Background: Adolescents and young adults (AYAs) with advanced cancer often receive intensive end-of-life care, yet it is unclear if this is goal-concordant. Advance care planning (ACP) video tools may promote identification and communication of AYA preferences. Patients and Methods: We conducted a dual-site, 1:1 pilot randomized controlled trial of a novel video-based ACP tool in 50 dyads of AYA patients aged 18 to 39 years with advanced cancer and their caregivers. ACP readiness and knowledge, preferences for future care, and decisional conflict were obtained pre, post, and 3 months after the intervention and compared between groups. Results: Of the 50 AYA/caregiver dyads enrolled, 25 (50%) were randomized to the intervention. Participants primarily identified as female, white, and non-Hispanic. Most AYAs (76%) and caregivers (86%) identified their overall goal as life-prolonging preintervention; less identified this goal postintervention (42% AYAs; 52% caregivers). There was no significant difference in change in proportion of AYAs or caregivers choosing life-prolonging care, CPR, or ventilation between arms postintervention or at 3 months. The change in participant scores for ACP knowledge (AYAs and caregivers) and ACP readiness (AYAs) from preintervention to postintervention was greater in the video arm compared with the control arm; the difference in caregivers’ scores for decisional conflict from preintervention to postintervention in the video arm was statistically significant (15 vs 7; P=.005). Feedback from the video participants was overwhelmingly positive; of the 45 intervention participants who provided video feedback, 43 (96%) found the video helpful, 40 (89%) were comfortable viewing the video, and 42 (93%) indicated they would recommend the video to other patients facing similar decisions. Conclusions: Most AYAs with advanced cancer and their caregivers preferred life-prolonging care in advanced illness, with fewer preferring this type of care postintervention. A brief video-based ACP tool was well-liked by participants and improved caregiver decisional certainty. Videos may be a useful tool to inform AYAs and caregivers about end-of-life care options and promote ACP discussions.
A Pilot Randomized Trial of an Advance Care Planning Video Decision Support Tool for Adolescents and Young Adults With Advanced Cancer
Jennifer M. Snaman, Deborah Feifer, Gabrielle Helton, Yuchiao Chang, Areej El-Jawahri, Angelo E. Volandes, and Joanne Wolfe
Social Determinants of Health and Cardiac Risk for Patients With Breast Cancer: Beyond Racial Disparities
Matilde Corianò, Matteo Armillotta, and Nicolò Matteo Luca Battisti
Social Determinants of Health and Racial Disparities in Cardiac Events in Breast Cancer
Nickolas Stabellini, Mantas Dmukauskas, Marcio S. Bittencourt, Jennifer Cullen, Amie J. Barda, Justin X. Moore, Susan Dent, Husam Abdel-Qadir, Aniket A. Kawatkar, Ambarish Pandey, John Shanahan, Jill S. Barnholtz-Sloan, Kristin A. Waite, Alberto J. Montero, and Avirup Guha
Background: Racial disparities have been reported for breast cancer and cardiovascular disease (CVD) outcomes. The determinants of racial disparities in CVD outcomes are not yet fully understood. We aimed to examine the impact of individual and neighborhood-level social determinants of health (SDOH) on the racial disparities in major adverse cardiovascular events (MACE; consisting of heart failure, acute coronary syndrome, atrial fibrillation, and ischemic stroke) among female patients with breast cancer. Methods: This 10-year longitudinal retrospective study was based on a cancer informatics platform with electronic medical record supplementation. We included women aged ≥18 years diagnosed with breast cancer. SDOH were obtained from LexisNexis, and consisted of the domains of social and community context, neighborhood and built environment, education access and quality, and economic stability. Race-agnostic (overall data with race as a feature) and race-specific machine learning models were developed to account for and rank the SDOH impact in 2-year MACE. Results: We included 4,309 patients (765 non-Hispanic Black [NHB]; 3,321 non-Hispanic white). In the race-agnostic model (C-index, 0.79; 95% CI, 0.78–0.80), the 5 most important adverse SDOH variables were neighborhood median household income (SHapley Additive exPlanations [SHAP] score [SS], 0.07), neighborhood crime index (SS = 0.06), number of transportation properties in the household (SS = 0.05), neighborhood burglary index (SS = 0.04), and neighborhood median home values (SS = 0.03). Race was not significantly associated with MACE when adverse SDOH were included as covariates (adjusted subdistribution hazard ratio, 1.22; 95% CI, 0.91–1.64). NHB patients were more likely to have unfavorable SDOH conditions for 8 of the 10 most important SDOH variables for the MACE prediction. Conclusions: Neighborhood and built environment variables are the most important SDOH predictors for 2-year MACE, and NHB patients were more likely to have unfavorable SDOH conditions. This finding reinforces that race is a social construct.
