American Cancer Society's first female CEO discusses goals, lessons learned amid pandemic

Karen E. Knudsen, PhD, MBA, is the first woman to serve as CEO of American Cancer Society and its advocacy affiliate, American Cancer Society Cancer Action Network. Knudsen spoke with HemOnc Today about her goals for the new position and her experiences improving patient care and care delivery systems in oncology. Just in the past 7 years, we established three additional advance care hubs across two states that provide our patients with access to specialists and clinical trials.

Long-course chemoradiation may improve organ preservation rates in rectal cancer

Researchers compared organ preservation rates - defined as alive, total mesorectal excision-free and having no evidence of disease in the pelvis - among 332 patients with rectal cancer (median age, 57 years;62.1% men) who underwent short-course (n = 76) vs. long-course (n = 256) chemoradiation total neoadjuvant therapy. Patient and tumor characteristics appeared similar between the groups, with no significant differences in high-risk features, and most patients (81.6%) had clinical stage III disease. Results showed 2-year OS rates of 95% with long-course vs. 92% with short-course chemoradiation, DFS rates of 78% vs. 70%, and distant recurrence rates of 20% vs. 21%. [...]researchers observed a 2-year organ preservation rate of 40% (95% CI, 35-47) with long-course vs. 29% (95% CI, 20-42) with short-course chemoradiation and, among those managed with a watch-and-wait approach, 88% (95% CI, 81-94) with long-course and 67% (95% CI, 51-87) with short-course chemoradiation.

Oncology practices struggle 'to run at all levels' amid workforce shortage

"More than 300,000 health care providers dropped out of the workforce in 2021, including physicians, nurse practitioners, physician assistants and other clinicians who left the workforce that year," Shikha Jain, MD, FACP, associate professor of medicine with tenure in the division of hematology and oncology at University of Illinois Cancer Center in Chicago, consulting editor for Healio Women in Oncology and host of Healio's Oncology Overdrive podcast, told Healio ;HemOnc Today. In a nationwide survey of 1,000 U.S. health care professionals, more than half (57%) of respondents reported concerns about burnout from repetitive tasks and required documentation, 28% reported quitting a job in health care due to burnout and 48% reported concerns about the health care systems ability to retain and hire staff if automation is not prioritized. According to SITC, 95% of cancer centers reported personnel issues resulting from the "great resignation" and a poll of 44 NCI-designated cancer centers showed clinical trial accrual rates down 20% from January 2020 levels. Ongoing staffing issues have affected not only clinical trials at academic medical centers but also all stakeholders in the development of cancer therapies, including contract research organizations and trial sponsors, summit co-chair Leisha A. Emens, MD, PhD, SITC vice president, professor of medicine in hematology and oncology at University of Pittsburgh School of Medicine, and co-leader of UPMC Hillman Cancer Centers cancer immunology and immunotherapy program, told Healio ;HemOnc Today at the time of the summit.

Inpatient hospitalization, mortality high among patients with cancer, COVID-19

Patients with cancer who contracted COVID-19 had high risk for inpatient hospital admission and death, according to study results. "COVID-19 in patients with solid tumors and hematologic malignancies undergoing active therapy is associated with poor outcomes, including a high risk [for] inpatient mortality," Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, told HemOnc Today. The Leukemia b Lymphoma Society encourages all patients with blood cancer to get vaccinated because the side-effect profile of vaccination is no different for them than the general population.

Early treatment of COVID-19 crucial for patients with cancer

More than 2 years after the COVID-19 pandemic began, new treatments, vaccines and preventive measures have improved safety and disease outcomes for patients with cancer, according to a keynote lecture. In her lecture, Kamboj addressed frequently asked questions about various aspects of COVID-19 vaccination, testing and treatment among patients with cancer. When considering which patients with cancer might be eligible for revaccination, Kamboj said clinicians should think about those who received B-cell depleting therapies, chimeric antigen receptor T-cell therapy and stem cell transplant, when there is evidence of immune reconstitution.

