly distributed from those characteristics. It’s not that patients who had more aggressive disease or who had a higher history or longer history of smoking, they got to be under control arm, which is that they did not get on the clinical trial. So patients in both groups were evenly matched for demographic and disease characteristics. So this basically tells me that if you get to enroll on a clinical trial, the overall survival is higher than if you do not. Monika Sharda: And do we know why that might be? Why patients that were enrolled in clinical trials tended to live longer? Dr. Agarwal: As I said, clinical trial allows me and my patients to have those technology or those drugs available to the clinic 5 years before FDA approval. And that's the ballpark. It can be 7 years. It can be 10 years. It can be 3 years. But in general, 5 years is the mark I use with my patients. So if a patient is getting to be treated with a drug 5 years before that drug would be available by prescription, there is an advantage of time, because if we look at the median survival of this patient population, there is no way they could have just waited for that drug to get approved and be available by prescription in the clinic. So I think that's a huge advantage, that they had access to a drug for their cancers which was not available to those patients who did not get to go on a clinical trial. I think that's the number one, or the main advantage, why the survival is so much better in the patients who got to go on a clinical trial. Monika Sharda: Right. And the other study focuses on clinical trial enrollment. So statistics show that less than 10% of people with cancer participate in clinical trials. For this  study, researchers surveyed 120 doctors and clinical trial research staff and also 150 cancer patients to try and find out why participation is so low. So Dr. Markham, can you tell us briefly what the researchers found? Dr. Markham: Sure. I think 1 of the things that is striking is that the number of patients who enroll on trials is so low, the percentage. And we know the barriers to clinical trial enrollments do exist. What this study showed actually was that the perceptions of what these barriers are, really differed between the physicians and research staff and the patients. So clearly we didn't have a great understanding of the barriers on each side. I'll give you just a couple of examples. In this study, patients more often than physicians or research staff believed that trials are only available and only for people whose cancer is considered hopeless. We know that's not reality, but that's a perception that panned out in the study. Also more patients, more so than physicians or staff, believe that clinical trials don't help an individual patient. And we know that not to be true. And I think that former study is a really good example of that where in the prior study participating in a clinical trial actually did improve survival. And then a third example is physicians and research staff in the study, more so than patients, were more likely to believe that patients decline a clinical trial due to either language or cultural barriers or due to a lack of understanding about clinical trials. Monika Sharda: Where do you think these perceptions arise from that people have about clinical trials, just going back to the couple of examples that you gave? For example, people thinking that clinical trials are only used when their disease is hopeless or that they don't actually help the patients themselves. Where do you think those perceptions stem from? Dr. Markham: It's hard to know, but I think communication or lack of communication about trials, or lack of enough communication about clinical trials is really a large part of the problem. I think that clearly this is evidence that we oncologists and cancer researchers maybe haven't done a great job or as good a job as we should be doing when it comes to educating our patients. I think this study demonstrates that we do have a lot of room to improve on the patient education piece. Monika Sharda: Do you have any thoughts on some specific ways that people with cancer and their family can work together with doctors to communicate better about clinical trials? Dr. Markham: I think the more education on the cancer or various topics that patients want to bring up in the exam room, the more sort of preparation work a patient and a caregiver can do in advance of the visit the better. Coming to an appointment with a list of questions about trials for example can really help to guide a conversation. I think that it's also a good idea to bring somebody with you to an appointment and this holds true for other reasons, including listening in and having some extra set of ears there to hear important parts of a discussion about a cancer diagnosis or prognosis or treatment. But really helping to sort of prompt questions about clinical trials may be useful. I think for doctors, a good way to open up this conversation is just with open-ended questions. Some of the things I like to ask my patients are, "What do you know about clinical trials?” or, “What would you like to know about clinical trials?" And this is really a good way for me as a physician to gauge the level of understanding of a trial at the outset. And I can gauge whether there's any perceptions or misperceptions that I can help to clarify. And it's a great launching pad for a discussion about clinical trials. Monika Sharda: Dr. Agarwal, did you have anything to add about this study? Dr. Agarwal: I think I agree with everything Dr. Markham just said. In my practice, I spend a significant amount of time when I see a patient for the first time who has come to establish care in my clinic, on just orienting them on clinical trials regardless of whether they are currently eligible for the trial or we have a trial for them or not. I just talk to them about the clinical trials. And that is a theme in my practice. Even a nurse practitioner and nurses, the more our patients hear about clinical trials, I think more amenable they will be or they are, in our experience, to accept enrollment on a clinical trial down the line. But as Dr. Markham said, it's not only 1 doctor or 1 nurse or 1 nurse practitioner. I think it has to be a more holistic approach educating