Samyukta Mullangi, MD, MBA, of Memorial Sloan Kettering Cancer Center, discusses her findings showing that physicians’ prescribing behavior may be influenced by payer-led pathways. Pathway compliance was associated with higher medical costs during a 6-month baseline period but lower health-care utilization, as measured in hospitalizations and emergency department visits during that baseline period (Abstract 7).
Regina Barragán-Carrillo, MD, of Mexico’s National Institute of Medical Sciences and Nutrition Salvador Zubirán, discusses her findings showing that currently, physicians have limited knowledge about breast cancer screening in transgender patients. Were this topic addressed with widespread information, it could possibly reduce the health-care inequalities faced by this diverse group of patients (Abstract 71).
Jensa C. Morris, MD, of the Yale School of Medicine, Smilow Hospitalist Service, discusses her findings on the benefits of hospitalist co-management of patients with cancer: It reduced the length of hospital stay by 1 day, increased early discharge (before 11:00 AM) by threefold; raised the educational rankings of house staff, and lowered oncologists’ stress level, improving their ability to manage competing responsibilities (Abstract 1).
Joannie M. Ivory, MD, MSPH, of The University of North Carolina at Chapel Hill, discusses ways to raise the number of Black patients with cancer who take part in clinical trials. More successful accrual may be linked to conducting trials where Black patients live and designing studies to recruit a concrete target percentage of marginalized populations.
Changchuan Jiang, MD, MPH, of Roswell Park Comprehensive Cancer Center, discusses the lack of transportation as a potentially modifiable barrier to care for patients with cancer. Timely intervention may reduce visits to hospital emergency departments, lower costs, and improve outcomes (Abstract 70).
Dawn L. Hershman, MD, of Columbia University College of Physicians and Surgeons, discusses findings that showed substantial variability in clinicians’ adherence to prescribing primary prophylactic colony stimulating factors in a pragmatic trial. Although the ability to opt out of the intervention is a feature of pragmatic trials, careful prestudy planning to estimate nonadherence is critical to ensure adequate power to detect an effect. Understanding reasons for intervention opt-outs may also inform future pragmatic studies aimed at improving adherence to practice guidelines.
Clifford A. Hudis, MD, of the American Society of Clinical Oncology, and Karen E. Knudsen, PhD, MBA, of the American Cancer Society, discuss their collaboration, pooling their research and education resources to help empower patients with cancer and their families. Within 48 hours, Drs. Hudis and Knudsen were able to gear up a rapid response to the crisis in Ukraine, forming a clinical corps of volunteers to post information online in multiple languages, which helped patients navigate their care in the war-torn region. To date, 300 European cancer organizations have joined their efforts.
Nickolas Papadopoulos, PhD, of the Sidney Kimmel Comprehensive Cancer Center, discusses early detection as the key to reducing cancer mortality and the lack of tests for many malignancies. Liquid biopsies have the potential to screen for various tumor types, albeit with varying levels of sensitivity. Dr. Papadopoulos discusses his research on such blood tests, following patients prospectively to find the best combination of genetic and epigenetic biomarkers to increase sensitivity (Abstract PL02).
Maria Alma Rodriguez, MD, of The University of Texas MD Anderson Cancer Center, discusses the need for various types of vaccinations in patients with cancer, who are vulnerable to infection while under active treatment and whose immune deficits may persist long after treatment is finished. Dr. Rodriguez reviews new treatment guidelines and the steps oncology clinicians should take to ensure their patients are protected against infections.
Charles L. Sawyers, MD, of Memorial Sloan Kettering Cancer Center, discusses the battle against treatment resistance and how to overcome it, as well as the power of observational clinical data in precision oncology, derived largely from his experience with Project GENIE, and the role of genetic ancestry (Abstract PL02).
Priscilla K. Brastianos, MD, of Harvard Medical School and Massachusetts General Hospital, talks about her efforts to better understand how brain metastases evolve genomically and to test such agents as abemaciclib, paxalisib, and entrectinib, which may stop their growth. Palbociclib, a CDK inhibitor, has already shown potential benefit. A national cooperative group trial is underway in multiple centers to identify novel treatments for patients with brain metastases, who typically have a poor prognosis (Abstract SY38).
