Prioritization and multilevel mapping of implementation strategies for a cancer rehabilitation navigation program.

Background: Although determinants and strategies for implementing a cancer rehabilitation navigation (CRNav) program have been described, defining specific implementation interventions could improve uptake in oncology care delivery. This manuscript shares prioritized implementation interventions using a multilevel framework.

Methods: We convened interdisciplinary stakeholders from two CRNav programs to participate in an implementation mapping focus group.

Combinatory actions of cytokines induce M2-like macrophages in anaplastic thyroid cancer.

Anaplastic thyroid cancer (ATC) is a lethal endocrine malignancy. It has been shown that tumor-associated macrophages (TAMs) contribute to the aggressiveness of ATC. However, stimulatory factors that could facilitate the induction and infiltration of TAMs in the ATC tumor microenvironment (TME) are not fully elucidated.

Real-World Evidence of the Impact of CanAssist Breast on Physician's Decision About the Use of Adjuvant Chemotherapy in Early Breast Cancer.

Background Clinicians use prognostic biomarker/multi-gene-based tests for predicting recurrence in hormone receptor-positive/HER2-negative (HR+/HER2-) early-stage breast cancer (EBC). CanAssist Beast (CAB) uses the expression of five protein biomarkers in combination with tumor-specific parameters such as tumor size, histopathological grade, and lymph node status to predict the risk of distant recurrence within five years of diagnosis for patients with HR+/HER2-, EBC. The current study aimed to evaluate the impact of prognostic tests on adjuvant chemotherapy decisions by assessing the agreement between clinical and CAB risk stratification as low-risk (LR) or high-risk (HR) for distant recurrence.

Cryptococcal Pneumonia in Multiple Myeloma: A Case Report.

Patients with multiple myeloma (MM) often experience infections due to aberrant immunoglobulin production by malignant plasma cells and immunosuppressive therapeutic interventions that are used to treat the condition. A rare but serious infection that may occur in these patients is Cryptococcus, an encapsulated fungus that typically infects immunocompromised individuals. Cryptococcus infections often present as pneumonia but can disseminate to the central nervous system, potentially causing meningitis.

Myeloid cells meet CD8 T cell exhaustion in cancer: What, why and how.

Exhausted T cell (Tex) is a specific state of T cell dysfunction, in which these T cells gradually lose their effector function and change their phenotype during chronic antigen stimulation. The enrichment of exhausted CD8 T cell (CD8 Tex) in the tumor microenvironment is one of the important reasons leading to the poor efficacy of immunotherapy. Recent studies have reported many reasons leading to the CD8 T cell exhaustion.

Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy.

Purpose: This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).

Methods And Materials: In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%.

Brief Report: Clinical Characteristics and Outcomes of Patients With Thoracic SMARCA4-Deficient Undifferentiated Tumors.

Introduction: Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UTs) are a recently defined group of aggressive cancers in which the effectiveness of standard treatments for lung cancer is unknown.

Methods: We collected clinical, pathologic, and demographic variables from five institutions for patients whose tumors met criteria for SMARCA4-UTs (undifferentiated phenotype and loss of SMARCA4 (BRG1) by immunohistochemistry).

Results: We identified 92 patients with SMARCA4-UTs; 58 (63%) had stage IV disease at diagnosis and 16 (17%) developed recurrent or metastatic disease after initial diagnosis.

Bcl-2 and galectin-3 expression is associated with recurrence of ameloblastoma.

Background: Ameloblastoma is a benign odontogenic neoplasm with a high recurrence rate. Identifying cellular and molecular changes in this neoplasm may help predict the recurrence risk. Bcl-2 and galectin-3 are anti-apoptotic proteins associated with the prognosis of many neoplasms.

Access to timely cancer treatment initiation in India: extent, determinants and trends.

Background: Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evaluated. In order to bridge this gap, we determined the delayed time to treatment initiation (TTI) among cancer patients in India, ascertained its determinants, and assessed the trends of delayed TTI.