Surprising' rise in distant-stage cervical cancer rates driven by white and younger women

Researchers gathered data from the U.S. Cancer Statistics program and used the Behavioral Risk Factor Surveillance System and TeenVaxView to evaluate the rates of cervical cancer screening and vaccination between 2001 and 2018. [...]researchers observed a nearly twofold higher rate of missed or lack of guideline screening among white women compared with Black women (26.6% vs. 13.8%). Since this database was from 2001 to 2018, these trends may have worsened with barriers accessing health care due to the COVID-19 pandemic," she said. - by Jennifer R. Southall For more information:

AACR report: Cancer deaths decline 2.3% amid treatment advances, but disparities persist

"From 1991 to 2019, this accounts for 3.5 million cancer deaths that were avoided." [...]significant inroads have been made in research against previously recalcitrant cancers such as melanoma. The new anticancer agents approved during that period include: * tebentafusp-tebn (Kimmtrak, Im-munocore), the first T-cell receptor therapeutic to receive regulatory approval for treatment of uveal melanoma, the most common form of ocular cancer in adults;* belzutifan (Welireg, Merck), the first FDA-approved molecularly targeted drug against hypoxia-inducible factor-2 alpha for patients with solid tumors linked to von Hippel-Tindau syndrome, a rare inherited genetic disorder;and * relatlimab-rmbw (Opdualag, Bristol Myers Squibb), the first new immune checkpoint inhibitor against a novel target in 8 years, for treatment of unresectable or metastatic melanoma. Disruption or delay in cancer treatment due to concerns over terminating a pregnancy could cause cancer progression. [...]global crises such as the COVID-19 pandemic and ongoing wars have affected all aspects of cancer research and patient care.

Cancer care after COVID-19

Many cities and states so far have avoided these awful numbers of cases and deaths, possibly because they had more lead time to introduce public health measures that have reduced the spread of the virus. Most large cancer centers have been able to use existing technology against a background of relaxed billing and regulatory requirements, plus a willingness of both providers and patients to consider virtual visits as a safer alternative to in-person visits with the risk for exposure to the coronavirus. The impact of diagnostic and treatment delays, changes to therapy schedules, accrual to clinical trials, and monitoring and management of acute issues all will provide vital information about optimal care of our patients, not only during a future pandemic but in our "new normal" landscape.

ADT and COVID-19 - A therapeutic discussion

By way of background, I need to draw on my experience in genitourinary oncology - one of the genes involved in the genesis of prostate cancer is TMPRSS2, a serine protease located on the cell surface, which is involved in several biological functions including cellular invasion by viruses. In addition to the possibility that castration may reduce the risk for COVID-19 infection, Kantoff and his colleagues question whether specific gene targeting of TMPRSS2 may provide protection (that is, without the need for clinical castration) either from COVID-19 infection or perhaps the severity of pulmonary involvement (a major cause of COVID-19related death). In the interregnum, prior to this producing a defined clinical result and/or the introduction of either effective COVID-19 therapies or vaccines, any well-connected reader who wishes to help any national or locoregional leaders who have been captivated by the swirl (absent clear data) surrounding the chloroquine derivatives might offer them this more datadriven option that suggests that ADT may really protect against COVID-19 infection.

The accidental 'stupidpower' - It is what it is

Testing, population size and death rates When thinking about improving survival of the population, I am so irritated by the conflict between the rational majority of physicians and the inhabitants of the White House, a collection of random politicians of conservative bent, and a small group of flat-Earth physicians (apparently led by one who views demons as the purveyors of illness in the land), regarding science and real data. Populations with community participation in the simple strategies of routine masking and social distancing have COVID-19-related death rates vs. population size of less than 10% of the conservative U.S. states and the nation as a whole. Another influential constituency that has abrogated its responsibility is the CDC - having initially lost some of its formerly authoritative credibility in the botched introduction of testing, it has compounded the felony by consistently issuing misinformation, caving into the scientific mumbo-jumbo being quoted by the White House, and reversing sensible decisions whenever someone of influence frowns at them.

