Journal articles on the topic 'Oncology Knowledge Base'
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Chakravarty, Debyani, Jianjiong Gao, Sarah Phillips, Ritika Kundra, Hongxin Zhang, Jiaojiao Wang, Julia E. Rudolph, et al. "OncoKB: A Precision Oncology Knowledge Base." JCO Precision Oncology, no. 1 (November 2017): 1–16. http://dx.doi.org/10.1200/po.17.00011.
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Purpose With prospective clinical sequencing of tumors emerging as a mainstay in cancer care, an urgent need exists for a clinical support tool that distills the clinical implications associated with specific mutation events into a standardized and easily interpretable format. To this end, we developed OncoKB, an expert-guided precision oncology knowledge base. Methods OncoKB annotates the biologic and oncogenic effects and prognostic and predictive significance of somatic molecular alterations. Potential treatment implications are stratified by the level of evidence that a specific molecular alteration is predictive of drug response on the basis of US Food and Drug Administration labeling, National Comprehensive Cancer Network guidelines, disease-focused expert group recommendations, and scientific literature. Results To date, > 3,000 unique mutations, fusions, and copy number alterations in 418 cancer-associated genes have been annotated. To test the utility of OncoKB, we annotated all genomic events in 5,983 primary tumor samples in 19 cancer types. Forty-one percent of samples harbored at least one potentially actionable alteration, of which 7.5% were predictive of clinical benefit from a standard treatment. OncoKB annotations are available through a public Web resource ( http://oncokb.org ) and are incorporated into the cBioPortal for Cancer Genomics to facilitate the interpretation of genomic alterations by physicians and researchers. Conclusion OncoKB, a comprehensive and curated precision oncology knowledge base, offers oncologists detailed, evidence-based information about individual somatic mutations and structural alterations present in patient tumors with the goal of supporting optimal treatment decisions.
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Suehnholz, Sarah P., Moriah Nissan, Hongxin Zhang, Ritika Kundra, Calvin Lu, Benjamin Xu, Maria E. Arcila, et al. "Abstract 1189: OncoKB, MSK’s precision oncology knowledge base." Cancer Research 82, no. 12_Supplement (June 15, 2022): 1189. http://dx.doi.org/10.1158/1538-7445.am2022-1189.
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Abstract OncoKB, Memorial Sloan Kettering Cancer Center’s (MSK) precision oncology knowledge base (www.oncokb.org), is a comprehensive database that annotates the oncogenic effects and clinical actionability of somatic alterations in cancer. OncoKB supports variant interpretation by the cBioPortal for Cancer Genomics and is used to annotate >12,000 MSK patient sequencing reports annually. Since its introduction in 2016, OncoKB has expanded to include 5685 alterations in 682 genes, and in October 2021, it became the first somatic knowledge base to be partially recognized by the FDA. The scope of the OncoKB FDA recognition includes clinically actionable variants that map to an FDA level of evidence, the processes of variant curation, and policies regarding database oversight, personnel training and transparency of data sources and operations. This recognition credentials OncoKB as providing accurate, reliable and clinically meaningful information to the medical and scientific communities. The OncoKB Therapeutic (Tx) Levels of Evidence categorize variants based on their tumor type-specific predictive value of sensitivity or resistance to matched standard care or investigational targeted therapies. To date, OncoKB includes 43 Level 1 genes (included in the FDA drug label), 23 Level 2 genes (included in professional guidelines), 25 Level 3A genes (predictive of drug response in well-powered clinical studies), 23 Level 4 genes (predictive of drug response based on compelling biological evidence), and 11 R1 or R2 resistance genes. Initially focused on solid tumors, OncoKB was expanded to include hematologic disease annotation in 2019 and introduced Diagnostic (Dx) and Prognostic (Px) levels of evidence. All three level of evidence systems (Tx, Dx and Px) are consistent with the guidelines for evidence-based categorization of somatic variants published as a joint consensus recommendation by AMP/ASCO/CAP. OncoKB is governed by a Clinical Genomics Annotation Committee, composed of MSK physicians and scientists who ensure that the information captured is accurate and current, and an external advisory board composed of leaders in the clinical oncology and genomics communities who oversee OncoKB updates and progress. OncoKB curation rules and processes are transparent and documented in the OncoKB Curation Standard Operating Procedure, which is publicly available via the website. User feedback to OncoKB content is encouraged via the website and through cBioPortal. Queries or suggestions by OncoKB users are addressed by the OncoKB team within 72 hours. OncoKB offers licenses for academic, commercial and hospital use, with which users can programmatically access the web API. Future work includes coverage of additional cancer-associated genes, annotation of germline alterations that are predictive of drug response and/or associated with increased heritable cancer risk and the development of a clinical trial matching system. Citation Format: Sarah P. Suehnholz, Moriah Nissan, Hongxin Zhang, Ritika Kundra, Calvin Lu, Benjamin Xu, Maria E. Arcila, Marc Ladanyi, Michael F. Berger, Ahmet Zehir, Aijaz Syed, Julia E. Rudolph, Ross L. Levine, Ahmet Dogan, Jianjiong Gao, David B. Solit, Nikolaus Schultz, Debyani Chakravarty. OncoKB, MSK’s precision oncology knowledge base [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1189.
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Akabe, Koichi, Toshiki Takeuchi, Takashi Aoki, and Kunihiro Nishimura. "Information retrieval on oncology knowledge base using recursive paraphrase lattice." Journal of Biomedical Informatics 116 (April 2021): 103705. http://dx.doi.org/10.1016/j.jbi.2021.103705.
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Rubinstein, Samuel M., Tarsheen Sethi, Neeta K. Venepalli, Bishal Gyawali, Candice Schwartz, Donna R. Rivera, Peter C. Yang, and Jeremy L. Warner. "Chemotherapy Knowledge Base Management in the Era of Precision Oncology." JCO Clinical Cancer Informatics, no. 5 (January 2021): 30–35. http://dx.doi.org/10.1200/cci.20.00076.
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Cancer medicine has grown increasingly complex in recent years with the advent of precision oncology and wide utilization of multidrug regimens. Representing this increasingly granular knowledge is a significant challenge. As users and managers of a freely available chemotherapy drug and regimen database, we describe the changes we have made to accommodate these challenges. These include the development of a domain ontology and increased granularity in the classification of cancer types on the website.
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Takeuchi, Shiho, and Shujiro Okuda. "Knowledge base toward understanding actionable alterations and realizing precision oncology." International Journal of Clinical Oncology 24, no. 2 (December 12, 2018): 123–30. http://dx.doi.org/10.1007/s10147-018-1378-0.
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Rogers, Leland, Igor Barani, Marc Chamberlain, Thomas J. Kaley, Michael McDermott, Jeffrey Raizer, David Schiff, Damien C. Weber, Patrick Y. Wen, and Michael A. Vogelbaum. "Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review." Journal of Neurosurgery 122, no. 1 (January 2015): 4–23. http://dx.doi.org/10.3171/2014.7.jns131644.
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Evolving interest in meningioma, the most common primary brain tumor, has refined contemporary management of these tumors. Problematic, however, is the paucity of prospective clinical trials that provide an evidence-based algorithm for managing meningioma. This review summarizes the published literature regarding the treatment of newly diagnosed and recurrent meningioma, with an emphasis on outcomes stratified by WHO tumor grade. Specifically, this review focuses on patient outcomes following treatment (either adjuvant or at recurrence) with surgery or radiation therapy inclusive of radiosurgery and fractionated radiation therapy. Phase II trials for patients with meningioma have recently completed accrual within the Radiation Therapy Oncology Group and the European Organisation for Research and Treatment of Cancer consortia, and Phase III studies are being developed. However, at present, there are no completed prospective, randomized trials assessing the role of either surgery or radiation therapy. Successful completion of future studies will require a multidisciplinary effort, dissemination of the current knowledge base, improved implementation of WHO grading criteria, standardization of response criteria and other outcome end points, and concerted efforts to address weaknesses in present treatment paradigms, particularly for patients with progressive or recurrent low-grade meningioma or with high-grade meningioma. In parallel efforts, Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a paper on systemic therapies for meningioma and a separate article proposing standardized end point and response criteria for meningioma.
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Pallarz, Steffen, Manuela Benary, Mario Lamping, Damian Rieke, Johannes Starlinger, Christine Sers, David Luis Wiegandt, et al. "Comparative Analysis of Public Knowledge Bases for Precision Oncology." JCO Precision Oncology, no. 3 (December 2019): 1–8. http://dx.doi.org/10.1200/po.18.00371.
