Journal of Clinical Medicine

Editorial

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2 pages, 137 KiB

Open AccessEditorial

Integrating Clinical and Translational Research Networks—Building Team Medicine

by Ravi Salgia and Prakash Kulkarni

J. Clin. Med. 2020, 9(9), 2975; https://doi.org/10.3390/jcm9092975 - 15 Sep 2020

Cited by 6 | Viewed by 1813

Abstract

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(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

Research

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12 pages, 1208 KiB

Open AccessArticle

An Analysis and Comparison of Survival and Functional Outcomes in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Concurrent Chemoradiation Therapy within City of Hope Cancer Center Sites

by Rebecca Pharaon, Samuel Chung, Arya Amini, Ellie Maghami, Arnab Chowdhury, Nayana Vora, Sue Chang, Robert Kang, Thomas Gernon, Kelly Hansen, Christina Kelly, Denise Ackerman, Lalit Vora, Sagus Sampath and Erminia Massarelli

J. Clin. Med. 2020, 9(10), 3083; https://doi.org/10.3390/jcm9103083 - 24 Sep 2020

Cited by 1 | Viewed by 2407

Abstract

Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s [...] Read more.

Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy (n = 94) were identified and included in the study. Patients underwent treatment at the COH main campus site (n = 50) or satellite sites (n = 44). The majority of patients were Caucasian, male, and diagnosed with p16 positive stage IV locally advanced OPSCC by AJCC 7th edition. Most patients completed their prescribed cumulative radiation therapy dose and had a complete response to treatment. No significant difference in overall survival and progression-free survival was observed between the main campus and the satellite sites. Our study demonstrates successful treatment completion rates as well as comparable recurrence rates between the main campus and COH-associated satellite sites. A trend toward significant difference in feeding tube dependency at 6-months was observed. Differences in feeding tube placement and dependency rates could be addressed by the establishment of on-site supportive services in satellite sites. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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9 pages, 241 KiB

Open AccessArticle

Use of HER2-Directed Therapy in Metastatic Breast Cancer and How Community Physicians Collaborate to Improve Care

by Joanne E. Mortimer, Laura Kruper, Mary Cianfrocca, Sayeh Lavasani, Sariah Liu, Niki Tank-Patel, Mina Sedrak, Wade Smith, Daphne Stewart, James Waisman, Christina Yeon, Tina Wang and Yuan Yuan

J. Clin. Med. 2020, 9(6), 1984; https://doi.org/10.3390/jcm9061984 - 24 Jun 2020

Cited by 4 | Viewed by 2294

Abstract

The development of new HER2-directed therapies has resulted in a significant prolongation of survival for women with metastatic HER2-positive breast cancer. Discoveries in the laboratory inform clinical trials which are the basis for improving the standard of care and are also the backbone [...] Read more.

The development of new HER2-directed therapies has resulted in a significant prolongation of survival for women with metastatic HER2-positive breast cancer. Discoveries in the laboratory inform clinical trials which are the basis for improving the standard of care and are also the backbone for quality improvement. Clinical trials can be completed more rapidly by expanding trial enrollment to community sites. In this article we review some of the challenges in treating metastatic breast cancer with HER2-directed therapies and our strategies for incorporating our community partners into the research network. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

7 pages, 194 KiB

Open AccessArticle

NCI–Clinical Trial Accrual in a Community Network Affiliated with a Designated Cancer Center

by Daniel J. Kim, Dan Otap, Nora Ruel, Naveen Gupta, Naveed Khan and Tanya Dorff

J. Clin. Med. 2020, 9(6), 1970; https://doi.org/10.3390/jcm9061970 - 24 Jun 2020

Cited by 7 | Viewed by 2313

Abstract

Most cancer care is delivered in the community, while most clinical trials exist in academic centers. We analyzed clinical trial accrual of a tertiary care cancer center and its affiliated community sites to better understand what types of trials accrued at the community [...] Read more.