Uncertainty estimation in diagnosis generation from large language models: next-word probability is not pre-test probability.

Objective: To evaluate large language models (LLMs) for pre-test diagnostic probability estimation and compare their uncertainty estimation performance with a traditional machine learning classifier.

Materials And Methods: We assessed 2 instruction-tuned LLMs, Mistral-7B-Instruct and Llama3-70B-chat-hf, on predicting binary outcomes for Sepsis, Arrhythmia, and Congestive Heart Failure (CHF) using electronic health record (EHR) data from 660 patients. Three uncertainty estimation methods-Verbalized Confidence, Token Logits, and LLM Embedding+XGB-were compared against an eXtreme Gradient Boosting (XGB) classifier trained on raw EHR data.

Evaluation of artificial intelligence-based autosegmentation for a high-performance cone-beam computed tomography imaging system in the pelvic region.

Background And Purpose: A novel ring-gantry cone-beam computed tomography (CBCT) imaging system shows improved image quality compared to its conventional version, but its effect on autosegmentation is unknown. This study evaluates the impact of this high-performance CBCT on autosegmentation performance, inter-observer variability, contour correction times and delineation confidence, compared to the conventional CBCT.

Materials And Methods: Twenty prostate cancer patients were enrolled in this prospective clinical study.

Diversity, Equity, and Inclusion in Multiple Myeloma: A Call to Action.

Background: Although advancements in multiple myeloma therapy have rapidly evolved, pervasive racial and social inequities prevent uniform benefit across diverse patient populations. This affects access to US Food and Drug Administration-approved treatments and to clinical studies. The impact of health-care inequities is not well understood and thus, the development of effective strategies is inadequate.

Advances in Myelofibrosis Management: New Janus Kinase Inhibitors Beyond Ruxolitinib.

Myelofibrosis is a myeloproliferative neoplasm characterized by the buildup of fibrous scar tissue in the bone marrow occurring secondary to the secretion of inflammatory cytokines, leading to cytopenias, dysfunctional hematopoiesis, and constitutional symptoms. One of the pathologic mechanisms that underlies myelofibrosis is aberrant activation of the Janus kinase (JAK)-STAT pathway. Targeting the JAK-STAT pathway via JAK inhibition can lead to significant improvements in spleen volume reduction and symptom improvement in intermediate- and high-risk myelofibrosis.

Impact of an Oncology Clinical Pharmacist Intervention on Clinical Trial Enrollment in The US Oncology Network's MYLUNG Consortium.

Introduction: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium™ (MYLUNG) clinical trial platform aims to advance the use of precision medicine in patients with non-small cell lung cancer through a series of prospective and iterative clinical trials. Timely patient accrual onto oncology clinical trials is a known practice challenge and impaired accrual rates can lead to premature trial closure or properly powered trial outcomes. The US Oncology Network recently implemented a clinical pharmacist (ClinReview) initiative to provide remote clinical services to screen patients for enrollment onto MYLUNG Protocol 2.

The Effect of Pelvic Floor Rehabilitation on Low Anterior Resection Syndrome After Colorectal Cancer Treatment.

Purpose: Low anterior resection (LAR) is the preferred surgical treatment of rectosigmoid or rectal cancers. However, it is often associated with bowel dysfunction, which is termed low anterior resection syndrome (LARS). Daily bowel dysfunction symptoms have a detrimental effect on quality of life (QOL).

Safety in Subsequent Lines of Therapy in Patients With Relapsed/Refractory Follicular Lymphoma.