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PURPOSE Precision oncology depends on the availability of up-to-date, comprehensive, and accurate information about associations between genetic variants and therapeutic options. Recently, a number of knowledge bases (KBs) have been developed that gather such information on the basis of expert curation of the scientific literature. We performed a quantitative and qualitative comparison of Clinical Interpretations of Variants in Cancer, OncoKB, Cancer Gene Census, Database of Curated Mutations, CGI Biomarkers (the cancer genome interpreter biomarker database), Tumor Alterations Relevant for Genomics-Driven Therapy, and the Precision Medicine Knowledge Base. METHODS We downloaded each KB and restructured their content to describe variants, genes, drugs, and gene-drug associations in a common format. We normalized gene names to Entrez Gene IDs and drug names to ChEMBL and DrugBank IDs. For the analysis of clinically relevant gene-drug associations, we obtained lists of genes affected by genetic alterations and putative drug therapies for 113 patients with cancer whose cases were presented at the Molecular Tumor Board (MTB) of the Charité Comprehensive Cancer Center. RESULTS Our analysis revealed that the KBs are largely overlapping but also that each source harbors a notable amount of unique information. Although some KBs cover more genes, others contain more data about gene-drug associations. Retrospective comparisons with findings of the Charitè MTB at the gene level showed that use of multiple KBs may considerably improve retrieval results. The relative importance of a KB in terms of cancer genes was assessed in more detail by logistic regression, which revealed that all but one source had a notable impact on result quality. We confirmed these findings using a second data set obtained from an independent MTB. CONCLUSION To date, none of the existing publicly available KBs on gene-drug associations in precision oncology fully subsumes the others, but all of them exhibit specific strengths and weaknesses. Consideration of multiple KBs, therefore, is essential to obtain comprehensive results.
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Reardon, Brendan, Nathanael D. Moore, Nicholas S. Moore, Eric Kofman, Saud H. AlDubayan, Alexander T. M. Cheung, Jake Conway, et al. "Integrating molecular profiles into clinical frameworks through the Molecular Oncology Almanac to prospectively guide precision oncology." Nature Cancer 2, no. 10 (September 30, 2021): 1102–12. http://dx.doi.org/10.1038/s43018-021-00243-3.
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AbstractTumor molecular profiling of single gene-variant (‘first-order’) genomic alterations informs potential therapeutic approaches. Interactions between such first-order events and global molecular features (for example, mutational signatures) are increasingly associated with clinical outcomes, but these ‘second-order’ alterations are not yet accounted for in clinical interpretation algorithms and knowledge bases. We introduce the Molecular Oncology Almanac (MOAlmanac), a paired clinical interpretation algorithm and knowledge base to enable integrative interpretation of multimodal genomic data for point-of-care decision making and translational-hypothesis generation. We benchmarked MOAlmanac to a first-order interpretation method across multiple retrospective cohorts and observed an increased number of clinical hypotheses from evaluation of molecular features and profile-to-cell line matchmaking. When applied to a prospective precision oncology trial cohort, MOAlmanac nominated a median of two therapies per patient and identified therapeutic strategies administered in 47% of patients. Overall, we present an open-source computational method for integrative clinical interpretation of individualized molecular profiles.
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Maggiore, Ronald J., William Dale, Arti Hurria, Heidi D. Klepin, Andrew Chapman, Efrat Dotan, Supriya G. Mohile, Arash Naeim, Ajeet Gajra, and Mary K. Buss. "Hematology-Oncology Fellows’ Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology–Sponsored National Survey." Journal of Oncology Practice 13, no. 11 (November 2017): e900-e908. http://dx.doi.org/10.1200/jop.2017.022111.
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Purpose: Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well geriatrics or geriatric oncology training is being incorporated into hematology-oncology (hem-onc) fellowships. Methods: A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in geriatric oncology during training; knowledge base in geriatric oncology; confidence in managing older adults with cancer; and general attitudes toward geriatric oncology principles. Results: Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated geriatric oncology as important or very important (84%); however, only 25% reported having access to a geriatric oncology clinic and more than one half (53%) reported no lectures in geriatric oncology. Fellows reported fewer educational experiences in geriatric oncology than in nongeriatric oncology. For example, among procedure-based activities, 12% learned how to perform a geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Conclusion: Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to geriatric oncology. The high value fellows place on geriatric oncology suggests that they would be receptive to additional training in this area.
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Mai, Yun, Kyeryoung Lee, Zongzhi Liu, Meng Ma, Christopher Gilman, Minghao Li, Mingwei Zhang, et al. "Phenotyping of clinical trial eligibility text from cancer studies into computable criteria in electronic health records." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6592. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6592.
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6592 Background: Clinical trial phenotyping is the process of extracting clinical features and patient characteristics from eligibility criteria. Phenotyping is a crucial step that precedes automated cohort identification from patient electronic health records (EHRs) against trial criteria. We establish a clinical trial phenotyping pipeline to transform clinical trial eligibility criteria into computable criteria and enable high throughput cohort selection in EHRs. Methods: Formalized clinical trial criteria attributes were acquired from a natural-language processing (NLP)-assisted approach. We implemented a clinical trial phenotyping pipeline that included three components: First, a rule-based knowledge engineering component was introduced to annotate the trial attributes into a computable and customizable granularity from EHRs. The second component involved normalizing annotated attributes using standard terminologies and pre-defined reference tables. Third, a knowledge base of computable criteria attributes was built to match patients to clinical trials. We evaluated the pipeline performance by independent manual review. The inter-rater agreement of the annotation was measured on a random sample of the knowledge base. The accuracy of the pipeline was evaluated on a subset of randomly selected matched patients for a subset of randomly selected attributes. Results: Our pipeline phenotyped 2954 clinical trials from five cancer types including Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Prostate Cancer, Breast Cancer, and Multiple Myeloma. We built a knowledge base of 256 computable attributes that included comorbidities, comorbidity-related treatment, previous lines of therapy, laboratory tests, and performance such as ECOG and Karnofsky score. Among 256 attributes, 132 attributes were encoded using standard terminologies and 124 attributes were normalized to customized concepts. The inter-rater agreement of the annotation measured by Cohen’s Kappa coefficient was 0.83. We applied the knowledge base to our EHRs and efficiently identified 33258 potential subjects for cancer clinical trials. Our evaluation on the patient matching indicated the F1 score was 0.94. Conclusions: We established a clinical trial phenotyping pipeline and built a knowledge base of computable criteria attributes that enabled efficient screening of EHRs for patients meeting clinical trial eligibility criteria, providing an automated way to efficiently and accurately identify clinical trial cohorts. The application of this knowledge base to patient matching from EHR data across different institutes demonstrates its generalization capability. Taken together, this knowledge base will be particularly valuable in computer-assisted clinical trial subject selection and clinical trial protocol design in cancer studies based on real-world evidence.
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Siekkinen, M., A. Ryhanen, and S. Pyrhonen. "538 oral BREAST CANCER PATIENTS' KNOWLEDGE BASE OF RADIOTHERAPY-DEVELOPING AN E-KNOWLEDGE TEST." Radiotherapy and Oncology 99 (May 2011): S220. http://dx.doi.org/10.1016/s0167-8140(11)70660-0.
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Levy, Mia Alyce, Christine Micheel, Neha Jain, and Kathleen F. Mittendorf. "Assessment of actionability of cancer genomic testing panels based on a structured clinical trial knowledge base." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6533. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6533.
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6533 Background: Today’s oncologist is responsible for choosing appropriate cancer genomics tests to inform patient treatment from multiple available platforms, weighing cost, availability, sensitivity and specificity, and clinical actionability. Knowledge-driven clinical decision support tools can assist clinicians in choosing the panel that is most informative in a given clinical space. Methods: Using a queryable knowledgebase of >1800 active clinical trials containing structured eligibility criteria curations for diagnosis and genomic alterations, we compared two CLIA-regulated genomic panels for clinical actionability over the landscape of solid, breast, and lung cancer clinical trials. Results: The larger panel (73 genes) was more actionable than the smaller panel (62 genes) in the breast cancer (10x more trials returned) and solid tumor (2.7x more trials returned) clinical trial space, while the smaller panel returned 1.2x more trials in the lung cancer space (see table). Conclusions: This analysis demonstrates that patient diagnosis has a significant effect on the potential clinical actionability of a given genomic panel. Further, this analysis demonstrates the clinical utility of knowledge-driven clinical decision support tools for test selection, especially given the often-limited tumor sample available, cost of genomic panel testing, and continuously shifting trial landscape. [Table: see text]
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Hopkins, Janice, and Matthew P. Mumber. "Patient Navigation Through the Cancer Care Continuum: An Overview." Journal of Oncology Practice 5, no. 4 (July 2009): 150–52. http://dx.doi.org/10.1200/jop.0943501.
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Technologic advances, medical specialization, novel payment structures, and an increased scientific knowledge base have resulted in a health care system requiring trained experts to deliver guidance as patients complete care plans: Enter the concept of patient navigation.
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Malapelle, U., F. Pepe, P. Pisapia, L. Righi, A. Listì, M. L. Reale, F. Passiglia, et al. "EP16.03-040 Biomarkersatlas.com: the Italian NSCLC Precision Medicine Knowledge Data Base." Journal of Thoracic Oncology 17, no. 9 (September 2022): S607—S608. http://dx.doi.org/10.1016/j.jtho.2022.07.1101.
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Yancik, Rosemary, Patricia A. Ganz, Claudette G. Varricchio, and Barbara Conley. "Perspectives on Comorbidity and Cancer in Older Patients: Approaches to Expand the Knowledge Base." Journal of Clinical Oncology 19, no. 4 (February 15, 2001): 1147–51. http://dx.doi.org/10.1200/jco.2001.19.4.1147.