Most cancer care is delivered in the community, while most clinical trials exist in academic centers. We analyzed clinical trial accrual of a tertiary care cancer center and its affiliated community sites to better understand what types of trials accrued at the community sites and whether community accrual increased ethnic diversity. The institutional clinical trial database was searched for solid tumor accruals during 2018–2019. Patient’s race was abstracted, and trial’s funding source, phase, and disease type/stage were tabulated. Of 3689 accruals, 133 were at community sites, representing 26 unique trials while the main campus accrued to 93 unique trials. Community site accruals were highest for breast and colorectal cancer, but patients with less common cancers such as renal, nasopharyngeal, and gastric cancer were also accrued at community sites. Accruals occurred to randomized trials, as well as phase Ib and translational biomarker studies. Minority patients constituted 20.0% and 32.5% of community site accruals for therapeutic and non-therapeutic trials respectively, compared to 20.6% and 29.8% of main campus accruals for therapeutic and non-therapeutic trials, respectively. We conclude that community sites affiliated with an academic cancer center can accrue to a broad spectrum of clinical trials while enhancing racial diversity in participation of clinical trials. Further expansion of access to clinical trials in community sites is necessary to broaden patient access to state-of-the-art and next-generation treatment options. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

23 pages, 1585 KiB

Open AccessArticle

Complex Oncological Decision-Making Utilizing Fast-and-Frugal Trees in a Community Setting—Role of Academic and Hybrid Modeling

by Ravi Salgia, Isa Mambetsariev, Tingting Tan, Amanda Schwer, Daryl P. Pearlstein, Hazem Chehabi, Angel Baroz, Jeremy Fricke, Rebecca Pharaon, Hannah Romo, Thomas Waddington, Razmig Babikian, Linda Buck, Prakash Kulkarni, Mary Cianfrocca, Benjamin Djulbegovic and Sumanta K. Pal

J. Clin. Med. 2020, 9(6), 1884; https://doi.org/10.3390/jcm9061884 - 16 Jun 2020

Cited by 5 | Viewed by 3787

Abstract

Non-small cell lung cancer is a devastating disease and with the advent of targeted therapies and molecular testing, the decision-making process has become complex. While established guidelines and pathways offer some guidance, they are difficult to utilize in a busy community practice and [...] Read more.

Non-small cell lung cancer is a devastating disease and with the advent of targeted therapies and molecular testing, the decision-making process has become complex. While established guidelines and pathways offer some guidance, they are difficult to utilize in a busy community practice and are not always implemented in the community. The rationale of the study was to identify a cohort of patients with lung adenocarcinoma at a City of Hope community site (n = 11) and utilize their case studies to develop a decision-making framework utilizing fast-and-frugal tree (FFT) heuristics. Most patients had stage IV (N = 9, 81.8%) disease at the time of the first consultation. The most common symptoms at initial presentation were cough (N = 5, 45.5%), shortness of breath (N = 3, 27.2%), and weight loss (N = 3, 27.2%). The Eastern Cooperative Oncology Group (ECOG) performance status ranged from 0-1 in all patients in this study. Distribution of molecular drivers among the patients were as follows: EGFR (N = 5, 45.5%), KRAS (N = 2, 18.2%), ALK (N = 2, 18.2%), MET (N = 2, 18.2%), and RET (N = 1, 9.1%). Seven initial FFTs were developed for the various case scenarios, but ultimately the decisions were condensed into one FFT, a molecular stage IV FFT, that arrived at accurate decisions without sacrificing initial information. While these FFT decision trees may seem arbitrary to an experienced oncologist at an academic site, the simplicity of their utility is essential for community practice where patients often do not get molecular testing and are not assigned proper therapy. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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11 pages, 1346 KiB

Open AccessArticle

Implementing Lung Cancer Screening and Prevention in Academic Centers, Affiliated Network Offices and Collaborating Care Sites

by Cary A. Presant, Ravi Salgia, Prakash Kulkarni, Brian L. Tiep, Shamel Sanani, Benjamin Leach, Kimlin Ashing, Jossie Sandoval, Mina S. Sedrak, Shana Landau, Sophia Yeung, Dan Raz and Shanmugga Subbiah

J. Clin. Med. 2020, 9(6), 1820; https://doi.org/10.3390/jcm9061820 - 11 Jun 2020

Cited by 8 | Viewed by 2816

Abstract

Lung cancer is one of the deadliest and yet largely preventable neoplasms. Smoking cessation and lung cancer screening are effective yet underutilized lung cancer interventions. City of Hope Medical Center, a National Cancer Institute (NCI)- designated comprehensive cancer center, has 27 community cancer [...] Read more.