at different levels. All the websites as we discussed as we know of from Cancer.Net, NCI, ClinicalTrials.gov. All those websites have great information on clinical trial availability of a clinical trial for a given disease condition or given stage of a disease. By doing all of those our patients can be made aware of all those websites other than the orientation in the clinic. So I think this has to be a global approach and which ultimately will lead to increased awareness and increased participation of our patients on clinical trials. Monika Sharda: Thanks. And I appreciate you sharing some resources with our listeners of where they can learn more about clinical trials so they can be prepared to have these conversations with their health care team. And just a quick note for our listeners, you can learn more about clinical trials on Cancer.Net by visiting cancer.net/clinicaltrials. And there's also a couple of other resources that Dr. Agarwal mentioned. Dr. Markham, did you want to add any other resources? Dr. Markham: Sure. So Cancer.Net is definitely a great resource. And it's written in a way that is easily understandable. The other 2 that I would mention are the American Cancer Society's website and the National Comprehensive Cancer Network or NCCN. And both of those have very good information about clinical trials in general. ClinicalTrials.gov, as Dr. Agarwal mentioned, also does and can be a very useful tool at finding a specific clinical trial for a specific condition. Monika Sharda: Great. Well, thank you both for taking the time to distill these studies and the takeaways for people with cancer and their loved ones. Is there anything else that you would like to note about either of these studies or about clinical trials in general that we haven't already touched on? Dr. Markham: Yeah, I was going to say I think I would just add that I commend the researchers who did these studies and are getting their work published. I think it's important that we improve access to clinical trials as much as possible. And these two studies help to work in that direction. Dr. Agarwal: I agree, 100%. Monika Sharda: Great. Well, thank you both again for your time. ASCO: Thank you Dr. Agarwal and Dr. Markham. You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network, a collection of 9 programs covering a range of educational and scientific content offering insight into the world of cancer care. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

  Faculty: Abel Jarell, MD In this podcast, Dr. Jarell shares how to best manage pigmented lesions and reviews the appropriate National Comprehensive Cancer Network guidelines on the management of melanoma. The management of “atypical moles” (dysplastic nevi) is also discussed.   Dr. Abel Jarell is a practicing Dermatologist, Dermatopathologist, [...]

Subscribe through iTunes and Google Play. Welcome to this ASCO in Action podcast. This is ASCO's podcast series where we explore policy and practice issues that impact oncologists, the entire cancer care delivery team, and most importantly, the patients we care for, people with cancer. My name is Cliff Hudis. And I'm the CEO of ASCO, as well as the host of this ASCO in Action podcast series. For today's podcast, we're going to do something a little different. We don't have a guest today. Instead, we're going to spend some time going over a quick update on an important clarification issued recently by the CDC, the Center for Disease Control and Prevention, and specifically, their guidelines for prescribing opioids for chronic pain, a very topical issue. The clarification they issued was the form of a letter from the agency to ASCO, as well as to ASH and the NCCN. And in this letter, the clarification affirmed that the CDC guideline was never intended to deny access to clinically appropriate opioid therapy for patients suffering with acute or chronic pain from conditions like cancer and sickle cell disease. But I want to explain first why it was important that they issue this clarification and then talk about what we have to do next. Opioid abuse in the United States is clearly a very serious issue. And the tremendous toll that it's been extracting on individuals and families across the nation is well-reported. Indeed, it was one of the reasons originally given for the passage of the 21st Century Cures Act. In fact, one of the motivations had to do with addressing some parts of the opioid crisis. And so this just makes the point that finding a solution to the problem is among the very highest priorities that government and really the general public, as well as professional societies and advocacy groups and all stakeholders, have to be working towards. However, we do have to, at the same time, be careful that we don't overreach and cause additional harm, especially to vulnerable populations, as we take steps to reduce opioid abuse. What happened before was that there was a misinterpretation of the opioid prescribing recommendations that had been issued by the CDC. And this resulted in part in new laws and regulations, as well as third-party payment policies that severely limited essential pain medications from patients with cancer and sickle cell disease. The consequence for them was suffering and even more prolonged hospitalizations and health care expenses. So the challenge here was to fix this mistake. As we talk about how this happened, I want to take a moment and provide a little bit of background on this. Last spring, about a year ago I think, there were papers published, at least one in particular, that highlighted seeming discrepancies-- and I emphasize the word seeming-- between opioid use guidelines that had been issued by the CDC, the NCCN, ASCO, and others. To their credit, the NCCN, led by Bob Carlson, responded to this by reaching out to us at ASCO and asking if we would be willing to collaborate on a meeting of the minds to identify what was true and not true in terms of those supposedly conflicting guidelines and then issue some sort of a unified statement to help address the situation. In November of 2018, hosted here at ASCO headquarters, representatives from ASCO, the National Comprehensive Cancer Network or NCCN, the American Society of Hematology, ASH, and the CDC met to discuss the similarities, as well as the