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Abstract : Not only do persons 65 years and older bear a disproportionate burden of cancer, advancing age is associated with increased vulnerability to other age-related health problems. Newly diagnosed older cancer patients who have lived into later years of life may have concurrent ailments (eg, diabetes, chronic obstructive pulmonary disease, heart disease, arthritis, and/or hypertension) that could affect treatment choice, prognosis, and survival. The clinician must often make cancer treatment decisions in the context of an older individual’s pre-existing health problems (ie, comorbidity). Ways to produce reliable information on comorbidity that can be effectively used in evaluation of older cancer patients are urgently needed. What is the nature and severity of the older patient’s comorbid health problems? How do other age-related conditions influence treatment decisions and the cancer course? How do already compromised older patients tolerate the stress of cancer and its treatment? How are concomitant comorbid conditions managed? At present, no established, valid way to assess comorbidity in older cancer patients exists. Such technology, with a solid conceptual and scientific base, promises a high positive clinical yield to assure quality cancer care for older patients if reliable and valid instruments can be integrated into oncology practice. Much preliminary scientific work must be performed. A synthesis of viewpoints on what to include in comorbidity assessment of older cancer patients and development approaches were expressed in a multidisciplinary working group convened by the National Institute on Aging and the National Cancer Institute. We share the key issues raised regarding complexities of comorbidity assessment and suggestions for scientific inquiry.
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Yesupriya, A., M. Gwinn, and M. J. Khoury. "Building a Knowledge Base on Genetic Variation and Cancer Risk Through Field Synopses." JNCI Journal of the National Cancer Institute 101, no. 1 (December 30, 2008): 4–5. http://dx.doi.org/10.1093/jnci/djn452.
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Luttrell, Julianne, Sarah Sumner, Emy-lee Marie Anglo Ricafrente, and Marlon Saria. "Beyond the Chemotherapy Certificate: Building a Knowledge Base Virtually for Oncology Nursing Practice Across a Health System." Clinical Journal of Oncology Nursing 25, no. 4 (August 1, 2021): 465–69. http://dx.doi.org/10.1188/21.cjon.465-469.
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Soysal, E., H.-J. Lee, Y. Zhang, L.-C. Huang, X. Chen, Q. Wei, W. Zheng, et al. "CATTLE (CAncer treatment treasury with linked evidence): An integrated knowledge base for personalized oncology research and practice." CPT: Pharmacometrics & Systems Pharmacology 6, no. 3 (March 2017): 188–96. http://dx.doi.org/10.1002/psp4.12174.
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Huang, Linda, Helen Fernandes, Hamid Zia, Peyman Tavassoli, Hanna Rennert, David Pisapia, Marcin Imielinski, et al. "The cancer precision medicine knowledge base for structured clinical-grade mutations and interpretations." Journal of the American Medical Informatics Association 24, no. 3 (October 27, 2016): 513–19. http://dx.doi.org/10.1093/jamia/ocw148.
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Objective: This paper describes the Precision Medicine Knowledge Base (PMKB; https://pmkb.weill.cornell.edu), an interactive online application for collaborative editing, maintenance, and sharing of structured clinical-grade cancer mutation interpretations. Materials and Methods: PMKB was built using the Ruby on Rails Web application framework. Leveraging existing standards such as the Human Genome Variation Society variant description format, we implemented a data model that links variants to tumor-specific and tissue-specific interpretations. Key features of PMKB include support for all major variant types, standardized authentication, distinct user roles including high-level approvers, and detailed activity history. A REpresentational State Transfer (REST) application-programming interface (API) was implemented to query the PMKB programmatically. Results: At the time of writing, PMKB contains 457 variant descriptions with 281 clinical-grade interpretations. The EGFR, BRAF, KRAS, and KIT genes are associated with the largest numbers of interpretable variants. PMKB’s interpretations have been used in over 1500 AmpliSeq tests and 750 whole-exome sequencing tests. The interpretations are accessed either directly via the Web interface or programmatically via the existing API. Discussion: An accurate and up-to-date knowledge base of genomic alterations of clinical significance is critical to the success of precision medicine programs. The open-access, programmatically accessible PMKB represents an important attempt at creating such a resource in the field of oncology. Conclusion: The PMKB was designed to help collect and maintain clinical-grade mutation interpretations and facilitate reporting for clinical cancer genomic testing. The PMKB was also designed to enable the creation of clinical cancer genomics automated reporting pipelines via an API.
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Johnson, Philip E., George Dahlman, Kirby Eng, Rekha Garg, Scott Gottlieb, James M. Hoffman, Peyton Howell, et al. "NCCN Oncology Risk Evaluation and Mitigation Strategies White Paper: Recommendations for Stakeholders." Journal of the National Comprehensive Cancer Network 8, Suppl_7 (September 2010): S—7—S—27. http://dx.doi.org/10.6004/jnccn.2010.0135.
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REMS are a particularly important issue for oncology and the National Comprehensive Cancer Network (NCCN). A disproportionate number of drugs with complex REMS are used in patients with cancer or hematologic disorders. REMS policies and processes within oncology may act as a model for other clinical areas. A breadth of experience and access to a wide knowledge base exists within oncology that will ensure appropriate development and consideration of the practical implications of REMS. NCCN is uniquely positioned to assume a leadership role in this process given its status as the arbiter of high-quality cancer care based on its world-leading institutions and clinicians. Notwithstanding the potential benefits, the successful design, implementation, and analysis of the FDA's recent requirement for REMS for some high-risk drugs and biologics will present significant challenges for stakeholders, including patients, providers, cancer centers, manufacturers, payors, health information technology vendors, and regulatory agencies. To provide guidance to these stakeholders regarding REMS challenges, the NCCN assembled a work group comprised of thought leaders from NCCN Member Institutions and other outside experts. The Work Group identified challenges across the REMS spectrum, including the areas of standardization, development and assessment of REMS programs, medication guides, provider knowledge and impact on prescribing, provider burden and compensation, and incorporation of REMS into clinical practice.
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Thews, O., C. Rohrbach, M. Sergl, K. Pommerening, and R. Müller. "A Graph-Grammar Approach to Represent Causal, Temporal and Other Contexts in an Oncological Patient Record." Methods of Information in Medicine 35, no. 02 (April 1996): 127–41. http://dx.doi.org/10.1055/s-0038-1634641.
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AbstractThe data of a patient undergoing complex diagnostic and therapeutic procedures do not only form a simple chronology of events, but are closely related in many ways. Such data contexts include causal or temporal relationships, they express inconsistencies and revision processes, or describe patient-specific heuristics. The knowledge of data contexts supports the retrospective understanding of the medical decision-making process and is a valuable base for further treatment. Conventional data models usually neglect the problem of context knowledge, or simply use free text which is not processed by the program. In connection with the development of the knowledge-based system THEMPO (Therapy Management in Pediatric Oncology), which supports therapy and monitoring in pediatric oncology, a graph-grammar approach has been used to design and implement a graph-oriented patient model which allows the representation of non-trivial (causal, temporal, etc.) clinical contexts. For context acquisition a mouse-based tool has been developed allowing the physician to specify contexts in a comfortable graphical manner. Furthermore, the retrieval of contexts is realized with graphical tools as well.
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Jain, Neha, Kathleen F. Mittendorf, Marilyn Holt, Michele Lenoue-Newton, Ian Maurer, Clinton Miller, Matthew Stachowiak, et al. "The My Cancer Genome clinical trial data model and trial curation workflow." Journal of the American Medical Informatics Association 27, no. 7 (June 1, 2020): 1057–66. http://dx.doi.org/10.1093/jamia/ocaa066.
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Abstract Objective As clinical trials evolve in complexity, clinical trial data models that can capture relevant trial data in meaningful, structured annotations and computable forms are needed to support accrual. Material and Methods We have developed a clinical trial information model, curation information system, and a standard operating procedure for consistent and accurate annotation of cancer clinical trials. Clinical trial documents are pulled into the curation system from publicly available sources. Using a web-based interface, a curator creates structured assertions related to disease-biomarker eligibility criteria, therapeutic context, and treatment cohorts by leveraging our data model features. These structured assertions are published on the My Cancer Genome (MCG) website. Results To date, over 5000 oncology trials have been manually curated. All trial assertion data are available for public view on the MCG website. Querying our structured knowledge base, we performed a landscape analysis to assess the top diseases, biomarker alterations, and drugs featured across all cancer trials. Discussion Beyond curating commonly captured elements, such as disease and biomarker eligibility criteria, we have expanded our model to support the curation of trial interventions and therapeutic context (ie, neoadjuvant, metastatic, etc.), and the respective biomarker-disease treatment cohorts. To the best of our knowledge, this is the first effort to capture these fields in a structured format. Conclusion This paper makes a significant contribution to the field of biomedical informatics and knowledge dissemination for precision oncology via the MCG website. Key words knowledge representation, My Cancer Genome, precision oncology, knowledge curation, cancer informatics, clinical trial data model
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Chidambaram, Swathi, Sergio W. Guadix, John Kwon, Justin Tang, Amanda Rivera, Aviva Berkowitz, Shalom Kalnicki, and Susan C. Pannullo. "Evidence-based practice of stereotactic radiosurgery: Outcomes from an educational course for neurosurgery and radiation oncology residents." Surgical Neurology International 12 (March 2, 2021): 77. http://dx.doi.org/10.25259/sni_539_2020.