Death in hospice facility less common among rural vs. urban residents with hematologic malignancies

Conversely, researchers found deaths less likely in nursing facilities than in a medical facility in large metropolitan (OR = 0.67;95% CI, 0.66-0.67) and small or medium metropolitan areas (OR = 0.87;95% CI, 0.86-0.87). [...]deaths at home vs. at a medical facility were less common among residents of large metropolitan areas (OR = 0.86;95% CI, 0.850.87), but similar for small or medium metropolitan areas (OR = 1.04;95% CI, 1.02-1.05), compared with rural areas. Study limitations included a lack of information on income and insurance, which may dictate access to resources, and a lack of clinical details relevant to hospice uptake, including cancer diagnosis, therapies received, patient preferences, rate of functional decline, presence of a caregiver and hospice use in other settings. Limitations to this analysis include missing variables that could influence the place of death, like disease and treatment characteristics, insurance status, hospice utilization in specific settings, and individual preferences.

Number of cancer survivors in U.S. rises to 18 million, disparities in care remain

The report from American Cancer Society, in collaboration with NCI, cited ongoing issues such as poor survivorship care integration between oncology and primary care, shortages in the clinician workforce and a lack of strong guidelines for posttreatment care, as well as racial disparities in treatment and survival for many common cancer types. Miller and colleagues used survival data from SEER cancer registries, vital statistics from the CDC and population projections from the U.S. Census Bureau to identify current treatment patterns for the most common cancer types according to race. Specifically, a lower proportion of Black patients received surgery for NSCLC compared with white patients for stage I to stage II disease (49% vs. 55%) and for stage III disease (16% vs. 22%). [...]only 41% of Black patients with stage I rectal cancer received proctectomy or proctocolectomy vs. 66% of white patients, and Black women were less likely to be diagnosed with stage I uterine corpus cancer than white women (59% vs. 73%).

Individuals with long COVID may be at greater risk for abnormal blood clotting

Individuals with long COVID may have a higher risk for abnormal blood clotting, especially those who have difficulties with basic exercise for more than 12 weeks after infection, according to a study published in Blood Advances. Long COVID, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath and cognitive slowing, is an increasingly recognized complication of acute COVID-19 infection, according to Nithya Prasannan, researcher in the department of hematology at University College London Hospitals NHS Foundation Trust in the U.K., and colleagues. Investigators sought to examine whether patients with long COVID referred to a dedicated post-CO VID-19 clinic experienced a prothrombotic state associated with symptom severity The analysis included 330 patients (median age, 46 years;range, 18-88;60% female), 97% of whom had symptoms for 3 months or more after acute COVID-19 infection.

Late-stage cancer diagnoses rise after pandemic-related drop in screenings

A study of U.S. Health Care Cost Institute and American Cancer Society data, published in April in The American Surgeon, showed increases not only in diagnoses of lung/bronchus (0.29%), pancreatic (1.46%), breast (2.89%), colorectal (19.72%) and prostate cancer (144.5%) in 2020 (P < .01 for all), but also in the total number of deaths due to colorectal, pancreatic, breast and prostate cancers from 2019 to 2021. A study of visits to Moores Cancer Center at University of California, San Diego Health in 2019 vs. 2020 showed a numeric increase in the percentage of patients with colorectal cancer who presented with stage IV disease (6.7% [n = 3] vs. 19.5% [n = 8];OR = 0.3;95% CI, 0.05-1.37) and a numeric decrease in the number who presented with stage I disease (17.8% [n = 8] vs. 14.6% [n = 6];OR = 1.26;95% CI, 0.34-4.88). Specifically, three established Cancer Intervention and Surveillance Modeling Network breast cancer models projected 950 cumulative excess breast cancer deaths associated with decreased screening, 1,314 associated with delayed diagnosis of symptomatic cases and 151 associated with decreased use of chemotherapy in women with hormone receptor-positive, earlystage disease. [...]we observed a decrease of approximately 50% in screenings as patients who were supposed to come to the hospital for screening did not out of fear," Villena-Vargas said during an interview with Healio ;HemOnc Today.