differences, among our various published respective guidelines in the area of managing chronic pain. We also discussed how to more clearly communicate to all of our respective memberships how and when practice guidelines should be applied in patient care. While discussing the CDC guideline, it became very clear to all of us that it was necessary to issue at some point a clarification on the question of where the CDC guideline applied to patients with cancer and sickle cell. And indeed, the first action item we took after this November meeting was that ASCO, ASH, and the NCCN sent a letter to the CDC asking for clarification. We're really happy, again, to report that this collaboration worked. Very soon after they received this letter from us, the CDC responded favorably. And in their response letter, they noted that their guideline, that is, the CDC's guideline, was initially developed to provide recommendations for primary care clinicians who prescribe opioids for patients with chronic pain outside of active cancer treatment, outside of palliative care, and outside of end of life care. So I want to pause for just a second and make very clear the aim of their original publication was primary care docs, not oncologists or hematologists, and the patients they were talking about were by and large not the patients who are seen and cared for in oncologists' offices. So the letter really did clarify that the CDC's guideline was never intended to deny clinically appropriate opioid therapy to any patients with acute or chronic pain from conditions like cancer and sickle cell disease. But instead, it was intended to ensure that physicians and patients consider all safe and effective treatment options for all patients with pain. And underneath all this remained the shared goal of reducing inappropriate use. Beyond this, the CDC also noted that the treatment guidelines from disease-specific experts-- and that means ASCO, NCCN, and ASH-- should be the guide to treatment and reimbursement decisions in the specific circumstances they cover. So let's just spend another 30 seconds on this idea. They did issue a guideline. It does apply to the general population. They never intended for it to apply to cancer patients or sickle cell patients. And they further called out in a sense the primacy of the disease special list in terms of the guideline priority. So it's great that we got this clarification. It's wonderful news. But I would submit to you that it's really just the first step towards ensuring that our patients don't suffer needlessly. So with this clarification in hand, we can and I would say we must act swiftly to correct existing policies that have already resulted in some areas in blanket restrictions on opioid prescribing, again, based on a misinterpretation over application of the CDC guideline. Every single day that goes by, there are Americans who are experiencing debilitating pain that could be avoided with appropriate treatment. We have some evidence for this. In 2018, as you may know, the American Cancer Society Cancer Action Network, that's ACS CAN, reported that 30% of cancer patients and survivors said that they were unable to obtain their prescribed opioid medication because of insurance denials. And that was a significant increase almost threefold from the 11% reported in 2016. So if you remember what we were talking about a moment ago, here's a set of guidelines that come out. They're not meant to be applied to cancer patients. And yet, we saw that as they were being misinterpreted and misapplied, there was a tripling in the number of patients reporting trouble getting indicated medications, and I mean cancer patients. Furthermore, 48% of individuals with cancer reported that their options for pain management were being limited by laws, guidelines, or insurance coverage denials. So this was, again, an external hand influencing their care coming from outside of their doctor's office. And even in states that exempt patients undergoing cancer treatment, there are significant administrative hurdles that are delaying access to much needed pain relief, not to mention that such exemptions often excluded cancer survivors. And survivors can have chronic pain for years sometimes from the disease or treatment. And without that exemption, they would, in fact, be suffering in a way that should be avoided. So it goes without saying, but I'll say it, that we really appreciate the CDC's leadership on this complex crisis. The agency has rightly noted that the opioid epidemic will continue to need ongoing collaboration and leadership. And we all need this as we work towards resolving the crisis. But they also acknowledge the importance of making sure that cancer patients and patients with sickle cell disease get the care and caring that they need and they deserve. I'll also point out that the US Food and Drug Administration plays an important role in advancing the use of evidence-based prescribing guidelines so that they are able to more accurately and appropriately direct the prescription of opioids. Former FDA commissioner Dr. Scott Gottlieb recognized this. And we look forward to continuing this important partnership with acting FDA commissioner Dr. Ned Sharpless. I think it's fair to say that the opioid crisis requires a response that protects the public, limits abuse, and ensures access for individuals who live with severe chronic pain. That's a vulnerable group. Clinicians, legislators, regulators, insurers, guideline developers, and patients have to join forces to make sure that we establish sensible, evidence-based approaches that confront opioid abuse but do not add a new group that suffers unnecessarily. We don't want to have one national crisis become two. So I want to close by extending my deepest appreciation to NCCN and ASH for collaborating with us to address this critically important issue and to ensure that our respective members are able to provide the highest quality care that their patients expect and deserve. If you want more information on our efforts to ensure access to appropriate pain control for patients with cancer and our other policy priorities, please visit ASCO in Action on our website at asco.org/ascoaction all one word. And until next time, I thank you for listening to this ASCO in Action podcast.