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Background: As the field of brain and spine stereotactic radiosurgery (SRS) continues to grow, so will the need for a comprehensive evidence base. However, it is unclear to what degree trainees feel properly equipped to use SRS. We assess the perceptions and comfort level reported by neurosurgery and radiation oncology residents concerning the evidence-based practice of SRS. Methods: A continuing medical education (CME) course provided peer-reviewed updates regarding treatment with intracranial and spinal SRS. Presentations were given by neurosurgery and radiation oncology residents with mentorship by senior faculty. To gauge perceptions regarding SRS, attendees were surveyed. Responses before and after the course were analyzed using the Fisher’s exact test in R statistical software. Results: Participants reported the greatest knowledge improvements concerning data registries (P < 0.001) and clinical trials (P = 0.026). About 82% of all (n = 17) radiation oncology and neurosurgery residents either agreed or strongly agreed that a brain and spine SRS rotation would be beneficial in their training. However, only 47% agreed or strongly agreed that one was currently part of their training. In addition, knowledge gains in SRS indications (P = 0.084) and ability to seek collaboration with colleagues (P = 0.084) showed notable trends. Conclusion: There are clear knowledge gaps shared by potential future practitioners of SRS. Specifically, knowledge regarding SRS data registries, indications, and clinical trials offer potential areas for increased educational focus. Furthermore, the gap between enthusiasm for increased SRS training and the current availability of such training at medical institutions must be addressed.
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Reardon, Brendan Michael, and Eliezer Mendel Van Allen. "Expanding clinical actionability in individual patient profiles with the Molecular Oncology Almanac." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 3015. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.3015.
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3015 Background: The clinical care of oncology patients is routinely informed by tumor and inherited genetic profiles. This is accomplished by molecular pathologists synthesizing the growing body of clinical guidelines and scientific evidence that associates cancer genome alterations and therapeutic response, and applying that knowledge during case reviews. Many academic medical centers formalize this process in the form of molecular tumor boards. As the number of cases for review and literature continue to increase, there is opportunity to leverage clinical interpretation algorithms to computationally prioritize molecular features and both enhance and automate the sample contextualization process. Here, we present the Molecular Oncology Almanac (MOAlmanac) to enable the rapid assessment of tumor actionability. Methods: Molecular Oncology Almanac is an open source clinical interpretation algorithm and paired knowledge base for precision cancer medicine. It is used to rapidly characterize and identify genomic features related to therapeutic sensitivity and resistance and of prognostic relevance. This is performed by assessing not only individual genomic features (e.g. somatic variants, copy number alterations, germline variants, and fusions) but also interactions between these events as well as secondary features such as mutational burden, mutational signatures, MSI status, and aneuploidy. MOAlmanac summarizes all clinically relevant findings into a web-based actionability report. The underlying knowledge base can be accessed through our API endpoints and web browser, and entries may be recommended through either Github or our browser extension. In addition, we developed a cloud-based web portal on top of the Terra framework to increase accessibility. Results: A total of 32,108 samples from 30,607 patients across 66 cancer types received targeted sequencing to characterize somatic variants, copy number alterations, and fusions from PROFILE’s Oncopanel and were evaluated with MOAlmanac. Based on Oncopanel’s tier 1 and tier 2 criteria for clinical actionability, we observed that 8,285 samples (26%, 0 - 69% by cancer type) of patients harbored at least one alteration suggesting therapeutic sensitivity based on FDA approvals or clinical guidelines. Actionability increases to 18,117 samples (56%, 0 - 85% by cancer type) when considering an expanded set of evidence to include relationships captured from clinical trials, clinical, preclinical, and inferential evidence; consequently providing at least one therapeutic hypothesis to otherwise variant-negative patients. Conclusions: Clinical actionability of molecular tumor data was increased in individual patients by expanding the set of evidence considered. Source code and a web portal for this project are available at moalmanac.org .
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Braun, Ilana M., Alexi Wright, John Peteet, Fremonta L. Meyer, David P. Yuppa, Dragana Bolcic-Jankovic, Jessica LeBlanc, et al. "Medical Oncologists’ Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study." Journal of Clinical Oncology 36, no. 19 (July 1, 2018): 1957–62. http://dx.doi.org/10.1200/jco.2017.76.1221.
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Background Although almost every state medical marijuana (MM) law identifies cancer as a qualifying condition, little research supports MM’s use in oncology. We hypothesized that the discrepancy between these laws and the scientific evidence base poses clinical challenges for oncologists. Oncologists’ beliefs, knowledge, and practices regarding MM were examined in this study. Methods In November 2016, we mailed a survey on MM to a nationally-representative, random sample of 400 medical oncologists. Main outcome measures included whether oncologists reported discussing MM with patients, recommended MM clinically in the past year, or felt sufficiently informed to make such recommendations. The survey also queried oncologists’ views on MM’s comparative effectiveness for several conditions (including its use as an adjunct to standard pain management strategies) and its risks compared with prescription opioids. Bivariate and multivariate analyses were performed using standard statistical techniques. Results The overall response rate was 63%. Whereas only 30% of oncologists felt sufficiently informed to make recommendations regarding MM, 80% conducted discussions about MM with patients, and 46% recommended MM clinically. Sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies, and 65% thought MM is equally or more effective than standard treatments for anorexia and cachexia. Conclusion Our findings identify a concerning discrepancy between oncologists’ self-reported knowledge base and their beliefs and practices regarding MM. Although 70% of oncologists do not feel equipped to make clinical recommendations regarding MM, the vast majority conduct discussions with patients about MM and nearly one-half do, in fact, recommend it clinically. A majority believes MM is useful for certain indications. These findings are clinically important and suggest critical gaps in research, medical education, and policy regarding MM.
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Saadeh, Claire, David Bright, and Danielle Rustem. "Precision Medicine in Oncology Pharmacy Practice." Acta Medica Academica 48, no. 1 (June 26, 2019): 90. http://dx.doi.org/10.5644/ama2006-124.246.
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<p>The objective of this review is to provide an overview of the components, process and resources available to apply precision medicine strategies to drug therapy in cancer medicine, with an emphasis on oncology pharmacy practice. Precision medicine initiatives in oncology take into account individual variability in genes, environment and lifestyle factors. Genomic assays of patient tumors is now the standard of care in oncology and recommendations for targeted drug therapies are often formulated by interprofessional teams. Pharmacogenomics (PGx) is a component of precision medicine based on polymorphisms that impact medication selection and/or dosing. Several oncolytic agents used in the treatment of cancer and supportive care have pharmacogenomic-based dosing recommendations to minimize potential toxicities. Several resources are reviewed here to guide treatment options in oncology as they relate to somatic mutations and PGx. Examples include: OncoKB is a precision oncology knowledge base that offers evidence-based information for somatic mutations. The Clinical Pharmacogenetics Implementation Consortium provides PGx-based guidelines for several oncolytic therapies used to treat cancer and for supportive care. Pharmacists can be integral members of the interprofessional team in many practicesettings in precision medicine. Involvement can include membership in molecular tumor boards, PGx dosing services and provide patient education.</p><p><strong>Conclusion. </strong>Precision medicine is a rapidly evolving field in oncology that requires an interprofessional approach of drug therapy experts.</p>
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Kamal, Arif, Kristen McNiff, Ann A. Prestrud, Dale Lupu, Molly Gavigan, Yousuf Zafar, Richard L. Schilsky, and Amy Pickar Abernethy. "Developing a virtual collaborative to facilitate palliative care and quality improvement learning in oncology." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 252. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.252.
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252 Background: Despite a strong evidence base and increasing calls for integration, oncologists find it difficult to deliver primary palliative care concurrent with standard oncology care. Solutions that promote practical integration of palliative care in oncology are needed. In an AHRQ-funded pilot, ASCO and the American Academy of Hospice and Palliative Medicine are developing the Virtual Learning Collaborative (VLC) to develop and test a scalable model for quality improvement and dissemination of best practices in palliative care within the oncology setting. Methods: The VLC will be a web-based learning and collaboration system built upon existing ASCO technology resources. We will select at least 25 oncology practices to participate in regular, facilitated learning sessions, collaborative discussions, and sharing of best practices. The VLC will equip each practice with the knowledge, tools, and coaching to select, test, and adopt a quality improvement intervention relevant to their own palliative care needs. Development of the VLC is ongoing; oncology practices begin participation in Spring 2014. Results: We will assess the VLC using protocol-driven evaluation methods common to technology development, quality improvement, implementation science, and educational initiatives. VLC usability, feasibility, and acceptability will be assessed through surveys of participating practices and focus groups. Longitudinal changes in conformance to palliative care metrics will be assessed using ASCO’s Quality Oncology Practice Initiative (QOPI) system. We will use mixed qualitative and quantitative evaluation methods to assess ongoing changes in clinician knowledge and self-efficacy in applying palliative care principles. Conclusions: We aim to develop and test a novel method for facilitating quality improvement and palliative care learning in oncology. Through this pilot, we will refine the VLC for implementation in the greater oncology community. Ultimately, this effort supports other ASCO and AAHPM quality improvement initiatives focused on clinician education and dissemination of best practices.
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Zalmanek, Brynn, James Goss, Mialy DeFelice, Jay Hodgson, Ashley Clayton, Stockard Simon, Marco Marasca, et al. "Abstract 1675: NF Research Tools Database: A knowledge base of experimental research tools for neurofibromatosis." Cancer Research 82, no. 12_Supplement (June 15, 2022): 1675. http://dx.doi.org/10.1158/1538-7445.am2022-1675.