Lung cancer is one of the deadliest and yet largely preventable neoplasms. Smoking cessation and lung cancer screening are effective yet underutilized lung cancer interventions. City of Hope Medical Center, a National Cancer Institute (NCI)- designated comprehensive cancer center, has 27 community cancer centers and has prioritized tobacco control and lung cancer screening throughout its network. Despite challenges, we are implementing and monitoring the City of Hope Tobacco Control Initiative including (1) a Planning and Implementation Committee; (2) integration of IT, e.g., medical records and clinician notification/prompts to facilitate screening, cessation referral, and digital health, e.g., telehealth and social media; (3) clinician training and endorsing national guidelines; (4) providing clinical champions at all sites for site leadership; (5) Coverage and Payment reform and aids to facilitate patient access and reduce cost barriers; (6) increasing tobacco exposure screening for all patients; (7) smoking cessation intervention and evaluation—patient-centered recommendations for smoking cessation for all current and recent quitters along with including QuitLine referral for current smokers and smoking care-givers; and (8) establishing a Tobacco Registry for advancing science and discoveries including team science for basic, translation and clinical studies. These strategies are intended to inform screening, prevention and treatment research and patient-centered care. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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17 pages, 849 KiB

Open AccessArticle

Advancing the Science and Management of Renal Cell Carcinoma: Bridging the Divide between Academic and Community Practices

by Nicholas J. Salgia, Errol J. Philip, Mohammadbagher Ziari, Kelly Yap and Sumanta Kumar Pal

J. Clin. Med. 2020, 9(5), 1508; https://doi.org/10.3390/jcm9051508 - 17 May 2020

Cited by 3 | Viewed by 3051

Abstract

The treatment of metastatic renal cell carcinoma (mRCC) has rapidly evolved; however, the progress made in the field is heavily contingent upon timely and efficient accrual to clinical trials. While a substantial proportion of accrual occurs at tertiary care centers, community sites are [...] Read more.

The treatment of metastatic renal cell carcinoma (mRCC) has rapidly evolved; however, the progress made in the field is heavily contingent upon timely and efficient accrual to clinical trials. While a substantial proportion of accrual occurs at tertiary care centers, community sites are playing an increasing role in patient recruitment. In this article, we discuss strategies to optimize collaborations between academic and community sites to facilitate clinical research. Further, as the role of biomarker discovery has become increasingly important in tailoring therapy, we will discuss opportunities to bridge diverse accrual sites for the purpose of translational research. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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Review

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38 pages, 4279 KiB

Open AccessReview

Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience

by Linda D. Bosserman, Mary Cianfrocca, Bertram Yuh, Christina Yeon, Helen Chen, Stephen Sentovich, Amy Polverini, Finly Zachariah, Debbie Deaville, Ashley B. Lee, Mina S. Sedrak, Elisabeth King, Stacy Gray, Denise Morse, Scott Glaser, Geetika Bhatt, Camille Adeimy, TingTing Tan, Joseph Chao, Arin Nam, Isaac B. Paz, Laura Kruper, Poornima Rao, Karen Sokolov, Prakash Kulkarni, Ravi Salgia, Jonathan Yamzon and Deron Johnson Show full author list Hide full author list

J. Clin. Med. 2021, 10(2), 188; https://doi.org/10.3390/jcm10020188 - 7 Jan 2021

Cited by 17 | Viewed by 7749

Abstract

As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal [...] Read more.

As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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16 pages, 285 KiB

Open AccessReview

Frontline Management of Epithelial Ovarian Cancer—Combining Clinical Expertise with Community Practice Collaboration and Cutting-Edge Research

by Edward Wenge Wang, Christina Hsiao Wei, Sariah Liu, Stephen Jae-Jin Lee, Susan Shehayeb, Scott Glaser, Richard Li, Siamak Saadat, James Shen, Thanh Dellinger, Ernest Soyoung Han, Daphne Stewart, Sharon Wilczynski, Mihaela Cristea and Lorna Rodriguez-Rodriguez

J. Clin. Med. 2020, 9(9), 2830; https://doi.org/10.3390/jcm9092830 - 1 Sep 2020

Cited by 4 | Viewed by 2955

Abstract

Epithelial ovarian cancer (EOC) is the most common histology of ovarian cancer defined as epithelial cancer derived from the ovaries, fallopian tubes, or primary peritoneum. It is the fifth most common cause of cancer-related death in women in the United States. Because of [...] Read more.