Follicular lymphoma (FL) is a disease often characterized by chronic and successive relapses after first-line chemoimmunotherapy. Although chemoimmunotherapy and combination therapy, such as lenalidomide with rituximab, are well established in the treatment sequence of FL, there is a need to streamline treatment options and determine placement of novel agents, such as chimeric antigen receptor T-cell therapy, an enhancer of zeste homolog 2 inhibitor, or a phosphoinositide 3 kinase inhibitor, into the treatment landscape. As such, the purpose of this review is to compare the safety profiles of approved agents in subsequent lines of therapy for relapsed or refractory FL and to assess how the management of adverse events may impact treatment choice.

A standards-based application for improving platelet transfusion workflow.

Objective: Thrombocytopenia is a common complication of hematopoietic stem-cell transplantation (HSCT), though many patients will become immune refractory to platelet transfusions over time. We built and evaluated an electronic health record (EHR)-integrated, standards-based application that enables blood-bank clinicians to match platelet inventory with patients using data previously not available at the point-of-care, like human leukocyte antigen (HLA) data for donors and recipients.

Materials And Methods: The web-based application launches as an EHR-embedded application or as a standalone application.

Long-Term Postoperative Donor Site Musculoskeletal Morbidity after Osseous Free Flap Harvest.

Objective: Complex ablative maxillary and mandibular defects often require osseous free flap reconstruction. Workhorse options include the fibula, scapula, and osteocutaneous radial forearm flap (OCRFF). The choice of donor site for harvest should be driven not only by reconstructive goals but also by donor site morbidity.

Incidence, Risk Factors and Outcomes of Urinary Tract Infections among Patients Undergoing Thyroidectomy: Insights from the ACS-NSQIP.

 Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy.  This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy.  This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019.

Drug-Linker Constructs Bearing Unique Dual-Mechanism Tubulin Binding Payloads Tethered through Cleavable and Non-Cleavable Linkers.

Antibody-drug conjugates (ADCs) have advanced as a mainstay among the most promising cancer therapeutics, offering enhanced antigen targeting and encompassing wide diversity in their linker and payload components. Small-molecule inhibitors of tubulin polymerization have found success as payloads in FDA approved ADCs and represent further promise in next-generation, pre-clinical and developmental ADCs. Unique dual-mechanism payloads (previously designed and synthesized in our laboratories) function as both potent antiproliferative agents and promising vascular disrupting agents capable of imparting selective and effective damage to tumor-associated microvessels.

Minimally Invasive Surgery Deserts: Is There a Role for Robotic Assisted Surgery?

Despite evidence indicating patient and hospital benefits of minimally invasive surgery (MIS) over open surgery, there is still access barriers to MIS. Availability of training and associated learning curve, health literacy, and hospital characteristics (location, size) have been identified as the primary barriers to the adoption of MIS. Robotic assisted surgery could help to overcome some of these barriers and increase access to MIS through easier tele-mentoring and potential for remote access.

An Overview of Patient-reported Outcomes for Men with Prostate Cancer: Results from the PIONEER Consortium.

Background And Objective: Patient-reported outcome measures (PROMs) are increasingly being used to capture the patients' perspective of their functional status and quality of life (QoL). Big data can help us better understand patient-reported outcomes (PROs). Using prospectively collected data from the Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) consortium, we aimed to describe the functional status and QoL in men with prostate cancer (PCa) treated with active surveillance (AS), radical prostatectomy (RP), and radiotherapy (RT), and to demonstrate the applicability of PROM data on a large scale and at a European level.

Impact of Additional Active Treatment for Prostate Cancer on Health-related Quality of Life of Men: Results from the EUPROMS 2.0 1-year Follow-up Survey.

Background And Objective: In 2019 and 2021, Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study (EUPROMS) and the EUPROMS 2.0 survey, with the goal of collecting data on patients' self-reported perspective on physical and mental well-being outside of a clinical trial setting, to be able to investigate the burden of prostate cancer (PCa) treatment from a patient-to-patient perspective. Acknowledging the importance of collecting quality of life (QoL) follow-up data, a 1-yr follow-up (1yrFU) study was conducted to assess the effect of additional PCa treatment on QoL.