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Abstract Research tools, such as model organisms, cell lines, and antibodies, are essential to designing and executing successful biological experiments. These resources are often shared or made commercially available to support scientific progress. Given the fast pace of research, it can be difficult to keep track of the large number of available tools. Moreover, for those new to a particular disease area, learning about the array of tools available can be a major impediment. Our experience in the neurofibromatosis field has shown that researchers struggle to identify the research tools available to them, determine where tools can be acquired, and understand what tools are most well-suited for which experiments. While a variety of databases exist to help researchers find useful research tools, these databases often a) are specific to one type of research tool while being disease-agnostic, b) provide only high-level information, c) do not contain information about in-development models, and d) do not contain observational data for the research tools. To address these limitations, we created the Neurofibromatosis Research Tools Database, a user-friendly, open-access database and companion portal designed to help the neurofibromatosis type 1 (NF1) research community easily find, obtain, and use NF1-relevant research tools. This prototype database catalogs a wide variety of NF1-relevant research tools using databases such as Cellosaurus, AntibodyRegistry, RRID Portal, among others, as well as information provided in literature and from the NF community. We aggregated and curated metadata for NF1-relevant animal models, cell lines, genetic reagents, antibodies, and biobanks. The database includes core metadata for all tools, e.g., name, type of tool, synonyms, developer, as well as tool type-specific metadata, e.g., for cell lines or animal models, the type of cancer that the model recapitulates. The database is also designed to store observational data contributed directly from the research community. Our companion web portal allows users to search and filter this database interactively and easily explore these tools. This website was built within the NF Data Portal (nf.synapse.org), and is available at tools.nf.synapse.org. Community members can actively contribute to the growth of the database and portal by submitting information about the reliability, biology, usage, and other observations on each research tool. By collating and curating this information and surfacing it in an open-access exploration portal, we anticipate that this database will serve as a valuable resource to help the NF community discover, understand, and use NF1 research tools. Citation Format: Brynn Zalmanek, James Goss, Mialy DeFelice, Jay Hodgson, Ashley Clayton, Stockard Simon, Marco Marasca, Julie Bletz, James A. Eddy, Milen Nikolov, Kevin Boske, Ljubomir Bradic, Jineta Banerjee, Kalyan Vinnakota, Caroline Morin, YooRi Kim, Robert J. Allaway. NF Research Tools Database: A knowledge base of experimental research tools for neurofibromatosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1675.
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Tess, Laura, Erika Timko Olson, and Emily Schafhauser. "Nurse-Initiated Constipation Education (NICE) protocol: Improved health outcomes in the outpatient oncology setting." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 237. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.237.
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237 Background: Many patients living with cancer experience pain requiring opioid therapy, and appreciation of the risks and benefits of opioids has grown in recent years. Opioid induced constipation (OIC) is one of the potential sequelae of opioid therapy. Evidence-based management strategies for OIC utilize lifestyle modifications and over-the-counter medications as initial steps. At a community cancer center, nurses are often the first team members identifying patients with OIC and suggesting management strategies. Thus, providing updated education and tools to nurses is an appropriate means for improving constipation management for patients living with cancer. Methods: Participants in the intervention included RNs and LPNs working in a specific region of the outpatient oncology practice. An evidence-based teaching tool was developed that included five handouts and a 20-minute pre-recorded educational presentation. Changes in nurse knowledge and confidence level were measured using a pretest/post-test design, and constipation related incidents were measured across a 2 month pre- and post-intervention period through review of the triage call tracking system. Data collection also included OIC incidents during the same timeframe. Results: 14 nurse participants completed a pre- and post-test after watching the presentation. Nursing constipation management knowledge scores increased by almost 30% and confidence ratings increased by 16.2%, indicating both an improved knowledge base and comfort level. Constipation-related incidents decreased by 39% post-implementation. Conclusions: Arming nurses with constipation management tools based on current evidence-based practices resulted in improved knowledge and comfort levels and led to decreased patient-reported incidents of constipation and OIC. Utilizing quality evidence-based tools and resources can help to prevent future negative health outcomes.
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Pasaol, Jayson Cagadas. "Assessment of knowledge, attitude and practice and associated factors towards palliative care among health care providers to the pediatric oncology patients in southern Philippines." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e21536-e21536. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e21536.
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e21536 Background: Palliative care (PC) aims to prevent, relieve and manage the symptoms of cancer and the adverse effects of cancer treatment; however, lack of education is among the biggest challenges facing PC in Philippines. Education and Awareness are dismal, especially in Southern Philippines. This study aimed to assess the level of knowledge, attitude, and practice of Health Care Provider towards pediatric PC. And to discover associated factors that limits the pediatric oncology patients to receive PC and identify the barriers in providing PC by the cancer centers to the pediatric oncology patients. Methods: A cross-sectional study design, conducted at tertiary care hospital that offers PC to pediatric oncology patients at Southern Philippines. Structured questionnaire was circulated to identify the barriers of PC, and assess the Knowledge, Attitude and Practices (KAP) of health care provider using a systematic random sampling method. The data was entered, cleaned and analyzed using excel and SPSS version 19.0 software. The chisquare test was employed to assess the association between variables. A p-value of less than 0.05 was considered as statistically significant. Results: From the total of 508 health care providers selected, a response rate of 500 (98.4%) were registered. Among the respondents 287(57.4%) had good knowledge and 259 (58.1%) had favorable attitude towards pediatric PC. In contrast, the level of practice showed that the majority 384 (76.8%) of health care providers had poor practice towards PC. Results showed that 94% to 99% of health care providers believed that the inadequate research evidence base to guide and measure the quality of life and lack of staff training in pediatric PC were the major barriers in providing PC by the cancer centers to the pediatric oncology patients. And 100% health care providers affirmed that the ignorance and lack of awareness about the existing program and resources of PC were the major factors that limits the pediatric oncology patients to receive pediatric PC in Southern Philippines. Conclusions: The health care providers had poor training and knowledge aspect of practice, but their attitude towards PC was favorable. Recommendations are the needs to be incorporated in the Department of Health through Continuing Professional Development to promote regular training for PC. Also, Educational awareness to assist healthcare professionals and pediatric oncology patients involved in PC needs to be regulated and provide.
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Hurria, Arti, Laura A. Levit, William Dale, Supriya G. Mohile, Hyman B. Muss, Louis Fehrenbacher, Allison Magnuson, et al. "Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement." Journal of Clinical Oncology 33, no. 32 (November 10, 2015): 3826–33. http://dx.doi.org/10.1200/jco.2015.63.0319.
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The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.
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Lin, Frank Po-Yen, Subotheni Thavaneswaran, John P. Grady, Christine E. Napier, Maya Kansara, Lucille Sebastian, Damien Kee, et al. "Molecular therapy selection in treatment-refractory advanced cancers: A retrospective cohort study determining the utility of TOPOGRAPH knowledge base." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 3073. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.3073.
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3073 Background: Comprehensive genomic profiling (CGP) is increasingly used to guide therapy selection in advanced cancer patients who have exhausted standard therapy options. Here we assess the utility of Therapy Oriented Precision Oncology Guidelines for Recommending Anticancer Pharmaceuticals (TOPOGRAPH) to guide matching of drug treatments based on CGP in this setting. Methods: This study was conducted in an Australia-wide precision oncology program, the Molecular Screening and Therapeutics Study (MoST, ANZCTR registration ACTRN12616000908437). All patients with advanced cancer after exhausting standard treatments underwent CGP in 2016-2021 were stratified into cohort A (no further therapy received) and B (received ≥1 therapy after CGP). The primary outcome was overall survival (OS) estimated by the Kaplan-Meier method, using the log rank test to assess between-group differences. TOPOGRAPH matched the treatment history to the CGP results, stratified into clinically active (Tiers 1-3, T1-3), investigational (T3B/4), inactive (R2) or unmatched groups. Results: Over a median follow-up of 21.7 months (mo) for 2852 patients (75% with rare cancers, n = 2150), the median OS (mOS) from the date of CGP result was 7.0 mo (95% CI 6.4-7.6) for cohort A (n = 1562) and 15.8 mo (95% CI 14.5-16.9) for cohort B (n = 1290). In both cohorts, patients with CGP results matching any TOPOGRAPH tier (T1-4) had shorter OS compared to patients without a matching tier (A: 6.4 v 20.5 mo, hazard ratio for death [HR] 2.15, p<0.001; B: 14.7 v 23.6 mo, HR 1.43, p<0.001). Patients in cohort B receiving matched therapy (n=342, 27%) had a longer mOS than 948 patients who received only unmatched therapy (16.9 v 10.4 mo, HR 0.70, p<0.001). For CGP results matched to T1-3, 122 patients who received a T1-3 therapy had a significantly longer mOS than those who received unmatched therapy (22.1 v 9.8 mo, HR 0.51, p<0.001). For CGP results matched only to T3B/4, a trend toward longer mOS was observed in patients receiving matched therapy in T3B/4 (n = 138, 14.5 v unmatched 10.0 mo, HR 0.81, P = 0.07). In tier-matched analysis, the mOS were not significantly different between patients who received genomics matched v unmatched therapy in T3B (matching outside cognate histotypes, n = 48 v 508, 11.9 v 9.7 mo, HR 0.84, p = 0.36) and T4 (n = 32 v 134; therapy with preclinical/early clinical evidence, 17.1 v 12.2 mo, HR 0.69, p = 0.17). Conclusions: TOPOGRAPH is prognostic and likely predictive of treatment effect based on CGP, supporting its utility in guiding molecular therapy selection in patients who have exhausted standard treatment options. [Table: see text]
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MacIntyre, Jessica, Rita D'Aoust, Deborah Baker, Ginger Hanson, Lauren Nicole Gjolaj, Chaitra Swain Simpson, Lawrence M. Negret, and Daniel O'Neil. "Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for improving knowledge and compliance with national safety standards." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 370. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.370.