This JCO Podcast provides observations and commentary on the JCO article “Tamoxifen pharmacogenetics and metabolism: Results from the prospective CYPTAM study” by Sanchez-Spitman et al. My name is Vered Stearns, and I am a Professor of Oncology and Co-Director of the Breast and Ovarian Cancer Program at the Kimmel Cancer Center at Johns Hopkins in Baltimore, Maryland. My oncologic specialty is medical oncology. In the paper that accompanies this podcast, the authors report results of a prospective clinical study designated CYPTAM, which was designed to correlate endoxifen serum concentrations and outcomes of women prescribed adjuvant tamoxifen. The investigators enrolled 667 women with breast cancer who were initiating tamoxifen or who have been on tamoxifen for fewer than 12 months. The investigators obtained blood samples for CYP2D6 genotyping using the Amplichip CYP450 Test, and measured steady state concentrations of endoxifen with a high-performance liquid chromatography-tandem mass spectrometry. Co-primary endpoints included association of recurrence-free survival with endoxifen concentrations and with CYP2D6 genotypes. The patients were censored at the time of tamoxifen-discontinuation in case of a transition to an aromatase inhibitor. Several additional endpoints included disease-free survival, complete relapse-free survival, complete disease-free survival and overall survival. The statistical analysis plan was designed as a gate-keeper analysis for the co-primary objectives. Only if an association was found with a p-value below 0.05, were the remaining objectives considered.   The authors were not able to demonstrate an association between endoxifen concentrations and recurrence-free survival on tamoxifen. They also were not able to demonstrate an association either when exploring endoxifen concentrations in quartiles or when considering other thresholds. Likewise, there was no association between CYP2D6 genotypes and recurrence-free survival.   Almost two decades ago, researchers recognized that the absence or inhibition of the CYP2D6 enzyme is associated with very low concentrations of endoxifen, a potent and abundant anti-estrogen metabolite of tamoxifen. Whether low concentrations of endoxifen predict an inferior survival outcome has not been definitively determined. Multiple retrospective and small prospective studies evaluated CYP2D6 genotypes and survival outcomes and have provided mixed evidence. Clinicians have, therefore, wondered whether CYP2D6 genotype testing or endoxifen monitoring will assist in treatment recommendations. The CYPTAM investigators attempted to prospectively correlate endoxifen serum concentrations and outcomes for women taking tamoxifen.   The CYPTAM study is associated with several limitations, and, therefore, it does not provide a definitive answer to the controversy. For example, women were enrolled in the study either before starting tamoxifen or up to 12 months after initiation of the drug. This strategy could have led to incomplete baseline data and to the exclusion of individuals with early recurrences. In addition, about two-thirds of study participants transitioned to aromatase inhibitors following a short course of tamoxifen. The sequential administration of tamoxifen and aromatase inhibitors is superior to tamoxifen alone. Some of the patients who transitioned to aromatase inhibitors could have suffered a recurrence had they have stayed on tamoxifen alone. Furthermore, the authors did not have information regarding concomitant CYP2D6 inhibitor use. CYP2D6 inhibitors are commonly co-administered with tamoxifen and can contribute to misclassification of the CYP2D6 phenotype.    The challenge moving forward is that single agent adjuvant tamoxifen is rarely used. Most postmenopausal women with hormone receptor-positive breast cancer are recommended an  aromatase inhibitor instead of, or in sequence with, tamoxifen. Premenopausal women with high risk hormone receptor-positive tumors are recommended ovarian suppression with tamoxifen or an aromatase inhibitor. Women prescribed tamoxifen alone are usually at extremely low risk of recurrence, and a prospective study in this group of women will require a large number of participants to demonstrate differences between phenotypes. Given current practice, it may not be feasible to fully determine the role of endoxifen concentrations and CYP2D6 genotypes as predictors of tamoxifen efficacy.   Retrospective analyses that used samples obtained through large prospective studies, such as the Arimidex, Tamoxifen, Alone or in Combination and the Breast International Group 1-98, failed to demonstrate an association between CYP2D6 phenotypes and survival outcomes. Taken together, the data at present are insufficient to recommend CYP2D6 testing or analysis of metabolic profile in women for whom tamoxifen is considered. Indeed, clinical guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network do not recommend CYP2D6 genotyping. Moving forward, prospective studies of altered metabolism due to single nucleotide polymorphism, or administration of inhibitors, should be considered in clinical trials of standard and novel agents as these can lead to differences in drug efficacy and toxicity.   This concludes this JCO Podcast. Thank you for listening.

