Current Oncology

Healthcare providers in oncology experience exceptionally high stress rates. Research emphasizes that stress management programs must be quick to implement, flexible to accommodate demanding schedules, cost-effective, accessible to all staff, and tailored to the needs of oncology personnel. Programs that fail to meet these criteria often struggle with uptake and sustainability. This mixed-methods exploratory study aimed (1) to design an online stress management program, Breathe with the Waves (BWW), based on breathing techniques; (2) to evaluate its acceptability, satisfaction, and relevance; (3) to identify perceived benefits and challenges; and (4) to generate potential outcome measures for future studies. A team of Canadian researchers and end-users co-designed the intervention. Twenty oncology professionals completed BWW, which featured pre-recorded breathing videos, and provided feedback via questionnaires and semi-structured interviews. We used t-tests and Wilcoxon rank tests to analyze quantitative data, and template analysis for qualitative data. Participants found BWW highly acceptable, satisfactory, and relevant. Participants reported three categories of benefits: stress reduction, improved work performance, and increased mindfulness. Challenges included anticipated challenges and experienced challenges. Potential outcome measures fell into six categories: physical health, mental health, relational, work, mindfulness and personal practice. BWW, available in English and French, represents a promising and accessible approach to supporting the well-being of oncology personnel.

The gut microbiome is an established predictor of response to immune checkpoint inhibitors (ICI) in melanoma, and antibiotic exposure prior to ICI initiation is a validated negative prognostic factor. About half of melanoma patients harbor BRAF mutations and are treated with BRAF/MEK inhibitors (BRAFi/MEKi). While the detrimental impact of antibiotics is well described in the ICI setting, their effect on BRAFi/MEKi efficacy remains unknown. We retrospectively analyzed 49 advanced BRAF-mutant melanoma patients treated with BRAFi/MEKi. Antibiotic-exposed patients were compared with non-exposed patients across three time windows: within 30, 60, or 90 days before and after therapy initiation. Outcomes included progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). Among the cohort, 41% had antibiotic exposure within ±30 days, 53% within ±60 days, and 57% within ±90 days. Baseline characteristics were comparable between groups, except for worse ECOG scores in antibiotic-exposed patients. Across all windows, ORR, PFS, and OS were comparable between groups. Unlike what was observed in the ICI setting, antibiotic use did not negatively affect outcomes with BRAFi/MEKi. Despite small sample size, these findings suggest that the detrimental prognostic impact of antibiotics is specific to immunotherapy, highlighting the importance of evaluating the microbiome as a predictive biomarker across treatment contexts.

Randomized clinical trials are considered the gold standard for the evaluation of new interventions and therapies. The results from randomized clinical trials are highly influential in treatment decision-making and decisions about the implementation of new therapeutic options within the field of oncology. This article describes a narrative review of the literature to further explore the strengths and limitations of real-world evidence in comparison to randomized clinical trials and provides a commentary on opportunities for real-world evidence in thoracic malignancies. However, randomized trials often exclude oncology patients with poorer functional status or comorbidities which are routinely considered for treatment in real-world practice. Real-world data may complement existing data from randomized clinical trials and play an important role in evaluating patterns and outcomes of care, informing everyday oncology practice. While real-world data is increasingly reported in the medical literature, strengths and limitations exist which can also limit their applicability. More work is needed to standardize methodologies for real-world studies.