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370 Background: Oral chemotherapy drugs are not always subject to the same safety standards as intravenous chemotherapy. Variability in safety practices can cause gaps in care, creating a need for continuous review of this process. This quality improvement (QI) project sought to improve provider and staff general knowledge on oral chemotherapy and on national safety standards through an educational intervention and to evaluate the implementation of an electronic medical record (EMR) integrated chemotherapy documentation template geared towards improving compliance with national safety standards pertinent to oral treatment. Methods: We used a pre/post-test design to compare knowledge following an educational session. A 15-question test covering national guidelines and safety standards relevant to oral chemotherapy were used to evaluate base knowledge before and after the session. We compared pre and post-test scores using paired t-tests. Then, a chemotherapy documentation template was developed in the EMR. The medical records of 44 patients at the center were reviewed four months before and 44 patients one month after the template’s introduction and documentation compliance was assessed using 24 national chemotherapy administration safety standards from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative and the 2016 ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards. Comparison of compliance rates were performed using independent t-tests. Results: A total of 65 providers and staff participated in the educational session and completed both the pre and post-test. There was a statistical significance in knowledge gained from pre-test to post-test (p value of < 0.001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < 0.001). The participants (n = 29) also scored the documentation template as above average indicating overall ease of use and feasibility for continued use. Conclusions: This QI initiative improved provider knowledge and compliance with oral chemotherapy national safety standards. As a result, more centers should focus efforts on awareness and utilization of established national safety guidelines; critical to addressing the disparities in practice. Additionally, having a standardized workflow that prompts documentation within the EMR and discussion of the national standards is key to quality and safe practice.
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Hayashi, Meagan, and Chad A. Bousman. "Experience, Knowledge, and Perceptions of Pharmacogenomics among Pharmacists and Nurse Practitioners in Alberta Hospitals." Pharmacy 10, no. 6 (October 26, 2022): 139. http://dx.doi.org/10.3390/pharmacy10060139.
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Background: Despite evidence of clinical utility and the availability of prescription guidelines, pharmacogenomics (PGx) is not broadly used in institutional settings in Canada. To inform future implementation, this study aimed to identify healthcare provider knowledge, experience, and perceptions of PGx in Alberta, Canada. Methods: An online 44-item survey was distributed to pharmacists, nurse practitioners, and physicians employed or contracted with Alberta Health Services from January to May 2022. Questions included: demographics, professional history, PGx education and exposure, knowledge, and ability to use PGx, and attitudes towards, feasibility, clinical utility, education, and implementation. Results: Ninety-one pharmacists, 37 nurse practitioners, and 6 physicians completed the survey. Fifty-nine percent had 10 or more years of experience, and 71% practiced in urban settings. Only one-third had training in PGx, and one-quarter had used PGx. Most respondents (63%) had no knowledge of PGx resources, including the Pharmacogenomics Knowledge Base (75%), or the Clinical Pharmacogenetics Implementation Consortium guidelines (85%). While participants agreed that they understood genetic (75%) and PGx (63%) concepts, most disagreed with their ability regarding practical applications of PGx such as translating genotype to phenotype (74%) or counselling patients on results (66%). Participants agreed on the clinical utility of PGx in preventing adverse drug reactions (80%) and enhancing medication efficacy (77%), and identified oncology (62%), cardiovascular/stroke (60%), and psychiatry (56%) as therapeutic areas to consider implementation. At present, healthcare provider knowledge (87%), cost (81%), and limited guidelines/evidence (70%) are seen as the greatest barriers to implementation. Conclusion: Alberta healthcare providers have limited training, experience, or knowledge in PGx. However, most appear to have a positive outlook regarding clinical utility, especially within oncology, cardiology, and psychiatry. More effort is required to socialize the availability and quality of evidence and guidelines for the interpretation of PGx test results, address other knowledge gaps, and improve financial limitations.
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Malara, Natalia, György Kovacs, Francesco Bussu, Teresa Ferrazzo, Virginia Garo, Cinzia Raso, Patrizia Cornacchione, Roberto Iezzi, and Luca Tagliaferri. "Liquid Biopsy-Guided Interventional Oncology: A Proof of Concept with a Special Focus on Radiotherapy and Radiology." Cancers 14, no. 19 (September 26, 2022): 4676. http://dx.doi.org/10.3390/cancers14194676.
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Although the role of liquid biopsy (LB) to measure minimal residual disease (MRD) in the treatment of epithelial cancer is well known, the biology of the change in the availability of circulating biomarkers arising throughout treatments such as radiotherapy and interventional radio-oncology is less explained. Deep knowledge of how therapeutic effects can influence the biology of the release mechanism at the base of the biomarkers available in the bloodstream is needed for selecting the appropriate treatment-induced tumor circulating biomarker. Combining existing progress in the LB and interventional oncology (IO) fields, a proof of concept is provided, discussing the advantages of the traditional risk assessment of relapsing lesions, limitations, and the timing of detection of the circulating biomarker. The current review aims to help both interventional radiologists and interventional radiation oncologists evaluate the possibility of drawing a tailor-made board of blood-based surveillance markers to reveal subclinical diseases and avoid overtreatment.
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Kent, Erin E., Sandra A. Mitchell, Kathleen M. Castro, Darren A. DeWalt, Arnold D. Kaluzny, Judith A. Hautala, Oren Grad, et al. "Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology." Journal of Clinical Oncology 33, no. 24 (August 20, 2015): 2705–11. http://dx.doi.org/10.1200/jco.2014.60.6210.
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Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.
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Bekaii-Saab, Tanios, Sanjay Goel, Adrien Dickerson, Jamie Von Roenn, Michael A. Thompson, and Anne S. Tsao. "Competitive Funding Strategies for the Conquer Cancer Foundation of ASCO." Journal of Oncology Practice 13, no. 1 (January 2017): e62-e67. http://dx.doi.org/10.1200/jop.2016.014571.
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Purpose: The Conquer Cancer Foundation (CCF), the philanthropic arm of ASCO, is responsible for funding innovative clinical research. CCF wants to broaden its donor base instead of relying predominantly on health-care companies. Our Leadership Development Program (LDP) group was tasked with identifying potential donor sources and making recommendations to increase funding. Materials and Methods: We selected three sources to research: the general public, crowdsourcing/social media, and ASCO members. We subsequently focused our efforts on ASCO members, of whom only 2% to 3% are donors to CCF and < 8% are repeat donors. To analyze this low rate, we sent out two separate surveys to various groups of members within ASCO. Results: We identified lack of knowledge as a major deterrent to giving; surprisingly, even those who hold ASCO leadership positions or participated in committees lacked knowledge about CCF funding. Also, the misconception that ASCO is rich and does not need philanthropic support deterred giving; however, respondents would donate if given the right message that stresses the need of continued member-led donations. Conclusion: ASCO members, including those in leadership positions, need to be engaged more aggressively to support CCF. Increased education and updating the CCF message is likely to provide the greatest impact on higher member donation, repeated donations, and facilitate CCF’s goal of diversifying its donor base away from healthcare companies. Furthermore, we recommend using technology, such as mobile applications, and providing incentives and visibility to major donors.
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Ghanem, Sassine, Janine Claudia Khadija Harewood, Jia-Llon Yee, Brian Campbell Jimenez, and Jason Parker Gonsky. "Efficacy of a fully remote primary lecture series at an academic hematology and oncology fellowship program." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 11031. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.11031.
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11031 Background: 615 fellows began training in American combined hematology/oncology fellowship programs in July 2020. These new fellows face a steep learning curve. The coronavirus pandemic has significantly affected how we learn, with programs having to convert most collective learning to a completely virtual format. Research on the efficacy of introductory lecture series in academic hematology/oncology programs is limited especially regarding virtual formats. We introduced a virtual introductory lecture series with the goal of increasing the clinical confidence and knowledge base of first-year fellows. Methods: A once weekly remotely-delivered two-hour primer series was designed with lectures given by both third-year fellows and faculty from July-August 2020. Fellows were asked to complete pre & post-test evaluations of each lecture. Evaluations included a combination of knowledge-based questions & self-reported confidence assessment. Results: 14 fellows were assigned pre- and post-tests in the study. 1 fellow was excluded due to lack of participation. A total of 123 paired pre and post-tests were compared. Data analysis was performed with SPSS v 24.0 using the paired samples t-test. Pre and post-tests were graded on a scale of 0-100. The pre to post mean difference compares the mean test result of the post tests to that of the corresponding pretests. Questions were divided into 2 groups. The 1st group tested the fellow’s medical knowledge regarding the pathology while the 2nd group tested the comfort in the management, diagnosis and treatment. In the statistical analysis, these questions were defined as “Knowledge” and “Comfort” accordingly, the sum as “Complete”. A statistically significant improvement in post-test knowledge for fellows of all years was noted with a pre to post test mean difference of 12.52, P <.0001. The difference was more pronounced among 1st year fellows with a pre to post test mean difference of 16.84, P <.0001. A similar improvement was seen for the comfort in management questions. The post-test comfort pre to post test mean difference was 10.48, P <.0001 for fellows of all years and 6.70, P <.0001 for first year fellows. Conclusions: A remotely-delivered introductory lecture series for fellows in a hematology/oncology training program increases both clinical knowledge and clinical confidence in fellows of all years of training.[Table: see text]
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Man, Ralph Xiu-gee, David Lack, Charlotte Wyatt, and Virginia Murray. "The Effect of Natural Disasters on Cancer Care: A Systematic Review." Prehospital and Disaster Medicine 34, s1 (May 2019): s48. http://dx.doi.org/10.1017/s1049023x19001146.