A physician finding balance when also being a patient.  Read the related article "Searching For Evidence-Based Reassurance Where None Could Be Found" by Rozalina G. McCoy on JCO.org.   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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer Stories-- The Art of Oncology Podcasts presents Giuliana Rancic reading the essay "Evidence-Based Reassurance Where None Could Be Found," by Rozalina McCoy, published April 20, 2018. "Searching for Evidence-Based Reassurance Where None Could Be Found," Rozalina G McCoy. Quote, "I do not recommend any further scans unless you develop concerning symptoms now that you are in complete remission," end quote. I am a young woman with two preschool age children, a wonderful family, and a rewarding career. Three months ago, I completed a six-month course of chemotherapy for advanced Hodgkin's lymphoma. I am also a physician and health services researcher, and I deeply believe in the theory and practice of high-value, cost-conscious care. In fact, my research focuses on improvement of the patient-centered and value of diabetes care and on reduction of overtesting and overtreatment that may lead, not only to wasted resources, but also to real patient harm. Throughout my career, I've been involved in state and institutional efforts to identify and reduce low-value services, consistent with the American Board of Internal Medicine Choosing Wisely Initiative, to promote and enable a conversation between patients and clinicians, to ultimately avoid unnecessary medical tests, treatments and procedures. I also advocated for patients and clinicians to both play a role in fostering high-value, cost-conscious care through the use of shared decision-making to marry autonomy and paternalism and thus, ensure patient-centeredness without the undue burden of unsupported choice. That is why my visceral reaction to my oncologist recommendation not to perform routine surveillance scans after HL was so unexpected. I was surprised, confused, fearful, and even defiant. Could I really forego these tests? The American Society of Hematology Choosing Wisely recommendation advises providers to limit surveillance computed tomography scans in asymptomatic patients following curative intent treatment for aggressive non HL lymphoma. In HL, the National Comprehensive Cancer Network Guidelines were not definitive in their recommendation for post-treatment surveillance of HL. But my oncologist felt strongly about foregoing CT and other routine imaging unless warranted by symptoms or signs of illness. She argued that routine imaging generates false positive findings, anxiety, and high costs, without definitive or meaningful survival benefit. Wearing my professional hat, I agreed. But as the patient, I found myself anxious, afraid, and wanting more-- not because I was confident that doing more would help, but because doing something, anything, gave me the illusion that I had some semblance of control over what would happen to me. I was scared. During the past nine months, I've been engaged, composed, and realistically optimistic as I underwent diagnosis and treatment, six months of ABVD, doxorubicin, bleomycin, vin-blastine, and dacarbazine chemotherapy for HL. However, when I emerged on the other side of treatment, instead of finding peace, I was more anxious than ever before. I longed for the comfort of a defined, structured and standardized treatment program, with its unwavering cycle of biweekly bloodwork, clinical evaluation, chemotherapy, and post-chemotherapy symptoms, no matter how incredibly unpleasant these were. I was, of course, thrilled to be done with treatment and elated to return to parts of my life that had been put on hold. However, I could not shake the fear that this reprieve was an illusion, that my lymphoma would come back, and that I would be blindsided by its unrelenting return. As I sat in my oncologist's office, I understood something I should have realized a long time ago-- it's hard to practice what I preach. Although common sense and simple in the abstract, the application of value principles to individual circumstances was much harder. I was torn between following my oncologist's advice to do less, thereby pursuing high-value and cost-conscious care, and acquiescing to my yearning to do more. Imaging seemed essential to early detection of recurrence, even if not consistently supported by the evidence. I was afraid that we would miss something, that my disease would progress, and that I would die. My oncologist taught me that such fear of recurrence is common. And I am grateful for her insights, as she patiently guided me through the confusion and fear and allowed me to find some comfort in our decision, in my own time and in my own way. We have deliberately replayed our discussion about clinical, versus routine radiographic surveillance at every subsequent appointment, as I near the end of my first year with the diagnosis. It is a conversation that echoes in my mind every time I have a cold, feel tired, or ache from a long day with two young kids. I wonder if my symptoms are normal or if they herald the recurrence of lymphoma. Because the National Comprehensive Cancer Network guidelines are not prescriptive, and surveillance imaging is said to be reasonable, I invariably find myself wondering, what's the harm of just one more CT? I know the harms. I saw my medical bills and know the cost that repeated imaging could add. I understand the anxiety of waiting for routine imaging, in essence, living from scan to scan. I had also experienced the downstream effects of false positive findings. Just two months earlier, a post chemotherapy positron emission tomography CT revealed a minimally concerning, but nonetheless positive new lymph node that had to be worked up and biopsied. In retrospect, this scan may have been low value. But my oncologist had relented to my request to get it done. The biopsy came back benign. But I cannot forget the buildup of anxiety that led to the scan and the biopsy as I waited for the results that I had hoped would provide a temporary reprieve from my disease. I did not want to experience this again, yet I yearned for the affirmation of being cancer-free. Living through these experiences led me to question and appreciate the best tenets of shared decision-making. Shared decision-making is predicted on the idea that clinical decisions should be reached through conversation and consensus between clinician and patient. In this dynamic conversation, clinicians contribute clinical expertise about the disease and treatment options, and patients provide expertise about their body, circumstances, goals for life, and expectations from care. Yet, after my diagnosis, unlike a patient with chronic disease, I did not feel like an expert. I had not had the chance to learn my new post-cancer preferences or my capacity, and I did not know how they aligned with my treatment and surveillance options. My goals were to live