Timothy A. Yap, MBBS, PhD, of The University of Texas MD Anderson Cancer Center, discusses how research is building on the success of first-generation PARP inhibitors in the clinic and the potential of novel potent PARP1-selective inhibitors, which may lead to improved patient outcomes. Given recent advances in drug discovery, says Dr. Yap, we now can go beyond PARP by drugging other key DNA damage response targets in the clinic, including ATR, WEE1, DNA-PK, RAD51, POLQ, and USP1.
Lillian L. Siu, MD, of Canada’s Princess Margaret Cancer Centre, discusses biomarker-driven precision cancer medicine, the optimal sequencing of immunotherapy (IO) with standard treatments in curative settings, IO targets beyond PD-1/PD-L1 and combinatorial strategies, and next-generation adoptive cell therapies (Abstract PL06).
Marcia R. Cruz-Correa, MD, PhD, of the University of Puerto Rico Comprehensive Cancer Center, discusses a way to possibly transform cancer outcomes by teaming up basic scientists, clinical researchers, and community advocates to work together, decode the complexity of cancer, and find points at which to intervene in the development of tumor cells. One strong focus is on communities disproportionately affected based on their genomic ancestry, geographic location, and ethnicity (Abstract PL06).
Cheryl L. Willman, MD, of the Mayo Clinic Comprehensive Cancer Center, discusses the profound cancer health disparities among Native Americans, exacerbated by low rates of screening and limited access to care. Dr. Willman is heading an effort to promote community engagement in comprehensive genomic sequencing with the hope that researchers will discover novel mutations and genome-wide mutational signatures that can ultimately be translated to improved screening and therapy in this population (Abstract PL03).
Gautam Mehta, MD, of the U.S. Food and Drug Administration, discusses how accelerated approval of potentially life-saving cancer therapies has been applied in precision oncology. Although “fast-tracking” drugs presents opportunities and challenges, one possible measure of the program’s success is the fact that, to date, no solid tumor accelerated-approval indications have been withdrawn (Abstract DC06).
Electra D. Paskett, PhD, of The Ohio State University, discusses various factors that may contribute to cancer such as socioeconomic status, discrimination, violence, and access to health care. When clinicians identify these factors and intervene with access to services, it may be possible to improve outcomes for their patients (Abstract SY33).
Klaus Pantel, MD, of the University Medical Center Hamburg-Eppendorf, discusses liquid biopsy technologies and biomarkers, with a focus on circulating tumor cells and circulating tumor DNA; clinical applications such as early detection of cancer, improved staging, and surveillance of measurable residual disease; and how best to detect and monitor response to systemic therapies, as well as ways to identify therapeutic targets and resistance mechanisms (Abstract SY08).
Vivek Subbiah, MD, of The University of Texas MD Anderson Cancer Center, talks about innovative design of clinical studies that may help demonstrate clinical benefit in precision medicine and advance treatment to deliver the right intervention to the right patient at the right time (Abstract DC06).
Karen E. Knudsen, PhD, MBA, Chief Executive Officer of the American Cancer Society, discusses ways to address the inequities in genitourinary screening, treatment, and outcomes. Her suggestions focus on increasing awareness of screening, identifying risk factors, the dramatic rise in incidence among Hispanic individuals, and the basis for increased mortality in Black men.
Lynda Chin, MD, of the University of Texas, Austin Dell Medical School and Apricity Health, discusses precision medicine, barriers to its progress, and the challenges that must be met to facilitate better outcomes for patients. Building evidence and trust is key, Dr. Chin explains, as is developing an infrastructure that allows more clinicians to take part in the process.
Sean Khozin, MD, MPH, of CancerLinQ, discusses the therapeutic advances that have made cancer care more targeted, even as real-world patient outcomes lag behind those reported in clinical trials. Dr. Khozin makes the case for the use of digital decision support tools to advance precision at the point of care.
Daniel F. Hayes, MD, of the University of Michigan Rogel Cancer Center, discusses whether liquid biopsies can provide insight into the challenge of curing metastatic breast and possibly other cancers, how oligometastases are similar to a primary cancer, and why some kinds of local therapy for widespread disease might improve survival and lead to a cure.