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Introduction:As the incidence of cancer and the frequency of extreme weather events rise, disaster mitigation is becoming increasingly relevant to oncology care.Aim:To investigate the effect of natural disasters on cancer care and the associated health effects on patients with cancer through the means of a systematic review.Methods:Between database inception and November 12, 2016, Embase, ScienceDirect, MEDLINE, Scopus, PsycINFO, Web of Science, and CINAHL were searched for articles. Those identifying the effect of natural disasters on oncology services, or the associated health implications for patients with cancer, were included. Only articles published in English were included. Data extraction was done by two authors independently and then verified by all authors. The effects of disaster events on oncology services, survival outcomes, and psychological issues were assessed.Results:Natural disasters cause substantial interruption to the provision of oncology care. Of the 4,593 studies identified, only 85 articles met all the eligibility criteria. Damage to infrastructure, communication systems, medication, and medical record losses substantially disrupt oncology care. The effect of extreme weather events on survival outcomes is limited to only a small number of studies, often with inadequate follow-up periods.Discussion:To the best the authors’ knowledge, this is the first systematic review to assess the existing evidence base on the health effects of natural disaster events on cancer care. Disaster planning must begin to take into consideration patients with cancer.
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O'CONNOR, S. J. "Building the knowledge base for patient-centred care: improving the use of qualitative study findings through meta-analysis and systematic reviews." European Journal of Cancer Care 18, no. 5 (September 2009): 433–36. http://dx.doi.org/10.1111/j.1365-2354.2009.01132.x.
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Paceley, Megan S., Shanna K. Kattari, Nina Jackson Levin, Anthony Banks, Virginia Ramseyer Winter, Loren Bauerband, and Diane M. Harper. "Interdisciplinary, Inclusive, and Innovative: Promoting a Paradigmatic Shift in Cancer Research Among Transgender and Gender Diverse Adolescents and Young Adults." Annals of LGBTQ Public and Population Health 3, no. 2 (June 1, 2022): 129–34. http://dx.doi.org/10.1891/lgbtq-2021-0005.
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Transgender and gender diverse (TGD) adolescents and young adults (AYA) face heightened risks of cancer due to cissexism and transphobia in healthcare, low cancer screening rates, limited knowledge and awareness of cancer risk and screenings, poor healthcare experiences, and exposure to sexually transmitted infections (STIs). Despite this, TGD AYA cancer risk is relatively unexamined in oncology research. To intervene early and mitigate risk, we require holistic understandings of cancer risk among TGD AYA. This research brief engages with an interdisciplinary knowledge base to identify gaps and limitations warranting critical attention by TGD AYA and cancer scholars. The current literature on TGD AYA risks for cancer are explored with specific attention to the social environment and its impact on cancer risk. The brief ends with a call to action for a paradigmatic shift to promote inclusive, innovative, and interdisciplinary cancer research with TGD AYA.
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Tilburt, Jon Charles, Joel E. Pacyna, Daniel G. Petereit, Judith Salmon Kaur, Bruce D. Rapkin, Robert Grubb, George J. Chang, et al. "Decision aids for localized prostate cancer: Initial outcomes from NCI Community Oncology Research Program Alliance Research Base Cancer Care Delivery Research (CCDR) Protocol - A191402CD - A Cluster-Randomized Trial." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24176-e24176. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24176.
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e24176 Background: Decision aids for prostate cancer treatment can improve knowledge, but the relative effect of pre-consultation and within-consultation DAs is not known. Methods: We conducted a parallel design, 2-by-2 factorial, 4-arm, cluster-RCT in urology practices affiliated with the NCI’s Alliance research base. We compared patient knowledge immediately after consultation (%12-item% correct) intervention arms compared to usual care. We used mixed effects regression modeling to assess effect of interventions on knowledge adjusting for site-clustering, race/ethnicity (non-Hispanic White; Other), age (years), clinical stage (T1-3), PSA, and Gleason score. Results: 15 of 21 randomized centers accrued 158 pts from Nov 2017 to June 2019. The arm delivering both DAs (n = 3 sites) recruited 25 pts. The pre-consultation DA arm (n = 4 sites) recruited 39 pts. The within-consultation DA arm (n = 4 sites) recruited 44 pts. The no DA arm (n = 4 sites) accrued 50 pts. Overall, mean age was 64; 54% were AA; 73% had T1 stage; median Gleason = 7; and median PSA = 7. The combined DAs group, followed by pre-consultation reported higher median knowledge (75% and 67%, respectively). The within-consultation and no DA arms both reported median knowledge scores (58%). Within arm, inter-site standard deviations in mean knowledge scores ranged from 0.164 in in the pre-consultation arm to 0.232 in the usual care arm. Neither pre-consultation nor within-consultation DAs had statistically significant effects (p = .15 and p = .99, respectively). Pre-specified adjusted difference [97.5% CIs], comparing the pre-consultation DA and the within-consultation DA with the control was 9.4% [-7.3%, 26.2%] and -0.4% [-16.9%, 16.1%], respectively. Intra-cluster correlation (ICC) coefficient was high (.24). No interaction effects were identified (p = .98). A post-hoc analysis comparing any DA vs usual care found a mean adjusted difference [95% CI] of 5.6% [-8.5%, 19.8%] (p = 0.40), 63.9% for any DA and 58.3% for usual care. Conclusions: Possible knowledge gains associated with some DAs for early prostate cancer were obscured by larger-than-expected intra-cluster correlation effects associated with the primary outcome. How interventions were used was not measured. Support:UG1CA189823; https://acknowledgments.alliancefound.org ; R01 MD008934-06. Clinical trial information: NCT03103321 .
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Stadler, Zsofia K., Anna Maio, Debyani Chakravarty, Yelena Kemel, Margaret Sheehan, Erin Salo-Mullen, Kaitlyn Tkachuk, et al. "Therapeutic Implications of Germline Testing in Patients With Advanced Cancers." Journal of Clinical Oncology 39, no. 24 (August 20, 2021): 2698–709. http://dx.doi.org/10.1200/jco.20.03661.
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PURPOSE Tumor mutational profiling is increasingly performed in patients with advanced cancer. We determined the extent to which germline mutation profiling guides therapy selection in patients with advanced cancer. METHODS Patients with cancer undergoing tumor genomic profiling were prospectively consented for germline cancer predisposition gene analysis (2015-2019). In patients harboring germline likely pathogenic or pathogenic (LP/P) alterations, therapeutic actionability was classified using a precision oncology knowledge base. Patients with metastatic or recurrent cancer receiving germline genotype–directed therapy were determined. RESULTS Among 11,947 patients across > 50 malignancies, 17% (n = 2,037) harbored a germline LP/P variant. By oncology knowledge base classification, 9% (n = 1042) had an LP/P variant in a gene with therapeutic implications (4% level 1; 4% level 3B; < 1% level 4). BRCA1/2 variants accounted for 42% of therapeutically actionable findings, followed by CHEK2 (13%), ATM (12%), mismatch repair genes (11%), and PALB2 (5%). When limited to the 9,079 patients with metastatic or recurrent cancer, 8% (n = 710) harbored level 1 or 3B genetic findings and 3.2% (n = 289) received germline genotype–directed therapy. Germline genotype–directed therapy was received by 61% and 18% of metastatic cancer patients with level 1 and level 3B findings, respectively, and by 54% of BRCA1/2, 75% of mismatch repair, 43% of PALB2, 35% of RAD51C/D, 24% of BRIP1, and 19% of ATM carriers. Of BRCA1/2 patients receiving a poly(ADP-ribose) polymerase inhibitor, 45% (84 of 188) had tumors other than breast or ovarian cancer, wherein the drug, at time of delivery, was delivered in an investigational setting. CONCLUSION In a pan-cancer analysis, 8% of patients with advanced cancer harbored a germline variant with therapeutic actionability with 40% of these patients receiving germline genotype–directed treatment. Germline sequence analysis is additive to tumor sequence analysis for therapy selection and should be considered for all patients with advanced cancer.
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Kanesvaran, Ravindran, Supriya Mohile, Enrique Soto-Perez-de-Celis, and Harpreet Singh. "The Globalization of Geriatric Oncology: From Data to Practice." American Society of Clinical Oncology Educational Book, no. 40 (May 2020): e107-e115. http://dx.doi.org/10.1200/edbk_279513.