every day the best I could, have no regrets, survive, and put these months behind me. I did not know how surveillance imaging or the many other day-to-day decisions I have had to make throughout this journey mapped to these personal goals. Through open conversation about my fears and concerns, my oncologist and I have agreed on clinical followup visits and laboratory checkups for now, with the use of imaging if new or concerning symptoms develop. Through exploration of the reasons for wanting to do more, I was able to accept doing less. I still long for the additional reassurance that imaging offers, but I realize that no tests can provide complete reassurance. I hope that with time, I will grow to be more comfortable with uncertainty and less afraid of what may be hiding underneath my skin. As a physician in clinical practice, I no longer have the same naive confidence in my ability to counsel patients about the waste of low-value tests, procedures, and treatments. Instead, I can empathize in a new and real way with their worries, hopes, and internal conflicts about treatment decisions. I hope that I can do for them what my oncologist continues to do for me-- practice evidence-based medicine, instill trust through compassion, and empower all patients to freely express their fears, uncertainties, and expectations, along with their goals, preferences, and values. [MUSIC PLAYING] I'm Lidia Schapira, your host for Cancer Stories-- the Art of Oncology Podcasts. Our guest today is Dr. Rozalina [? Gerbina ?] McCoy, author of the essay "Searching for Evidence-Based Reassurance Where None Could Be Found, to be published in Journal of Clinical Oncology. Dr. McCoy is an associate professor of medicine at the Division of Primary Care Internal Medicine and Division of Health Care Policy and Research at Mayo Clinic in Rochester. She's a primary care physician, endocrinologist, and health services researcher. Welcome to the program, Rozalina. It's a pleasure to have you, and we enjoyed reading your essay. Tell us a little bit about what led you to write this. I think I am definitely not one to write pieces like this, being primarily a very data, big data driven researcher. But as I was coming back from one of my appointments after I finished treatments in chemotherapy, it struck me that I was really wanting the things that I have been telling my patients, my colleagues, the students I teach, not to do. And at first, I thought it was ironic and interesting. And then I thought that it really was teaching me a lot about myself, about disease management, things that I thought I should have known before, but never encountered. And as I was speaking with my friends, they tried to make me feel better and say, well, this is not something that's obvious. It's something that I have unique insight into, having just gone through treatment, especially in the context of being a physician and a researcher. So I wanted to share it, especially after I got similar feedback after teaching medical students about this. So I think a lot of people thought it was interesting and would help. So that the biggest reason I did it, I think, is really to help physicians understand what's going on in the minds of their patients, when they may be too differential to just say it themselves, and for patients to understand what they're going through and that it's very reasonable and very normal. You're absolutely right. And we learned so much from-- and physicians who then are cast patients and have to learn what it's like to be on the other side. You talk about how you handled, in your professional life, the idea of making decisions that take into consideration cost and value. And then, when you as a cancer patient had to make these decisions with your oncologist, it felt very different. So tell us a little about that. How did you manage to switch between those two roles, and how did you manage to adapt all of a sudden to listening to the advice of your oncologist and perhaps even ignoring your gut, which was to do more? Yeah, so I think I would be very kind to myself if I said that I have accepted this and come to terms with this. I'm not quite sure I have. This is something that every time I speak with my oncologist or even with my friends and colleagues, I think it's a battle that I fight every day. I still think that chronic disease management is very different from cancer care. But I understand that that's influenced by my own personal experiences and being very biased and subjective in this area. And I think it's very important to incorporate this patient preference and now the overall context of the disease and the treatment when you make decisions. But what I realized is that it's not always fair to expect patients to be able to contribute that to the conversation. And I realize that shared decision-making is a lot harder than I thought it was, not just for the physician, but also for the patient. I am still not completely thrilled, I think, with our plan of action. It helps that I trust my oncologist 100%. I think she really has the best intentions at heart. She is data-driven. She shares the data with me when I ask her to. So I trust that what she's doing is for the best. I don't like it. I think it's very similar to my conversations with my little kids, who I hope know that what I'm telling them is the right thing to do, even if they don't like it, and they don't want to do it, so they just put up with it, because I say so. So I think I'm taking somewhat of the same approach with my oncologist. It's funny and sweet and also difficult, of course, to think about all of these things. Here you are. You describe yourself. And as you lead into the assay as a mother, as a physician, health services researcher, and here you are. You bring all of this. And you're diagnosed with a lymphoma. You undergo the treatment. And then at the end, you had this longing, it would seem, for that structure, for wanting to continue to do things, because. It always feels better to do something. And then you start to ask yourself, well, what is reasonable? So it's interesting to have you tell us a little bit about how emotionally complex this is, right? Maybe that's one of the things that happened to you, that all of a sudden, when you were feeling all of these things, it became harder to know what was right. Is that about what you were trying to convey? Absolutely. I think I have been and continue to be torn about both wanting to have surveillance imaging and not wanting it, at the same time. I think I want the reassurance and the definitiveness that having a positive result, some, would offer. I want it to actually be the negative result that's going to stay with me, even though I know that's not true. And if I do get a negative result, it's probably not as negative as I want it to be, because things can change very quickly. So reassurance today means nothing a month from now. And then, at the same time, I don't want to have to be doing the imaging, because of