Epithelial ovarian cancer (EOC) is the most common histology of ovarian cancer defined as epithelial cancer derived from the ovaries, fallopian tubes, or primary peritoneum. It is the fifth most common cause of cancer-related death in women in the United States. Because of a lack of effective screening and non-specific symptoms, EOC is typically diagnosed at an advanced stage (FIGO stage III or IV) and approximately one third of patients have malignant ascites at initial presentation. The treatment of ovarian cancer consists of a combination of cytoreductive surgery and systemic chemotherapy. Despite the advances with new cytotoxic and targeted therapies, the five-year survival rate for all-stage EOC in the United States is 48.6%. Delivery of up-to-date guideline care and multidisciplinary team efforts are important drivers of overall survival. In this paper, we review our frontline management of EOC that relies on a multi-disciplinary approach drawing on clinical expertise and collaboration combined with community practice and cutting edge clinical and translational research. By optimizing partnerships through team medicine and clinical research, we combine our cancer center clinical expertise, community practice partnership, and clinical and translational research to understand the biology of this deadly disease, advance therapy and connect our patients with the optimal treatment that offers the best possible outcomes. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

19 pages, 755 KiB

Open AccessReview

Small Cell Lung Cancer from Traditional to Innovative Therapeutics: Building a Comprehensive Network to Optimize Clinical and Translational Research

by Shanmuga Subbiah, Arin Nam, Natasha Garg, Amita Behal, Prakash Kulkarni and Ravi Salgia

J. Clin. Med. 2020, 9(8), 2433; https://doi.org/10.3390/jcm9082433 - 30 Jul 2020

Cited by 9 | Viewed by 4113

Abstract

Small cell lung cancer (SCLC) is an aggressive, complex disease with a distinct biology that contributes to its poor prognosis. Management of SCLC is still widely limited to chemotherapy and radiation therapy, and research recruitment still poses a considerable challenge. Here, we review [...] Read more.

Small cell lung cancer (SCLC) is an aggressive, complex disease with a distinct biology that contributes to its poor prognosis. Management of SCLC is still widely limited to chemotherapy and radiation therapy, and research recruitment still poses a considerable challenge. Here, we review the current standard of care for SCLC and advances made in utilizing immunotherapy. We also highlight research in the development of targeted therapies and emphasize the importance of a team-based approach to make clinical advances. Building an integrative network between an academic site and community practice sites optimizes biomarker and drug target discovery for managing and treating a difficult disease like SCLC. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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25 pages, 1203 KiB

Open AccessReview

The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

by Marilena Melas, Shanmuga Subbiah, Siamak Saadat, Swapnil Rajurkar and Kevin J. McDonnell

J. Clin. Med. 2020, 9(7), 2125; https://doi.org/10.3390/jcm9072125 - 6 Jul 2020

Cited by 10 | Viewed by 4476

Abstract

Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the [...] Read more.

Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients’ needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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26 pages, 1207 KiB

Open AccessReview

Non-Small Cell Lung Cancer from Genomics to Therapeutics: A Framework for Community Practice Integration to Arrive at Personalized Therapy Strategies

by Swapnil Rajurkar, Isa Mambetsariev, Rebecca Pharaon, Benjamin Leach, TingTing Tan, Prakash Kulkarni and Ravi Salgia

J. Clin. Med. 2020, 9(6), 1870; https://doi.org/10.3390/jcm9061870 - 15 Jun 2020

Cited by 16 | Viewed by 5252

Abstract

Non-small cell lung cancer (NSCLC) is a heterogeneous disease, and therapeutic management has advanced with the identification of various key oncogenic mutations that promote lung cancer tumorigenesis. Subsequent studies have developed targeted therapies against these oncogenes in the hope of personalizing therapy based [...] Read more.

Non-small cell lung cancer (NSCLC) is a heterogeneous disease, and therapeutic management has advanced with the identification of various key oncogenic mutations that promote lung cancer tumorigenesis. Subsequent studies have developed targeted therapies against these oncogenes in the hope of personalizing therapy based on the molecular genomics of the tumor. This review presents approved treatments against actionable mutations in NSCLC as well as promising targets and therapies. We also discuss the current status of molecular testing practices in community oncology sites that would help to direct oncologists in lung cancer decision-making. We propose a collaborative framework between community practice and academic sites that can help improve the utilization of personalized strategies in the community, through incorporation of increased testing rates, virtual molecular tumor boards, vendor-based oncology clinical pathways, and an academic-type singular electronic health record system. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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7 pages, 712 KiB

Open AccessReview

Integrating Academic and Community Practices in the Management of Colorectal Cancer: The City of Hope Model

by Misagh Karimi, Chongkai Wang, Bahareh Bahadini, George Hajjar and Marwan Fakih

J. Clin. Med. 2020, 9(6), 1687; https://doi.org/10.3390/jcm9061687 - 2 Jun 2020

Cited by 5 | Viewed by 2645

Abstract

Colorectal cancer (CRC) management continues to evolve. In metastatic CRC, several clinical and molecular biomarkers are now recommended to guide treatment decisions. Primary tumor location (right versus left) has been shown to predict benefit from anti-epidermal growth factor receptors (EGFRs) in rat sarcoma [...] Read more.