Matthew Manning, MD, of Cone Health Cancer Center, discusses findings that showed changes to the way cancer care is delivered may help eliminate racial disparities in survival among patients with early-stage lung and breast cancers. Identifying and addressing obstacles that kept patients from finishing radiation treatments for cancer were associated with improved 5-year survival rates for all patients (Abstract 53).
Karen M. Winkfield, MD, PhD, of Vanderbilt University Medical Center, who co-chaired a session (PS 02) on digital health, summarizes the talks, which included ways to reduce disparities with digital innovations and the importance of patient input, especially in the form of patient-reported outcomes and experience measures. Advancing digital health, which the FDA defines as including health information technology, telemedicine, and personalized medicine, can potentially improve cancer care.
Morgan R.L. Lichtenstein, MD, of Columbia University Medical Center, discusses a single-center prospective study examining the complex relationship between time to oral oncolytic receipt and clinical or process-related factors, such as prior authorization, diagnosis, and insurance type.
Aakash Desai, MPH, MD, of the Mayo Clinic in Rochester, Minnesota, talks about the urgent need for drug pricing reform, given the average expenditure of Medicare part D, and the ultimate out-of-pocket costs for patients with cancer. The promise of precision oncology will fail, says Dr. Desai, if we fail to bring the right drugs to the right patient at the right time, with the right price.
Jenny Jing Xiang, MD, of Yale University School of Medicine, discusses a universal, standardized clinical trial prescreening protocol, which streamlined research recruitment and was associated with yearly increases in patient enrollment at the Veterans Administration (VA) Connecticut Cancer Center. The Center became the top-accruing VA site for National Cancer Institute–sponsored trials and was ranked in the top 10 enrolling sites nationally for VA and non-VA hospitals.
Joseph M. Unger, PhD, of Fred Hutchinson Cancer Research Center, discusses findings from his study of the National Cancer Institute’s Clinical Trials Network, which has conducted publicly funded cancer research for more than 50 years. The substantial gains in life years for patients with cancer, he says, supports the critical role of government-sponsored cancer research (Abstract 1503O).
John V. Cox, DO, MBA, of The University of Texas Southwestern Medical Center, summarizes his Joseph V. Simone Lecture, in which he stressed the need for coordinated care among practices. The concept of oncology medical homes, he says, has evolved to a broader-based model in which oncologists cooperate with other practices to manage patients and their comorbidities with optimal outcomes. Professional organizations such as the American College of Physicians and ASCO can provide clinicians with the tools they need to engage in this future of health care.
Divya Gupta, MD, of the Stanford Cancer Center, discusses an intervention utilizing a computer model and lay care coaches to improve advance care planning conversations with patients who have metastatic cancer. The study, Dr. Gupta reports, showed a trend toward less intensive care for patients at the end of life.
Divya A. Parikh, MD, of Stanford University School of Medicine, discusses findings that suggest an evidence-based tool, the Serious Illness Conversation Guide, may engage patients with metastatic or recurrent urologic cancer in goals-of-care conversations, potentially resulting in an increase of documentation of their goals in the electronic medical record.
Courtney Williams, DrPH, of the National Cancer Institute, discusses the costs associated with cancer survivors who don’t take their medications and cites the need for research to better understand whether residing in an urban or rural area may affect prescription adherence, and what interventions might help increase drug adherence and improve health outcomes.
Benjamin W. Corn, MD, of Shaare Zedek Medical Center in Jerusalem, discusses hope: what it takes for hope to thrive; how he and his colleagues are helping patients and providers become more hopeful through workshops; and his collaboration with the Southwest Oncology Group to aid patients, through hopefulness, to better adhere to treatment regimens.
Sarah S. Mougalian, MD, of Yale Cancer Center, discusses the increasingly common problem of long wait times for access to oncology care. Her team developed a next-day access program in several of Yale’s oncology services, which was well received by patients and decreased the time to first visit.
Manali I. Patel, MD, MPH, of Stanford University School of Medicine, discusses data suggesting that community health workers and innovative payer models can better engage low-income and minority patients with cancer, improve their health-related quality of life, and reduce unwanted and unnecessary acute care.
Neeraj Agarwal, MD, of Huntsman Cancer Institute at the University of Utah, discusses three studies that examined real-world treatment patterns and utilization of advanced therapies in men with metastatic castration-sensitive prostate cancer, which served to highlight the ways in which Black men may be treated differently (Abstracts 5072, 5073, 5704).