the anxiety leading up to it. And I had that-- what I had to have my PET scan after treatment. I know the likelihood of false positives and having to work those up. I think, deep down, I am still fighting the mini tantrum, as I call it, of I just wish I didn't have to deal with all of this-- which I know is not going to go anywhere. So the hardest part, I think, is both wanting and not wanting this something at the same time, and not fully knowing how to process it yet. But knowing the fact that I trust my physician completely is the only reason, I think, I can get through this. Because I know that she will do what is best for me. I think that also, most of all, taught me the importance of having trust in your physician, having that good relationship, knowing that you can question what is recommended and trust the results, and not second-guessing yourself at the end. Yes, oh, that's so important. So you mentioned this quest for reassurance. And it's in the title of your essay, that you're searching for reassurance. So if you're not going to find reassurance in the scans, where do you find it? So my oncologist tells me that I'll find it with the passage of time as I learn my new body and I know what is normal and what isn't, and trusting that there is nothing bad hiding there, and that my cold and my flu is just that. And at the same time, I think that finding reassurance in every day-- none of us know what's going to happen in the future. And this way, I learn to really make the most of every single day, no matter what the future holds-- not being fatalistic or pessimistic, thinking that I will die tomorrow, but really having the confidence of knowing I am here now, and that's what really matters. And we'll see what tomorrow holds. I wonder how this personal experience has affected the way you now discuss things with your patients. Do you have any anecdotes you can share with us? Yeah, probably too many. With sharing things with my patients, especially, as a primary care physician, I really get to form a bond with the people I take care of. I think I can very personally connect with them about their fears as we are working up unknown symptoms, talking to patients about the fears that come with waiting for results or even waiting for scans to be scheduled, fear of the unknown, and the fear that they likely experience as they are receiving information or not receiving information from the specialist involved in their care. I know that many of my patients with whom I've had this conversation, they've been very appreciative of the fact that I share this with them, so that they don't feel cowardly for being afraid or for wanting reassurance. And at the same time, they don't feel like they're not doing their all or their best if they don't want to be very aggressive. I know this is something we're taught to talk about with elderly patients and at the end of life, but not with younger patients. So being able to just tell them my story very briefly and telling them what I have felt, I think it allowed them to talk to me about their emotions, their fears, and be more OK with it. Yeah, it sounds like it's been an experience that has led to probably even some emotional growth in some ways. That's what I hear from my patients and what I read in your words. When we talk about handling the uncertainty and these fears that cancer can shorten your life or affect you in so many different ways, we sometimes talk about handling or managing uncertainty. But I wonder if you can tell us, from the perspective of your lived experience, if you think it is possible to manage or handle it, and if so, how you would distill that wisdom for your colleagues who are dealing and trying to do their best to counsel their patients with cancer every day. I mean, I found it very helpful for my oncologist to tell me that this is normal, and everyone feels that way. And the fact that I have doubts does not mean that it's necessarily going to happen. So what I mean by that is I thought that if I am worried that I have a recurrence, because I'm not feeling well, that that means something must be there. Because there's a reason why I'm worried. I'm not a worrier by nature. And so acknowledging the fact that this is a normal reaction and a normal emotion, it made me feel less anxious that there's something going on that I may be missing. It's also reassuring to know that if there is something going on, it's very obvious. It's not something that's just going to sneak up on you. Because then it makes me be less anxious that I may be missing something. And I can put it out of my mind with a thought that, well, if it's going to be there, it's going to hit me in the face, and it's going to be obvious. So if nothing is hitting me in the face, it's OK. And trying to put it out of mind, I think if we were to talk, hopefully, five years from now, I know I would have a lot more insights. I am at my one-year post-diagnosis anniversary now. So it's still very new. And I think a big part of coming to terms with it was writing this piece, to help me process what I'm feeling, why I'm feeling it, and rationalize it, in a way. So I think I would encourage patients not journal, but something. Talk to colleagues, friends, family, or even just write things down as a way to process what you're feeling. Because it's a lot, and I think it's hard to understand if you haven't got through it. Yes, and we have learned that through journaling and talking, and even attending support groups, it gives people the opportunity to stay connected in some ways to normalize their experience, as well, and also to get and receive support. Well, I thank you for your sincerity. I sincerely hope that you write a piece for us several years from now and that we can have another chance to talk about lessons learned. Thank you so much, Rozalina, for being a part of this program. And thank you, all, for listening.

This Month in AJN –  July 2018 monthly highlights July 2018Editor-in-chief Shawn Kennedy and clinical editor Betsy Todd present the highlights of the July issue of AJN. Our first CE, “Original Research: The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care,” describes a study that evaluated the efficacy and safety of a practice protocol allowing critical care RNs to independently administer IV ketamine for burn wound care. Our second CE, “Breast Cancer Screening: A Review of Current Guidelines,” reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients. The authors of our next article, “Ethics Champion Programs,” discuss how these programs prepare nurses to function as unit-based ethics resources for colleagues as they face common ethical issues and challenges. “Cultivating Quality: Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool” reports on a QI initiative to create a simple evidence-based tool to help novice nurses predict which patients will present peripheral IV access challenges. In addition, there's News, Reflections, Drug Watch, Art of Nursing, and more.