Colorectal cancer (CRC) management continues to evolve. In metastatic CRC, several clinical and molecular biomarkers are now recommended to guide treatment decisions. Primary tumor location (right versus left) has been shown to predict benefit from anti-epidermal growth factor receptors (EGFRs) in rat sarcoma viral oncogene homologue (RAS) and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) wild-type patients. Anti-EGFR therapy has not resulted in any benefit in RAS-mutated tumors, irrespective of the primary tumor location. BRAF-V600E mutations have been associated with poor prognosis and treatment resistance but may benefit from a combination of anti-EGFR therapy and BRAF inhibitors. Human epidermal growth factor receptor 2 (HER-2) amplification was recently shown to predict relative resistance to anti-EGFR therapy but a response to dual HER-2 targeting within the RAS wild-type population. Finally, the mismatch repair (MMR)-deficient subgroup benefits significantly from immunotherapeutic strategies. In addition to the increasingly complex biomarker landscape in CRC, metastatic CRC remains one of the few malignancies that benefits from metastasectomies, ablative therapies, and regional hepatic treatments. This treatment complexity requires a multi-disciplinary approach to treatment and close collaborations between various stakeholders in large cancer center networks. Here, we describe the City of Hope experience and strategy to enhance colorectal cancer care across its network. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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6 pages, 337 KiB

Open AccessReview

Managing Bladder Cancer Care during the COVID-19 Pandemic Using a Team-Based Approach

by Tina Wang, Sariah Liu, Thomas Joseph and Yung Lyou

J. Clin. Med. 2020, 9(5), 1574; https://doi.org/10.3390/jcm9051574 - 22 May 2020

Cited by 9 | Viewed by 2838

Abstract

The recent novel coronavirus, named coronavirus disease 2019 (COVID-19), has developed into an international pandemic affecting millions of individuals with hundreds of thousands of deaths worldwide. The highly infectious nature and widespread prevalence of this disease create a new set of obstacles for [...] Read more.

The recent novel coronavirus, named coronavirus disease 2019 (COVID-19), has developed into an international pandemic affecting millions of individuals with hundreds of thousands of deaths worldwide. The highly infectious nature and widespread prevalence of this disease create a new set of obstacles for the bladder cancer community in both delivering and receiving care. In this manuscript, we address the unique issues regarding treatment prioritization for the patient with bladder cancer and how we at City of Hope have adjusted our clinical practices using a team-based approach that utilizes shared decision making with all stakeholders (physicians, patients, caregivers) to optimize outcomes during this difficult time. In addition to taking standard precautions for minimizing COVID-19 risk of exposure for those entering a healthcare facility (screening all personnel upon entry and donning facemasks at all times), we suggest the following three measures: (1) delay post-treatment surveillance visits until there is a decrease in local COVID-19 cases, (2) continue curative intent treatments for localized bladder cancer with COVID-19 precautions (i.e., choosing gemcitabine/cisplatin (GC) over dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) neoadjuvant chemotherapy), and (3) increase the off-treatment period between cycles of palliative systemic therapy in metastatic urothelial carcinoma patients. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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12 pages, 743 KiB

Open AccessReview

Strategies to Improve Participation of Older Adults in Cancer Research

by Jennifer Liu, Eutiquio Gutierrez, Abhay Tiwari, Simran Padam, Daneng Li, William Dale, Sumanta K. Pal, Daphne Stewart, Shanmugga Subbiah, Linda D. Bosserman, Cary Presant, Tanyanika Phillips, Kelly Yap, Addie Hill, Geetika Bhatt, Christina Yeon, Mary Cianfrocca, Yuan Yuan, Joanne Mortimer and Mina S. Sedrak

J. Clin. Med. 2020, 9(5), 1571; https://doi.org/10.3390/jcm9051571 - 22 May 2020

Cited by 17 | Viewed by 4061

Abstract

Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians [...] Read more.

Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine)

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