Peter C. Black, MD, of the Vancouver Prostate Centre, University of British Columbia, reviews three studies on early detection and treatment of Black patients with prostate cancer: a large-scale analysis of genomic profiling; the use of PSA screening; and integrating a patient-specific genomic classifier to improve risk classification and treatment recommendations for Black men (Abstracts 5003, 5004, and 5005).
Debora S. Bruno, MD, of Seidman Cancer Center at Cleveland Medical Center, discusses study findings that show Black patients with advanced or metastatic non–small cell lung cancer tend to be less likely to undergo biomarker testing or to be treated in clinical trials than White patients. Recommended broad-based testing, says Dr. Bruno, may help ensure equal access to quality care and clinical trials (Abstract 9005).
Narjust Duma, MD, of the Carbone Cancer Center at the University of Wisconsin, Madison, and Gladys I. Rodriguez, MD, of South Texas Oncology and Hematology, talk about the underrepresentation of Hispanic individuals in medicine, especially in oncology, and their efforts to create the first Young Investigator Award in Recognition of an Outstanding Latina Researcher to encourage Hispanic women to enter medicine and cancer research.
Jingxuan Zhao, MPH, of the American Cancer Society, discusses study findings that showed worse long-term survival among low-income patients with cancer who live in states that have not expanded Medicaid eligibility (Abstract 6512).
John Marshall, MD, of the Lombardi Cancer Center at Georgetown University, and his wife, Liza Marshall, a breast cancer survivor, talk about the impact of her diagnosis, how it changed their view of cancer care and the way clinicians communicate, and why their memoir has an important message.
Karen H. Vousden, PhD, of The Francis Crick Institute, and Matthew G. Vander Heiden, MD, PhD, of the Koch Institute for Integrative Cancer Research at MIT, discuss emerging evidence that diet may affect which nutrients are available to tumor cells, which can influence both tumor growth and response to therapy. Clinicians may be able to personalize dietary interventions to optimize patient care.
Ralph R. Weichselbaum, MD, of the University of Chicago, discusses oligometastasis as a part of the metastatic spectrum where ablative therapies, such as surgery or stereotactic body radiotherapy, may be curative alone or with systemic agents, as well as some potential biomarkers to guide treatment selection.
Charlotte E. Ariyan, MD, PhD, of Memorial Sloan Kettering Cancer Center, discusses improved outcomes with metastasectomy in the setting of checkpoint inhibitors, with the removal of residual disease and “escape” lesions. Surgical outcomes may also be better than targeted treatments, although long-term data and biomarkers are needed to confirm these findings.
Jeanne Tie, MD, MBChB, of the Peter MacCallum Cancer Centre, discusses how to improve the current, somewhat imprecise, approach based on pathologic staging alone, used to select patients for adjuvant treatment. Circulating tumor DNA analysis after curative-intent treatment may detect minimal residual disease and might be used to predict recurrence and adjuvant treatment efficacy across multiple tumor types.
Joann G. Elmore, MD, MPH, of the UCLA Fielding School of Public Health, discusses previous studies that show wide variability in cancer diagnoses, the uncertainties introduced by computer-aided detection tools, and new research on artificial intelligence and machine learning that may lead to more consistent and accurate diagnoses and prognoses, potentially improving treatment (Abstract SY01-03).
Gabrielle A. Zecha, PA-C, MHA, of Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, and Aaron Begue, MS, RN, NP-C, OCN, of Memorial Sloan Kettering Cancer Center, discuss how advanced practice providers are recruited and trained, ways to retain these valuable health-care professionals in the face of burnout, metrics to measure their productivity, and their future role in cancer care.
Robert Winn, MD, of the Virginia Commonwealth University Massey Cancer Center, discusses the creation of a health equity report card to track how institutions are dealing with disparities in oncology care, ways to recognize bias in care, and adding health equity experts to guideline panels and other advisory groups.
Shivan J. Mehta, MD, MBA, of Abramson Cancer Center at the University of Pennsylvania, discusses how insights from behavioral economics could be harnessed to improve HPV vaccination rates, thus lowering the rate of cervical, genital, and head/neck cancers, all of which are linked to HPV.