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Older adults with cancer are a unique group of patients who require specialized care and treatment. The field of geriatric oncology (GO) was born more than 3 decades ago to address the needs of this growing group of patients. Some challenges in the GO field include establishing a GO clinical service, educating and training personnel, and conducting research in GO. These issues are addressed to varying extents with global initiatives in GO, which are largely dependent on the socioeconomic status of the countries involved. To overcome disparities seen globally, scientific journals that reach an international cancer audience should publish content related to improving care of older adults with cancer around the world, develop an organizational structure that encourages global dissemination of GO knowledge, and advance reporting policies that encourage higher-quality reporting of data relevant to older adults with cancer worldwide. A number of international scientific journals have risen to the occasion to address these disparities. A key battle in enabling access of this vulnerable group of patients to clinical trials is now being fought and won on the global front with numerous regulatory initiatives. The U.S. Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) recently issued draft guidance on the inclusion of older adults in cancer clinical trials. This and other global initiatives led by the FDA have the potential to further improve the evidence base for older adults with cancer.
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Yaung, S., J. Li, A. Pek, L. Niu, J. F. Palma, and M. Schmid. "136P Evaluation of a regularly updated knowledge base and automated variant interpretation tool for somatic mutations detected in solid tumours." Annals of Oncology 31 (September 2020): S294. http://dx.doi.org/10.1016/j.annonc.2020.08.257.
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Liu, Brent J. "A Knowledge-Based Imaging Informatics Approach for Managing Proton Beam Therapy of Cancer Patients." Technology in Cancer Research & Treatment 6, no. 4_suppl (August 2007): 77–84. http://dx.doi.org/10.1177/15330346070060s413.
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The need for a unified patient-oriented information system to handle complex proton therapy (PT) imaging and informatics data during the course of patient treatment is becoming steadily apparent due to the ever increasing demands for better diagnostic treatment planning and more accurate information. Currently, this information is scattered throughout each of the different treatment and information systems in the oncology department. Furthermore, the lack of organization with standardized methods makes it difficult and time-consuming to navigate through the maze of data, resulting in challenges during patient treatment planning. We present a methodology to develop this electronic patient record (ePR) system based on DICOM standards and perform knowledge-based medical imaging informatics research on specific clinical scenarios where patients are treated with PT. Treatment planning is similar in workflow to traditional radiation therapy (RT) methods such as intensity-modulated radiation therapy (IMRT), which utilizes a priori knowledge to drive the treatment plan in an inverse manner. In March 2006, two new RT objects were drafted in a DICOM-RT Supplement 102 specifically for ion therapy, which includes PT. The standardization of DICOM-RT-ION objects and the development of a knowledge base as well as decision-support tools that can be add-on features to the ePR DICOM-RT system were researched. This methodology can be used to extend to PT and the development of future clinical decision-making scenarios during the course of the patient's treatment that utilize “inverse treatment planning.” We present the initial steps of this imaging and informatics methodology for PT and lay the foundation for development of future decision-support tools tailored to cancer patients treated with PT. By integrating decision-support knowledge and tools designed to assist in the decision-making process, a new and improved “ knowledge-enhanced treatment planning” approach can be realized.
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Smith, Sophia K., Matthew Loscalzo, Carole Mayer, and Donald L. Rosenstein. "Best Practices in Oncology Distress Management: Beyond the Screen." American Society of Clinical Oncology Educational Book, no. 38 (May 2018): 813–21. http://dx.doi.org/10.1200/edbk_201307.
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The field of psychosocial oncology is a young discipline with a rapidly expanding evidence base. Over the past few decades, several lines of research have established that psychosocial problems, such as anxiety, depression, post-traumatic stress, fatigue, sexual dysfunction, and cognitive complaints, are common and consequential in patients with cancer. The word “distress” was chosen deliberately to capture a broad concept; consequently, distress screening is meant to function as an initial step in the more targeted evaluation of the source(s) of the patient’s distress. In 2015, the American College of Surgeons’ Commission on Cancer mandated psychosocial distress screening as part of their accreditation process. Similar screening requirements are in place internationally, including in Canada, where screening for distress is endorsed as the sixth vital sign and a standard of care that must be met by any Canadian health care organization providing cancer services that seeks to be accredited. Over the past few years, cancer centers around the world have been exploring optimum ways to implement and evaluate distress screening initiatives. This paper presents three approaches to distress screening implementation: (1) a model that incorporates the importance of shared values, perceived benefits, and relevant outcomes in the implementation of distress management protocols; (2) a Canadian knowledge translation application to distress screening, including triage considerations and interventions; and (3) a novel approach to distress management via the use of a mobile application to manage post-traumatic stress symptoms. In closing, future opportunities and challenges associated with the emergence of technology will be discussed.
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Kuhlman, Patrick, Donna Williams, Amy Amornmarn, Joshua Harbaugh, and Thomas Lycan. "Just-in-Time Teaching (JiTT) screencasts for the resident inpatient oncology service: A pilot study evaluating feasibility and effectiveness." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 11025. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.11025.
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11025 Background: Just-in-Time Teaching (JiTT) screencasts have been viewed positively in some undergraduate and graduate medical settings. JiTT screencast effectiveness has not yet been evaluated for medical trainees in the inpatient adult hematology/oncology setting. Objectives: Our pilot study’s goal was to identify relevant learning objectives, to assess feasibility of screencast development, and to optimize screencast delivery. Methods: To identify key clinical topics, a mixed methods approach first utilized institutional retrospective data (6/1/2018-6/30/2019) to determine the most common inpatient medical problems followed by qualitative interviews of teaching faculty and senior residents. The following six topics were identified for inclusion: 1. Metastatic disease to spine 2. Brain metastases 3. Oncologic emergencies 4. Cancer associated venous thromboembolism 5. Hematologic emergencies 6. Sickle cell disease: inpatient management For each topic, a literature review was performed to develop teaching points which were then refined with input from clinician experts. Each screencast went through several rounds of edits by faculty and trainees prior to submission to the instructional design team for final editing. Screencast length ranged from 13 – 25 minutes (mean of 18 minutes). Qualitative and quantitative feedback was obtained from residents by structured focus group session and online surveys. Results: All residents reported that educational content was “just right.” The series of 6 screencasts was completed within 2 months of dedicated fellow research time. Preferred screencast length was 10-20 minutes and preferred viewing speed was 1.5x original speed (7/10). All residents reported that a screencast database would be a helpful resource for future clinical rotations. All residents (n = 10) reported that screencasts improved medical oncology knowledge base and will improve care provided to cancer patients. Conclusions: Creation of a screencast series was feasible for a hematology-oncology fellow. Systematic identification of key clinical topics led to materials which were confirmed by faculty and trainees to be important for internal medicine medical education on inpatient oncology services. This pilot data indicate that JiTT screencasts may be an effective educational intervention and directly informed a randomized educational research study which is currently enrolling participants.
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Surrey, Lea F., Minjie Luo, Fengqi Chang, and Marilyn M. Li. "The Genomic Era of Clinical Oncology: Integrated Genomic Analysis for Precision Cancer Care." Cytogenetic and Genome Research 150, no. 3-4 (2016): 162–75. http://dx.doi.org/10.1159/000454655.
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Genomic alterations are important biological markers for cancer diagnosis and prognosis, disease classification, risk stratification, and treatment selection. Chromosomal microarray analysis (CMA) and next-generation sequencing (NGS) technologies are superb new tools for evaluating cancer genomes. These state-of-the-art technologies offer high-throughput, highly accurate, targeted and whole-genome evaluation of genomic alterations in tumor tissues. The application of CMA and NGS technologies in cancer research has generated a wealth of useful information about the landscape of genomic alterations in cancer and their implications in cancer care. As the knowledge base in cancer genomics and genome biology grows, the focus of research is now shifting toward the clinical applications of these technologies to improve patient care. Although not yet standard of care in cancer, there is an increasing interest among the cancer genomics communities in applying these new technologies to cancer diagnosis in the Clinical Laboratory Improvement Amendments (CLIA)-certified laboratories. Many clinical laboratories have already started adopting these technologies for cancer genomic analysis. We anticipate that CMA and NGS will soon become the major diagnostic means for cancer genomic analysis to meet the increasing demands of precision cancer care.
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Bolderston, Amanda. "Maintaining competence: a holistic view of continuous professional development." Journal of Radiotherapy in Practice 6, no. 03 (September 2007): 133–41. http://dx.doi.org/10.1017/s1460396907006103.
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AbstractContinuous professional development (CPD) is regarded as an essential component of working life for radiation therapists and is increasingly being used by professional associations to ’prove’ the competence of their members. In the past, CPD activities have primarily been viewed as an individual responsibility, and have focused on maintaining a professional knowledge base and, subsequently, hands-on competency through didactic learning. However, there are drawbacks associated with this model; and concentrating on only one facet of learning ignores other theoretical areas of knowledge acquisition. This article explores several areas of social and organisational theories of learning including social networks, communities of practice, learning organisations, knowledge management, knowledge translation and research utilisation. It is concluded that maintenance of competence after graduation is multilayered and should be viewed in a holistic manner to incorporate some of the relevant elements of the concepts discussed. This article also offers some suggestions for the individual wanting to maximise their educational opportunities beyond traditional models of CPD.