This Month in AJN –  July 2018 monthly highlights July 2018Editor-in-chief Shawn Kennedy and clinical editor Betsy Todd present the highlights of the July issue of AJN. Our first CE, “Original Research: The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care,” describes a study that evaluated the efficacy and safety of a practice protocol allowing critical care RNs to independently administer IV ketamine for burn wound care. Our second CE, “Breast Cancer Screening: A Review of Current Guidelines,” reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients. The authors of our next article, “Ethics Champion Programs,” discuss how these programs prepare nurses to function as unit-based ethics resources for colleagues as they face common ethical issues and challenges. “Cultivating Quality: Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool” reports on a QI initiative to create a simple evidence-based tool to help novice nurses predict which patients will present peripheral IV access challenges. In addition, there’s News, Reflections, Drug Watch, Art of Nursing, and more.

On this episode, we chat with Dr. Lucas Schulz (@LucasTSchulz), infectious disease and critical care pharmacist at University of Wisconsin Health. Luke is also an adviser to ILÚM Health Solutions - an infectious disease (ID) platform and real-time information service that supports patient management decisions, quality programs, and better outcomes through: Clinical collaboration and ongoing quality consulting Program level insight Point-of-care clinical decision support Luke helps us to understand: What it means to be an infectious disease and critical care pharmacist How to establish an Antimicrobial Stewardship program and which health system teams/departments are involved How a platform like ILÚM helps you move from anecdotal to evidenced-based medicine How to deliver high quality care and simultaneously deal with the business and financial pressures of running a health system This interview is part of our HIMSS18 coverage. We'll be talking with thought leaders and vendors all week at the annual Health Information Management Society conference in Las Vegas.     About Dr. Lucas Schulz Dr. Lucas Schulz is the infectious diseases clinical coordinator and PGY2 Infectious Diseases residency program director at University of Wisconsin Health. Following graduation from the University of Wisconsin - School of Pharmacy, he completed PGY1 and PGY2 critical care residencies at the University of Wisconsin Hospitals and Clinics. In his current role, he is responsible for all anti-infective use across the UW Health enterprise leading the antimicrobial stewardship program at UW Health and is involved with all institutional committees pertaining to infectious diseases.  He has served as PGY2 Infectious Diseases Residency Program Director for 7 years His patient care, research, and teaching activities focus on antimicrobial stewardship, PK/PD optimization, hospital-acquired infections, and clinical decision support development. 32 peer-reviewed publications on infectious diseases topics. Currently serves on the Wisconsin Department of Health Antimicrobial Steering Committee, a panel member for the National Comprehensive Cancer Network guideline on prevention and treatment of cancer-related infections, and the programming committee for the Society of Infectious Diseases Pharmacists 2017 Annual Meeting. Active member of the Vizient Antimicrobial Stewardship Taskforce and Research Committee. https://www.uwhealth.org/ https://www.uwhealth.org/antimicrobial-stewardship/ @LucasTSchulz     About ILÚM Health Solutions ILÚM Health Solutions was created by Merck HSS and shares the vision to improve health and well-being. ILÚM is a specialized service focused on the unique challenges of infectious disease with the goal of supporting improved patient and hospital outcomes. Their technology-enabled solution helps leverage HIT assets to maximize the impact of quality programs. ILÚM Health Solutions aims to help hospitals and healthcare institutions: Efficiently target patients and accelerate time to interventions to make improved empiric treatment decisions Efficiently and consistently track performance, prescribing, and patient outcomes Enhance timely communication and clinical collaboration within workflow https://www.ilumhealthsolutions.com/blog/  @ilumhealth You can find the rest of our HIMSS18 Interviews here. Subscribe to Weekly Updates If you like what we're doing here, then please consider signing up for our weekly newsletter. You'll get one email from me each week detailing: New podcast episodes and blog posts. Content or ideas that I've found valuable in the past week. Insider info about the show like stats, upcoming episodes and future plans that I won't put anywhere else. Plain text and straight from the heart :) No SPAM or fancy graphics and you can unsubscribe with a single click anytime. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

ONS's Pamela Ginex, EdD, MPH, RN, OCN®, discusses the new immunotherapy toxicity guidelines released by the National Comprehensive Cancer Network and the American Society of Clinical Oncology. We talk about ONS's role in helping to develop the information, the importance of educating oncology nurses about immunotherapy-related side effects, as well as the new resources available for providers and patients. Music Credit: "Fireflies and Stardust" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0   Episode notes: Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy ONS.org Immunotherapy Resources Immunotherapy Resources on ONS Voice Clinical Journal of Oncology Nursing Immunotherapy Supplement Immunotherapy on ONS Communities Checkpoint Inhibitor Infographics How They Work Potential Adverse Reactions

The National Comprehensive Cancer Network in October will release a new tool designed to help doctors understand the value of different cancer therapies by taking into account the costs of treatments. The effort from the influential group follows similar initiatives by Sloan Kettering Cancer Center and the American Society of Clinical Oncology. We spoke to Bob Carlson, CEO of the National Comprehensive Cancer Network, about the rising costs of cancer care, the new tool, and what impact it will likely have on drug pricing in the future.