NCCN Virtual Policy Summit: Defining the “New Normal” — 2021 and the State of Cancer Care in America Following 2020
Alyssa A. Schatz, Lindsey Bandini, and Robert W. Carlson
US healthcare systems have been deeply impacted by significant societal shifts over the past several years. The COVID-19 pandemic has changed the way we interact with healthcare, political narratives have impacted how healthcare is perceived and engaged with by the public, and the United States has become increasingly aware of historic and ongoing racial injustices across all health and social systems. The watershed events experienced during the last several years play a critical role in shaping the future of cancer care for payers, providers, manufacturers, and, most importantly, patients and survivors. To explore these issues, in June 2021 NCCN convened a virtual policy summit: Defining the “New Normal” — 2021 and the State of Cancer Care in America Following 2020. This summit offered the opportunity for a varied group of stakeholders to begin to explore the impact of recent events on the current and future state of oncology in the United States. Topics included the impact of COVID-19 on cancer detection and treatment, the role of innovation in ensuring continuity of care, and efforts to create more equitable systems of care.
Volume 21 (2023): Issue 5.5 (Jun 2023): Highlights of the NCCN 2023 Annual Conference
Volume 21 (2023): Issue 6 (Jun 2023)
Abstracts From the NCCN 2023 Annual Conference
Advances in the Management of Metastatic Breast Cancer
Presented by: William J. Gradishar
Recent advances in the understanding of the molecular underpinnings of metastatic breast cancer have led to the identification of novel therapeutic targets. The latest update to the NCCN Guidelines for Breast Cancer reflects a rapidly evolving treatment landscape, highlighting the growing importance of combination therapies and personalized medicine in managing estrogen-receptor (ER)–positive, HER2-positive, and triple-negative subtypes. For patients with ER-positive disease, the standard of care remains combination therapies involving cyclin-dependent kinase 4/6 inhibitors, endocrine therapy, and PI3 kinase. In patients with HER2-positive disease, the use of fam-trastuzumab deruxtecan-nxki and tucatinib have demonstrated improved outcomes. For those with triple-negative breast cancer, pembrolizumab, PARP inhibitors, and antibody–drug conjugates (eg, sacituzumab govitecan-hziy) have shown activity.
Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology
Al B. Benson III, Alan P. Venook, Mahmoud M. Al-Hawary, Nilofer Azad, Yi-Jen Chen, Kristen K. Ciombor, Stacey Cohen, Harry S. Cooper, Dustin Deming, Ignacio Garrido-Laguna, Jean L. Grem, J. Randolph Hecht, Sarah Hoffe, Joleen Hubbard, Steven Hunt, Hisham Hussan, William Jeck, Kimberly L. Johung, Nora Joseph, Natalie Kirilcuk, Smitha Krishnamurthi, Jennifer Maratt, Wells A. Messersmith, Jeffrey Meyerhardt, Eric D. Miller, Mary F. Mulcahy, Steven Nurkin, Michael J. Overman, Aparna Parikh, Hitendra Patel, Katrina Pedersen, Leonard Saltz, Charles Schneider, David Shibata, John M. Skibber, Constantinos T. Sofocleous, Eden Stotsky-Himelfarb, Anna Tavakkoli, Christopher G. Willett, Grant Williams, Frankie Algieri, Lisa Gurski, and Katie Stehman
This discussion summarizes the NCCN Clinical Practice Guidelines for managing squamous cell anal carcinoma, which represents the most common histologic form of the disease. A multidisciplinary approach including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology is necessary. Primary treatment of perianal cancer and anal canal cancer are similar and include chemoradiation in most cases. Follow-up clinical evaluations are recommended for all patients with anal carcinoma because additional curative-intent treatment is possible. Biopsy-proven evidence of locally recurrent or persistent disease after primary treatment may require surgical treatment. Systemic therapy is generally recommended for extrapelvic metastatic disease. Recent updates to the NCCN Guidelines for Anal Carcinoma include staging classification updates based on the 9th edition of the AJCC Staging System and updates to the systemic therapy recommendations based on new data that better define optimal treatment of patients with metastatic anal carcinoma.
Best Practices for Addressing the Health Needs of the LGBTQ+ Community in Oncology Care
Presented by: Bláz Bush, Paula Chambers Raney, Shail Maingi, Mandi L. Pratt-Chapman, and Scout
Moderated by: Clifford Goodman
Patients with cancer in the LGBTQ+ community experience worse health outcomes when compared with their non-LGBTQ+ peers because of a variety of factors, including stigma, underrepresentation in research, lack of support, and implicit bias on the part of clinicians. For generations, many LGBTQ+ people have feared disclosing their identity to providers, leading to gaps in care and even higher mortality. As more people are identifying as members of the LGBTQ+ community, it’s crucial for providers to recognize them appropriately in healthcare, take steps such as acknowledging chosen names and pronouns, and provide care free from judgment. In today’s political climate, members of this community are facing increasing scrutiny, challenges, and barriers to accessing safe and affirming care. Providers can do their part to improve health outcomes among LGBTQ+ people by making their practices known as safe and affirming spaces, working to increase inclusivity in oncology care and improving data collection.