Outreach effort increases stem cell transplant referrals, may reduce racial disparities

Academic center outreach to community practices considerably increased stem cell transplant referrals for patients with multiple myeloma, according to study results. Stem cell transplant confers a survival benefit to patients with multiple myeloma, but referral to transplant centers remains a barrier. The outreach program is expected to expand to include areas around Macon and Savannah, allowing for coverage in a large portion of western South Carolina and eastern Georgia, a region where health outcomes tend to vary widely based on race and socioeconomic status.

Nanomedicine in oncology: Tiny particles, huge potential

NBTXR3 is designed to destroy tumors and trigger the immune system for local tumor control and treatment, and is used to strengthen the effect of radiation therapy. [...]it provides a strategy that can deliver therapeutic agents to immune cells more effectively - a 'super shuttle,' per se," she said. A drug will hit the soluble form of a target of interest, but it's also going to hit membrane forms that perform vital regulatory functions, leading to toxicity"' Cancer cells with high levels of PDL1 inhibit the immune system from attacking tumors, allowing them to progress. Kim also discussed previous research into quantum dots, nanocrystals that give off an array of very bright colors depending on the crystal size.

'Striking' racial disparities observed in surgical care of gastrointestinal tract cancer

Gastrointestinal cancer accounts for approximately one-third of all cancer deaths," Baylee F. Bakkila, BA, BS, and Sajid A. Khan, MD, FACS, of Yale School of Medicine, and Caroline H. Johnson, PhD, of Yale School of Public Health, told Healio ;HemOnc Today in a joint statement. "Given our team's expertise at Yale in gastrointestinal surgical oncology, we wanted to examine whether race-specific treatment disparities exist with curativeintent surgery and the impact this might have on clinical outcome for patients across the U.S" The retrospective cohort study included 565,124 adults (10.9% Black, 83.5% white;54.7% men;50.7% with Medicare coverage) diagnosed with gastrointestinal tract cancers between 2004 to 2017 who underwent surgical resection. In a related editorial, Shervin Assari, MD, MPH, associate professor of family medicine at Charles R. Drew University of Medicine and Science, and Helena Hansen, MD, PhD, chair of research theme in translational social science and health equity and associate director of the Center for Social Medicine at UCLAs David Geffen School of Medicine, wrote the Yale study leaves questions about the systemic mechanisms driving inequalities unanswered.

Ibrutinib regimen extends PFS for older adults with mantle cell lymphoma

A novel first-line regimen significantly improved PFS compared with standard chemoimmunotherapy for older patients with mantle cell lymphoma, according to randomized phase 3 study results. If we are not able to add more chemotherapy, we need to add something that does not increase too much toxicity but can improve efficacy Ibrutinib - an oral Bruton tyrosine kinase inhibitor - is approved in the United States as monotherapy for patients with mantle cell lymphoma who received at least one prior therapy. In the ibrutinib group, researchers reported one death due to each of the following causes: respiratory disorder, general physical health deterioration, traumatic intracranial hemorrhage, tumor lysis syndrome, cancer and ischemic stroke. [...]does it make sense to begin the maintenance phase right after the bendamustine-rituximab portion is complete?

'Communication is key' to reduce suicide risk after cancer diagnosis

A separate meta-analysis of 28 studies by Heinrich and colleagues, published in March in Nature Medicine, showed an 85% higher suicide rate among patients with cancer compared with the general population, with strong correlations of risk with cancer prognosis and stage, time since diagnosis and geographic region. "Suicide is a huge problem in America, and we will most likely see a significant increase since the COVID-19 pandemic began," Nosayaba Osazuwa-Peters, PhD, BDS, MPH, CHES, member of Duke Cancer Institute and assistant professor in head and neck surgery and communication sciences and population health sciences at Duke University School of Medicine, told Healio ;HemOnc Today. Osazuwa-Peters and colleagues reported even larger differences in suicide risk based on area of residence among patients with head and neck cancer. The cross-sectional study, published last year in JAMA Otolaryngology-Head & Neck Surgery, included data from the SEL1 - https://media.proquest.com/media/hms/PFT/1/uf1BN?_a=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%2BgIBToIDA1dlYooDHENJRDoyMDIyMDYwNzEyMjczMzc0NTo3NTEyNTQ%3D&_s=9mfYeas7Ijzr6FwcjkLk0av32yU%3D